Abortion as empowerment: reproductive rights activism in a legally restricted context

The pleasure, joy and positive emotional experiences of abortion accompaniment after 17 weeks' gestation

Research documents how abortion can be emotionally difficult and stigmatising, but generally has not considered whether and how involvement in abortion may be a source of positive emotions, including pleasure, belonging and even joy. The absence of explorations that start from the possibility of abortion pleasure and joy represents an epistemic foreclosure. Moreover, it highlights how social science literature has tended to emphasise the negative aspects of abortion care in ways that produce or amplify normative negative associations. In this paper, we investigate the positive emotions, pleasure and joy of abortion involvement by drawing on interviews conducted in 2019 with 28 abortion accompaniers in Argentina, Chile, and Ecuador about their experiences accompanying abortions after 17 weeks' gestation. Abortion accompaniment is a response to unsafe and/or inaccessible abortion whereby volunteer activists guide abortion seekers through a medication abortion. Interviewees described how the practice of accompaniment generated positive emotions by building a feminist community, shared intimacy among women, and witnessing aborting people claim their strength. Importantly, these positive emotional experiences of involvement with abortion were not distinct from the broader marginalisation of abortion but were, instead, rooted in its marginalisation.

Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries

OBJECTIVE

This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion.

METHODS

We conducted interviews with people seeking abortion aged 15-41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants.

RESULTS

We identified six themes that contributed to high-quality abortion care from the clients' perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain.

CONCLUSIONS

People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.

Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

BACKGROUND

Global mechanisms have been established to monitor and facilitate state accountability regarding the legal status of abortion. However, there is little evidence describing whether these mechanisms capture accurate data. Moreover, it is uncertain whether the "legal status of abortion" is a valid proxy measure for access to safe abortion, pursuant to the global goals of reducing preventable maternal mortality and advancing reproductive rights. Therefore, this study sought to assess the accuracy of reported monitoring data, and to determine whether evidence supports the consistent application of domestic law by health care professionals such that legality of abortion functions as a valid indicator of access.

METHODS AND FINDINGS

We conducted a validation study using three countries as illustrative case examples: Argentina, Ghana, and India. We compared data reported by two global monitoring mechanisms (Countdown to 2030 and the Global Abortion Policies Database) against domestic source documents collected through in-depth policy review. We then surveyed health care professionals authorized to perform abortions about their knowledge of abortion law in their countries and their personal attitudes and practices regarding provision of legal abortion. We compared professionals' responses to the domestic legal frameworks described in the source documents to establish whether professionals consistently applied the law as written. This analysis revealed weaknesses in the criterion validity and construct validity of the "legal status of abortion" indicator. We detected discrepancies between data reported by the global monitoring and accountability mechanisms and the domestic policy reviews, even though all referenced the same source documents. Further, provider surveys unearthed important context-specific barriers to legal abortion not captured by the indicator, including conscientious objection and imposition of restrictions at the provider's discretion.

CONCLUSIONS

Taken together, these findings denote weaknesses in the indicator "legal status of abortion" as a proxy for access to safe abortion, as well as inaccuracies in data reported to global monitoring mechanisms. This information provides important groundwork for strengthening indicators for monitoring access to abortion and for renewed advocacy to assure abortion rights worldwide.

Secondary Education and Class Stratification: Understanding the Hierarchy of Sexuality Education in a Chinese Vocational High School

The discussion of sexuality education has a long history in China since the onset of modernisation in the early 20th century. Sexuality education has also existed in China's educational system for a long time but in various forms. However, the discussions regarding students' experiences and the influence of social stratification in China's particular social context are still limited. From March to September 2019, the author visited an academic high school (pugao) and a vocational high school (zhigao) in Tianjin, China, to gain first-hand data to understand young people's sexuality education experiences. In this paper, the author specifically paid attention to China's social class, a rarely discussed topic in China's society. She also tried to listen to the voices of young people and schoolteachers and help them to be heard. By presenting the insights from schoolteachers, students, as well as the materials from a nationally approved textbook, the author conducted a thematic analysis about how social class influences young people's sexuality education experiences in secondary education in China.

Viapolitics and the emancipatory possibilities of abortion mobilities

Scholarship on abortion travel has examined the places women travel between and why such journeys are necessary. However, there has been scant attention paid to the journeys themselves and how these journeys are undertaken. This paper uses William Walters' notion of 'viapolitics' to better attend to how people travel by focussing on the role of vehicles in abortion politics. This takes three parts: an exploration of the emotional and embodied journeys that women have to take to access abortions; the role of the vehicle as a site of political activism around abortion rights; and the transportation of abortion medication. Viapolitics has to date only been used within migration politics but as this paper shows, it has utility beyond this field to interrogate abortion travels and highlight the role of vehicles in abortion access as well as to explore how abortion transport can be emancipatory for women. This paper furthers viapolitics by arguing that we need to consider the journeys of 'things' and not just people. In the case of abortion access, it is the transportation of abortion medication rather than the travel of women that is the most socially just solution to discriminatory laws and extra-legal barriers.

From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires

Abortion stigma is experienced not only by women but also by providers and health professionals in a wide range of legal contexts. This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. A court ruling in 2012, FAL/12, changed the interpretation of abortion’s legal status, clarifying the decriminalisation of abortion in cases of rape, and also requiring public policies and procedures to speed up access to legal abortion. Between 2014 and 2017, we conducted 27 in-depth, semi-structured interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires. We found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers’ experiences changed as the social and legal context changed. FAL/12 – as a clear, legal ruling – was a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride.

What has reproductive health decision-making capacity got to do with unintended pregnancy? Evidence from the 2014 Ghana Demographic and Health Survey

INTRODUCTION

Women's reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana.

MATERIALS AND METHODS

We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively.

RESULTS

We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51-0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25-29 years [AOR = 0.29; CI = 0.13-0.63], 30-34 years [AOR = 0.18; CI = 0.08-0.45], and 35-39 years [AOR = 0.26; CI = 0.10-0.68] being less likely to experience unintended pregnancy compared to those aged 15-19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12-3.84].

CONCLUSION

This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15-19 years, those with primary education, Traditionalists and unmarried women.