J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28209623
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AIM: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who h...AIM: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion. METHODOLOGY: This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. FINDINGS: After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. CONCLUSIONS: The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported 'counselling' and what this term actually involves within a PAC setting.
J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28188146
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OBJECTIVE: To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan. DESIGN: Focused ethnography. SETTING: A facility providing reproductive health services, including induce...OBJECTIVE: To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan. DESIGN: Focused ethnography. SETTING: A facility providing reproductive health services, including induced abortions in Chakwal, a small town in Northern Punjab, Pakistan. POPULATION: Women who came to the clinic seeking an abortion or who had had one in the last 6 months (=23) and all healthcare providers working in the facility (=14). METHODS: Semi-structured interviews (=37), a focus group discussion (=1) and participant observation (=41). Latent content analysis was conducted drawing on principles of constant comparison to generate key themes in reported experiences. RESULTS: All the respondents had sought an abortion to limit their fertility. Although some reported contraceptive use, improper use, undesirable side effects and restrictions on use had led to the unwanted pregnancy. All the women specifically requested misoprostol within days of their pregnancy, suggesting that they not only had knowledge of misoprostol as a backup in case of contraceptive failure, but may have pre-planned its use of using contraception. Women reconciled their decision to undergo an abortion by describing it as a mistake, miscarriage or menstrual cycle issue. CONCLUSIONS: Misoprostol's availability, ease of use and effectiveness have increased the role of abortion in fertility control.
Erickson M, Goldenberg SM, Akello M
… +4 more, Muzaaya G, Nguyen P, Birungi J, Shannon K
J Fam Plann Reprod Health Care
· 2017 Jul · PMID 28183852
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BACKGROUND: While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected s...BACKGROUND: While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions. METHODS: Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011-2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO. RESULTS: Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99-3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31-9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39-19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42-15.61). DISCUSSION AND CONCLUSIONS: These results suggest a critical need for removal of legal and social barriers to realising the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalised and criminalised populations of FSWs.
J Fam Plann Reprod Health Care
· 2017 Jul · PMID 28108504
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BACKGROUND: Since the internet has become an important source of contraceptive information with YouTube.com as the second most visited site, we analysed contraceptive implant YouTube videos for content and clinical accur...BACKGROUND: Since the internet has become an important source of contraceptive information with YouTube.com as the second most visited site, we analysed contraceptive implant YouTube videos for content and clinical accuracy. METHODS: Using the terms 'contraceptive implant', 'Nexplanon' and 'Implanon', the top 20 results on YouTube by relevance and view count were identified. After excluding duplicates, single-rod implant videos in English were included. Videos were classified as providing a professional or patient perspective. Views, duration and comments were noted. Videos were rated for reliability, global quality scale and whether they were positive or negative about the implant. Inter-rater agreement was measured. RESULTS: A total of 120 videos were retrieved; 52 were eligible for review. Less than 23% were professional videos; the majority reported patient experience (46% testimonials, 27% real-time procedure videos, 4% other). Patient videos had been posted a significantly longer duration of time than professional videos (364 vs 188 days, =0.02), were less reliable (≤0.0001) and were of lower global quality (<0.0001). Some 61% of implant testimonial videos were rated as 'positive experiences' and inter-rater agreement was very good (κ=0.81). All testimonials mentioned side effects, commonly irregular bleeding and discomfort with insertion. A minority (26%) reported misinformation. CONCLUSIONS: This study found that most of the information on YouTube pertaining to contraceptive implants is accurate, is presented from the patient's perspective, and promotes the method's use.
J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28100470
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BACKGROUND: Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. AIM AND DESIGN: This stud...BACKGROUND: Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. AIM AND DESIGN: This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption. CONCLUSIONS: A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients.