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Fernández JJ, Juif D. Does Abortion Liberalisation Accelerate Fertility Decline? A Worldwide Time-Series Analysis. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2023; 39:36. [PMID: 38051427 PMCID: PMC10697910 DOI: 10.1007/s10680-023-09687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Since WWII, the two most important global trends in family planning have been fertility decline and abortion liberalisation. But are they related? Specifically: Does abortion liberalisation affect changes in fertility rates? The demographic literature has yet to answer this important question and instead offers two opposing predictions. Some studies argue that liberalisation of this medical procedure reduces fertility rates. By contrast, others note that such legal reforms may merely have an average, negligible effect on fertility levels. We adjudicate between the two approaches by conducting, in our view, the most comprehensive global, quantitative analysis of the relationship between those legal reforms and changing fertility rates. The analysis relies on two-way fixed models and three different indicators of abortion policy liberalism created by independent research teams to estimate the relationship between abortion liberalisation and total fertility changes. The data cover 185 independent states between 1970 and 2019. Fertility rates are significantly related to average public education levels and alternative contraceptive use. Using multiple model specifications, however, abortion reforms do not have a robust association with the outcome. Replication materials for this article can be found at https://figshare.com/s/5336a4422f47c8c39228 .
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Affiliation(s)
| | - Dácil Juif
- Universidad Carlos III of Madrid, Madrid, Spain
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2
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Williams CR, Valeria Bahamondes M, Gómez Ponce de León R, da Costa Machado H, Bahamondes L, Caffe S, Serruya SJ. Analysing the context and characteristics of legal abortion and comprehensive post-abortion care among adolescents aged 10-14 in a network of sentinel centres in Latin America: a retrospective cross-sectional study, 2016-2020. Sex Reprod Health Matters 2023; 31:2175442. [PMID: 36919908 PMCID: PMC10026806 DOI: 10.1080/26410397.2023.2175442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Pregnancy-related complications are a substantial source of morbidity and mortality among adolescents in low- and middle-income countries. While the youngest adolescents (those aged 10-14) are considered to be at particularly high risk of adverse outcomes, there is little empirical data available on their sexual and reproductive health. Using a unique dataset of clinical records drawn from a regional network of sentinel centres providing legal abortion and comprehensive post-abortion care in 12 Latin American and Caribbean countries, we described the population of adolescents aged 10-14 seeking legal abortion and post-abortion care and calculated institutional rates of complications, using older adolescents (aged 15-19) and young adults (aged 20-24) as comparator groups. We also assessed the quality of care provided as compared to WHO recommendations. Nearly 17% (89 out of 533) of young adolescents sought care when they were already at 15 or more weeks' gestation. Young adolescents were at higher risk of pre-procedure and intra-operative complications than older adolescents and young adults, though the trend is less clear for the most severe complications. In general, the quality of care provided by centres in the network was aligned with WHO recommendations for safe abortion and comprehensive post-abortion care. Taken together, these findings provide insight into the challenges facing the global health community in assuring the sexual and reproductive health and rights of the youngest adolescents, and outline avenues for future research, advocacy, and evidence-based policymaking.
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Affiliation(s)
- Caitlin R Williams
- PhD Candidate, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Valeria Bahamondes
- International Consultant, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Rodolfo Gómez Ponce de León
- Regional Reproductive Health Advisor, Latin American Center for Perinatology/Women's Health and Reproductive Health Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Helymar da Costa Machado
- Statistician, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Cidade Universitária, Rua Alexander Fleming 101, Campinas, SP 13083-881, Brazil
| | - Luis Bahamondes
- Professor of Gynaecology, Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Sonja Caffe
- Regional Adolescent Health Advisor, Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - Suzanne Jacob Serruya
- Director, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
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Chen Y, Xiao Y, Zhang Y, Wang R, Wang F, Gao H, Liu Y, Zhang R, Sun H, Zhou Z, Wang S, Chen K, Sun Y, Tu M, Li J, Luo Q, Wu Y, Zhu L, Huang Y, Sun X, Guo G, Zhang D. Single-cell landscape analysis reveals systematic senescence in mammalian Down syndrome. Clin Transl Med 2023; 13:e1310. [PMID: 37461266 PMCID: PMC10352595 DOI: 10.1002/ctm2.1310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/28/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Down syndrome (DS), which is characterized by various malfunctions, is the most common chromosomal disorder. As the DS population continues to grow and most of those with DS live beyond puberty, early-onset health problems have become apparent. However, the cellular landscape and molecular alterations have not been thoroughly studied. METHODS This study utilized single-cell resolution techniques to examine DS in humans and mice, spanning seven distinct organs. A total of 71 934 mouse and 98 207 human cells were analyzed to uncover the molecular alterations occurring in different cell types and organs related to DS, specifically starting from the fetal stage. Additionally, SA-β-Gal staining, western blot, and histological study were employed to verify the alterations. RESULTS In this study, we firstly established the transcriptomic profile of the mammalian DS, deciphering the cellular map and molecular mechanism. Our analysis indicated that DS cells across various types and organs experienced senescence stresses from as early as the fetal stage. This was marked by elevated SA-β-Gal activity, overexpression of cell cycle inhibitors, augmented inflammatory responses, and a loss of cellular identity. Furthermore, we found evidence of mitochondrial disturbance, an increase in ribosomal protein transcription, and heightened apoptosis in fetal DS cells. This investigation also unearthed a regulatory network driven by an HSA21 gene, which leads to genome-wide expression changes. CONCLUSION The findings from this study offer significant insights into the molecular alterations that occur in DS, shedding light on the pathological processes underlying this disorder. These results can potentially guide future research and treatment development for DS.
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Affiliation(s)
- Yao Chen
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanyu Xiao
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanye Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Renying Wang
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Feixia Wang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huajing Gao
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yifeng Liu
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Runju Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyu Sun
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziming Zhou
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Siwen Wang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Chen
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yixi Sun
- Department of Reproductive Genetics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mixue Tu
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Li
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Birth Defect Control and Prevention Research Center of Zhejiang Province, Hangzhou, China
| | - Qiong Luo
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Birth Defect Control and Prevention Research Center of Zhejiang Province, Hangzhou, China
| | - Yiqing Wu
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Birth Defect Control and Prevention Research Center of Zhejiang Province, Hangzhou, China
| | - Linling Zhu
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Yun Huang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Birth Defect Control and Prevention Research Center of Zhejiang Province, Hangzhou, China
| | - Xiao Sun
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoji Guo
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Birth Defect Control and Prevention Research Center of Zhejiang Province, Hangzhou, China
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Bagade T, Chojenta C, Harris M, Oldmeadow C, Loxton D. The human right to safely give birth: data from 193 countries show that gender equality does affect maternal mortality. BMC Pregnancy Childbirth 2022; 22:874. [PMID: 36424537 PMCID: PMC9685845 DOI: 10.1186/s12884-022-05225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While a reduction in the global maternal mortality ratio (MMR) has slowed, newer strategies are needed to achieve an ongoing and sustainable reduction of the MMR. Previous studies have investigated the association between health system-related factors such as wealth inequalities, healthcare access and use on maternal mortality. However, a women's rights-based approach to address MMR has not been studied, excluding the health system-related factors. This study aimed to analyse the association between gender equality and MMR globally. METHODS Using structural equation modelling (SEM), secondary and open access data from the United Nations and other international agencies from 193 countries were analysed using structural equation modelling (SEM). Gender-sensitive variables that represented the theoretical, conceptual framework of the study were selected. The association between latent variable gender equality and the outcome, MMR, was examined in the SEM. A second SEM model (n = 158) was designed to include two variables related to gender-based violence. FINDINGS The latent variable, gender equality, was negatively associated with MMR (p < 0‧001, Z = -6‧96, 95% CI: - 6508.98 to - 3141.89 for Model 1 and p < 0‧001, Z = -7‧23, 95% CI: - 6045.356 to - 3467.515 for Model 2). INTERPRETATION Gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.
