Access To Safe Abortion Research Articles

What Counts as Global Health?

Safe abortion access is an essential aspect of reproductive justice and key to reducing global rates of maternal mortality, yet within the global heath enterprise, the rhetoric of sexual and reproductive health and rights has not yet been realised in practice. Access to safe legal abortion remains inequitable globally and within nations and deaths due to unsafe abortion take their highest toll in the Global South in jurisdictions with restrictive laws. Clandestine abortion access activist networks have been filling this gap offering life, dignity and futures to the people who seek their services. What should we make of clandestine activist networks around the world that help people access medication abortion? Such groups have been important players in women’s reproductive health in many jurisdictions for decades – but have typically, by necessity and design, flown under the radar. If visibility, accountability and humanitarian appeal are essential characteristic of global health work, how do we acknowledge and understand the work of clandestine abortion access activist networks? Does it count as global health? In this essay I offer the notion of ‘critique in action’ to further our understanding of such networks and also consider the idea of abortion access activist networks as an anti-regime of global health.

Maternal Mortality and Morbidity Following Unsafe Abortion in a Tertiary Medical College Hospital

Background: Unsafe abortion refers to the termination of an undesired pregnancy by individuals lacking the requisite skills in an environment lacking minimal medical standards, or both. It stands as a prominent contributor to pregnancy-related mortality in Bangladesh. Notably, approximately one-third of all births in Bangladesh are unplanned and unwanted. The initiation of unsafe abortion may be attributed to the woman herself, an unqualified practitioner, or health workers operating in unhygienic conditions. Objectives: The primary aim of this study was to implement interventions aimed at mitigating maternal mortality and morbidity resulting from unsafe abortion. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology at Khulna Medical College and Hospital, Khulna, spanning from July 2010 to June 2011. After applying exclusion criteria, which involved cases of medical termination of pregnancy and individuals with known medical conditions, a total of 145 abortion cases were admitted to two maternity units at Khulna Medical College Hospital. These cases exhibited a history of menstrual regulation (MR) and induced abortion performed by unskilled individuals, in unhygienic conditions, or both, throughout the study period. The primary outcome variables assessed in this study included age, marital status, education level, socio-economic status, parity, duration of amenorrhea, methods of induction, and maternal complications. Results: In this study, it has been seen that 588 (29.80%) of gynecological admissions are of abortion, and the incidence of unsafe abortion is 145 (24.65%) of all abortion patients. The majority are primarily educated and their socio-economic status is below average. Most of them are multipara. They had come to the hospital after the development of complications. Among the unsafe abortions, 9 (6.20%) expired and 136 (93.79%) improved after experiencing some sort of minor or major suffering. Conclusion: Maternal mortality is a key women’s health indicator. Reducing it is a global goal, but tracking progress is challenging, especially in developing countries with weak health data systems. Unsafe abortions are underreported, and many deny the truth even when in dire conditions. To address this, promoting modern contraceptives, training personnel for abortions, and emphasizing contraception’s importance is vital. Relaxing abortion laws may be necessary, as women may seek abortions regardless, risking their lives. Ensuring safe abortion access is essential for women’s rights and preventing harm to them and their families. Reducing unplanned pregnancies and providing safe abortion services are critical.

Qualitative research to advance social norms initiatives of the RHRA: Mombasa County, HAKI Jamii, and the RHRA Study

Background: In Kenya, there is a general lack of knowledge on the prevention of unintended pregnancies, especially among the rural poor and women living in urban and peri-urban informal settlements. Unsafe abortion is common, and stigma directed at the woman, provider, woman’s family, and facility is common. Objective: To explore public perceptions of abortion, gather awareness of the legal provisions for abortion, and determine access to information and services. Methods: Qualitative in-depth research used four focus groups of women and men aged 18-54 years. The interactions were face-to-face and verbatim transcripts. The messages were organized, coded, and categorized into three categories using the delve software. Coding followed a mix of deductive and inductive processes. Results: There were highly resistant views on abortion across all four groups, focusing mainly on potential complications and death. Emerging voices support termination for rape, defilement, and incest. Abortion occurs more often among married women than among girls. Regarding the legal provisions, safe abortion respondents said it was illegal yet legal. It can be kept secret and influenced by one’s religion. Barriers to safe abortion access included high cost and lack of knowledge of where services are available. However, unintended pregnancies were common in informal settlements, resulting from transactional sex, sex, and gender-based violence, and lack of knowledge of and access to contraception. Conclusion: There is a need to unpack the collective social silence and the association of abortion with unpleasant social issues and to understand and target the drivers of abortion stigma, including premature death, future fertility concerns, guilt, and the murder label.

