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Akilimali P, Moreau C, Byrne M, Kayembe D, Larson E, Bell SO. Estimating induced abortion incidence and the use of non-recommended abortion methods and sources in two provinces of the Democratic Republic of the Congo (Kinshasa and Kongo Central) in 2021: results from population-based, cross-sectional surveys of reproductive-aged women. Sex Reprod Health Matters 2023; 31:2207279. [PMID: 37216481 PMCID: PMC10208208 DOI: 10.1080/26410397.2023.2207279] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
The changing abortion legal and practice landscape in the DRC in recent years calls for a re-examining of induced abortion experiences. The current study provides population-level estimates of induced abortion incidence and safety by women's characteristics in two provinces using direct and indirect approaches to assess indirect method performance. We use representative survey data on women aged 15-49 in Kinshasa and Kongo Central collected from December 2021 to April 2022. The survey had questions on respondents' and their closest friends' experience with induced abortion, including methods and sources used. We estimated one-year abortion incidence and proportion using non-recommended methods and sources overall and by background characteristics for each province separately for respondents and friends. The fully adjusted one-year friend abortion rate was 105.3 per 1000 women of reproductive age in Kinshasa and 44.3 per 1000 in Kongo Central in 2021; these were substantially higher than corresponding respondent estimates. Women earlier in their reproductive lifespan were more likely to have had a recent abortion. Approximately 17.0% of abortions in Kinshasa and one-third of abortions in Kongo Central involved non-recommended methods and sources according to respondent and friend estimates. The more accurate friend abortion incidence estimates indicate that women in the DRC often rely on abortion to regulate their fertility. Many use non-recommended means and sources to terminate, thus, significant work remains to actualise the commitments made in the Maputo Protocol to provide comprehensive reproductive health services that combine primary and secondary prevention services to reduce unsafe abortion and its consequences.
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Affiliation(s)
- Pierre Akilimali
- Professor, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC
| | - Caroline Moreau
- Associate Professor, 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, VillejuifF-94800, France
| | - Meagan Byrne
- Senior Program Officer, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dynah Kayembe
- Field Coordinator, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC
| | - Elizabeth Larson
- PhD Student, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suzanne O. Bell
- Assistant Professor, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sheehy G, Omoluabi E, OlaOlorun FM, Mosso R, Bazié F, Moreau C, Bell SO. A mixed-methods study exploring women's perceptions of terminology surrounding fertility and menstrual regulation in Côte d'Ivoire and Nigeria. Reprod Health 2021; 18:251. [PMID: 34930322 PMCID: PMC8686364 DOI: 10.1186/s12978-021-01306-5] [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] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background Women use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences (specifically menstrual regulation and pregnancy removal), and the specific scenarios that these practices encompass among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and Côte d’Ivoire. Methods Our analysis draws upon surveys with women in Nigeria (n = 1114) and Cote d’Ivoire (n = 352). We also draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States in Nigeria, and Abidjan, Cote d’Ivoire (n = 30 in both countries). We examine survey and interview questions that explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis. Results We find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy. Conclusions Overall, menstrual regulation and pregnancy removal are seen as distinct experiences in both settings. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01306-5. Women use various words and phrases to describe their experiences managing their fertility and menstrual irregularities, and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology women use to refer to abortion-like experiences (specifically menstrual regulation, which refers to actions taken to regulate a menstrual cycle, and pregnancy removal), and the specific scenarios that these practices encompass among women who reported having had an abortion in Côte d’Ivoire and Nigeria. Our analysis draws upon data from surveys and qualitative interviews conducted in both countries. We find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs.
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Affiliation(s)
- Grace Sheehy
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Elizabeth Omoluabi
- Centre for Research, Evaluation Resources and Development, Ile-Ife, Nigeria.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | | | - Rosine Mosso
- École Nationale Supérieure de Statistique et d'Économie Appliquée d'Abidjan (ENSEA), Abidjan, Côte d'Ivoire
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Tesfaye B, Tewabe M, Ferede A, Dawson A. Induced Second Trimester Abortion and Associated Factors at Debre Markos Referral Hospital: Cross-Sectional Study. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520929546. [PMID: 32578513 PMCID: PMC7315676 DOI: 10.1177/1745506520929546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion. OBJECTIVE The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors. RESULT Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41-17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16-32.76) were associated with induced second trimester abortion. CONCLUSION This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.
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Affiliation(s)
- Bekele Tesfaye
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mesenbet Tewabe
- Department of Medicine, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Aster Ferede
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Angela Dawson
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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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.
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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
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Abstract
Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015-16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15-49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015-16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.