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Affiliation(s)
- Tanmay Bagade
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Catherine Chojenta
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Melissa Harris
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Christopher Oldmeadow
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Clinical Research Design, IT and Statistical Support (CReDITSS), Level 4 West (Public Health), HMRI Building, NSW 2305 New Lambton Heights, Australia
| | - Deborah Loxton
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
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Pekkurnaz D, Ökem ZG, Çakar M. Understanding women's provider choice for induced abortion in Turkey. Health Policy 2021; 125:1385-1392. [PMID: 34391598 DOI: 10.1016/j.healthpol.2021.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
In Turkey, women gained free access to induced abortion from public facilities through the legalization of abortion in 1983. However, due to unmet need and abortion stigma, women use predominantly private services. The political discourse on anti-abortion in the past decade has triggered a diminishing trend in public provision. This runs against both the 1983 Law and the healthcare reforms initiated in 2003, which aimed at universal access to health services. This study investigates the socioeconomic characteristics of women affecting the utilization of public services for induced abortion. Using "Turkey Demographic and Health Survey 2013", the results of Probit models indicate that women who were young, unmarried, wealthier and whose abortion decisions were made by themselves or their spouses were less likely to choose the public services for induced abortion. Regional differences in the utilization of public sector were also observed. Findings indicate a need to ensure and widen women's access to abortion nationwide; both at the hospital and outpatient level. Health education programs including family planning should give special emphasis to young, single and socioeconomically disadvantaged women who are more prone to apply for unsafe abortion when access to public and/or private sector is limited. A transparent referral system should be designed to timely direct women to abortion services.
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Affiliation(s)
- Didem Pekkurnaz
- Başkent University, Faculty of Economics and Administrative Sciences, Department of Economics, Bağlıca Campus, Fatih Sultan Mahallesi, Eskişehir Yolu 18. Km, Etimesgut, 06790 Ankara, Turkey.
| | - Zeynep Güldem Ökem
- TOBB University of Economics and Technology, Faculty of Economics and Administrative Sciences, Department of International Entrepreneurship, Söğütözü Street No: 43, Söğütözü, 06560 Ankara, Turkey.
| | - Mehmet Çakar
- Başkent University, Faculty of Economics and Administrative Sciences, Department of Management, Bağlıca Campus, Fatih Sultan Mahallesi, Eskişehir Yolu 18. Km, Etimesgut, 06790 Ankara, Turkey.
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Ishola F, Ukah UV, Nandi A. Impact of abortion law reforms on women's health services and outcomes: a systematic review protocol. Syst Rev 2021; 10:192. [PMID: 34183064 PMCID: PMC8240208 DOI: 10.1186/s13643-021-01739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A country's abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women's access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women's health services and outcomes in LMICs. METHODS We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women's health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description. DISCUSSION This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women's health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126927.
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Affiliation(s)
- Foluso Ishola
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - U. Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
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Ishola F, Ukah UV, Alli BY, Nandi A. Impact of abortion law reforms on health services and health outcomes in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:1483-1498. [PMID: 34133729 DOI: 10.1093/heapol/czab069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 11/14/2022] Open
Abstract
While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, expanding the grounds on which abortion can be performed legally. However, the implications of these reforms on women's access to and use of health services, as well as their health outcomes, are uncertain. This systematic review aimed to evaluate and synthesize empirical research evidence concerning the effects of abortion law reforms on women's health services and health outcomes in LMICs. We searched Medline, Embase, CINAHL and Web of Science databases, as well as grey literature and reference lists of included studies. We included pre-post and quasi-experimental studies that aimed to estimate the causal effect of a change in abortion law on at least one of four outcomes: (1) use of and access to abortion services, (2) fertility rates, (3) maternal and/or neonatal morbidity and mortality and (4) contraceptive use. We assessed the quality of studies using the quasi-experimental study design series checklist and synthesized evidence through a narrative description. Of the 2796 records identified by our search, we included 13 studies in the review, which covered reforms occurring in Uruguay, Ethiopia, Mexico, Nepal, Chile, Romania, India and Ghana. Studies employed pre-post, interrupted time series, difference-in-differences and synthetic control designs. Legislative reforms from highly restrictive to relatively liberal were associated with reductions in fertility, particularly among women from 20 to 34 years of age, as well as lower maternal mortality. Evidence regarding the impact of abortion reforms on other outcomes, as well as whether effects vary by socioeconomic status, is limited. Further research is required to strengthen the evidence base for informing abortion legislation in LMICs. This review explicitly points to the need for rigorous quasi-experimental studies with sensitivity analyses to assess underlying assumptions. The systematic review was registered in PROSPERO database CRD42019126927.
