Dias Amaral Bianca, Sakellariou Dikaios
London School of Hygiene and Tropical Medicine, London, United Kingdom.
School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom.
Front Glob Womens Health. 2021 Sep 21;2:699121. doi: 10.3389/fgwh.2021.699121. eCollection 2021.
During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010-2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.
在人道主义危机期间，妇女特别容易意外怀孕。不安全堕胎是孕产妇死亡的五大主要原因之一，也是唯一完全可以预防的原因。本研究旨在确定人道主义组织提供安全堕胎护理的障碍和促进因素。2020年7月，我们对2010 - 2020年期间的文献进行了范围综述，涉及以下数据库：医学索引数据库（Medline）、全球健康数据库（Global Health）、护理学与健康领域数据库（CINAHL Plus）和救济网（ReliefWeb）。我们对所有纳入的文章进行了严格评估，并对研究结果进行了叙述性综合分析。我们检索到881篇文章。在去除重复文章并排除不符合纳入标准的文章后，2015年至2020年期间发表的24篇文章被纳入综述。其中9篇纳入论文为非研究实践项目。研究结果揭示了五个主要主题：法律环境；背景；耻辱感；经济因素；以及服务提供。据报告，限制性法律、耻辱感和资金短缺是安全堕胎的主要障碍，而主要促进因素包括大多数国家在某些情况下允许堕胎、人道主义行为体在人道主义危机初期影响医疗保健政策的能力以及社区参与。这项范围综述揭示了已发表研究的匮乏。增加关于终止妊娠（ToP）研究的传播可以提高不安全堕胎的关注度以及在人道主义环境中提供终止妊娠服务的必要性。此外，人道主义组织需要有关于安全堕胎的明确方案，并深入了解包括国际人道主义法在内的相关立法，以便在法律允许的范围内充分提供这项服务。
