1
|
Ouedraogo R, Wanjiru S, Zan ML, Rossier C, Owolabi O, Athero S, Oduor C, Bangha M. "I always know she cannot betray me." Disclosure of abortion and methods of abortion used in informal settlements in Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003252. [PMID: 39018278 PMCID: PMC11253939 DOI: 10.1371/journal.pgph.0003252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/11/2024] [Indexed: 07/19/2024]
Abstract
Despite abortion being stigmatized and legally restricted in Kenya, women still disclose their abortions within their network. Evidence has shown how stigma can influence and regulate individual abortion disclosure decisions and behaviors. This paper seeks to understand why and how women make the decisions to disclose their abortion and the associated methods used. The data are from a qualitative formative study and a respondent-driven sampling survey conducted between 2020 and 2021 in two informal settlements in Nairobi, Kenya. The data were analyzed using a descriptive analysis approach for the quantitative data, and thematic analysis for the qualitative data. Our findings reveal that information sharing about abortion is enclosed in a social dynamic of secrecy. This dynamic contributes to making abortion a secret that respondents decided to share with confidants in 81% of the abortion cases. These confidants include intimate relationships such as trusted friends (62%), followed by female relatives. Information was shared in many cases either to get support (i.e. method to use), or because participants had close ties with the confidants. Regarding the methods used, unidentified pills were the most used regardless of the confidant; followed by traditional methods especially among those who sought help with their mothers/aunts/grandmothers (33%), while Medical Abortion and Manual Vacuum Aspiration were rarely used, mostly by those who confided in friends or sisters/cousins. Our findings show that the disclosure of abortion is a complex process embedded in existing codes regarding the circulation of information on sensitive issues and "help" seeking. Our findings show that the need for information on safe abortion and lack of financial resources frequently empowers them to overcome the fear of stigma and disclose their abortion. However, this often resulted in use of unsafe procedures. The findings suggest the need for strengthening the circulation of information on safe methods within communities, using community champions and intermediaries to increase the likelihood of women being directed through safe methods to enhance their use.
Collapse
Affiliation(s)
| | - Shelmith Wanjiru
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Moussa L. Zan
- Institut Supérieur des Sciences de la Population, Ouagadougou, Burkina Faso
| | | | - Onikepe Owolabi
- Guttmacher Institute, New York, New York, United States of America
| | - Sherine Athero
- African Population and Health Research Center, Nairobi, Kenya
| | - Clement Oduor
- African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
| | | |
Collapse
|
2
|
Mwadhi MK, Bangha M, Wanjiru S, Mbuthia M, Kimemia G, Juma K, Shirima J, Unda S, Achieng A, Both J, Ouedraogo R. Why do most young women not take up contraceptives after post-abortion care? An ethnographic study on the effectiveness and quality of contraceptive counselling after PAC in Kilifi County, Kenya. Sex Reprod Health Matters 2023; 31:2264688. [PMID: 37937821 PMCID: PMC10653685 DOI: 10.1080/26410397.2023.2264688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Post-abortion care (PAC) counselling and the provision of contraceptive methods are core components of PAC services. Nevertheless, this service is not uniformly provided to PAC patients. This paper explores the factors contributing to young women leaving health facilities without counselling and contraceptive methods. The paper draws from an ethnographic study conducted in Kilifi County, Kenya, in 2021. We conducted participant observation in health facilities and neighbouring communities, and held in-depth interviews with 21 young women aged 15-24 who received PAC. In addition, we interviewed 11 healthcare providers recruited from the public and private health facilities observed. Findings revealed that post-abortion contraceptive counselling and methods were not always offered to patients as part of PAC as prescribed in the PAC guidelines. When PAC contraceptive counselling was offered, certain barriers affected uptake of the methods, including inadequate information, coercion by providers and partners, and fears of side effects. Together, these factors contributed to repeat unintended pregnancies and repeat abortions. The absence of quality contraceptive counselling therefore infringes on the right to health of girls and young women. Findings underscore the need to strengthen the capacities of health providers on PAC contraceptive counselling and address their attitudes towards young female PAC patients.
