Region: Africa

Human Rights and African Abortion Laws: A Handbook for Judges.

This handbook, written by Prof. Charles Ngwena and published by the Ipas Africa Alliance, is designed to raise judges’ awareness about the human rights obligations associated with abortion. Judges can use it as a guide to interpret and apply domestic abortion laws, taking into account global and regional human rights standards

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Abortion is not a crime

For far too long, Malawians’ view of termination of pregnancy has condemned women and girls to either death or permanent disability. These are needless injuries and deaths that can be prevented if only we stop looking at termination of pregnancy as a crime, moral, faith or cultural issue-but rather as public health issue.

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Moving from legality to reality: How medical abortion methods were introduced with implementation science in Zambia

Abortion is technically legal in Zambia, but the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document two years of implementation. The findings provide a case study of medical abortion introduction in Zambia and offer important lessons for expanding safe and legal abortion access in similar settings across Africa.

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Decade of progress providing safe abortion services in Ethiopia: Results of national assessments in 2008 and 2014

To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia, drawing on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. Using the Safe Abortion Care Model as a framework of analysis, the study found that service availability and quality has increased, but that access to lifesaving comprehensive care still falls short of recommended levels.

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Costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

This analysis aimed to estimate the costs and cost- effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. It found that the cost per complete medication abortion was lower than the cost per complete MVA. This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

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What contraception do women use after abortion? An analysis of 319,385 cases from eight countries

Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2,326 public-sector health facilities in eight African and Asian countries. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas. Overall, postabortion contraceptive uptake was 73 percent. The findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs.

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Correlates of individual-level stigma and unsafe abortions among women seeking abortion care in Trans Nzoia and Machakos Counties, Kenya

This study compared levels of abortion stigma in regions with high and low incidence of unsafe abortion in Kenya to explore whether abortion-related stigma is associated with incidence of unsafe abortion. Respondents from a county with higher incidence of unsafe abortion reported higher stigma scores. Age, marital status, type of abortion service, and socioeconomic status were all significantly associated with stigmatizing attitudes.

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Understanding abortion-related stigma and incidence of unsafe abortion: Experiences from community members in Machakos and Trans Nzoia counties Kenya

This study sought to explore abortion-related stigma at the community level as a barrier to women realizing their right to a safe, legal abortion. It found that abortion-related stigma plays a major role in a woman’s decision on whether to have a safe or unsafe abortion. Young unmarried women, in particular, bore the brunt of being stigmatized.

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Abortion in a progressive legal environment: The need for vigilance in protecting and promoting access to safe abortion services in South Africa

The importance of South Africa as a model for reproductive self-determination in Africa cannot be underestimated. Abortion has been legal since 1996, and the country has some of the most developed government systems for the provision of abortion care on the continent. Yet in the same way opponents of abortion in the United States have whittled away at access with increased bureaucracy, South Africa faces similar assaults that leave women without safe care and threaten to turn back achievements made during the past 16 years. This article explores the history of the law, subsequent legal challenges, and new threats to women’s access to abortion services, including service delivery issues that may influence the future of public health in the country.

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Implementation of misoprostol for postabortion care in Kenya and Uganda: A qualitative evaluation

This study evaluates the implementation of misoprostol for postabortion care (MPAC) in two African countries, Kenya and Uganda. The Ministries of Health, local health centers and hospitals, and NGO staff developed evidence-based service delivery protocols to introduce MPAC in selected facilities; implementation extended from January 2009 to October 2010. RESULTS: In both countries, MPAC was easy to use, and freed up provider time and health facility resources traditionally necessary for provision of PAC with uterine aspiration. On-going support of providers following training ensured high quality of care. Providers perceived that many women preferred MPAC, as they avoided instrumentation of the uterus, hospital admission, cost, and stigma associated with abortion.

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Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana

Understanding what factors influence the receipt of postabortion contraception can help improve comprehensive abortion care services. The abortion visit is an ideal time to reach women at the highest risk of unintended pregnancy with the most effective contraceptive methods. The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method.

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