Safe Abortion Services Research Articles

Comparative study of medical vs surgical abortion in the first trimester- which one is better choice?

Abortion is defined as the spontaneous and induced termination of a pregnancy before foetal viability. Abortions accounted for one-third of all pregnancies, and nearly half of the pregnancies were unintended. An effective way to prevent the burden of unsafe abortion could be access to safe abortion services. Both surgical and medical methods are available for abortion or the termination of a pregnancy. Thus, we compare the two methods of medical and surgical abortions in this study. The study was conducted on women attending obstetrics and gynaecology OPD for seeking treatment for abortion in the first trimester. 100 women were allocated to Group A, who opted for medical treatment, and Group B, for surgical abortion. Two groups were compared in terms of clinical parameters like blood loss, aftereffects, post-procedure visits, and efficacy. In group A, 14% of women had minimal bleeding, 70% had moderate bleeding, and 6% had heavy bleeding. In group B, 72% had minimal bleeding, 28% had moderate bleeding, and no one had heavy bleeding. The combined complication rate in surgical abortion was significantly lower as compared to medical abortion, but the difference in clinical efficacy is not significant. The medical method is a good alternative to surgical abortion. The medical termination was associated with more bleeding and more post-procedural aftereffects, although both procedures were comparable in clinical efficacy.

Mifepristone-Misoprostol Regimen vs. Surgical Abortion: Evaluating Pregnancy Termination Options in Bangladesh

Background: Access to safe and effective abortion services plays a vital role in safeguarding women's reproductive health, ultimately contributing to their overall well-being. This is particularly relevant in Bangladesh, where the legality of abortion is contingent upon specific circumstances. Therefore, ensuring women have the autonomy to choose between safe and effective termination methods becomes crucial. Objective: The study aims to see explore the efficacy, safety, and accessibility of mifepristone-misoprostol regimen and surgical abortion methods within the context of Bangladesh. Methods: This investigation employed a cross-sectional observational design, conducted within the Department of Obstetrics and Gynecology at Dhaka National Medical College in Bangladesh. The study spanned one year, commencing in March 2023 and concluding in February 2024. To ensure a representative sample of the patient population seeking abortion services, consecutive sampling was utilized. This approach involved recruiting all patients admitted during the designated timeframe who fulfilled the pre-established inclusion and exclusion criteria. Ultimately, the study enrolled 104 participants, a sample size determined by the number of admissions fitting the criteria within the one year. Results: The study found no significant difference in age distribution between women choosing medical or surgical abortion, with both groups mainly consisting of women aged 18-25. Overall complication rates were similar, but medical abortion had a higher need for additional procedures and longer stays, while surgical abortion required more bleeding observation. Pain experiences differed significantly, with no women in the medical group reporting no pain and a higher prevalence of moderate pain compared to surgical abortion. Women undergoing medical abortion were slightly more likely to experience complications overall, and primigravid women (first pregnancy) were significantly more likely to experience complications than multigravid women. Conclusion: Our findings suggest comparable safety profiles for both surgical and medical abortion procedures within the studied population. This indicates that surgical abortion can be a safe and effective option alongside medical abortion, potentially expanding the range of choices offered to women.

Type, Complications and Treatment of Abortion in a Tertiary Hospital

Background: Abortion remains a critical public health issue, particularly in low-resource settings like Bangladesh, where access to safe abortion services is often restricted. This study aimed to analyze the types of abortions, treatment methods, and post-abortion complications in a tertiary hospital in Bangladesh. Methods: A cross-sectional study was conducted from January to December 2017, including 100 cases of abortion at a 250-bed district hospital in Joypurhat, Bangladesh. Data were collected from patient records, focusing on demographic characteristics, type and nature of abortion, treatment methods, and complications. Descriptive statistics were used for analysis. Results: The majority of patients (42%) were aged 26–30 years, and 58% were primigravida. Most abortions (75%) occurred before 13 weeks of gestation, with incomplete abortions accounting for 86% of cases. Spontaneous abortions constituted 86%, and D&C was the primary treatment method in 83% of cases. Post-abortion complications were infrequent, with incomplete D&C (8%), shock (6%), and septicemia (3%) being the most common. Conclusion: Incomplete abortions and spontaneous abortions are the most common types observed, with D&C being the predominant treatment method. Although complications were low, the findings underscore the need for better access to safe abortion methods, including medical abortion, and the reduction of unsafe practices through improved healthcare education and policy reform.

Health care providers`attitude and associated factors to safe abortion in Ethiopia, 2023: A systematic review and meta-analysis.

