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

Abstract

IntroductionAn increase in post abortion care (PAC) research with adolescents, particularly in low- and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature.MethodsFollowing a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges.ResultsThe literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers.ConclusionAddressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international levels. Overall, despite the documentation of challenges in the published literature, guidance on handling several of these ethics challenges is sparse. We encourage further research to clarify the identified challenges and support the development of formal guidance in this area.

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

“…As outlined earlier, the described ethics challenges also affected the quality and impact of data from adolescent PAC studies. For example, risks associated with stigmatization undermined participation in studies among adolescents, a finding that resonates with a recent scoping review on ethics challenges related to research involving PAC (Zulu et al, 2018). Researchers sometimes changed their questions to focus indirectly on adolescents' perceptions and experiences, or completely abandoned their studies.…”

“…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.…”

“…Unsafe abortions among adolescents is a major health challenge for health systems in low-and middle-income countries (LIMCs) (Cresswell et al, 2016, Hanschmidt, Linde, Hilbert, Riedel-Heller, & Kersting, 2016. About 13% of maternal deaths globally result from unsafe abortions, and the proportion of maternal deaths from unsafe and how they have been addressed in practice, are lacking (Zulu et al, 2018). The review recommended the need for further research to clarify the challenges and support the development of formal guidance in this area (Zulu et al, 2018).…”

“…About 13% of maternal deaths globally result from unsafe abortions, and the proportion of maternal deaths from unsafe and how they have been addressed in practice, are lacking (Zulu et al, 2018). The review recommended the need for further research to clarify the challenges and support the development of formal guidance in this area (Zulu et al, 2018). This study sought to address this gap by empirically exploring how researchers experienced and resolved ethical challenges encountered while conducting research on PAC with adolescents in Zambia.…”

Issue and Challenges of Adopting Contraception Methods by Men and Women in Rural Uttar Pradesh

“…Joseph M. Zulu1 and Joseph Ali et al [20] suggested strategies for addressing the ethical challenge. An increase in post abortion care (PAC) research with adolescents particularly in low-and middle-income countries, that researchers face when conducting a scoping review of published literature PAC .…”