Women Leaders Perceived Barriers and Consequences of Safe Abortion in Rwanda: A Qualitative Study

Abstract Background: Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often do not have the power to make informed decisions on the subject. The purpose of this study is to explore the barriers and consequences of safe abortion as perceived by women leaders in Rwanda. Method: In this qualitative study, seven focus group discussions and seven key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. Results: The emerging theme “strong barriers and numerous consequences of safe abortion” illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: 1) “Perceived barriers of safe abortion” and 2) “Consequences of providing safe abortion”. The sub-categories for the first category are “Reluctance to fully support safe abortion due to perceived unjustified abortions”, “Abortion-related stigma, “Abortion is against cultural and religious beliefs”, and “Emotional attachment to the unborn”. The sub-categories for the second category are “Perceived physiological trauma”, “cause for barrenness/infertility”, “increase in services abuse by adolescents/women”, “increase of workload for healthcare providers”, “increase in sexual activities and STIs”, and “Abortion-related physiological trauma”. Conclusion: The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word ‘abortion’ disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word ‘abortion’ outweighs the word ‘safe’. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.

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The access paradox: abortion law, policy and practice in Ethiopia, Tanzania and Zambia

International Journal for Equity in Health ◽

10.1186/s12939-019-1024-0 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

Astrid Blystad ◽

Haldis Haukanes ◽

Getnet Tadele ◽

Marte E. S. Haaland ◽

Richard Sambaiga ◽

...

Keyword(s):

Addis Ababa ◽

Policy Research ◽

Unsafe Abortion ◽

Exploratory Research ◽

Access To Health Services ◽

Structured Interviews ◽

Safe Abortion ◽

Mortality And Morbidity ◽

Abortion Law ◽

Abortion Laws

Abstract Introduction Unsafe abortion is a major contributor to the continued high global maternal mortality and morbidity rates. Legal abortion frameworks and access to sexuality education and contraception have been pointed out as vital to reduce unsafe abortion rates. This paper explores the relationship between abortion law, policy and women’s access to safe abortion services within the different legal and political contexts of Ethiopia, Tanzania and Zambia. The research is inspired by recent calls for contextualized policy research. Methods The research was based in Addis Ababa (Ethiopa), Dar es Salaam (Tanzania) and Lusaka (Zambia) and had a qualitative exploratory research design. The project involved studying the three countries’ abortion laws and policies. It moreover targeted formal organizations as implementers of policy as well as stakeholders in support of, or in opposition to the existing abortion laws. Semi-structured interviews were carried out with study participants (79) differently situated vis-à-vis abortion, exploring their views on abortion-related legal- and policy frames and their perceived implications for access. Results The abortion laws have been classified as ‘liberal’ in Zambia, ‘semi-liberal’ in Ethiopia and ‘restrictive’ in Tanzania, but what we encountered in the three study contexts was a seeming paradoxical relationship between national abortion laws, abortion policy and women’s actual access to safe abortion services. The study findings moreover reveal that the texts that make up the three national abortion laws are highly ambiguous. The on-paper liberal Zambian and semi-liberal Ethiopian laws in no way ensure access, while the strict Tanzanian law is hardly sufficient to prevent young women from seeking and obtaining abortion. In line with Walt and Gilson’s call to move beyond a narrow focus on the content of policy, our study demonstrates that the connection between law, health policy and access to health services is complex and critically dependent on the socio-economic and political context of implementation. Conclusions Legal frameworks are vital instruments for securing the right to health, but broad contextualized studies rather than classifications of law along a liberal-restrictive continuum are demanded in order to enhance existing knowledge on access to safe abortion services in a given context.

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Cuidado humanizado às mulheres em situação de abortamento: uma análise reflexiva

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v11i12a25126p5074-5078-2017 ◽

2017 ◽

Vol 11 (12) ◽

pp. 5074

Author(s):

Laís Montenegro Lima ◽

Sabrina de Santana Gonçalves ◽

Diego Pereira Rodrigues ◽

Alane da Silva Clemente Araújo ◽

Amanda de Medeiros Correia ◽

...

