Abstract
BackgroundHumanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision.MethodIn-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach.ResultsThe national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies were available, but a lack of space created a barrier to service provision. Although training from organisations had made the health care providers confident and competent and had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limited and created a barrier to comprehensive abortion services. Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care.ConclusionThe availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers’ personal beliefs and a lack of cultural safety. To ensure the accessibility and availability of quality services, a comprehensive approach to sexual and reproductive health and rights is needed. Organisations must ensure that health care providers have knowledge of abortion policies and the ability to provide quality care that is woman-centred and non-judgmental.
Highlights
Humanitarian settings are characterised by limited access to comprehensive abortion care
Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care
The availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers’ personal beliefs and a lack of cultural safety
Summary
Humanitarian settings are characterised by limited access to comprehensive abortion care. Humanitarian settings are often characterised by limited access to comprehensive sexual and reproductive health (SRH) services, including safe abortion services [1, 2]. Humanitarian settings increase the vulnerability of women and girls to unsafe abortions due to reduced access to SRH services and supplies as a consequence of the collapse, weakening or disruption of the health system and the provision of health care [1, 3, 4]. International recommendations on sexual, reproductive, health and rights (SRHR) in humanitarian settings highlight the importance of incorporating a comprehensive approach to SRHR, including comprehensive abortion care (CAC) services, which comprise safe abortion care, post-abortion care (PAC) and the provision of contraceptives and contraceptive counselling, to reduce the risk of maternal mortality and morbidity as a consequence of unintended pregnancies and unsafe abortions [2]. Research in low- and middle-income countries (LMIC) has shown that HCPs play an important role in the provision of comprehensive abortion care and that their personal perception of abortion and attitudes toward women seeking abortion-related care can act as both a facilitator and a barrier in service provision [12, 13]
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