Men’s involvement in women’s abortion-related care: a scoping review of evidence from low- and middle-income countries

Abstract

Men’s involvement in abortion is significant, intersecting across the individual, community and macro factors that shape abortion-related care pathways. This scoping review maps the evidence from low- and middle-income countries relating to male involvement, including male abortion providers, in abortion trajectories. Five databases were searched, using search terms, to yield 7493 items published in English between 01.01.2010 and 20.12.2019. 37 items met the inclusion criteria for items relating to male involvement in women’s abortion trajectories and were synthesised using an abortion-related care-seeking framework. The majority of studies were conducted in sub-Saharan Africa and were qualitative. Evidence indicated that male involvement was significant, shaping the ability for a woman or girl to disclose her pregnancy or abortion decision. Men as partners were particularly influential, controlling resources necessary for abortion access and providing or withdrawing support for abortions. Denial or rejection of paternity was a critical juncture in many women’s abortion trajectories. Men’s involvement in abortion trajectories can be both direct and indirect. Contextual realities can make involving men in abortions a necessity, rather than a choice. The impact of male (lack of) involvement undermines the autonomy of a woman or girl to seek an abortion and shapes the conditions under which abortion-seekers are able to access care. This scoping review demonstrates the need for better understanding of the mechanisms, causes and intensions behind male involvement, centring the abortion seeker within this.

Partner involvement in abortion trajectories and subsequent abortion safety in Nigeria and Côte d’Ivoire

“…A greater proportion of respondents in Nigeria were married at the time they had an abortion and experienced some or multiple forms of partner involvement, and in Côte d’Ivoire, the majority of unmarried respondents experienced no partner involvement at all. This may reflect a preference for non-disclosure of the pregnancy among unmarried people who want an abortion, often due to the corresponding expectation for partner support, or lack thereof [ 7 , 19 , 20 , 24 ]. The distribution of ages at the time of the abortion also differs notably, with double the proportion of respondents in Côte d’Ivoire reporting on abortion that occurred before age 20 (44.4% vs. 22.1% in Nigeria).…”

“…The body of research describing the role of the partner in abortion experiences is predominantly qualitative and was conducted in several regions (primarily the United States and sub-Saharan African countries), under varied legal conditions, and among largely clinic-based samples [ 5 – 20 ]. This research emphasizes three junctures at which the partner’s influence is particularly salient to a pregnant person: (1) deciding whether to disclose the pregnancy to the partner, (2) deciding, or being told, what to do about the pregnancy, and (3) seeking and obtaining an abortion, including post-abortion care.…”

“…Among those who did feel they would have a duty towards their partner, the majority believed this to include assisting in obtaining the medication(s) needed. In some cases, partners make decisions about the abortion method and source unilaterally, which may or may not align with the expectations or preferences of the pregnant person and in some cases involves coercion [ 9 , 20 ]. Partners often provide financial support for the abortion [ 7 , 12 , 20 ], and, less frequently, emotional or spiritual support [ 5 , 8 , 10 ].…”

“…In some cases, partners make decisions about the abortion method and source unilaterally, which may or may not align with the expectations or preferences of the pregnant person and in some cases involves coercion [ 9 , 20 ]. Partners often provide financial support for the abortion [ 7 , 12 , 20 ], and, less frequently, emotional or spiritual support [ 5 , 8 , 10 ]. Some choose to accompany their partner to the clinic or other provider, though in some settings the heightened social risk of being seen in such a setting makes accompaniment undesirable [ 12 , 20 , 27 ].…”

“…Partners often provide financial support for the abortion [ 7 , 12 , 20 ], and, less frequently, emotional or spiritual support [ 5 , 8 , 10 ]. Some choose to accompany their partner to the clinic or other provider, though in some settings the heightened social risk of being seen in such a setting makes accompaniment undesirable [ 12 , 20 , 27 ].…”