Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review

Abstract

Background Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited. Main body This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others. Conclusion Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma.

Abortion information-seeking experiences among women who obtained abortions in Kinshasa, DRC: Results from a qualitative study

“…Fear of social stigma and rejection shaped participants’ pathways for information-gathering, echoing findings from other contexts [ 15 – 17 ]. These concerns reflect a reality for many women, who are often ostracized, isolated, and sometimes forced to leave their communities if they are found to have had an abortion [ 23 – 25 ].…”

“…Incomplete and inaccurate information often leads to misperceptions about risks, efficacy, and safety, deterring women from seeking care within formal healthcare settings [ 14 ]. Despite inadequate knowledge, research has found that women often limit their discussion of their abortion decisions to few, select people or keep the decision to abort entirely a secret, out of fear of stigmatization and potential rejection from family, friends, and partners [ 15 – 17 ]. Fear of stigmatization may be greater in a highly Catholic country like the DRC given the church’s prominent role in society and its opposition to abortion.…”

The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model

“…Two articles about abortion/TOP in midwifery are not enough to arrive at a universally applicable theory, but it is a solid beginning. In low- and middle-income countries, access to abortion care is sometimes restricted or hidden and information lacking [ 36 ]. Often, illegal drug sellers, people working with illegal providers, sex workers, taxi drivers, or feminist groups are key informants in the search for abortion providers.…”

What’s needed to improve safety and quality of abortion care: reflections from WHO/HRP Multi-Country Study on Abortion across the sub-Saharan Africa and Latin America and Caribbean regions

“…It will be important to use new approaches to reach women that are not reaching facility-level care. WHO is currently exploring network-based methods 20 to better understand how women’s social networks can deter or refer her to reach safe abortion care services.…”