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Alspaugh A, Swan LET, Auerbach SL, Bartmess M, Agbemenu K, Ely GE. Mistreatment in health care among women in Appalachia. Cult Health Sex 2023; 25:1690-1706. [PMID: 36780368 DOI: 10.1080/13691058.2023.2176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Good quality patient care requires health care providers to respect the humanity and autonomy of their patients. However, this is not achieved in all settings. This study used cross-sectional survey data including open-ended text responses to explore negative experiences with health care providers among women in Appalachia. We used the Heath Stigma & Discrimination Framework (HSDF) to identify how stigma is created and perpetuated through interactions with health care providers. Survey data from 628 women collected through purposive sampling identified that two out of three participants had had a bad encounter with a provider that made them not want to return for care. One in six participants had a negative experience specifically while seeking contraception. Using the domains of the HSDF framework, qualitative answers to open-ended questions illuminated how health care providers, influenced by social and cultural norms related to religiosity, patriarchal views, poverty, poor health infrastructure, and the opioid crisis, created and perpetuated stigma through dehumanising treatment, low-quality care, and health care misogyny. Because stigma is a driver of health inequity, these findings highlight the important and sometimes problematic role that health care providers can play when they create a barrier to future care through poor treatment of patients.
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Affiliation(s)
- Amy Alspaugh
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Gretchen E Ely
- College of Social Work, University of Tennessee, Knoxville, TN, USA
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Rongkapich R, Poolkumlung R, Sinthuchai N, Limsirorat P, Chiemchaisri N, Santibenchakul S, Jaisamrarn U. Knowledge, attitude, and intended practice of abortion among pharmacy students in Thailand after the amendment of the Thai Abortion Law. BMC Med Educ 2023; 23:533. [PMID: 37496054 PMCID: PMC10373229 DOI: 10.1186/s12909-023-04526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The recently amended Thai abortion law allows pregnant women to undergo abortions up to the gestational age of 12 weeks. Medical abortion is significant because it has revolutionized access to safe abortion care-abortion medicine can now be safely and effectively administered outside of a healthcare facility to women in early pregnancy. This contribution supports the pharmacists' role in interprofessional safe abortion teamwork. Adequate knowledge of the current laws regarding safe abortion services will increase pharmacists' competence in providing services. However, safe abortions as a subject have not been formally incorporated into the curriculum for Thai pharmacy students. Therefore, this study aimed to evaluate the knowledge, attitude, and intended practice of fifth-year pharmacy students at Chulalongkorn University. METHODS A cross-sectional study was conducted using an electronic self-administered questionnaire adapted from previously published studies to evaluate participants' knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. The invitations were sent to all fifth-year pharmacy students at Chulalongkorn University. RESULTS Among all invitations sent, 104/150 (69.3%) participants responded to the survey. Only a third of the participants (31.7%) had good knowledge scores. Based on five questions regarding the gestational age limit for legal abortion, most participants (52.7%) answered questions incorrectly. Although more than half of the participants (52.5%) disagreed with two pro-choice statements, an overwhelming majority (87.5%) agreed that abortion was a woman's right. Safe abortion services were mostly agreed upon with serious fetal defects (91.9%), non-HIV maternal health conditions (82.2%), and sexual assaults (77.4%). A positive attitude toward abortion affects the intention to perform an abortion under socioeconomic conditions. CONCLUSION Most participants lacked knowledge on the amended abortion law, especially on the gestational limits of abortion. Participants with favorable attitudes toward abortion tended to be more liberal regarding safe abortion services.
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Affiliation(s)
- Ratthapong Rongkapich
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Rada Poolkumlung
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Natchanika Sinthuchai
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA USA
| | - Phobsan Limsirorat
- Faculty of Pharmaceutical Science, Chulalongkorn University, 254 Phaya Thai Rd, Wang Mai District, Pathum Wan, Bangkok, 10330 Thailand
| | - Nattaporn Chiemchaisri
- Department of pharmacy, King Chulalongkorn memorial hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
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Tirado V, Ekström AM, Orsini N, Hanson C, Strömdahl S. Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden: a cross-sectional survey. BMC Public Health 2023; 23:551. [PMID: 36959645 PMCID: PMC10035217 DOI: 10.1186/s12889-023-15399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Background Sexual and reproductive health and rights (SRHR), including access and information on the laws and policies related to abortion, varies considerably between countries. Migrants may have limited knowledge of SRHR and related resources in their new country. This study investigates migrants’ knowledge of the right to safe and legal abortion and other associated factors including the recent law on sexual consent, the legal age for sexual consent and age to marry in Sweden. Methods We conducted a cross-sectional study from 2018 to 2019 among recent migrants attending high schools or Swedish language schools. Descriptive statistics were computed on the knowledge of the Swedish abortion law and other legal aspects. Univariable and multivariable logistic regression analyses were conducted to assess if migrants’ socio-demographic characteristics were associated with knowledge (i.e. correct/incorrect) of the Swedish abortion law and other key SRHR-related legal issues. Results Of the total 6,263 participants, 3,557 (57%) responded about whether it is legal to have an induced abortion in Sweden, and of these, 2,632 (74%) answered incorrectly. While more than half (61%) of the respondents knew the sexual consent law, nearly half (48%) did not know that sexual consent is also required for married couples. About 90% correctly responded that it is illegal to have sex with a minor (under the age of 15) and were aware of the legal age (18 years) to marry in Sweden. Incorrect knowledge of the Swedish abortion law was associated with being religious (adjusted odds ratio (AOR), 2.12; 95% confidence interval (CI), 1.42–3.15), not having previous sexual health education (AOR, 1.68; 95% CI, 1.38–2.05), coming from a country with predominantly restrictive abortion laws (AOR, 1.46; 95% CI, 1.16–1.84), low level of education (AOR, 1.29; 95% CI, 1.04–1.61) and having a temporary residence permit (AOR, 1.27; 95% CI, 1.02–1.57). Conclusion We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-15399-z.
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Affiliation(s)
- Veronika Tirado
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.416648.90000 0000 8986 2221Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Nicola Orsini
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Susanne Strömdahl
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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Alspaugh A, Swan LET, Auerbach SL, Bartmess M, Agbemenu K, Ely GE. Mistreatment in health care among women in Appalachia. Culture, Health & Sexuality 2023:1-17. [DOI: https:/doi.org/10.1080/13691058.2023.2176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/31/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Amy Alspaugh
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Laura E. T. Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Gretchen E. Ely
- College of Social Work, University of Tennessee, Knoxville, TN, USA
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Poolkumlung R, Rongkapich R, Sinthuchai N, Santibenchakul S, Meevasana V, Jaisamrarn U. Knowledge, attitude, and intended practice of abortion among medical students in Thailand after the amendment of the Thai abortion law. Contracept X 2023; 5:100091. [PMID: 37124455 PMCID: PMC10140783 DOI: 10.1016/j.conx.2023.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives Following the amendment of the Thai abortion law in February 2021, the authors conducted an anonymous survey to assess knowledge, attitude, and intended practice toward abortion among fifth-year medical students at Chulalongkorn University. Study design The authors developed a self-administrated questionnaire consisting of three parts: knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. Pilot testing showed a high Cronbach's alpha and test-retest reliability coefficient. Results Of the 292 surveyed medical students, 70% completed the questionnaire. The mean ± standard deviation of the knowledge part was 6.9 ± 1.8, of which the maximum score was 10. Nearly half of the participants (45.6%) answered at least 80% of the knowledge statements correctly. Sixty-four percent of participants answered correctly on the gestational limit for first-trimester abortion. Around one-third of participants answered correctly on the gestational limit for second-trimester abortion. Most participants (86.8%) agreed that abortion is a woman's right. The most acceptable conditions for abortion were pregnancy as a result of rape (93%) and serious anomalies that cause a nonviable neonate (95.6%). Conclusions Participants exhibited a lack of understanding regarding the legal gestational limit, which is a key aspect of the amendment. The findings of this study urge medical schools to emphasize the revised Thai abortion law in the Obstetrics and Gynecology curriculum. Implications Our results show that encouraging medical students to have up-to-date knowledge regarding the amendment of Thai abortion law may support their future decision to provide safe abortion services.
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Affiliation(s)
- Rada Poolkumlung
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ratthapong Rongkapich
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natchanika Sinthuchai
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Corresponding author.
| | | | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Bell SO, Guiella G, Byrne ME, Bazie F, Onadja Y, Thomas HL, Moreau C. Induced abortion incidence and safety in Burkina Faso in 2020: Results from a population-based survey using direct and social network-based estimation approaches. PLoS One 2022; 17:e0278168. [PMID: 36449473 DOI: 10.1371/journal.pone.0278168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
This study aims to estimate induced abortion incidence and safety in Burkina Faso using direct and indirect methods, overall and by women's background characteristics. Data come from a nationally representative survey of reproductive aged women (n = 6,388). To address social desirability bias in abortion reporting, we asked about respondents' closest female friends' experience with abortion. The one-year abortion incidence in 2020 for respondents was 4.0 (95% CI 2.2-5.9) per 1,000 women aged 15-49 while the adjusted friend incidence was 22.9 (95% CI 15.8-30.0). Although not significant, abortion incidence was higher for adolescents, unmarried women, those with higher education, and those in urban areas among both respondents and their friends. Approximately nine out of ten abortions were unsafe (90% respondents, 95% friends), with respondent and friend findings suggesting higher risk of unsafe abortion among older women, less educated women, and women residing in rural areas. Despite recent increases in contraceptive use and continued legal restrictions, abortion remains common in Burkina Faso and is largely unsafe, with evidence of potential disparities.
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Hinson L, Bhatti AM, Sebany M, Bell SO, Steinhaus M, Twose C, Izugbara C. How, when and where? A systematic review on abortion decision making in legally restricted settings in sub-Saharan Africa, Latin America, and the Caribbean. BMC Womens Health 2022; 22:415. [PMID: 36217197 PMCID: PMC9552475 DOI: 10.1186/s12905-022-01962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background With increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings. However, more than 22,000 women die each year from unsafe abortion, most often in developing countries where abortion is highly legally restricted. We conducted a systematic review to compile existing evidence regarding factors that influence women’s abortion-related decision making in countries where abortion is highly legally restricted.
Methods We searched ten databases in two languages (English and Spanish) for relevant literature published between 2000 and 2019 that address women’s decision-making regarding when, where and how to terminate a pregnancy in sub-Saharan African, Latin American and the Caribbean countries where abortion is highly legally restricted.
Results We identified 46 articles that met the review’s inclusion criteria. We found four primary factors that influenced women’s abortion-related decision-making processes: (1) the role of knowledge, including of laws, methods and sources; (2) the role of safety, including medical, legal and social safety; (3) the role of social networks and the internet, and; (4) cost affordability and convenience. Conclusions The choices women make after deciding to terminate a pregnancy are shaped by myriad factors, particularly in contexts where abortion is highly legally restricted. Our review catalogued the predominant influences on these decisions of when, where and how to abort. More research is needed to better understand how these factors work in concert to best meet women’s abortion needs to the full limit of the law and within a harm reduction framework for abortions outside of legal indications. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01962-0.
