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Hoggart L, Purcell C, Bloomer F, Newton V, Oluseye A. Social connectedness and supported self-management of early medication abortion in the UK: experiences from the COVID-19 pandemic and learning for the future. CULTURE, HEALTH & SEXUALITY 2024; 26:855-870. [PMID: 37830180 DOI: 10.1080/13691058.2023.2258189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care.
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Affiliation(s)
- Lesley Hoggart
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Carrie Purcell
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
| | - Victoria Newton
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Ayomide Oluseye
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
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Odum T, Bornstein M, Turner AN, Gyuras HJ, Rivlin K, Bostic S, McGhee A, Bessett D. Prior knowledge and experience with self-managed abortion among people seeking abortion care in US Midwestern states. Contraception 2024:110516. [PMID: 38908774 DOI: 10.1016/j.contraception.2024.110516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES This study seeks to understand what methods people use and/or have heard of others using for self-managed abortion (SMA) prior to coming to a health facility for abortion care. STUDY DESIGN We collected survey data on sociodemographics, gestational stage, and SMA awareness and methods from patients seeking care in 17 abortion facilities in Ohio, West Virginia, Kentucky, Pennsylvania, and Illinois from April 2020 to April 2022. We used descriptive statistics to examine the proportion of participants who had attempted SMA and, separately, who had heard of people attempting SMA. RESULTS In total, 71 respondents (4.2%) had attempted SMA, and 416 (25.5%) had heard of others attempting SMA. The most frequently attempted methods for self-management were taking herbs and/or vitamins (31% each) or hitting oneself/being hit (22.5%). About a third of those who tried SMA reported trying more than one method (30%). CONCLUSIONS Our findings suggest that people who attempt SMA are committed to self-managing their abortion. More research is needed to better understand sociodemographic characteristics of people who have attempted or heard of people attempting SMA research.
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Affiliation(s)
- Tamika Odum
- Department of Behavioral Science, University of Cincinnati, Cincinnati, OH, United States.
| | - Marta Bornstein
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Abigail Norris Turner
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, United States
| | - Hillary J Gyuras
- Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati, OH, United States
| | - Katherine Rivlin
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Sarah Bostic
- Department of Sociology, University of Cincinnati, Cincinnati, OH, United States
| | - Annie McGhee
- Department of Sociology, University of Cincinnati, Cincinnati, OH, United States
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, OH, United States
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Atienzo EE, Cruz V, Garduño S, Lomelí S, Meza M, Zurbriggen R, Carbone SL, Wollum A. Safe abortion in Latin America: a look at abortion accompaniment collectives from the perspective of their activists. CULTURE, HEALTH & SEXUALITY 2024; 26:588-604. [PMID: 37504892 DOI: 10.1080/13691058.2023.2233589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Over the last decade, activists in Latin America have expanded access to safe abortion through processes of accompaniment. Abortion accompaniment is characterised by activism and community-based strategies to facilitate access to, and safe use of, medication abortion, mainly outside clinical contexts. Drawing on findings from a survey of 515 activists who were part of Accompaniment Collectives in Latin America, this study describes the organisation of these collectives, barriers and facilitators to their activism, and how accompaniers perceive the impact and future of abortion accompaniment. Accompaniment Collectives are organised and flexible and operate in diverse social and legal contexts. The main goals of accompaniment are the normalisation and social decriminalisation of abortion culturally (84%); the social construction of autonomy (79%); and the protection of people's freedom (73%), life (71%) and health (67%). Activists in legally restrictive settings identified limited access to abortion medication (73%) and restrictive laws (71%) as the main barriers to accompaniment, while health care personnel objecting to abortion provision on grounds of conscience was most common in legally permissive settings (64%). Collectives have developed strategies to overcome such barriers to and expanding access to abortion care. Activists expect accompaniment to continue regardless of the legal status of abortion.
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Affiliation(s)
| | | | - Sofía Garduño
- Fondo de Aborto para la Justicia Social MARIA, Ciudad de México, México
| | - Stephanie Lomelí
- Fondo de Aborto para la Justicia Social MARIA, Ciudad de México, México
| | - Milena Meza
- Con las Amigas y en la Casa, Santiago, Chile
| | - Ruth Zurbriggen
- Colectiva Feminista La Revuelta en Socorristas en Red, Neuquén, Argentina
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Footman K. Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine. Sex Reprod Health Matters 2023; 31:2149379. [PMID: 36876426 PMCID: PMC10013513 DOI: 10.1080/26410397.2022.2149379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.
