Abortion Services Research Articles

Post-abortion care services in Zambian health facilities: a qualitative study of users’ experiences and perceptions

BackgroundDespite attempts to increase Universal Health Coverage, availability, accessibility, acceptability, and quality-related challenges remain barriers to receiving essential services by women who need them. We aimed to explore the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework.MethodsA qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen (15) women seeking post-abortion care services were` interviewed using audio recorders; transcribed data was analyzed using thematic analysis. We report women’s experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behaviour. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized post-abortion care services.ResultsWomen who experienced spontaneous abortions delayed seeking health care by viewing symptoms as ‘normal pregnancy symptoms’ and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care.ConclusionsWomen delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.

Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health

The U.S. Supreme Court decision on Dobbs v. Jackson Women’s Health has had a disruptive impact on not only the patients who seek reproductive health care, abortion care providers, and abortion care–adjacent organizations, but has also sparked a need for public health departments to take on new roles to support their communities. In the wake of that 2022 decision, the Philadelphia Department of Public Health launched an ongoing initiative to increase support for the provision of abortion and sexual and reproductive health care. The authors describe the effort, which started with a landscape analysis and qualitative interview analysis to understand the needs and concerns of those comprising the abortion care delivery system in Philadelphia. The authors found that the immediate, short-term needs to support the local abortion care delivery network included funding for patients seeking abortion care, plus communication and education to counter misinformation about the legality of abortion in Pennsylvania. Through the initiative’s research efforts, the authors also found that long-term needs included care capacity–building and health systems–strengthening by removing non–evidence-based restrictions on abortion access and care. Another ongoing role for public health systems is to address and avert legislative or regulatory efforts to impose restrictions to Medicaid coverage for abortion services or other impediments that would disrupt the ability or capacity of health care providers to deliver comprehensive reproductive care. Today, public health departments are uniquely suited to address and mitigate the emerging post-Dobbs chilling effect on both patients and clinicians who may fear legal, professional, or personal consequences as they navigate options for appropriate, evidence-based reproductive health care, even in states where abortion remains legal.

From political priority to service delivery: complexities to real-life priority of abortion services in Ethiopia.

Improving access to abortion services has been coined a high priority by the Ethiopian Federal Ministry of Health. Nevertheless, many women are still struggling to access abortion services. The dedicated commitment to expanding abortion services by central authorities and the difficulties in further improving access to the services make for an interesting case to explore the real-life complexities of health priority setting. This article thus explores what it means to make abortion services a priority by drawing on in-depth interviews with healthcare bureaucrats and key stakeholders working closely with abortion service policy and implementation. Data were collected from February to April 2022. Health bureaucrats from 9 of the 12 regional states in Ethiopia and the Federal Ministry of Health were interviewed in addition to key stakeholders from professional organizations and NGOs. The study found that political will and priority to abortion services by central authorities were not necessarily enough to ensure access to the service across the health sector. At the regional and local level, there were considerable challenges with a lack of funding, equipment and human resources for implementing and expanding access to abortion services. The inadequacy of indicators and reporting systems hindered accountability and made it difficult to give priority to abortion services among the series of health programmes and priorities that local health authorities had to implement. The situation was further challenged by the contested nature of the abortion issue itself, both in the general population, but also amongst health bureaucrats and hospital leaders. This study casts a light on the complex and entangled processes of turning national-level priorities into on-the-ground practice and highlights the real-life challenges of setting and implementing health priorities.

Primary care and abortion provider perspectives on mail-order medication abortion: a qualitative study

BackgroundThis qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.MethodsParticipants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.ResultsWe conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.ConclusionClinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.Trial registrationRegistry: Clinicaltrials.gov. Trial registration number: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

Advocacy and Activism for Health Care Providers in a Post-Roe World

Although the work of health care providers in delivering care for their patients and communities has always been impacted by legislative changes, reproductive health care services, especially abortion care, has received more scrutiny, undergone disparate and excessive attempts at overregulation, and has been subject to more restrictions than most fields of medicine. The June 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization, essentially overturning the federal constitutional protections of the legal right to access abortion afforded by the Roe v. Wade decision in 1973, has brought this issue to the forefront for many clinicians across sectors and disciplines. As trusted voices, physicians and other health care providers are uniquely positioned to discuss the implications of policies that restrict access to comprehensive reproductive health care, including abortion services, as they bear witness to the challenges this creates for them in practice and the communities they care for. This article discusses the impact of the Dobbs ruling on medical providers and their patients as well as the responsibility of health care providers to advocate for abortion access.

