Post Abortion Care

Post-abortion care (PAC) research is increasingly being conducted in low-and middle-income countries (LMICs) to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents' right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance.

Post-abortion care (PAC) research is increasingly being conducted in low-and middle-income countries (LMICs) to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents' right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance.

A Constituição de 1824 garantia formalmente a igualdade jurídica para os cidadãos brasileiros, no entanto, a permanência da escravidão e a restrição dos direitos políticos para amplos setores da população, foram características do Brasil no século XIX. Entre a retórica liberal e a prática dos governantes e da classe dominante, ocorreu o processo de desclassificação social dos trabalhadores livres e dos escravizados. Este artigo analisa o discurso de desclassificação, bem como apresenta algumas medidas e leis que visavam subordinar aqueles trabalhadores.The Constitution of 1824 ensured formally the legal equality to Braziliancitizens, however; the permanency of slavery and restriction of political rights of largesections of the population were characteristics of Brazil in the nineteenth century. Amongthe liberal rhetoric and the practice of rulers and dominant classes there was a process ofsocial disqualification of the free and enslaved workers. This article analyzes the discourseof...

Introduction: The success of a post abortion care program is associated with access to treatment, prevention of unintended pregnancies, access to family planning information, education counseling for choice, and integration of other reproductive health services. The use of a client-centered structured algorithm could enhance access to post-abortion services by ensuring that women are linked to appropriate services. This paper presents a client centered algorithm for enhancing access to post abortion care in Nairobi Kenya. Methodology: Purposive sampling was used to select participants for nominal group technique (n = 36). Through a series of discussions and voting, as post abortion care client algorithm was designed. Results: The nominal group technique (NGT) reflected the collective agreement of stakeholders (> 80%). These components encompassed an appropriate client navigation pathway with an appropriate minimum service package, service delivery points, and timelines. Conclusion: The client algorithm pathway ensured the application of a minimum service package for post abortion care for enhanced communication, coordination, and continuity of care among post-abortion clients. Recommendations: This patient navigation algorithm for post abortion care services can be scaled up for use in improving patients' experience and improving women's reproductive health outcomes.

Female sex workers (FSWs) are at risk of unintended pregnancies and induced abortions (IAs). This study aimed to describe attitudes towards and experiences of IA among FSWs in Laos. Methods: 258 FSWs were interviewed in Kaysone Phomvihan, Laos. Descriptive statistics and logistic regression were used to analyse the data. Results: Overall, 24% of the respondents reported experience of IA. Fifteen percent reported experience of unintended pregnancy after entering sex work, whereof all had ended in IA. Thirty-six percent had self-induced the last IA and 64% were carried out in private clinics. The main reasons for having IAs were paternity denial and lack of financial and social support. A majority agreed or strongly agreed that IA should not be legal in Laos and that women who undergo IA are immoral, but also that IA is the only option a FSW has when experiencing an unintended pregnancy. A positive attitude towards IA was associated with longer duration of sex work and being unmarried. Conclusion: IAs were common. Respondents' attitudes and practices reflected limited options when experiencing an unintended pregnancy, and were influenced by negative social perceptions. Interventions targeting FSWs should raise awareness of IA and post-abortion care, and promote dual contraceptive use with highly effective contraceptives.

O artigo "De escravos a negros livres: poder público e desigualdades raciais no Brasil, c. 1800–1900" analisa o papel do Estado brasileiro na perpetuação da escravidão e das desigualdades raciais antes e depois da abolição. Os autores argumentam que o poder público não apenas tolerou, mas ativamente contribuiu para a manutenção do sistema escravista e para a marginalização da população negra no período pós-abolição. O texto contesta narrativas que atribuem a escravidão apenas ao colonialismo português ou ao mercado de trabalho, demonstrando que o Estado organizou e institucionalizou práticas que garantiram a exclusão social e política dos negros no Brasil independente. Através de leis, políticas públicas e omissões deliberadas, o Estado facilitou tanto o tráfico ilegal de escravos quanto a construção de um regime de subcidadania para a população negra livre, perpetuando as hierarquias raciais que moldam a sociedade brasileira até hoje.