Keyword(s):

Qualitative Study ◽

Health Professionals ◽

Family Health ◽

Unsafe Abortion ◽

Undergraduate Nursing ◽

The Family ◽

The Subject ◽

Las Mujeres ◽

Reflexive Analysis ◽

Nursing Course

RESUMO Objetivo: discutir, a partir da análise reflexiva, acerca da assistência ofertada a mulher em situação de abortamento. Método: estudo qualitativo, do tipo análise reflexiva, originado na iniciação científica do curso de graduação em enfermagem, mediante das seguintes etapas: busca nas bases de dados, leitura do material selecionado, movimento da práxis analítica da temática, e formulação do material escrito. Resultados: as mulheres que realizam o aborto são submetidas ao desrespeito frente a sua escolha, culpabilizadas pela família, profissionais de saúde e sociedade, discriminadas e marginalizadas, e carecem de apoio de ordem física, emocional e psicológica. Conclusão: o cuidado deve ser focalizado na mulher, de forma integral, e articular para a qualidade e humanização da assistência. Devendo, o respeito as suas escolhas, sem o julgamento em que muitos profissionais executam, e desrespeitando as mulheres em situação de abortamento. Descritores: Abortamento Inseguro; Aborto espontâneo; Aborto Criminoso; Atendimento Emergencial; Humanização da Assistência; Enfermagem Obstétrica.ABSTRACT Objective: to discuss, based on the reflexive analysis, the assistance offered to women in situation of abortion. Method: qualitative study, of the reflexive analysis type, originated in the scientific initiation of the undergraduate nursing course, through the following steps: searching the databases, reading the selected material, moving the analytical praxis of the subject, and formulating written material. Results: women who undergo abortion are subjected to disrespect before their choice, blamed by the family, health professionals and society, discriminated and marginalized, and lack physical, emotional and psychological support. Conclusion: care should be focused on the woman, in an integral way, and articulate for the quality and humanization of care. They should respect their choices, without the judgment that many professionals carry out, and disrespect women in situation of abortion. Descpritors: Unsafe Abortion; Abortion Spontaneous; Abortion Criminal; Emergency Care; Humanization of Care; Obstetric Nursing.RESUMEN Objetivo: discutir la asistencia ofrecida a mujer en situación de aborto a partir de un análisis reflexivo. Método: estudio cualitativo, del tipo análisis reflexivo, a partir de la iniciación científica del curso de graduación en enfermería, mediante las siguientes etapas: búsqueda en las bases de datos, lectura del material seleccionado, movimiento de la praxis, analítica de la temática y formulación del material escrito. Resultados: las mujeres que realizaron el aborto son sometidas sin respeto frente a su elección, culpabilizadas por la familia, profesionales sanitarios y sociedad, discriminadas y marginadas, careciendo apoyo de orden físico, emocional y psicológico. Conclusión: el cuidado debe enfocarse en la mujer, de forma integral, y articularlo para la calidad y humanización de la asistencia. El respeto a sus elecciones debe verificarse sin juzgamientos realizados por muchos profesionales ni falta de respeto a las mujeres en situación de aborto. Descritores: Aborto Inseguro; Aborto Espontâneo; Aborto Criminal; Atención de Emergencia; Humanización de la Atención; Obstetricia.

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The Perceived Social Support by Iranian Women with Breast Cancer: A Qualitative Study

10.21203/rs.3.rs-295984/v1 ◽

2021 ◽

Author(s):

Leila Mokhtari ◽

Abdollah Khorami Markani ◽

Hamid Reza Khalkhali ◽

Aram Feizi

Keyword(s):

