Contraceptive Services Research Articles

Contraception Usage and Workforce Trends Through 2022

This cross-sectional study uses a national data set of medical prescription claims to examine contraception service and workforce changes from January 2019 through December 2022 in the US.

IJCM_43A: Status of sexual and reproductive health services among youths from a rural area of Madhya Pradesh: A mixed-method approach

Background: Warranting adequate sexual and reproductive health (SRH) among the youth population in India is challenging. While the Government has undertaken several measures to improve SRH services, gaps exist in terms of availability of these services at the health centre. Objective: To assess utilization of SRH services and explore the associated factors among youth population in rural area of Central India. Methodology: An explanatory sequential mixed method study was conducted which included collection and analysis of quantitative data pertaining to the utilization of SRH services from 236 youth (aged 15-24 years) selected through multistage cluster sampling. This was followed by 29 in-depth interviews conducted among the various stakeholders. Quantitative data was entered using MS Excel and analyzed using R v-4.1.0. The notes and audio recordings from the interviews were transcribed manually and thematic analysis was done. Results: Out of 236 youths, only 90 (38.1%) had ever availed SRH services, of whom 85.5% had visited the SRH clinic in the past 12 months. The most common reason to visit a government health facility was cited as a pregnancy test while in the case of private health facility the reasons were STD treatment, pregnancy tests, and abortions. Except the request for contraceptive services and adequate response to questions by clients, the services provided by the facilities were reported to be inadequate. Further exploration summarized the barriers and facilitators of the health care services under the themes of training, logistics, ARSH clinic, adolescent health days, and community awareness. Conclusion: Among the various influences of SRH, the healthcare system is a fundamental aspect; which seems to address inadequately the varied needs of the rural youth. Future efforts must focus on community awareness and involvement of all stakeholders to uplift SRH services, so as to have positive impact on their sexual health.

Preconception and contraceptive care for women living with HIV/AIDS attending antiretroviral treatment clinics in Lagos State, Nigeria.

Women living with HIV/AIDS possess fertility desires similar to their uninfected counterparts, and with advances in health therapies, these women can realistically have and raise uninfected children. Preconception care (PC) is a specialized form of intervention aimed at the prevention, identification, treatment, and management of biomedical, behavioural, and social conditions that militate against safe motherhood and the delivery of healthy offspring. The study aimed to assess preconception and contraceptive care among women living with HIV and attending Antiretroviral Therapy Clinics in Alimosho, Lagos State, Nigeria. This was a descriptive facility-based cross-sectional study of 383 women of reproductive age living with HIV/AIDS and attending ART clinics in the study area. Probability sampling methods were used in the selection procedures. Data were analyzed using descriptive statistics, Chi-square test, and univariate logistic regression at a 5% level of significance. Stratified and simple random sampling were used in the selection process. Only 37.4% of respondents received optimal PC services. Being 20-29 years old [OR =1.716 (95% CI: 1.664, 1.769), p = 0.020], being 30-39 years [OR =1.514 (95% CI: 0.598, 3.831), p = 0.005], tertiary education [OR =8.43. (95% CI: 1.41, 18.5), p = 0.020], and being single [OR =2.00 (95% CI: 1.928-2.072), p = 0.002] were significantly related to the utilization of contraceptives. There is a need to provide structure and guidelines for optimal streamlined PC and contraceptive services for women living with HIV/AIDS.

Exploring the Experiences of Midwives in the Provision of Postpartum Contraceptive Counselling to Rural Women in Pakistan: A Qualitative Approach

This study was conducted to examine the challenges faced by midwives in providing postpartum contraceptive counseling services to women in the rural area of Lahore city of Punjab Province, Pakistan. A qualitative research method was used wherein twenty study participants (midwives) purposively selected in the targeted locale were interviewed using a Semi-Structured Interview (SSI). The collected data was secured in the form of field notes which were subsequently analyzed while extracting four themes including (i) involvement of the client's family (ii) misinterpretation about the use of contraception (iii) contraception availability (iv) religious perspective on contraception. This study concluded that midwives are facing challenges from family, culture, and community while providing postpartum contraceptive counseling to rural women. Furthermore, the study also concluded that the personal choices, values, and religious beliefs of women also pose a significant challenge for midwives in providing contraceptive counseling to rural women in Pakistan.

Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria

BackgroundArmed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. MethodsWe conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017–2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED. ResultsExposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls’ childbearing. ConclusionOur findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Identification of key bottlenecks in human rights-based approach to family planning among HIV-infected women in a resource-restricted setting of Nepal

Purpose Family planning (FP) services through the lens of human rights are not well known in Nepal. This study aims to assess Family Planning 2020: Rights and Empowerment Principles for Family Planning and identify factors affecting contraceptive use among HIV-infected women living in rural Far Western Nepal. Design/methodology/approach This study conducted a cross-sectional survey using self-designed proforma. To assess the association between contraceptive use and independent variables, this study calculated adjusted odd ratio (AOR) with 95% confidence interval (CI) using statistical package for social sciences (SPSS) V.20. Findings Only 37.8% of participants had access to full range of contraceptive methods, and only 57.5% of participants received proper counseling. Agency/autonomy, transparency/accountability and voice/participation were practiced by 43.7%, 23.4% and 19.7% of participants, respectively. Husband’s support (AOR = 4.263; 95% CI: 1.640–11.086), availability of FP services in their locality (AOR = 2.497; 95% CI: 1.311–4.754), employment (AOR = 3.499; 95% CI: 1.186–10.328) and postpartum period (AOR = 0.103; 95% CI: 0.023–0.475) were significantly associated with contraceptive use. Research limitations/implications Health-care providers’ and program managers’ perspectives were not examined. Practical implications Findings of this study will be useful for making strategic plan on human rights-based approach to FP. Social implications Expanding access to contraceptive information and services and strengthening autonomy, accountability and participation are key to human rights-based approach to FP. Originality/value This study identified that inadequate counselling, nonavailability of full range of contraceptive methods, low level of autonomy, accountability and participation were key bottlenecks in fulfilling human rights-based approach to FP.

Improving Contraceptive Service Quality and Accessibility for Adolescents and Youth Through Proprietary Patent Medicine Vendors in Four Nigerian States.

In Nigeria, health care services and commodities have increasingly been accessed through private sector entities, including retail pharmacies and drug shops (also called proprietary patent medicine vendors [PPMVs]). However, PPMVs cannot provide long-acting or permanent methods, and concerns have been raised about their quality of services and their need to better comply with government regulations. This article describes how The Challenge Initiative's (TCI) family planning program supported 4 state governments in Nigeria to develop a model to strengthen public-private partnerships between PPMVs and primary health centers (PHCs) to leverage PPMVs to provide adolescents and youth with high-quality contraceptive information, services, and referrals to PHCs. The intervention implemented a hub-spoke model by strengthening the linkages between neighboring PPMVs and large PHCs for delivering contraceptive services to adolescents and youth. The steps in the implementation process included: (1) introducing the intervention to state governments, (2) selecting PPMVs as spokes and high-volume PHCs as hubs, (3) conducting whole-site orientations jointly with PPMV and PHC staff, (4) strengthening referral links between PPMVs and PHCs, (5) implementing supportive supervision and coaching, and (6) strengthening client data management. TCI worked with the state and local ministry of health to improve PPMV operators' knowledge, attitudes, and skills to deliver adolescent- and youth-friendly services. Implementing the PPMV intervention with state governments and PHCs strengthened the public-private partnership. A functional referral system in Plateau State demonstrated significant success, enabling increased contraceptive choice and adherence to regulations for adolescents and youth. We recommend that the government strengthen the working relationship between PPMVs and PHCs, incorporate PPMVs into the routine supportive supervision of the state health system, and incorporate a referral linkage with PHCs into the design and implementation of PPMV programs.

Prevalence and dynamics of contraceptive use by type during the COVID-19 pandemic: Evidence from Western Iran.