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Affiliation(s)
- Laura Hinson
- grid.419324.90000 0004 0508 0388International Center for Research on Women, Washington, DC USA
| | | | | | - Suzanne O. Bell
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Claire Twose
- grid.21107.350000 0001 2171 9311Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Chimaraoke Izugbara
- grid.419324.90000 0004 0508 0388International Center for Research on Women, Washington, DC USA
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Simmelink AM, Gichuki CM, Ampt FH, Manguro G, Lim MSC, Agius P, Hellard M, Jaoko W, Stoové MA, L'Engle K, Temmerman M, Gichangi P, Luchters S. Assessment of the lifetime prevalence and incidence of induced abortion and correlates among female sex workers in Mombasa, Kenya: a secondary cohort analysis. BMJ Open 2022; 12:e053218. [PMID: 36207033 PMCID: PMC9557798 DOI: 10.1136/bmjopen-2021-053218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Prevalence of lifetime-induced abortion in female sex workers (FSWs) in Kenya was previously estimated between 43% and 86%. Our analysis aimed at assessing lifetime prevalence and correlates, and incidence and predictors of induced abortions among FSWs in Kenya. METHODS This is a secondary prospective cohort analysis using data collected as part of the WHISPER or SHOUT cluster-randomised trial in Mombasa, assessing effectiveness of an SMS-intervention to reduce incidence of unintended pregnancy. Eligible participants were current FSWs, 16-34 years and not pregnant or planning pregnancy. Baseline data on self-reported lifetime abortion, correlates and predictors were collected between September 2016 and May 2017. Abortion incidence was measured at 6-month and 12-month follow-up. A multivariable logistic regression model was used to assess correlates of lifetime abortion and discrete-time survival analysis was used to assess predictors of abortions during follow-up. RESULTS Among 866 eligible participants, lifetime abortion prevalence was 11.9%, while lifetime unintended pregnancy prevalence was 51.2%. Correlates of lifetime abortions were currently not using a highly effective contraceptive (adjusted OR (AOR)=1.76 (95% CI=1.11 to 2.79), p=0.017) and having ever-experienced intimate partner violence (IPV) (AOR=2.61 (95% CI=1.35 to 5.06), p=0.005). Incidence of unintended pregnancy and induced abortion were 15.5 and 3.9 per 100 women-years, respectively. No statistically significant associations were found between hazard of abortion and age, sex work duration, partner status, contraceptive use and IPV experience. CONCLUSION Although experience of unintended pregnancy remains high, lifetime prevalence of abortion may have decreased among FSW in Kenya. Addressing IPV could further decrease induced abortions in this population. TRIAL REGISTRATION NUMBER ACTRN12616000852459.
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Affiliation(s)
| | - Caroline M Gichuki
- Department of Population Health, The Aga Khan University, Nairobi, Nairobi, Kenya
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Frances H Ampt
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Griffins Manguro
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Paul Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Walter Jaoko
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Mark A Stoové
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kelly L'Engle
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Marleen Temmerman
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Department of Obstetrics and Gynaecology, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- Technical University of Mombasa, Mombasa, Kenya
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Endler M, Petro G, Gemzell Danielsson K, Grossman D, Gomperts R, Weinryb M, Constant D. A telemedicine model for abortion in South Africa: a randomised, controlled, non-inferiority trial. Lancet 2022; 400:670-679. [PMID: 36030811 DOI: 10.1016/s0140-6736(22)01474-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Telemedicine for medical abortion increases access to safe abortion but its use has not been described in a controlled trial. We aimed to investigate the effectiveness, adherence, safety, and acceptability of a modified telemedicine protocol for abortion compared with standard care in a low-resource setting. METHODS In this randomised, controlled, non-inferiority trial we recruited women seeking medical abortion at or before 9 gestational weeks at four public health clinics in South Africa. Participants were randomly allocated (1:1) by computer-generated blocks of varying sizes to telemedicine or standard care. The telemedicine group received asynchronous online abortion consultation and instruction, self-assessed gestational duration, and had a uterine palpation as a safety measure. Participants in this group took 200 mg mifepristone and 800 μg misoprostol at home. The standard care group received in-person consultation and instruction together with an ultrasound, took 200 mg mifepristone in clinic and 800 μg misoprostol at home. Our primary outcome was complete abortion after initial treatment, assessed at a 6-week interview. Our non-inferiority margin was 4%. Group differences were assessed by modified intention-to-treat (mITT) analysis and per protocol. The trial is registered at ClinicalTrials.gov, NCT04336358, and the Pan African Clinical Trials Registry, PACTR202004661941593. FINDINGS Between Feb 28, 2020, and Oct 5, 2021, we enrolled 900 women, 153 (17·0%) of whom were discontinued before the abortion and were not included in the analysis. By mITT analysis, 355 (95·4%) of 372 women in the telemedicine group had a complete abortion compared with 338 (96·6%) of 350 in the standard care group (odds ratio 0·74 [95% CI 0·35 to 1·57]). The risk difference was -1·1% (-4·0 to 1·7). Among women who completed treatment as allocated (per protocol), 327 (95·6%) of 342 women in telemedicine group had complete abortion, compared with 338 (96·6%) of 350 in the standard care group (0·77 [0·36 to 1·68]), with a risk difference of -1·0% (-3·8 to 1·9). One participant (in the telemedicine group) had a ruptured ectopic pregnancy, and a further four participants were admitted to hospital (two in each group), of whom two had blood transfusions (one in each group). INTERPRETATION Asynchronous online consultation and instruction for medical abortion and home self-medication, with uterine palpation as the only in-person component, was non-inferior to standard care with respect to rates of complete abortion, and did not affect safety, adherence, or satisfaction. FUNDING Grand Challenges Canada and the Swedish Research Council.
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Affiliation(s)
- Margit Endler
- Department of Women's and Children's Health and WHO Collaborating Centre for Research and Research Training in Human Reproduction, Karolinska Institutet, Stockholm, Sweden; School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Gregory Petro
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Cape Town, South Africa
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health and WHO Collaborating Centre for Research and Research Training in Human Reproduction, Karolinska Institutet, Stockholm, Sweden
| | - Dan Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Maja Weinryb
- Department of Women's and Children's Health and WHO Collaborating Centre for Research and Research Training in Human Reproduction, Karolinska Institutet, Stockholm, Sweden
| | - Deborah Constant
- School of Public Health and Family Medicine, University of Cape Town, South Africa
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Baldwin A, Johnson DM, Broussard K, Tello-Pérez LA, Madera M, Ze-Noah C, Padron E, Aiken ARA. U.S. Abortion Care Providers' Perspectives on Self-Managed Abortion. Qual Health Res 2022; 32:788-799. [PMID: 35322703 PMCID: PMC9152602 DOI: 10.1177/10497323221077296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University
Sacramento, USA
| | - Dana M. Johnson
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | | | | | - Melissa Madera
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | - Carol Ze-Noah
- Department of Political Science, University of California Berkeley, USA
| | | | - Abigail R. A. Aiken
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
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Veldhuis S, Sánchez-Ramírez G, Darney BG. Locating Autonomous Abortion Accompanied by Feminist Activists in the Spectrum of Self-Managed Medication Abortion. Stud Fam Plann 2022; 53:377-387. [PMID: 35347718 DOI: 10.1111/sifp.12194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diverse models of self-managed medication abortion exist-ranging from some interaction with medical personnel to completely autonomous abortion. In this commentary, we propose a new classification of self-managed medication abortion and describe the different modalities. We highlight autonomous abortion accompanied by feminist activists, called "acompañantes," as a community- and rights-based strategy that can be a safe alternative to clinical abortion services in clandestine as well as legal settings. To improve access, abortion needs to be decriminalized and governments must acknowledge and facilitate the diversity of safe abortion options so women may choose where, when, how, and with whom to abort.
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Affiliation(s)
- Suzanne Veldhuis
- Department of Health, El Colegio de la Frontera Sur (ECOSUR), San Cristóbal de las Casas, Chiapas 29290, México
| | - Georgina Sánchez-Ramírez
- Department of Health, El Colegio de la Frontera Sur (ECOSUR), San Cristóbal de las Casas, Chiapas 29290, México
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA.,Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Publica (INSP), 62100 Cuernavaca, Morelos, México
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Katz AJ, Ramirez AM, Bercu C, Filippa S, Dirisu O, Egwuatu I, Nmezi S, Palmer L, Baum SE. “I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria. PLoS One 2022; 17:e0263072. [PMID: 35130269 PMCID: PMC8820635 DOI: 10.1371/journal.pone.0263072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/10/2022] [Indexed: 01/23/2023] Open
Abstract
This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients’ own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.
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Killinger K, Günther S, Gomperts R, Atay H, Endler M. Why women choose abortion through telemedicine outside the formal health sector in Germany: a mixed-methods study. BMJ Sex Reprod Health 2022; 48:e6-e12. [PMID: 33229399 DOI: 10.1136/bmjsrh-2020-200789] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. METHODS We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results. RESULTS The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners. CONCLUSIONS Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.
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Affiliation(s)
- Kristina Killinger
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Hazal Atay
- Women on Web, Toronto, Ontario, Canada
- Centre of Political Research, Sciences Po (CEVIPOF), Paris, France
| | - Margit Endler
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Women's Health Research Unit, University of Cape Town, Cape Town, South Africa
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Veldhuis S, Sánchez-Ramírez G, Darney BG. “Sigue siendo un sistema precario”. Barreras de acceso a abortos clínicos: la experiencia de acompañantes en tres regiones mexicanas. CAD SAUDE PUBLICA 2022; 38:ES124221. [DOI: 10.1590/0102-311xes124221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
El objetivo de esta investigación fue la identificación de las barreras más recurrentes de acceso a abortos en contextos clínicos (clandestinos o legales), desde la perspectiva de acompañantes, activistas feministas que acompañan a mujeres que optaron por abortos autogestionados con medicamentos. Realizamos 14 entrevistas semiestructuradas con acompañantes en tres regiones mexicanas: Baja California y Chiapas, ambos contextos restrictivos, y la Ciudad de México, donde el aborto por voluntad es legal hasta las 12 semanas. Identificamos cuatro categorías en las cuales se entretejen las vulnerabilidades sociales de las mujeres que deciden abortar, la falta de información, persistencia de estigma, y la influencia del marco legal, los fallos en la atención del aborto, incluso en las clínicas de interrupción legal de embarazo (en la Ciudad de México), y mala calidad de los servicios prestados -maltrato, objeción de conciencia y denuncia de los proveedores de salud-, y, por último, los grupos anti-derechos y sus estrategias. En las tres regiones, el acceso a abortos clínicos sigue siendo un privilegio reservado para las mujeres que cuentan con los recursos económicos, logísticos y sociales indispensables para realizarlo en esos espacios. La existencia de un programa Interrupción Legal de Embarazo en solamente una entidad denota la existencia de una desigualdad jurídica y sanitaria. Los hallazgos de este estudio sobre mujeres acompañantes de abortos aportan elementos para que el Estado mexicano mejore el acceso a abortos seguros para todas las mujeres, sobre todo ahora que la Suprema Corte de la Justicia de la Nación decretó la despenalización, y la legalización inminente en todo el país.