Breast Cancer ◽

Social Support ◽

Qualitative Study ◽

Lived Experience ◽

Qualitative Content Analysis ◽

Healthcare Providers ◽

Well Being ◽

Medical Sciences ◽

Structured Interviews ◽

The Family

Abstract Background: Social support has an importnat role in improving health outcomes and is considered as one of the crucial aspects of the modern care in cancer patients. Therefore this article aims at discovering and describing the dimensions of social support based on the lived experience of women suffering from breast cancer.Methods: In this qualitative study, 22 women with breast cancer were selected through purposive sampling from 7 hospitals affiliated to Urmia University of Medical Sciences. The data were collected through semi-structured interviews and were analyzed by the Conventional Qualitative Content Analysis and Graneheim’s and Lundman’s (2004) approach, using MAXQDA software, version 10.Results: After completion of the analyzing process, 6 categories were appeared including “creating an empathic atmosphere by family and community”, “creating a safe communication network for the patient”, “adaption to disease”, “giving meaning to life”, “the feeling of satisfaction with the healthcare providers for fulfilling their role”, and “accepting the support and help of family and friends in fighting the disease”. Conclusion: According to the findings, good social support during the illness can result in the spiritual, mental, and physical well-being of the patients and is one of the most effective factors in fighting the disease and feeling of recovery. The findings of this study can be used to develop plans to help the patients to achieve more support from the family, healthcare providers and the community and even providing the required supportive care for this group of women.

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‘An uneasy compromise’: strategies and dilemmas in realizing a permissive abortion law in Ethiopia

International Journal for Equity in Health ◽

10.1186/s12939-019-1017-z ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Getnet Tadele ◽

Haldis Haukanes ◽

Astrid Blystad ◽

Karen Marie Moland

Keyword(s):

Health Workers ◽

Qualitative Content Analysis ◽

Addis Ababa ◽

Safe Abortion ◽

Abortion Law ◽

Key Stakeholders ◽

Development Goals ◽

The Law ◽

Religious Dogma ◽

Global Agenda

Abstract Introduction At the turn of the century, when the Millennium Development Goals placed maternal mortality reduction high on the global agenda, Ethiopia relaxed its restrictive abortion law to expand grounds on which a woman could legally obtain an abortion. This radical policy shift took place within a context of predominant anti-abortion public opinion shaped by strong religious convictions. Drawing upon Walt and Gilson’s policy analysis framework, this paper explores the tension between public policy and religious dogma for the strategies chosen by the Ethiopian Ministry of Health and its partners implementing the new policy, and for access to safe abortion services. Methods The study employed a qualitative research methodology. It targeted organizations that are key stakeholders in the field of reproductive health. These included policy makers and policy implementers like ministries, UN agencies and international and national NGOs as well as religious organizations as key opinion leaders. The data collection took place in Addis Ababa between 2016 and 2018. A total of 26 interviews were conducted, transcribed, and analyzed using the principles of qualitative content analysis. Results Our analysis showed that the implementing organizations adopted a strategy of silence not to provoke anti-abortion sentiments and politicization of the abortion issue which was seen as a threat to the revised law and policy. This strategy has facilitated a rollout of services and has improved access to safe abortion care. Nevertheless informants were concerned that the silence strategy has prevented dissemination of knowledge about the revised law to the general public, to health workers and to the police. In turn this has caused confusion about eligibility to legal and safe abortion procedures. Conclusions While silence as a strategy works to protect the law enhancing the health and survival of young women, it may at the same time prevent the law from being fully effective. As a long term strategy, silence fails to expand awareness and access to safe abortion services, and may not sufficiently serve to fulfill the potential of the law to prevent abortion related maternal deaths.