Background: Unsafe abortion has been a significant cause of maternal morbidity and mortality in Nepal. Since legalization in 2002, more than 1,200 providers have been trained and 487 sites have been certified for the provision of safe abortion services. Little is known about health care workers' views on abortion legalization, such as their perceptions of women seeking abortion and the implications of legalization for abortion-related health care. Methods: To complement a quantitative study of the health effects of abortion legalization in Nepal, we conducted 35 in-depth interviews with physicians, nurses, counsellors and hospital administrators involved in abortion care and post-abortion complication treatment services at four major government hospitals. Thematic analysis techniques were used to analyze the data. Results: Overall, participants had positive views of abortion legalizationmany believed the severity of abortion complications had declined, contributing to lower maternal mortality and morbidity in the country. A number of participants indicated that the proportion of women obtaining abortion services from approved health facilities was increasing; however, others noted an increase in the number of women using unregulated medicines for abortion, contributing to rising complications. Some providers held negative judgments about abortion patients, including their reasons for abortion. Unmarried women were subject to especially strong negative perceptions. A few of the health workers felt that the law change was encouraging unmarried sexual activity and carelessness around pregnancy prevention and abortion, and that repeat abortion was becoming a problem. Many providers believed that although patients were less fearful than before legalization, they remained hesitant to disclose a history of induced abortion for fear of judgment or mistreatment. Conclusions: Providers were generally positive about the implications of abortion legalization for the country and for women. A focus on family planning and post-abortion counselling may be welcomed by providers concerned about multiple abortions. Some of the negative judgments of women held by providers could be tempered through values-clarification training, so that women are supported and comfortable sharing their abortion history, improving the quality of post-abortion treatment of complications.

Background: In Iran, nearly 530,000 intentional abortions take place every year. Intentional or criminal abortions make up nearly a third of all abortions, which is a significant number. In order to improve the mortality rate of pregnant mothers and reduce unsafe abortions, it is necessary to identify key causes of abortion. This study was conducted to investigate the factors affecting induced abortions, allowing for the development of effective solutions for policy-making based on the results. Methods: The present study was carried out using the scoping review method in 2023. This scoping review assessed articles related to the causes of induced abortion from 2003 to 2023 searched in English language databases, including Springer, PubMed, Web of Science, Emerald, ScienceDirect, and Scopus, as well as Persian electronic databases, including Magiran and SID, and the Google Scholar search engine. The data were analyzed qualitatively through content analysis and coded using MAXQDA software, version 20. Results: In this study, factors affecting induced abortion were categorized as predisposing factors, enabling factors, and need factors associated with the use or non-use of health services. Conclusion: The effective factors in fertility are the society's culture, as well as environmental, social, economic, political, and religious factors that determine fertility and abortion within the society. At the micro level, personal motives, people's attitudes, and their perceptions can affect people's behavior.

Objective: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. Design: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth interviews (n = 32) and in focus group discussions (n = 5) in year 2013, 2014, and 2016. All data were analyzed using thematic analysis. Findings: HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers' legal responsibility on whether to report a woman who discloses an illegal abortion. Conclusion: The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting. Implications for practice: To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited.

Reproductive health is a fundamental human right, but in conflict zones, accessing these services can become a life challenge. The interplay of violence, instability, and societal collapse often results in severe impediments to obtaining essential reproductive health care, including buying Abortion Pills online services. The Unique Challenges of Reproductive Health in Conflict Zones Access to Medical Facilities Conflict zones are characterized by the destruction of infrastructure, including hospitals and clinics. Bombings, looting, and occupation by armed groups often lead to the shutdown of these critical facilities. For many, this means traveling long distances through dangerous territories to reach the nearest functioning clinic, if one exists at all.

Sub-Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

Objective: To test an infographic two-pager on medication abortions (MA) aimed to improve pharmacists counseling in India. Methods: A quantitative baseline survey was conducted among 283 pharmacists in three districts around Lucknow, Uttar Pradesh in January 2018. The intervention (infographic) was given to 117 of these pharmacists a few weeks later and a follow-up survey was conducted 3 months later with 281 pharmacists. In addition, mystery clients were sent to 115 of the pharmacists. Results: A statistically significant improvement in knowledge post-intervention was found, compared to pre-, for almost all quality items measured. Difference-indifference estimators showed a difference in knowledge among indicators related to misoprostol in particular. However, mystery client reports showed few differences in pharmacist behaviors between intervention and control pharmacists. Conclusion: This simple, paper-based intervention, which required no training, showed a significant improvement in pharmacists' knowledge and was welcomed by the providers. Translating knowledge into behavior change, however, seems more difficult to impact. Adapting this simple intervention to motivate providers to change behaviors could improve the quality of care provided by pharmacists in India.

This paper is based on an ethnographic investigation of experiences of abortion care delivery in eastern Uganda between August 2018- March 201 Advances on liberalization of the law on abortion as an avenue for advancement of women’s freedom and rights to sexual and reproductive health. However, findings from both public and private profit-making health facilities, indicate that: (i) Inside liberalized contexts, all aspects of life (including care practice, and the restrictive law on abortion), was evaluated in the image of the economy. The boundary between right and wrong, legal and illegal is replaced with instrumental viability based on the level of economic value. (ii) Abortion care delivery can no longer be universally interpreted. In profit making health facilities, provision of abortion care service was motivated by the desire for pecuniary interests and so, care was interpreted as a means towards financial goals. Healthcare delivery practice that can be considered to be inher...

In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration's Global Gag Rule (GGR)which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortionthreatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August-September 2018, and June-September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty.

Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual...

One of the most topical areas in reproductive health today is the consequences of induced and often unsafe abortion. Safe motherhood initiatives continue to highlight the contribution of unsafe abortion to the persistent high rates of maternal mortality and morbidity in sub-Saharan Africa. In some countries, unsafe abortion is responsible for up to half of all maternal mortality and morbidity, with adolescents constituting a significant proportion of those procuring unsafe abortions. In Kenya, concern about the problem of incomplete and septic abortion has increased, particularly on the part of service providers who must treat women suffering from the complications of poorly performed procedures. Debate about what can be done to reduce the negative consequences of unsafe abortion ranges from highly emotional arguments to pragmatic policies and programs. In 1998, in response to requests for assistance from Kenyan policymakers, the Population Council embarked on a four-year collaborat...

Introduction We examined parity and age among women seeking an abortion in Mexico City's public first-trimester abortion programme, Interrupcion Legal de Embarazo (ILE). We hypothesised that younger women, especially students, used abortion to prevent first births while older women used abortion to limit births. Methods We used clinical data from a sample of 47 462 women who had an abortion between 2007 and 2016 and classified them as nulliparous or parous according to previous births prior to the abortion. We used logistic regression to identify sociodemographic and clinical factors associated with using abortion to prevent a first birth (nulliparous) versus limiting births (parous) and calculated absolute multivariable predicted probabilities. Results Overall, 41% of abortions were in nulliparous women seeking to prevent a first birth, and 59% were in women who already had one or more children. The adjusted probability of using abortion to prevent a first birth was 80.4% (95% CI 78.3 to 82.4) for women aged 12-17 years and 54.3% (95% CI 51.6 to 57.0) for women aged 18-24 years. Adolescents (aged 12-17 years) who were employed or students had nearly 90% adjusted probability of using abortion to prevent a first birth (employed 87.8%, 95% CI 82.9 to 92.8; students 88.5%, 95% CI 82.9 to 94.1). At all ages, employed women and students had higher probabilities of using abortion to prevent a first birth compared with unemployed women and women who work in the home. Conclusion Legal first-trimester abortion services in Mexico can help prevent first births in adolescents, especially students.