Knowledge and attitude towards current Ethiopian abortion law and its associated factors by abortion seeker women in Gedeo zone, Southern Ethiopia: Hospital-based cross-sectional study

IntroductionHuman rights laws defend the right to abortion. In Ethiopia, the 2005 abortion law permits termination in specific cases. Unsafe abortions account for 19.6 % of maternal deaths. ObjectiveAssessing knowledge and attitudes towards the current Ethiopian abortion law for women in Gedeo Zone, Ethiopia. MethodologyA cross-sectional study was undertaken in an institutional setting. We entered the data into Epi-Data version 4.6.0.2 and then exported it to SPSS Windows version 25. In bivariate logistic regression analysis, we included explanatory variables with a p-value < 0.25. In multivariable logistic regression analysis, we considered a p-value of 0.05, along with a 95 % CI, to be significant. A p-value of 0.05 and a 95 % CI are considered significant in the multivariable logistic regression analysis. The study employed AOR to establish the statistical association. ResultA study involving 398 individuals revealed that 61.3 % had good knowledge and 52.3 % favourable attitude toward the law. Married women were 3.91 times more likely to have good knowledge, can read and write were 8.29 times more likely to have a positive attitude. Housewives were 94 % less likely to have a good attitude. Women who recognized abortion complications were 3.11 times more likely to have a positive attitude, and sources of information were 2.62 times more likely to have a positive attitude. ConclusionRespondents show good knowledge and a positive attitude toward the current abortion law. However, there is still a need for further education and support for safe and legal abortion services.

Trends in Second‐Trimester Safe Abortion Service Utilization During the Two Phases of COVID‐19 Pandemic in an Ethiopian Setting: A Cross‐Sectional Study

ABSTRACTBackgroundProviding abortion services during pandemics without interruption is essential. The objective of the study was to compare the utilization of second‐trimester safe abortion care services between early pandemic and peak pandemic months.MethodsWe conducted a retrospective comparative study of second‐trimester safe abortion service provision during the peak of COVID‐19 pandemic in Ethiopia (April 2021) versus during that of early pandemic (April 2020). Data were collected using data extraction form from MICHU clinic HMIS registry. Data were analyzed using SPSS version 23. Chi‐squared test and simple descriptive statistics were applied as appropriate. A p‐value of less than 0.05 was used to describe the significance of the results.ResultsThere were significantly more second‐trimester abortions performed during the peak pandemic month as compared to early pandemic month (32.6% vs. 67.4%, respectively). Nearly half of the abortions were done for maternal health problems (47.8%, 44/92), and of which over 80% of them used medical methods for abortion (83.7%, 77/92). There was only one case of dilation and evacuation (D&amp;E) during the early pandemic, compared to 14 D&amp;E procedures during the pandemic peak.ConclusionWe found a significant increment in the second‐trimester abortion service coverage during the peak of COVID‐19 pandemic. The measures we took during the early pandemic: increasing public awareness about continuation of abortion care services during the pandemic, change in the attitude of care‐providers, and early sticking to national guidelines on essential care during COVID‐19 should be passed on as important lessons for future pandemics.

A survey of obstetric and gynaecology doctors at an Australian metropolitan tertiary hospital to understand their views, training and confidence in abortion care.

