Journal Articles: Bangladesh, India, Ghana, Senegal, Malawi, Spain/Italy
+ Feminism & Psychology special edition, Video from Nicaragua
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4 April 2017
BANGLADESH
From presentation at 7th APCRSHR, 2014 Access to and quality of menstrual regulation services and post-abortion care in Bangladesh: evidence from surveys of health facilities, 2014
by Altaf Hossain, Isaac Maddow-Zimet, Meghan Ingerick, Hadayeat Ullah Bhuiyan, Michael Vlassoff, Susheela Singh
Key points
> In 2014, an estimated 430,000 menstrual regulation procedures were performed in health facilities nationwide, representing a sharp 34% decline since 2010. The annual rate of MR was 10 per 1,000 women aged 15–49 in 2014, down from 17 in 2010.
> Some 257,000 women were treated for complications of induced abortion nationally in 2014, for a rate of six per 1,000 women aged 15–49.
> Fewer than half (42%) of public- and private-sector facilities permitted to provide MR services actually did so in 2014 (down from 57% in 2010). This proportion was particularly low among private facilities, of which only 20% reported providing MR in 2014 (down from 36% in 2010).
> Only about half of all union health and family welfare centres (UH&FWCs) provided MR procedures in 2014, a significant decline from two-thirds in 2010. These facilities are the primary health providers in rural areas, where the majority of the population lives.
> The decline in the proportion of UH&FWCs providing MR services may be due, in part, to a lack of training among younger providers recently recruited to replace a large cohort of UH&FWC providers reaching retirement age. At UH&FWCs that do not offer MR services, 92% of providers aged 20–29 reported they do not provide MR due to lack of training.
Unsafe abortion is still a significant public health problem in India, with complications of abortion accounting for 8-9% of maternal deaths. Every year an estimated 6.4 million abortions take place in India, and over half (56%) are estimated to be unsafe. Many women are not aware that abortion is legal, nor are they aware of facilities that are certified by the government to provide abortion services.
Ipas Development Foundation in coordination with the state governments of Bihar and Jharkhand piloted two intervention models in two selected districts each in Bihar and Jharkhand. The study compared a high-intensity model and a low-intensity model of communication and their relative effectiveness in terms of improving women’s knowledge and awareness of the legal aspects and sources of safe abortion services and experiences with regard to usage of abortion services; the study also examined the association between exposure to the intervention and levels of abortion knowledge.
The communication campaign centred on a fictional young woman called Kalyani, meaning auspicious. Using Kalyani as the protagonist, two different communication models were introduced to increase awareness and service usage among women in the districts. The high-intensity intervention consisted of communication activities including interpersonal communication through group meetings and interactive games, wall signs, street dramas and distribution of low-literacy reference materials. Interpersonal communication group meetings were carried out in different locations of the village with 8-10 married women aged 15-49 years. At the end of each group meeting, participants played interactive games to reinforce the key messages delivered in the meeting. Wall paintings and posters included the legality, availability, modern techniques of abortion and safety of first trimester abortion and were placed in central locations of the village and health facilities. A total of 877 villages received interventions through 851 wall paintings, 12,000 interpersonal communication meetings and 819 street dramas...
From: Millennium Village Evaluation – Mid-term Summary Report: 2016 “My friend who bought it for me, she has had an abortion before.” The influence of Ghanaian women’s social networks in determining the pathway to induced abortion
by Sarah D Rominski, Jody R Lori, Emmanuel SK Morhe
Journal of Family Planning and Reproductive Health Care, 22 March 2017,
DOI: http://dx.doi.org/10.1136/jfprhc-2016-101502 Abstract Background Even given the liberal abortion law in Ghana, abortion complications are a large contributor to maternal morbidity and mortality. This study sought to understand why young women seeking an abortion in a legally enabling environment chose to do this outside the formal healthcare system. Methods Women being treated for complications arising from a self-induced abortion as well as for elective abortions at three hospitals in Ghana were interviewed. Community-based focus groups were held with women as well as men, separately. Interviews and focus group discussions were conducted until saturation was reached. Results A total of 18 women seeking care for complications from a self-induced abortion and 11 seeking care for an elective abortion interviewed. The women ranged in age from 13 to 35 years. There were eight focus groups; two with men and six with women. The reasons women self-induce are: (1) abortion is illegal; (2) attitudes of the healthcare workers; (3) keeping the pregnancy a secret; and (4) social network influence. The meta-theme of normalisation of self-inducing an abortion was identified. Discussion When women are faced with an unplanned and unwanted pregnancy, they consult individuals in their social network whom they know have dealt with a similar situation. Misoprostol is widely available in Ghanaian cities and is successful at inducing an abortion for many women. In this way, self-inducing abortions using medication procured from pharmacists and chemical sellers has become normalised for women in Kumasi, Ghana.