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Affiliation(s)
| | | | - Blair G. Darney
- Oregon Health & Science University, USA; Instituto Nacional de Salud Publica, Mexico
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15
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Jacobs MG, Boing AC. [What do the national data say about the supply and performance of legal abortions in Brazil in 2019?]. CAD SAUDE PUBLICA 2021; 37:e00085321. [PMID: 34932679 DOI: 10.1590/0102-311x00085321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022] Open
Abstract
Abortion is supplied by the Brazilian Unified National Health System (SUS) in cases allowed under the prevailing legislation. The current study seeks to map and characterize the supply and performance of this procedure in Brazil in 2019. Data included the Referral Services for Termination of Pregnancy Authorized by Law (SRIGCPL) recorded in the National Registry of Healthcare Establishments (SCNES) and the establishments with records of abortion for medical and legal reasons in the Outpatient Information System and Hospital Information System. Establishments were characterized by type and subtype, legal status, and contractual agreements, and georeferenced according to data from the SCNES. Next, municipalities were classified as those with and without supply of the procedure in 2019 and were presented by categories of Municipal Human Development Index (HDI-M) and population size. The data were used to calculate the rates of legally authorized abortions performed in the two groups of municipalities. In all, 290 establishments supplied the service, of which 101 SRIGCPL and 251 establishments with records of the procedure. The establishments were situated in 3.6% (200) of Brazil's municipalities. The supply was mostly in hospitals (98.6%), under the public administration (62.1%), in contractual agreements with the SUS (99.7%), in municipalities in the Southeast of Brazil (40.5%), with more than 100,000 inhabitants (59.5%), and with high or very high HDI-M (77.5%). The rate of legally authorized abortions in childbearing-age residents of municipalities without supply of the service was 4.8 times lower than in municipalities with the service. The supply of legally authorized abortions in Brazil is distributed unequally across the territory, with possible negative implications for access to the service.
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Affiliation(s)
- Marina Gasino Jacobs
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Alexandra Crispim Boing
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, Brasil
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Byrne ME, Omoluabi E, OlaOlorun FM, Moreau C, Bell SO. Determinants of women's preferred and actual abortion provision locations in Nigeria. Reprod Health 2021; 18:240. [PMID: 34838089 PMCID: PMC8627088 DOI: 10.1186/s12978-021-01290-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women’s decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted. Methods This analysis uses data from a 2019–2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women’s preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women’s decisions about where to terminate their pregnancy and identify factors hindering women’s ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location. Results Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). “Privacy/confidentiality” was the most common main reason driving women’s abortion provider/location choice (20.7%), followed by “convenience” (16.9%) and “recommended” by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence. Conclusions These findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women’s choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women’s abortion care preferences in a legally restrictive environment. Many factors influence a woman’s pathway to obtaining an abortion, even in a setting with strict laws prohibiting the practice. This study aims to explore where women in Nigeria would prefer to and actually obtain their abortions, reasons why they could or could not use their preferred provider/location, and differences between women who were and were not able to use their preferred provider/location. The findings show that most women would opt to use a clinical source, such as a government or private hospital, especially among women who did not use their preferred source. Privacy/confidentiality, convenience, and recommendation from someone like a friend or partner drove women’s abortion care preferences, although these influences differed by type of provider/location (clinical, pharmacy/chemist, or other non-clinical). Issues like cost, distance, and lack of privacy were barriers that prevented women from using their preferred provider/location, instead obtaining their abortion from a less desired provider. However, the sociodemographic characteristics of women who did and did not use their preferred provider/location did not differ significantly, except by state. These findings provide insights on barriers to safe abortion care in Nigeria, suggesting social safety drives many women to seek care outside of the healthcare system, while cost and distance prevented many from seeking clinical services. Results also highlight the diversity of women’s abortion preferences in a setting where abortion is legally restricted.
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Affiliation(s)
- Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth Omoluabi
- Centre for Research, Evaluation Resources and Development, Ile-Ife, Nigeria.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | | | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, 94805, Villejuif, France
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Veldhuis S, Sánchez-Ramírez G, Darney BG. "Becoming the woman she wishes you to be": a qualitative study exploring the experiences of medication abortion acompañantes in thre regions in Mexico. Contraception 2021; 106:39-44. [PMID: 34742716 DOI: 10.1016/j.contraception.2021.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acompañantes are activists who accompany women who have medication abortions outside of clinical settings. We describe models of accompaniment across three states in Mexico with diverse abortion laws, access, and acompañantes, and describe how acompañantes conceptualize the benefits and challenges of their work. STUDY DESIGN In this exploratory, qualitative study, we conducted semi-structured interviews with 14 participants about their experiences as acompañantes, in two states with restrictive abortion legislation (Baja-California, Chiapas) at the time of research and Mexico City, where abortion is legal upon request in the first trimester. We used a feminist ethnography approach and analyzed data using a priori categories which included perceived benefits of and challenges of the accompaniment model. RESULTS Participants described similar steps and general characteristics of the accompaniment process regardless of the setting, supporting the concept of an overarching definition of the holistic accompaniment model for these acompañantes. Holistic accompaniment is a horizontal model that involves trusting women, not asking for the reasons for their abortion, preventing criminalization, economic support, respecting autonomy, emotional accompaniment, and being flexible. Participants described perceived advantages, including safety, even in settings otherwise unsafe, such as where women may be stigmatized and / or criminalized. Participants described benefits of autonomous abortion compared to in-clinic medication abortion or surgical abortion, and benefits specifically related to accompaniment, such as the potential to make the abortion a positive experience. CONCLUSIONS We describe components of a holistic accompaniment model in Mexico which has specific characteristics that may benefit women who opt for out-of-clinic abortion.
