Quality Of Abortion Services Research Articles

Striving towardsafe abortion services in Nepal: A review of barriers and facilitators.

Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

Investigation of the abortion-related experience of the providers, women, and advocators in South Korea: The neglected essential healthcare service.

The decriminalization of abortions in South Korea in 2019 has not been followed by the establishment of policies ensuring access to abortion services. This study aimed to explore the current challenges and barriers for quality abortion services in the Korean healthcare system. Eleven women, six healthcare providers, and 11 advocates participated in in-depth interviews in 2020. Experiences of abortion were analyzed using the modified Availability, Accessibility, Acceptability, and Quality (AAAQ)framework. While informal, access to surgical abortion services was possible in general. However, accessibility to services and information varied according to women's age, marital status, and physical condition. Considering that the Korean government has been reluctant to adopt proactive measures to ensure access to abortion services, the quality of abortion care in Korea remains questionable, with the mandate of male consent for abortion prevailing. The women interviewed in this study expressed dissatisfaction with their current access to and the quality of abortion services. Abortion is an essential service that ensures the sexual and reproductive health and rights of women. Although abortion was decriminalized in Korea in 2019, it remains an informal and stigmatized service. Further research and policy efforts are required to ensure access to abortion in Korea.

The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study

BackgroundGhana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana.MethodsWe utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision.ResultsLess than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity.DiscussionOverall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care.ConclusionsSAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.

Inequalities in access to and quality of abortion services in Mexico: Can task-sharing be an opportunity to increase legal and safe abortion care?

First-trimester abortion became legal in Mexico City in April 2007. Since then, 216755 abortions have been provided, initially in hospitals, by specialized physicians using surgical techniques. With time and experience, services were provided increasingly in health centers, by general physicians using medical therapies. Meanwhile, abortion remains legally restricted in the remaining 31/32 Mexican states. Demand and need for abortion care have increased throughout the country, while overall abortion-specific mortality rates have declined. In an effort to ensure universal access to and improved quality of reproductive and maternal health services, including abortion, Mexico recently expanded its cadres of health professionals. While initial advances are evident in pregnancy and delivery care, many obstacles and barriers impair the task-sharing/shifting process in abortion care. Efforts to expand the provider base for legal abortion and postabortion care to include midlevel professionals should be pursued by authorities in the new Mexican administration to further reduce abortion mortality and complications.

The Safety and Quality of Abortion Services in the United States: What Does the Evidence Indicate?

The National Academies of Sciences, Engineering, and Medicine was asked to answer a series of questions on the appropriate use of different types of abortion services, associated health risks, safe...

The influence of norms and values on the provision of termination of pregnancy services in South Africa

IntroductionAs front-line providers, nurses play an integral role in the implementation of South Africa’s Choice on Termination of Pregnancy Act and, thus, the promotion of women’s reproductive rights. In light of low levels of support for termination of pregnancy services in South Africa, it is important to understand nurses’ views of such services. The purpose of this study was to examine how nurses’ norms and values shape the provision of abortion services. MethodsQualitative interviews with nurses were conducted at seven rural hospitals in the Western Cape Province of South Africa. Data were analysed using thematic and narrative analysis. ResultsNurses, like other public service workers, make moral judgments about their clients. They classify clients seeking abortions into two groups: those ‘worthy’ of support, and those ‘unworthy’ of support. Nurses’ moral judgments are largely shaped by the circumstances of the pregnancy and the behaviour of the client. In addition, nurses’ understanding of their professional identity and their work environments may influence their decision whether a client deserves their assistance. While nurses claimed that they would offer the same services to all of their clients, further research on the availability and quality of abortion services is required to confirm these results. ConclusionThe study shows that nurses make moral judgments about abortion clients and divide them into deserving and less deserving clients. These value judgments undermine the rights-based approach of South African legislation, which provides every women with the right to choose whether they wish to terminate a pregnancy.

Meeting the need for safe abortion care in Ethiopia: Results of a national assessment in 2008

Complications of an unsafe abortion are a major contributor to maternal deaths and morbidity in Africa. When abortions are performed in safe environments, such complications are almost all preventable. This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. The safe abortion care (SAC) model, a monitoring approach to assess the amount, distribution, use and quality of abortion services, provided a framework. Data collection included key informant interviews with 335 health care providers, prospective data on 8911 women seeking treatment for abortion complications or induced abortion and review of facility logbooks. Although the existing hospitals perform most basic abortion care functions, the number of facilities providing basic and comprehensive abortion care for the population size fell far short of the recommended levels. Almost one-half (48%) of women treated for obstetric complications in the facilities had abortion complications. The use of appropriate abortion technologies in the first trimester and the provision of post-abortion contraception overall were reasonably strong, especially in private sector facilities. Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from an unsafe abortion. This study provides the first national snapshot to measure changes in a dynamic abortion care environment.

Abortion Needs or Abortion Rights? Claiming State Accountability for Women’s Reproductive Welfare

The Family Planning Association Northern Ireland (F.P.A.N.I.) has recently been successful in holding the state accountable for its duty to safeguard women’s reproductive health and welfare, and clarify the circumstances in which abortion is lawful. By demanding that the Minister for Health investigate abortion provision and produce abortion guidance, F.P.A.N.I. hope to improve the quality of abortion services and alleviate the situation of those women who are legally entitled to abortion in Northern Ireland but cannot access it there. This action has challenged a public failure which impacts most negatively on those women who cannot easily escape its effects. Although the case succeeded in shaming the state for such a failure, the judicial review strategy could not challenge the legal ethos which denies women a say over their reproductive lives. This case commentary argues that pro-choice strategic litigation needs to positively and generally assert women’s reproductive rights at the same time as it seeks to accommodate the needs of the most vulnerable.

The quality of abortion services in Turkey

The quality of abortion in Turkey's public sector hospitals is investigated using multiple research methods including observations of actual procedures, interviews with medical staff and clients, and an inventory of materials and equipment. The results suggest that women who obtain abortions in public sector hospitals have a higher abortion rate than the general population. They are likely to receive a vacuum aspiration with minimal pain control medication. Clinical infection control procedures are insufficient, as are interpersonal communication practices including counseling on reproductive health issues and providing factual information. Links with family planning services are strong and the majority of abortion patients who desire family planning receive a contraceptive method, either through direct provision of postabortion contraceptives or referral.

The quality of abortion services in Turkey

The quality of abortion in Turkey's public sector hospitals is investigated using multiple research methods including observations of actual procedures, interviews with medical staff and clients, and an inventory of materials and equipment. The results suggest that women who obtain abortions in public sector hospitals have a higher abortion rate than the general population. They are likely to receive a vacuum aspiration with minimal pain control medication. Clinical infection control procedures are insufficient, as are interpersonal communication practices including counseling on reproductive health issues and providing factual information. Links with family planning services are strong and the majority of abortion patients who desire family planning receive a contraceptive method, either through direct provision of postabortion contraceptives or referral.