In sub-Saharan Africa, the number of maternal deaths due to unsafe abortions has been gradually rising. In Ethiopia, unplanned pregnancies contribute to 25% of births, accounting for 6%-9% of the maternal deaths resulting from unsafe abortions. Despite several disjointed cross-sectional studies that have been carried out in the past, there is no comprehensive data on the attitudes of healthcare practitioners and other related aspects regarding safe abortion in Ethiopia. This study attempted to measure pooled health care providers' attitudes and determinants of safe abortion in Ethiopia. African Journals Online, Medline/PubMed, EMBASE, Science Direct, Hinari, and Google Scholar were the databases that were accessed. The studies were evaluated critically by using the Joanna Briggs Critical Appraisal methods. The study followed the recommendations set forth by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Data were extracted in an Excel spreadsheet and imported to STATA versions 17 software for meta-analysis. The random- effects model was used to pooled the health care providers' attitudes toward safe abortion. Heterogeneity between studies was evaluated using the Cochrane Q-test and I2 statistics (I squared statistics). To evaluate publication bias, egger's tests and funnel plots were employed. Forest plot was used to present the odds ratio (OR) with a 95% confidence interval. In this review and meta-analysis, a total of eight papers with a 2,826 sample size were considered. Overall, 65.49% of Ethiopian health care professionals had a positive attitude towards safe abortion (95%CI: 49.64, 81.34; I2 = 99.20%, P = 0.000). Knowledge of the abortion law (OR = 2.25, 95% CI: 1.06, 3.43), being a male provider (OR = 1.89, 95% CI: 1.23, 2.54), receiving training on abortion (OR = 2.91, 95% CI: 1.17, 4.65), working as a midwife (OR = 3.029, 95% CI: 1.605, 4.453) and practicing abortion procedures (OR = 2.55, 95% CI: 1.32, 3.78) were positively associated with the attitudes of the providers regarding safe abortion in Ethiopia. In Ethiopia, there was a low pooled prevalence of positive attitude towards safe abortion. Safe abortion services in Ethiopia are more likely to be viewed favorably by health care professionals who have received abortion service training and are familiar with abortion laws. As a result, it is imperative that all healthcare facilities and other relevant parties ensure that health professionals receive training on safe abortion services and are aware of Ethiopia's abortion laws.

Intersectionality in Developing a Virtual Community of Practice Platform on Abortion.

Abortion is an essential healthcare service in many countries including Canada. The number of people who seek abortion is disproportionately higher among equity-deserving populations. Yet the knowledge needed to provide evidence-based, culturally safe, and gender-affirming abortion services remain limited among healthcare professionals. Using an intersectional lens, we conducted focus group discussions with 14 healthcare professionals to understand how an abortion web-based platform, which is currently under development, can be adapted to meet the needs of equity deserving populations. The findings revealed the need for multi-lingual resources on abortion, information on funding coverage for undocumented migrants, educational resources on Indigenous cultural safety and gender-affirming practices, and a mapping tool to locate providers or pharmacists. Beyond presenting clinical guidelines on web platforms, this study revealed important considerations for the design of web platforms that can help advance access to abortion for equity-deserving populations.

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.

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 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.

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.

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.

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.

Exploring Knowledge, Attitudes and Perceptions of Young Women, Community Members and Health Care Providers on Legal Abortion in Lusaka District, Zambia

Background: In 1972, Zambia made abortion lawful on a broad basis. However, safe abortion services are still limited, and the necessary standards and requirements for executing an abortion remain stringent. Due to a lack of knowledge and understanding of abortion law, many women and girls continue to seek unsafe abortion methods outside of health facilities. Healthcare providers play a key role in the provision of safe abortion care to eligible girls and women, but little is known about how they handle it. The aim of this study was to Assess and Explore the Knowledge, attitudes, and perceptions of adolescent girls and young women, and healthcare providers on abortion in the Lusaka district. Data was collected from Chawama, Chilenje, Chipata Kanyama, and Matero Level 1 Hospitals in Lusaka District. Method: To answer the research topic, the study used Exploratory mixed approaches. Statistical Package for Social Science, Versioni20.0 (SPSS) was used. The matic analysis was used to examine qualitative data by extracting themes from the responses. To see if there were any differences or correlations between the variables' knowledge, perceptions, and attitudes, cross-tabulations were used. This was demonstrated using Chi-square tests, which were all done at a 95ipercenticonfidenceiinterval with ai 0.05 significance level as the crucial level. For reporting, the SPSS frequencies were exported to Microsoft Word. Results: The study indicated that the knowledge levels on abortion among participants were high (93.25%). However, some participants on the other hand did not have sufficient information regarding the legality of abortion in Zambia. The theme analysis of reasons why they do not favor abortion revealed that one of them is religious, believing that abortion is comparable to murder. The findings also reveal that a person's religious affiliation influences their decision-making and thought process regarding abortion. Conclusion: The findings of this study suggest.......

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.

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.

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.

Identifying Profiles of Support for Legal Abortion Services in Zambia: A Latent Class Analysis.

Relative to neighboring countries, Zambia has among the most progressive abortion policies, but numerous sociopolitical constraints inhibit knowledge of pregnancy termination rights and access to safe abortion services. Multistage cluster sampling was used to randomly select 1,486 women aged 15-44 years from households in three provinces. We used latent class analysis (LCA) to partition women into discrete groups based on patterns of endorsed support for legalized abortion on six socioeconomic and health conditions. Predictors of probabilistic membership in latent profiles of support for legal abortion services were identified through mixture modeling. A three-class solution of support patterns for legal abortion services emerged from LCA: (1) legal abortion opponents (∼58 percent) opposed legal abortion across scenarios; (2) legal abortion advocates (∼23 percent) universally endorsed legal protections for abortion care; and (3) conditional supporters of legal abortion (∼19 percent) only supported legal abortion in circumstances where the pregnancy threatened the fetus or mother. Advocates and Conditional supporters reported higher exposure to family planning messages compared to opponents. Relative to opponents, advocates were more educated, and Conditional supporters were wealthier. Findings reveal that attitudes towards abortion in Zambia are not monolithic, but women with access to financial/social assets exhibited more receptive attitudes towards legal abortion.

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.

Respectful Abortion Care initiative: How a large-scale virtual training for providers in India increased knowledge of the new 2021 Medical Termination of Pregnancy Act.

In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.

Abortion Legal Reform and Neonatal Mortality in Mozambique.

Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes. Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence. The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas. Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes.