Predictors and experiences of seeking abortion services from pharmacies in Nepal.

Abortion was legalized in Nepal in 2002; however, despite evidence of safety and quality provision of medical abortion (MA) pills by pharmacies in Nepal and elsewhere, it is still not legal for pharmacists to provide medication abortion in Nepal. However, pharmacies often do provide MA, but little is known about who seeks abortions from pharmacies and their experiences and outcomes. The purpose of this study is to understand the experiences of women seeking MA from a pharmacy, abortion complications experienced, and predictors for denial of MA. Data was collected from women seeking MA from four pharmacies in two districts of Nepal in 2021-2022. Data was collected at baseline (N = 153) and 6 weeks later (N = 138). Using descriptive results and multi-variable regression models, we explore differences between women who received and did not receive MA and predictors of denial of services. Most women requesting such pills received MA (78%), with those who were denied most commonly reporting denial due to the provider saying they were too far along. There were few socio-demographic differences between groups, with the exception of education and gestational age. Women reported receiving information on how to take pills and what to do about side effects. Just under half (45%) of women who took pills reported no adverse symptoms after taking them and only 13% sought care. Most women seeking MA from pharmacists in Nepal are receiving services, information, and having few post-abortion symptoms. This study expands the previous limited research on pharmacy provision of MA in Nepal using a unique dataset that recruits women at the time of abortion seeking and follows them over time, overcoming potential biases present in other study designs. This suggests that expansion of the law to allow pharmacy distribution would increase accessibility and reflect current practice.

An exploratory study of what happens to women who are denied abortions in Cape Town, South Africa.

BACKGROUND: Despite the change in legal status of abortion in South Africa in 1996, barriers to access remain. Stigma associated with abortion provision and care, privacy concerns, and negative provider attitudes often discourage women from seeking legal abortion services and sometimes force women outside of the legal system. What happens when women present for abortion at a designated abortion facility and are denied abortions due to gestational limits or other factors-is unknown. Whether women seek care at referral facilities, seek illegal abortion, or carry pregnancies to term has never been documented. This study, part of a multi-country Global Turnaway Study, explored the experiences of women after denial of legal abortion services. METHODS: Qualitative research methods were used to collect data at two non-governmental organization health care facilities providing abortion services. In depth interviews were held with women 2 to 3 months after they were denied an abortion. Data were analyzed using a thematic analysis approach. RESULTS: The most common reason for being turned away was due to gestational age over 12 weeks with some women denied abortions that day because they did not have enough money to pay for the procedure. Almost all women were extremely upset at being denied an abortion on the day that they visited the health care facility. Some women were so distressed that they openly discussed the option of seeking an illegal provider or exploring the possibility of securing another health care professional who would assist them. CONCLUSIONS: Despite South Africa's liberal abortion law and the relatively widespread availability of abortion services in urban settings, women in South Africa are denied abortion services largely due to being beyond the legal limits to obtain an abortion. A high proportion of women who were initially denied an abortion at legal facilities went on to seek options for pregnancy termination outside of the legal system through internet searches--some of which could have led to unsafe abortion practices. Further efforts should be directed towards informing women in all communities about the availability of free services in the public sector and educating them about the dangers of unsafe methods of pregnancy termination.

The stigma of having an abortion: development of a scale and characteristics of women experiencing abortion stigma.

CONTEXT: Although abortion is common in the United States, women who have abortions report significant social stigma. Currently, there is no standard measure for individual-level abortion stigma, and little is known about the social and demographic characteristics associated with it. METHODS: To create a measure of abortion stigma, an initial item pool was generated using abortion story content analysis and refined using cognitive interviews. In 2011, the final item pool was used to assess individual-level abortion stigma among 627 women at 13 U.S. Planned Parenthood health centers who reported a previous abortion. Factor analysis was conducted on the survey responses to reduce the number of items and to establish scale validity and reliability. Differences in level of reported abortion stigma were examined with multivariable linear regression. RESULTS: Factor analysis revealed a four-factor model for individual-level abortion stigma: worries about judgment, isolation, self-judgment and community condemnation (Cronbach's alphas, 0.8-0.9). Catholic and Protestant women experienced higher levels of stigma than nonreligious women (coefficients, 0.23 and 0.18, respectively). On the subscales, women with the strongest religious beliefs had higher levels of self-judgment and greater perception of community condemnation than only somewhat religious women. Additional differences were found by race, age, education, religiosity and motherhood status on the subscales. CONCLUSION: This valid and reliable scale can be used in research examining abortion stigma and related outcomes (e.g., women's health, relationships and behavior). The scale can also be used to evaluate programs and interventions that aim to reduce the stigma experienced by women who have abortions.