Collapse
Affiliation(s)
- Mercy Kadzo Mwadhi
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- Associate Research Scientist, African Population and Health Research Center, Nairobi, Kenya
| | - Shelmith Wanjiru
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Mbuthia
- Communications Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kimemia
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Juma
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Shirima
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Shilla Unda
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Anne Achieng
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Jonna Both
- Senior Researcher, Rutgers, Utrecht, Netherlands
| | - Ramatou Ouedraogo
- Research Scientist, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
3
|
Ouedraogo R, Obure V, Kimemia G, Achieng A, Kadzo M, Shirima J, Dama SU, Wanjiru S, Both J. "I will never wish this pain to even my worst enemy": Lived experiences of pain associated with manual vacuum aspiration during post-abortion care in Kenya. PLoS One 2023; 18:e0289689. [PMID: 37619217 PMCID: PMC10449468 DOI: 10.1371/journal.pone.0289689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors. METHODS We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers. RESULTS Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls. CONCLUSION The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care.
Collapse
Affiliation(s)
| | - Valleria Obure
- African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kimemia
- African Population and Health Research Center, Nairobi, Kenya
| | - Anne Achieng
- African Population and Health Research Center, Nairobi, Kenya
| | - Mercy Kadzo
- African Population and Health Research Center, Nairobi, Kenya
| | - Jane Shirima
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | |
Collapse
|
4
|
Lahiri S, Bingenheimer J, Sedlander E, Munar W, Rimal R. The role of social norms on adolescent family planning in rural Kilifi county, Kenya. PLoS One 2023; 18:e0275824. [PMID: 36730329 PMCID: PMC9894424 DOI: 10.1371/journal.pone.0275824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Despite Kenya's encouraging progress in increasing access to modern contraception among youth, several barriers remain preventing large-scale efforts to reduce demand-side unmet need for family planning. Shifting social norms around the use and acceptability of modern contraception may represent a potent target for future interventions. However, the structure of normative influence on individual modern contraceptive use among youth needs to be determined. Therefore, our aim was to estimate the influence of individual and group-level normative influence on modern contraceptive use among adolescents from two villages in rural Kenya. METHODS Trained enumerators collected data from individuals aged 15-24 who provided oral informed consent, or parental informed consent, in two villages in rural Kilifi county. Participants completed a questionnaire related to modern contraceptive use and were asked to nominate one to five people (referents) with whom they spend free time. The enumerators photographed each individual who nominated at least one referent using Android phones and matched them with their nominated referents. Using this social network data, we estimated group-level normative influence by taking an average of referents' modern contraception use. We then explored associations between descriptive norms, injunctive norms, and network modern contraceptive use on individual modern contraceptive use, controlling for known confounders using logistic regression models. We also conducted sensitivity analyses to test a pattern of differential referent influence on individual modern contraceptive use. RESULTS There was a positive association between pro-modern contraception descriptive and injunctive norms and individual modern contraception use (adjusted Odds Ratio (aOR) = 1.29, 95% confidence interval (CI) = 1.05-1.6, and aOR = 1.31, CI = 1.06-1.62, respectively). Network modern contraceptive use was associated with individual use in the bivariate model (aOR = 2.57, CI = 1.6-4.12), but not in the multivariable model (aOR = 1.67, CI = 0.98-2.87). When stratified by sex and marital status, network modern contraceptive use was associated with individual modern contraceptive use among female participants (aOR = 2.9, CI = 1.31-6.42), and unmarried female participants (aOR = 5.26, CI = 1.34-20.69), but not among males. No interactive effects between norms variables were detected. Sensitivity analyses with a different estimate of network modern contraceptive use showed similar results. CONCLUSIONS Social norms are multilevel phenomena that influence youth modern contraceptive use, especially among young women in rural Kenya. Unmarried women with modern contraceptive users in their social network may feel less stigma to use contraception themselves. This may reflect gendered differences in norms and social influence effects for modern contraceptive use. Future research should investigate group-level normative influence in relation to family planning behaviors.
Collapse
Affiliation(s)
- Shaon Lahiri
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
- Philosophy, Politics and Economics Program, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Jeffrey Bingenheimer
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Erica Sedlander
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, United States of America
| | - Wolfgang Munar
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Rajiv Rimal
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
| |
Collapse
|
5
|
Sorhaindo AM, Lavelanet AF. Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care. Soc Sci Med 2022; 311:115271. [PMID: 36152401 PMCID: PMC9577010 DOI: 10.1016/j.socscimed.2022.115271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022]
Abstract
Abortion stigma shapes the environment in which abortion is delivered and received and can have important implications for quality in abortion care. However, this has not previously been clearly articulated and evidenced. We conducted a scoping review of existing qualitative evidence to characterize the relationship between abortion stigma and quality in abortion care. Using a systematic process, we located 50 qualitative studies to include in our analysis. We applied the interface of the WHO quality of care and abortion stigma frameworks to the qualitative evidence to capture manifestations of the interaction between abortion stigma and quality in abortion care in the existing literature. Four overarching themes linked to abortion stigma emerged: A) abortion as a sin and other religious views; B) regulation of abortion; C) judgement, labelling and marking; and D) shame, denial, and secrecy. We further characterized the emerging ways in which abortion stigma operates to inhibit quality in abortion care into seven manifestations of the relationship between abortion stigma and quality in abortion care: 1) poor treatment and the repercussions, 2) gatekeeping and obstruction of access, 3) avoiding disclosure, 4) arduous and unnecessary requirements, 5) poor infrastructure and lack of resources, 6) punishment and threats and 7) lack of a designated place for abortion services. This evidence complements the abortion stigma-adapted WHO quality of care framework suggested by the International Network for the Reduction of Abortion Discrimination and Stigma (inroads) by illustrating specifically how the postulated stigma-related barriers to quality abortion care occur in practice. Further research should assess these manifestations in the quantitative literature and contribute to the development of quality in abortion care indicators that include measures of abortion stigma, and the development of abortion stigma reduction interventions to improve quality in abortion care.
Collapse
Affiliation(s)
- Annik Mahalia Sorhaindo
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Antonella Francheska Lavelanet
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland
| |
Collapse
|
6
|
McLean KE. Contemplating abortion: a qualitative study of men and women’s reactions to unplanned pregnancy in Sierra Leone. CULTURE, HEALTH & SEXUALITY 2022; 25:444-458. [PMID: 35297735 DOI: 10.1080/13691058.2022.2052186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Globally, millions of unintended pregnancies result in unsafe abortions each year. In Sierra Leone, abortion-related complications are a major driver of maternal mortality. Despite these costs, women continue to seek unsafe abortions, yet how individuals understand the risks and benefits of pregnancy termination remains under-researched. This study seeks to understand perceptions of abortion by women and men experiencing unplanned pregnancy and to highlight factors that inform their abortion trajectories. Findings indicate that abortion was contemplated in response to anxieties regarding caring for a child, interruptions to schooling, and stigma associated with extra-marital pregnancy. While many women and men preferred not to abort-due to cultural values tied to parenthood-others faced obstacles stemming from lack of knowledge of and access to services. Findings can be used to inform interventions to support women and men in realising their fertility preferences in the face of unplanned pregnancy.
Collapse
|
7
|
Mbehero F, Momanyi R, Hesel K. Facilitating Uptake of Post-abortion Contraception for Young People in Kenya. Front Glob Womens Health 2022; 2:733957. [PMID: 35128527 PMCID: PMC8810546 DOI: 10.3389/fgwh.2021.733957] [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: 07/18/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, maternal mortality is unacceptably high, and unsafe abortion is the most easily preventable cause of maternal death. Post-abortion contraception, recognized as a High Impact Practice in Family Planning, can reduce rates of unintended pregnancies and unsafe abortion and ultimately save lives. Implementation of this, however, is limited, especially for young people. This case study documents strategies, results, and lessons learned from Planned Parenthood Global's project in South West Kenya, which improved access to and provision of comprehensive abortion care, including safe abortion, post-abortion care and post-abortion contraception, at 80 public and private health facilities. By prioritizing training and mentorship of mid-level providers on both medical and surgical abortion care, post-abortion contraception and youth friendly services, in addition to community engagement and referrals, this intervention removes common barriers to care for women and young people. Eighty-five percent of abortion care clients served by the project accepted same-day contraception, with the vast majority-including 90% of clients aged 24 and under-choosing long-acting reversible contraception. The Closing the Gap project was funded by an anonymous donor.
