“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

Suh, Siri

doi:10.1016/j.socscimed.2015.04.030

Cited by 17 publications

(12 citation statements)

References 38 publications

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“…Service providers require full disclosure, including pregnancy gestational age, for a proper choice of treatment option. However, the illegality of abortion creates fear among patients, leading to incomplete disclosures of their history, leading to misdiagnosis and use of inappropriate technology in patient management [ 24 ], as has been previously demonstrated [ 37 ]. The entry of abortifacients in Kenya has significantly reduced the use of crude means of pregnancy termination, yet this alone cannot solve the challenges of unsafe abortion [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…This framework recognizes the need for correct equipment and medications to ensure safety and effectiveness of recommended PAC procedures [ 2 ]. Functional equipment for abortion care, sterilization, maintenance, and resupply are essential to enable facilities to deliver PAC at all times [ 24 , 25 ]. The use of appropriate technology rather than outdated techniques such as sharp curettage (Dilation and Curettage) improves quality PAC [ 26 , 27 ] and patient satisfaction with these services [ 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Policy, law and post-abortion care services in Kenya

et al. 2018

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BackgroundUnsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy.MethodsA cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality.ResultsThe provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge.DiscussionLegal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination.ConclusionGreater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Policy, law and post-abortion care services in Kenya

et al. 2018

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“…Instruments were in English, Spanish, French, and Portuguese. Of the 14 instruments collected, six were close-ended survey instruments [ 4 , 22 – 26 ], and eight were open-ended, in-depth interview guides [ 27 – 31 ] (personal communication with Joanna Mishtal and Bethany Kotlar).…”

Section: Methodsmentioning

confidence: 99%

Development of a Conceptual Model and Survey Instrument to Measure Conscientious Objection to Abortion Provision

et al. 2016

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Background and ObjectiveConscientious objection to abortion, clinicians’ refusal to perform legal abortions because of their religious or moral beliefs, has been the subject of increasing debate among bioethicists, policymakers, and public health advocates in recent years. Conscientious objection policies are intended to balance reproductive rights and clinicians’ beliefs. However, in practice, clinician objection can act as a barrier to abortion access–impinging on reproductive rights, and increasing unsafe abortion and related morbidity and mortality. There is little information about conscientious objection from a medical or public health perspective. A quantitative instrument is needed to assess prevalence of conscientious objection and to provide insight on its practice. This paper describes the development of a survey instrument to measure conscientious objection to abortion provision.MethodsA literature review, and in-depth formative interviews with stakeholders in Colombia were used to develop a conceptual model of conscientious objection. This model led to the development of a survey, which was piloted, and then administered, in Ghana.ResultsThe model posits three domains of conscientious objection that form the basis for the survey instrument: 1) beliefs about abortion and conscientious objection; 2) actions related to conscientious objection and abortion; and 3) self-identification as a conscientious objector.ConclusionsThe instrument is intended to be used to assess prevalence among clinicians trained to provide abortions, and to gain insight on how conscientious objection is practiced in a variety of settings. Its results can inform more effective and appropriate strategies to regulate conscientious objection.

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“…Providing FP counseling and services to women following abortion or treatment for its related complications has emerged as key strategy among others to address unmet need for contraception in developing countries [13][14][15]. Following successful pilot experiments in Senegal [15] and Burkina Faso [16], post-abortion care (PAC), including post-abortion FP, were gradually integrated into health facilities in Guinea, starting from 1998 [8], and are now available in 38 health facilities [17][18].…”

Section: Introductionmentioning

confidence: 99%

The Uptake of Modern Contraceptive Methods Among Clients of Post-Abortion Care Services in Urban Guinea

Millimouno¹,

Délamou²,

Sidibé³

et al. 2019

CAJPH

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In West Africa, there are limited data on the uptake of modern contraceptive methods among post-abortion care (PAC) clients. This study aimed at describing the knowledge, attitudes and practices of PAC clients towards modern contraceptive methods and identifying the factors associated with the uptake of long-acting contraceptive methods in Guinea. We conducted a cross-sectional study from March to August 2014 with a sample of 426 PAC clients in two communal medical centres in Conakry. Data were collected using a structured questionnaire and analysed using Stata software, version 14. A logistic regression was conducted to identify the factors associated with the uptake of long-acting contraceptive methods. Overall 45,5 % were students, and among them, 66.9% had a secondary or higher level of education. Among the respondents 21,8% had a history of abortion. Induced abortion (83.6%) was the most common type of abortion leading women to seek PAC services. Most of clients (73.6%) had previously heard about family planning (FP), either at school (42.7%), in a health facility/pharmacy (26.5%) or in the neighbourhood (5.9%). Among them, only 34% had used a contraceptive method in the last six months prior to the PAC visit. However, 79.1% of the sample had an unmet need for FP. During the PAC visit, 86.6% of women expressed a desire to postpone any pregnancy in the next 12 months. Overall, 388 women (91.1%) adopted a modern contraceptive method. Most of women (n=375; 96.6%) obtained the chosen contraceptive method before discharge. The intrauterine device (IUD) was the preferred contraceptive method for women (n=130; 34.7%) followed by implants (n=107; 28.5%). Having a history of abortion (OR= 2.5; CI= 1.3-4.7) and a non-desire for pregnancy in the following 12 months (OR= 4.8; CI= 2.0-11.5) were the factors statistically significantly associated with the uptake of long-acting contraceptive methods. In our context, induced or unsafe abortion mainly concerned students. There is a need to improve the uptake of contraceptive methods, especially among students and intensify awareness on the consequences of unsafe abortion among youths.

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“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

Cited by 17 publications

References 38 publications

Policy, law and post-abortion care services in Kenya

Policy, law and post-abortion care services in Kenya

Development of a Conceptual Model and Survey Instrument to Measure Conscientious Objection to Abortion Provision

The Uptake of Modern Contraceptive Methods Among Clients of Post-Abortion Care Services in Urban Guinea

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