Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence.

Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000-2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.

Adolescent abortion in 11 high-income countries including Australia: towards the establishment of a minimum data set.

OBJECTIVE: A major public health challenge in Australia is the lack of national adolescent abortion data. This descriptive study identifies, collates and describes publicly available adolescent abortion data in high-income countries including Australia, to describe trends over 10 years and provide recommendations for strengthening data collection. METHODS: Data were extracted from publicly available government sources that met inclusion criteria. All relevant adolescent abortion data from 2007 to 2017 were extracted from datasets and analysed. RESULTS: Eleven high-income countries were included. Incidence data for the adolescent population were available for all countries and states. Incidence of adolescent abortion over 10 years shows a downward trend in all countries. Gestational age at time of abortion was the second-most available variable. The level and type of data across all countries varied; there was a lack of age range standardisation and aggregation of gestational weeks differed, making comparisons difficult. CONCLUSION: A minimum data set of standardised abortion information will enable appropriate adolescent abortion policies and services to be developed that are informed by high quality, up-to-date intelligence. Implications for public health: Availability of data affects government's ability to adequately monitor national adolescent health outcomes and plan and evaluate appropriate reproductive health policy and services.

Women's Awareness and Knowledge of Abortion Laws: A Systematic Review.

BACKGROUND: Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women's access to safe, legal abortion services. OBJECTIVE: To provide a synthesis of evidence of women's awareness and knowledge of the legal status of abortion in their country, and the accuracy of women's knowledge on specific legal grounds and restrictions outlined in a country's abortion law. METHODS: A systematic search was carried for articles published between 1980-2015. Quantitative, mixed-method data collection, and objectives related to women's awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis. RESULTS: Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women's correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3%-68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8%-98%, while in the case of incest, ranged from 9.8%-64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7%-94% and 0%-89.5% respectively. CONCLUSION: This systematic review synthesizes literature on women's awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary.