Global Abortion Policies Database: a new approach to strengthening knowledge on laws, policies, and human rights standards

Johnson, Brooke; Lavelanet, Antonella; Schlitt, Stephanie

doi:10.1186/s12914-018-0174-2

Cited by 27 publications

(32 citation statements)

References 1 publication

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“…Online supplemental file 2 describes the legal status of abortion in the study countries, with the majority of countries having a law that allows or permits abortion only on one or more legal grounds. 27 …”

Section: Resultsmentioning

confidence: 99%

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

et al. 2021

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IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.MethodsA cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsThere were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).ConclusionThere is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.

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Section: Resultsmentioning

confidence: 99%

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

et al. 2021

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“… 4 However, official data may not be reliable enough to inform programmatic and policy decisions. 9 Estimations stem from national statistics on hospital discharges, with the majority being from the public health sector, which can lead to under-reporting due to the sensitivity of the issue and the difficulties in capturing the true nature of the reported abortions (spontaneous or induced) in the region. 3 10 11…”

Section: Introductionmentioning

confidence: 99%

Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A)

Romero

León²,

Baccaro

et al. 2021

BMJ Glob Health

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IntroductionAbortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women’s experiences with abortion care in selected countries of the Americas region.MethodsThis is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women’s characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsWe collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity.ConclusionsThis is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women’s experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.

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“…Unique or complex policy nuances that do not exactly match one of the common legal grounds are separately captured in the GAPD as other 2. The methodologic details related to the classifying and coding used for the GAPD have been previously described [12]. In this paper, we diverge from the way in which legal grounds are displayed on the GAPD to better describe the complexities related to legal categories of abortion; we do not present data related to additional access requirements.…”

Section: Methodsmentioning

confidence: 99%

Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion

Lavelanet

Schlitt

Johnson

et al. 2018

BMC Int Health Hum Rights

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BackgroundTexts and interpretations on the lawfulness of abortion and associated administrative requirements can be vague and confusing. It can also be difficult for a woman or provider to know exactly where to look for and how to interpret laws on abortion. To increase transparency, the Global Abortion Policies Database (GAPD), launched in 2017, facilitates the strengthening of knowledge and understanding of the complexities and nuances around lawful abortion as explicitly stated in laws and policies.MethodsWe report on data available in the GAPD as of May 2018. We reviewed the content and wording of laws, policies, standards and guidelines, judgments and other official statements for all countries where data is available in the GAPD. We analyzed data for 158 countries, where abortion is lawful on the woman’s request with no requirement for justification and/or for at least one legal ground, including additional indications that are nonequivalent to a single common legal ground. We classified laws on the basis of the explicit wording of the text. The GAPD treats legal categories as the circumstances under which abortion is lawful, that is, allowed or not contrary to law, or explicitly permitted or specified by law.Results32% of countries allow or permit abortion at the woman’s request with no requirement for justification. Approximately 82% of countries allow or permit abortion to save the woman’s life. 64% of countries specify health, physical health and/or mental (or psychological) health. 51% allow or permit abortion based on a fetal condition, 46% of countries allow or permit abortion where the pregnancy is the result of rape, and 10% specify an economic or social ground. Laws may also specify several additional indications that are nonequivalent to a single legal ground.ConclusionsThe GAPD reflects details that exist within countries’ laws and highlights the nuance within legal categories of abortion; no assumptions are made as to how laws are interpreted or applied in practice. By examining the text of the law, additional complexities related to the legal categories of abortion become more apparent.

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Global Abortion Policies Database: a new approach to strengthening knowledge on laws, policies, and human rights standards

Cited by 27 publications

References 1 publication

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A)

Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion

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