The barriers to comprehensive abortion care in Australian metropolitan tertiary hospitals are under-researched. Previous work has suggested that negative practitioner attitudes and lack of training may play a large role; however, this remains poorly understood. The aim was to survey doctors practicing obstetrics and gynaecology to better understand their views, training experience and confidence in abortion care. The method involved a cross-sectional study via an anonymous survey at a single metropolitan tertiary hospital not providing substantive abortion services in Melbourne, Australia. Inclusion criterion was obstetric and gynaecology medical staff working at that hospital. Data were collected regarding views, training experiences and confidence in first-trimester medical and surgical abortion, and second-trimester surgical abortion. Data were analysed according to levels of training, categorised as RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) Fellows, prevocational/vocational trainees and general practitioner specialists. Sixty-one valid responses were received from 90 eligible participants (response rate 68%). An overwhelming majority (96%) supported abortion services. The majority of RANZCOG Fellows felt confident performing first-trimester surgical abortion (89%) and first-trimester medical abortion (71%); however, only half felt confident performing second-trimester surgical abortion (50%). Prevocational/vocational trainees were overall less confident but overwhelmingly expressed interest in gaining further experience in abortion. Doctors are generally confident in providing first-trimester abortion services (medical or surgical) in the metropolitan tertiary setting. However, further work is required to understand ongoing barriers to comprehensive abortion care. There may also be a skills shortage for second-trimester surgical abortion, requiring significant improvements in abortion training.

Service Readiness for Safe Abortion Services.

Health service readiness is a prerequisite to accessing quality services. This study analyzes the readiness of health facilities in Nepal to provide comprehensive abortion services by focusing on the availability and quality of care. Methods:This is a cross-sectional study, and a multi-stage sampling approach was used to select health facilities. A total of 767 health facilities were surveyed from 30 Municipalities across the country. Results:In a study of 767 health facilities surveyed, only 223 (29%) offered abortion services. Among them, 92% offered medical abortion, 48% provided manual vacuum aspiration, 18% offered dilation and evacuation and 18% offered medical induction. Approximately 7% of health facilities lacked trained providers yet still provided services and 29% of health facilities providing abortion services were not compliant with legal requirements. Interestingly, 13% of these facilities lacked short-acting contraceptives. Conclusions:Most health facilities in Nepal lack readiness for Safe Abortion Services (SAS), failing to meet minimum criteria, including to provide abortion legally. Urgent collaborative efforts among policymakers, administrators, and healthcare providers are needed to align with Nepal's Sustainable Development Goals and address gaps in safe abortion service availability. This includes policy updates, strengthening Public-Private Partnerships (PPPs), and ensuring comprehensive SAS implementation and financing as part of essential health services.

A Critical Analysis of Safe Abortion Road Map in Nepal.

Abortion was legalized by the 2002 Muluki Ain to combat the surging rates of maternal mortality and morbidity. By 2021, the Maternal Mortality Rate plummeted to 151 from 539 in 1996. The decline in the abortion-related maternal mortality attributes to the implication of progressive abortion policies that includes expanded safe abortion services introduction of medical abortion, constitutional recognition of abortion, the mandates by Safe Motherhood and Reproductive Health Rights Act, and free-of-cost abortion services in government health facilities. This review study delves into exploring the contemporary abortion policies and its implications on women's access to safe abortion services as well as the factors that affect the access. This study incorporates findings from extensive desk review of abortion services in Nepal. The 2021 safe abortion services Program Implementation Guideline aims to expand safe abortion sites; however, the Nepal's challenging geography ensues its inequitable distribution, especially in mountainous area. Policy provisions on information and financial accessibility to abortion are well navigated by the Safe Motherhood and Reproductive Health Rights Act and regulation but consistent to sporadic gaps in its implementation were comprehended in this study. This paper further discussed the Safe Motherhood and Reproductive Health Rights Act's regressive mandate of 28-week gestational limit at any condition and the role of gender in abortion decision-making under the pretext of factors influencing safe abortion services. The review study recommends strategies: improving capacity for abortion services under federalism, combating stigma, improving the private sector's readiness, and building a resilient health system.

Barriers to Abortion among Women and Girls in Selected Districts of Nepal.

