This guide focuses on ways to plan, implement, use and finalize an assessment of how young women and their communities relate to abortion, through locally relevant, community and/or youth-led processes. It is designed to gain insights into the local context surrounding abortion care for young women to inform program design and to support meaningful youth participation in project design. It is a global resource for community groups, youth groups, peer educators, trainers, administrators, program managers and technical advisors of abortion care programs.
This is a short tool on how to use the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS).
Esta herramienta corta explica cómo utilizar la Escala de actitudes, creencias y acciones estigmatizantes (SABAS).
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.
Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: A pre-post evaluation
In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care.
Exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India
This study looked at the socio-economic profile of women seeking abortion services in public health facilities across Madhya Pradesh state and at out of pocket cost accessing abortion services. In particular, it examined the level of access that poor women have to safe abortion services in Madhya Pradesh. Findings highlight that, overall, 57% of women who received abortion care at public health facilities were poor, followed by 21% moderate and 22% rich. Improved availability of safe abortion services at the primary level in Madhya Pradesh has helped meeting the need of safe abortion services among poor, which eventually will help reducing the maternal mortality and morbidity due to unsafe abortion.
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.
‘How shall we survive’: A qualitative study of women’s experiences following denial of menstrual regulation (MR) services in Bangladesh
About one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation. Little is known about whether women denied MR seek abortion elsewhere, self-induce, or continue the pregnancy.
Intimate partner violence and constraints to reproductive autonomy and reproductive health among women seeking abortion services in Bangladesh
The objective of this study was to understand intersections between intimate partner violence (IPV) and other constraints to women’s reproductive autonomy, and the influence of IPV on reproductive health. There were 457 participants included in the analysis and 118 (25.8%) had experienced IPV in the preceding year. IPV was associated with discordance in fertility intentions with husbands/partners and in-laws, with in-law opposition to contraception, with perceived religious prohibition of contraception, and with presenting unaccompanied. Ensuring women’s reproductive freedom requires addressing IPV and related constraints.
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.
Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: A cross-sectional study
This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women’s knowledge and usage of safe abortion services. Although both intervention types improved abortion knowledge, the HIM intervention was more effective.
Correlates of contraceptive use four months post-abortion: Findings from a prospective study in Bangladesh
This study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions, and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling.
Associations between abortion services and acceptance of postabortion contraception in six Indian states
Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014.
This study estimates current health system costs of treating unsafe abortion complications and compares these findings with newly-projected costs for providing safe abortion in Malawi. It finds that transition to safe, legal abortion would yield an estimated cost reduction of 20-30 percent.
This study sought to understand women’s experiences using medication for menstrual regulation in Bangladesh. In-depth interviews were conducted with 20 rural and urban women.The majority had had positive experiences with medication for menstrual regulation and successful outcomes. Continued efforts to improve counselling by providers about the dose, medication and side-effects of medication for menstrual regulation, along with education of the community about medication as an option for menstrual regulation, will help to de-stigmatise the procedure and the women who seek it.
Expansion of safe abortion services in Nepal through auxiliary nurse-midwife provision of medical abortion, 2011-2013
Comprehensive abortion care services remain out of reach for many women in rural and remote areas of Nepal. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal.
Until recently, WHO operationally defined unsafe abortion as illegal abortion. In the past decade, however, the incidence of abortion by misoprostol administration has increased in countries with restrictive abortion laws. Access to safe surgical abortions has also increased in many such countries. An important effect of these trends has been that, even in an illegal environment, abortion is becoming safer, and an updated system for classifying abortion in accordance with safety is needed across categories of safety.
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.
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.
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.