Contraception represents a deliberate choice made by individuals, both men and women, to regulate their desired number of children. The primary objective of this study was to examine the prevalence and predictors of contraceptive use, while also exploring the shifts in contraception methods following the COVID-19 pandemic. This study employed a quantitative approach with a survey technique. The survey was conducted in Kermanshah, one of Iran's metropolises located in the western part of the country. The sampling methodology employed in this study involved a combination of multi-stage classification and systematic random methods. The survey took place between July and August 2022. The target population for the survey included women between the ages of 15 and 49. A total of 600 women from this population were selected and included in the survey sample. The sample was described using frequency tables, as well as central and dispersion indices (mean and standard deviation). Additionally, multivariate analysis was conducted through the application of logistic regression. Findings pointed out that approximately 65% of the women in the sample utilized contraception methods. Among these methods, the condom and oral pill were found to be the most prevalent choices. Moreover, the findings indicated that an increase in the number of both living and ideal children was associated with a decreased likelihood of contraceptive use. Following the occurrence of the COVID-19 pandemic, there was an observed increase in the utilization of traditional and natural methods of contraception. This shift highlights the importance of considering a broader range of contraceptive options and not solely focusing on restricting contraception services. In the midst of the coronavirus outbreak, women turned to traditional contraceptives, which may increase the risk of unintended pregnancies and subsequent miscarriages. Therefore, providing in-person services to women at their place of residence is necessary during epidemics.

Views and experiences of young women from a migrant or refugee background regarding the contraceptive implant in Australia

Young people comprise a significant proportion of migrants and refugees in Australia. Many encounter challenges in accessing contraception information and services. This study explored the views and experiences of young women from migrant and/or refugee backgrounds regarding the contraceptive implant and related decision-making. Interviews were conducted with 33 women, aged 15–24, living in New South Wales, Australia, who spoke a language other than English and had some experience of the implant. Three themes were developed from the data as follows: ‘Finding your own path’: contraception decision-making (in which participants described sex and contraception as being taboo in their community, yet still made independent contraceptive choices); Accessing ‘trustworthy’ contraception information and navigating services (in which participants consulted online resources and social media for contraception information, and preferred discussions with healthcare providers from outside their community); and Views and experiences of the contraceptive implant (while the implant was described as a ‘Western’ method, most participants regarded it as an acceptable, convenient, cost-effective, and confidential means of contraception). Decision-making regarding the implant is influenced by many factors which must be considered in health promotion efforts and when providing clinical care. Consideration of more informative health promotion resources, peer education strategies, and healthcare provider training is warranted to support contraception decision-making and choice.

"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

BackgroundThe timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh.MethodA qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15–49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman’s three-phase coding system.ResultsFive broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system.ConclusionAddressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

Use of contraceptives and associated factors among male adolescents in rural secondary schools, Coast Region, Tanzania: a school-based cross-sectional study

BackgroundTeenage pregnancy is still one of the reproductive health concerns facing adolescents in Tanzania. The problem has been associated with physiological, psychological, and social changes and increases the risk of unsafe abortion and adverse maternal, fetal, and neonatal outcomes among adolescents. Low utilization of contraceptive methods among adolescents is one of the key causes. The strategy of involving male adolescents in sexual and reproductive health programs can increase the rate of contraceptive use among adolescents, thereby preventing teenage pregnancy.ObjectiveTo examine factors associated with the uptake of contraceptives among male secondary school adolescent students.MethodsThis was a cross-sectional study conducted in rural secondary schools in Kisarawe District, Coast Region, Tanzania. Multi-stage sampling methods were used to recruit participants. Descriptive and multiple regression analyses were conducted to assess the prevalence and factors associated with contraceptive use. 95% confidence interval and p-value < 0.05 were considered statistical significance. Univariate and multivariate logistic regression were tested for the Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) respectively.ResultsThe study involved 422 male students with the majority of them 58.1% aged 17–19 years, 50.2% were Muslim, 76.3% were studying in government schools, 62.3% were from households size of 4–6 members, 87.4% were not in a relationship, and 64.2% were living with both parents. Less than half (38.9%) of male students reported ever having sex in their lifetime, and among them, very few (29.8%) used any method of contraceptive. The reported lowest age for the first sex was 10 years. The male condom was the most method used (69.4%) and Pharmacy/Chemist Shops were the common source of contraceptive services (55.1%). Students who had adequate knowledge of contraceptives were more likely to report the use of contraceptive methods compared to those who had inadequate knowledge (AOR = 2.704, 95% CI: 1.220–5.995, p = 0.014). Participants in Private schools were 4.3 times more likely to report the use of contraceptives than those in government schools (AOR = 4.347, 95% CI: 1.758–10.762, p = 0.01). Students in a relationship were 3.5 times more likely than those not in a relationship to report the use of a contraceptive method (AOR = 3.51, 95% CI: 1.421–8.670, p = 0.006).ConclusionThe study found the low use of contraceptives among male adolescents who ever had sex in their lifetime. Thus, it’s suggested that age-tailored comprehensive sexual and reproductive health education should start to be taught from a very young age as adolescents initiate sex at an early age. Also, Teenage pregnancy prevention programs should involve males as the key players during the development and implementation of the program as most of the decisions among partners are from men.

