The study: This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. It focused on qualitative research from multiple perspectives on women’s experiences of self-management of first trimester medical abortion.
(1) The qualitative evidence base is still small. Available evidence points to the overall acceptability of self-administration of medical abortion. Further qualitative research is needed to strengthen this important evidence base.
(2) Providers were generally approving of the concept of self-management, including self-administration if initiation of medical abortion was supported by trained providers, and they believed that it could be done feasibly, effectively and safely.
Further research needed: Dealing with the products of conception is an important experiential element of self-management of medical abortion, and one that is not well reported on in the qualitative literature... FULL STORY
The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion
by Tiziana Leone, Ernestina Coast, Divya Parmar, Bellington Vwalika
Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs.
We use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. This study demonstrates that despite liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access... FULL STORY
Rethinking the pregnancy planning paradigm: unintended conceptions or unrepresentative concepts?
by Abigail RA Aiken, Sonya Borrero, Lisa S Callegari, Christine Dehlendorf
Approximately half of pregnancies occurring each year in the United States are unintended: They either occurred too soon or were not intended at any time. This commonly cited statistic is testament to the dominance of unintended pregnancy as a public health benchmark for measuring and improving women’s reproductive health. In addition to its use as a public health metric, this timing-based definition of unintended pregnancy is reflected in pregnancy planning paradigms in clinical practice. According to these paradigms, women are expected to map out their intentions regarding whether and when to conceive, and to formulate specific plans to follow through on their intentions.
We propose, however, that public health and clinical efforts focused on reducing unintended pregnancy and improving pregnancy outcomes solely by promoting planning are subject to several important limitations. Furthermore, we hypothesize that a woman who judges her pregnancy to be acceptable, regardless of whether it was planned, and goes on to give birth is more likely to experience positive personal and social outcomes than a woman who judges her pregnancy to be unacceptable. Our model also accommodates the fact that women who find having an ongoing pregnancy unacceptable and are able to choose abortion may experience more positive outcomes than those whose unacceptable pregnancy results in birth... FULL STORY
CATHOLICS FOR CHOICE
Vatican Museums spiral staircase Conscientious objection and abortion access: Italy, USA and India
One of the themes of this issue of Conscience is "conscience and autonomy". How did these concepts develop and what role have they played in determining our beliefs about abortion and other reproductive health issues? How do medical professionals weigh their personal beliefs against their responsibilities to patients? What about women who have no opportunities to exercise either conscience or autonomy in decisions about their reproductive health?
Last winter, Catholics for Choice held a conference in New York and brought together providers, academics, advocates and journalists to talk about the meaning of conscience and autonomy. The articles featured in this issue were born from these conversations. Here are links to four of them.
(2) Personal Jesus, by Dr Willie Parker, Obstetrician-Gynecologist, Member of the Board, Physicians for Reproductive Choice, USA
(3) Opt in, opt out, and generation next, by Dr Uta Landy, National Director, Ryan Residency Training Program Fellowship in Family Planning, University of California, San Francisco Bixby Center for Global Reproductive Health, USA
The toolkit contains instructions for facilitating a two-day workshop, includes handouts, worksheets, and slides that articulate the main concepts in the guide for educators, youth advocates, and advocacy organizations both in-country and globally... FULL STORY