Abortion decision-making process trajectories and determinants in low- and middle-income countries: A mixed-methods systematic review and meta-analysis.
Abortion decision-making process trajectories and determinants in low- and middle-income countries: A mixed-methods systematic review and meta-analysis.
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低收入和中等收入国家的堕胎决策过程轨迹和决定因素：混合方法系统的审查和荟萃分析。
DOI：
10.1016/j.eclinm.2022.101694
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发表时间：
2022-12
影响因子：
15.1
通讯作者：
Nair, Manisha
中科院分区：
文献类型：
--
作者：
Lokubal, Paul;Corcuera, Ines;Balil, Jessica Macias;Frischer, Sandrena Ruth;Kayemba, Christine Nalwadda;Kurinczuk, Jennifer J.;Opondo, Charles;Nair, Manisha
关键词：
所有人工流产中约有45.1%是不安全的，其中97%发生在低收入和中等收入国家。妇女的堕胎决定可能很复杂，受到各种因素的影响。我们的目的是描绘妇女的堕胎决策轨迹和他们的决定因素在中低收入国家。我们检索了Medline、EMBASE、PsychInfo、Global Health、Web of Science、Scopus、IBSS、CINAHL、WHO全球医学索引、科克伦图书馆、WHO网站、ProQuest和Google Scholar，以查找2000年1月1日至2021年2月16日期间发表的主要研究和报告（2022年6月6日更新），关于LMIC中人工流产决策轨迹和/或其决定因素。我们排除了关于自然流产的研究。两名独立的评审员提取并评估每篇论文的质量。我们使用“最佳拟合”框架合成人工流产决策轨迹和专题合成合成其决定因素。我们使用随机效应模型分析了定量结果。本研究方案注册于PROSPERO编号CRD 42021224719。在识别的6960篇文章中，我们将79篇纳入系统综述，将14篇纳入荟萃分析。我们确定了九个堕胎决策轨迹：怀孕意识，自我反思，最初的堕胎决定，披露和寻求支持，谈判，最终决定，获取和信息，堕胎程序，堕胎后的经验和护理。轨迹的决定因素包括决策自主权、获得和选择三大主题。对7 737名妇女的数据进行的一项荟萃分析显示，妇女参与堕胎决策的总体比例为0.86（95% CI：0.73-0.95，I2 = 99.5%），伴侣参与堕胎决策的总体比例为0.48（95% CI：0.29-0.68，I2 = 99.6%）。政策和战略应在社会、法律和经济上解决妇女对安全堕胎的看法，并酌情让男性伴侣参与堕胎决策过程，以促进安全堕胎。临床异质性是我们研究的一个局限性，不同的研究对“最终决策者”的定义不同。人口健康博士奖学金PL，牛津大学的纳菲尔德部门，和医学研究理事会职业发展奖MN（补助金参考：MR/P022030/1）。
About 45.1% of all induced abortions are unsafe and 97% of these occur in low- and middle-income countries (LMICs). Women's abortion decisions may be complex and are influenced by various factors. We aimed to delineate women's abortion decision-making trajectories and their determinants in LMICs. We searched Medline, EMBASE, PsychInfo, Global Health, Web of Science, Scopus, IBSS, CINAHL, WHO Global Index Medicus, the Cochrane Library, WHO website, ProQuest, and Google Scholar for primary studies and reports published between January 1, 2000, and February 16, 2021 (updated on June 06, 2022), on induced abortion decision-making trajectories and/or their determinants in LMICs. We excluded studies on spontaneous abortion. Two independent reviewers extracted and assessed quality of each paper. We used “best fit” framework synthesis to synthesise abortion decision-making trajectories and thematic synthesis to synthesise their determinants. We analysed quantitative findings using random effects model. The study protocol is registered with PROSPERO number CRD42021224719. Of the 6960 articles identified, we included 79 in the systematic review and 14 in the meta-analysis. We identified nine abortion decision-making trajectories: pregnancy awareness, self-reflection, initial abortion decision, disclosure and seeking support, negotiations, final decision, access and information, abortion procedure, and post-abortion experience and care. Determinants of trajectories included three major themes of autonomy in decision-making, access and choice. A meta-analysis of data from 7737 women showed that the proportion of the overall women's involvement in abortion decision-making was 0.86 (95% CI:0.73–0.95, I2 = 99.5%) and overall partner involvement was 0.48 (95% CI:0.29–0.68, I2 = 99.6%). Policies and strategies should address women's perceptions of safe abortion socially, legally, and economically, and where appropriate, involvement of male partners in abortion decision-making processes to facilitate safe abortion. Clinical heterogeneity, in which various studies defined “the final decision-maker” differentially, was a limitation of our study. Nuffield Department of Population Health DPhil Scholarship for PL, University of Oxford, and the Medical Research Council Career Development Award for MN (Grant Ref: MR/P022030/1).
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