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Sayami JT. Trends in Comprehensive Abortion Care (CAC) and characteristics of women receiving abortion care in a tertiary hospital in Nepal. BMC WOMENS HEALTH 2019; 19:41. [PMID: 30819171 PMCID: PMC6393986 DOI: 10.1186/s12905-019-0739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 02/21/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND One of the leading cause of maternal mortality and morbidity is unsafe abortion. Globally 55.7million of abortions occurred each year between 2010 and 2014. In lower resource countries 24.3 million abortions were unsafe which is significantly higher. Nepal is one of the lower resource countries among others. Comprehensive abortion care (CAC) service can reduce this burden among women. METHODS A retrospective review of CAC service register at Tribhuvan University Teaching Hospital (TUTH) was conducted to collect data from 2006 to2015 with approval from the Nursing Department to identify the trends of CAC service delivery, client characteristics, category of service providers, and reason for seeking CAC services, its effectiveness and complications. The data was entered in SPSS software and descriptive analysis was performed. RESULTS A total of 2367 women received CAC in ten years period showing similar trend as 272-275 cases per year. Women's mean age was 28.4 years, 34% attained secondary level education and 98.9% were married. 70% were house wives and 84% multi gravid. The gestational period varied from 5 to 12 weeks. 85.6% had Manual Vacuum Aspiration (MVA) and 14.4% had Medical Abortion (MA). Only 37.6% women used any method of post abortion contraception. Unwanted pregnancy was the commonest reason for CAC. A majority of service providers were doctors (62.4%). The nurses were equally competent to provide CAC service as doctors. CONCLUSIONS The number of women receiving CAC was relatively constant over the ten-year period. Nurses should be promoted for providing CAC services to cover a larger population in need.
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Affiliation(s)
- Jamuna Tamrakar Sayami
- Cardio Thoracic Vascular and Transplant Center (MCTVC), Tribhuvan University Teaching Hospital Complex, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
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Zulu JM, Ali J, Hallez K, Kass N, Michelo C, Hyder AA. Ethics challenges and guidance related to research involving adolescent post-abortion care: a scoping review. Reprod Health 2018; 15:71. [PMID: 29720276 PMCID: PMC5930754 DOI: 10.1186/s12978-018-0515-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/24/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction An increase in post abortion care (PAC) research with adolescents, particularly in low- and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature. Methods Following a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges. Results The literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers. Conclusion Addressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international levels. Overall, despite the documentation of challenges in the published literature, guidance on handling several of these ethics challenges is sparse. We encourage further research to clarify the identified challenges and support the development of formal guidance in this area.
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Affiliation(s)
- Joseph M Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
| | - Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kristina Hallez
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Nancy Kass
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Charles Michelo
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Adnan A Hyder
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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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.
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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
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Kyilleh JM, Tabong PTN, Konlaan BB. Adolescents' reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:6. [PMID: 29361947 PMCID: PMC5782392 DOI: 10.1186/s12914-018-0147-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Ghana, adolescents constitute about a quarter of the total population. These adolescents make reproductive health decisions and choices based on their knowledge and the availability of such choices. These reproductive health decisions and choices can either negatively or positively affect their lives. This study therefore explored adolescents' reproductive health knowledge and choices, the type of choices they make and the factors that affect these choices. METHODS This qualitative study adopted a narrative approach to qualitative enquiry. Eight focus group discussions (N = 80) were conducted among both in-school and out-of-school adolescents aged 10-19 years. The discussions were stratified by sex and studentship. In addition, nine in-depth interviews were conducted with various stakeholders in reproductive health services and community opinion leaders. Both the focus group discussions and in-depth interviews were recorded, transcribed and analysed using NVivo 11. Thematic analysis was employed in analysing data. RESULTS The study found that knowledge on reproductive health choices was low among respondents with majority of them relying on their peers for information on sexual and reproductive health. Having a sexual partner(s) and engaging in premarital sex was common and viewed as normal. Adolescents engaged in unprotected sexual practices as a way of testing their fertility, assurance of love, bait for marriage and for livelihood. Inserting herbs into the vagina, drinking concoctions and boiled pawpaw leaves were identified as local methods employed by adolescents to induce abortion. Reproductive health services were available in the community but received low utilization because of perceived negative attitude of health workers, confidentiality and social norms. CONCLUSIONS Adolescents in this study generally engaged in risky reproductive health choices that can negatively affect their reproductive health. Adolescents in this part of Ghana have challenges utilizing available reproductive health services because of socio-cultural and health system barriers.