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Affiliation(s)
- Katy Footman
- PhD Candidate, London School of Economics, London, UK. Correspondence:
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Jung C, Nippita S. Self-managed Medication Abortion in the United States. Clin Obstet Gynecol 2023; 66:739-748. [PMID: 37750672 DOI: 10.1097/grf.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
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Jayaweera R, Egwuatu I, Nmezi S, Kristianingrum IA, Zurbriggen R, Grosso B, Bercu C, Gerdts C, Moseson H. Medication Abortion Safety and Effectiveness With Misoprostol Alone. JAMA Netw Open 2023; 6:e2340042. [PMID: 37889485 PMCID: PMC10611991 DOI: 10.1001/jamanetworkopen.2023.40042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 10/28/2023] Open
Abstract
Importance Misoprostol-alone regimens for abortion may be more effective than previously thought. Objective To estimate the effectiveness of medication abortion with misoprostol alone among individuals self-managing their abortion. Design, Setting, and Participants For this prospective observational cohort study of callers to safe abortion hotlines and accompaniment groups in Argentina, Nigeria, and Southeast Asia, participants were recruited between July 31, 2019, and October 1, 2020, prior to starting their medication abortion. Eligible participants were 13 years or older, had no contraindications to medication abortion, and were not currently bleeding. Participants completed a baseline and 2 follow-up surveys. The analysis was restricted to participants who reported using misoprostol alone and was performed between January 6, 2022 and September 8, 2023. Exposure Self-managed medication abortion using misoprostol alone. Main Outcomes and Measures The primary outcome was effectiveness, defined as participant self-report of complete abortion without procedural intervention, measured at 1 week and 3 weeks after taking misoprostol. Secondary outcomes included method safety, measured by self-report of experiencing warning signs (eg, heavy bleeding, pain, fever, discharge) indicative of a potential complication and by medical treatment (eg, blood transfusion, intravenous fluids, overnight hospital stay) indicative of a potential adverse event. Additional outcomes included length of bleeding and cramping, time to expulsion, and experience of adverse effects. Results Among 1352 enrolled participants, 637 used misoprostol-alone regimens for abortion and were included in the analysis (591 [92.8%] from Nigeria, 45 [7.1%] from Southeast Asia, and 1 [0.2%] from Argentina; 384 [60.2%] aged 20-29 years; 317 [49.8%] with pregnancy durations <7 weeks and 205 [32.2%] with pregnancy durations between 7 and <9 weeks). At last follow-up after taking medication (median, 22 days; IQR, 21-26 days), 625 participants (98.1%; 95% CI, 96.7%-98.9%) had a complete abortion without procedural intervention. Potential adverse events were reported by 6 participants (0.9%; 95% CI, 0.4%-2.1%). Most participants experienced bleeding for less than 1 week (median, 4 days; IQR, 3-6 days) and expelled their pregnancy within 24 hours of starting the abortion process (median, 12 hours; IQR, 9-15 hours). Common side effects included nausea (335 participants [52.6%]), fever (232 [36.4%]), and diarrhea (181 [28.4%]). Conclusions and Relevance The findings suggest that misoprostol alone is a highly effective method of pregnancy termination. Future research should explore strategies to maximize the effectiveness of misoprostol alone in clinical and nonclinical settings.
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Affiliation(s)
| | - Ijeoma Egwuatu
- Generation Initiative Women and Youth Network, Lagos, Nigeria
| | - Sybil Nmezi
- Generation Initiative Women and Youth Network, Lagos, Nigeria
| | | | | | - Belén Grosso
- La Revuelta Colectiva Feminista, Neuquén, Argentina
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Goemans S, Singh A, Yadav AK, McDougal L, Raj A, Averbach SH. The Association Between Self-Managed versus Clinician-Managed Abortion and Self-Reported Abortion Complications: A Cross-Sectional Analysis in India. Int J Womens Health 2023; 15:1467-1473. [PMID: 37795194 PMCID: PMC10545903 DOI: 10.2147/ijwh.s414599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose To examine the association between self-managed abortion and the self-reported experience of abortion complications in India, a country with a high incidence of self-managed abortion. Patients and Methods The study used a cross-sectional multivariable logistic regression analysis of data from the National Family Health Survey (NFHS-4) of 2015-2016 to compare the odds of self-reported complications experienced during abortion between self-managed and clinician-managed abortions in India. Results On average, self-managed abortions occurred earlier in gestation than clinician-managed abortions, 7.8 weeks and 11.3 weeks, respectively (p < 0.001). Self-managed abortion was associated with fewer self-reported abortion-related complications than clinician-managed abortions when adjusted for covariates not including gestational age (Adjusted Odds Ratio (aOR) 0.82, 95% confidence interval (CI) 0.69, 0.97). However, once adjusted for gestational age, there was no longer a clinically meaningful or statistically significant difference in the odds of self-reported complications between self-managed and clinician-managed abortions (aOR = 0.98, 95% CI 0.81, 1.18). Conclusion These findings suggest that people in India are using safe methods to self-manage abortions and support the hypothesis that self-managed abortion can improve access to abortion and reproductive choice without increasing risk.
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Affiliation(s)
- Sophie Goemans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
- Centre of Demography of Gender, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Ajit Kumar Yadav
- GENDER Project, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
| | - Sarah H Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
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8
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Footman K. Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales. Health Policy 2023; 132:104799. [PMID: 37001286 DOI: 10.1016/j.healthpol.2023.104799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/13/2023] [Accepted: 03/19/2023] [Indexed: 03/28/2023]
Abstract
Although patient choice of abortion method is a key component of quality care, medical abortion (MA) has become the most common method (87%) in England and Wales, as in many countries worldwide. This research aimed to critically examine factors influencing the growth in MA use in England and Wales. Mixed methods were used, combining multi-level regression analysis of national abortion statistics (2011-2020) and key informant interviews with abortion service managers, commissioners, and providers (n=27). Overall trends have been driven by growth in MA use for abortions under 10 weeks in the private non-profit sector. Variation in MA use between patient sub-groups and regions has narrowed over time. Qualitative findings highlight health system constraints that have influenced the shift towards MA, including workforce constraints, infrastructure requirements, provider policies, cost, and commissioning practices involving under-funding and competition, which have caused the private non-profit sector to limit method choice across their services to remain financially viable. While removal of legal restrictions on MA has expanded choice, similar policy progress has not been seen for surgical methods. The study concludes that abortion method choice has been constrained by structural health system factors, with potential negative consequences for service acceptability, inequalities, and patient-centredness.
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Carson A, Cameron ES, Paynter M, Norman WV, Munro S, Martin-Misener R. Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach. J Adv Nurs 2023; 79:686-697. [PMID: 36369652 PMCID: PMC10100085 DOI: 10.1111/jan.15487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
AIMS To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. DESIGN A qualitative approach informed by feminist theory and integrated knowledge translation. METHODS Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. RESULTS Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. CONCLUSION When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. IMPACT The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. PATIENT OR PUBLIC CONTRIBUTION This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.
