Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010–2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.

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Pattern of Abortion Care in a Tertiary Level Maternity Hospital in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.2262 ◽

2013 ◽

Vol 52 (191) ◽

Cited By ~ 1

Author(s):

Punya Paudel ◽

Luna Paudel ◽

Manisha Bhochhibhoya ◽

Sapana Amatya Vaidhya ◽

Nabina Shah ◽

...

Keyword(s):

Hospital Admissions ◽

Tertiary Care ◽

Unwanted Pregnancy ◽

Safe Motherhood ◽

Unsafe Abortion ◽

Care Hospital ◽

Safe Abortion ◽

Abortion Care ◽

Care Services ◽

The Future

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly.Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed.Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste.Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future._______________________________________________________________________________________Keywords: abortion; pattern; socio-demographic.

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Economics of abortion: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-029939 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029939 ◽

Cited By ~ 1

Author(s):

Ernestina Coast ◽

Samantha R Lattof ◽

Yana van der Meulen Rodgers ◽

Brittany Moore

Keyword(s):

Scoping Review ◽

Economic Outcomes ◽

Primary Data ◽

Science Literature ◽

Safe Abortion ◽

Economic Implications ◽

Abortion Care ◽

Scoping Reviews ◽

The Impact ◽

Analytical Approaches

IntroductionAbortion is a common feature of people’s reproductive lives. However, the economic implications of abortion and policies affecting abortion provision are poorly understood. This scoping review aims to systematically review social science literature for studies that have investigated the impact of abortion care (ie, un/safe abortion, post-abortion care) or abortion policies on economic outcomes at the micro-levels (ie, abortion seekers and their households), meso-levels (ie, communities and health systems) and macro-levels (ie, societies and nation states). Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline for protocols, this protocol details the scoping review’s methodological and analytical approaches.Methods and analysisThis scoping review will utilise the PRISMA extension for Scoping Reviews (PRISMA-ScR) tool. Studies reporting on qualitative and/or quantitative data from any world region will be considered. For inclusion, studies must examine one of the following economic outcomes at the micro-levels, meso-levels and/or macro-levels: costs, benefits, impacts and/or value of abortion care or abortion policies. Searches will be conducted in eight electronic databases. We will conduct the searches and application of inclusion/exclusion criteria according to the PRISMA-ScR flow approach. No assessments of items’ quality will be made, as the purpose of this scoping review is to synthesise and describe the coverage of the evidence. After extracting all data, we will inductively develop an economic framework around the economics of abortion. The analysis will synthesise the evidence base and identify knowledge gaps on the costs and benefits of abortion to stakeholders at various levels.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through peer-reviewed publications, conference presentations, and condensed summaries for key stakeholders and partners in the field.

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Ambivalent Humanitarian Crises and Complex Emergencies

Oxford Research Encyclopedia of Politics ◽

10.1093/acrefore/9780190228637.013.1606 ◽

2020 ◽

Author(s):

Dennis Dijkzeul ◽

Diana Griesinger

Keyword(s):

Academic Disciplines ◽

International Humanitarian Law ◽

Humanitarian Law ◽

Humanitarian Crisis ◽

Fine Grained ◽

Humanitarian Action ◽

Humanitarian Crises ◽

Different Types ◽

Local Actors ◽

Definition Of

The term “humanitarian crisis” combines two words of controversial meaning and definitions that are often used in very different situations. For example, there is no official definition of “humanitarian crisis” in international humanitarian law. Although some academic disciplines have developed ways of collecting and analyzing data on (potential) crises, all of them have difficulties understanding, defining, and even identifying humanitarian crises. Following an overview of the use of the compound noun “humanitarian crisis,” three perspectives from respectively the disciplines International Humanitarian Law, Public Health, and Humanitarian Studies are discussed in order to explore their different but partly overlapping approaches to (incompletely) defining, representing, and negotiating humanitarian crises. These disciplinary perspectives often paint an incomplete and technocratic picture of crises that is rarely contextualized and, thus, fails to reflect adequately the political causes of crises and the roles of local actors. They center more on defining humanitarian action than on humanitarian crises. They also show four different types of humanitarian action, namely radical, traditional Dunantist, multimandate, and resilience humanitarianism. These humanitarianisms have different strengths and weaknesses in different types of crisis, but none comprehensively and successfully defines humanitarian crises. Finally, a multiperspective and power-sensitive definition of crises, and a more fine-grained language for comprehending the diversity of crises will do more justice to the complexity and longevity of crises and the persons who are surviving—or attempting to survive—them.

