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Shochet T, Berro Pizzarossa L, Larrea S, Blum J, Jelinska K, Comendant R, Sagaidac I. Self-managed abortion via the internet: Analysis of one year of service delivery data from Women Help Women. Gates Open Res 2023; 7:41. [PMID: 37123048 PMCID: PMC10130357 DOI: 10.12688/gatesopenres.14369.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
Background: To better comprehend the demand for online medication abortion and to inform service delivery practice, we conducted an analysis of Women Help Women (WHW) service delivery statistics. The primary goals were to understand their user profile, evaluate self-reported outcomes and use of other medical services, and assess the overall experience both with the abortion itself and with the counseling and care provided by WHW. Methods: We retrospectively evaluated user characteristics, abortion outcomes, and acceptability of both the medication abortion and WHW’s services, using consultation data and corresponding evaluation data from a one-year period. For users who did not complete the evaluation form, WHW staff reviewed email correspondences to identify key outcomes. Results: From August 2016-July 2017, 3,307 individuals received abortion pills from WHW. Users were geographically located in thirty countries and correspondence was conducted in seven languages. Most reported their gestational age to be less than eight weeks. Of the 2,295 who took the pills and provided outcome information, almost all (99.1%, n=2275) reported that they were no longer pregnant. The majority (84.1%, n=1576/1875) used symptoms to confirm outcome; one fourth (22.8%, n=428) sought an ultrasound and one sixth (18.0%, n=338) used urine and/or serum testing. One in eight users (12.6%, n=292/2317) reported seeking additional medical care after taking the abortion pills. Most (87.5%, n=1551/1773) reported being satisfied or very satisfied with the abortion. Conclusions: Our study confirms that self-managed abortion is a process that people can do safely and effectively with community support and without medical supervision. In the context of a global backlash against abortion rights, self-managed abortion is an integral part of a spectrum of options for abortion care that must be made available to all.
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Affiliation(s)
| | | | - Sara Larrea
- Women Help Women, Amsterdam, The Netherlands
- Independent Researcher, Amstersdam, The Netherlands
| | | | | | - Rodica Comendant
- Women Help Women, Amsterdam, The Netherlands
- Reproductive Health Training Center, Chisinau, Moldova
| | - Irina Sagaidac
- Women Help Women, Amsterdam, The Netherlands
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
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Rossier C, Owolabi O, Kouanda S, Bangha M, Kim CR, Ganatra B, Feehan D, Breen C, Zan M, Compaoré R, Baguiya A, Ouédraogo R, Oduor C, Bagnoa V, Athero S. Describing the safety of abortion at the population level using network-based survey approaches. Reprod Health 2022; 19:231. [PMID: 36575489 PMCID: PMC9795788 DOI: 10.1186/s12978-022-01518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. OBJECTIVE This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. METHODS This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. DISCUSSION This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.
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Affiliation(s)
- Clémentine Rossier
- Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d'Arve, 1211, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | - Onikepe Owolabi
- grid.417837.e0000 0001 1019 058XGuttmacher Institute, New York, USA
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | - Martin Bangha
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Caron R. Kim
- grid.3575.40000000121633745UNDP/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, WHO, Geneva, Switzerland
| | - Bela Ganatra
- grid.3575.40000000121633745UNDP/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, WHO, Geneva, Switzerland
| | - Dennis Feehan
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Casey Breen
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Moussa Zan
- grid.8591.50000 0001 2322 4988Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d’Arve, 1211 Geneva, Switzerland
| | | | - Adama Baguiya
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | | | - Clement Oduor
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Vincent Bagnoa
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
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Rossier C, Marchin A, Kim C, Ganatra B. Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review. Reprod Health 2021; 18:114. [PMID: 34098958 PMCID: PMC8186048 DOI: 10.1186/s12978-021-01165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited. Main body This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others. Conclusion Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01165-0. Women seeking an induced abortion in LMICs often face inexistent or inadequate, difficult to find and/ or stigmatizing legal services, leading to the use of informal methods and providers, and unsafe abortions. A growing number of studies have shown that abortion seekers contact social network members beyond their intimate circle when seeking care. However, results have been inconsistent. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in restrictive LMICs. We screened 4101 references, yielding 79 articles with data from 33 countries for extraction. We grouped countries (or social groups within countries) into four types of settings: (1) anonymous access possible, hyper stigma; (2) anonymous access possible, high stigma; (3) non-anonymous access, high stigma; (4) non-anonymous access, hyper stigma. Most studies fitted Type 3. Disclosing to network members increased across setting types: no women confided in network members in Type 1 settings, a minority in Type 2 and a majority in Type 3. No setting fitted Type 4. The informal use of medical abortion did not modify disclosure to others. Abortion seekers in restrictive LMICs frequently contact their social network in some settings/groups but less frequently in others, depending on the availability of anonymous access to abortion care and the level of stigma. This knowledge is useful for designing interventions to improve information on safe abortion and for developing network-based data collection strategies.