Even after two decades of legalization of abortion in Nepal, most women and girls still do not have knowledge on abortion legality and face abortion barriers. This study will explore perceived barriers to safe abortion and the factors associated with it. A Mixed method study design was conducted in 30 wards of 20 Municipals of seven districts of Lumbini and Sudurpaschim provinces. Quantitative data was analyzed for 673 women of reproductive age of 15-49 years. For qualitative data, key informant interviews were conducted. The analysis was done on five different barriers and a composite variable was created from them. Most women and girls perceived social (34.6%), followed by family (30.6%), physical (30.6%), personal (29.5%), and health facility (14.9%) barriers to access safe abortion services. The key finding was that women and girls with knowledge on abortion legality were more likely to perceive barriers to abortion (AOR:2.31, CI:1.574-3.394). Women and girls with higher educational and economic status as well as Dalit women were less likely to perceive barriers to abortion services whereas never married women and girls perceived more barriers in accessing abortion services. Women and girls perceived several barriers to access safe abortion services. Women who have better knowledge on abortion legality recognize more barriers regarding abortion. This highlights the importance of raising awareness of women and girls on abortion rights to empower them in recognizing and advocating for the removal of the obstacles that stop them from getting abortion services.

Trends and Inequities in Use of Abortion Services in Nepal: A Nepal Demographic and Health Survey Data Analysis 1996-2022 A.D.

Despite policy advances and public health initiatives in Nepal to improve access to reproductive healthcare, disparities persist in utilization of abortion services. Grounded in longitudinal data from the Nepal Demographic and Health Survey from 1996 to 2022, this study aims to shed light on evolving patterns in pregnancy outcomes and inequities in use of abortion services across ecological zones and wealth quintiles. Utilizing six rounds of Nepal Demographic and Health Survey data, pregnancy outcomes were categorized as abortion, delivery, miscarriage, or stillbirth. Income-related inequality in the utilization of abortion services was assessed through the concentration index, ranging from -1 to 1. Trends over time were evaluated using the annual rate of change. The ARC indicated a substantial rise in induced abortion rates, surging from 0.4% in 1996 to 8.8% in 2022. In contrast, live births witnessed a decline from 92.8% to 81.2%. Significant variations were observed across ecological zones and wealth quintiles, with the Mountain zone and the Poorest group experiencing the most pronounced increases in induced abortion rates. By 2022, the concentration index reached a near-zero value, signifying a near-elimination of income-related disparities in the use of induced abortion services. The findings suggest that while there has been significant progress in access to and use of abortion services in Nepal, particularly post-2002 policy shifts, challenges remain. Women from lower socio-economic backgrounds continue to face barriers, indicating the need for a multi-pronged approach to address residual challenges. Nepal has made remarkable strides in enhancing equitable access to and use of induced abortion services, but more needs to be done to guarantee equitable access for all women. Future efforts should focus on policy reforms, infrastructural improvements, and societal change to eliminate existing barriers to reproductive healthcare.

An Estimate of Abortion Incidence and Unintended Pregnancies.

After the legalization of abortion in Nepal, there has been remarkable changes in policies and service delivery. However, even after two decades of legalization, access to and use of safe abortion services remains limited. The objective of this study is to estimate the incidence of abortion and unintended pregnancies in Nepal. A cross sectional study was conducted in 767 health facilities using structured questionnaires to assess the availability of abortion services, and 231 key informant interviews were conducted. Information on medical abortion drugs was collected from distributors and pharmacies. Abortion estimations were segmented into categories: those performed within healthcare facilities, those conducted outside healthcare facilities, and those using other traditional methods. To estimate pregnancy outcomes, we utilized secondary data from national censuses and health surveys. The total incidence of induced abortion cases in Nepal was estimated to be 333,343 for the year 2021. Only 48 percent of abortion services were provided from the listed (legal) sites and providers. The estimates showed that total facility based induced abortion in Nepal was 176,216 in 2021, more than half were medical abortions. The highest and lowest abortion cases were in Bagmati and Karnali province respectively. The result showed that more than half of the pregnancies were unintended (53.3%). Despite a relatively liberal legal environment, more than half of all abortions are extra-legal in Nepal. Unintended pregnancies are also common, resulting in induced abortion. This demands for increasing access to information and services on contraception and safe abortion among women and girls.

