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Malek M, Homer CS, McDonald C, Hannon CM, Moore P, Wilson AN. Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences. BMC Pregnancy Childbirth 2024; 24:112. [PMID: 38321392 PMCID: PMC10845525 DOI: 10.1186/s12884-024-06299-0] [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: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.
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Affiliation(s)
- Mary Malek
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | | | - Clare McDonald
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Catherine M Hannon
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paddy Moore
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Alyce N Wilson
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia.
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Khachidze N, Manjavidze T, Anda EE, Nedberg IH, Sandøy IF, Rylander C. The impact of COVID-19-related restrictions on pregnancy and abortion rates in the Republic of Georgia. BMC Health Serv Res 2023; 23:1435. [PMID: 38110928 PMCID: PMC10729579 DOI: 10.1186/s12913-023-10417-7] [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: 03/01/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The Republic of Georgia implemented COVID-19-related restrictions starting on 31 March 2020, when it imposed a 1-month strict lockdown, after which the country continued with some form of restrictions for 1 year. These restrictions created barriers to healthcare access, affected healthcare services, caused severe economic degradation, and changed reproductive behavior. The aim of this study was to explore the impact of COVID-19-related restrictions on pregnancy and abortion rates in Georgia. METHODS Information on pregnancy, abortion, and related variables was extracted from the Georgian Birth Registry from January 2018 through April 2022. The final study sample included 232,594 pregnancies and 86,729 abortions. We used interrupted time series analysis to study the impact of COVID-19-related restrictions. RESULTS There were slightly decreasing trends in pregnancy and abortion rates in the pre-pandemic period (1 January 2018-31 March 2020). During the 1-month strict lockdown (1 April-30 April 2020), pregnancy and abortion rates decreased in all investigated age groups. There were no substantial differences in pregnancy or abortion rates in the pandemic period (for pregnancies: 1 April 2020-30 June 2021; for abortions: 1 April 2020-30 April 2022) compared to the pre-pandemic period. The precision of all estimates suggested that both small increases and decreases in pregnancy and abortion rates are reasonably compatible with our data. CONCLUSIONS Despite the 1-year-long COVID-19-related restrictions, our results did not indicate substantial long-term changes in pregnancy or abortion rates during the study period for any age group. This may indicate that the restrictions did not substantially influence access to contraception, abortion services, or reproductive behavior.
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Affiliation(s)
- Nia Khachidze
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Tinatin Manjavidze
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ingvild Fossgard Sandøy
- Center for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Vazzano A, Briggs S, Kim L, Parekh J, Manlove J. Adapting Family Planning Service Delivery in Title X and School-Based Settings during COVID-19: Provider and Staff Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3592. [PMID: 36834286 PMCID: PMC9963328 DOI: 10.3390/ijerph20043592] [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: 12/23/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic introduced urgent and unique challenges to family planning providers and staff in ensuring continued access to high-quality services, particularly for groups who experience greater barriers to accessing services, such as women with systemically marginalized identities and adolescents and young adults (AYA). While research has documented key adaptations made to service delivery during the early phase of the pandemic, limited studies have used qualitative methods. This paper draws on qualitative interview data from family planning providers and staff in Title-X-funded clinics and school-based clinics-two settings that serve populations that experience greater barriers to accessing care-to (a) describe the adaptations made to service delivery during the first year of the pandemic and (b) explore provider and staff experiences and impressions implementing these adaptations. In-depth interviews were conducted with 75 providers and staff between February 2020 and February 2021. Verbatim transcripts were analyzed via inductive content analysis followed by thematic analysis. Four key themes were identified: (1) Title-X- and school-based staff made multiple, concurrent adaptations to continue family planning services; (2) providers embraced flexibility for patient-centered care; (3) school-based staff faced unique challenges to reaching and serving youth; and (4) COVID-19 created key opportunities for innovation. The findings suggest several lasting changes to family planning service delivery and provider mindsets at clinics serving populations hardest hit by the pandemic. Future studies should evaluate promising practices in family planning service delivery-including telehealth and streamlined administrative procedures-and explore how these are experienced by diverse patient populations, particularly AYA and those in areas where privacy or internet access are limited.
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Affiliation(s)
- Andrea Vazzano
- Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA
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Steiner RJ, Zapata LB, Curtis KM, Whiteman MK, Carvalho Guimarães MA, Fasula AM, Tromble EE, Brittain AW, Nguyen A. Is the COVID-19 Pandemic Continuing to Impact Sexual and Reproductive Health Services for Adolescents? Findings From a 2021 Survey of US Physicians. J Adolesc Health 2023; 72:696-702. [PMID: 36775748 PMCID: PMC9916602 DOI: 10.1016/j.jadohealth.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE We examined the impact of the COVID-19 pandemic in Fall 2021 on sexual and reproductive health (SRH) services among physicians whose practice provided these services to adolescents just before the pandemic. METHODS Data were from the DocStyles online panel survey administered September-November 2021 to US physicians who reported their practice provided SRH services to adolescent patients before the pandemic (n = 948). We calculated prevalence of service delivery challenges (e.g., limited long-acting reversible contraception services) and use of strategies to support access (e.g., telehealth) in the month prior to survey completion, compared these estimates with prevalence "at any point during the COVID-19 pandemic", and examined differences by physician specialty and adolescent patient volume. RESULTS Fewer physicians reported their practice experienced service delivery challenges in the month prior to survey completion than at any point during the pandemic. About 10% indicated limited long-acting reversible contraception and sexually transmitted infection testing services in the prior month overall; prevalence varied by physician specialty (e.g., 26% and 17%, respectively by service, among internists). Overall, about 25% of physicians reported reductions in walk-in hours, weekend/evening hours, and adolescents seeking care in the prior month. While most practices that initiated strategies supporting access to services during the pandemic used such strategies in the prior month, some practices (22%-37% depending on the strategy) did not. DISCUSSION Findings suggest some physicians who serve adolescents continued to experience challenges providing SRH services in the Fall 2021, and some discontinued strategies to support access that had been initiated during the pandemic.
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Affiliation(s)
- Riley J. Steiner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia,Address correspondence to: Riley J. Steiner, M.P.H., Ph.D., Senior Director, Research and Evaluation, Power to Decide
| | - Lauren B. Zapata
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Kathryn M. Curtis
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Maura K. Whiteman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | | | - Amy M. Fasula
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Erin E. Tromble
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | - Anna W. Brittain
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Antoinette Nguyen
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Bukuluki P, Kisaakye P, Mulekya F, Mushomi J, Mayora C, Palattiyil G, Sidhva D, Nair H. Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda. J Glob Health 2022; 12:04065. [PMID: 35972848 PMCID: PMC9380899 DOI: 10.7189/jogh.12.04065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders. Methods Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19. Results Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts. Conclusions Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Francis Mulekya
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - John Mushomi
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Chrispus Mayora
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - George Palattiyil
- Department of Social Work, School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | - Dina Sidhva
- Department of Social Work, School of Education and Social Sciences, University of the West of Scotland, Paisley, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
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