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Affiliation(s)
| | | | - Benson Boinkum Konlaan
- Department of Community Health and Family Medicine, University for Development Studies, Tamale, Ghana
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Guillaume A, Rossier C. L’avortement dans le monde. État des lieux des législations, mesures, tendances et conséquences. POPULATION 2018. [DOI: 10.3917/popu.1802.0225] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Legal rights to safe abortion: knowledge and attitude of women in North-West Ethiopia toward the current Ethiopian abortion law. Public Health 2017; 148:129-136. [PMID: 28482320 DOI: 10.1016/j.puhe.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/09/2017] [Accepted: 03/31/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess women's knowledge and attitude toward Ethiopian current abortion law. STUDY DESIGN A quantitative, community-based cross-sectional survey. METHODS Women of reproductive age in three selected lower districts in Bahir Dar, North-West Ethiopia, were included. Multi-stage simple random sampling and simple random sampling were used to select the districts and respondents, respectively. Data were collected using a structured questionnaire comprising questions related to knowledge and attitude toward legal status of abortion and cases where abortion is currently allowed by law in Ethiopia. Descriptive statistics were used to summarize the data and multivariable logistic regression computed to assess the magnitude and significance of associations. RESULTS Of 845 eligible women selected, 774 (92%) consented to participate and completed the interview. A total of 512 (66%) women were aware of the legal status of the Ethiopian abortion law and their primary sources of information were electronic media such as television and radio (43%) followed by healthcare providers (38.7%). Among women with awareness of the law, 293 (57.2%) were poor in knowledge, 188 (36.7%) fairly knowledgeable, and 31 (6.1%) good in knowledge about the cases where abortion is allowed by law. Of the total 774 women included, 438 (56.5%) hold liberal and 336 (43.5%) conservative attitude toward legalization of abortion. In the multivariable logistic regression, age had a significant association with knowledge, whereas occupation had a significant association with attitude toward the law. Women who had poor knowledge toward the law were more likely to have conservative attitude toward the law (adjusted odds ratio, 0.40; 95% confidence interval, 0.23-0.61). CONCLUSION Though the Ethiopian criminal code legalized abortion under certain circumstances since 2005, a significant number of women knew little about the law and several protested legalization of abortion. Countries such as Ethiopia with high maternal mortality records need to lift high-impact interventions that would trigger women to understand and exercise their legal rights to safe abortion and other reproductive health securities.
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Dawson A, Bateson D, Estoesta J, Sullivan E. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia. BMC Health Serv Res 2016; 16:612. [PMID: 27770797 PMCID: PMC5075393 DOI: 10.1186/s12913-016-1846-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. METHODS We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. RESULTS This review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. CONCLUSIONS Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.
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Affiliation(s)
- Angela Dawson
- Faculty of Health, University of Technology, Sydney (UTS), P.O. Box 123, Ultimo, NSW 2007, Sydney, NSW Australia
| | - Deborah Bateson
- Discipline, Gynaecology and Neonatology, University of Sydney, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Jane Estoesta
- Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Elizabeth Sullivan
- Public Health, Faculty of Health, University of Technology, Sydney (UTS), Jones Street, Sydney, NSW Australia
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Gebrehiwot Y, Fetters T, Gebreselassie H, Moore A, Hailemariam M, Dibaba Y, Bankole A, Getachew Y. Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 42:121-130. [PMID: 28825903 PMCID: PMC5568644 DOI: 10.1363/42e1916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care-i.e., legal abortion and treatment of abortion complications-changed over time. METHODS Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities-some of which provide abortion care-to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014. RESULTS The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception. CONCLUSIONS Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved.
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Affiliation(s)
- Yirgu Gebrehiwot
- associate professor and consultant obstetrician/gynecologist, Faculty of Medicine, Addis Ababa University, Ethiopia,
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Bonnen KI, Tuijje DN, Rasch V. Determinants of first and second trimester induced abortion - results from a cross-sectional study taken place 7 years after abortion law revisions in Ethiopia. BMC Pregnancy Childbirth 2014; 14:416. [PMID: 25622947 PMCID: PMC4307197 DOI: 10.1186/s12884-014-0416-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/05/2014] [Indexed: 11/13/2022] Open
Abstract
Background In 2005 Ethiopia took the important step to protect women’s reproductive health by liberalizing the abortion law. As a result women were given access to safe pregnancy termination in first and second trimester. This study aims to describe socio-economic characteristics and contraceptive experience among women seeking abortion in Jimma, Ethiopia and to describe determinants of second trimester abortion. Methods A cross-sectional study conducted October 2011 - April 2012 in Jimma Town, Ethiopia among women having safely induced abortion and women having unsafely induced abortion. In all 808 safe abortion cases and 21 unsafe abortion cases were included in the study. Of the 829 abortions, 729 were first trimester and 100 were second trimester abortions. Bivariate and multivariate logistic regressions were used to determine risk factors associated with second trimester abortion. The associations are presented as odds ratios (OR) with 95% confidential intervals. Age stratified analyses of contraceptive experience among women with first and second trimester abortions are also presented. Results Socio-economic characteristics associated with increased ORs of second trimester abortion were: age < 19 years, being single, widowed or divorced, attending school, being unemployment, being nullipara or para 3+, and having low education. The contraceptive prevalence rate varied across age groups and was particularly low among young girls and young women experiencing second trimester abortion where only 15% and 19% stated they had ever used contraception. Conclusion Young age, poor education and the prospect of single parenthood were associated with second trimester abortion. Young girls and young women were using contraception comparatively less often than older women. To ensure women full right to control their fertility in the setting studied, modern contraception should be made available, accessible and affordable for all women, regardless of age.
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Affiliation(s)
| | | | - Vibeke Rasch
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark.
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