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Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Accounting for Misclassification and Selection Bias in Estimating Effectiveness of Self-managed Medication Abortion. Epidemiology 2023; 34:140-149. [PMID: 36455250 DOI: 10.1097/ede.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Studies on the effectiveness of self-managed medication abortion may suffer from misclassification and selection bias due to self-reported outcomes and loss of follow-up. Monte Carlo sensitivity analysis can estimate self-managed abortion effectiveness accounting for these potential biases. METHODS We conducted a Monte Carlo sensitivity analysis based on data from the Studying Accompaniment model Feasibility and Effectiveness Study (the SAFE Study), to generate bias-adjusted estimates of the effectiveness of self-managed abortion with accompaniment group support. Between July 2019 and April 2020, we enrolled a total of 1051 callers who contacted accompaniment groups in Argentina and Nigeria for self-managed abortion information; 961 took abortion medications and completed at least one follow-up. Using these data, we calculated measures of effectiveness adjusted for ineligibility, misclassification, and selection bias across 50,000 simulations with bias parameters drawn from pre-specified Beta distributions in R. RESULTS After accounting for the potential influence of various sources of bias, bias-adjusted estimates of effectiveness were similar to observed estimates, conditional on chosen bias parameters: 92.68% (95% simulation interval: 87.80%, 95.74%) for mifepristone in combination with misoprostol (versus 93.7% in the observed data) and 98.47% (95% simulation interval: 96.79%, 99.39%) for misoprostol alone (versus 99.3% in the observed data). CONCLUSIONS After adjustment for multiple potential sources of bias, estimates of self-managed medication abortion effectiveness remain high. Monte Carlo sensitivity analysis may be useful in studies measuring an epidemiologic proportion (i.e., effectiveness, prevalence, cumulative incidence) while accounting for possible selection or misclassification bias.
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Duffy D, Freeman C, Rodríguez S. Building infrastructures of abortion care in an un-caring state: acompañante's carework and abortion access in Peru. SIGNS 2023; 48:585-608. [PMID: 37324651 PMCID: PMC7614643 DOI: 10.1086/723296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
For abortion seekers, Peru is an uncaring state where legal and policy interventions have resulted in violence, persecution, and neglect. This state of abortion uncare is set within historic and ongoing denials of reproductive autonomy, coercive reproductive care, and the marginalisation of abortion. Abortion is not supported, even where legally permissible. Here we explore abortion care activism within the Peruvian context, foregrounding a key mobilisation that has emerged against a state of un-care - acompañante carework. Through interviews with people involved in abortion access and activism in Peru, we argue that acompañantes have constructed an infrastructure of abortion care in Peru through the bringing together of actors, technologies, and strategies. This infrastructure is shaped by a feminist ethic of care that differs from minority world care assumptions regarding high quality abortion care in three key ways: (i) care is provided beyond the state; (ii) care is holistic; and (iii) care is collective. We argue that US feminist debates relating to the emerging hyperrestrictive state of abortion un-care as well as broader research on feminist care can learn from acompañante activism strategically and conceptually.
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Affiliation(s)
- Deirdre Duffy
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Manchester
| | - Cordelia Freeman
- Department of Geography, University of Exeter. Amory Building, Rennes Drive, Exeter, EX4 4RJ
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Madera M, Johnson DM, Broussard K, Tello-Pérez LA, Ze-Noah CA, Baldwin A, Gomperts R, Aiken AR. Experiences seeking, sourcing, and using abortion pills at home in the United States through an online telemedicine service. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100075. [PMID: 37503356 PMCID: PMC10372773 DOI: 10.1016/j.ssmqr.2022.100075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
A growing number of people in the United States seek to self-manage their abortions by self-sourcing abortion medications online. Prior research focuses on people's motivations for seeking self-management of abortion and experiences trying to obtain medications. However, little is known about the experiences of people in the U.S. who actually complete a self-managed abortion using medications they self-sourced online. We conducted anonymous in-depth interviews with 80 individuals who sought abortion medications through Aid Access, the only online telemedicine service that provides abortion medications in all 50 U.S. states. Through grounded theory analysis we identified five key themes: 1) participants viewed Aid Access as a "godsend"; 2) Fears of scams, shipping delays, and surveillance made ordering pills online a "nerve-racking" experience; 3) a "personal touch" calmed fears and fostered trust in Aid Access; 4) participants were worried about the "what ifs" of the self-managed abortion experience; and 5) overall, participants felt that online telemedicine met their important needs. Our findings demonstrate that online telemedicine provided by Aid Access not only provided a critical service, but also offered care that participants deemed legitimate and trustworthy.
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Affiliation(s)
| | | | | | | | | | - Aleta Baldwin
- California State University, Sacramento, Sacramento, CA, USA
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13
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Bazié F, Thomas HL, Byrne ME, Kindo B, Bell SO, Moreau C. Typologies of women's abortion trajectories in Burkina Faso: findings from a qualitative study. Reprod Health 2022; 19:212. [PMID: 36443828 PMCID: PMC9707265 DOI: 10.1186/s12978-022-01526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Abortion is a legally restricted, yet common reproductive life event among women in Burkina Faso; however, women's abortion experiences vary greatly depending on their social and economic capital, partner involvement, and level of knowledge. We sought to classify women's abortion care-seeking experiences across the life course and social conditions into typologies using qualitative data. METHODS An initial quantitative survey among a nationally representative sample of women ages 15-49 years collected information on women's induced abortion experiences. Women who reported an abortion in the last 10 years were asked if they would agree to participate in a subsequent in-depth interview (IDI) to learn more about their abortion experience. Twenty-five women, identified via purposive sampling, completed an IDI. Using a process of typology construction, we identified attributes of each woman's condition at the time of her abortion and aspects of her abortion experience, created a matrix of attributes and cases, and identified emerging relationships. Three types were identified through this process. RESULTS Twenty-three IDIs were analyzed, and women's abortion experiences were grouped into three types: abortion to delay childbearing in adolescence; abortion to space childbirth among women in union; abortion to avoid childbearing among single mothers. Two cases were identified as outliers. Cases were grouped based on the context of their pregnancy, the reason for the abortion and involved decision-makers, and their patterns of care-seeking, including methods and sources used. CONCLUSION Structural inequities related to gender and wealth were prominent forces shaping women's abortion experiences. Comprehensive sexuality education coupled with community-based interventions to promote gender-equitable relationships and address social stigma related to women's sexuality could reduce reproductive coercion and unintended pregnancies.
