Dataset Information

Women's experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study.

ABSTRACT:

Background

In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population.

Methods

We recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe abortion access needs.

Results

We enrolled 42 women, nearly one-third of whom reported they were sex workers. Thirty-four women (81%) reported having had one informal sector abortion within the past 5 years, 14% reported having had two, and 5% reported having had three. These women consumed home remedies, herbal mixtures from traditional healers, or tablets from an unregistered provider. Twelve sought additional care for potential warning signs of complications. Privacy and fear of mistreatment at public sector facilities were among the main reported reasons for attempting informal sector abortion. Most women (67%) cited other community members as their source of information about informal sector abortion; posted signs and fliers in public spaces also served as an important source of information.

Conclusions

Women are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities. Some were unaware how or where to seek formal sector services, or believed the cost was too high. Many informal methods are ineffective and unsafe, leading to potential warning signs of complications and continued pregnancy. Sex workers may be at particular risk of unsafe abortion. Based on these results, it is essential that future studies sample women outside of the formal health sector. The use of innovative sampling methods would greatly improve our knowledge about informal sector abortion in South Africa.

SUBMITTER: Gerdts C

PROVIDER: S-EPMC5625615 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Publications

Women's experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study.

Gerdts Caitlin C Raifman Sarah S Daskilewicz Kristen K Momberg Mariette M Roberts Sarah S Harries Jane J

BMC women's health 20171002 1

<h4>Background</h4>In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specif ...[more]

PMID: 28969631

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Project description:Abortion is regulated in Mexico at the state level, and it is permitted under certain criteria in all 32 states, except in Mexico City where first-trimester abortion is decriminalized. Yet, more than a million abortions occur in Mexico each year. But most terminations occurring outside of Mexico City are clandestine and unsafe due to profound stigma against the procedure, lack of trained providers, lack of knowledge of where to find a safe abortion and poor knowledge of the laws. While this situation is moderated by the increasing use of misoprostol, a relatively safe method of abortion, the safety of the procedure cannot be assured in restrictive legal contexts. The purpose of this study is to explore women's experiences with induced abortion in three federal entities with different legal contexts, and whether abortion seeking behavior and experiences differ across these settings. The study was carried out in three states, representing three different degrees of restrictiveness of abortion legislation. Queretaro with the "most restrictive" law, Tabasco with a "moderately restrictive" law, and Mexico state with the "least restrictive" law. We hypothesize that women living in more restrictive states will resort to the use of more unsafe and risky methods and providers for their abortion than their counterparts in less restrictive states. Women who recently obtained abortions were selected through snowball sampling and qualitative data were collected from them using semi-structured indepth interviews. Data collection took place between mid-2014 and mid-2015, with a final sample size N = 60 (20 from each state). Various themes involved in the process of abortion seeking behavior were developed from the IDIs and examined here: women's knowledge of the abortion law in their state, reasons for having an abortion; the methods and providers used and women's positive and negative experiences with abortion methods and providers used. Our results indicate that abortion safety is not associated with the restrictiveness of abortion legislation. Findings show that there is a new pattern of abortion service provision in Mexico, with misoprostol, a relatively safe and easy to use method, playing an important role. Nevertheless, while access to misoprostol tends to increase the safety of abortion, the improvement is moderated by women and their informants (relatives, friends and partners) not having accurate information on how to safely self-induce an abortion with misoprostol. On the other hand, some women manage to have safe abortion in illegal setting by going to Mexico City or with the support of NGOs knowlegeable on abortion. Findings demonstrate the importance of decriminalization of abortion, but meanwhile, harm reduction strategies, including promotion of accurate information about self-use of misoprostol where abortion is legally restricted will result in safe abortion.

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Project description:ObjectiveTo document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only.MethodsRepeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort.ResultsThe 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts.ConclusionThe introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.

Project description:BackgroundRepeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners.MethodsThis cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi'an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson's chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed.ResultsOf 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08-1.73 for 31-35 years; 1.82, 1.29-2.57 for ≥36 years), received a low-level education (1.86, 1.42-2.43 for ≤senior high school; 1.46, 1.17-1.83 for junior college), were jobless (2.46, 1.18-5.13), had one child (1.54, 1.10-2.17), had a general (1.60, 1.28-1.98) or no (2.51, 2.02-3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09-1.61), withdrawal (1.43, 1.12-1.84), and emergency measures (1.48, 1.09-1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06-1.68 for 31-35 years; 2.13, 1.56-2.91 for ≥36 years), attained a low-level education (1.66, 1.28-2.15 for ≤senior high school; 1.38, 1.10-1.74 for junior college), received a high-level monthly income (1.34, 1.08-1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42-19.33) were more likely to have a repeat abortion.ConclusionsThe study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practice.

Dataset Information

Women's experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study.

Background

Methods

Results

Conclusions

Publications

Women's experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study.

Similar Datasets

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