Seeking Abortion Services Research Articles

Theaudio-Visual (video) Media’s Concern for the knowledge and Attitudes of Adolescents about Abortion in the Southern Konawe Coastal Area

The phenomenon of abortion is familiar among the people of Indonesia. Many unsafe abortions are performed in Indonesia. Overall, nearly half of all women seek abortion services in Indonesia. Early health education is considered the best solution in dealing with the problem of high abortion rates in adolescents. One of the learning media that can be used is audio visual media (video). The use of audio visual media in the learning process is one of the plans prepared to make the learning process more interesting and can motivate students in learning. The study used a pre-experimental design of one group pre-posttest. The sample in this study was 51 girls of class XII at Sma 6 Konawe Selatan. Sampling technique with proportional stratified random sampling. The instruments used are knowledge and attitude questionnaires. The data was analyzed with the Wilcoxon test using SPSS version 26. The results showed the influence of health education using audio visual media (video) on the knowledge and attitudes of adolescent girls about unsafe abortion with P value = 0.000 (P < 0.05) for the knowledge and attitude of young women about unsafe abortions at SMA 6 South Konawe. Researchers suggest the need to use audio-visual media as a means of health promotion and KIE in adolescent girls and parents about adolescent reproductive health, especially the prevention of unwanted pregnancies and the impact of unsafe abortion practices.

Abortion policy implementation in Ireland: Lessons from the community model of care.

BackgroundIn 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation.MethodsWe collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach.ResultsWe collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas.ConclusionsWe conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.

Gendered Violence, Religion and UK-Based Anti-Abortion Activism

AbstractThe United Nations view access to abortion as a fundamental human right. Yet increasingly in theUK, religiously-motivated activists undertake public displays opposing abortion, often outside abortion clinics, and precipitated through international campaigns like40 Days for Life(Lowe and Page forthcoming). Activists see their actions as an essential intervention; some explicitly frame this as a form of help. But examining this from the perspective of how bodies are gendered and regulated in the public sphere raises questions regarding whether this is a form of harassment, and therefore gendered violence. This article is based on aUKethnography. Using Kelly’s (1988) continuum of violence thesis, we examine whether this activism constitutes gendered violence, examining two different activities—prayer and graphic images. Despite these activities being distinct and contrasting, we argue that both should be understood as part of a continuum of violence, causing harm to those seeking abortion services.

Gendered Violence, Religion and UK-Based Anti-Abortion Activism

AbstractThe United Nations view access to abortion as a fundamental human right. Yet increasingly in theUK, religiously-motivated activists undertake public displays opposing abortion, often outside abortion clinics, and precipitated through international campaigns like40 Days for Life(Lowe and Page forthcoming). Activists see their actions as an essential intervention; some explicitly frame this as a form of help. But examining this from the perspective of how bodies are gendered and regulated in the public sphere raises questions regarding whether this is a form of harassment, and therefore gendered violence. This article is based on aUKethnography. Using Kelly’s (1988) continuum of violence thesis, we examine whether this activism constitutes gendered violence, examining two different activities—prayer and graphic images. Despite these activities being distinct and contrasting, we argue that both should be understood as part of a continuum of violence, causing harm to those seeking abortion services.

Hold my Hand

Hold my Hand

Repeat-induced abortion and associated factors among reproductive-age women seeking abortion services in South Ethiopia.

Introduction:Despite the advances in modern health care, maternal morbidity and mortality remain major problems in Ethiopia. Repeat-induced abortion is an indispensable contributor to this problem. Even though there are adverse effects on health, a significant proportion of Ethiopian women procure more than one abortion during their reproductive lifetime. This study aimed to determine the prevalence and associated factors of repeat-induced abortion in South Ethiopia, in 2020.Methods:An institution-based cross-sectional study design and a systematic random sampling technique were used to collect data from 410 samples of women. Data were collected using pre-tested and semi-structured interviewer-administered questionnaires. The data were coded and entered into EpiData version 4.6.2.0 before being exported to Statistical Package for Social Sciences (SPSS) version 26 for analysis. Variables with a p-value of less than 0.05 in binary logistic regressions were exported into multivariate logistic regression analysis. Finally, variables with a p-value of less than 0.05 in the multivariate logistic regression analysis were used to declare statistical significance.Result:The prevalence of repeat-induced abortion was found to be 35.4% (95% confidence interval = 30.7–40). Not facing a complication in prior abortion care, having more than two partners in the last 12 preceding months, perceiving abortion procedure as non-painful, having a sexual debut before the age of 18 years, and consuming alcohol have higher odds of repeat-induced abortion when compared with their counterparts.Conclusion:The prevalence of repeat-induced abortion in Hawassa city is high compared to studies conducted in other parts of Ethiopia. Not facing complications during previous abortion care, perceiving the abortion procedure as non-painful, alcohol consumption, having multiple sexual partners, and having a sexual debut before the age of 18 years are found to increase the chance of repeat-induced abortion.