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Affiliation(s)
- Fiacre Bazié
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Boukary Kindo
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, 94800, Villejuif, France
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Hinson L, Bhatti AM, Sebany M, Bell SO, Steinhaus M, Twose C, Izugbara C. How, when and where? A systematic review on abortion decision making in legally restricted settings in sub-Saharan Africa, Latin America, and the Caribbean. BMC Womens Health 2022; 22:415. [PMID: 36217197 PMCID: PMC9552475 DOI: 10.1186/s12905-022-01962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background With increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings. However, more than 22,000 women die each year from unsafe abortion, most often in developing countries where abortion is highly legally restricted. We conducted a systematic review to compile existing evidence regarding factors that influence women’s abortion-related decision making in countries where abortion is highly legally restricted.
Methods We searched ten databases in two languages (English and Spanish) for relevant literature published between 2000 and 2019 that address women’s decision-making regarding when, where and how to terminate a pregnancy in sub-Saharan African, Latin American and the Caribbean countries where abortion is highly legally restricted.
Results We identified 46 articles that met the review’s inclusion criteria. We found four primary factors that influenced women’s abortion-related decision-making processes: (1) the role of knowledge, including of laws, methods and sources; (2) the role of safety, including medical, legal and social safety; (3) the role of social networks and the internet, and; (4) cost affordability and convenience. Conclusions The choices women make after deciding to terminate a pregnancy are shaped by myriad factors, particularly in contexts where abortion is highly legally restricted. Our review catalogued the predominant influences on these decisions of when, where and how to abort. More research is needed to better understand how these factors work in concert to best meet women’s abortion needs to the full limit of the law and within a harm reduction framework for abortions outside of legal indications. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01962-0.
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Affiliation(s)
- Laura Hinson
- grid.419324.90000 0004 0508 0388International Center for Research on Women, Washington, DC USA
| | | | | | - Suzanne O. Bell
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Claire Twose
- grid.21107.350000 0001 2171 9311Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Chimaraoke Izugbara
- grid.419324.90000 0004 0508 0388International Center for Research on Women, Washington, DC USA
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15
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The influence of feminist abortion accompaniment on emotions related to abortion: A longitudinal observational study in Mexico. SSM Popul Health 2022; 19:101259. [PMID: 36238820 PMCID: PMC9552094 DOI: 10.1016/j.ssmph.2022.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/22/2022] Open
Abstract
Emotions can reflect how individuals internalize identities, social roles, and broader power structures, including abortion stigma. Abortion accompaniment, in the form of logistical, informational, and emotional support offered by individuals and organizations, takes a person-centered, feminist, and rights-based approach. We tested the extent to which abortion accompaniment may decrease negative and increase positive feelings an individual holds related to their abortion. Using observational longitudinal data collected between January 2017 and mid-2018, we compared negative and positive emotional responses to a personal abortion experience one month and six months following the abortion to emotions immediately prior to the abortion ("baseline"), among women travelling from outside of Mexico City to abortion clinics in Mexico City with and without support of the accompaniment organization, Fondo MARIA. We used doubly robust longitudinal mixed effects models with inverse probability weighting methods. At baseline, accompanied and unaccompanied participants experienced an average of 4.9 and 4.4 negative emotions out of eight respectively (i.e., anguish, nervousness, scared, anxious, sadness, guilt, anger, shame) and 1.7 and 1.9 positive emotions of out 4 respectively (happiness, calmness, decidedness, and relief). From our model results, women accompanied (n = 77) had larger decreases in negative feelings (p < .05) and larger increases in positive feelings (p < .01) toward their abortion compared to those who were not accompanied (n = 119) at six months. These changes led the majority of accompanied respondents to have primarily positive feelings about their abortion by endline. Abortion accompaniment through Fondo MARIA in Mexico City was associated with a larger decrease in negative feelings, particularly those related to stigma, and a larger increase in positive feelings six months after abortion. Accompaniment's focus on person-centered support, self-determination, and autonomy may enable people seeking abortion to view their decision as one that is valid and legitimate, and resist the predominant stigmatizing narratives framing abortion as something that is transgressive.
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16
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Skuster P, Menzel J, Ghorashi AR, Perkins M. Policy surveillance for a global analysis of national abortion laws. Sex Reprod Health Matters 2022; 30:2064208. [PMID: 35583503 PMCID: PMC9122351 DOI: 10.1080/26410397.2022.2064208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Policy surveillance offers a novel and important method for comparing law across jurisdictions. We used policy surveillance to examine abortion laws across the globe. Self-managed abortion, which generally takes place outside formal healthcare settings, is increasing in prevalence and can be safe. We analysed provisions that do not account for the prevalence of self-managed abortion and evidence of its safety. Such provisions require that abortion take place in a formal healthcare setting. We also analysed criminal penalties for non-compliance. Our method included development of a legal framework, an iterative process of refining coding schemes and procedures, and rigorous quality control. We limited our analysis to liberal abortion laws for two reasons. Abortion laws globally trend towards less restrictive. In addition, we aimed to focus on how laws relate to abortion outside a formal healthcare setting specifically and excluded laws that prohibit abortion more broadly. We found that in all countries with liberal national abortion laws, the law permits only healthcare professionals or trained health workers to perform legal abortion and the majority require the abortion to take place in a specified health facility. With policy surveillance methods we can illuminate characteristics of law across many jurisdictions and the need for widespread reform, toward laws that reflect scientific evidence and the way people have abortions.
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Affiliation(s)
- Patty Skuster
- Beck Chair in Law, Temple University Beasley School of Law, Philadelphia, PA, USA. Correspondence:
| | - Jamie Menzel
- Senior Advisor, Research and Evaluation, Ipas, Denver, CO, USA
| | - Adrienne R Ghorashi
- Program Manager, Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
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17
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Veldhuis S, Sánchez-Ramírez G, Darney BG. Locating Autonomous Abortion Accompanied by Feminist Activists in the Spectrum of Self-Managed Medication Abortion. Stud Fam Plann 2022; 53:377-387. [PMID: 35347718 DOI: 10.1111/sifp.12194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diverse models of self-managed medication abortion exist-ranging from some interaction with medical personnel to completely autonomous abortion. In this commentary, we propose a new classification of self-managed medication abortion and describe the different modalities. We highlight autonomous abortion accompanied by feminist activists, called "acompañantes," as a community- and rights-based strategy that can be a safe alternative to clinical abortion services in clandestine as well as legal settings. To improve access, abortion needs to be decriminalized and governments must acknowledge and facilitate the diversity of safe abortion options so women may choose where, when, how, and with whom to abort.
