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Introduction: Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes. Methods: Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence. Results: The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas. Discussion: Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes. Significance: What is Already Known on this Topic: While abortion reforms have been hypothesized to affect a host of maternal and neonatal outcomes, few empirical studies have examined the effect of abortion reforms on neonatal outcomes. What this Study Adds: Due to challenges in the implementation of the 2014 abortion legalization in Mozambique, it may have negatively influenced neonatal outcomes, particularly for socially disadvantaged women. Abortion legalization alone without adequate implementation and enforcement is unlikely to be sufficient for substantial change in abortion access and health outcomes. [ABSTRACT FROM AUTHOR]

Background: A country's abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women's access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women's health services and outcomes in LMICs. Methods: We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women's health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description. Discussion: This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women's health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility. Systematic review registration: PROSPERO CRD42019126927 [ABSTRACT FROM AUTHOR]

Background Evidence shows that fewer than 1% of all international development projects worldwide, including those in Nigeria, were evaluated at least 2 years after completion to learn what genuinely changed. With over 787 million US Dollars in official development assistance to Nigeria's health sector in 2017, this seeming disinterest in assessing sustainability – particularly in light of the international commitments to the Sustainable Development Goals – is concerning. Objectives We aim to assess the overall body of knowledge on the evaluation of sustainability of health programmes in Nigeria. Methods We conducted a broad literature search, which included grey literature such as development project reports to identify all relevant studies reporting on our study objective. Articles were selected for inclusion using predefined criteria and data were extracted onto a purposely designed data extraction form. Results Four articles met our search criteria. The review identified financial, technical, social and environmental barriers to sustainability. Recommendations encompassed all stages of the project cycle: funding, design, implementation, monitoring and evaluation. Conclusion This review explored the overall body of knowledge on the evaluation of sustainability for health programmes in Nigeria. A clear understanding of operational indicators for sustainability, embedding sustainability early in the project cycle, community ownership, capacity building, effective collaboration, leadership and quality post evaluation are key for sustainable development in Nigeria. A limitation of this review is the small number of studies included and the assessment of sustainability at a single point in time. Much more empirical and rigorous research is needed to explore sustainability of health programmes in Nigeria. Research should also seek to understand the views of key stakeholders such as donors, implementing partners and the government. [ABSTRACT FROM AUTHOR]

Background: Promoting respectful care at childbirth is important to improve quality of care and encourage women to utilize skilled delivery services. However, there has been a relative lack of public health research on this topic in Nigeria. A systematic review was conducted to synthesize current evidence on disrespect and abuse of women during childbirth in Nigeria in order to understand its nature and extent, contributing factors and consequences, and propose solutions. Methods: Five electronic databases were searched for relevant published studies, and five data sources for additional grey literature. A qualitative synthesis was conducted using the Bowser and Hill landscape analytical framework on disrespect and abuse of women during childbirth. Results: Fourteen studies were included in this review. Of these studies, eleven were cross sectional studies, one was a qualitative study and two used a mixed method approach. The type of abuse most frequently reported was non-dignified care in form of negative, poor and unfriendly provider attitude and the least frequent were physical abuse and detention in facilities. These behaviors were influenced by low socioeconomic status, lack of education and empowerment of women, poor provider training and supervision, weak health systems, lack of accountability and legal redress mechanisms. Overall, disrespectful and abusive behavior undermined the utilization of health facilities for delivery and created psychological distance between women and health providers. Conclusion: This systematic review documented a broad range of disrespectful and abusive behavior experienced by women during childbirth in Nigeria, their contributing factors and consequences. The nature of the factors influencing disrespectful and abusive behavior suggests that educating women on their rights, strengthening health systems to respond to specific needs of women at childbirth, improving providers training to encompass interpersonal aspects of care, and implementing and enforcing policies on respectful maternity care are important. This review has also shown that more robust research is needed to explore disrespect and abuse of women during childbirth in Nigeria and propose compelling interventions. [ABSTRACT FROM AUTHOR]