Contextualizing medication abortion in seven African nations: A literature review

Moseson, Heidi; Shaw, Jessica; Chandrasekaran, Sruthi; Kimani, E; Maina, J.; Malisau, Pearson; Musa, Yiga; Nmezi, Sybil; Philipo, Kitungano; Borjas, Eva Bonnefoy; Young, Yves-Yvette; Janssen, Kantjil

doi:10.1080/07399332.2019.1608207

Cited by 7 publications

(6 citation statements)

References 69 publications

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“…On a macro-level, we hope that the PDMM can be utilized to identify specific cultural and sociopolitical barriers and limitations to reproductive access, so that we may be better equipped to pursue global equity initiatives toward reproductive justice (Association of Women’s Health, Obstetric, and Neonatal Nursing, 2009; Moseson et al, 2019). Specifically, we hope that this intersectional approach spurs greater understanding of the factors affecting pregnant people who are marginalized so that we may break away from a cisheteronormative and colonialist viewpoint of unintended pregnancy and be better prepared to dismantle the structures that restrict the autonomy and agency of all pregnant people.…”

Section: Discussionmentioning

confidence: 99%

“…Last is logistical access—can the pregnant person physically access the pregnancy decision they chose? This may relate to one’s geographic location and physical proximity to hospitals or abortion providers (Moseson et al, 2019). It may also concern one’s ability to travel to access said services, which could be impeded by terrain, lack of transportation, border-crossing restrictions, or inability to secure childcare for existing children or to take leave from work.…”

Section: The Proposed Pdmmmentioning

confidence: 99%

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A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

Klann

Wong

2020

Psychology of Women Quarterly

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Empirical data from the past 50 years have illuminated some of the factors that influence pregnancy decision-making. Yet, formal models of pregnancy decision-making are uncommon and rarely incorporate cultural perspectives. In order to address this gap in the literature, we propose the Pregnancy Decision-Making Model (PDMM), a comprehensive model of the factors that are likely to affect pregnancy decisions in the context of unintended pregnancy, with special attention to relational and intersectional components of pregnancy decisions. The PDMM begins with three primary Evaluation factors: Evaluation of Capital, Evaluation of Values, and Evaluation of Narratives. Barriers to Access are proposed to be a key factor in limiting agency and autonomy and determining pregnancy outcomes. Social Influences are also hypothesized to influence Evaluation factors and their relationship with outcome variables, which include the Pregnancy Outcome, Decisional Certainty, and Decisional Satisfaction. As the PDMM is designed to be flexible in its prediction of a variety of outcomes, we consider a number of possible permutations of the model. Finally, we discuss the utility of the PDMM for inspiring future research, as well as the practical implications of the model.

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Section: Discussionmentioning

confidence: 99%

Section: The Proposed Pdmmmentioning

confidence: 99%

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

Klann

Wong

2020

Psychology of Women Quarterly

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“…Medication abortion has been identified as partly responsible for the decline in severe abortion-related morbidity and mortality across the globe ( 9 , 10 ). The safety and efficacy of MA when correctly administered, as well as its crucial role in mitigating the consequences of unsafe abortions, have been well documented ( 11 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients

Akinyemi

Owolabi

Erinfolami

et al. 2022

Front. Glob. Womens Health

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BackgroundEvidence confirmed that the demand for medical abortion (MA) increased significantly during the COVID-19 outbreak in many developing countries including Nigeria. In an abortion-restrictive setting like Nigeria, local pharmacies, and proprietary patent medicine vendors (PPMVs) continue to play a major role in the provision of MA including misoprostol. There is the need to understand these providers' knowledge about the use of misoprostol for abortion and the quality of information they provide to their clients. This analysis is focused on assessing the quality of care provided by both drug seller types, from drug sellers' and women's perspectives.MethodologyThis study utilized primary data collected from drug sellers (pharmacists and PPMVs) and women across 6 Local Government Areas in Lagos State, Nigeria. The core sample included 126 drug sellers who had sold abortion-inducing drugs and 386 women who procured abortion-inducing drugs from the drug sellers during the time of the study. We calculate quality-of-care indices for the care women received from drug sellers, drawing on WHO guidelines for medication abortion provision. The index based on information from the sellers had two domains—technical competency and information provided to clients, while the index from the women's perspectives includes an additional domain, client experience.ResultsResults show that the majority of drug sellers in the sample, 56% (n = 70), were pharmacists. However, far more than half of women 60% (n = 233) had visited PPMVs. Overall, the total quality score amongst all drug sellers (mean 0.48, SD0.15) was higher than the total score calculated based on women's responses (mean 0.39, SD 0.21). Using our quality-of-care index, pharmacies and PPMVs seem to have similar technical competency (mean score of 0.23, SD 0.13 in both groups (range 0–1), whilst PPMV's performed better on the information provided to client domain (mean score of 0.79, SD 0.17 compared with pharmacies 0.69, SD 0.25). Based on women's reports, PPMVs scored better on both quality of care domains (technical competency and information provided to clients) compared with pharmacies.Program/Policy ImplicationIn resource-constrained settings such as Nigeria, particularly in the context of health emergencies like COVID-19, there is the need to continue to strengthen and engage PPMVs' capacity and skills in dispensing and administration of MA drugs as a harm reduction strategy. Also, there is the need to target frontline providers in pharmacies for training and skill upscale in MA provision.

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“…Regulations restricting the range of abortion methods from which women can choose, including medication abortion in particular, may also affect abortion access [ 26 , 27 ]. A literature review contextualizing medication abortion in seven African countries reported that incidence of medication abortion is low despite being a safe, effective, and low-cost abortion method, likely due to legal restrictions on access to the medications [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol

2021

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Background A country’s abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women’s access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women’s health services and outcomes in LMICs. Methods We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women’s health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description. Discussion This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women’s health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility. Systematic review registration PROSPERO CRD42019126927

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Contextualizing medication abortion in seven African nations: A literature review

Cited by 7 publications

References 69 publications

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients

Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol

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