This eight-page brief outlines selected findings from a research project on the burden of abortion-related complications and their contributing factors in the Maternity of Castors in Bangui, Central African Republic. The study found a greater severity of abortion-related complications in this facility compared to African hospitals in stable settings and reinforces the need to recognize abortion as a serious health issue among fragile or crisis-affected populations.
These two fact sheets—Measuring Abortion Service Quality and Abortion Metrics Matter— describe the Abortion Service Quality Initiative’s work to develop a set of common, reliable and evidenced-based metrics to evaluate the quality of abortion care.
Determining the accuracy of pregnancy-length dating among women presenting for induced abortions in Ghana
This study sought to determine the proportion of women presenting for an induced abortion in Ghana who could use a gestational wheel to determine if they had reached at least 13 weeks or fewer than 13 weeks of pregnancy accurately.
Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone–misoprostol regimen for medical termination at ≤10 weeks of gestation meet US Food and Drug Administration regulatory criteria for over-the-counter (OTC) approval, and if not, what are the present research gaps?
Accessing medical and surgical first-trimester abortion services: Women’s experiences and costs from an operations research study in KwaZulu-Natal Province, South Africa
This study explored women’s experiences accessing services and estimate costs incurred for first-trimester abortion at four public hospitals in KwaZulu-Natal Province, South Africa. Despite the availability of government assistance for children through South Africa’s “child grant,” the affordability of raising a child was a major concern for women. Although theoretically available free of charge in the public sector, women experienced challenges accessing abortion services and incurred costs which may have been burdensome given average local earnings. These potential barriers could be addressed by reducing the number of required visits and improving availability of pregnancy tests and supplies in public facilities.
Research has not kept abreast of women’s self-use of medical abortion, leaving many gaps in the scientific literature regarding the ideal conditions for safe and effective use. In December 2016, a group of 20 global abortion researchers convened following the Africa Regional Conference on Abortion to discuss current and future research on medical abortion self-use. This article lays out their list of identified research gaps and methodologic considerations in addressing them—challenges that are intended to inform both ongoing and future research.
Developing a scale to measure stigmatizing attitudes and beliefs about women who have abortions: Results from Ghana and Zambia
The objective of this research was to explore the context of abortion stigma in Ghana and Zambia through qualitative research, and develop a quantitative instrument to measure stigmatizing attitudes and beliefs about abortion. Focus group discussions were conducted in both countries, and a Stigmatizing Attitudes, Beliefs, and Actions scale was created. It captures three important dimensions of abortion stigma: negative stereotypes about men and women who are associated with abortion, discrimination/exclusion of women who have abortions, and fear of contagion as a result of coming into contact with a woman who has had an abortion. It provides a validated tool for measuring stigmatizing attitudes and beliefs about abortion in Ghana and Zambia and has the potential to be applicable in other country settings.
Governments, advocates, providers, policymakers and other stakeholders who want to fully support women’s rights to access abortion across the globe must address quality of care, in addition to efforts to change abortion laws, train providers and expand service provision. Documenting and working to improve the quality of abortion care is necessary in order to improve service delivery and health outcomes, expand access to safe abortion especially in legally restricted settings, and to ensure the human right to the highest attainable standard of health, as outlined by the WHO.
A mixed methods evaluation of the Youth Focused Social Network Initiative for safe abortion in Rupandehi, Nepal
The Youth Focused Social Network Initiative was a program to increase young women’s knowledge of and skills in accessing comprehensive abortion care in Rupandehi, Nepal from 2012-2014. The program trained peer educators to provide information and support related to comprehensive abortion care and encouraged adults to support youth in their communities. This study evaluated the effectiveness of the program and found that it had produced positive results in youth knowledge of and attitudes about comprehensive abortion care. Program expansion should be considered in light of continued need in Nepal.
Doing more for less: Identifying opportunities to expand public sector access to safe abortion in South Africa through budget impact analysis
The objective of this study was to estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. It concludes that South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided–and says that more research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions.
Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation
The objective of this study was to determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman’s eligibility for medical abortion using a toolkit, compared to comprehensive-abortion-care-trained providers.
Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?
This study sought to identify socio-demographic factors associated with presenting for abortion services past the gestational age limit (12 weeks), and thus not receiving services, in Mexico City’s public sector first-trimester abortion program. We found that women living in Mexico City and with higher levels of education had lower odds of presenting past the gestational age limit. Adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults.
Values clarification workshops to improve abortion knowledge, attitudes and intentions: A pre-post assessment in 12 countries
Women’s access to abortion care is often denied or hampered due to a range of barriers, many of which are rooted in abortion stigma. Abortion values clarification and attitude transformation (VCAT) workshops are conducted with abortion providers, trainers, and policymakers and other stakeholders to mitigate the effects of abortion stigma and increase provision of and access to abortion care.
This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014. We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available.
Since the liberalization of Nepal’s abortion law in 2002, intensive provider training and facility support have proven successful strategies for increasing the availability of comprehensive abortion care (CAC) services in the country. However, little is known about the pathways through which women access safe abortion services. This publication presents research on how women in Nepal access safe abortion information and services, including evidence-based recommendations indicating that increasing contraceptive education and access to female community health volunteers can improve women’s ability to manage their reproductive health.
Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19–20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both.
Improving health worker performance of abortion services: An assessment of post-training support to providers in India, Nepal and Nigeria
This paper reports the results of an intervention with 3,471 abortion providers in India, Nepal and Nigeria. Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period. The intervention also included technical assistance to and upgrades in facilities where the providers worked.
What factors contribute to postabortion contraceptive uptake by young women? A program evaluation in 10 countries in Asia and sub-Saharan Africa
This evaluation assesses the factors that influence contraceptive uptake among adolescents and young women seeking abortion care in health facilities. We analyzed client log book data from 921,918 abortion care cases in 4,881 health facilities in 10 countries from July 2011 through June 2015, and found that programmatic support to health systems, including provider training in contraceptive counseling and provision, was associated with women’s higher acceptance of postabortion contraception.
This fact sheet describes the impact of unsafe abortion in Sierra Leone as evidenced by three studies.