From Planned Parenthood Global: When abortion is a crime Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal
by Siri Suh
Global Public Health, 13 March 2017. DOI: http://dx.doi.org/10.1080/17441692.2017.1301513 Abstract
Reproductive governance operates through calculating demographic statistics that offer selective truths about reproductive practices, bodies, and subjectivities. Post-abortion care, a global reproductive health intervention, represents a transnational reproductive regime that establishes motherhood as women’s primary legitimate reproductive status. Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I illustrate how post-abortion care accomplishes reproductive governance in a context where abortion is prohibited altogether and the US is the primary bilateral donor of population aid. Reproductive governance unfolds in hospital gynecological wards and the national health information system through the mobilization and interpretation of post-abortion care data. Although health workers search women’s bodies and behavior for signs of illegal abortion, they minimize police intervention in the hospital by classifying most post-abortion care cases as miscarriage. Health authorities deploy this account of post-abortion care to align the intervention with national and global maternal health policies that valorize motherhood. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma by scrutinizing women’s bodies and masking induced abortion within and beyond the hospital. Post-abortion care reinforces reproductive inequities by withholding safe, affordable obstetric care from women until after they have resorted to unsafe abortion.
Decline in MVA use in three public hospitals 2008-2012, PLOS One ‘It’s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for post-abortion care in Malawi: a qualitative study
Abstract
Unsafe abortions are an important contributor to Malawi’s maternal mortality and morbidity... Post-abortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence… this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study… provided insights into rejections of innovations in a low-middle income country perspective.
Obstetrician-gynaecologists’ perspectives on abortion stigma in Italy and Spain
by Silvia de Zordo
Global Public Health 5 March 2017. DOI: http://dx.doi.org/10.1080/17441692.2017.1293707 Abstract
This article explores obstetricians-gynaecologists’ experiences and attitudes towards abortion, based on two mixed-methods studies respectively undertaken in Italy in 2011–2012, and in Spain (Cataluña) in 2013–2015. Short questionnaires and in-depth interviews were conducted with 54 obstetricians-gynaecologists at 4 hospitals providing abortion care in Rome and Milan, and with 23 obstetricians-gynaecologists at 2 hospitals and one clinic providing abortion care in Barcelona. A medical/moral classification of abortions, from those considered ‘more acceptable’, both medically and morally – for severe fetal malformations – to the ‘least acceptable’ ones – repeated ‘voluntary abortions’, emerged in the discourse of most obstetricians-gynaecologists working in public hospitals, regardless of their religiosity. I argue that this is the result of the increasing medicalisation of contraception as well as of reproduction, which has reinforced the stigmatisation of ‘voluntary abortion’ (in case of unintended pregnancy) in a context of declining fertility rates. This contributes to explain why obstetricians-gynaecologists working in Catalan hospitals, which provide terminations only for medical reasons, unlike Italian hospitals, do not experience abortion stigma and do not object to abortion care as much as their Italian colleagues do.
Editorial
Abortion in legal, social, and healthcare contexts, by Jeanne Marecek, Catriona Macleod, Lesley Hoggart
Articles
Constructing abortion as a social problem: “Sex selection” and the British abortion debate, by Ellie Lee
The bio-politics of population control and sex-selective abortion in China and India, by Lisa Eklund, Navtej Purewal
Depicting abortion access on American television, 2005–2015, by Gretchen Sisson, Katrina Kimport
“Simply providing information”: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy, by Niamh Stephenson, Catherine Mills, Kim McLeod
Commentaries
The fragility of de facto abortion on demand in New Zealand Aotearoa, by Alison McCulloch, Ann Weatherall
Abortion in the United States: The continuing controversy, by Linda J Beckman
+ Book reviews
This documentary film (Spanish/Eng subtitles) features the experiences of young, rural, pregnant women who arrive at a public hospital’s emergency room in Nicaragua, many of them adolescents, from 16-17 weeks pregnant onwards, with life-threatening obstetric conditions. It has screened in festivals and theatres all over the world. Trailer
To purchase a copy (US$21) for your library, university, organization or institute, or arrange a public screening, contact: aquietinquistion@gmail.com.