Using cellphilm-making as advocacy: adolescent girls’ access to reproductive health services in primary health care facilities in rural northern KwaZulu-Natal

This paper reports on a qualitative study that employed participatory visual methods to understand how adolescents access contraception in a rural community of northern KwaZulu-Natal. We focus on a cellphilm, a short film recorded with a cellphone, produced by a group of adolescent girls to share their perspectives regarding the challenges they encounter when seeking reproductive health services at primary health care facilities. Harsh health care worker attitudes, sub-standard communication and the lack of confidentiality were significant barriers to adolescents accessing youth-friendly sexual and reproductive health services in this community. Entrenched socio-cultural beliefs on adolescent female sexuality underpinned judgement and victimisation of girls seeking contraception and antenatal care services. In efforts to contest health care providers’ moralistic attitudes and illuminate the consequences thereof, adolescent girls exercise their agency by creating a cellphilm for health authorities.

Integrating reproductive health into community development and social work: Strategies for effective engagement and empowerment

The integration of reproductive health into community development and social work represents a critical endeavor in promoting holistic well-being and empowerment at the grassroots level. This review highlights strategies for effective engagement and empowerment within this framework. Firstly, a comprehensive understanding of the community's socio-cultural context is imperative. Cultural sensitivity and competence enable practitioners to navigate sensitive reproductive health issues within diverse communities. Utilizing ethnographic approaches and community-based participatory research facilitates the identification of local beliefs, practices, and barriers related to reproductive health. Secondly, building collaborative partnerships with key stakeholders is essential. Engaging local leaders, healthcare providers, educators, and religious institutions fosters buy-in and facilitates the development of culturally relevant interventions. These partnerships enhance the reach and sustainability of reproductive health initiatives by leveraging existing community resources and networks. Thirdly, incorporating a rights-based approach is fundamental for empowering individuals and communities. By promoting reproductive rights, including access to comprehensive sexuality education, contraception, and safe abortion services, practitioners empower individuals to make informed choices about their sexual and reproductive health. Moreover, advocating for gender equality and addressing harmful gender norms and practices are integral components of fostering reproductive autonomy and empowerment. Furthermore, capacity-building efforts play a pivotal role in enhancing community resilience and sustainability. Equipping community members with knowledge and skills in reproductive health education, advocacy, and service provision enables them to take ownership of their health and drive sustainable change within their communities. Finally, leveraging innovative technologies and communication channels enhances the accessibility and effectiveness of reproductive health interventions. Mobile health applications, telemedicine, and social media platforms provide avenues for disseminating information, delivering services, and promoting dialogue on reproductive health issues. Integrating reproductive health into community development and social work requires a multi-faceted approach that prioritizes cultural competence, collaboration, rights-based empowerment, capacity-building, and innovation. By employing these strategies, practitioners can effectively engage communities and empower individuals to achieve optimal reproductive health outcomes and overall well-being.

Knowledge, Attitude, Practice, and Associated Factors of Implant Use in Women, Ethiopia.