Mexico City metropolitan area's 21 million inhabitants reside. We estimate the impact on effective access to legal abortion created by this legislative discrepancy and examine how unmet need for care is experienced differentially by social class. Methods: We used data abstracted from charts of 34,699 women seeking care in Mexico City's public abortion program (Interrupcion Legal de Embarazo, ILE) in 2010-2012 and the 2010 census. We compared municipality-level utilization between Mexico City and the State of Mexico and estimated the counterfactual utilization if all women accessed care at the same rate as those living in a municipality with an ILE service provider. We also explored the relationship between ability to travel to access care and social and demographic factors. Results: The 15,197 women from the State of Mexico who received a legal abortion as part of the ILE program in 2010-2012 represented only 16.3% of the expected counterfactual utilization if women in the State of Mexico could access care at the same rates as women who have an ILE provider in their municipality. Furthermore, the degree to which travel time impedes access was mediated by education. Conclusions: The travel time induced by differential legalization of abortion represents a barrier to care in the Mexico City metropolitan area. This effect is more pronounced among women with less education, meaning that current legislation is likely perpetuating inequalities.

Objectives: We aimed to examine whether women consider adoption after being denied a wanted abortion. Methods: Through the Turnaway Study, we conducted semiannual interviews over 5 years with 956 women who sought abortions, including 182 women who were denied care. For this analysis, we assessed bivariate differences in the demographic profile of participants who chose adoption versus parenting using mixed effects regression. We selected 31 participants (28 chosen randomly, 3 chosen purposively) for open-ended interviews about their pregnancy decision making, feelings about their choice and perception of its impact on their lives. Two researchers deductively and inductively coded interview transcripts, having used three randomly selected transcripts to develop initial codes, which were jointly reconciled. Results: Most participants who gave birth chose to parent (90%); few reported considering adoption (11.5%). Parenting participants did not differ from participants who chose adoption on measures of age, race or poverty status, though participants who chose adoption were somewhat less likely to be employed (0% vs. 11%, p=.07) and somewhat more likely to have completed high school (15% vs. 4%, p=.06) and to have reported difficulty making an abortion decision (3% vs. 13%, p=.08). In interviews, participants rarely reported considering adoption; very few viewed adoption as an alternative to abortion. Conclusions: Even among women who are highly motivated to avoid parenthood, adoption is infrequently chosen. These findings suggest that women who choose adoption after abortion denial are more demographically similar to women who parent after abortion denial than they are to non-Turnaway birth mothers who do not typically pursue abortion care.

Background:It is estimated that one in every five pregnancies globally ends up as abortion, with about 40% being unsafe. Abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC), which aims to provide high quality, safe and affordable services to women, unsafe abortions rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia.Materials and methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August, 2021 in nine selected public health facilities of Zambia. A total of 17 interviews were conducted with participants purposively sampled. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed a number of barriers and fac...

Although abortion is legal in Zambia under a variety of broad conditions, unsafe abortion remains common. The purpose of this project was to compare the financial costs for women when they have an induced abortion at a facility, with costs for an induced abortion outside a facility, followed by care for abortion-related complications. We gathered household wealth data at one point in time (T1) and longitudinal qualitative data at two points in time (T1 and T2, three-four months later), in Lusaka and Kafue districts, between 2014 and 2015. The data were collected from women (n = 38) obtaining a legal termination of pregnancy (TOP), or care for unsafe abortions (CUA). The women were recruited from four health facilities (two hospitals and two private clinics, one of each per district). At T2, CUA cost women, on average, 520 ZMW (USD 81), while TOP cost women, on average, 396 ZMW (USD 62). About two-thirds of the costs had been incurred by T1, while an additional one-third of the total costs was incurred between T1 and T2. Women in all three wealth tertiles sought a TOP in a health facility or an unsafe abortion outside a facility. Women who obtained CUA tended to be further removed from the money that was used to pay for their abortion care. Women's financial dependence leaves them unequipped to manage a financial shock such as an abortion. Improved TOP and post-abortion care are needed to reduce the health sequelae women experience after both types of abortion-related care.

Background: Malawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor. Curettage is most frequently used as the surgical method for treating incomplete abortions, even though it is costly for an impoverished health system and the less expensive and safe manual vacuum aspiration (MVA) method is recommended. Methods: The aim of this 2016-17 study is to explore health worker's perception of doing MVA 1 year after an educational intervention. Focus group discussions were recorded, transcribed verbatim, and analyzed using content analysis for interpreting the findings. A knowledge, attitude and practice survey was administered to health professionals to obtain background information before the MVA training program was introduced. Results: Prior to the training sessions, the participants demonstrated knowledge on abortion practices and had positive attitudes about participating in the service, but preferred curettage over MVA. The training was well received, and participants felt more confident in doing MVA after the intervention. However, focus group discussions revealed obstacles to perform MVA such as broken equipment and lack of support. Additionally, the training could have been more comprehensive. Still, the participants appreciated task-sharing and team work. Conclusion: Training sessions are considered useful in increasing the use of MVA. This study provides important insight on how to proceed in improving post-abortion care in a country where complications of unsafe abortion are common and the health system is low on resources.

Background In Malawi, abortion is only legal to save a pregnant woman’s life. Treatment for complications after unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester, surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health care providers’ perceptions on this matter are crucial. Methods A qualitative approach was used to explore health care providers’ perceptions of misoprostol for the treatment of incomplete aborti...

Background: In Brazil, a Ministry of Health report revealed women who underwent an abortion were predominantly in the use of contraceptive methods, but mentioned inconsistent or erroneously contraceptive use. Promoting the use of contraceptive methods to prevent unwanted pregnancies is one of the most effective strategies to reduce abortion rates and maternal morbidity and mortality. Therefore, providing post-abortion family planning services that include structured contraceptive counseling with free and easy access to contraceptive methods can be suitable. So the objective of this study is to determine the acceptance and selection of contraceptive methods followed by a postabortion family planning counseling. Methods: A cross-sectional study was carried out from July to October 2008, enrolling 150 low income women to receive post-abortion care at a family planning clinic in a public hospital located in Recife, Brazil. The subjects were invited to take part of the study before receiving hospital leave from five different public maternities. An appointment was made for them at a family planning clinic at IMIP from the 8 th to the 15 th day after they had undergone an abortion. Every woman received information on contraceptive methods, side effects and fertility. Counseling was individualized and addressed them about feelings, expectations and motivations regarding contraception as well as pregnancy intention. Results: Of all women enrolled in this study, 97.4% accepted at least one contraceptive method. Most of them (73.4%) had no previous abortion history. Forty of the women who had undergone a previous abortion, 47.5% reported undergoing unsafe abortion. Slightly more than half of the pregnancies (52%) were unwanted. All women had knowledge of the use of condoms, oral contraceptives and injectables. The most chosen method was injectables, followed by oral contraceptives and condoms. Only one woman chose an intrauterine device. Conclusion: The acceptance rate of post-abortion contraceptive methods was greater and the most chosen method was the best-known one. Implementing a specialized family planning post abortion service may promote an acceptance, regardless of the chosen method. Most important is they do receive contraception if they do not wish for an immediate pregnancy.

Background: The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods: Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four...

Objective: To examine whether auxiliary nurse-midwife provision of medical abortion in pharmacies is associated with reduced post-abortion contraceptive use in Nepal. Methods: The present prospective observational study compared contraceptive use among women aged 16-45 years and up to 63 days of pregnancy, who presented at one of six privately-owned pharmacies or six public health facilities in the Chitwan and Jhapa districts of Nepal for medical abortion between October 16, 2014, and September 1, 2015. Participants obtained medical abortions per Nepali protocol and completed a follow-up visit and interview at 14-21 days. Effective contraceptive use was compared between abortion care settings using multivariable mixed effects logistic regression.