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Affiliation(s)
- Suzanne Veldhuis
- Department of Health, El Colegio de la Frontera Sur (ECOSUR), San Cristóbal de las Casas, Chiapas 29290, México
| | - Georgina Sánchez-Ramírez
- Department of Health, El Colegio de la Frontera Sur (ECOSUR), San Cristóbal de las Casas, Chiapas 29290, México
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA.,Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Publica (INSP), 62100 Cuernavaca, Morelos, México
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18
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Luigi-Bravo G, Gill RK. Safe abortion within the Venezuelan complex humanitarian emergency: understanding context as key to identifying the potential for digital self-care tools in expanding access. Sex Reprod Health Matters 2022; 29:2067104. [PMID: 35593266 PMCID: PMC9132459 DOI: 10.1080/26410397.2022.2067104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Génesis Luigi-Bravo
- Community Engagement Lead, Vitala Global Foundation, Vancouver, British Columbia, Canada; Graduate Institue of Geneva, Geneva, Switzerland
| | - Roopan Kaur Gill
- Executive Director, Vitala Global Foundation, Vancouver, British Columbia Canada; Clinican Investigator, Assistant Professor, University of Toronto, Department of Obstetrics & Gynecology, Toronto, Canada. Correspondence:
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19
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Assis MP. Misoprostol on trial: a descriptive study of the criminalization of an essential medicine in Brazil. CAD SAUDE PUBLICA 2021; 37:e00272520. [PMID: 34730693 DOI: 10.1590/0102-311x00272520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
Misoprostol is a medicine with a "double" social life recorded in several places, including Brazil. Within formal and authorized health facilities, it is an essential medicine, used for life-saving obstetric procedures. On the streets, or in online informal markets, misoprostol is treated as a dangerous drug used to induce illegal abortions. In the Brazilian case, despite a rich anthropological and public health analysis of the social consequences of misoprostol's double life, there are no studies on the legal implications. This article offers such descriptive analysis, presenting and examining a comprehensive dataset of how Brazilian courts have treated misoprostol in the past three decades. It consists of an encompassing mapping of the "when, where, how, and who" of misoprostol criminalization in Brazil, pointing to the unjust consequences of the use of criminal law for the purpose of protecting public health.
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20
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Veldhuis S, Sánchez-Ramírez G, Darney BG. "Becoming the woman she wishes you to be": a qualitative study exploring the experiences of medication abortion acompañantes in thre regions in Mexico. Contraception 2021; 106:39-44. [PMID: 34742716 DOI: 10.1016/j.contraception.2021.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acompañantes are activists who accompany women who have medication abortions outside of clinical settings. We describe models of accompaniment across three states in Mexico with diverse abortion laws, access, and acompañantes, and describe how acompañantes conceptualize the benefits and challenges of their work. STUDY DESIGN In this exploratory, qualitative study, we conducted semi-structured interviews with 14 participants about their experiences as acompañantes, in two states with restrictive abortion legislation (Baja-California, Chiapas) at the time of research and Mexico City, where abortion is legal upon request in the first trimester. We used a feminist ethnography approach and analyzed data using a priori categories which included perceived benefits of and challenges of the accompaniment model. RESULTS Participants described similar steps and general characteristics of the accompaniment process regardless of the setting, supporting the concept of an overarching definition of the holistic accompaniment model for these acompañantes. Holistic accompaniment is a horizontal model that involves trusting women, not asking for the reasons for their abortion, preventing criminalization, economic support, respecting autonomy, emotional accompaniment, and being flexible. Participants described perceived advantages, including safety, even in settings otherwise unsafe, such as where women may be stigmatized and / or criminalized. Participants described benefits of autonomous abortion compared to in-clinic medication abortion or surgical abortion, and benefits specifically related to accompaniment, such as the potential to make the abortion a positive experience. CONCLUSIONS We describe components of a holistic accompaniment model in Mexico which has specific characteristics that may benefit women who opt for out-of-clinic abortion.
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Affiliation(s)
- Suzanne Veldhuis
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230.
| | - Georgina Sánchez-Ramírez
- El Colegio de la Frontera Sur (ECOSUR), Carretera Panamericana y Periférico Sur s/n. Barrio de María Auxiliadora, San Cristóbal de las Casas, México C.P. 29230
| | - Blair G Darney
- Oregon Health & Science University, Portland, Oregon, USA; Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
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21
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Goemans SL, Singh A, Yadav AK, McDougal L, Raj A, Averbach SH. The association between intimate partner violence and recent self-managed abortion in India. AJOG GLOBAL REPORTS 2021; 1. [PMID: 35291317 PMCID: PMC8920295 DOI: 10.1016/j.xagr.2021.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have shown that women who experience intimate partner violence have higher rates of unintended pregnancy and abortion—but whether there are differences between the types of abortion care accessed is unknown. Understanding the predictors of self-managed abortion is important for providing risk-mitigating information and resources to those at highest risk for unintended pregnancy and intimate partner violence. With access to information and medication abortion drugs, it is possible that self-managed abortion can be performed safely, increasing reproductive autonomy for women. OBJECTIVE The purpose of this study is to evaluate the association between experiencing intimate partner violence and using self-managed abortion. STUDY DESIGN This is a cross-sectional analysis of responses of 57,090 married women to the National Family Health Survey-4 conducted across India from 2015 to 2016. The association between the type of intimate partner violence and self-managed abortion was analyzed using multivariable multinomial logistic regression. RESULTS Women who have ever experienced physical intimate partner violence were more likely to have any abortion (adjusted relative risk=1.5; 95% confidence interval, 1.2–2.0) and use self-managed abortion (adjusted relative risk=1.7; 95% confidence interval, 1.1–2.6) than women who have not experienced physical intimate partner violence. Women who have ever experienced sexual intimate partner violence may have been more likely to use self-managed abortion, though this association was not statistically significant (adjusted relative risk=2.7; 95% confidence interval, 0.7–10.4). CONCLUSION Women who have experienced physical intimate partner violence disproportionately use abortion care, both facility-based and self-managed. Women who have experienced sexual intimate partner violence may also be more likely to use self-managed abortion. Although abortion is legal, self-managed abortion is commonly occurring in India. Self-managed abortion represents an additional choice and enhances reproductive autonomy in settings where abortion is legal. The implementation of risk-mitigation resources and policies regarding self-managed abortion would provide protection and enhanced autonomy to susceptible groups across India.
