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Background: Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia. Methodology: This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis. Results: Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers. Conclusion: The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school. [ABSTRACT FROM AUTHOR]

Background: Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin. Methods: We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process. Results: Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality). Conclusion: Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety. Plain Language Summary: Despite the availability of safe abortion methods in sub-Saharan Africa, women and girls in the region continue to resort to unsafe methods, leading to severe complications, disabilities, and maternal death. This can be attributed to restrictive abortion laws, lack of awareness on safe abortion methods, poverty, and sociocultural and health system barriers. This paper uses data from a larger ethnographic study in Kilifi County, Kenya, and Atlantique Department, Benin, to understand which methods women and girls use, and why, to help improve the use of safe abortion methods. Data were collected through in-depth interviews with 95 girls and women who had recently undergone an abortion, as well as key informant interviews, focus group discussions, and participant observation. The findings reveal that women and girls use various methods to terminate their pregnancies, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical methods. They often use these methods once, multiple times, or in combination to achieve their goal. The main reason for their choice of methods is not medical safety but social safety, including preserving social relationships and avoiding shame and stigma. We conclude that there is a pressing need for greater access to accurate, well-framed information about safe abortion methods. Abortion services should consider not only medical safety but also discretion to mitigate the social implications of having an abortion in a medical facility. By addressing these factors, it is possible to enhance the use of safe abortion methods and reduce the reliance on unsafe practices. [ABSTRACT FROM AUTHOR]

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Advocacy actors play a unique role in promoting changes in policy, legal, and social environments for sexual and gender minorities in sub-Saharan Africa (SSA). However, their efforts may be hampered by limited incorporation of evidence because there is a massive gulf between what researchers focus on and what evidence users need. Together with fifty key stakeholders across SSA, we—a team of researchers and policy engagement specialists—co-created a research agenda and identified policy goals and research priorities to support evidence-informed policy and advocacy that can foster social inclusion of sexual and gender minorities in the region. We identified six research priority areas: (1) The history of lesbian, gay, bisexual and trans people and people whose identities do not conform to typical binary notions of male and female, or identify themselves using other categories to describe sexuality (LGBT+) in Africa and their lived realities; (2) Cost of non-inclusion and benefits of inclusion; (3) Strategies fostering inclusion; (4) Challenges and needs of LGBT + people; and (5) Implementation science on the effectiveness of provisions in sexual and reproductive health and HIV strategies or guidelines; and (6) Understanding the existing policy and legal architecture. This co-created research agenda can guide the generation of policy-relevant evidence, increase collaboration between researchers and policy actors, and increase research uptake to support efforts toward inclusion. [ABSTRACT FROM AUTHOR]

Introduction: Unsafe abortion is a leading cause of maternal mortality, and access to safe abortion services remains a public health priority in sub-Saharan Africa (SSA). A considerable amount of abortion research exists in the region; however, the spread of existing evidence is uneven such that some countries have an acute shortage of data with others over-researched. The imbalance reflects the complexities in prioritization among researchers, academics, and funders, and undeniably impedes effective policy and advocacy efforts. This scoping review aims to identify and map the landscape of abortion research in SSA, summarize existing knowledge, and pinpoint significant gaps, both substantive and geographic, requiring further investigation. This review will provide direction for future research, investments, and offer guidance for policy and programming on safe abortion. Materials and methods: We utilize the Joanna Briggs Institute's methodology for conducting scoping reviews. We will perform the search for articles in 8 electronic databases (i.e., PubMed, AJOL, Science Direct, SCOPUS, HINARI, Web of Knowledge, CINAHL, and WHO Regional Databases). We will include studies written in English or French language, produced or published between January 1, 2011, and July 31, 2021, and pertain directly to the subject of abortion in SSA. Using a tailored extraction frame, we will extract relevant information from publications that meet the inclusion criteria. Data will be analyzed using descriptive statistics and thematic analysis in response to key review questions. Ethics and dissemination: Formal ethical approval is not required, as no primary data will be collected. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. [ABSTRACT FROM AUTHOR]

Introduction Previous studies have attempted to review the vast body of evidence on adolescent sexual and reproductive health (ASRH), but none has focused on a complete mapping and synthesis of the body of inquiry and evidence on ASRH in sub-Saharan Africa (SSA). Such a comprehensive scoping is needed, however, to offer direction to policy, programming and future research. We aim to undertake a scoping review of studies on ASRH in SSA to capture the landscape of extant research and findings and identify gaps for future research. Methods and analysis This protocol is designed using the framework for scoping reviews developed by the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on ASRH (aged 10–19) in SSA published between January 2010 and June 2019. A three-step search strategy involving an initial search of three databases to refine the keywords, a full search of all databases and screening of references of previous review studies for relevant articles missing from our full search will be employed. We will search AJOL, JSTOR, HINARI, Scopus, Science Direct, Google Scholar and the websites for the WHO, UNICEF, UNFPA, UNESCO and Guttmacher Institute. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility and inclusion—using Covidence (an online software). We will then extract relevant information from studies that meet the inclusion criteria using a tailored extraction frame and template. Extracted data will be analysed using descriptive statistics and thematic analysis. Results will be presented using tables and charts and summaries of key themes arising from available research findings. Ethics and dissemination Ethical approval is not required for a scoping review as it synthesises publicly available publications. Dissemination will be through publication in a peer-review journal and presentation at relevant conferences and convening of policymakers and civil society organisations working on ASRH in SSA. [ABSTRACT FROM AUTHOR]