“We need to confirm at least from two or three”: Healthcare workers’ discretion as gatekeepers in the context of the Ethiopian abortion law

IntroductionWomen’s access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women’s access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky’s theory of street-level bureaucrats, the article discusses healthcare workers’ discretion and the substantial authority they hold as gatekeepers to safe abortion services.MethodsThe study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers’ perspectives were examined with reference to the national abortion legislation and guidelines.ResultsThe findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women’s access to legally-endorsed abortion services.ConclusionsHealthcare workers’ practices in this rural area were found to challenge the basic provisions laid out in Ethiopia’s abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.

(122) RIGHTS-BASED REPRODUCTIVE SERVICES IN THE MEDICAL SCHOOLS IN THREE STATES IN INDIA: BASELINE FINDINGS OF A MIXED METHODS IMPLEMENTATION RESEARCH

Abstract Introduction Women’s sexual and reproductive health depends on their autonomy to decide, freedom to choose free from coercion, right to education and information, right to dignity, and equity in access to sexual and reproductive health services. These services, especially regarding family planning and abortion services, must be strengthened in the Indian medical schools. Hence, implementation research with baseline and endline comparison was conducted to strengthen reproductive rights and evidence-based practices related to family planning and abortion care services in these schools. This study presents the findings of baseline assessment. Objective To determine the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools Methods A concurrent mixed methods study design was used to conduct the baseline assessment in nine medical schools in Rajasthan, Gujarat, and Union territory in India from October 2018 to June 2019. Reproductive health services provided to 104 women during counseling for family planning (N=85) and abortion (N=19) were observed quantitatively using a predesigned, pre-tested checklist. In-depth interviews of 33 faculty members from the Department of Obstetrics and Gynecology were conducted to qualitatively explore their beliefs and practices regarding a rights-based approach to providing reproductive healthcare services. The Capability, Opportunity, and Motivation model of behaviors (COM-B) was used to qualitatively identify barriers and facilitators of reproductive rights while providing family planning and abortion services in medical schools. Results Family planning counseling services with a cafeteria approach were observed in 69.4% of cases. Among these, 7.1% were provided with couple counseling services. Auditory privacy could be provided to 22.2% of the family planning counseling sessions. The choice of three or more contraceptives was offered to 76.5% nullipara, 54.2% para one, and 75.6% multipara women. The average duration of counseling was 7.4 minutes. Counseling on family planning and abortion was provided to 31.6% of clients. For 36.8% of clients, sterilization/IUD insertion was kept as a pre-condition for abortion. Medical schools lacked space, staffing, and logistics to provide rights-based reproductive health services. Social barriers like the poor socio-economic status of the clients, lack of education and awareness of women's rights, less autonomy in decision-making, and social and gender bias compromised women's reproductive rights. As per the COM-B model, the reproductive rights-based approach facilitators included well-informed faculty regarding dignified and respectful care, ensuring total privacy and confidentiality. However, infrastructure gaps, limited space, high workload, insufficient human resources, and lack of standard operating procedures often compromise privacy and confidentiality during counseling. Conclusions Right-based reproductive services around family planning counseling and abortion services were delivered partially despite the medical schools' trained faculty. This was mainly due to limited workspace, high workload, less autonomy, and lower awareness of reproductive rights among women. Disclosure No.

Examining service delivery patterns before and after implementation of a direct-to-patient telehealth service providing medication abortion in Australia.

In August 2016, MSI Australia (MSIA) brought to scale a direct-to-patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre- and post-periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas.

To participate or not to participate: The troublesome question of nurses' conscientious objection to abortion: A qualitative study.

To report a study investigating the implementation of the "conscience clause" by practising nurses in two National Health Service Hospital Trusts in the UK. A qualitative study. Data were collected from 2018 to 2020 through qualitative face-to-face interviews with 20 nurses, transcribed verbatim and analyzed by thematic analysis. Major themes were developing conscience, negotiating conscience and parameters of participation. Participants had varied views on conscientious objection, reflecting a continuum from unwillingness to be near anything related to abortion to being willing to participate in the whole process. Most participants framed involvement as fulfilling their "duty of care" to their patient. Direct experience of witnessing abortion overrode faith-based foundations to shape participants' beliefs as objectors or non-objectors. Non-objectors were supportive of objecting colleagues. The complex nature of conscience as a fundamental human right is inherently related to the cultural and social context of nursing. "Employability" raised important questions over the real world of a nurse's legal right to invoke conscientious objection without consequences. Problem addressed Conscientious objection to abortion continues to affect nursing. Main findings There was little knowledge of the law and a reluctance to make formal objections. Where and on whom will the research have an impact It highlights the need for delineated and implemented guidelines on conscientious objection in practice for nurses. Its findings, while local, may be applicable to other abortion services. Representatives of each were key in our advisory group. COREQ checklist for qualitative research.