Collapse
Affiliation(s)
- Faith Mbehero
- Clinical Quality of Care Consultant: Planned Parenthood Global, Nairobi, Kenya
| | - Ruth Momanyi
- Program Learning Officer, Planned Parenthood Global, Africa Regional Office, Nairobi, Kenya
| | - Kate Hesel
- Director of Program Learning and Impact, Planned Parenthood Global, New York, NY, United States
| |
Collapse
|
8
|
Eboigbe E, Gadama L, Filippi V, Mehrtash H, Adu-Bonsaffoh K, Bello FA, Compaoré R, Dossou JP, Idi N, Kim CR, Msusa AT, Mugerwa KY, Wolomby-Molondo JJ, Tunçalp Ӧ, Calvert C. Adolescents' satisfaction with care for abortion-related complications in 11 Sub-Saharan African countries: A cross-sectional facility-based study. Int J Gynaecol Obstet 2021; 156 Suppl 1:63-70. [PMID: 34676896 DOI: 10.1002/ijgo.13896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess satisfaction with care for abortion-related complications experienced among adolescents compared to older women. METHODS A secondary analysis of the WHO Multi-Country Survey on Abortion-related Morbidity and Mortality-a cross-sectional study conducted in health facilities in 11 Sub-Saharan African countries. Women with abortion-related complications who participated in an audio computer-assisted self-interview were included. Two composite measures of overall satisfaction were created based on five questions: (1) study participants who were either satisfied or very satisfied across all five questions; and (2) study participants who reported being very satisfied only across all five questions. Multivariable general estimating equation analyses were conducted to assess whether there was any evidence that age (adolescents 12-19 years and older women 20+) was associated with each composite measure of satisfaction, controlling for key confounders. RESULTS The study sample consisted of 2817 women (15% adolescents). Over 75% of participants reported being satisfied or very satisfied for four out of five questions. Overall, 52.9% of study participants reported being satisfied/very satisfied across all five questions and 22.4% reported being consistently very satisfied. Multivariable analyses showed no evidence of an association between age group and being either satisfied or very satisfied (OR 1.07; 95% CI, 0.82-1.41, P = 0.60), but showed strong evidence that adolescents were 50% more likely to be consistently very satisfied with their overall care than older women (OR 1.49; 95% CI, 1.13-1.96, P = 0.005). CONCLUSION Both adolescents and older women reported high levels of satisfaction with care when looking at different components of care individually, but the results of the composite measure for satisfaction showed that many study participants reported being less than satisfied with at least one element of their care. Further studies to explore the expectations, needs, and values of women's satisfaction with care for abortion-related complications are needed.