Background: Post-abortion family planning counselling and provision are known high impact practices preventing unintended pregnancies. Little is known, however, about specific needs in the second trimester. Our study aims to assess post-abortion family planning uptake and its associated factors among women with second-trimester incomplete abortion. Methods: We conducted a cross-sectional survey of 1191 women with incomplete second trimester abortion that received treatment at 14 comprehensive emergency obstetric care public health facilities in central Uganda from August 2018 to November 2021. We computed the post-abortion uptake of family planning within 2 weeks of treatment, described the types of methods accepted, and the reasons for declining family planning. We described the socio-demographic, reproductive, abortion-related, and health facility characteristics. We used mixed effects generalized linear models to obtain percentage differences for factors independently associated with post-abortion family planning uptake. Results: Second-trimester post-abortion family planning uptake was 65.6%. Implants (37.5%) and progestin only injectables (36.5%) were the commonly chosen methods; natural (0.1%), permanent (0.8%), and condoms (4%) were the least chosen methods. 45.2% of the women who declined family planning desired another pregnancy soon. Women whose spouses were aware of the pregnancy or had planned pregnancy had 11% (− 10.5, 95% CI − 17.1 to − 3.8) and 12% (− 11.7, 95% CI − 19.0 to − 4.4) less uptake compared to women whose spouses were not aware of the pregnancy or those with unplanned pregnancies respectively. Uptake was 8% (− 7.8, 95% CI − 12.6% to − 3.0%) lower among Islamic women compared to Anglicans. Women who received post-abortion family planning counselling or had more than four live births had 59% (59.4, 95% CI 42.1 to 76.7) and 13% (13.4, 95% CI 4.0 to 22.8%) higher uptake compared to women who did not receive counselling or women with no live births, respectively. Conclusions: The uptake of second-trimester post-abortion family planning in Uganda was higher than previous estimates. Post-abortion family planning counselling, grand multiparity, and the need to avoid an unplanned pregnancy enhance post-abortion family planning uptake in the second trimester. Ministry of Health should strengthen

Unsafe abortion practices remain the major contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care. Using an ethnographic design and critical discourse analysis, we explored the operations of power in setting maternal healthcare priorities, as evident at the 2018 Reproductive, Maternal, Neonatal, Child and Adolescents Health Conference. Observational data were collected of the policy-making activities, processes and events and key informant interviews were conducted with 27 participants. We describe how neoliberal and state governance through the structure and organization of policy-making, epistemic governance and universal concepts of ‘high-impact’ interventions, results-based financing, cost-effectiveness and accountability converge to suppress the articulation of local conditions associated with unsafe and risky abortion. By defining maternity along the continuum of birth and emphasizing birthing women, p...

Introduction Information, counseling, availability of contraceptives, and their adoption by post-abortion care (PAC) patients are central to the quality of PAC in healthcare facilities. Effective contraceptive adoption by these patients reduces the risks of unintended pregnancy and repeat abortion. Methods This study uses data from the Incidence and Magnitude of Unsafe Abortion Study of 2012 to assess the level and determinants of highly effective contraception among patients treated with complications from an unsafe abortion in healthcare facilities in Kenya. Highly effective contraception was defined as any method adopted by a PAC patient that reduces pregnancy rate by over 99%. Results Generally, contraceptive counseling was high among all PAC patients (90%). However, only 54% of them received a modern family planning method-45% a short-acting method and 9% a long-acting and permanent method. Adoption of highly effective contraception was determined by patient's previous exposure to unintended pregnancies, induced abortion and modern family planning (FP). Facility level factors associated with the uptake of highly effective contraceptives included: facility ownership, availability of evacuation procedure room, whether the facility had a specialized obstetric-gynecologist, a facility that also had maternity services and the number of FP methods available for PAC patients.