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Affiliation(s)
- Foluso Ishola
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - U Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Babatunde Y Alli
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC H3A 1G1, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada.,Institute for Health and Social Policy, 1130 Pine Ave West, Montreal, QC H3A 1A3, Canada
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Rossier C, Marchin A, Kim C, Ganatra B. Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review. Reprod Health 2021; 18:114. [PMID: 34098958 PMCID: PMC8186048 DOI: 10.1186/s12978-021-01165-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited. Main body This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others. Conclusion Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01165-0. Women seeking an induced abortion in LMICs often face inexistent or inadequate, difficult to find and/ or stigmatizing legal services, leading to the use of informal methods and providers, and unsafe abortions. A growing number of studies have shown that abortion seekers contact social network members beyond their intimate circle when seeking care. However, results have been inconsistent. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in restrictive LMICs. We screened 4101 references, yielding 79 articles with data from 33 countries for extraction. We grouped countries (or social groups within countries) into four types of settings: (1) anonymous access possible, hyper stigma; (2) anonymous access possible, high stigma; (3) non-anonymous access, high stigma; (4) non-anonymous access, hyper stigma. Most studies fitted Type 3. Disclosing to network members increased across setting types: no women confided in network members in Type 1 settings, a minority in Type 2 and a majority in Type 3. No setting fitted Type 4. The informal use of medical abortion did not modify disclosure to others. Abortion seekers in restrictive LMICs frequently contact their social network in some settings/groups but less frequently in others, depending on the availability of anonymous access to abortion care and the level of stigma. This knowledge is useful for designing interventions to improve information on safe abortion and for developing network-based data collection strategies.
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Affiliation(s)
- Clémentine Rossier
- Université de Genève, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | | | - Caron Kim
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Ajayi AI, Odunga SA, Oduor C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18:19. [PMID: 33482843 PMCID: PMC7821647 DOI: 10.1186/s12978-021-01078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy. Methods We used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy. Results Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. Conclusion A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya.
| | - Sally Atieno Odunga
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Clement Oduor
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Yohannes Dibaba Wado
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
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Moseson H, Bullard KA, Cisternas C, Grosso B, Vera V, Gerdts C. Effectiveness of self-managed medication abortion between 13 and 24 weeks gestation: A retrospective review of case records from accompaniment groups in Argentina, Chile, and Ecuador. Contraception 2020; 102:91-98. [DOI: 10.1016/j.contraception.2020.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
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11
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Maffi I, Tønnessen L. The Limits of the Law: Abortion in the Middle East and North Africa. Health Hum Rights 2019; 21:1-6. [PMID: 31885431 PMCID: PMC6927385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Irene Maffi
- Professor of Cultural and Social Anthropology at the University of Lausanne, Switzerland, and Senior Researcher at the Chr. Michelsen Institute, Bergen, Norway
| | - Liv Tønnessen
- Professor of Cultural and Social Anthropology at the University of Lausanne, Switzerland, and Senior Researcher at the Chr. Michelsen Institute, Bergen, Norway
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12
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Lentiro K, Gebru T, Worku A, Asfaw A, Gebremariam T, Tesfaye A. Risk factors of induced abortion among preparatory school student in Guraghe zone, Southern region, Ethiopia: a cross-sectional study. BMC Womens Health 2019; 19:115. [PMID: 31510987 PMCID: PMC6739923 DOI: 10.1186/s12905-019-0813-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/30/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Induced abortion is a common undergo in many societies of the world. Every year, around 20 million unsafe abortions are done worldwide. From fragmented studies conducted in Ethiopia, the prevalence of induced abortion and its adverse effects are increasing over time. The aim of this study was to assess factors associated with induced abortion among female preparatory school students in Guraghe zone. METHODS A cross-sectional study was conducted among female students of preparatory schools in April 2017. Systematic random sampling technique was employed to select 404 students from the total of 3960 female preparatory school students in the study area. Data was collected through self-administered questionnaires. Descriptive summary, binary and multivariate analyses were underwent to identify factors associated with induced abortion. The study was ethically approved by institutional review board of Wolkite University. RESULTS The response rate of this study was 98.3%. The lifetime prevalence of induced abortion among young preparatory schools students whose age range from 15 to 22 years was 13.6% [95% CI (10.4, 17.1)]. The odds of induced abortion undergo was 2.3 times more likely in rural family residents [AOR = 2.3, 95% CI (1.1, 4.8)] as compared to that of urban family residents. Students without sexual health education were 6.4 times more likely to undergo induced abortion as compared to those who got sexual health education at sc0000hool [AOR = 6.4, 95% CI (3.1, 13.1)]. Furthermore, students who drank alcohol often were 4 times [AOR = 4.0, 95% CI (1.1, 14.2)] more likely to undergo induced abortion and students who consumed alcohol sometimes had 3.3 times [AOR: 3.3, 95%CI (1.4, 8.1)] the risk of induced abortion compared with girls with no history of alcohol consumption. CONCLUSION A high lifetime prevalence of induced abortion among young adolescent was observed. Being rural residence, not having reproductive health education, and alcohol consumption were found to be independent predictors of induced abortion undergo. Therefore, IEC/BCC programs with special emphasis on youth friendly sexual and reproductive health services should be strengthened to reduce induced abortion.