Health care providers attitude towards safe abortion care and its associated factors in Northwest, Ethiopia, 2021: a health facility-based cross-sectional study

BackgroundA negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia.ObjectiveThis study aimed to assess health care provider’s attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia.MethodsA health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant.ResultsThe response rate of the study was 99.3%, and 70.2% [95% CI: 65.6–74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25–29, 30–34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03–10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43–19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55–6.60], midwives [AOR = 6.50, 95% CI = 2.40–17.44], working at hospital [AOR = 4.77, 95% CI = 1.53–14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29–11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13–5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23–16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15–13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52–24.26] were associated with a favorable attitude towards safe abortion care.ConclusionsHealthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units.

Transformative reproductive futures in Northern Ireland

A foundation of rights-based solidarity has fostered an environment of cooperation between LGBTQ+ (lesbian, gay, bisexual, transgender and queer) rights and reproductive justice in Northern Ireland (NI) following the introduction of equal marriage and the decriminalization of abortion in 2019. This article provides a grounded look at this reproductive justice organizing in NI as an example of transformative organizing for reproductive futures. The case study considers a conversation with two activists who have been central to this work. Emma Campbell coconvenor of Alliance for Choice and Danielle Roberts the coconvenor of Reclaim the Agenda and former Senior Policy and Development Officer of HERe NI. Reclaim the Agenda is a coalition of feminist, youth, LGBTQ+ and community organizations that connects and mobilizes women to promote feminist activism through education, campaigning and celebration. HERe NI is a community organization and registered charity based in Belfast that supports lesbian and bisexual women and their families across NI. Alliance for Choice campaigns for free, safe legal and local abortion access for everyone who needs it in NI. Together these groups approach reproductive justice using a framework informed by lesbian feminist organizing and an intersectional approach that views access to abortion as part of a broader understanding of gender justice inspired by Black-women led SisterSong through (1) cross-movement organizing (2) centering bodily autonomy and (3) trans affirming feminist approaches to navigating shifting language about gender. The case study will be of interest to those working provide abortion services in a queer-informed way, as well as those navigating the challenges of reforming abortion policy.

Developing a comprehensive abortion prevention program for couples based on I-change model: study protocol for a mixed method research

BackgroundIn countries where abortion laws are stringent, induced abortions are prevalent. The limited availability of abortion services within these regions amplifies the likelihood of maternal complications and mortality. Induced abortions represent a significant public health concern in Iran and are characterized by a multitude of intricate factors that remain largely unexplored. Gaps in knowledge persist pertaining to the influences driving induced abortion within the Iranian context. To adequately address the issue of induced abortion, it is imperative to discern the determinants that shape the decision-making process. The primary objective of this study was to design an intervention program focused on mitigating the occurrence of induced abortion within couples, with an emphasis on identifying the key factors that contribute to this phenomenon.MethodsThis study comprises three phases. In the first phase, a qualitative approach based on the I-change model will be employed to identify the factors influencing induced abortion. The second phase involves a systematic review to identify the determinants of induced abortion and strategies to prevent induced abortion. In the third phase, the outcomes of the qualitative approach and systematic review will be shared with experts and specialists using the Delphi method to categorize and prioritize strategies. Subsequently, based on the final consensus, a comprehensive program will be developed to prevent induced abortion.DiscussionThis study introduces an I-change model-based program for the prevention of induced abortion. The prevention of induced abortion holds great significance in mitigating maternal morbidity and mortality, curtailing healthcare expenses, and fostering population growth rates. The research findings will be disseminated via reputable peer-reviewed journals and communicated to the academic and medical communities. This dissemination aims to provide valuable insights that can contribute to the advancement of induced abortion and abortion prevention programs.