Availability, Utilization, and Health Providers' Attitudes Towards Safe Abortion Services in Public Health Facilities of a District in West Bengal, India

Health care providers attitude towards safe abortion care and its associated factors in Northwest, Ethiopia, 2021: a health facility-based cross-sectional study

BACKGROUND

A negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia.

OBJECTIVE

This study aimed to assess health care provider's attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia.

METHODS

A health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant.

RESULTS

The response rate of the study was 99.3%, and 70.2% [95% CI: 65.6-74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25-29, 30-34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03-10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43-19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55-6.60], midwives [AOR = 6.50, 95% CI = 2.40-17.44], working at hospital [AOR = 4.77, 95% CI = 1.53-14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29-11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13-5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23-16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15-13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52-24.26] were associated with a favorable attitude towards safe abortion care.

CONCLUSIONS

Healthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units.

Determinants of Health Care Providers' Attitudes Toward Safe Abortion Care in Ethiopia: A Systematic Review and Meta-Analysis

Background

Unsafe abortion is a serious reproductive health problem in developing countries including Ethiopia. The attitude of healthcare providers toward abortion is one of contributing factors to unsafe abortion. This study aimed to determine the pooled effect of healthcare workers' attitudes toward safe abortion care and its determinants factors in Ethiopia.

Methods

Search engines such as Scopus, CINAHL, EMBASE, PubMed, Web of Science, and CAB Abstracts were used to find published studies where as Google and Google Scholar were used to find unpublished research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The analysis was performed using STATA 14 and the random-effects model was used to calculate the odds ratios of medical professionals' attitudes regarding safe abortion services. Study heterogeneity was assessed by using I2 and P-values. To evaluate the stability of pooled values to outliers and publication bias, respectively, sensitivity analysis and funnel plot were also performed.

Results

A total of 15 published and unpublished articles with a sample size of 4060 were incorporated in this Review. The overall pooled prevalence of this study was 56% (95% CI: 45-67). Sex of participants (AOR: 2.37; 95% CI: 1.57, 3.58), having training (AOR: 2.86; 95% CI: 1.58, 5.17), Professional type (AOR: 1.55; 95% CI: 1.04, 4.46), and knowledge of abortion law (AOR:2.26; 95% CI: 1.14, 4.46) were the determinants factors that significantly associated with health care workers' attitude toward safe abortion care. Sensitivity analysis shows that the pooled odds ratios were consistently stable throughout all meta-analyses, and the funnel plot shows no evidence of publication bias.

Conclusion

Half of health care providers sampled among the pooled studies have favorable attitudes toward abortion services in Ethiopia; which could hamper women's access to safe abortion care. Sex, training, type of profession, and knowing abortion law were determinants of health care workers' attitudes toward safe abortion services. Stakeholders should emphasize improving the attitude of healthcare workers toward safe abortion care which has a vital role in reducing maternal mortality. Moreover, working on modifiable factors like training, assigning personnel whose professions align with the service, and updating care providers about abortion law is also the essential key point to improve their intentions to deliver the services.

Patterns and Predictors of Abortion Care-Seeking Practices in India: Evidence From a Nationally Representative Cross-Sectional Survey (2019-2021)

Background India continues to have unsafe abortions despite progressive legislation since the past five decades facilitating ease of access to abortion services. This study describes abortion care-seeking patterns (social/therapeutic/humanitarian/sex-selective/safe/unsafe), preferences (public/private/at home), and their determinants among Indian women. Methods Data were taken from the Indian National Family and Health Survey (NFHS-5) (2019-2021) including women aged 15-49 years, who had terminated their last pregnancy by induced abortion within five years prior to the survey (N = 5,856). A bivariate analysis, followed by a multinomial logistic regression model, was performed to assess the predictors affecting the choice of healthcare facility type for an abortion. Predictors of unsafe and self-managed abortions were examined using binary logistic regression. Results About 665,671 women in the reproductive age group responded to the survey, of which 3.42% (n=22,767) reported their most recent pregnancy within the last five years terminated in either a miscarriage, stillbirth or abortion, of which 5,856 (25.72%) underwent an induced abortion. Women undergoing surgical abortion were more likely to avail of either a public (adjusted relative risk ratio (aRRR)=38.06 (23.62, 61.35)) or a private facility (aRRR=44.53 (28.11,70.53)) compared to at-home abortions. Women reporting a social and humanitarian reason for abortion were less likely to undergo an abortion at a public (aRRR=0.25 (0.17,0.35)) or private facility (aRRR=0.32 (0.23,0.44)) than at home. Furthermore, a total of 147 (2.43%) abortions were classified as unsafe. Women reporting sex-selective reasons for abortion were observed to have a higher likelihood of engaging in an unsafe abortion (adjusted odds ratio (aOR)= 1.61 (0.70, 3.70)) compared to those citing a therapeutic reason. Conclusions Self-managed abortions at home were more prevalent in women of lower socioeconomic status, adolescent girls, and those reporting sex-selective reasons for abortion. Furthermore, the reproductive-health program in India should enhance capacity-building initiatives for primary-care healthcare providers, including doctors, nurses, and pharmacists, to effectively prescribe and supervise abortion through medication methods.

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.