Background: Abortion draws varied emotions based on individual and societal beliefs. Often, women known to have sought or those seeking abortion services experience stigma and social exclusion within their communities. Understanding community perception of abortion is critical in informing the design and delivery of interventions that reduce the gaps in access to safe abortion for women. Objective: We explored community perceptions and beliefs relating to abortion, clients of abortion services, and abortifacients in Kenya. Methods: We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) in Kisumu and Nairobi counties in Kenya among a mix of adult men and women, pharmacists, nurses, and community health volunteers. Results: Community perspectives around abortion were heterogeneous, reflecting a myriad of opinions ranging from total anti-abortion to more pro-choice positions, and with rural-urban differences. Notably, negative views on abortion became more nuanced and tempered, especially among young women in urban areas, as details of factors that motivate women to seek abortion became apparent. Participants were mostly aware of the pathways through which women and girls access abortion services. Whereas abortion is commonplace, multiple structural and socioeconomic barriers, as well as stigma, are prevalent, thus impeding access to safe and quality services. Conclusion: Community perceptions on abortion are heterogeneous, varying by gender, occupation, level of education, residence, and position in society. Stigma and the hostile abortion environment limit access to safe abortion services, with several negative consequences. There is urgent need to strengthen community-based approaches to mitigate predisposing and enabling factors for unsafe abortions. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) prevalence is rising fastest in lower income settings, and with more devastating outcomes compared to High Income Countries (HICs). While evidence is consistent on the growing health and economic consequences of NCDs in sub-Saharan Africa (SSA), specific efforts aimed at addressing NCD prevention and control remain less than optimum and country level progress of implementing evidence backed cost-effective NCD prevention approaches such as tobacco taxation and restrictions on marketing of unhealthy food and drinks is slow. Similarly, increasing interest to employ multi-sectoral approaches (MSA) in NCD prevention and policy is impeded by scarce knowledge on the mechanisms of MSA application in NCD prevention, their coordination, and potential successes in SSA. In recognition of the above gaps in NCD programming and interventions in Africa, the East Africa NCD alliance (EANCDA) in partnership with the African Population and Health Research Center (APHRC) organized a three-day NCDs conference in Nairobi. The conference entitled "First Africa Non-Communicable Disease Research Conference 2017: Sharing Evidence and Identifying Research Priorities" drew more than one hundred fifty participants and researchers from several institutions in Kenya, South Africa, Nigeria, Cameroon, Uganda, Tanzania, Rwanda, Burundi, Malawi, Belgium, USA and Canada. The sections that follow provide detailed overview of the conference, its objectives, a summary of the proceedings and recommendations on the African NCD research agenda to address NCD prevention efforts in Africa. [ABSTRACT FROM AUTHOR]

Background: In many parts of sub-Saharan Africa, access to abortion is legally restricted, which partly contributes to high incidence of unsafe abortion. This may result in unsafe abortion-related complications that demand long hospital stays, treatment and attendance by skilled health providers. There is however, limited knowledge on the capacity of public health facilities to deliver post-abortion care (PAC), and the spread of PAC services in these settings. We describe and discuss the preparedness and capacity of public health facilities to deliver complete and quality PAC services in Burkina Faso, Kenya and Nigeria.Methods: A cross-sectional survey of primary, secondary and tertiary-level public health facilities was conducted between November 2018 and February 2019 in the three countries. Data on signal functions (including information on essential equipment and supplies, staffing and training among others) for measuring the ability of health facilities to provide post-abortion services were collected and analyzed.Results: Across the three countries, fewer primary health facilities (ranging from 6.3-12.1% in Kenya and Burkina Faso) had the capacity to deliver on all components of basic PAC services. Approximately one-third (26-43%) of referral facilities across Burkina Faso, Kenya and Nigeria could provide comprehensive PAC services. Lack of trained staff, absence of necessary equipment and lack of PAC commodities and supplies were a main reason for inability to deliver specific PAC services (such as surgical procedures for abortion complications, blood transfusion and post-PAC contraceptive counselling). Further, the lack of capacity to refer acute PAC cases to higher-level facilities was identified as a key weakness in provision of post-abortion care services.Conclusions: Our findings reveal considerable gaps and weaknesses in the delivery of basic and comprehensive PAC within the three countries, linked to both the legal and policy contexts for abortion as well as broad health system challenges in the countries. There is a need for increased investments by governments to strengthen the capacity of primary, secondary and tertiary public health facilities to deliver quality PAC services, in order to increase access to PAC and avert preventable maternal mortalities. [ABSTRACT FROM AUTHOR]

Although the Kenyan government has made efforts to invest in maternal health over the past 15 years, there is no evidence of decline in maternal mortality. To provide necessary evidence to inform maternal health care provision, we conducted a nationally representative study to describe the incidence and causes of maternal near-miss (MNM), and the quality of obstetric care in referral hospitals in Kenya. We collected data from 54 referral hospitals in 27 counties. Individuals admitted with potentially life-threatening conditions (using World Health Organization criteria) in pregnancy, childbirth or puerperium over a three month study period were eligible for inclusion in our study. All cases of severe maternal outcome (SMO, MNM cases and deaths) were prospectively identified, and after consent, included in the study. The national annual incidence of MNM was 7.2 per 1,000 live births and the intra-hospital maternal mortality ratio was 36.2 per 100,000 live births. The major causes of SMOs were postpartum haemorrhage and severe pre-eclampsia/eclampsia. However, only 77% of women with severe preeclampsia/eclampsia received magnesium sulphate and 67% with antepartum haemorrhage who needed blood received it. To reduce the burden of SMOs in Kenya, there is need for timely management of complications and improved access to essential emergency obstetric care interventions. [ABSTRACT FROM AUTHOR]