Access to safe abortion: building choices for women living with HIV and AIDS

Abstract

In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of all pregnancies worldwide in 2008, 41% were reported as unintended or unplanned, and approximately 50% of these ended in abortion. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights.In this paper, we explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting.Similarities and differences are discussed, and we further outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.

Contemplating abortion: HIV-positive women's decision to terminate pregnancy

“…Other studies have documented that economically dependent women are more likely to be influenced by family and partner preferences. (Bedimo, Bessinger, and Kissinger 1998; Kanniappan, Jeyapaul, and Kalyanwala 2008; Chi et al 2011; Lindgren et al 1998; Orner et al 2010; Orner et al 2011; Villela et al 2012; de Bruyn 2004, 2006)…”

“…Health care providers in Brazil and other contexts have reportedly misinformed or coerced pregnant HIV-positive women to terminate their pregnancies or undergo sterilisation (Orner et al 2011; Cooper et al 2007; Hopkins et al 2005; International Community of Women Living with HIV/AIDS 2008). Given this reality, the fact that health care providers in our study gave accurate medical information on preventing vertical transmission to HIV-positive women is promising.…”

Fertility-related research needs among women at the margins

“…20,21 The legal status of abortion in many countries and pervasive stigma have also resulted in less information on the relationship between HIV and abortion, including the safety of abortion in the context of HIV and access to post-abortion care. [22][23][24][25] Information available suggests that Figure 2. Overview of fertility-related research areas for women of reproductive age.…”

Articulating reproductive justice through reparative justice: case studies of abortion in Great Britain and South Africa

“…Poor women and women in rural areas are more likely to die from abortion related complications than their counterparts (Orner et al 2011). Notably, women in urban centres and wealthier women can access services through private providers (in particular Marie Stopes).…”

“…In the same study, women reported fears of being ostracised from their communities, which often led to them seeking care outside of their residential area. This stigma is exacerbated when the women are also HIV+ (Orner et al 2011).…”