Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique

Abortion Legal Reform and Neonatal Mortality in Mozambique

INTRODUCTION

Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes.

METHODS

Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence.

RESULTS

The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas.

DISCUSSION

Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes.

Knowledge, Attitude and Associated Factors Toward Ethiopian Abortion Law Among Reproductive Age Women in Bule Hora Town, Southern Oromia, Ethiopia, 2022

Objectives

A woman's health and wellbeing are impacted by illegal abortion since improper procedures can lead to consequences like extreme bleeding, infection, and damage to the reproductive organs and low awareness and attitude toward abortion law is one of the public health problems in Ethiopia. This study aimed to assess the knowledge, and attitude, and identify the effect of short birth interval and wealth index on the abortion law among reproductive-age women in Bule Hora town, Southern Oromia, Ethiopia.

Methods

A community-based cross-sectional study design was conducted from June 20 to July 20, 2022. A systematic random sampling technique was carried out to select 402 reproductive-age women. Data was collected by using a structured questionnaire with face-to-face interviews after the tools were pretested. The data was cleaned, coded, and entered into Epidata 3.1 and exported to STATA 14 for analysis. The model goodness of fit was checked using the Hosmer-Lemeshow test. Statistical significance is declared at P < .05 and a 95% confidence interval.

Results

The study revealed that 153 (38%) of respondents had good knowledge and 192 (47%) had a favorable attitude toward the Ethiopian abortion law, with a 100% response rate. Women's educational status, having information regarding the criteria of legal abortion services, and short birth intervals as a reason for induced abortion were significantly associated with knowledge. On the other hand, women who attended secondary education and above, have information regarding the criteria of legal abortion services, wealth index middle/average and richer, using the contraceptive method, and short birth interval as a reason for induced abortion were predictors of attitude toward Ethiopian abortion law.

Conclusion

This study shows that knowledge and attitude toward Ethiopian abortion law was not sufficient. So focusing on awareness creation and health education strategies by mobilization of the community to minimize the knowledge and attitude gap is essential.

Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice

Introduction

UNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities.

Methods

Peer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data.

Findings

Across these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions.

Discussion

A legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.