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Affiliation(s)
- Kifle Lentiro
- Department of Public Health, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
| | - Teklemichael Gebru
- Department of Public Health, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
| | - Abdusemed Worku
- Department of Medicine, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
| | - Agizie Asfaw
- Department of Public Health, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
| | - Tigist Gebremariam
- Department of Public Health, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
| | - Addisu Tesfaye
- Department of Public Health, Medicine and Health Science College, Wolkite University, Wolkite, Ethiopia
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13
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Kim C, Sorhaindo A, Ganatra B. WHO guidelines and the role of the physician in task sharing in safe abortion care. Best Pract Res Clin Obstet Gynaecol 2019; 63:56-66. [PMID: 31937493 DOI: 10.1016/j.bpobgyn.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
Globally, many women undergo unsafe abortion, although abortion is extremely safe when done in accordance with recommended guidelines. Hence, many women suffer from abortion-related complications, and unsafe abortion remains a major cause of maternal mortality. The high percentage of unsafe abortion is attributed to the inability of women to access safe abortion services. A critical barrier to access is the lack of trained providers. To address this problem, task sharing and the expansion of health worker roles in abortion care have become a public health strategy to mitigate health worker shortages and reduce unsafe abortion. This chapter provides an overview of the WHO guidance on task sharing in safe abortion care, discusses the special role of physicians, and highlights the complexity of implementing task sharing by analyzing the findings from six country case studies.
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Affiliation(s)
- Caron Kim
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Avenue Appia 20, Geneva, Switzerland.
| | - Annik Sorhaindo
- Independent Consultant in Reproductive and Sexual Health, Mexico City, Mexico.
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Avenue Appia 20, Geneva, Switzerland.
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14
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Erdman JN, Cook RJ. Decriminalization of abortion - A human rights imperative. Best Pract Res Clin Obstet Gynaecol 2019; 62:11-24. [PMID: 31230835 DOI: 10.1016/j.bpobgyn.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022]
Abstract
This chapter reviews the evolving consensus in international human rights law, first supporting the liberalization of criminal abortion laws to improve access to care and now supporting their repeal or decriminalization as a human rights imperative to protect the health, equality, and dignity of people. This consensus is based on human rights standards or the authoritative interpretations of U.N. and regional human rights treaties in general comments and recommendations, individual communications and inquiry reports of treaty monitoring bodies, and in the thematic reports of special rapporteurs and working groups of the U.N. and regional human rights systems. This chapter explores the reach and influence of human rights standards, especially how high courts in many countries reference these standards to hold governments accountable for the reform and repeal of criminal abortion laws.
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Affiliation(s)
- Joanna N Erdman
- Health Law and Policy in the Schulich School of Law, Dalhousie University, Halifax, Canada
| | - Rebecca J Cook
- The Faculty of Law, the Faculty of Medicine and the Joint Centre for Bioethics, University of Toronto, Toronto, Canada; International Reproductive and Sexual Health Law Program, Faculty of Law, University of Toronto, Toronto, Canada.
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15
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Baschieri A, Gordeev VS, Akuze J, Kwesiga D, Blencowe H, Cousens S, Waiswa P, Fisker AB, Thysen SM, Rodrigues A, Biks GA, Abebe SM, Gelaye KA, Mengistu MY, Geremew BM, Delele TG, Tesega AK, Yitayew TA, Kasasa S, Galiwango E, Natukwatsa D, Kajungu D, Enuameh YAK, Nettey OE, Dzabeng F, Amenga-Etego S, Newton SK, Manu AA, Tawiah C, Asante KP, Owusu-Agyei S, Alam N, Haider MM, Alam SS, Arnold F, Byass P, Croft TN, Herbst K, Kishor S, Serbanescu F, Lawn JE. "Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites. J Glob Health 2019; 9:010901. [PMID: 30820319 PMCID: PMC6377797 DOI: 10.7189/jogh.09.010901] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths. METHODS This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken. CONCLUSIONS This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.
