Women's experiences with unplanned pregnancy and abortion in Kenya: A qualitative study.
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ABSTRACT:
SUBMITTER: Jayaweera RT
PROVIDER: S-EPMC5784933 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. METHODS:Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. RESULTS:Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment. CONCLUSIONS:While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.
| S-EPMC6632190 | biostudies-literature
Project description:ObjectiveTo evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers.Data sourceFrom 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states.Study designIn-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment.Data extractionData were transcribed verbatim before being coded.Principal findingsIn two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates.ConclusionsPoor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health.
| S-EPMC3589964 | biostudies-literature
Project description:ObjectiveTo explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement.DesignQualitative interview study.SettingEarly Pregnancy Assessment Units in the UK.SampleA maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018.MethodsIn-depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway.Main outcome measuresWomen's experiences of EPAU services.ResultsWe found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway.ConclusionsRecommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service.Tweetable abstractEarly Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved.
| S-EPMC9292489 | biostudies-literature
Project description:ObjectiveTo explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic.DesignQualitative interview study.SettingOne National Health Service health board (administrative) area in Scotland.Population or sampleWomen in Scotland who had undergone medical TOP ≤63 days, and self-managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014.MethodsIn-depth, semi-structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method.Main outcome measuresWomen's experiences of self-management of TOP ≤63 days of gestation.ResultsKey themes emerging from the analysis related to self-administration of misoprostol in clinic; reasons for choosing home self-management; facilitation of self-management and expectation-setting; experiences of getting home; self-managing and monitoring treatment progress; support for self-management (in person and remotely); and pregnancy self-testing to confirm completion.ConclusionsParticipants primarily found self-administration of misoprostol and home self-management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self-management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol.Tweetable abstractWomen undergoing medical TOP 63 days found home self-management to be acceptable and/or preferable.
| S-EPMC5724679 | biostudies-literature
Project description:ObjectiveTo investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding.DesignMultimethod, qualitative study; questionnaire, focus groups and interviews.SettingNorthern and Southern Tasmania, Australia.Participants127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013.ResultsMothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure).Conclusions and implicationsFor many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.
| S-EPMC6528004 | biostudies-literature
Project description:Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used.Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades.This article summarizes the findings of a literature review on women's experiences with medical abortion in Latin American countries where voluntary abortion is illegal.Women's personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support.Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and the fact that some women eventually need to seek medical care at a hospital where they might be sanctioned for having an abortion and even reported to the police.
| S-EPMC3557184 | biostudies-literature
Project description:BackgroundAbdominal examination is a routine procedure performed by midwives several times during pregnancy to monitor the growth and well-being of the baby. Literature and instructions regarding abdominal examination focus on the technical performance, with limited attention paid to the women's experience of the examination or the bonding-related aspects between the mother and baby. The aim of the study was to explore how pregnant women experience the abdominal examination and how the examination affects maternal-fetal attachment.MethodsParticipant observation and semi-structured interviews with 10 pregnant women. We used thematic analysis to identify themes across the empirical material.ResultsWe identified the following four central themes: an essential examination, the baby becomes real, the importance of being involved and different senses provide different experiences. These themes describe how the women regarded the abdominal examination as an essential part of the midwifery consultation and considered it the occasion when the baby became real and tangible. Being prepared and involved before and during the examination were pivotal for how the examination was experienced by the women. The abdominal examination was crucial to the pregnant women because it provided them with important sensory aspects that were not obtained from ultrasound examination.ConclusionThe abdominal examination is regarded as essential in midwifery consultations and has the potential for supporting a woman's bodily sensation of her baby, which is reinforced by the midwife's manual palpation. Touch can be a way for a pregnant woman to become acquainted with her unborn child, which provides midwives a profound potential to facilitate the process of maternal-fetal attachment.
| S-EPMC9887567 | biostudies-literature
Project description:BackgroundRaising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women's perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis.MethodsA qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an Evidence for Policy and Practice Information (EPPI)-Centre quality assessment tool. Data synthesis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual.ResultsNine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women's perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ' … like a feather inside my belly' - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low.ConclusionThis qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMs. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women's perspective of assessing FMs in pregnancy are required.
| S-EPMC7944914 | biostudies-literature
Project description:BackgroundIn 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.MethodsWe 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.ResultsWe 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.ConclusionsWomen 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.
| S-EPMC5625615 | biostudies-literature
Project description:BackgroundPost-partum rectus diastasis, or the separation of the abdominal muscles after pregnancy, occurs in conjunction with physical symptoms and impaired quality of life. In Australia, health funding for surgery to treat diastasis was ceased in 2016, but reinstated in mid-2022, providing a unique context from which women's experiences of this condition can be analysed.ObjectivesThe objective is to examine the experiences of Australian women with post-partum rectus diastasis.DesignThis is an interview-style study with qualitative content analysis.MethodsWomen diagnosed with rectus diastasis were recruited to complete a baseline questionnaire (n = 45). Twenty-three responded to invitation for one-on-one interview via Zoom® between November 2021 and May 2022. Interviews were recorded, transcribed, and analysed using qualitative content analysis to identify key themes.ResultsEighteen women had undergone caesarean section and eight had twins. Thirteen had private health insurance. Women were most often diagnosed by a physiotherapist (n = 10). Key themes identified included changed physical appearance and function; issues with self-esteem and intimacy; barriers to treatment; lack of recognition as a medical condition; and overall frustration. The impact of rectus diastasis extended beyond physical and psychological symptoms to affect women's social functioning, child rearing, and return to work. There was a complex interaction between healthcare providers' knowledge of rectus the removal of funding for surgical treatment, and limitations of conservative therapy, with women's lived experiences and symptoms. The lack of an established medical definition also influenced the experiences of these women and their engagement with treatment.ConclusionThis study contextualizes women's experience of post-partum rectus diastasis with respect to the unique landscape of Australia's healthcare economy and provides evidence of women's absorption of health policy surrounding this condition. Our qualitative analysis provides critical knowledge for future quantitative studies, the results of which in combination could advance the definition of rectus diastasis and inform healthcare policy surrounding treatment.
| S-EPMC10998484 | biostudies-literature