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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. It provides the first national snapshot to measure changes in a dynamic abortion care environment.
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.
Training mid-level providers to offer medical abortion services after 12 weeks of pregnancy independently of physicians is feasible—and results in comparable clinical outcomes.
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.
This study aimed to understand women’s pathways of seeking care for postabortion complications in Madhya Pradesh, India. The study recruited 786 women between July and November 2007.
Unsafe abortion’s significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal’s restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal’s Ministry of Health and Population, enabled the country subsequently to introduce and scale-up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination.