Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Centre for Research, Evaluation Resources and Development, Ile-Ife, Nigeria.
Reprod Health. 2021 Nov 27;18(1):240. doi: 10.1186/s12978-021-01290-w.
Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women's decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted.
This analysis uses data from a 2019-2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women's preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women's decisions about where to terminate their pregnancy and identify factors hindering women's ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location.
Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). "Privacy/confidentiality" was the most common main reason driving women's abortion provider/location choice (20.7%), followed by "convenience" (16.9%) and "recommended" by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence.
These findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women's choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women's abortion care preferences in a legally restrictive environment.
不安全堕胎仍然是全球孕产妇死亡的主要原因。许多因素会影响妇女在何处寻求堕胎护理的决定；然而，在资源匮乏的环境中，特别是在堕胎受到法律限制的地方，对人口层面的堕胎护理决策的研究甚少。
本分析使用了来自 2019-2020 年对尼日利亚六个州的 1144 名在 2018 年横断面调查中报告堕胎经历的妇女的后续调查数据。我们通过区分临床、药房/药剂师或其他非临床提供者或地点，描述了妇女首选和实际的主要堕胎护理提供者/地点。我们还研究了影响妇女终止妊娠地点决定的因素，并确定了阻碍妇女实现其偏好的因素。然后，我们检查了无法使用首选提供者/地点的妇女的特征。
非临床提供者（55.0%）的使用频率高于临床提供者（45.0%）；然而，大多数妇女更喜欢临床提供者（55.6%）。实际与首选堕胎提供者/地点之间的最大差异是私立医院（实际 7.6%，首选 37.2%）、公立医院（实际 4.3%，首选 22.6%）、药剂师（实际 26.5%，首选 5.9%）和药店（实际 14.9%，首选 6.6%）。“隐私/保密性”是驱动妇女堕胎提供者/地点选择的最常见主要原因（20.7%），其次是“方便”（16.9%）和“他人推荐”（12.3%），最常见的是朋友（60.8%），尽管首选提供者/地点的原因因提供者/地点类型而异。费用和距离是妇女未使用首选提供者/地点的两个最常见原因（分别为 46.1%和 21.9%）。能够使用首选提供者/地点的妇女与无法实施首选选择的妇女在社会人口特征方面没有统计学上的显著差异，除了居住地。
这些发现提供了尼日利亚堕胎护理障碍的见解，表明谨慎是许多妇女选择堕胎地点的关键，而费用和距离则阻止许多人寻求他们首选的护理提供者/地点。结果还突出了在法律限制环境中妇女堕胎护理偏好的多样性。
