Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence

Abstract

Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.

Abortion care in a pandemic: an analysis of the number and social profile of people requesting and receiving abortion care during the first COVID-19 lockdown (March 16 to June 14, 2020) in Flanders, Belgium

“…Concerning abortion care, possible pre-existing difficulties such as arranging childcare, taking time off from work, and transport to the abortion centre [4][5][6][7][8][9] may have potentially been increased by both the pandemic itself and the protective measures installed by the Belgian government. Additionally, the COVID-19 pandemic may have resulted in new barriers due to, for example, conflicting media messages concerning the availability of PHC-services, fear of infection with COVID-19 when using public transport or visiting PHC-services, and fear of being sanctioned for traveling outside the house.…”

Factors associated with pregnancy and induced abortion among street-involved female adolescents in two Nigerian urban cities: a mixed-method study

“…From 2010 to 2014, an estimated 25 million unsafe abortions occurred annually worldwide [ 2 ], and 8 million were carried out in unsafe conditions [ 3 ], and most were in developing countries. Also, 15% or 3.2 million of the 21.2 million unsafe abortions were among adolescents aged 15–19 years [ 4 , 5 ]. The prevalence of unsafe abortion is high in countries with restrictive abortion laws [ 6 ], many of which are in low- and middle-income countries that also limit the access of adolescents to contraception [ 5 ].…”

“…Also, 15% or 3.2 million of the 21.2 million unsafe abortions were among adolescents aged 15–19 years [ 4 , 5 ]. The prevalence of unsafe abortion is high in countries with restrictive abortion laws [ 6 ], many of which are in low- and middle-income countries that also limit the access of adolescents to contraception [ 5 ]. These restrictive laws have negative consequences – about half of the pregnancies among female adolescents aged 15–19 was unintended, and a higher proportion of these pregnancies end in unsafe abortions [ 7 ].…”

The Importance of Resources and Relationships: An Introduction to the Special Issue on Expectant and Parenting Youth in Foster Care

“…Research has attributed at least some of the decrease in adolescent pregnancy and childbirth to abstaining from sexual activity and more effective use of contraception (Lindberg et al, 2016 ; Santelli et al, 2007 ). Important among these factors is the availability and quality of sexual and reproductive health care, including and especially contraception and unrestricted access to abortion services (Assifi et al, 2020 ; Lindberg et al, 2018 ).…”

“…Existing research also demonstrates that young people who have spent time in foster care exhibit higher rates of early pregnancy and parenthood than their peers in the general youth population and that their birth rates have not declined at the same rate (Dworsky & Courtney, 2010 ; Font et al, 2019 ; King et al, 2014 ; Shpiegel et al, 2021 ). Given the recent reversal of Roe v. Wade by the US Supreme Court and the disproportional impact of restricted access to abortion services on vulnerable populations (Assifi et al, 2020 ; Bryson et al, 2022 ; Committee on Health Care for Underserved Women, 2020 ), there is a risk that rates of early pregnancy and parenthood will increase for all youth, but more so for those who have spent time in foster care (Finigan-Carr et al, 2015 , 2018 ; Geiger & Schelbe, 2014 ). As such, a focus on expectant and parenting youth who are in or transitioning from care is especially relevant.…”