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Affiliation(s)
- Suzanne Veldhuis
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230.
| | - Georgina Sánchez-Ramírez
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230
| | - Blair G Darney
- Oregon Health & Science University, Portland, Oregon, USA; Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
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Jenkins J, Woodside F, Lipinsky K, Simmonds K, Coplon L. Abortion With Pills: Review of Current Options in The United States. J Midwifery Womens Health 2021; 66:749-757. [PMID: 34699129 DOI: 10.1111/jmwh.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
Interest in self-management approaches to abortion with pills in the United States preceded the coronavirus disease 2019 (COVID-19) pandemic and has accelerated during this global health crisis. Coupled with the unclear future of legal abortion in the United States, clinical care providers need to be aware of the range of self-managed abortion approaches and of the varying levels of engagement with the formal health care system they entail. This article is intended to serve as a resource to inform providers of the current landscape of abortion with pills in the United States, while also describing possible shifts in the future that may result due to the ongoing pandemic and the continuing erosion of access to abortion care and services.
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Affiliation(s)
- Julie Jenkins
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | | | - Katherine Simmonds
- MGH Institute of Health Professions School of Nursing, Boston, Massachusetts
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19
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Miller C. Maternal Mortality from Induced Abortion in Malawi: What Does the Latest Evidence Suggest? Int J Environ Res Public Health 2021; 18:ijerph181910506. [PMID: 34639806 PMCID: PMC8507663 DOI: 10.3390/ijerph181910506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence—itself from 15 to 20 years ago—suggests that 6–7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70–150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion.
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Affiliation(s)
- Calum Miller
- St. Benet's Hall, University of Oxford, Oxford OX1 3LN, UK
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20
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Harries J, Daskilewicz K, Bessenaar T, Gerdts C. Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study. Reprod Health 2021; 18:190. [PMID: 34556120 PMCID: PMC8460179 DOI: 10.1186/s12978-021-01243-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. Methods We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. Results Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. Conclusions The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women’s needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions. Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, who they discuss and seek help from, and the factors that influence their decision to seek an abortion outside of the formal health care sector. We interviewed 15 women who had obtained an abortion outside of the health care sector in Cape Town, South Africa. Women were aware that abortions were legal and available in public clinics, but they were concerned about negative and judgmental attitudes from health care providers even though some women were aware of the possible health safety issues related to seeking an abortion outside of the clinic setting. Abortion services should adapt to women’s needs and offer them options of facility-based care but also self-managed medical abortions under the guidance of health care providers.
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Affiliation(s)
- Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Kristen Daskilewicz
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin St, Oakland, CA, USA
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21
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Nortén H, Ilozumba O, Wilkinson J, Gemzell-Danielsson K, Gomperts R. 10-year evaluation of the use of medical abortion through telemedicine: a retrospective cohort study. BJOG 2021; 129:151-159. [PMID: 34018294 DOI: 10.1111/1471-0528.16765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide a descriptive overview and evaluate changes in the use and outcome of abortions provided worldwide by telemedicine in the past 10 years. DESIGN Retrospective cohort study. SETTING Multi-country. POPULATION/SAMPLE 30 344 women who completed the follow-up survey of the telemedical abortion service Women on Web from January 2009 till January 2020. METHODS Analyses of follow-up surveys, binary logistic regressions to test the association between year and outcomes. MAIN OUTCOME MEASURES Rate of complete abortions, surgical interventions, ongoing pregnancies, blood transfusions per year, socio-economic situation, knowledge on medical abortion, acceptability of receiving service, appropriateness of method and the likelihood of recommending the service to a friend. RESULTS Medical abortions were provided to 81 683 women, of whom 30 344 (37.2%) completed the follow-up survey. In total, 26 076 women reported doing the medical abortion, of whom 1.5% reported an ongoing pregnancy, 10.2% a surgical intervention and 0.6% a blood transfusion. Acceptability of the service was 99%, and 59.2% of the users reported previous knowledge of medical abortion. We found a significant increase in complete abortions in 2019 (odds ratio 1.92; 95% CI 1.59-2.31) and decrease in surgical interventions (odds ratio 0.49; 95% CI 0.40-0.60) compared with 2009. CONCLUSION Low follow-up rates present a limitation in analysing trends in telemedical abortion usage. However, our findings suggest that it is a highly acceptable method around the world and that there has been an increase in complete abortions by telemedical abortions and a decrease in surgical interventions in the last 10 years. TWEETABLE ABSTRACT In the last 10 years, there has been an increase in complete abortions and decrease in surgical interventions of telemedical abortion.
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Affiliation(s)
- Hanna Nortén
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Women on Web, 1 Yonge Street, Toronto, Canada
| | - Onaedo Ilozumba
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Wilkinson
- Division of Population Health, Health Services Research and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, UK
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - R Gomperts
- Women on Web, 1 Yonge Street, Toronto, Canada
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Abstract
Access to first trimester abortions has increased significantly in the past few decades in low and middle-income countries. Manual vacuum aspiration is now standard of care for procedural abortion and postabortion care. Medication abortion has shifted abortions to being performed earlier in pregnancy and is becoming more widely available with new service delivery strategies to broaden access. Widespread availability of misoprostol has made abortions induced outside of the formal medical sector overall safer. In both legally restrictive and supportive environments, there is increased interested in self-managed abortions as part of a shift towards demedicalizing abortion through task-sharing.