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22
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Eagen-Torkko M, Yanow S. The Critical Role of Midwives in Safe Self-Managed Abortion. J Midwifery Womens Health 2021; 66:795-800. [PMID: 34549524 DOI: 10.1111/jmwh.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
As access to legal abortion in the United States becomes more complex, there is increasing interest in self-managed abortion. Choosing to seek abortion care outside the clinical setting can also help people marginalized or harmed by existing health care systems to access needed care in a way that feels safe and empowering. However, patients and midwives alike often have a lack of information about expected outcomes and potential complications that may arise, as well as how to manage these in a health care system that may make appropriate follow-up difficult to access if needed. This article discusses patient education as a harm-reduction approach, and reviews ways that midwives may strategically and ethically participate in this patient education need. As trusted health care providers who are expert in pregnancy and reproductive health, midwives are ideally positioned to meet patient knowledge needs around self-managed abortion.
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Affiliation(s)
- Meghan Eagen-Torkko
- University of Washington Bothell & Public Health Seattle-King County, Seattle, Washington
| | - Susan Yanow
- Reproductive Health Consultant, Cambridge, Massachusetts
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23
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Assis MP, Erdman JN. Abortion rights beyond the medico-legal paradigm. Glob Public Health 2021; 17:2235-2250. [PMID: 34487487 DOI: 10.1080/17441692.2021.1971278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abortion rights in international law have historically been framed within a medico-legal paradigm, the belief that regulated systems of legal and medical control guarantee safe abortion. However, a growing worldwide practice of self-managed abortion (SMA) supported by feminist activism challenges key precepts of this paradigm. SMA activism has shown that more than medical service delivery matters to safe abortion and has called into question the legal regulation of abortion beyond criminal prohibitions. This article explores how abortion rights have begun to depart from the medico-legal paradigm and to support the novel norms and practices of SMA activism in a transformation of the abortion field. Abortion rights as reimagined in SMA activism increasingly feature in human rights agendas related to structural violence and inequality, collective organising and international solidarity, and democratic engagement.
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Affiliation(s)
| | - Joanna N Erdman
- Schulich School of Law, Dalhousie University, Halifax, Canada
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24
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Jayaweera R, Powell B, Gerdts C, Kakesa J, Ouedraogo R, Ramazani U, Wado YD, Wheeler E, Fetters T. The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts. Front Glob Womens Health 2021; 2:681039. [PMID: 34816230 PMCID: PMC8593970 DOI: 10.3389/fgwh.2021.681039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Refugees and displaced people face uniquely challenging barriers to abortion access, including the collapse of health systems, statelessness, and a lack of prioritization of sexual and reproductive health services by humanitarian agencies. This article summarizes the evidence around abortion access in humanitarian contexts, and highlights the opportunities for interventions that could increase knowledge and support around self-managed abortion. We explore how lessons learned from other contexts can be applied to the development of effective interventions to reduce abortion-related morbidity and mortality, and may improve access to information about safe methods of abortion, including self-management, in humanitarian settings. We conclude by laying out a forward-thinking research agenda that addresses gaps in our knowledge around abortion access and experiences in humanitarian contexts.
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Affiliation(s)
| | | | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Erin Wheeler
- International Rescue Committee, New York, NY, United States
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25
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Yanow S, Pizzarossa LB, Jelinska K. Self-managed abortion: Exploring synergies between institutional medical systems and autonomous health movements. Contraception 2021; 104:219-221. [PMID: 34139153 DOI: 10.1016/j.contraception.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Susan Yanow
- Women Help Women, PO Box 15798, 1001 NG Amsterdam, Netherlands.
| | | | - Kinga Jelinska
- Women Help Women, PO Box 15798, 1001 NG Amsterdam, Netherlands.
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26
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Väisänen H, Moore AM, Owolabi O, Stillman M, Fatusi A, Akinyemi A. Sexual and Reproductive Health Literacy, Misoprostol Knowledge and Use of Medication Abortion in Lagos State, Nigeria: A Mixed Methods Study. Stud Fam Plann 2021; 52:217-237. [PMID: 34043236 PMCID: PMC8362169 DOI: 10.1111/sifp.12156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Little is known about the link between health literacy and women's ability to safely and successfully use misoprostol to self‐induce an abortion. While abortion is only allowed to save a woman's life in Nigeria, misoprostol is widely available from drug sellers. We interviewed 394 women in 2018 in Lagos State, Nigeria, who induced abortion using misoprostol obtained from a drug seller to determine their sexual and reproductive health literacy (SRHL) and misoprostol knowledge levels; and how these were associated with ending the pregnancy successfully or seeking care for (perceived) complications. Our results show that women's misoprostol knowledge (measured both quantitatively and qualitatively) was low, but that almost all women were nevertheless able to use the drug effectively and safely. Higher SRHL was associated with being more likely to end the pregnancy successfully and also seeking postabortion health care. Our study is the first to examine this association and adds to the scarce literature examining the relationship between health literacy and self‐use of misoprostol to induce abortions in restrictive settings.