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Affiliation(s)
- Angela Baschieri
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Vladimir S Gordeev
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Joseph Akuze
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Doris Kwesiga
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Ane B Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sanne M Thysen
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Center for Global Health, Department of Public Health, Aarhus University Denmark, Aarhus, Denmark
| | | | - Gashaw A Biks
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon M Abebe
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun A Gelaye
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Y Mengistu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bisrat M Geremew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse G Delele
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane K Tesega
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen A Yitayew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simon Kasasa
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Edward Galiwango
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Davis Natukwatsa
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Dan Kajungu
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Yeetey AK Enuameh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | - Sam K Newton
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | - Seth Owusu-Agyei
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
- University of Health and Allied Sciences, Kintampo Health Research Centre, Kintampo, Ghana
- Malaria Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Nurul Alam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - M M Haider
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Sayed S Alam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Peter Byass
- Department of Epidemiology & Global Health, Umeå University, Umeå, Sweden
| | | | | | | | - Florina Serbanescu
- Centers for Disease Control and Prevention, Division of reproductive Health, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
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Lavelanet AF, Schlitt S, Johnson BR, Ganatra B. Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:44. [PMID: 30572956 PMCID: PMC6302420 DOI: 10.1186/s12914-018-0183-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/21/2018] [Indexed: 12/02/2022]
Abstract
Background Texts and interpretations on the lawfulness of abortion and associated administrative requirements can be vague and confusing. It can also be difficult for a woman or provider to know exactly where to look for and how to interpret laws on abortion. To increase transparency, the Global Abortion Policies Database (GAPD), launched in 2017, facilitates the strengthening of knowledge and understanding of the complexities and nuances around lawful abortion as explicitly stated in laws and policies. Methods We report on data available in the GAPD as of May 2018. We reviewed the content and wording of laws, policies, standards and guidelines, judgments and other official statements for all countries where data is available in the GAPD. We analyzed data for 158 countries, where abortion is lawful on the woman’s request with no requirement for justification and/or for at least one legal ground, including additional indications that are nonequivalent to a single common legal ground. We classified laws on the basis of the explicit wording of the text. The GAPD treats legal categories as the circumstances under which abortion is lawful, that is, allowed or not contrary to law, or explicitly permitted or specified by law. Results 32% of countries allow or permit abortion at the woman’s request with no requirement for justification. Approximately 82% of countries allow or permit abortion to save the woman’s life. 64% of countries specify health, physical health and/or mental (or psychological) health. 51% allow or permit abortion based on a fetal condition, 46% of countries allow or permit abortion where the pregnancy is the result of rape, and 10% specify an economic or social ground. Laws may also specify several additional indications that are nonequivalent to a single legal ground. Conclusions The GAPD reflects details that exist within countries’ laws and highlights the nuance within legal categories of abortion; no assumptions are made as to how laws are interpreted or applied in practice. By examining the text of the law, additional complexities related to the legal categories of abortion become more apparent.
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Affiliation(s)
- Antonella F Lavelanet
- Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, 27, Geneva, Switzerland.
| | - Stephanie Schlitt
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, 27, Geneva, Switzerland
| | - Brooke Ronald Johnson
- Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, 27, Geneva, Switzerland
| | - Bela Ganatra
- Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, 27, Geneva, Switzerland
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17
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Robson S. What exactly is excellence in women's health? Aust N Z J Obstet Gynaecol 2018; 58:603-605. [PMID: 30536507 DOI: 10.1111/ajo.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Steve Robson
- President, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, East Melbourne, Victoria, Australia
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18
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Fullerton J, Butler MM, Aman C, Reid T, Dowler M. Abortion-related care and the role of the midwife: a global perspective. Int J Womens Health 2018; 10:751-762. [PMID: 30538585 PMCID: PMC6260173 DOI: 10.2147/ijwh.s178601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The International Confederation of Midwives (ICM) represents 132 midwifery associations in 113 countries. The ICM disseminates the Essential Competencies for Basic Midwifery Practice (EC) that describes the global scope of midwifery practice. The basic (core) and expanded (additional or optional) role of midwives in providing abortion-related care services was first described in 2010. A literature review about three items that are particularly critical to access to abortion services was conducted. Findings that emerged in the recent 2016-2017 update study about these three items are presented. Methods A modified Delphi study was administered via the Internet in a series of three rounds. Thirty-seven statements of abortion-related knowledge and skill were presented. Results A total of 895 individuals participated. The total of respondents across all three rounds represented 90 of the 105 member countries at the time of the study. The role of midwives in providing comprehensive abortion care, including referral for abortion and provision of postabortion family planning, achieved the necessary 85% agreement to be designated as essential (basic) knowledge or skill for the global scope of midwifery practice. The provision of medication abortion and performance of manual vacuum aspiration abortion were designated as optional for midwives who wished to provide these services. Endorsement of these latter practices was highest in both Francophone and Anglophone regions of Africa, Asian Pacific countries, and countries at a lower state of economic development. Conclusion The role of midwives in provision of abortion-related care services was reaffirmed in the recent Delphi study to inform the update to the EC. The role of midwives as direct providers of medical and vacuum aspiration abortions was reaffirmed for those individual midwives who wish to obtain the requisite competency to provide those services, in jurisdictions where these services are legally authorized.