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Raifman S, Ralph L, Biggs MA, Grossman D. "I'll just deal with this on my own": a qualitative exploration of experiences with self-managed abortion in the United States. Reprod Health 2021; 18:91. [PMID: 33947413 PMCID: PMC8093912 DOI: 10.1186/s12978-021-01142-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes. Methods In 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos’ KnowledgePanel that, since 2000, they had attempted SMA while living in the United States. We asked participants about their reproductive histories, experiences seeking reproductive health care, and SMA experiences. We used an iterative process to develop codes and analyzed transcripts using thematic content analysis methods. Results Motivations and perceptions of effectiveness varied by whether participants had confirmed the pregnancy prior to SMA. Participants who confirmed their pregnancies chose SMA because it was convenient, accessible, and private. Those who did not test for pregnancy were motivated by a preference for autonomy and felt empowered by the ability to try something on their own before seeking facility-based care. Participants prioritized methods that were safe and available, though not always effective. Most used herbs or over-the-counter medications; none used self-sourced abortion medications, mifepristone and/or misoprostol. Five participants obtained facility-based abortions and one participant decided to continue the pregnancy after attempting SMA. The remaining eight reported being no longer pregnant after SMA. None of the participants sought care for SMA complications; one participant saw a provider to confirm abortion completion. Conclusions There are many types of SMA experiences. In addition to those who pursue SMA as a last resort (after facing barriers to facility-based care) or as a first resort (because they prefer homeopathic remedies), our findings show that some individuals view SMA as a potential interim step worth trying after suspecting pregnancy and before accessing facility-based care. These people in particular would benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill. Some people in the United States (US) attempt to end a pregnancy on their own without medical supervision. What we know about this experience comes from studies focused on people who go to clinics. In this study, we conducted 14 interviews with self-identified women ages 18–49 who recently reported attempting to end a pregnancy on their own and who were recruited outside of the clinic setting. We asked participants about their fertility histories, experiences seeking reproductive health care, and experiences ending a pregnancy without medical assistance. Those who took a pregnancy test and then chose to end the pregnancy on their own did so because it was convenient, accessible, and private. Those who did not test for pregnancy felt empowered by the ability to try something on their own before seeking facility-based care. All participants prioritized methods that were safe and available, though not always effective. After they attempted to end the pregnancy on their own, five participants accessed abortion care in facilities, one decided to continue the pregnancy, and eight were no longer pregnant. Our findings show that, in addition to people who end a pregnancy on their own as a last resort (after facing barriers to facility-based care) or as a first resort (because of preferences for homeopathic methods), a third group values having an interim step to try after suspecting pregnancy and before accessing facility-based care. These people would particularly benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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Affiliation(s)
- Lucía Berro Pizzarossa
- Postdoctoral Fellow, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Rishita Nandagiri
- ESRC Postdoctoral Fellow, Department of Methodology, London School of Economics and Political Science, London, UK
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25
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Kaswa R, Yogeswaran P. Abortion reforms in South Africa: An overview of the Choice on Termination of Pregnancy Act. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 33314950 PMCID: PMC8378188 DOI: 10.4102/safp.v62i1.5240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/01/2022] Open
Abstract
Access to sexual and reproductive healthcare is a constitutional right and on a broader perspective is part of the universal right to health. The Choice on Termination of Pregnancy (CTOP) Act of 1996 was a major step towards commitment to providing comprehensive sexual and reproductive health services in an equitable and rights-based approach. Despite abortion being legally available, unsafe abortion is still an avoidable factor of maternal deaths after more than two decades of abortion law reform in South Africa. The CTOP Act 92 of 1996, with its amendments, provides a legislative framework; however, more is needed to reaffirm the sexual and reproductive health freedom.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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26
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Affiliation(s)
| | - Banchiamlack Dessalegn
- Regional Director, East and Southern Africa, MSI Reproductive Choices, Addis Ababa, Ethiopia
| | - George Hayes
- Regional Advocacy Advisor, MSI Reproductive Choices, London, UK
| | - Kathryn Church
- Director of Global Evidence, MSI Reproductive Choices, London, UK
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27
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Baum SE, Ramirez AM, Larrea S, Filippa S, Egwuatu I, Wydrzynska J, Piasecka M, Nmezi S, Jelinska K. "It's not a seven-headed beast": abortion experience among women that received support from helplines for medication abortion in restrictive settings. Health Care Women Int 2020; 41:1128-1146. [PMID: 33156737 DOI: 10.1080/07399332.2020.1823981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are a growing number of abortion helplines where counselors provide person-centered medication abortion services in legally restrictive settings. Few researchers have explored the perceptions and experiences of the people who obtain support from these helplines. Between April and August 2017, we conducted 30 interviews with women who had a medication abortion with support from helpline counselors in Poland, Brazil, or Nigeria. Before seeking care with the helpline, women often heard negative stories about abortion and faced enacted stigma from the formal healthcare sector, or chose not to seek services from their doctors due to fear of stigmatizing treatment. Conversely, during their care with the helpline counselors, women received clear information in a timely manner, and were treated with kindness, compassion, respect, and without judgment. Many women gained knowledge and understanding of medication abortion, and some gained a sense of community among those who experienced abortion. Helpline models can provide high-quality, person-centered abortion care to people seeking abortions in legally restrictive contexts. Evidence from these service-delivery models could help improve service within the formal healthcare systems and expand access to high-quality, safe abortion by redefining what it means to provide care.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, Oakland, California, USA
| | | | - Sara Larrea
- Women Help Women, Amsterdam, the Netherlands
| | | | - Ijeoma Egwuatu
- Generation Initiative for Youth and Women Network, Lagos, Nigeria
| | | | | | - Sybil Nmezi
- Generation Initiative for Youth and Women Network, Lagos, Nigeria
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28
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Haaland MES, Mumba Zulu J, Moland KM, Haukanes H. When abortion becomes public - Everyday politics of reproduction in rural Zambia. Soc Sci Med 2020; 265:113502. [PMID: 33183861 DOI: 10.1016/j.socscimed.2020.113502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/15/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
This article takes the public reaction to the discovery of an aborted foetus in a rural Zambian community as the empirical starting point for exploring the everyday politics of reproduction. It builds on eleven months of ethnographic fieldwork on abortion and abortion policy in Zambia in 2017 and 2018, including participant observation in the community where the episode took place and interviews with clinic staff and neighbours. The article explores local dynamics of abortion opposition in a country where abortion is legally permitted on broad grounds. By analysing this case as an anthropological event, it discusses how opposition to abortion is dynamic and changes depending on the situation at hand. While abortions that avoid public attention may be silently tolerated, abortions that become openly known are harshly condemned. Through scrutiny of a specific case of collective moral judgement of abortion, the article examines how values like responsible motherhood, sexual virtue and protection of life emerge and are shared, allowing participants to protect and accumulate their own integrity in a moral economy that forges stronger social ties within the community. The article argues that even the harshest expressions of opposition to abortion may not be as categorical as they first appear. It calls for increased attention to dynamics of moral and political opposition to abortion to understand what is socially at stake for those who engage in it.