Religious pressures on women's rights in Southeast Asia: Examining the right to an abortion in the Philippines, Malaysia, and Vietnam

This article aims to interrogate the “cultural wars” in Asia brought upon by rapid changes in gender roles in the world and the reactionary “return” to heteronormative families in Asia. For this article, the Philippines, Malaysia, and Vietnam were chosen for their diverse religious, cultural, and political definitions of the family and openness to global human rights discourses. As the article will show, despite the diversity of these three countries, one prevalent theme in access to abortions is the influence of religion. As one of the fastest growing regions in the world, Southeast Asia experienced a resurgence in religiosity in response to a change in economic and social relations over the past two decades. This growth took place thanks to active efforts by the state to manage population growth, often times through family planning efforts—including through providing access to abortions in some countries. But in a region where deeply entrenched stigmas are attached to abortions, nations treated abortions as a health imperative on the personal level, or a population control tool at the national level, but never as a personal right. Thus, as the role of religion in the region changes, becomes deeper and more personal, this article argues that pressures on safe abortion access becomes threatened. Through a socio-legal lens, this article will examine the legal right to an abortion in three Southeast Asian countries and argues that because abortions were primarily used as a tool for population control, and was not treated as fundamental right, the rise of religiosity in the region threatens precarious access to abortions in Southeast Asia.

“Time and money and support”: Adolescents and young adults’ perceived social and logistical support needs for safe abortion care

ObjectiveTo understand what support adolescents and young adults need to access abortion amidst the changing legal landscape. Study designA diverse nationwide sample (N = 638, response rate 78%) of individuals aged 14–24 responded to a text message survey in July 2022 about the social and logistical support they would need for safe abortion access. Responses were coded and analyzed thematically. ResultsRespondents described parents and friends as primary sources of social support for potential abortion decisions. They frequently cited money and transportation as logistical support needs for out-of-state abortion care. ConclusionsAdolescents and young adults report needing social support and specific resources to ensure access to abortion. ImplicationsThis study highlights the perspectives and experiences of a diverse, nationwide sample of adolescents and young adults on their perceived abortion-related social and logistical support needs. These findings can support centering adolescents and young adults in practice and policy change to minimize barriers, improve social support, tailor resources and information about abortion, and streamline access to essential reproductive health services in a post-Dobbs landscape.

The global impact of COVID-19 on abortion care

BackgroundThe COVID-19 pandemic placed unprecedented strain on healthcare globally, which exacerbated factors leading to unplanned pregnancies. ObjectivesThe primary objective was to analyze the effect of COVID-19 on abortion services globally. Secondary objectives were to discuss issues regarding access to safe abortion and provide recommendations on continued access during pandemics. Search strategyA search for relevant articles was conducted by utilizing multiple databases (PubMed, Cochrane, etc.). Selection criteriaStudies on COVID-19 and abortion were included. Data collection & analysisThe legislation governing abortion services across the globe was examined, inclusive of modifications to service provision during the pandemic. Global data on abortion rates and analyses of selected articles were also included. Main results14 countries instituted legislative changes related to the pandemic, 11 relaxed abortion regulations, while three restricted abortion access. An increase in abortion rates was seen particularly where telemedicine was available. Where abortions were postponed, second-trimester abortions increased after services resumed. ConclusionsLegislation, risk of exposure to infection, and access to telemedicine affect access to abortion. The use of novel technologies, maintaining existing infrastructure and enhancing the roles of trained manpower for safe abortion access is recommended to avoid the marginalization of women's health and reproductive rights.

Definitions, perspectives, and reasons for conscientious objection among healthcare workers, facility managers, and staff in South Africa: a qualitative study

Conscientious objection (CO) on the part of healthcare providers is a growing threat to safe abortion access. In South Africa, evidence suggests that this legal clause may be manipulated as a justification for public-sector healthcare providers to exempt themselves from their duties to provide essential reproductive health services as required by national laws and protocols. This qualitative study improves our understanding of the definitions, perspectives, and use of CO among providers, staff, and facility managers in South Africa, and CO’s effect on public-sector abortion availability. Using 18 focus group discussions and 23 in-depth interviews, we examined CO attitudes and behaviours of staff from health facilities that provide abortion care in Gauteng, Limpopo, KwaZulu-Natal, and Eastern Cape Provinces. We find that CO is invoked for a variety of reasons, some unrelated to the legal basis for objection. There have been progressive shifts in attitudes towards abortion over time, but stigma against women and girls who seek abortion remains substantial among staff at facilities providing abortion. Providers who offer abortion services also report high levels of discrimination and isolation from colleagues. Such factors, combined with operational barriers to offering quality abortion care (such as lack of training support or financial incentives) and lack of clarity on CO definitions and procedures, may incentivise some providers to invoke CO inappropriately. Dissemination of national guidelines on CO should be prioritised to reduce ambiguity, and interventions addressing abortion stigma should be considered for all facility staff to safeguard abortion availability in South Africa.

Implementation of Telemedicine Services for Safe Abortion Access During the Covid-19 Pandemic in Colombia

Background: Covid-19 represented a health, humanitarian and economic crisis that affected the world's population, causing changes in the dynamics, structure and behavior of society. Health services were reorganized or interrupted due to the change in the prioritization of health needs and tele-abortion was one of the alternatives to ensure access to safe abortion during the pandemic. Aim: To identify the challenges and opportunities for the provision of tele-abortion services in Colombia, specifically in the Profamilia Association during and after the Covid-19 health emergency. Methods: Qualitative exploratory-descriptive research, based on the methodology of systematization of experiences, developed in three stages: the review of public policy documents, the use of manuscript and oral primary sources, and the analysis of the information collected. Results: In Colombia, the health crisis led to a more accelerated implementation of telemedicine and telehealth standards. The implementation of tele-abortion services in Profamilia began in 2020 through the "Mía Kit" as part of a strategy to expand the right to self-managed abortion. The organization faced challenges and opportunities at the organizational, socio-political and cultural levels. The challenges were related to the need for training in the effective use of Information and Communication Technologies, the lack of guidelines for the provision of tele-abortion services and social imaginaries about the suitability of face-to-face care. Opportunities were found to be related to national coverage, protocols, programs and organizational policies on abortion care, and the preference of some users to receive abortion care in a non-face-to-face setting. Conclusion: Tele-abortion represents an opportunity to reduce the stigma associated with this intervention, allowing women to access this service in an environment they consider adequate and safe. Virtual advising and accompaniment are essential for this practice to be effective.

The impact of COVID-19 on safe abortion access in Africa: An analysis through a framework of reproductive justice and lens of structural violence.

The SARS-CoV-2 virus causing the coronavirus disease (COVID-19) global pandemic heightened restrictions on sexual and reproductive health and rights (SRHR), especially concerning safe abortion access. The African region has been particularly susceptible to the impact of COVID-19 on sexual and reproductive health services. Using a framework of reproductive justice, we interviewed key informants from the Mobilizing Action around Medication Abortion (MAMA) Network regarding the impacts of structural violence and COVID-19 on SRHR programming in Africa, particularly programming on self-managed abortion. We identified themes of lacking infrastructures of support, emergent marginality, and neocolonial funding environments as facets of structural violence within the context of the MAMA Network, as heightened by the COVID-19 global pandemic.

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study

BackgroundAlthough abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa.MethodsWe conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach.ResultsParticipants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers.ConclusionsThe findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women’s needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions.

Treading the Thin Line: Pharmacy Workers' Perspectives on Medication Abortion Provision in Lusaka, Zambia.

Despite liberal abortion laws, safe abortion access in Zambia is impeded by limited legal awareness, lack of services, and restrictive clinical policies. As in many countries with restricted abortion access, women frequently seek abortions informally from pharmacies. We conducted 16 in-depth interviews in 2019 to understand the experiences and motivations of pharmacy workers who sell medication abortion (MA) drugs in Lusaka. We found that pharmacy staff reluctantly assume a gatekeeper role for MA due to competing pressures from clients and from regulatory constraints. Pharmacy staff often decide to provide MA, motivated by their duty of care and desire to help clients, as well as financial interests. However, pharmacy workers' motivation to protect themselves from legal and business risk perpetuates inequalities in abortion access, as pharmacy workers improvise additional eligibility criteria based on personal risk and values such as age, partner approval, reason for abortion, and level of desperation. These findings highlight how pharmacy staff informally determine women's abortion access when laws and policies prevent comprehensive access to safe abortion. Reform of clinical guidelines, public education, strengthened public sector availability, task sharing, and improved access to prescription services are needed to ensure women can legally access safe abortion.

"It's a walk of shame": Experiences of unintended pregnancy and abortion among sexual- and gender-minoritized females in urban India.