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Affiliation(s)
- Heini Väisänen
- Heini Väisänen, Sexual and Reproductive Health and Rights unit, Institut national d'études démographiques (INED), Aubervilliers, France.,Centre for Population Change, University of Southampton, Southampton, UK
| | - Ann M Moore
- Ann M. Moore, Onikepe Owolabi, Melissa Stillman, Guttmacher Institute, New York, USA
| | - Onikepe Owolabi
- Ann M. Moore, Onikepe Owolabi, Melissa Stillman, Guttmacher Institute, New York, USA
| | - Melissa Stillman
- Ann M. Moore, Onikepe Owolabi, Melissa Stillman, Guttmacher Institute, New York, USA
| | - Adesegun Fatusi
- Adesegun Fatusi, Academy for Health Development (AHEAD), Ile-Ife, Nigeria.,University of Medical Sciences, Ondo, Ondo, Nigeria
| | - Akanni Akinyemi
- Akanni Akinyemi, Centre for Research, Evaluation Resources and Development (CRERD), Ile-Ife, Nigeria
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27
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Gill RK, Cleeve A, Lavelanet AF. Abortion hotlines around the world: a mixed-methods systematic and descriptive review. Sex Reprod Health Matters 2021; 29:1907027. [PMID: 33910479 PMCID: PMC8097399 DOI: 10.1080/26410397.2021.1907027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Barriers to access abortion services globally have led to the development of alternative methods to assist and support women who seek an abortion. One such method is the use of hotlines, currently utilised globally for abortion care. This review aimed to understand (1) how abortion hotlines facilitate access to abortion; and (2) how women and stakeholders describe the impact of hotlines on abortion access. Published quantitative and qualitative studies and grey literature were systematically reviewed alongside an identification and description of abortion hotlines in the public domain. Our findings highlight that the existence of abortion hotlines is highly context-dependent. They may exist either as an independent community-based model of care, or as part of formal care pathways within the health system. Hotlines operating in contexts with legal restrictions seem to be broader in scope and will use innovative approaches to adapt to their setting and reach hard-to-reach populations. All the abortion hotlines that provided information on a data extraction form used evidence-based guidelines but women seeking medical abortion still struggle to access quality medications. There is limited data in general on abortion hotlines, especially on the user and provider experience. Abortion hotlines have the potential to facilitate access to safe abortion care through evidence-based information and to decrease maternal mortality and morbidity from unsafe abortions for women and girls globally.
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Affiliation(s)
- Roopan K Gill
- Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Amanda Cleeve
- Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden; South General Hospital, Stockholm, Sweden
| | - Antonella F Lavelanet
- Medical Officer, Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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28
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Footman K, Chelwa N, Douthwaite M, Mdala J, Mulenga D, Brander C, Church K. Treading the Thin Line: Pharmacy Workers' Perspectives on Medication Abortion Provision in Lusaka, Zambia. Stud Fam Plann 2021; 52:179-194. [PMID: 33826147 DOI: 10.1111/sifp.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CONTEXT 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Katharine Footman
- MSI Reproductive Choices, London, W1T 6LP, UK.,Department of Social Policy, London School of Economics and Political Science
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29
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Berro Pizzarossa L, Nandagiri R. Self-managed abortion: a constellation of actors, a cacophony of laws? Sex Reprod Health Matters 2021; 29:1899764. [PMID: 33764856 PMCID: PMC8009018 DOI: 10.1080/26410397.2021.1899764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lucía Berro Pizzarossa
- Postdoctoral Fellow, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Rishita Nandagiri
- ESRC Postdoctoral Fellow, Department of Methodology, London School of Economics and Political Science, London, UK
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30
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Garnsey C, Wollum A, Garduño Huerta S, Uribe OL, Keefe-Oates B, Baum SE. Factors influencing abortion decisions, delays, and experiences with abortion accompaniment in Mexico among women living outside Mexico City: results from a cross-sectional study. Sex Reprod Health Matters 2021; 29:2038359. [PMID: 35262471 PMCID: PMC8920378 DOI: 10.1080/26410397.2022.2038359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria’s support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria’s services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico.
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Affiliation(s)
- Camille Garnsey
- Research Assistant, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | - Alexandra Wollum
- Senior Associate Research Scientist, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | | | | | - Brianna Keefe-Oates
- Senior Project Manager, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | - Sarah E Baum
- Senior Research Scientist, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
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Jayaweera RT, Moseson H, Gerdts C. Misoprostol in the era of COVID-19: a love letter to the original medical abortion pill. Sex Reprod Health Matters 2020; 28:1829406. [PMID: 33111643 PMCID: PMC7887983 DOI: 10.1080/26410397.2020.1829406] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ruvani T Jayaweera
- Senior Project Manager, Ibis Reproductive Health, Oakland, CA, USA; Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, USA
| | - Heidi Moseson
- Epidemiologist, Ibis Reproductive Health, Oakland, CA, USA
| | - Caitlin Gerdts
- Vice-President for Research, Ibis Reproductive Health, Oakland, CA, USA
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Baum SE, Ramirez AM, Larrea S, Filippa S, Egwuatu I, Wydrzynska J, Piasecka M, Nmezi S, Jelinska K. "It's not a seven-headed beast": abortion experience among women that received support from helplines for medication abortion in restrictive settings. Health Care Women Int 2020; 41:1128-1146. [PMID: 33156737 DOI: 10.1080/07399332.2020.1823981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are a growing number of abortion helplines where counselors provide person-centered medication abortion services in legally restrictive settings. Few researchers have explored the perceptions and experiences of the people who obtain support from these helplines. Between April and August 2017, we conducted 30 interviews with women who had a medication abortion with support from helpline counselors in Poland, Brazil, or Nigeria. Before seeking care with the helpline, women often heard negative stories about abortion and faced enacted stigma from the formal healthcare sector, or chose not to seek services from their doctors due to fear of stigmatizing treatment. Conversely, during their care with the helpline counselors, women received clear information in a timely manner, and were treated with kindness, compassion, respect, and without judgment. Many women gained knowledge and understanding of medication abortion, and some gained a sense of community among those who experienced abortion. Helpline models can provide high-quality, person-centered abortion care to people seeking abortions in legally restrictive contexts. Evidence from these service-delivery models could help improve service within the formal healthcare systems and expand access to high-quality, safe abortion by redefining what it means to provide care.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, Oakland, California, USA
| | | | - Sara Larrea
- Women Help Women, Amsterdam, the Netherlands
| | | | - Ijeoma Egwuatu
- Generation Initiative for Youth and Women Network, Lagos, Nigeria
| | | | | | - Sybil Nmezi
- Generation Initiative for Youth and Women Network, Lagos, Nigeria
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McGuinness S, Montgomery J. Legal Determinants of Health: Regulating Abortion Care. Public Health Ethics 2020. [DOI: 10.1093/phe/phaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
In The legal determinants of health: Harnessing the power of law for global health and sustainable development, Gostin et al. provide a sustained account of how law can and should be used as an instrument of health promotion. We pick up on the themes of this report with a specific focus of the importance of abortion for women’s sexual and reproductive health and the impact that particular ways of framing abortion in law can have on the lives of women and girls. In this short comment, we wish to emphasize that abortion regulations need to move beyond frameworks based on narrow understandings of harm towards more progressive agendas that take into account the social determinants of health in order to reduce barriers to care. This contribution is particularly relevant to the Commission’s criticism that those ‘[l]aws that stigmatise or discriminate against marginalized populations are especially harmful and exacerbate health disparities’.