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana.

This paper examined women's pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion.

Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review

ObjectiveWe sought to systematically review the literature on contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraception, and women seeking abortion services, globally. Study designWe searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding users’ values and preferences for contraception. Results were divided into four sub-groups. ResultsTwenty-three studies from 10 countries met the inclusion criteria. Values and preferences across all four sub-groups were influenced by method effectiveness, access, availability, convenience, cost, side effects, previous experience, partner approval, and societal norms. Similarities and differences were evident across sub-groups, especially concerning contraceptive benefits and side effects. No contraceptive method had all the features users deemed important. Many studies emphasized values and preferences surrounding long-acting reversible contraception (LARC), including convenience of accessing LARCs and concerns about side effect profiles. DiscussionIndividuals must have access to a full range of safe and effective modern contraceptive options, allowing people to make decisions based on evolving contraceptive preferences over time. Future contraception guideline development, policy, and programmatic implementation should continue considering the added influence of these specific reproductive experiences on contraceptive values and preferences of users to improve access, counseling, and method choice.

The Financial Burden of Antiquated Laws: The Case of Massachusetts' Parental Involvement Law for Abortion

Background: A majority of U.S. states enforce parental involvement laws that require minors seeking abortion to obtain parental consent, or else obtain judicial bypass through the court system. Although such laws are widespread, the financial cost of their enforcement has yet to be documented.Methods: We used data from a retrospective observational cohort study among adolescents (aged ≤17 years old) who sought abortion services at Planned Parenthood League of Massachusetts (PPLM) between 2010 and 2016. We assessed the direct financial burden of judicial bypass among 449 minors accounting for direct public legal costs, private professional costs, cost of lost school, and cost to the young person.Results: The total added cost of judicial bypass in our cohort amounted to $374,982.04 (median cost of $705.14 per abortion). The direct out-of-pocket cost amounted to $84,370.23 ($179.89 per abortion). The majority of this cost was due to increased average procedure costs solely due to delays in care incurred by judicial bypass (range $0 to $5,200.50). In total, 74% of minors in our cohort were insured through Medicaid at the time of their abortion. Additional out-of-pocket costs for bypass were 20.2% of their household's maximum monthly income.Conclusions: These analyses show that judicial bypass as a function of parental involvement laws correlates with increased costs to individual minors and to the public, with the heaviest burden placed on minors of low socioeconomic status.

Running an obstacle-course: a qualitative study of women’s experiences with abortion-seeking in Tamil Nadu, India

Irrespective of the legal status of abortion, access to abortion services for women is fraught with numerous challenges across the world. A recent study in India found that most women who had an abortion sought care outside an authorised facility or from a less qualified provider. An analysis of women’s experiences in seeking abortion services would provide a better understanding of the underlying reasons. This paper is based on a qualitative study of the experiences of 16 married women from rural Tamil Nadu, India. The in-depth interviews focused on their pregnancy and childbirth experiences and access to abortion services. The study highlights the obstacle course that women seeking to terminate an unwanted pregnancy have to traverse. Many women were not aware of the legal status of abortion, and frontline workers discouraged them and gave misleading information. The pathways to seeking an abortion were more complex for women from marginalised communities. Providers were judgemental and used delaying tactics or denied abortion services. For the less privileged women, abortion services from government health facilities were conditional on the acceptance of female sterilisation. The providers’ attitudes in government and private health facilities were disrespectful of the women seeking abortion services. To uphold the reproductive and human rights of women who seek abortion services, we need accessible and publicly funded health care services that respect the dignity of all women, are empathetic and uphold women’s right to safe abortion services.

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.

Repeat abortion and associated factors among women seeking abortion services in northwestern China: a cross-sectional study

BackgroundRepeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners.MethodsThis cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi’an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson’s chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed.ResultsOf 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08–1.73 for 31–35 years; 1.82, 1.29–2.57 for ≥36 years), received a low-level education (1.86, 1.42–2.43 for ≤senior high school; 1.46, 1.17–1.83 for junior college), were jobless (2.46, 1.18–5.13), had one child (1.54, 1.10–2.17), had a general (1.60, 1.28–1.98) or no (2.51, 2.02–3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09–1.61), withdrawal (1.43, 1.12–1.84), and emergency measures (1.48, 1.09–1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06–1.68 for 31–35 years; 2.13, 1.56–2.91 for ≥36 years), attained a low-level education (1.66, 1.28–2.15 for ≤senior high school; 1.38, 1.10–1.74 for junior college), received a high-level monthly income (1.34, 1.08–1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42–19.33) were more likely to have a repeat abortion.ConclusionsThe study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practice.

