Conducting Collaborative Abortion Research in International Settings

Abstract

Nearly 20% of the 208 million pregnancies that occur annually are aborted. More than half of these (21.6 million) are unsafe, resulting in 47,000 abortion-related deaths each year. Accurate reports on the prevalence of abortion, the conditions under which it occurs, and the experiences women have in obtaining abortions are essential to addressing unsafe abortion globally. It is difficult, however, to obtain accurate and reliable reports of attitudes and practices given that abortion is often controversial and stigmatized, even in settings where it is legal. To improve the understanding and measurement of abortion, specific considerations are needed throughout all stages of the planning, design, and implementation of research on abortion: Establishment of strong local partnerships, knowledge of local culture, integration of innovative methodologies, and approaches that may facilitate better reporting. This paper draws on the authors' collaborative research experiences conducting abortion-related studies using clinic-and community-based samples in five diverse settings (Poland, Zanzibar, Mexico City, the Philippines, and Bangladesh). The purpose of this paper is to share insights and lessons learned with new and established researchers to inform the development and implementation of abortion-related research. The paper discusses the unique challenges of conducting abortion-related research and key considerations for the design and implementation of abortion research, both to maximize data quality and to frame inferences from this research appropriately.

Ethical challenges in research on post-abortion care with adolescents: experiences of researchers in Zambia

“…We believe that the researchers' views need to be complemented with those of the adolescents who have participated in PAC clinical and behavioural studies. These situations may limit generalizability of the findings outside the Zambian context, though similar challenges have been documented elsewhere (Gipson et al, 2011;Hess, 2006;Ringheim, 1999). Even though wide generalizability was not the intention, the rich description of phenomena (researcher's experiences of conducting PAC research in Zambia) and the use of a multi-disciplinary team (with expertise in PAC research, bioethics, law, public health and anthropology) in the study design, data analysis and writing enriched the process as the authors were able to draw on and collate inputs from various professional areas.…”

“…Researchers working in this area reported several ethical challenges, including those associated with negotiating policy dynamics, seeking and securing ethical approvals, recruiting study participants, collecting data, and reporting data. Other studies have shown that conducting PAC research with adolescents raises particular challenges, underscoring both the need for more research with that group, but also more ethical guidance (Gipson et al, 2011;Hess, 2006;Ringheim, 1999;Söderberg, Andersson, Janzon, & Sjöberg, 1998).…”

“…One major ethical challenge during the recruitment phase was securing valid informed consent, a concern also noted in other studies (Gipson et al, 2011;Hess, 2006;Ringheim, 1999;Söderberg et al, 1998;Zulu et al, 2018). Several respondents reported that it was difficult to effectively recruit adolescents into PAC studies and carry out the consent and assent process mainly due to the taboo of discussing abortion, inadequate knowledge of the law by the community, and the stigma and discrimination associated with abortion.…”

Trajectories to abortion and abortion-related care: a conceptual framework

“…Abortion is a common feature of the reproductive lives of women globally, and unsafe abortion continues to be a major public health problem (Lohr et al, 2014). However research on abortion is challenging, particularly in settings where abortion is illegal and/or highly stigmatised (Gipson et al, 2011). This difficulty is reflected in the small volume of social science research on abortion to the relative import of the issue on the lives of women and their reproductive experiences.…”

Ethics challenges and guidance related to research involving adolescent post-abortion care: a scoping review

“…In order to improve PAC access and quality, there has been increased research on barriers and challenges for PAC involving adolescents [ 10 , 12 ]. PAC researchers focusing on adolescents often face a range of ethics challenges, commonly due to abortion being a controversial, sensitive and stigmatized topic in many settings, including in LMICs where abortion is legal [ 13 – 15 ]. While some studies have been conducted on ethics issues associated with PAC research [ 15 , 16 ], a comprehensive review of the ethics issues raised in international literature on adolescent post abortion care research is lacking.…”