Introduction: Family planning services can bring a wide range of benefits to women, their families and society as a whole. Many women of reproductive age have little or incorrect information about family planning methods. Even when they know some methods of contraceptives, they don’t know the availability or how to use them properly. The aim of this study is to find out the prevalence of contraception use among women visiting the outpatient department of gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women visiting the gynaecological outpatient department from 10 April 2021 to 10 April 2022 after taking ethical approval from the Institutional review committee (Reference number: 2079/80-03). Women aged 18 to 49 years visiting during the study period were included and pregnant, postmenopausal and unmarried women were excluded from the study. Data was collected from one-to-one interviews. A convenience sampling method was used. P...

Unsafe abortion practices remain the major contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care. Using an ethnographic design and critical discourse analysis, we explored the operations of power in setting maternal healthcare priorities, as evident at the 2018 Reproductive, Maternal, Neonatal, Child and Adolescents Health Conference. Observational data were collected of the policy-making activities, processes and events and key informant interviews were conducted with 27 participants. We describe how neoliberal and state governance through the structure and organization of policy-making, epistemic governance and universal concepts of ‘high-impact’ interventions, results-based financing, cost-effectiveness and accountability converge to suppress the articulation of local conditions associated with unsafe and risky abortion. By defining maternity along the continuum of birth and emphasizing birthing women, p...

Introduction Information, counseling, availability of contraceptives, and their adoption by post-abortion care (PAC) patients are central to the quality of PAC in healthcare facilities. Effective contraceptive adoption by these patients reduces the risks of unintended pregnancy and repeat abortion. Methods This study uses data from the Incidence and Magnitude of Unsafe Abortion Study of 2012 to assess the level and determinants of highly effective contraception among patients treated with complications from an unsafe abortion in healthcare facilities in Kenya. Highly effective contraception was defined as any method adopted by a PAC patient that reduces pregnancy rate by over 99%. Results Generally, contraceptive counseling was high among all PAC patients (90%). However, only 54% of them received a modern family planning method-45% a short-acting method and 9% a long-acting and permanent method. Adoption of highly effective contraception was determined by patient's previous exposure to unintended pregnancies, induced abortion and modern family planning (FP). Facility level factors associated with the uptake of highly effective contraceptives included: facility ownership, availability of evacuation procedure room, whether the facility had a specialized obstetric-gynecologist, a facility that also had maternity services and the number of FP methods available for PAC patients.

Despite liberal abortion laws, safe abortion access in Zambia is impeded by limited legal awareness, lack of services, and restrictive clinical policies. As in many countries with restricted abortion access, women frequently seek abortions informally from pharmacies. Methods: We conducted  in-depth interviews in  to understand the experiences and motivations of pharmacy workers who sell medication abortion (MA) drugs in Lusaka. Results: We found that pharmacy staff reluctantly assume a gatekeeper role for MA due to competing pressures from clients and from regulatory constraints. Pharmacy staff often decide to provide MA, motivated by their duty of care and desire to help clients, as well as financial interests. However, pharmacy workers' motivation to protect themselves from legal and business risk perpetuates inequalities in abortion access, as pharmacy workers improvise additional eligibility criteria based on personal risk and values such as age, partner approval, reason for abortion, and level of desperation. Conclusion: These findings highlight how pharmacy staff informally determine women's abortion access when laws and policies prevent comprehensive access to safe abortion. Reform of clinical guidelines, public education, strengthened public sector availability, task sharing, and improved access to prescription services are needed to ensure women can legally access safe abortion.

Introduction: Family planning services can bring a wide range of benefits to women, their families and society as a whole. Many women of reproductive age have little or incorrect information about family planning methods. Even when they know some methods of contraceptives, they don’t know the availability or how to use them properly. The aim of this study is to find out the prevalence of contraception use among women visiting the outpatient department of gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women visiting the gynaecological outpatient department from 10 April 2021 to 10 April 2022 after taking ethical approval from the Institutional review committee (Reference number: 2079/80-03). Women aged 18 to 49 years visiting during the study period were included and pregnant, postmenopausal and unmarried women were excluded from the study. Data was collected from one-to-one interviews. A convenience sampling method was used. P...

Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics & Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of ...

S169 to take the pill. This finding is the result of an online survey in 2011 among over 5000 boys and girls in the Netherlands carried out by the Dutch Foundation for Contraception. Almost simultaneously an online survey-resulting in a publication "Sex under 25"-was carried out among 8000 youngsters by Rutgers WPF-the Dutch Expert Centre on Sexuality-and STI Aids Netherlands-Expert Centre on HIV/AIDS and other STI's. At the age of 14.4 year half of the youngsters experienced kissing, gradually in the forthcoming years extending to necking at 15.2, masturbation at 16.3 and first sexual intercourse at 17.1 year. Over 75% was using protection at "the first time"; 34% of the boys and 41% of the girls were using double protection. There are differences between groups with regard to age, ethnicity, religion and level of education. Findings of similar studies within Europe will be compared with the findings in the Netherlands.

La presente investigación tiene como objetivo revisar la literatura científica en orden cronológico sobre los aspectos psicológicos asociados al aborto y estudiados en Sudamérica; cumple con un diseño de investigación teórica, a través de una revisión sistemática. Se hizo una búsqueda de artículos científicos e informes institucionales, a través de diferentes plataformas virtuales, los cuales se encontraban en idioma español, inglés y portugués. En la búsqueda se obtuvieron 31 artículos, pero solo 20 cumplieron con todos los criterios, esas investigaciones se sitúan en las tres últimas décadas, de 1991 al 2021. Dada la revisión de los artículos, se puede concluir que hay más investigación en las consecuencias psicológicas negativas del aborto, entre estos episodios de depresión, ansiedad y estrés postraumático, y cómo este repercute tanto antes, durante y después del procedimiento, asimismo hay una escasez de investigaciones frente a la actitud y la prevención del aborto u opciones ...

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services.

The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.

Government funding for contraceptive services is decreasing, which results in increasingly limited community access to contraception, especially to the poor. The aim of this study is to determine contraceptive use and assess its association with sociodemographic factors, socioeconomic status, the source of obtaining contraception and type of contraception among poor women in Indonesia. This study is a cross-sectional study using the 2017 Indonesian National SocioEconomic Survey. The sample in this study was women who had been married aged 15-49 years in urban and rural communities. The total sample is 20,642 women. Socioeconomic status is measured based on the international poverty line (IPL) set by the World Bank, which is US$ 1.9/day/capita in purchasing power parity (PPP). CPR in poor women was 52.5%. They prefer to use short-acting reversible contraceptives (SARCs) rather than long-acting reversible contraceptives (LARCs). The use of SARCs in urban areas was 76.0% and in rural areas was 78.3%. The results of multivariate logistic regression analysis found a significant positive relationship between socioeconomic status and contraceptive use with modern methods among urban and rural communities with OR = 0.92 (0.85-0.99). A significant positive relationship was also found between working poor women and the use of contraception with the modern method in urban communities with OR = 1.14 (1.01-1.28). It is necessary to increase funding for contraception by the government and to socialize the use of LARCs so that birth control can be realized in poor women.

The quality of abortion in Turkey's public sector hospitals is investigated using multiple research methods including observations of actual procedures, interviews with medical staff and clients, and an inventory of materials and equip ment. The results suggest that women who obtain abortions in public sector hospitals have a higher abortion rate than the general population. They are likely to receive a vacuum aspiration with minimal pain control medication. Clinical infection control procedures are insufficient, as are interpersonal communication practices including counseling on reproductive health issues and providing factual information. Links with family planning services are strong and the majority of abortion patients who desire family planning receive a contraceptive method, either through direct provision of postabortion contraceptives or referral.