Impact of the COVID-19 pandemic on sexual and reproductive health among women with induced abortion

The coronavirus disease (COVID-19) has already been declared a global pandemic. To our knowledge, there is very little information regarding the effects of COVID-19 on women seeking reproductive health services, specifically abortion. This study was aimed to assess the impact of the COVID-19 pandemic on reproductive and sexual health among women seeking abortion services. We conducted a series of preliminary analyses using data collected from ten maternal and child health hospitals of seven provinces in China before and during the COVID-19 lockdown. The present study showed that a significant decrease was observed in the frequency of sexual intercourse during the COVID-19 pandemic. Moreover, a significant increase in contraceptive use including condom, rhythm method and coitus interruptus whereas a decrease in choosing oral contraceptives were observed during the COVID-19 pandemic. In addition, the pandemic was associated with increased intention of seeking induced abortion due to social factors. Future research should look into the long-term impact of the COVID-19 pandemic on sexual and reproductive health.

Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people\u2019s experiences crossing borders to obtain care

BackgroundThe laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019.MethodsWe recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts.ResultsOver a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult.ConclusionsThis analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities.

Family planning practices and prehospital care received by women seeking abortion services in a tertiary care hospital

Background: The study was carried out in the department of Gynaecology and Obstetrics at RG Kar Medical college and Hospital, among 114 attendees seeking induced or spontaneous abortion. The aim of the study was to assess their socio demographic characteristics, elicit their family planning knowledge, practices and prehospital care received by them before coming to this institute.Methods: An observational descriptive cross-sectional study was carried out using a predesigned, pretested schedule using systemic random sampling technique among women seeking abortion services at a tertiary care centre.Results: Out of the 114 interviewees, 53 (46.5%) underwent induced abortion and rest had spontaneous abortion. Statistically significant difference was found between the mean age of induced and spontaneous abortion seekers. Majority i.e. 28 (52.8%) of induced abortion seekers first sought help at illegal abortion service providers. Statistically significant difference was found in duration of marriage, gravidity and number of living children between induced and spontaneous abortion candidates. Contraceptive knowledge and practice were found to be higher among induced abortion seekers.Conclusions: This study clearly shows the need to focus on unmet need for family planning services including safe abortion services at pre-tertiary hospital level. The Government needs to stop advertisement and sale of over the counter abortifacients which is proving to be a menace to women’s health.

Profile and Pattern of Women Seeking Medical Termination of Pregnancy in a Tertiary care Centre in National Capital Region

Background: Induced abortion whether safe or unsafe, legal or illegal is a reproductive health service thatis part of the lives of women, couples and communities all over the country. When faced with unintendedpregnancies, especially in contexts in which women lack access to effective family planning, inducedabortion is an important part of women’s reproductive health care. In this backdrop the present study wasundertaken with the objective to study socio-demographic profile, methods, various indications in MedicalTermination of Pregnancy cases performed in our institution.Method: This study was conducted in the Department of Forensic Medicine in collaboration withDepartment of Obstetrics and Gynaecology, at SMSR, GautambudhNagar, India. Information was obtainedfrom the patient seeking abortion services, patient’s case record file in the hospital, Medical Terminationof Pregnancy (MTP) register and direct interview with concerned consultant in charge in the form of predesigned questionnaire..Conclusion: The most common reason for MTP was unwanted pregnancy due to non use of contraceptivesby the women of reproductive age group. We recommend comprehensive contraceptive counseling canhelp prevent unintended pregnancies that lead to abortions and should include information on when fertilityreturns after a birth or abortion. Also dedicating a special cell to focus on a woman’s unmet needs ofcontraception would go a long way in resolution of unintended pregnancies and abortions.

Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care

IntroductionThirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent.MethodsBetween May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis.ResultsParental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements.ConclusionsParental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast.Policy ImplicationsRemoving parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

Perceptions on Abortion and Long-acting Contraceptive Use among Women of Reproductive Age in Selected Nigerian States: A Cross-sectional Study

