Department of International Development, London School of Economics and Political Science, London, United Kingdom.
Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America.
PLoS One. 2020 Nov 4;15(11):e0237227. doi: 10.1371/journal.pone.0237227. eCollection 2020.
Despite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies.
Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources.
The evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.
尽管全球堕胎发生率很高，但我们缺乏对中观经济层面（即卫生系统和社区）已知堕胎护理和堕胎政策经济后果的综合评估。本范围综述旨在研究堕胎护理和政策的中观经济成本、效益、影响和价值。
在八个电子数据库中进行了检索。我们使用 PRISMA 扩展版进行了检索和纳入/排除标准的应用。纳入的研究必须至少检查以下结果之一：堕胎护理或堕胎政策的成本、效益、影响和价值。对定量和定性数据进行了提取，以进行描述性统计和主题分析。在 150 项中观经济研究中，卫生系统成本是最常报告的中观经济结果（n=116），其次是影响（n=40）、效益（n=17）和价值（n=11）。在卫生机构和卫生系统内，提供堕胎服务的成本差异很大，尤其是考虑到研究人员确定和计算服务成本的范围。在保持或甚至提高堕胎服务质量的同时，可以实现财务节约。适应不断变化的法律和政策对卫生机构来说代价高昂。美国的堕胎政策对国内外的卫生系统和机构都产生了经济影响。提供堕胎后护理需要大量的卫生机构资源。
证据基础主要集中在高收入国家的卫生系统和卫生机构的堕胎成本上，而对中低收入国家的相关研究较少。关于堕胎对社区的经济影响或中东和北非地区堕胎的中观经济学知之甚少。在方法学方面，综述论文是最常见的研究类型，这表明研究人员依赖于核心一组成本核算论文的证据。需要生成关于中观经济结果的新原始数据的研究来加强证据基础。
