Hidden realities: What women do when they want to terminate an unwanted pregnancy in Bolivia

Abstract

ObjectiveTo explore women's experience of unwanted pregnancy and induced abortion in Bolivia, where nearly all induced abortions are carried out in clandestine, unregulated, and unsafe conditions.MethodsQualitative and quantitative research methods, including focus group discussions, in‐depth interviews and a structured survey of women of reproductive age, were used to explore the experience of unwanted pregnancy and induced abortion in poor urban areas of 5 Bolivian cities.ResultsOf the 1175 sexually experienced women surveyed, 13% reported having had an induced abortion. The methods they tried included surgical abortion, taking misoprostol, drinking herbal and chemical preparations, and inflicting physical trauma on themselves. Many women made multiple attempts before successfully terminating a pregnancy. Lack of knowledge and confusion about how to use misoprostol may have contributed to the complications that resulted in seeking postabortion care.ConclusionIncreased access to accurate information and counseling about abortion options are paramount if women are to make informed decisions and minimize health risks.

Self-management of medical abortion: a qualitative evidence synthesis

“…[33][34][35][36] Self-management and selfadministration allowed providers in restricted contexts to distance themselves legally from the abortion. 37,38 Providers in legal contexts could accomplish a similar kind of distancing on moral grounds. 17 Women were also generally approving of the concept of self-management.…”

“…32,35,36,39 Women in settings where there is little formal public information about abortion (whether in legal or legally-restricted settings), can sometimes be confused about the distinction between misoprostol for medical abortion, emergency contraception and oral contraceptives. 36,38 Women's perceptions of the acceptability of self-management without in-person contact with health professionals depended on: the standard of care and their prior experiences with medical abortion, local notions of professional medical hierarchy, abortion taboos and stigma, and perceptions around the strength, danger and complexity of the drugs. 20,32,40,41 Providers' perceptions about which healthcare workers should be able to provide medical abortion drugs to women for self-administration varied and depended on: perceptions of the strength of the drugs and hence the expertise in anatomy and physiology needed to explain their full effects; a provider's training in appropriate counselling for abortion; a provider's knowledge of abortionfriendly emergency departments to refer women to in the case of complications; and the client's experience, and therefore trust, of different healthcare workers.…”

Expanding access to medical abortion: Perspectives of women and providers in developing countries

“…• Providers' and medical students' knowledge and opinions about MA (Brazil [15], China [16], India [17], and Turkey [18]). • Access to MA from the perspectives of women (Bolivia [19], India [20], Mexico [21], and Nepal [22]). In the studies from Bolivia and India, women living in the general community were interviewed regarding their knowledge and opinions about different abortion methods and about local abortion providers.…”

“…Some of the studies in the present Supplement suggest that deficiencies occur at many facilities that provide abortion or postabortion care despite the existence of policies promoting quality abortion and postabortion care that includes empathetic treatment and counseling about family planning methods. For instance, many of the Bolivian women who received postabortion care at public hospitals reported disrespectful treatment from staff, and many received no counseling about contraception [19]. Women in Tamil Nadu, India, avoided public-sector abortion providers because, among other reasons, these providers were not seen as guaranteeing confidentiality and often insisted that they adopt a contraceptive method as a condition for receiving an abortion [20].…”

“…Women's poor access to reliable information about the relative safety of different abortion methods and providers is among the root causes of the high rates of maternal deaths and injury due to unsafe abortion in countries such as Bolivia [19]. A lack of accurate information is also a serious problem in some counties, such as India, where the grounds for legal abortion are more liberal.…”