Background: It is estimated that over 210 million pregnancies occur each year, with almost half of these unplanned. The evidence further shows that about 76 million of these unplanned pregnancies occur in the developing world, with 19% ending in induced abortion and 11% of these abortions being unsafe. In sub-Saharan Africa, 2.2 unplanned pregnancies occur each year, with many of these in Nigeria. Reports show that 760,000 abortions occur each year in Nigeria, resulting in about 20,000 deaths. Abortion is greatly stigmatized in Nigeria, and the lack of a legal framework to support access to abortion services necessitates women to seek abortion services in unsafe places. This study, therefore, examines the perception of women regarding abortion (prevalence and stigma) and long-acting contraceptive (LARC) use in Nigeria. Methods: We performed secondary data analysis of round 5 of performance monitoring and accountability (PMA) in seven states of Nigeria for women in reproductive age (n = 11,284). Responses with regard to abortion incidence, perceptions on stigmatization and LARC use were examined using chi-square (χ2) analysis and binary logistic regression models. Results: Socio-demographic factors examined were found to be significantly associated with the perception that abortion was common; however, women who were educated to any level were twice more likely to report abortion being common in their communities compared to women who agreed that abortion was shameful. Place of residence was a significant factor and women resident in rural areas were more likely to undergo an abortion (OR = 1.34, 95% CI= 1.21 – 1.48). Further, married women (OR = 15.18, 95% CI=7.40 – 31.11) were 15 times more likely to use LARC. Conclusion: Perceptions that abortion is common and that it is a shameful practice were found to be underlying contributors to the use of LARC in Nigeria. However, the most significant influence was found to be exerted by respondents’ socio-demographic characteristics. Therefore, government and implementing agencies must develop an intervention to scale-up the use of LARC in Nigeria, and the framework should consider how to tackle socio-demographic barriers to access of contraceptive uptake as this would not only help increase the contraceptive prevalence rate but also reduce mortality from abortions.

Magnitude of Severe Acute Maternal Morbidity and Associated Factors Related to Abortion: A Cross-Sectional Study in Hawassa University Comprehensive Specialized Hospital, Ethiopia, 2019.

Background Abortion-related mortality is decreasing, but the complication is still causing a significant morbidity to mothers especially in developing countries. Recently, suitable criteria to assess maternal near miss for sub-Saharan countries were adapted in harmony with the previous World Health Organization near-miss criteria. The aim of this study was to assess the magnitude of severe acute maternal morbidity and associated factors related to abortion in Hawassa University Comprehensive Specialized Hospital, Ethiopia. Method An institution-based cross-sectional study was conducted among 337 women who sought abortion services at Hawassa University Comprehensive Specialized Hospital from January 1 to October 30, 2019. The participants were selected conveniently. Data was collected by using prospective morbidity methodology with pretested anonymous structured English questionnaire. The collected data were then entered into SPSS version 20 for analysis. Variables with p value ≤ 0.2 in the bivariate analysis, not collinear, were entered to multivariable regression. The strength of association is presented by odds ratio and 95% confidence interval. p value less than 0.05 was used as a cut-off point to determine statistically significant association. Results The magnitude of severe acute maternal morbidity and maternal near miss is found to be 35.6 and 17.7%, respectively. Factors significantly associated with severe acute maternal morbidity were as follows: women uneducated (AOR: 3.02; 95% CI 1.24-7.33), second-trimester pregnancy (1.89-9.14), and delayed presentation (AOR: 4.32, 95% CI 1.76-10.59). Conclusion Severe acute maternal morbidity and maternal near miss related to abortion are high despite the availability of safe termination. Near-miss cases could be better traced by using reasonably adapted World Health Organization near-miss criteria for sub-Saharan countries. Lack of education, increased gestational age, and delayed presentation had increased severe acute maternal morbidity associated with abortion which may need further education on health care seeking culture of the community.

“The Ripping Apart of Silence”

This article explores the gendered sound world of anti-abortion protests outside U.S. abortion clinics. These clinics are spaces of dissent where, on a daily basis, protesters congregate to vocalize their opposition to abortion. We employ the concept of sonic patriarchy, the sonic counterpart to the male gaze, to explore how anti-abortion protesting dominates the aural space surrounding abortion clinics and is used as a vehicle for controlling gendered bodies. Protesters use megaphones, speakers, and yelling to infuse the soundscape of the abortion clinic with an overwhelming cacophony that people must enter to receive care. This article reconceptualizes how we think about sound and violence by emphasizing how the everyday sounds of anti-abortion protesting are perceived and experienced as violence by people seeking abortion services. This domination of the sound world engenders a form of nonconsensual listening, in which it becomes difficult, if not impossible, to ignore the sonic performances of protesters. We also discuss the additional labor that clinic staff and volunteers must provide to shield patients against this volume of sound, as well as the affective and physical consequences of entering this sound world to receive healthcare. Furthermore, we describe the inherent difficulties in regulating sound and the importance of understanding the intent and context of sound-making in identifying certain sounds as violent. We argue for a more rigorous regulation of sound-making outside of clinics, as it perpetuates not only abortion stigma but also gendered sonic violence on all people who enter abortion clinics.