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The Implementable Needs of Woman With Maternal Near Miss Experience: A Qualitative Study of Healthcare Providers

10.21203/rs.3.rs-892546/v1 ◽

2021 ◽

Author(s):

Sedigheh Abdollahpour ◽

Abbas Heydari ◽

Hosein Ebrahimipour ◽

Farhad Faridhoseini ◽

Talat Khadivzadeh

Keyword(s):

Qualitative Study ◽

Qualitative Content Analysis ◽

Quality Care ◽

Healthcare Providers ◽

Care Quality ◽

Near Miss ◽

Maternal Near Miss ◽

Health Providers ◽

Data Saturation ◽

Maternal Health Policy

Abstract Introduction: Maternal Near Miss (MNM) case is defined as “a woman who nearly died but survived a life-threatening and failure organ during pregnancy or childbirth complication that the challenges of this group of mothers have not been addressed. Aim: This qualitative study of healthcare providers was conducted to discover the Iranian near miss mother’s (NMM) needs. Design: conventional qualitative content analysis Methods: In this study 37 participants of key informants, health providers, NMM and their husbands were selected using purposive sampling. Semi structured in-depth interviews were conducted for data collection until data saturation was achieved. Data was analyzed using Graneheim and Lundman. MAXQDA 10 software was used for organizing data and managing the process of analysis. Results: The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement of the care quality care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerged from 18 sub-categories, were formed from 2112 codes. Conclusions: Maternal health policy makers should call on health provider centers to work on program designed to support NMMs according to standard guidelines designed to assessment needs.

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A gap between Law and Practice: A Community’s Perception of Unmarried Women’s Abortion Options in Nepal

Health Prospect ◽

10.3126/hprospect.v12i2.9869 ◽

2014 ◽

Vol 12 (2) ◽

pp. 24-30

Author(s):

Simone Christensen Hald ◽

Ditte Aagaard Sondergaard

Keyword(s):

Cross Sectional Survey ◽

Cross Sectional ◽

Safe Abortion ◽

Community Attitudes ◽

Abortion Law ◽

Premarital Sexual Activity ◽

Premarital Sexual ◽

The Right ◽

Changing Attitudes ◽

Depth Interviews

Background In 2002, the Nepalese abortion law went from being highly restrictive to fully liberal. This study aimed to explore a local community’s perception of the situation for unmarried Nepalese women wanting to practice their legal right to abortion.Methods The study comprised a cross-sectional survey and in-depth interviews with men and women above the age of 16 years living in the Makwanpur District, Nepal. The final data included 55 questionnaires and 16 interviews. The questionnaire data was univariate analysed, while a condensation of meaning analysis was carried out on the interviews.Results The overall awareness of abortion being legal was high, although the extent of knowledge of the specific legal grounds varied. Unmarried women were believed to have access to abortion services, although they risked stigmatisation due to their marital status. The community attitude towards these women having abortions was very negative, hence it differed from the legal acceptance of all women having the right to abortion. This was explained by societal norms on premarital sexual activity. Generally, the participants felt that changing attitudes would be difficult but possible over time.Conclusion A considerable gap exists between the legal acceptance of abortion and community attitudes when it comes to unmarried women as this group encounters barriers when wanting to practice their right. Therefore, these barriers need to be addressed to allow unmarried Nepalese women access to safe abortion services without the risk of being stigmatised.One possible alternative is educational initiatives such as disseminating information vigorously through mass media to create awareness.DOI: http://dx.doi.org/10.3126/hprospect.v12i2.9869 Health Prospect Vol.12(2) 2013: 24-30

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Exploring the experiences related to postpartum changes: perspectives of mothers and healthcare providers in Iran

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03504-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mahboobeh Asadi ◽

Mahnaz Noroozi ◽

Mousa Alavi

Keyword(s):