Collapse
Affiliation(s)
| | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hedieh Mehrtash
- 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
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | | | - Rachidatou Compaoré
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Nafiou Idi
- Université Abdou Moumouni de Niamey, Niamey, Niger
| | - Caron R Kim
- 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
| | - Ausbert Thoko Msusa
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Ӧzge Tunçalp
- 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
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Baum SE, Wilkins R, Wachira M, Gupta D, Dupte S, Ngugi P, Makleff S. Abortion quality of care from the client perspective: a qualitative study in India and Kenya. Health Policy Plan 2021; 36:1362-1370. [PMID: 34133733 PMCID: PMC8505864 DOI: 10.1093/heapol/czab065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/30/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Quality healthcare is a key part of people's right to health and dignity, yet access to high-quality care can be limited by legal, social and economic contexts. There is limited consensus on what domains constitute quality in abortion care and the opinions of people seeking abortion have little representation in current abortion quality measures. In this qualitative study, we conducted 45 interviews with abortion clients in Mumbai, India, and in Eldoret and Thika, Kenya, to assess experiences with abortion care, definitions of quality and priorities for high-quality abortion care. Among the many aspects of care that mattered to clients, the client-provider relationships emerged as essential. Clients prioritized being treated with kindness, respect and dignity; receiving information and counselling that was personalized to their individual situation and reassurance and support from their provider throughout the entire abortion process, including follow-up after the abortion. Many clients also noted the importance of skilled providers and appropriate care. There were similarities across the two country contexts, yet there were some differences in how clients defined high-quality care; therefore, specific political and cultural influences must be considered when implementing measurement and improving person-centred quality of care. These domains, particularly interpersonal interactions, should be prioritized in India and Kenya when health systems, facilities and providers design person-centred measures for quality in abortion care.
Collapse
Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA 94612, USA
| | - Rebecca Wilkins
- International Planned Parenthood Federation, 4 Newhams Row, London SE1 3UZ, UK
| | - Muthoni Wachira
- International Planned Parenthood Federation/Africa Regional Office, Lenana/Galana Road Junction, PO Box 30234, Nairobi, Kenya
| | - Deepesh Gupta
- International Planned Parenthood Federation/South Asia Regional Office, 231 Okhla Industrial Estate, Phase-3, New Dehli-110020, India
| | - Shamala Dupte
- Family Planning Association of India, Nariman Point, Mumbai 400 021, India
| | - Peter Ngugi
- Family Health of Kenya, Mai Mahiu Road, Nairobi, Kenya
| | - Shelly Makleff
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA 94612, USA
| |
Collapse
|
10
|
Kafu C, Ligaga D, Wachira J. Exploring media framing of abortion content on Kenyan television: a qualitative study protocol. Reprod Health 2021; 18:12. [PMID: 33468185 PMCID: PMC7814727 DOI: 10.1186/s12978-021-01071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Media framing of abortion messages is an emerging field of research. However, little is known about how the news media frames abortion messages aimed at influencing adolescents' reproductive health choices. This study therefore seeks to investigate the framing of abortion in TV news items on three leading Kenyan TV outlets over a period of 3 years, understand Kenyan journalists' perceptions and experiences with abortion coverage, and to examine adolescents' perceptions and experiences with abortion coverage on Kenyan televised news media. METHODS This qualitative study which will be conducted in two sites-Nairobi and Uasin Gishu counties-in Kenya will purposively sample abortion news items from three leading media outlets aired between January 2016 to December 2019, for content analysis. Additionally, 12 journalists (9 reporters, 3 news editors) will be purposively sampled for Key Informant Interviews (KIIs) on journalist framing of abortion messages. Finally, convenience sampling will be used to select approximately 48 university-going adolescents for four Focus Group Discussions (FGDs)-2 female, 2 male- aimed at examining adolescents' perceptions and experiences with abortion coverage in the broadcast news media. The KIIs and FGDs will be audio-recorded, transcribed and translated. These data will be analyzed thematically. DISCUSSION This study moves beyond interrogating only media items to further exploring framing from the perspectives of media consumers and investigations in the process behind production of abortion messages. The study interrogates abortion messages aimed at younger demographics such as adolescents as well as the gendered differences of the effects of these abortion messages, an area barely explored. The study findings will be informative to those who wish to develop media that could be used to promote safe abortion as well as advocate for sexual reproductive health rights, especially among adolescents.
Collapse
Affiliation(s)
- Catherine Kafu
- Department of Media Studies, Faculty of Humanities, School of Literature, Language and Media, University of the Witwatersrand, Johannesburg, South Africa.
- Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, Kenya.
| | - Dina Ligaga
- Department of Media Studies, Faculty of Humanities, School of Literature, Language and Media, University of the Witwatersrand, Johannesburg, South Africa
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| |
Collapse
|
11
|
Espinoza C, Samandari G, Andersen K. Abortion knowledge, attitudes and experiences among adolescent girls: a review of the literature. Sex Reprod Health Matters 2020; 28:1744225. [PMID: 32284012 PMCID: PMC7888105 DOI: 10.1080/26410397.2020.1744225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Adolescent girls comprise a considerable proportion of annual abortion deaths, worldwide, with 15% of all unsafe abortions taking place among girls under 20 years of age. Despite recent global attention to the health and welfare of adolescent girls, little is known about their abortion experience, particularly of those under the age of 15 years. This review examines existing peer-reviewed and grey literature on abortion-related experiences of adolescent girls, paying particular attention to girls ages 10-14. In December 2019, the authors conducted a comprehensive search of five major online resource databases, using a two-part keyword search strategy for articles from 2003 to 2019. Of the original 3,100+ articles, 1,228 were individually screened and 35 retained for inclusion in the analysis. Findings show that while adolescent girls may have knowledge of abortion in general, they lack specific knowledge of sources of care and delay care-seeking due to the fear of stigma, lack of resources and provider bias. Adolescent girls do not experience higher rates of physical complications compared to older cohorts, but they are at risk of psychosocial harm. For girls ages 10-14, abortion experience may be compounded by pregnancy due to sexual abuse or transactional sex, and they face even more barriers to care than older adolescents in terms of provider bias and lack of agency. Adolescents have unique needs and experiences around abortion, which should be accounted for in programming and advocacy. Adolescent girls need information about safe abortion at an early age and a responsive and stigma-free health system.
Collapse
Affiliation(s)
- Cecilia Espinoza
- Ipas Senior Advocacy Advisor, Ipas, Chapel Hill, North Carolina, USA
| | | | - Kathryn Andersen
- Chief Scientific and Technical Officer, Ipas, Chapel Hill, North Carolina, USA
| |
Collapse
|
12
|
Sudhinaraset M, Landrian A, Afulani PA, Phillips B, Diamond-Smith N, Cotter S. Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya. BMC WOMENS HEALTH 2020; 20:208. [PMID: 32950052 PMCID: PMC7501655 DOI: 10.1186/s12905-020-01071-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
Background There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. Methods Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity. Results We developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability. Conclusions This validated scale will facilitate measurement and further research to better understand women’s experiences during abortion care and to improve the quality of women’s overall reproductive health experiences to improve health outcomes.
Collapse
Affiliation(s)
- May Sudhinaraset
- Community Health Sciences, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 650 Charles E Young Dr. S, Los Angeles, CA, USA
| | - Amanda Landrian
- Community Health Sciences, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 650 Charles E Young Dr. S, Los Angeles, CA, USA.
| | - Patience A Afulani
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Sun Cotter
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| |
Collapse
|
13
|
Ewnetu DB, Thorsen VC, Solbakk JH, Magelssen M. Still a moral dilemma: how Ethiopian professionals providing abortion come to terms with conflicting norms and demands. BMC Med Ethics 2020; 21:16. [PMID: 32046695 PMCID: PMC7014608 DOI: 10.1186/s12910-020-0458-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background The Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other. Method A qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. Results For the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals. Conclusions This study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education.
Collapse
Affiliation(s)
- Demelash Bezabih Ewnetu
- Department of Physiology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway
| | - Viva Combs Thorsen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Helge Solbakk
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway.
| |
Collapse
|
14
|
Izugbara C, Wekesah FM, Sebany M, Echoka E, Amo-Adjei J, Muga W. Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review. Health Care Women Int 2019; 41:732-760. [PMID: 31855511 DOI: 10.1080/07399332.2019.1703991] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
At the 1994 ICPD, sub-Saharan African (SSA) states pledged, inter alia, to guarantee quality post-abortion care (PAC) services. We synthesized existing research on PAC services provision, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and availability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-quality treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the existing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abortion reproductive health services in the context of PAC; and health care provider-community partnerships.
