Université de Genève, Geneva, Switzerland.
Institut National d'Etudes Démographiques, Paris, France.
Reprod Health. 2021 Jun 7;18(1):114. doi: 10.1186/s12978-021-01165-0.
Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited.
This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others.
Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma.
在中低收入国家（LMICs），对污名化的生殖实践进行医疗保健往往是非法的；即使合法，也往往是不充分的，难以找到和/或带有污名化，这导致妇女推迟护理或转向非正式的信息来源和提供者。在 LMICs 中寻求人工流产的妇女经常面临这种障碍，导致不安全的堕胎。越来越多的研究表明，寻求堕胎的人在寻找正规或非正规护理时会向社交网络成员透露信息。然而，结果并不一致；在一些堕胎服务受限的 LMICs（限制堕胎的 LMICs）中，披露的情况似乎受到限制。
本系统评价旨在确定在限制堕胎的 LMICs 中向社交网络成员披露的程度，并探讨获得非正式医疗堕胎的妇女与其他堕胎寻求者之间的差异。这些知识对于设计旨在改善安全堕胎信息的干预措施或开发基于网络的数据收集策略可能是有用的。我们在 Pubmed、POPLINE、AIMS、LILACS、IMSEAR 和 WPRIM 数据库中搜索了 2000 年至 2018 年期间发表的关于在堕胎服务受限的中低收入国家获取堕胎信息、沟通、网络和服务的同行评议文章，这些文章涉及使用语言。我们根据匿名获取堕胎服务和当地堕胎污名化的可能性，将环境分为四种类型：（1）匿名访问可能，高度污名化；（2）匿名访问可能，高度污名化；（3）非匿名访问，高度污名化；（4）非匿名访问，高度污名化。我们筛选了 4101 篇参考文献，从 33 个国家的 79 篇文章中提取数据。我们发现一些国家（或国家内的一些群体）代表了前两种环境类型，而大多数研究都符合第三种类型。向网络成员披露的堕胎寻求者比例随着环境类型的不同而增加，在第 1 类场所，没有妇女向亲密圈子之外的网络成员披露，在第 2 类场所只有少数，在第 3 类场所则多数。在限制堕胎的 LMICs 中，使用非正式医疗堕胎并不总能改变向他人披露的情况。
根据匿名获取堕胎信息和服务的情况以及污名化程度，在限制堕胎的 LMICs 中，寻求堕胎的妇女向其更大的社交网络成员披露的程度因环境/社会群体而异，差异很大。