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Affiliation(s)
- Clémentine Rossier
- Université de Genève, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | | | - Caron Kim
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Kerestes C, Sheets K, Stockdale CK, Hardy-Fairbanks AJ. Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health clinics. Sex Reprod Health Matters 2020; 27:1571311. [PMID: 31533561 PMCID: PMC7887767 DOI: 10.1080/09688080.2019.1571311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the setting of increasing restrictions to legal abortion in the United States, reports have emerged of self-induced termination of pregnancies with misoprostol, obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion, and how they access information. In a cross-sectional study of women immediately following their abortion at three reproductive health clinics in the Midwestern United States, an anonymous survey queried gestational age, barriers, online investigation about self-induction and opinions concerning the availability of medical abortion. From June to September 2016, 276 women participated out of 437 presenting to the clinics during the study period. One hundred and ninety-one (74.6%) women had investigated abortion options online, and of those, 58 (30.9%) investigated misoprostol online, for home use. Women who investigated online options were less likely to have had a prior abortion than those who did not investigate online (29.3% vs. 63.1%, p < .01). They were also more likely to report prior home attempts to end this pregnancy (8.6% vs. 0%, p = .05). Overall, four (1.6%) of the respondents purchased misoprostol and three (1.2%) used it. A majority of women seeking an abortion sought online information prior to their clinic appointment, and almost a third of those had investigated misoprostol for home use. Women are accessing information regarding misoprostol for self-induction of abortion on the Internet. As barriers to legal abortion increase, women may be more likely to self-induce abortion.
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Affiliation(s)
- Courtney Kerestes
- Resident Physician, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - Kelsey Sheets
- Medical student/researcher, University of Iowa Carver College of Medicine , Iowa City , IA , USA
| | - Colleen K Stockdale
- Clinical Professor, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - Abbey J Hardy-Fairbanks
- Associate Clinical Professor, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
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Moseson H, Herold S, Filippa S, Barr-Walker J, Baum SE, Gerdts C. Self-managed abortion: A systematic scoping review. Best Pract Res Clin Obstet Gynaecol 2019; 63:87-110. [PMID: 31859163 DOI: 10.1016/j.bpobgyn.2019.08.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Stephanie Herold
- Advancing New Standards in Reproductive Health, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Sofia Filippa
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Jill Barr-Walker
- Zuckerberg San Francisco General (ZSFG) Library, University of California, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Sarah E Baum
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin Street, Oakland, CA, 94612, USA.
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Bokek-Cohen Y. Jewish Law, Scarcity of Sperm Donors and the Consequent Private Import of Sperm of Non-Jews by Israeli Women. Gynecol Obstet Invest 2015; 81:000435880. [PMID: 26305452 DOI: 10.1159/000435880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/11/2015] [Indexed: 11/19/2022]
Abstract
AIM The objective of this article is to explore how Israeli Jewish women cope with the religious prohibition on sperm donation and the scarcity of Israeli donors, and to estimate the number of available sperm donors in Israel. METHODS A key word search was employed to retrieve relevant Hebrew and English sources; additional information was collected via interviews with two sperm donors and twelve donor insemination patients. RESULTS Rabbinical instructions focus on married women and refrain from acknowledging the growing number of non-married donor insemination patients. Non-married women follow the restrictions relevant to married women and hence refrain from purchasing Jewish sperm. Israeli sperm banks offer donations of Jewish donors whose number is estimated at a maximum of 140 and a minimum of 50 for the entire Jewish population of 6.2 million. In order to abide by American Society for Reproductive Medicine recommendations, the number of available donors should optimally be six times larger. The scarcity of sperm donors drives the private import of American sperm donations. CONCLUSION Reconsideration of the rabbinical prohibition to allow collecting sperm for donating to women who wish to have a baby is needed for the sake of increasing the donor pool, along with measures to ensure donors' privacy and dignity. © 2015 S. Karger AG, Basel.
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Iftikhar R, Aba Al Khail BA. Knowledge about missed contraceptive pills among married women at King Abdulaziz University Hospital. Patient Prefer Adherence 2015; 9:401-11. [PMID: 25792813 PMCID: PMC4362980 DOI: 10.2147/ppa.s67171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral contraceptive pills (OCPs) are one of the most reliable methods of contraception. However, lack of knowledge about oral contraceptive use and inconsistent pill-taking might result in decreased efficacy. The study reported here aimed to explore women's knowledge about oral contraceptive use and assess the factors associated with knowledge about OCPs among users. METHODS This cross-sectional survey was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between April and June 2014. We included married, non-pregnant women >18 years old who had used a combined 21-day OCP for at least 3 months prior to recruitment. A questionnaire was used to collect the participants' demographic information. It also assessed their knowledge about OCPs. Data were entered into and analyzed using SPSS software. RESULTS A total of 357 women were recruited. Of these, 57.7% reported they knew what to do after missing one or two pills, but only 18.3% knew exactly what to do after missing more than two pills consecutively. Postgraduate women had a significantly higher knowledge score than illiterate women (P=0.002) and those who had completed at least primary education (P=0.001). Conversely, there was no difference in knowledge scores between Saudi and expatriate women (P=0.2). Monthly incomes (P=0.2) and mode of OCP selection (P=0.2) were also not significantly associated with knowledge scores. CONCLUSION Women had poor knowledge about OCP use. Appropriate measures should be taken to educate women about proper oral contraceptive use.
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Affiliation(s)
- Rahila Iftikhar
- Family and Community Medicine Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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