IPSRH: Focus on Abortion

IPSRH: Focus on Abortion is a special supplement to the final volume of International Perspectives on Sexual and Reproductive Health. It provides an in-depth examination of many facets of abortion in low- and middle-income countries. Abortion in these countries tends to be legally restricted and highly stigmatized, and people who wish to terminate a pregnancy often have little recourse but to seek an unsafe abortion, which can result in severe injuries and even death.

The articles and other content included in this supplement encompass diverse aspects of the abortion experience and touch on innovation in research methodologies, changes in laws and policies, and implementation of public health programs. Taken together, they point to progress that has been made in the study of, access to and provision of abortion worldwide, while highlighting remaining gaps in abortion research and care in low- and middle-income countries.

Focus on Abortion

Focus on Abortion: Introduction
The Editors

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Assessing Readiness to Provide Comprehensive Abortion Care in the Democratic Republic of the Congo After Passage of the Maputo Protocol

By Annie L. Glover, Patrick Kayembe, Didine Kaba and Pélagie Babakazo

The Democratic Republic of the Congo (DRC) decriminalized abortion under certain circumstances in 2018 through the Maputo Protocol; however, little is known about the readiness of the country’s health facilities to provide comprehensive abortion care. In this article, the authors use the signal functions approach to assess the ability of health facilities in the DRC to provide abortion care by measuring their readiness to terminate pregnancy, provide basic and comprehensive treatment of postabortion complications, and provide postabortion contraceptive care.
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An Application of the List Experiment to Estimate Abortion Prevalence in Karachi, Pakistan

By Sarah Huber-Krum, Kristy Hackett, Navdep Kaur, Sidrah Nausheen, Sajid Soofi, David Canning and Iqbal Shah

In Pakistan, low modern contraceptive use and high unmet need for contraception put women at risk of unintended pregnancy and abortion. In settings, such as Pakistan, where abortion is legally restricted or highly stigmatized, estimating the prevalence of abortion is particularly difficult. In this study, researchers use the List Experiment—an indirect technique for measuring sensitive health behaviors—to estimate lifetime abortion prevalence among women in the Pakistani city of Karachi.
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Chilean Medical and Midwifery Faculty’s Views on Conscientious Objection for Abortion Services

By Lidia Casas, Lori Freedman, Alejandra Ramm, Sara Correa, C. Finley Baba and M. Antonia Biggs

In 2017, Chile reformed its abortion law from a complete ban to one permitting the procedure when the woman’s life is at risk and in cases involving rape or fetal anomaly. The law also allows a range of clinical and nonclinical health care personnel present during the procedure—as well as private institutions as a whole—to claim conscientious objection (CO) and refuse to provide abortion services. In this article, the authors explore the views of medical and midwifery school faculty from universities in Santiago regarding abortion and CO, to inform how these topics are being taught to the country’s future health care providers.
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Contraceptive Receipt Among First-Trimester Abortion Clients and Postpartum Women in Urban Mexico

By Blair G. Darney, Evelyn Fuentes-Rivera, Biani Saavedra-Avendaño, Patricio Sanhueza-Smith and Raffaela Schiavon

First-trimester abortion is legal in Mexico City and is available through its public-sector abortion program, Interrupcion Legal del Embarazo (ILE). Contraceptive counseling and provision are essential components of abortion services and are integrated into the ILE program at no cost to clients; however, evidence suggests that, in Mexico overall, provision of the most effective contraceptive methods is linked with childbirth. In this article, the authors compare contraceptive uptake prior to discharge between ILE abortion clients and postpartum women from urban settings to understand and identify where improvements in care following an obstetric event can be made across the health system.
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Global Developments in Laws on Induced Abortion: 2008–2019

By Lisa Remez, Katherine Mayall and Susheela Singh

Whether women experiencing an unintended pregnancy are able to interrupt it legally—and safely—varies greatly by where women live. Evidence shows that laws restricting abortion do not eliminate the practice, but instead result in women having clandestine abortions, which are likely to be unsafe. This article, the third in a series, reviews the legal status of abortion throughout the world from 2008 through 2019.
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Feasibility of Multilevel Pregnancy Tests for Telemedicine Abortion Service Follow-Up: a Pilot Study

By Erica Chong, Wendy R. Sheldon, Danielle Lopez-Green, Cecilia Gonzalez H., Bárbara Hernández Castillo, Marián Gulías Ogando, Nirdesh Tuladhar and Jennifer Blum

There is a growing worldwide demand for medication abortion through telemedicine. Most aspects of medication abortion can be delivered just as effectively via telemedicine as in person, but provision of remote follow-up care presents some challenges. Telemedicine clients wishing to confirm a successful medication abortion outside of a clinic setting are commonly instructed to use high-sensitivity urine pregnancy tests, which can take up to four weeks to yield accurate results. In this article, the authors present findings from a pilot study that incorporated multilevel urine pregnancy tests—which provide accurate results in one week—into telemedicine abortion services.
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Expanding Access to Comprehensive Abortion Care in Humanitarian Contexts: Case Study from the Rohingya Refugee Camps in Bangladesh

By Sharmin Sultana, Shadie Tofigh, Rezwana Chowdhury, Sayed Rubayet, Ghazaleh Samandari and Alison Edelman

During humanitarian crises, the need for comprehensive sexual and reproductive health care is vital; however, access to abortion and abortion related care can be particularly limited in such settings, resulting in many women being delayed from seeking abortion until later in pregnancy. In this special report, the authors detail Ipas’s efforts to expand access to abortion-related care after the first trimester in the context of the Rohingya refugee camps in Cox’s Bazar, Bangladesh.
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Refugee and Internally Displaced Women’s Abortion Knowledge, Attitudes and Practices: Addressing the Lack of Research in Low- and Middle-Income Countries

By Blake Erhardt-Ohren and Sarah Lewinger

Research on the abortion knowledge, attitudes and practices (KAP) of refugee and internally displaced women in low- and middle-income countries is needed to adequately address the epidemic of unsafe abortion worldwide, and to ensure access to high-quality reproductive health services. In this viewpoint, the authors review what is currently known about abortion KAP among refugees and internally displaced people, and call for more research on the subject.
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COVID-19 and Abortion: Making Structural Violence Visible

By Rishita Nandagiri, Ernestina Coast and Joe Strong

COVID-19 has compromised and disrupted sexual and reproductive health across multiple dimensions, and has particularly affected abortion access and service provision. The pandemic has exposed—and heightened—existing fractures and fissures within abortion access and provision. In this viewpoint, the authors address how institutionalized and everyday forms of violence restrict and affect abortion access and quality of care.
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Abortion Self-Care: A Forward-Looking Solution to Inequitable Access

By Lucia Vázquez-Quesada, Ankita Shukla, Isabel Vieitez, Rajib Acharya and Saumya RamaRao

Abortion self-care is the ability of pregnant individuals to manage their unwanted pregnancies with or without the support of health care providers. Despite the technological possibilities and scientific evidence supporting abortion self-care, access to this type of abortion care is not equal for all pregnant people. In this viewpoint, the authors focus on the regulatory aspects of medication abortion that determine people’s access to quality and affordable abortifacient drugs, as well as to accurate information on their use.
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This special supplement was edited by Peter Doskoch, Peter Ephross, Michael Klitsch, Lisa Melhado and Jenny Sherman, under the direction of executive editor Jared Rosenberg. It was completed with the help of Mary Del Plato, publications assistant; Sandy Ramashwar, production coordinator; and Dan Tarnowski, web production assistant.