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Affiliation(s)
- Marte E S Haaland
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Norway.
| | | | - Karen Marie Moland
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Norway
| | - Haldis Haukanes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
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29
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Moseson H, Jayaweera R, Raifman S, Keefe-Oates B, Filippa S, Motana R, Egwuatu I, Grosso B, Kristianingrum I, Nmezi S, Zurbriggen R, Gerdts C. Self-managed medication abortion outcomes: results from a prospective pilot study. Reprod Health 2020; 17:164. [PMID: 33109230 PMCID: PMC7588945 DOI: 10.1186/s12978-020-01016-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the feasibility of conducting a prospective study to measure self-managed medication abortion outcomes, and to collect preliminary data on safety and effectiveness of self-managed medication abortion, we recruited callers to accompaniment groups (volunteer networks that provide counselling through the out-of-clinic medication abortion process by trained counselors over the phone or in-person). METHODS In 2019, we enrolled callers to three abortion accompaniment groups in three countries into a prospective study on the safety and effectiveness of self-managed medication abortion with accompaniment support. Participants completed up to five interview-administered questionnaires from baseline through 6-weeks after taking the pills. Primary outcomes included: (1) the number of participants enrolled in a 30-day period, (2) the proportion that had a complete abortion; and (3) the proportion who experienced any warning signs of potential or actual complications. RESULTS Over the 30-day recruitment period, we enrolled 227 participants (95% of those invited), and retained 204 participants (90%) for at least one study follow-up visit. At the 1-week follow-up, two participants (1%) reported a miscarriage prior to taking the pills, and 202 participants (89% of those enrolled and 99% of those who participated in the 1-week survey) had obtained and taken the medications. Three weeks after taking the medications, 192 (95%) participants reported feeling that their abortion was complete. Three (1.5%) received a surgical intervention, two (1%) received antibiotics, and five (3%) received other medications. Participants did not report any major adverse events. CONCLUSION These results establish the feasibility of conducting prospective studies of self-managed medication abortion in legally restrictive settings. Further, the high effectiveness of self-managed medication abortion with accompaniment support reported here is consistent with high levels of effectiveness reported in prior studies. Trial registration ISRCTN95769543.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, USA.
| | - Ruvani Jayaweera
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, USA
| | - Sarah Raifman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Sofia Filippa
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, USA
| | | | - Ijeoma Egwuatu
- Generation Initiative for Women and Youth, Lagos, Nigeria
| | - Belen Grosso
- La Revuelta Colectiva Feminista, Neuquén, Argentina
| | | | - Sybil Nmezi
- Generation Initiative for Women and Youth, Lagos, Nigeria
| | | | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, USA
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30
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Rowlands S, Wale J. A Constructivist Vision of the First-Trimester Abortion Experience. Health Hum Rights 2020; 22:237-249. [PMID: 32669804 PMCID: PMC7348450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
How might the abortion experience look in a world without the existing regulatory constraints? This paper critically assesses the evidence about how a high-quality abortion experience might be achieved in the first trimester. There would need to be positive obligations on states in pursuance of women's reproductive rights. The onus would be on states and state actors to justify interferences and constraints upon a woman's right to terminate in the first trimester of her pregnancy. In this vision, abortion is person-centered and normalized as far as possible. High-quality information about abortion would be freely available through multiple sources and in varying formats. Whenever possible, abortion would happen in a place chosen by the woman, and in the case of medical abortion, could be self-managed with excellent clinical backup on hand should the need arise. The overarching purpose of this paper is to highlight the broader environment and framework of state obligations necessary to underpin the lived experience of abortion.
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Affiliation(s)
- Sam Rowlands
- Visiting Professor in the Department of Medical Sciences and Public Health at Bournemouth University, Bournemouth, UK
| | - Jeffrey Wale
- Senior Lecturer in Law in the Department of Humanities and Law at Bournemouth University, Bournemouth, UK
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31
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Danet Danet A. [Women's emotional accounts of induced abortion]. Gac Sanit 2020; 35:361-373. [PMID: 32451189 DOI: 10.1016/j.gaceta.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications. METHOD Qualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis. RESULTS The analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system. CONCLUSIONS The emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.
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Affiliation(s)
- Alina Danet Danet
- Departamento de Organización de Empresas, Marketing y Sociología, Área de Sociología, Universidad de Jaén, Jaén, España.
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32
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Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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33
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Moseson H, Herold S, Filippa S, Barr-Walker J, Baum SE, Gerdts C. Self-managed abortion: A systematic scoping review. Best Pract Res Clin Obstet Gynaecol 2019; 63:87-110. [PMID: 31859163 DOI: 10.1016/j.bpobgyn.2019.08.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Stephanie Herold
- Advancing New Standards in Reproductive Health, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Sofia Filippa
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Jill Barr-Walker
- Zuckerberg San Francisco General (ZSFG) Library, University of California, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Sarah E Baum
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
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