Background:Unintended pregnancy and safe abortion access in India remain critical public health concerns. The health of sexual- and gender-minoritized females (SGMF; those assigned female at birth and identify as other than heterosexual and/or as other than cisgender women) in India is understudied.Aim:We examined experiences of unintended pregnancy and abortion among SGMF individuals in urban India.Methods:We used focus group discussions (n = 8 individuals in two groups) and interviews (n = 20) with SGMF individuals. Data were collected in December 2017. Transcripts were analyzed using a priori thematic analysis and then open thematic analysis in Dedoose online software.Results:Nine participants experienced or suspected they had unintended pregnancies. Pregnancy circumstances were mostly due to sex without using a barrier method. Participants discussed using traditional methods to induce abortion or changing their approach to contraception. Social support was often lacking, though partners were supportive of abortion choices. Participants reported stigma and surveillance from family, friends, providers, and community members.Conclusion:These findings highlight the effects of stigma in relation to abortion and unintended pregnancy on health and relationships.

Preparing for an Increased Need for Abortion Access in India during and after COVID-19: Challenges and Strategies.

Access to safe abortion is a reproductive rights and justice issue, and it is imperative that safe abortion access during and after the COVID-19 pandemic is a reality for all. India imposed a lockdown in March 2020 to contain the spread of the pandemic. Limited mobility, lack of clarity about abortion as an essential service and abortion as a service permitted through telemedicine, shut down of services providing long-acting and permanent methods of contraception, and changes to decision-making about birthing and parenting during a pandemic are factors that may impact the demand for abortion during and after the lockdown. Shortage of raw materials and limited inter- and intra- state transport of drugs may result in breakages in the supply of medication abortion. Given that 73 percent of abortions in India in 2015 occurred outside of health facilities, the pandemic may have several implications on the need for evidence-based information and quality abortion services, as well as if and how medication abortion is accessed in India, and what self-managed abortion looks like in the COVID-19 era. We discuss factors contributing to reduced access to abortion, changes in abortion need, and suggest strategies to respond to an increased demand for abortion in India.

The role of midwives in first-trimester abortion care: A 40-year experience in Tunisia.

ObjectiveTo review the relevant literature on abortion and summarize interviews with key stakeholders to assess the role of midwives in the evolution of abortion‐related care in Tunisia.MethodsInterviews with eight stakeholders from different organizations based on a guide developed for the study, focusing on policies, strategies used for implementation, capacities used for expansion, user opinions and experience, obstacles and facilitators, and control and evaluation.ResultsTask‐sharing for midwifes was encouraged in the family planning program from the beginning and when medical abortion was introduced. It allows midwifes to contribute widely, develop good skills and performance for several tasks, and helps reduce regional disparities in human resource allocation. Success and safety of home use of medical abortion confirms the ability of women to manage their own abortion. Yet, obstacles to accessing abortion still exist for several reasons.ConclusionThis study, based on interviews with personnel with significant experience and solid knowledge of sexual and reproductive health services, allowed us to consider proposals for a future strategy to integrate task‐sharing into abortion care and address the barriers to legal and safe abortion access for all women in Tunisia.

Barriers to safe abortion access: uterine rupture as complication of unsafe abortion in a Ugandan girl

A 15-year-old girl at 18 weeks gestation by the last menstrual period presented to a rural Ugandan healthcare facility for termination of her pregnancy as a result of rape by...

Women\u2019s experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study

BackgroundIn settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population.MethodsWe recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe abortion access needs.ResultsWe enrolled 42 women, nearly one-third of whom reported they were sex workers. Thirty-four women (81%) reported having had one informal sector abortion within the past 5 years, 14% reported having had two, and 5% reported having had three. These women consumed home remedies, herbal mixtures from traditional healers, or tablets from an unregistered provider. Twelve sought additional care for potential warning signs of complications. Privacy and fear of mistreatment at public sector facilities were among the main reported reasons for attempting informal sector abortion. Most women (67%) cited other community members as their source of information about informal sector abortion; posted signs and fliers in public spaces also served as an important source of information.ConclusionsWomen are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities. Some were unaware how or where to seek formal sector services, or believed the cost was too high. Many informal methods are ineffective and unsafe, leading to potential warning signs of complications and continued pregnancy. Sex workers may be at particular risk of unsafe abortion. Based on these results, it is essential that future studies sample women outside of the formal health sector. The use of innovative sampling methods would greatly improve our knowledge about informal sector abortion in South Africa.

