Access to contraception and sexual and reproductive health information post-abortion: a systematic review of literature from low- and middle-income countries

Abstract

Aim This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low-and middle-income countries who have undergone medical or surgical abortion. Methodology This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low-and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. Findings After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. Conclusions The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported 'counselling' and what this term actually involves within a PAC setting.

Abortion history and its association with current use of modern contraceptive methods in Luanda, Angola

“… 2 Post-abortion care (PAC) is intended to be legally available to all women, regardless of a country’s abortion policies, and research on postabortion contraceptive behavior suggests that women are more likely to use a modern contraceptive method after an abortion if PAC services are offered. 9 , 10 The mixed evidence from these studies indicates a need for additional research to better understand whether women who have induced abortions in places where it is not widely available are getting the services they need to prevent future unintended pregnancies and repeat abortions.…”

Pharmacy access to medical abortion from trained providers and post‐abortion contraception in Nepal

“…These challenges could be elevated when women receive care for induced abortions outside of clinical settings. Research has shown important differences in post‐abortion contraceptive access by both provider characteristics and facility type: specifically, research has suggested that women receiving care from non‐governmental or private facilities could be more likely to receive information and supplies than women at public facilities and hospitals . The present findings of similarly high contraceptive use between pharmacies and public health facilities could be due to the fact that all providers were trained and experienced ANMs who worked in both pharmacy and public facility settings.…”

“…Prior research has highlighted the particular challenges to providing post‐abortion contraception across diverse contexts, including inadequate time for counseling, privacy and space limitations, shortages of trained staff and supplies, and stigmatization of women having induced abortions . These challenges could be elevated when women receive care for induced abortions outside of clinical settings.…”

Contraceptive use among migrant women with a history of induced abortion in Finland

“…Third, an abortion obtained in Finland or elsewhere may have a different effect on contraceptive behaviour, particularly if the abortion was illegal or unsafe. In these contexts, women do not receive post-abortion contraceptive counselling [40] and many suffer from adverse health consequences [41].…”