Collapse
Affiliation(s)
| | | | - Meroji Sebany
- International Center for Research on Women, Washington, D.C, USA
| | - Elizabeth Echoka
- Centre for Public Health Research, Kenya Medical Research Institute - KEMRI, Nairobi, Kenya
| | - Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Winstoun Muga
- African Population & Health Research Center, Nairobi, Kenya
| |
Collapse
|
15
|
Casey SE, Steven VJ, Deitch J, Dumas EF, Gallagher MC, Martinez S, Morris CN, Rafanoharana RV, Wheeler E. "You must first save her life": community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo. Sex Reprod Health Matters 2019; 27:1571309. [PMID: 31533559 PMCID: PMC7887765 DOI: 10.1080/09688080.2019.1571309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Structural barriers such as a restrictive legal environment, limited medical resources, and high-costs inhibit access to safe abortion in the Democratic Republic of the Congo (DRC); these barriers are exacerbated by two decades of conflict. Socio-normative barriers further complicate access to safe abortion and post-abortion care (PAC) in DRC, where fear of abortion-related stigma may lead women to avoid PAC services. Programme partners support the Ministry of Health to provide good quality contraceptive and PAC services in North and South Kivu, DRC. This paper presents results from focus group discussions that explored community members' attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members' attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context.
Collapse
Affiliation(s)
- Sara E Casey
- Director, RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Victoria J Steven
- Research Assistant, RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julianne Deitch
- Research Assistant, RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Erin Files Dumas
- Technical Advisor, Sexual and Reproductive Health and Rights, CARE USA, Atlanta, GA, USA
| | - Meghan C Gallagher
- Doctoral Candidate, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephanie Martinez
- Research Assistant, RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Catherine N Morris
- Research Assistant, RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Erin Wheeler
- Contraception and Abortion Care Advisor, International Rescue Committee, New York, NY, USA
| |
Collapse
|
16
|
Sudhinaraset M, Landrian A, Montagu D, Mugwanga Z. Is there a difference in women's experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services. PLoS One 2019; 14:e0225333. [PMID: 31765417 PMCID: PMC6876888 DOI: 10.1371/journal.pone.0225333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022] Open
Abstract
Little evidence exists on women's experiences of care during abortion care, partly due to limitations in existing measures. Moreover, globally, the development and rapid growth in the availability of medication abortions (MA) has radically changed the options for safe abortions for women. It is therefore important to understand how women's experiences of care may differ across medication and manual vacuum aspiration (MVA) abortions. This study uses a validated person-centered abortion care scale (categorized as low, medium, and high levels, with high levels representing the greatest level of person-centered care) to assess women's experiences of care undergoing medication abortions vs. MVA. This paper reports on a cross-sectional study of 353 women undergoing abortions at one of six family planning clinics in Nairobi County, Kenya in 2018. Comparing abortion types, we found that the MVA sample was more likely to report "high" levels of person-centered abortion care compared to the MA sample (36.3% vs. 23.0%, p = 0.005). No differences were detected with respect to Respectful and Supportive Care; however, the MVA sample was significantly more likely to report "high" levels of Communication and Autonomy compared to the MA sample (23.6% vs. 11.2%, p<0.0001). In multivariable ordered logistic regression, we found that the MVA sample had a 92% greater likelihood of reporting higher person-centered abortion care scores compared to MA clients (aOR1.92, CI: 1.17-3.17). Being employed and reporting higher self-rated health were associated with higher person-centered abortion care scores, while reporting higher levels of stigma were associated with lower person-centered abortion care scores. Our findings suggest that more efforts are needed to improve the domain of Communication and Autonomy, particularly for MA clients.
