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OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016–2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences. RESUMEN OBJETIVO Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016–2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba chi-cuadrado. RESULTADOS En el 2016, 37 personas por cada 100,000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100,000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100,000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0.2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas.

Supplemental material, sj-pdf-1-yas-10.1177_0044118X211011015 for Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria by Laura E. Jacobson, Ana Maria Ramirez, Chiara Bercu, Anna Katz, Caitlin Gerdts and Sarah E. Baum in Youth & Society

Supplemental material, sj-pdf-1-yas-10.1177_0044118X211011015 for Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria by Laura E. Jacobson, Ana Maria Ramirez, Chiara Bercu, Anna Katz, Caitlin Gerdts and Sarah E. Baum in Youth & Society

Cognitive Interview Guide. (DOCX 33 kb)

BackgroundIn 2006, Colombia's constitutional court overturned a complete ban on abortion, liberalizing the procedure. Despite a relatively liberal new law, women still struggle to access safe and legal abortion services. We aimed to understand why women are denied services in Colombia, and what factors determine if and how they ultimately terminate pregnancies.MethodsWe recruited women denied abortion at a private facility in Bogota. Twenty-one participants completed an initial interview and eight completed a second longer interview. Two researchers documented themes and developed and applied a codebook to transcripts using ATLAS.ti.ResultsParticipants faced barriers, such as lack of knowledge of service availability and delayed pregnancy recognition, leading to denial. Five out of eight participants ultimately received abortions in public hospitals, due to support from partners and a robust referral system; nevertheless, they received poor care. Those who continued pregnancies endured stigmatizing events and inaccurate medical counselling at referral facilities. Several women contemplated illegal abortion though were afraid to attempt it.ConclusionWe propose the following recommendations: 1) increase awareness about availability and legality of abortion services to prevent delay and consequent denial; 2) provide counseling and referral upon denial; and 3) train providers in interpersonal quality abortion care.

Survey Instrument. This is the survey instrument used to survey participants. (PDF 450Â kb)

Interview Guide. This is the interview guide used to interview key informants. (DOCX 33Â kb)

Interview Guide. (PDF 335kb)

R Code for Analysis. (DOCX 15 kb)

Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. Results The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. Conclusions The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.

Where the Burden Lies: A framework and evaluation of systematic error in measurement of the health effects of unsafe abortionByCaitlin E. GerdtsDoctor of Philosophy in EpidemiologyUniversity of California, BerkeleyProfessor Jennifer Ahern, ChairBackground:Measuring the incidence and sequellae of unsafe abortion is notoriously challenging. In the parts of the world where abortion is considered unsafe, it is often also illegal (or heavily restricted), and highly stigmatized. Women experiencing abortion related complications, for fear of severe legal, social, or religious repercussions, are, therefore, less likely than women experiencing other kinds of pregnancy-related complications to seek care in medical facilities, or disclose their experiences with abortion. Biases are repeatedly discussed in accounts of post abortion care (PAC) 2 3,4 where researchers are interested in the proportion of cases resulting from induced vs. spontaneous abortion, often in similarly restrictive legal and social settings. Classification of PAC resulting from induced abortion as PAC resulting from spontaneous abortion is known to occur frequently, and the reverse is also thought to be common.The field of global reproductive health needs a simple, straightforward, quantitative framework through which to assess the expected direction and magnitude of biases that exists in studies of unsafe abortion (and resulting sequellea). Such a framework would not only allow the researchers to better quantify bias in their own studies, but would aid readers ability to incorporate quantitative information about existing biases into their interpretation of results. Methods:Analyses investigating separate research aims related to systematic error in the measurement of unsafe abortion related mortality and morbidity will be conducted over three chapters, as follows: Chapter 1: Systematic Review of current estimates of unsafe abortion related mortality from 2000-2011, Chapter 2: Bias Framework and Multiple bias analysis of the proportion of maternal mortality resulting from unsafe abortion, and Chapter 3: Multiple bias analysis of unsafe abortion related post abortion care seekers in Zanzibar, Tanzania.Discussion and Significance:The results of the three preceding analyses suggest it is likely that unsafe abortion has been significantly underestimated as a cause of maternal death and post abortion care. These results have clear implications for increasing efforts aimed at the proven interventions which help to decrease abortion related mortality and morbidity: reducing unintended pregnancy, ensuring access to safe abortion services where it is legal, increasing access to safe abortion services where laws have the potential to be revised, and providing access to comprehensive post abortion care with contraceptive counseling in places where access to abortion remains highly restricted. These results also have implications for scientists committed to producing sound evidence in a field with endemic measurement challenges. Improving methods to quantify the direction and magnitude of systematic error in studies, and integrate such information into the interpretation of results concerning the burden of unsafe abortion-related mortality and morbidity is the necessary first step in understanding these grave public health concerns, and targeting interventions that appropriately address their underlying causes.

Annotated R Code. (DOCX 166Â kb)

Annotated R Code. (DOCX 166Â kb)