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Sexual and Reproductive Health, Maternity and Newborns
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Comprehensive abortion care encompassing post-abortion care and safe abortion is of particular relevance in humanitarian settings due to vulnerabilities such as poor access to contraception and increased risk of sexual violence. Despite unsafe abortion being a leading cause of maternal mortality, abortion services are often neglected in humanitarian response due to four key reasons: the need is not recognised, abortion is considered too complicated to be provided in crises donors do not fund abortion services and abortion is believed to be illegal.9
Introduction
Published in Irehobhude O. Iyioha, Women’s Health and the Limits of Law, 2019
Following an assessment of domestic and international laws and policies in South Africa and Nigeria on women’s reproductive health, including the constitutions of both countries, South Africa’s Choice on Termination of Pregnancy Act,21 the National Health Act of South Africa22 and Nigeria,23 as well as relevant healthcare policies in Nigeria, the authors proceed to consider the extent to which these laws and policies address the problems of inaccessible and inadequate healthcare services. One of such critical services is abortion and post-abortion care, which – when lacking, inadequate or inaccessible – contribute to unacceptably high maternal mortality rates. Within this context, the authors summarily examine the reasons why South Africa’s liberal laws on abortion have failed to ameliorate the problem of illegal and clandestine abortions among South African women.
Health promotion and vector-borne disease outbreaks
Published in Glenn Laverack, Health Promotion in Disease Outbreaks and Health Emergencies, 2017
The role of health promotion is to provide accurate information about access to sexual and reproductive healthcare and services for all women and adolescent girls of reproductive age in the affected areas. This includes access to family planning, counselling, contraceptive services, safe abortion services and post-abortion care. Ensuring all groups are included in national response plans and related Zika prevention activities are also carried out as a part of health promotion in coordination with local authorities and non-government partners. Health and social systems need to adjust to a greater demand from families affected by the complications of the Zika virus for rehabilitative services, social assistance and protection, psychosocial support and specialised healthcare and education. Multiple disciplines will be required to ensure the effective delivery of essential health services and the management of Zika complications, delivered by a skilled health and social care workforce.
Analysing the context and characteristics of legal abortion and comprehensive post-abortion care among adolescents aged 10–14 in a network of sentinel centres in Latin America: a retrospective cross-sectional study, 2016–2020
Published in Sexual and Reproductive Health Matters, 2023
Caitlin R. Williams, M. Valeria Bahamondes, Rodolfo Gómez Ponce de León, Helymar da Costa Machado, Luis Bahamondes, Sonja Caffe, Suzanne Jacob Serruya
As of 2019, 41% of the global population lives in countries where abortion is significantly restricted.9 Latin America and the Caribbean (LAC) is one of the regions where access to abortion is most highly restricted. People may only legally access abortion without providing justification (e.g. risk to life or health) in a handful of countries, and even then, only up to 8, 12, or 14 weeks’ gestation (at the time of data collection, Guyana, Cuba and Uruguay, and Argentina, respectively). Some jurisdictions in Mexico (Mexico City, Oaxaca, Hidalgo, and Veracruz) also fully recognise the right to abortion without need for justification up until 12 weeks’ gestation, but other states criminalise all abortions other than those that occur in response to cases of rape. Providing post-abortion care is a legal obligation in all countries in the region, in line with World Health Organization (WHO) recommendations and United Nations treaty body jurisprudence.10,11 Yet in practice, in countries where abortion is heavily restricted or prohibited altogether, pregnant people may fear that seeking post-abortion care could make them targets for state surveillance and harassment.12 Some have suggested that young adolescents are disproportionately impacted by abortion restrictions,13,14 but there are few empirical studies on this group as adolescents under the age of 15 are generally excluded from surveys on reproductive health.8
An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool
Published in Sexual and Reproductive Health Matters, 2023
Palitha Gunarathna Mahipala, Sabeen Afzal, Qudsia Uzma, Atiya Aabroo, Nilmini Hemachandra, Katy Footman, Heidi Bart Johnston, Bela Ganatra, Tahira Ezra Reza, Ahsan Maqbool Ahmad, Hasan Bin Hamza, Maida Umar, Kauser Hanif, Sayema Awais, Mariyam Sarfraz, Ellen Thom
This SARA assessment was implemented in Pakistan shortly after the Essential Package of Health Services (EPHS) endorsed the provision of therapeutic abortion and post-abortion care at community, primary and hospital levels of the health system in 2020.6 The inclusion of therapeutic abortion within primary care was in line with Pakistan’s National Service Delivery Standards and Guidelines for High-Quality Safe Uterine Evacuation/Post-Abortion Care5 which state that “both vacuum aspiration and medical methods may be considered at the primary-care level, but where capacity to provide high-quality uterine evacuation care services does not exist, referral to services at higher levels is essential”. The EPHS also aligns with the 2022 WHO abortion care guideline, which recommends that abortion must be centred within primary health care, which itself is fully integrated within the health system, facilitating referral pathways for higher-level care.17 This is essential for the achievement of universal health coverage and realisation of reproductive rights. The SARA assessment, therefore, provides an important insight into the service delivery gaps which need to be addressed for the EPHS to be fully implemented, particularly in primary care. The findings can inform future health system strengthening for therapeutic abortion and post-abortion care.
The impact of COVID-19 lockdown on abortion care: a time series analysis of data from Marie Stopes Nepal
Published in Sexual and Reproductive Health Matters, 2022
Corrina Horan, Melissa Palmer, Raman Shrestha, Chelsey Porter Erlank, Kathryn Church
Client information centre (CLIC) data were collected from clients at the time of service provision, both to facilitate client care and for reporting purposes. Patient-level data collected included basic sociodemographic factors (age, sex, number of children, occupation and educational attainment), last menstrual period and the type of SRH services sought that day (such as abortion care, contraception, vaccinations or general health counselling). Data were entered electronically by reception clerks following initial clinician data entry on paper forms. A dataset was extracted from CLIC in a fully anonymised format. Individual transaction-level data (i.e. unique service units) were collapsed into visit level data, using unique IDs. For our analysis, abortion care is referring to attendance for a medical or surgical procedure to end a pregnancy. Additionally, post-abortion care is referring to both repeat surgical/medical procedures and counselling/other general follow-up could be provided for treatment undertaken either at an MSN clinic or another abortion provider.