Collapse
Affiliation(s)
- May Sudhinaraset
- Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Amanda Landrian
- Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Dominic Montagu
- Institute for Global Health Sciences, University of California San Francisco, School of Medicine, San Francisco, CA, United States of America
| | | |
Collapse
|
17
|
The patient perspective: perceptions of the quality of the abortion experience. Curr Opin Obstet Gynecol 2019; 30:407-413. [PMID: 30299320 DOI: 10.1097/gco.0000000000000492] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Abortion services are essential in sexual and reproductive health and should be held to the same standards as other health services. Patient (or person)-centeredness is a key dimension of healthcare quality that incorporates the perspectives of patients in care provision. The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care. RECENT FINDINGS Considering person-centeredness in abortion care using dimensions of dignity, autonomy, privacy, communication, social support, supportive care and health facility environment allows for critical evaluation of data describing women's experiences with abortion and postabortion services. Review of the available literature shed light on the impact of social stigma, health policy and abortion restrictions on women's abortion experiences. SUMMARY Considering multiple domains and varied settings, current data suggest abortion services worldwide generally fail to provide person-centered care. Institutions and providers may be limited in their ability to provide patient-centered abortion care because of deeply embedded social stigma, institutional regulations and legal restrictions.
Collapse
|
18
|
Cleeve A, Nalwadda G, Zadik T, Sterner K, Klingberg-Allvin M. Morality versus duty - A qualitative study exploring midwives' perspectives on post-abortion care in Uganda. Midwifery 2019; 77:71-77. [PMID: 31255911 DOI: 10.1016/j.midw.2019.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care. DESIGN This was a qualitative study using individual in-depth interviews and an inductive thematic analysis. SETTING AND PARTICIPANTS Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings. FINDINGS The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.
Collapse
Affiliation(s)
- Amanda Cleeve
- Karolinska Institutet, Department of Women's and Children's Health, SE-171 77, Stockholm, Sweden.
| | - Gorette Nalwadda
- Department of Nursing, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Tove Zadik
- School of Education, Health and Social Sciences, Dalarna University, 791 88, Falun, Sweden
| | - Kathy Sterner
- School of Education, Health and Social Sciences, Dalarna University, 791 88, Falun, Sweden
| | - Marie Klingberg-Allvin
- Karolinska Institutet, Department of Women's and Children's Health, SE-171 77, Stockholm, Sweden; School of Education, Health and Social Sciences, Dalarna University, 791 88, Falun, Sweden.
| |
Collapse
|
19
|
Aantjes CJ, Gilmoor A, Syurina EV, Crankshaw TL. The status of provision of post abortion care services for women and girls in Eastern and Southern Africa: a systematic review. Contraception 2018; 98:S0010-7824(18)30094-5. [PMID: 29550457 DOI: 10.1016/j.contraception.2018.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To conduct a systematic review of the status of post-abortion care (PAC) provision in Eastern and Southern Africa with particular reference to reach, quality and costs of these services. STUDY DESIGN We searched Pubmed, EMBASE, Science Direct, POPLINE and Web of Science for articles published between 2000 and October 2017 presenting primary or secondary data from one or more countries in the region. RESULTS Seventy articles representing data from fourteen countries were abstracted and included in the review. Implementation of PAC services was found to be patchy across countries for which data was available. However, there is evidence of efforts to introduce PAC at lower level health facilities, to use mid-level providers and to employ less invasive medical techniques. Eleven countries from the region were not represented in this review, exposing a considerable knowledge gap over the state of PAC in the region. The disparate access for rural women and girls, the suboptimal service quality and the neglect of adolescent-specific needs were critical gaps in the current PAC provision. CONCLUSION PAC provision and research in this domain cannot be detached from the broader legal and societal context, as social stigma constitutes a major blockage to the advancement of the service. Adolescent girls are a particularly vulnerable and underserved group in the region. IMPLICATIONS The next generation research on PAC should favor multi-country and interdisciplinary study designs with a view to understanding inter-regional differences and supporting advancement towards universal access of PAC by 2030.
Collapse
Affiliation(s)
- Carolien J Aantjes
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban.
| | - Andrew Gilmoor
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, Vrije Universiteit Amsterdam
| | - Elena V Syurina
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, Vrije Universiteit Amsterdam
| | - Tamaryn L Crankshaw
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban
| |
Collapse
|