Exploring Congolese refugees’ experiences with abortion care in Uganda: a multi-methods qualitative study

Nara, Ruth; Banura, Amanda; Foster, Angel M.

doi:10.1080/26410397.2019.1681091

Cited by 16 publications

(30 citation statements)

References 25 publications

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Section: Legal Environmentmentioning

confidence: 99%

“…Most articles referred to legal restrictions as one of the main barriers to access ToP, and the main reason why humanitarian organisations may opt not to offer ToP under any circumstances in humanitarian contexts (5,23,24,(27)(28)(29)(30)(31)(32)(33)(34)(35). Among other reasons, restrictive abortion laws (23,24,29,30,34,35), i.e. laws that restrict women's access to ToP services, and organisations' lack of legal knowledge about ToP provision in the country of operations (5,29,33,34) make ToP inaccessible to women within the legal framework (27,29,31,32).…”

Section: Legal Environmentmentioning

confidence: 99%

“…Immediate consequences of humanitarian crises, such as health system collapse, (35) insecurity (37), travel restrictions, (24,34) and sexual violence (37) complicate access to and delivery of healthcare services. Additionally, logistical challenges such as the mountainous terrain of Nepal, (15) or checkpoints in Colombia, (30) can impose an extra obstacle to accessing care. Barriers to ToP also include possible tension with local authorities and weak communication between stakeholders (15,33).…”

Section: Contextmentioning

confidence: 99%

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Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

Amaral

Sakellariou

2021

Front. Glob. Womens Health

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During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010–2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.

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Section: Legal Environmentmentioning

confidence: 99%

Section: Legal Environmentmentioning

confidence: 99%

Section: Contextmentioning

confidence: 99%

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Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

Amaral

Sakellariou

2021

Front. Glob. Womens Health

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“…An estimated 10 million unintended pregnancies are reported among girls aged 15–17 years in low income countries annually [ 9 ]. The numbers of unintended pregnancies are estimated to be even higher among refugee adolescents because they are at a high risk of sexual and/or gender-based violence, abuse, and forced marriages, which may lead to unintended pregnancy [ 10 ] and unsafe abortion [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial

et al. 2021

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Background The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. Objective To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. Methods A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care. Results Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition. Conclusion Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents’ fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.

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“…[19][20][21] Such restrictive policies influence how abortion services are perceived and accessed by women and girls. 22,23 Societal norms further influence how health workers perceive and provide care to pregnant women seeking abortion services. Various studies from sub-Saharan Africa reflect a lack of understanding around abortion legislation by healthcare providers, as well as women and girls.…”

Section: Introductionmentioning

confidence: 99%

“Better dead than being mocked”: an anthropological study on perceptions and attitudes towards unwanted pregnancy and abortion in the Democratic Republic of Congo

Burtscher¹,

Schulte-Hillen

Saint-Sauveur

et al. 2020

Sexual and Reproductive Health Matters

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Unwanted pregnancy and unsafe abortion contribute significantly to the burden of maternal suffering, ill health and death in the Democratic Republic of Congo (DRC). This qualitative study examines the vulnerabilities of women and girls regarding unwanted pregnancy and abortion, to better understand their health-seeking behaviour and to identify barriers that hinder them from accessing care. Data were collected in three different areas in eastern DRC, using in-depth individual interviews, group interviews and focus group discussions. Respondents were purposively sampled. All interviews were audio recorded and transcribed verbatim. Transcriptions were screened for relevant information, manually coded and analysed using qualitative content analysis. Perceptions and attitudes towards unwanted pregnancy and abortion varied across the three study areas. In North Kivu, interviews predominantly reflected the view that abortions are morally reprehensible, which contrasts the widespread practice of abortion. In Ituri many perceive abortions as an appropriate solution for reducing maternal mortality. Legal constraints were cited as a barrier for health professionals to providing adequate medical care. In South Kivu, the general view was one of opposition to abortion, with some tolerance towards breastfeeding women. The main reasons women have abortions are related to stigma and shame, socio-demographics and finances, transactional sex and rape. Contrary to the prevailing critical narrative on abortion, this study highlights a significant need for safe abortion care services. The proverb “Better dead than being mocked” shows that women and girls prefer to risk dying through unsafe abortion, rather than staying pregnant and facing stigma for an unwanted pregnancy.

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Exploring Congolese refugees’ experiences with abortion care in Uganda: a multi-methods qualitative study

Cited by 16 publications

References 25 publications

Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial

“Better dead than being mocked”: an anthropological study on perceptions and attitudes towards unwanted pregnancy and abortion in the Democratic Republic of Congo

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