Abortion politics in Cambodia social history, local forms and transnational issues

ABSTRACTCambodia’s current abortion rate and ratio could be among the highest in Southeast Asia. In 1997, the Cambodian parliament passed the first law regulating abortions. This law was adopted to contribute to reduce the high maternal mortality ratio, as a significant number of maternal deaths were believed to be related to complications of unsafe abortion. A decade later, the Ministry of Health had not yet established medical protocols for safe abortion access and women often continued to induce their own terminations or seek unsafe services. However, in 2009, the Cambodian authorities approved the importation and distribution of one manufactured abortion pill. In addition, manual vacuum abortions and medical abortion training programmes were implemented at the referral hospital level. How has this situation come about? What do we know about the local agencies of the transnational reproductive health policies related to safe abortion access in this country? This paper aims to analyse how history and intersections between global interventions, state policies, local moralities and individual strategies shape abortion policies, practices and technologies. Finally, our findings raise some issues for public health programming.

Perspectives on induced abortion among Palestinian women: religion, culture and access in the occupied Palestinian territories

Induced abortion is an important public health issue in the occupied Palestinian territories (OPT), where it is illegal in most cases. This study was designed to elicit the views of Palestinian women on induced abortion given the unique religious, ethical and social challenges in the OPT. Sixty Palestinian women were interviewed on their perceptions of the religious implications, social consequences and accessibility of induced abortions in the OPT at Al-Makassed Islamic Charitable Hospital in East Jerusalem. Themes arising from the interviews included: the centrality of religion in affecting women’s choices and views on abortion; the importance of community norms in regulating perspectives on elective abortion; and the impact of the unique medico-legal situation of the OPT on access to abortion under occupation. Limitations to safe abortion access included: legal restrictions; significant social consequences from the discovery of an abortion by one’s community or family; and different levels of access to abortion depending on whether a woman lived in East Jerusalem, the West Bank, or Gaza. This knowledge should be incorporated to work towards a legal and medical framework in Palestine that would allow for safe abortions for women in need.

Towards safe abortion access: an exploratory study of medical abortion in Cambodia

In 2010, following its approval by the Ministry of Health, the medical abortion combination pack Medabon (containing mifepristone and misoprostol) was made available at pharmacies and in a restricted number of health facilities in Cambodia. The qualitative study presented in this paper was conducted in 2012 as a follow-up to longer-term ethnographical research related to reproductive health and fertility regulation between 2008 and 2012. Observations were carried out at several clinic and pharmacy sites and in-depth interviews were conducted with a purposive sample of 20 women who attended two MSI Cambodia centres and 10 women identified through social networks; six men (women’s male partners); eight health care providers at the two MSI centres and four pill sellers at private or informal pharmacies (who also provided health care services in private clinics). Although the level of training among the drug sellers and providers varied, their knowledge about medical abortion regimens, correct usage and common side effects was good. Overall, women were satisfied with the services provided. Medical abortion was not always a women-only process in this study as some male partners were also involved in the care process. The study illustrates positive steps forward being taken in making abortion safe and preventing and reducing unsafe abortion practices in Cambodia.

Health care providers' opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina.

BackgroundIn Argentina, abortion has been decriminalized under certain circumstances since the enactment of the Penal Code in 1922. Nevertheless, access to abortion under this regulatory framework has been extremely limited in spite of some recent changes. This article reports the findings of the first phase of an operations research study conducted in the Province of Santa Fe, Argentina, regarding the implementation of the local legal and safe abortion access policy.MethodsThe project combined research and training to generate a virtuous circle of knowledge production, decision-making, and the fostering of an informed healthcare policy. The project used a pre-post design of three phases: baseline, intervention, and evaluation. It was conducted in two public hospitals. An anonymous self-administered questionnaire (n = 157) and semi-structured interviews (n = 27) were applied to gather information about tacit knowledge about the regulatory framework; personal opinions regarding abortion and its decriminalization; opinions on the requirements needed to carry out legal abortions; and service’s responses to women in need of an abortion.ResultsFirstly, a fairly high percentage of health care providers lack accurate information on current legal framework. This deficit goes side by side with a restrictive understanding of both health and rape indications. Secondly, while a great majority of health care providers support abortion under the circumstances consider in the Penal Code, most of them are reluctant towards unrestricted access to abortion. Thirdly, health care providers’ willingness to perform abortions is noticeably low given that only half of them are ready to perform an abortion when a woman’s life is at risk. Willingness is even lower for each of the other current legal indications.ConclusionsFindings suggest that there are important challenges for the implementation of a legal abortion policy. Results of the study call for specific strategies targeting health care providers in order to better inform about current legal abortion regulations and to sensitize them about abortion social determinants. The interpretation of the current legal framework needs to be broadened in order to reflect a comprehensive view of the health indication, and stereotypes regarding women’s sexuality and abortion decisions need to be dismantled.Electronic supplementary materialThe online version of this article (doi:10.1186/1742-4755-11-72) contains supplementary material, which is available to authorized users.