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Baraitser P, Free C, Norman WV, Lewandowska M, Meiksin R, Palmer MJ, Scott R, French R, Wellings K, Ivory A, Wong G. Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review. BMJ Open 2022; 12:e066650. [PMID: 36385017 PMCID: PMC9670095 DOI: 10.1136/bmjopen-2022-066650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To inform UK service development to support medical abortion at home, appropriate for person and context. DESIGN Realist review SETTING/PARTICIPANTS: Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. INTERVENTIONS Interventions and new models of abortion care relevant to the UK. OUTCOME MEASURES Causal explanations, in the form of context-mechanism-outcome configurations, to test and develop our realist programme theory. RESULTS We identified 12 401 abstracts, selecting 944 for full text assessment. Our final review included 50 papers. Medical abortion at home is safe, effective and acceptable to most, but clinical pathways and user experience are variable and a minority would not choose this method again. Having a choice of abortion location remains essential, as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (appointment number, timing and wait-times), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and desire for awareness/involvement in the process. We found experiences could be improved by offering: an option for self-referral through a telemedicine consultation, realistic information on a range of experiences, opportunities to personalise the process, improved pain relief, and choice of when and how to discuss contraception. CONCLUSIONS Acknowledging the work done by patients when moving medical abortion care from clinic to home is important. Patients may benefit from support to: prepare a space, manage privacy and work/caring obligations, decide when/how to take medications, understand what is normal, assess experience and decide when and how to ask for help. The transition of this complex intervention when delivered outside healthcare environments could be supported by strategies that reduce surprise or anxiety, enabling preparation and a sense of control.
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Affiliation(s)
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Scott
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alice Ivory
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Abstract
CONTEXT Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries. METHODS We searched PubMed and SveMed+ for peer-reviewed articles published between January 2010 and May 2020. The analyses identified factors influencing men's experiences of and access to SRHC. RESULTS The majority of the 68 articles included focused on pregnancy, birth, infertility and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organisational obstacles, such as women-centred SRHC and no assigned healthcare profession for men's sexual and reproductive health issues, hindered men's access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men's access to SRHC. CONCLUSIONS The literature lacked the perspectives of specific groups of men such as migrants, men who have sex with men and transmen, as well as the experiences of men in SRHC related to sexual function, contraceptive use and gender-based violence. These knowledge gaps, taken together with the lack of a clear entry point for men into SRHC, indicate the necessity of an improved health and medical education of healthcare providers, as well as of health system interventions.
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Affiliation(s)
- Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Jon Petter Stoor
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
- Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Hanna Blåhed
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Kerstin Edin
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
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Male Abortion Beneficiaries: Exploring the Long-Term Educational and Economic Associations of Abortion Among Men Who Report Teen Pregnancy. J Adolesc Health 2019; 65:520-526. [PMID: 31277990 PMCID: PMC6755038 DOI: 10.1016/j.jadohealth.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study was to determine if men who report avoiding adolescent fatherhood through a partner's use of abortion have different socioeconomic outcomes than men who report a live birth during adolescence. METHODS We analyzed a subsample of men who reported a pregnancy before the age of 20 years that ended in either a live birth (n = 460) or abortion (n = 137) in the National Longitudinal Study of Adolescent to Adult Health. We used propensity score and exact matching of baseline characteristics from Wave I of the study completed in 1994 to compare college completion and income reported in Wave IV of the study completed between 2007 and 2008. RESULTS Among men who reported a live birth, 5.8% reported graduating from college, and 32.4% had any post-high school education compared with 22.1%, and 58.5% of men who reported a pregnancy ended in abortion. In the multivariable matching analysis, men whose adolescent pregnancies ended in abortion had an increased probability of graduating from college (average treatment effect = 8.6; p < .01) and completing any post-high school education in the treatment group (average treatment effect of the treated = 16.5; p < .001) than men whose adolescent pregnancies ended in live birth. We found a positive association between abortion and personal income only compared to men who did not reside with their child born during adolescence. CONCLUSION Women's use of abortion services were associated with educational benefits for men who report teen pregnancies.
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Kelly K, Gochanour AA. Men and ‘post abortion syndrome’: claims versus evidence. EUR J CONTRACEP REPR 2019; 24:13-17. [DOI: 10.1080/13625187.2018.1563066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kimberly Kelly
- Department of Sociology, Mississippi State University, Mississippi State, MS, USA
| | - Amanda A. Gochanour
- Department of Sociology, Mississippi State University, Mississippi State, MS, USA
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Altshuler AL, Nguyen BT, Riley HEM, Tinsley ML, Tuncalp Ö. Male Partners' Involvement in Abortion Care: A Mixed-Methods Systematic Review. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:209-219. [PMID: 27727503 DOI: 10.1363/psrh.12000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Although some women may desire the involvement of their partners when obtaining abortion care, male partners are not routinely included in the abortion process. A review of the literature on how male involvement relates to women's abortion experiences may help guide facilities that are considering incorporating male partners in abortion care. METHODS PubMed, PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature database, and the Cochrane Library were systematically searched without restrictions through September 23, 2015, to identify qualitative and quantitative primary studies investigating male partner accompaniment during the abortion process in noncoercive situations. Analysis focused on identifying different types of male involvement and their associations with women's abortion experiences. RESULTS Some 1,316 unique articles were reviewed; 15 were analyzed. These studies were conducted in six countries and published between 1985 and 2012, primarily with observational designs. Four types of male partner involvement emerged: presence in the medical facility, participation in preabortion counseling, presence in the room during the surgical abortion procedure or while the woman is experiencing the effects of abortifacient medications, and participation in postabortion care. Studies explored relationships between type of involvement and women's access to abortion care and their emotional and physical well-being. Most findings suggested that male involvement was positively associated with women's well-being and their assessment of the experience; no negative associations were found. CONCLUSION In noncoercive circumstances, women who include their male partners in the abortion process may find this involvement beneficial.
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Affiliation(s)
- Anna L Altshuler
- Obstetriciangynecologist, California Pacifi c Medical Center Research Institute, San Francisco
| | - Brian T Nguyen
- Fellow in family planning, Department of Obstetrics and Gynecology, University of Chicago
| | - Halley E M Riley
- Doctoral student, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta
| | - Marilyn L Tinsley
- Research services librarian, Lane Medical Library, Stanford University School of Medicine, Stanford, California
| | - Özge Tuncalp
- Scientist, Department of Reproductive Health and Research, World Health Organization, Geneva
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Wainwright M, Colvin CJ, Swartz A, Leon N. Self-management of medical abortion: a qualitative evidence synthesis. REPRODUCTIVE HEALTH MATTERS 2016; 24:155-67. [PMID: 27578349 DOI: 10.1016/j.rhm.2016.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/25/2016] [Accepted: 06/26/2016] [Indexed: 11/28/2022] Open
Abstract
Medical abortion is a method of pregnancy termination that by its nature enables more active involvement of women in the process of managing, and sometimes even administering the medications for, their abortions. This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. We focused on qualitative research from multiple perspectives on women's experiences of self-management of first trimester medical abortion (<12weeks gestation). We included research from both legal and legally-restricted contexts whether medical abortion was accessed through formal or informal systems. A review team of four identified 36 studies meeting inclusion criteria, extracted data from these studies, and synthesized review findings. Review findings were organized under the following themes: general perceptions of self-management, preparation for self-management, logistical considerations, issues of choice and control, and meaning and experience. The synthesis highlights that the qualitative evidence base is still small, but that the available evidence points to the overall acceptability of self-administration of medical abortion. We highlight particular considerations when offering self-management options, and identify key areas for future research. Further qualitative research is needed to strengthen this important evidence base.
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Affiliation(s)
- Megan Wainwright
- Postdoctoral Research Fellow, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Christopher J Colvin
- Associate Professor, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Alison Swartz
- Lecturer, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Natalie Leon
- Specialist Scientist, Medical Research Council, South Africa
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Coyle CT, Rue VM. A Thematic Analysis of Men's Experience With a Partner's Elective Abortion. COUNSELING AND VALUES 2015. [DOI: 10.1002/cvj.12010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Vincent M. Rue
- Alliance for Post-Abortion Research and Training; Jacksonville Florida
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Coyle CT, Rue VM. Men’s Perceptions Concerning Disclosure of a Partner’s Abortion: Implications for Counseling. ACTA ACUST UNITED AC 2015. [DOI: 10.5964/ejcop.v3i2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Utilizing an online survey, adult male partners of women who underwent induced abortion were queried concerning the men’s disclosure of the experience to others. Responses were obtained from 101 men who identified positive and negative aspects related to their disclosure. Positive aspects included: relief, spiritual benefits, support, acceptance, empathy, forgiveness, helping others, acknowledgment of child, and increased understanding. Negative aspects included: lack of empathy, pain of facing reality, lack of resolution, and condemnation. For this group of men, disclosure was perceived positively more often than negatively. Implications for counseling are discussed.
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Makenzius M, Tydén T, Darj E, Larsson M. Autonomy and dependence - experiences of home abortion, contraception and prevention. Scand J Caring Sci 2012; 27:569-79. [DOI: 10.1111/j.1471-6712.2012.01068.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kero A, Lalos A, Wulff M. Why shouldn't one report on women's positive feelings with regard to abortion? EUR J CONTRACEP REPR 2010; 15:150-1. [PMID: 20230341 DOI: 10.3109/13625181003706604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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