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A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings

Conflict and Health ◽

10.1186/s13031-019-0240-y ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Lauren Jennings ◽

Asha S. George ◽

Tanya Jacobs ◽

Karl Blanchet ◽

Neha S. Singh

Keyword(s):

Systematic Review ◽

Young People ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Grey Literature ◽

Safe Abortion ◽

Humanitarian Settings ◽

Abortion Care ◽

Humanitarian Crises ◽

Urogenital Fistulae

Abstract Background Young people including adolescents face barriers to healthcare and increased risk of poor sexual and reproductive health (SRH), which are exacerbated in humanitarian settings. Our systematic review assessed the evidence on SRH interventions for young people including adolescents in humanitarian settings, strategies to increase their utilisation and their effects on health outcomes. Methods We searched peer-reviewed and grey literature published between 1980 and 2018 using search terms for adolescents, young people, humanitarian crises in low- and middle- income countries and SRH in four databases and relevant websites. We analysed literature matching pre-defined inclusion criteria using narrative synthesis methodology, and appraised for study quality. Findings We found nine peer-reviewed and five grey literature articles, the majority published post-2012 and mostly high- or medium-quality, focusing on prevention of unintended pregnancies, HIV/STIs, maternal and newborn health, and prevention of sexual and gender-based violence. We found no studies on prevention of mother-to-child transmission (PMTCT), safe abortion, post-abortion care, urogenital fistulae or female genital mutilation (FGM). Thirteen studies reported positive effects on outcomes (majority were positive changes in knowledge and attitudes), seven studies reported no effects in some SRH outcomes measured, and one study reported a decrease in number of new and repeat FP clients. Strategies to increase intervention utilisation by young people include adolescent-friendly spaces, peer workers, school-based activities, and involving young people. Discussion Young people, including adolescents, continue to be a neglected group in humanitarian settings. While we found evidence that some SRH interventions for young people are being implemented, there are insufficient details of specific intervention components and outcome measurements to adequately map these interventions. Efforts to address this key population’s SRH needs and evaluate effective implementation modalities require urgent attention. Specifically, greater quantity and quality of evidence on programmatic implementation of these interventions are needed, especially for comprehensive abortion care, PMTCT, urogenital fistulae, FGM, and for LGBTQI populations and persons with disabilities. If embedded within a broader SRH programme, implementers and/or researchers should include young people-specific strategies, targeted at both girls/women and boys/men where appropriate, and collect age- and sex-disaggregated data to help ascertain if this population’s diverse needs are being addressed.

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Abortion Practices in Nepal: What does Evidence Show?

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v10i1.13186 ◽

2015 ◽

Vol 10 (1) ◽

pp. 3-11

Author(s):

TR Bhandari ◽

G Dangal

Keyword(s):

Maternal Mortality ◽

Pregnancy Termination ◽

Unmet Need ◽

Negative Attitude ◽

Safe Motherhood ◽

Cultural Norms ◽

Web Pages ◽

Unsafe Abortion ◽

Safe Abortion ◽

Abortion Care

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year around 22 million women seek unsafe abortion in developing countries. Globally, the unsafe abortion accounts for 13% maternal deaths. Out of the total aborted women, around five million women were admitted to hospitals as a result of unsafe abortion. Similarly, more than three million women suffer from severe complications from unsafe abortion every year. In 2002, responding to the public voices and high attribution of unsafe abortion on maternal mortality, Nepal granted legal access to safe abortion introducing safe abortion act. Women can seek abortion up to 12 weeks of gestation for any indication. However, sex selective pregnancy termination is prohibited in Nepal. This study aimed to assess the results of various studies on abortion practices in Nepal. Literature published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2014 were used to prepare this paper. From 2004 to 2014, more than half a million women sought safe abortion care in Nepal. Despite the considerable progress, unsafe abortion is still a major issue in Nepal as it has been estimated that it constitutes half of all abortions undertaken every year. Published literature further showed that still an unmet need of safe abortion services exists in Nepal. However, the overall awareness of legal abortion was found to be high among Nepalese women. We found negative attitude of most people towards women who sought abortion care. Similarly, a large number of unmarried women were found at risk for seeking abortion care due to socio-cultural norms, values and stigmas in Nepal.

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Abortion metrics: a scoping review of abortion measures and indicators

BMJ Global Health ◽

10.1136/bmjgh-2020-003813 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003813

Author(s):

Veronique Filippi ◽

Mardieh Dennis ◽

Clara Calvert ◽

Özge Tunçalp ◽

Bela Ganatra ◽

...