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Affiliation(s)
- Judith Fullerton
- Retired, School of Medicine, University of California, San Diego, CA, USA,
| | - Michelle M Butler
- Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Cheryl Aman
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
| | - Tobi Reid
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Dowler
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
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19
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Johnson BR, Lavelanet AF, Schlitt S. Global Abortion Policies Database: a new approach to strengthening knowledge on laws, policies, and human rights standards. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:35. [PMID: 30208877 PMCID: PMC6134502 DOI: 10.1186/s12914-018-0174-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Global Abortion Policies Database (GAPD), launched in June 2017, provides a verifiable, comprehensive, nuanced approach to information and data sources on abortion law and policy. Abortion laws, policies, and guidelines from United Nations (UN) and World Health Organization (WHO) Member States are juxtaposed to information and recommendations from WHO safe abortion guidance, national sexual and reproductive health indicators, and relevant UN human rights bodies' concluding observations to countries. MAIN BODY The Global Abortion Policies Database aims to increase transparency of information and accountability of states for the protection of individuals' health and human rights. The database presents current information on abortion laws and policies that goes beyond categories of lawful abortion to include information on additional access requirements, service provision, conscientious objection, and penalties. Wide-ranging variations among countries' legal requirements and criminal penalties raise questions about the evidentiary and human rights basis for abortion laws and policies. Source documents found in the database highlight that in many jurisdictions legal and policy guidance is either non-existent, not clear, or conflicting. By juxtaposing a jurisdiction's abortion laws and policies to relevant WHO guidance and by facilitating comparisons of countries' sexual and reproductive health indicators, the database can enable deep policy analysis of states' obligations to meet the health needs and human rights of individuals in the context of abortion. Policy analysis in the context of authoritative guidance on human rights standards can enable health and rights advocates to hold governments accountable for respecting, protecting, and fulfilling individuals' human rights. CONCLUSION The GAPD is a comprehensive tool that can be used to strengthen knowledge, inform law and policy research to generate evidence on the impact of laws and policies in practice, and facilitate greater awareness of the many challenges to creating enabling policy environments for safe abortion.
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Affiliation(s)
- Brooke Ronald Johnson
- Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland.
| | - Antonella Francheska Lavelanet
- Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland
| | - Stephanie Schlitt
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland
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20
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Erdman JN, Johnson BR. Access to knowledge and the Global Abortion Policies Database. Int J Gynaecol Obstet 2018; 142:120-124. [PMID: 29656526 DOI: 10.1002/ijgo.12509] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research shows that women, healthcare providers, and even policy makers worldwide have limited or inaccurate knowledge of the abortion law and policies in their country. These knowledge gaps sometimes stem from the vague and broad terms of the law, which breed uncertainty and even conflict when unaccompanied by accessible regulation or guidelines. Inconsistency across national law and policy further impedes safe and evidence-based practice. This lack of transparency creates a crisis of accountability. Those seeking care cannot know their legal entitlements, service providers cannot practice with legal protection, and governments can escape legal responsibility for the adverse effects of their laws. This is the context for the newly launched Global Abortion Policies Database-an open-access repository that seeks to promote transparency and state accountability by providing clear and comprehensive information about national laws, policies, health standards, and guidelines, and by creating the capacity for comparative analysis and cross-referencing to health indicators, WHO recommendations, and human rights standards.
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Affiliation(s)
- Joanna N Erdman
- Schulich School of Law, Dalhousie University, Halifax, NS, Canada
| | - Brooke Ronald Johnson
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
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