Postpartum Period ◽

Qualitative Content Analysis ◽

Healthcare Providers ◽

Educational Interventions ◽

Psychological State ◽

Structured Interviews ◽

Childbearing Age ◽

New Period ◽

Women's Lives ◽

Field Notes

Abstract Background Numerous changes occur in different aspects of women’s lives in the postpartum period. Women’s adjusting with problems and taking advantage of this opportunity can develop their personality. In this regard, accurate knowledge of their experiences and feelings is necessary to help them to benefit from this period. Therefore, the present study aimed to explore the experiences related to postpartum changes in women. Methods In the present qualitative study, 23 participants, including women of childbearing age who gave birth and healthcare providers (midwives and obstetricians) in Isfahan, Iran were selected using purposive sampling with a maximum variation strategy. Data were collected through in-depth semi structured interviews, field notes, and daily notes, and simultaneously analyzed using the conventional qualitative content analysis. Results The data analysis results led to the extraction of three main categories including “feeling of decreased female attractiveness” (with two sub-categories of “ feeling of decreased beauty” and “feeling of decreased sexual function”), “feeling of insolvency and helplessness” (with two sub-categories of “physical burnout”, and “mental preoccupations”) and “beginning a new period in life” (with three sub-categories of “changing the meaning of life”, “feeling of maturity” and “deepening the communication”). Conclusions Findings of this study can provide a good context for designing interventions to improve the women’s quality of life by explaining and highlighting their experiences in the postpartum period. In this regard, providing sufficient empathy, social and psychological support from family members (especially husband), performing appropriate educational interventions and also regular assessment of women’s psychological state by healthcare providers in postpartum period can reduce their concerns and help to improve their health.

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Perceived Barriers to COVID-19 Testing

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052278 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2278

Author(s):

Pearl A. McElfish ◽

Rachel Purvis ◽

Laura P. James ◽

Don E. Willis ◽

Jennifer A. Andersen

Keyword(s):

Analytical Approach ◽

Nasal Swab ◽

Healthcare Providers ◽

Research Participant ◽

Perceived Barriers ◽

Lower Income ◽

The Us ◽

Qualitative Descriptive ◽

Descriptive Method ◽

Background Prior

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.

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NICU and postpartum nurse perspectives on involving fathers in newborn care: a qualitative study

BMC Nursing ◽

10.1186/s12912-021-00553-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Katharine W. Buek ◽

Dagoberto Cortez ◽

Dorothy J. Mandell

Keyword(s):

Qualitative Study ◽

Father Involvement ◽

Perinatal Care ◽

Healthcare Providers ◽

Newborn Care ◽

Small Scale ◽

Structured Interviews ◽

Provider Attitudes ◽

Attitudes And Practices ◽

Sense Of Efficacy

Abstract Background Perinatal care nurses are well positioned to provide the education and support new fathers need to navigate the transition to fatherhood and to encourage positive father involvement from the earliest hours of a child’s life. To effectively serve fathers in perinatal settings, it is important to understand the attitudes, beliefs, and behaviors of healthcare providers that may encourage and engage them, or alternatively alienate and discourage them. Methods This qualitative study involved structured interviews with ten NICU and postpartum nurses from hospitals in two large Texas cities. The interview protocol was designed to elicit descriptive information about nurses’ attitudes and beliefs, sense of efficacy and intention for working with fathers, as well as their father-directed behaviors. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 25 to 35 min. Data were analyzed using a qualitative descriptive approach. Results Overall, study participants held very positive subjective attitudes toward fathers and father involvement. Nevertheless, many of the nurses signaled normative beliefs based on race/ethnicity, gender, and culture that may moderate their intention to engage with fathers. Participants also indicated that their education as well as the culture of perinatal healthcare are focused almost entirely on the mother-baby dyad. In line with this focus on mothers, participants comments reflected a normative belief that fathers are secondary caregivers to their newborns, there to help when the mother is unavailable. Conclusions Nurse attitudes and practices that place mothers in the role of primary caregiver may be interpreted by fathers as excluding or disregarding them. Further research is needed to validate the results of this small-scale study, and to assess whether and how provider attitudes impact their practices in educating and engaging fathers in newborn care.

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“I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge, and Use of the UV Index

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041615 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1615

Author(s):

Katharina Diehl ◽

Tatiana Görig ◽

Charlotte Jansen ◽

Maike Carola Hruby ◽

Annette B. Pfahlberg ◽

...

Keyword(s):

Qualitative Study ◽

Qualitative Content Analysis ◽

Sun Protection ◽

Structured Interviews ◽

Protection Factor ◽

Protection Measures ◽

Uv Index ◽

Correct Definition ◽

Definition Of

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

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