Keyword(s):

Scoping Review ◽

Population Level ◽

Monitoring And Evaluation ◽

Well Being ◽

Safe Abortion ◽

Abortion Care ◽

Country Level ◽

Supplemental Appendix ◽

Abortion Access ◽

Special Studies

Consensus is lacking on the most appropriate indicators to document progress in safe abortion at programmatic and country level. We conducted a scoping review to provide an extensive summary of abortion indicators used over 10 years (2008–2018) to inform the debate on how progress in the provision and access to abortion care can be best captured. Documents were identified in PubMed and Popline and supplemented by materials identified on major non-governmental organisation websites. We screened 1999 abstracts and seven additional relevant documents. Ultimately, we extracted information on 792 indicators from 142 documents. Using a conceptual framework developed inductively, we grouped indicators into seven domains (social and policy context, abortion access and availability, abortion prevalence and incidence, abortion care, abortion outcomes, abortion impact and characteristics of women) and 40 subdomains. Indicators of access and availability and of the provision of abortion care were the most common. Indicators of outcomes were fewer and focused on physical health, with few measures of psychological well-being and no measures of quality of life or functioning. Similarly, there were few indicators attempting to measure the context, including beliefs and social attitudes at the population level. Most indicators used special studies either in facilities or at population level. The list of indicators (in online supplemental appendix) is an extensive resource for the design of monitoring and evaluation plans of abortion programmes. The large number indicators, many specific to one source only and with similar concepts measured in a multitude of ways, suggest the need for standardisation.

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History and scientific background on the economics of abortion

PLoS ONE ◽

10.1371/journal.pone.0257360 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257360

Author(s):

Brittany Moore ◽

Yana van der Meulen Rodgers ◽

Ernestina Coast ◽

Samantha R. Lattof ◽

Cheri Poss

Keyword(s):

Scoping Review ◽

Evidence Base ◽

Economic Outcomes ◽

Secondary Outcome ◽

Care Seeking ◽

Safe Abortion ◽

World Region ◽

Abortion Care ◽

Scientific Background ◽

Scoping Reviews

Background Approximately one quarter of all pregnancies globally end in abortion, making it one of the most common gynecological practices worldwide. Despite the high incidence of abortion around the globe, the synthesis of known economic outcomes of abortion care and policies is lacking. Using data from a systematic scoping review, we synthesized the literature on the economics of abortion at the microeconomic, mesoeconomic, and mesoeconomic levels and presented the results in a collection of studies. This article describes the history and scientific background for collection, presents the scoping review framework, and discusses the value of this knowledge base. Methods and findings We conducted a scoping review using the PRISMA extension for Scoping Reviews. Studies reporting on qualitative and/or quantitative data from any world region were considered. For inclusion, studies must have examined one of the following outcomes: costs, impacts, benefits, and/or value of abortion-related care or policies. Our searches yielded 19,653 unique items, of which 365 items were included in our final inventory. Studies most often reported costs (n = 262), followed by impacts (n = 140), benefits (n = 58), and values (n = 40). Approximately one quarter (89/365) of studies contained information on the secondary outcome on stigma. Economic factors can lead to a delay in abortion care-seeking and can restrict health systems from adequately meeting the demand for abortion services. Provision of post-abortion care (PAC) services requires more resources then safe abortion services. Lack of insurance or public funding for abortion services can increase the cost of services and the overall economic impact on individuals both seeking and providing care. Conclusions Consistent economic themes emerge from research on abortion, though evidence gaps remain that need to be addressed through more standardized methods and consideration to framing of abortion issues in economics terms. Given the highly charged political nature of abortion around the world, it is imperative that researchers continue to build the evidence base on economic outcomes of abortion services and regulations.

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Guidelines and best practice recommendations on contraception and safe abortion care service provision amid COVID-19 pandemic: Scoping review.

10.21203/rs.3.rs-25326/v1 ◽

2020 ◽

Author(s):

Lemi Belay Tolu ◽

Garumma Tolu Feyissa

Keyword(s):

Reproductive Health ◽

Scoping Review ◽

Service Provision ◽

Care Service ◽

Data Extraction ◽

Assessment Tools ◽

Safe Abortion ◽

Practice Recommendations ◽

Abortion Care ◽

Consensus Statements

Abstract Introduction: During pandemics there is uncertainty and information overload. Policy makers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available best guidelines, consensus statements, standard of practice and practice recommendations on contraception and safe abortion care service provision during the COVID-19 pandemics.Methods: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health to locate guidelines, protocols, consensus statements and practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE and Google Scholar. We included English records labelled guideline, or recommendation, or consensus, or practice parameter, or position papers on contraception and safe abortion care service practice during the COVID-19 pandemics. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that’s relevant to the review question. The difference between the two authors on data extraction was resolved by discussion.Results: Eleven records on safe abortion care and nine records on contraception service were identified. Identified recommendations were categorized into thematic areas. The records addressed approaches to the safe medication and surgical abortion, self-serving family planning and long term and reversible contraception. We haven’t employed any of the quality assessment tools as the pandemic is new clinical entity and evidences are based on expert opinion and limited clinical evidence.Conclusions: Consensus statements and recommendations consistently stated that there should be access to contraception service and safe abortion care during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine or digital health and community/home-based care or self-care.

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Global Epidemiology of Induced Abortion

10.1093/acrefore/9780190632366.013.346 ◽

2021 ◽

Author(s):

Suzanne O. Bell ◽

Mridula Shankar ◽

Caroline Moreau

Keyword(s):

Health Care ◽

Reproductive Health ◽

Induced Abortion ◽

World Health ◽

Unsafe Abortion ◽

Safe Procedure ◽

Safe Abortion ◽

Abortion Care ◽

Postabortion Care ◽

Global Epidemiology

Induced abortion is a common reproductive experience, with more than 73 million abortions occurring each year globally. Worldwide, the annual abortion incidence decreased in the 1990s and the early decades of the 21st century, but this decline has been driven by high-resource settings, whereas abortion rates in low- and middle-resource countries have remained stable. Induced abortion is a very safe procedure when performed according to World Health Organization guidelines; however, legal restrictions, stigma, cost, lack of resources, and poor health system accountability limit the availability, accessibility, and use of quality abortion care services. Even as women’s use of safer self-managed medication abortion options becomes more common in some parts of the world, 45% of all abortions annually are unsafe, nearly all of which occur in low- and middle-resource settings, where unsafe abortion remains a primary cause of maternal death. Beyond country-level legal and health care system factors, significant disparities exist in women’s reliance on unsafe abortion. Even among women who receive a safe abortion, quality of care is often poor. Yet abortion’s precarious status as a health care service and its clandestine practice have precluded a systematic focus on quality monitoring and evaluation of service inputs. Improving abortion and postabortion care quality is essential to meeting this reproductive health need, as are efforts to prevent abortion-related mortality and morbidity more broadly. This requires a three-tier approach: primary prevention to reduce unintended pregnancy, secondary prevention to make abortion procedures safer, and tertiary prevention to reduce the negative sequelae of unsafe abortion procedures. Strategies include two complementary approaches: vulnerability reduction and harm reduction, the first focusing on the root causes of unsafe abortion by addressing the determinants of unwanted pregnancy and clandestine abortion, while the latter addresses the harmful consequences of clandestine abortion. Political commitments to extend service coverage of abortion and postabortion care need to be implemented through actions that build the public health system’s capacity. Beyond the model of receiving care exclusively in clinical settings, models of guided self-managed abortion are expanding the capacity of individuals to take evidence-based actions to terminate their pregnancies safely and without the threat of judgment. Research has strived to keep up with the changes in the abortion care landscape, but there remains a continuing need to improve methodologies to generate robust evidence to identify and address inequities in abortion care and its health consequences in a diversified landscape. Doing so will provide information for stakeholders to take actions toward a new era of health care reforms that repositions abortion as an integral component of sexual and reproductive health care.

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Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

Youth & Society ◽

10.1177/0044118x211011015 ◽

2021 ◽

pp. 0044118X2110110

Author(s):

Laura E. Jacobson ◽

Ana Maria Ramirez ◽

Chiara Bercu ◽

Anna Katz ◽

Caitlin Gerdts ◽

...

Keyword(s):

Young People ◽

Quality Care ◽

First Trimester ◽

Structural Barriers ◽

Structured Interviews ◽

Safe Abortion ◽

Medication Abortion ◽

Abortion Care ◽

The Mean ◽

Reproductive Healthcare

Young people face social and structural barriers when accessing abortions. High-quality, sexual and reproductive healthcare is needed; however, literature on youth-informed abortion services is limited. This study assesses accounts of youth who obtained an abortion in Argentina, Bangladesh, Ethiopia, and Nigeria and provides recommendations to improve person-centered aspects of abortion quality. We analyzed 48 semi-structured interviews with clients recruited from clinics, safe abortion hotlines, and patent and proprietary medicine vendors. We coded transcripts and conducted a thematic analysis. The mean age was 21 years (range 16–24), and the majority had a first trimester, medication abortion. Prominent themes included access to information; privacy; stigma associated with age or marital status; the decision-making process; and comfort and rapport with providers. Youth-centered abortion care should anticipate the distinct needs of younger clients. Supportive providers have an important role in offering a non-judgmental service that makes young clients feel comfortable and prepared.

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