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Abstract
In the context of Ireland’s new legislation governing abortion, I outline and examine the spatial consequences of political decision-making. I argue that Ireland’s new abortion law and its clinical guidance permit travel for some pregnant people but impose fixity on others. I analyse the spatial consequences of legal limitations, including non-medically necessary delays in care and medical control of medication abortions, that necessitate travel for abortion. I demonstrate how current laws fix some pregnant people in place, including diverse migrant populations within Ireland, with no possibilities for abortion-related travel. This critique of the ‘new’ law demonstrates the Irish state’s continued political and medical control of abortion.
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Gerdts C, Jayaweera RT, Kristianingrum IA, Khan Z, Hudaya I. Effect of a smartphone intervention on self-managed medication abortion experiences among safe-abortion hotline clients in Indonesia: A randomized controlled trial. Int J Gynaecol Obstet 2020; 149:48-55. [PMID: 31834936 DOI: 10.1002/ijgo.13086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/31/2019] [Accepted: 12/11/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the impact of a smartphone application (app) providing information and support for medication abortion (MA) on the primary outcomes of 'feelings of support' and 'preparedness' among clients of Samsara, a safe-abortion hotline in Indonesia. METHODS In a parallel-arm, non-clinical, randomized controlled trial, women (ages ≥15) who contacted Samsara between February 2017- July 2018 seeking information on MA for pregnancies ≤13 weeks gestation were randomized to receive either an app with abortion information, or standard of care (high-quality comprehensive and empathic counseling on pregnancy options). Participants completed a questionnaire 24 days after enrollment; Fisher exact tests and risk differences were used to assess differences in self-reported feelings of preparedness and support throughout the process of self-managed MA. RESULTS No differences in feelings of support or preparedness were detected between participants in the app arm versus the standard of care arm. CONCLUSION This study represents the first-ever randomized control trial (and prospective study) among those who contacted a safe-abortion hotline for information about and support for self-managed abortion. Levels of preparedness, confidence, and feelings of support were all extremely high among both control and intervention arms-indicative of the high-quality, evidence-based information, comprehensive, and supportive abortion counseling that safe-abortion hotline clients receive.
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Affiliation(s)
| | - Ruvani T Jayaweera
- Ibis Reproductive Health, Oakland, CA, USA
- Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | | | - Zara Khan
- Ibis Reproductive Health, Oakland, CA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Sonalkar S, Schreiber CA. It is cost effective to improve the standard of care for women experiencing miscarriage. THE LANCET GLOBAL HEALTH 2019; 7:e1164-e1165. [DOI: 10.1016/s2214-109x(19)30314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Julia Hussein
- a Editor-in Chief, Reproductive Health Matters , London , UK
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Rogers C, Sapkota S, Paudel R, Dantas JAR. Medical abortion in Nepal: a qualitative study on women's experiences at safe abortion services and pharmacies. Reprod Health 2019; 16:105. [PMID: 31307474 PMCID: PMC6632190 DOI: 10.1186/s12978-019-0755-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. Methods Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. Results Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women’s personal, social and economic empowerment. Conclusions While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women. Electronic supplementary material The online version of this article (10.1186/s12978-019-0755-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Rogers
- International Health Programme, Faculty of Health Sciences, Curtin University, Perth, 6102, Western Australia.
| | | | - Rasmita Paudel
- Independent Health Research Consultant, Kathmandu, Nepal
| | - Jaya A R Dantas
- International Health Programme, Faculty of Health Sciences, Curtin University, Perth, 6102, Western Australia
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Fathalla MF. Safe abortion: The public health rationale. Best Pract Res Clin Obstet Gynaecol 2019; 63:2-12. [PMID: 31201007 DOI: 10.1016/j.bpobgyn.2019.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
It is now more than 50 years since the World Health Assembly recognized abortion as a serious public health problem. The challenge still stands. Addressing the problem of unsafe abortion is a national and global public health imperative, dictated by the magnitude of the problem and its impact on individuals and society, inequity of the burden of disease, and an international consensus of the global health community. Almost every abortion death and disability could be prevented through cost-effective public health interventions including sexuality education, use of effective contraception, provision of safe, legal induced abortion, and quality humane postabortion care. Safe abortion continues to be a challenge to public health because of diverse national restrictive legal regulations, prevailing stigma, and lack of political commitment. Health professionals have a social responsibility to educate policymakers, legislators, and the public at large about adverse impacts of restrictive abortion regulations, laws, and policies on women's health.
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Affiliation(s)
- Mahmoud F Fathalla
- Department of Obstetrics and Gynecology, Assiut University, P.O.Box.30, Assiut, Egypt.
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