Abortion stigma around the globe: a qualitative synthesis
Making inroads, 31 March 2016
After a review of literature and available resources, we discovered a lack of analysis of qualitative research. Through the production of this resource, we hoped to paint a picture of how stigma appears in different geographic regions, and across the different levels of the ecological model. We specifically examined peer-reviewed articles that addressed abortion stigma (in the title, abstract or subject heading), employed qualitative methods, and reported thematic findings on abortion stigma. We found that stigma, not surprisingly, is socially constructed, culturally and socially embedded and is influenced by social and cultural mores. Without cultural norm transformation, stigma continues to manifest in multiple ways, across a variety of contexts.
Constructing a validated scale to measure community-level abortion stigma in Mexico
Annik M Sorhaindo, Tahilin S Karver, Jonathan G Karver, Sandra G Garcia
Abstract: We developed a scale to measure abortion stigma at the community level, examine its prevalence and explore factors associated with abortion stigma in a nationally representative sample. Following intensive qualitative work to identify dimensions of the stigma construct, we developed a comprehensive list of statements that were cognitively tested and reduced to 33 to form a scale. We piloted the scale in a nationally and sub-regionally representative household public opinion survey administered to 5600 Mexican residents… Abortion stigma prevents women from accessing safe abortion services. Measuring community-level abortion stigma is key to documenting its pervasiveness, testing interventions aimed at reducing it and understanding associated factors. This scale may be useful in countries similar to Mexico to support policymakers, practitioners and advocates in upholding women’s reproductive rights.
Editor’s note: This is a very complicated research article, but the list of statements expressing abortion stigma that people were asked to respond to are extremely useful.
Abortion incidence between 1990 and 2014: global, regional, and sub-regional levels and trends
Gilda Sedgh, Jonathan Bearak, Susheela Singh, Akinrinola Bankole, et al.
The primary transmission route of Zika virus is via the Aedes mosquito. However, sexual transmission of Zika virus may also be possible, with limited evidence recorded in a few cases. This is of concern due to an association between Zika virus infection and potential complications, including microcephaly and Guillain-Barré syndrome. The current evidence base on Zika virus remains extremely limited. This guidance will be reviewed and the recommendations updated as new evidence emerges.
- All patients (male and female) with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the potential risks of sexual transmission of Zika virus, contraceptive measures and safer sexual practices1, and should be provided with condoms when feasible. Women who have had unprotected sex and do not wish to become pregnant because of concern with infection with Zika virus should also have ready access to emergency contraceptive services and counselling.
- Sexual partners of pregnant women, living in or returning from areas where local transmission of Zika virus is known to occur, should use safer sexual practices or abstinence from sexual activity for the duration of the pregnancy.
- Men and women living in areas where local transmission of Zika virus is known to occur should consider adopting safer sexual practices or abstaining from sexual activity.
- Men and women returning from where local transmission of Zika virus is known to occur should adopt safer sexual practices or consider abstinence for at least four weeks after return.
- Independently of considerations regarding Zika virus, WHO always recommends the use of safer sexual practices including correct and consistent use of condoms to prevent HIV, other sexually transmitted infections and unwanted pregnancies.
WHO does not recommend routine semen testing to detect Zika virus.
Measuring unsafe abortion-related mortality: a systematic review of the existing methods
Caitlin Gerdts, Divya Vohra, Jennifer Ahern
Abstract: To our knowledge, no systematic assessment of the validity of studies reporting estimates of abortion-related mortality exists. Articles in this study had to be published between 1 Sept 2000 and 1 Dec 2011; utilized data from a country where abortion is considered unsafe; specified and enumerated causes of maternal death, including “abortion”; enumerated maternal deaths; were quantitative research; and were published in a peer-reviewed journal. Of 7,438 articles identified, 36 were ultimately included. Overall, studies rated “very good” found the highest estimates of abortion-related mortality (median 16%, range 1–27.4%). Studies rated “very poor” found the lowest overall proportion of abortion-related deaths (median 2%, range 1.3–9.4%).
Conclusions: Improvements in the quality of data collection would facilitate better understanding of global abortion-related mortality. Until improved data exist, better reporting of study procedures and standardization of the definition of abortion and abortion-related mortality should be encouraged.
Identifying indicators for quality abortion care: a systematic literature review
Amanda Dennis, Kelly Blanchard, Tshego Bessenaar
A systematic review was conducted of 13 peer-reviewed articles and eight reports focused on indicators of quality abortion care. A total of 75 indicators of quality abortion were identified; these indicators address a variety of issues including policy, health systems, trained-provider availability, women’s decision making, and morbidity and mortality. There is little agreement about indicators for measuring quality abortion care; more work is needed to ensure efforts to assess quality are informed and coordinated.
Randomized trial assessing home use of two pregnancy tests for determining early medical abortion outcomes at 3, 7 and 14 days after mifepristone
Jennifer Blum, Wendy R Sheldon, Nguyen Thi Nhu Ngoc, Beverly Winikoff, et al.
Contraception, 8 April 2016
Abstract: To evaluate the accuracy, feasibility and acceptability of two urine pregnancy tests in assessing abortion outcomes at three time points after mifepristone administration. This randomized trial enrolled women seeking early medical abortion at two hospitals in Vietnam. Investigators randomly allocated participants to at-home administration of a multilevel urine pregnancy test (MLPT) or a high sensitivity urine pregnancy test (HSPT) to assess their abortion outcomes. A baseline test was administered on the same day as mifepristone. Participants performed and interpreted results of pregnancy tests taken 3, 7 and 14 days after mifepristone. Ultrasound exam determined continuing pregnancy.
Results and conclusions: Six hundred women enrolled, and 300 received each test. 97.4% (584) had follow-up, of whom 13 women had continuing pregnancies. At all three time points, the sensitivity and negative predictive values for both tests were 100.0%. Most women found their assigned tests easy to use and would prefer future home follow-up with a pregnancy test. The MLPT enables women to assess their abortion outcomes more reliably than with HSPT. With MLPT, women can know their outcomes as early as 3 days after mifepristone.
Implications: Medical abortion service delivery with an MLPT to obtain a baseline (pre-abortion) human chorionic gonadotropin (hCG) estimate and a second follow-up MLPT 1 to 2 weeks later can establish whether there has been a drop in hCG, signifying absence of a continuing pregnancy. Used this way, MLPTs can enable women to assess their abortion status outside of a clinic setting and without serum hCG testing and/or ultrasound.