The world is in a dramatic expansion of population that resulted from the continued high birth rates in developing countries. At present, only a handful of countries have reduced fertility rates. That is enough to make gains as a result of reduced fertility or to ensure that their population will stabilize unforeseeable future. Ethiopia is the second largest country by population in Africa, but contraceptive use in Ethiopia is still low. The main objective of the study was to assess knowledge, attitude, and practice and associated factors towards implant use among married reproductive age group women. An institutional-based cross-sectional study design was used to collect the data from 272 married reproductive age group women attending the family planning clinic at Ejere Health Center from October 9, 2021 to November 24, 2021. A systematic random sampling technique was used to select and approach the study subjects. The collected data was analyzed using SPSS window version 21, and bi variable, multivariable logistic regression was used to test the association between independent and dependent variables. A P value of less than 0.05 and 95% CI was considered to be statistically significant. Finally, the result was presented using tables and graphs. The finding shows that most of the respondents know implant (87.6%). Concerning the practice of implants, the overall prevalence of implants was 51 (20.6%), and in attitude towards implant utilization among study clients, most of them wrongly believed that using implant can result in irregular uterine bleeding and cause pain during insertion and removal. Mothers who attended primary school 2.580 times (AOR = 2.580, 95% CI: 1.255-5.305, P value =0.01) had more positive attitudes than those who could not read and write. Mothers having positive attitude were 2.066 times (AOR = 2.066, 95% CI: 1.185-3.600, P value =0.01) knowledgeable about implant than those with negative attitudes. Even if most of the respondents were knowledgeable, practice and attitude towards implant utilization were low. To overcome this gap, we recommended adequate early counseling, on possible side effects, and creating awareness on implant contraceptive services and refresher courses for health workers regarding implant contraception should be given regularly regarding reproductive issues.

Enhancing Contraceptive Utilization among Females of Reproductive Age: Factors, Challenges, and Strategies at Jinja Regional Referral Hospital

The research aimed to assess the factors influencing the utilization of contraceptives among females of reproductive age seeking health services at Jinja Regional Referral Hospital. Specifically, it sought to establish socio-demographic characteristics, examine health service factors affecting contraceptive utilization, and determine its prevalence. A cross-sectional and descriptive research design employing both quantitative and qualitative methodologies was utilized to ensure the gathered information was representative of the population and captured at a single point in time. The study discovered a prevalence of contraceptive use among females of 55.7%, with short-term hormonal methods being the most common at 57.1%. Key findings revealed that females aged 18 to 30 years (57.1%) were significantly more likely to use contraception (p-value = 0.036), and multiparous individuals (98.2%) were more inclined to utilize contraception compared to para-one individuals (50.6%) (p-value = 0.024). Moreover, prior counseling (73.2%) significantly promoted contraceptive usage (p-value = 0.015). In conclusion, despite the observed prevalence, contraceptive utilization remained relatively low. Recommendations include increasing the availability of contraceptive services at lower-level health care centers to enhance accessibility, educating mothers visiting health facilities about contraceptive services, and addressing contraception-related phobias through counseling to encourage uptake among females. Keywords: Contraceptives, Females, Reproductive age, Health services, Health facility.

Women’s experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study

BackgroundThe unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but...

How do South African policies address provision of contraception among adolescents?

The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). We examined how national policies address access and provision of contraception to adolescents in South Africa. South African national policies. We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution:This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences.

In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.

Assessment of unintended pregnancies, contraception, and abortion in Botswana.

Botswana has a policy of contraception for all that is delivered through a rights-based family planning program. The program combines a "rights-based family planning approach" with "supportive policies for contraception," and "a commitment to promote equitable access to modern contraception, and expand availability, method mix and uptake of modern contraceptive methods for all women and girls." However, abortion is legally restricted up to 16 weeks of pregnancy provided that provisions of Section160-162 of the Botswana Penal Code Amendment Act 1991 are met, and that the termination of pregnancy is carried out by a registered medical practitioner in a health facility approved for the purpose. In 2020, the Ministry of Health and Wellness, Botswana, in collaboration with United Nations Population Fund and World Health Organization, conducted a strategic assessment of unintended pregnancies, contraception, unsafe abortion, and abortion services in Botswana. A consensus operational plan to address these issues was developed during a national stakeholder meeting in Gaborone, Botswana. The consensus reached was to avert unintended pregnancies, improve access to modern contraception, and open nationwide discussions around abortion in the community to enable positive change and decrease maternal morbidity and mortality from unsafe abortion. This article describes the findings of the assessment and outlines the foundation for new or modified services or practices to be developed and pilot tested.

Why a good law is not always good enough: a global review of restrictions to supportive laws for sexual and reproductive health and rights

Laws and regulations provide the framework for implementing sexual and reproductive health and rights (SRHR)-related policies, programmes and services. They can promote the fulfilment of health and human rights; however,...