Determinants of women's preferred and actual abortion provision locations in Nigeria.
Determinants of women's preferred and actual abortion provision locations in Nigeria.
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DOI：
10.1186/s12978-021-01290-w
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发表时间：
2021-11-27
影响因子：
3.4
通讯作者：
Bell SO
中科院分区：
文献类型：
--
作者：
Byrne ME;Omoluabi E;OlaOlorun FM;Moreau C;Bell SO
不安全堕胎仍然是全球孕产妇死亡的主要原因。许多因素可以影响妇女在哪里寻求堕胎护理的决定；然而，在资源匮乏的情况下，特别是在堕胎受到法律限制的情况下，很少有关于人口一级堕胎护理决定的研究。这项分析使用了2019-2020年对尼日利亚六个州1144名女性的跟踪调查数据，这些女性在2018年的一项横断面调查中报告了堕胎经历。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来描述妇女首选的和实际的初级堕胎护理提供者/地点。我们还审查了影响妇女决定在哪里终止妊娠的因素，并确定了阻碍妇女实施其偏好的能力的因素。然后，我们检查了无法使用其首选提供商/地点的女性的特征。非临床提供者(55.0%)比临床提供者(45.0%)更常使用；然而，大多数女性(55.6%)更喜欢临床提供者。在实际和首选堕胎提供者/地点方面差异最大的是私立医院(实际7.6%对37.2%)、公立医院(4.3%对22.6%)、药剂师(26.5%对5.9%)和药房(14.9%对6.6%)。“隐私/保密”是促使妇女选择堕胎提供者/地点的最常见的主要原因(20.7%)，其次是“方便”(16.9%)和“推荐”(12.3%)，最常见的原因是朋友(60.8%)，尽管最主要的原因因提供者/地点的类型而不同。费用和距离是女性不使用首选供应商/地点的两个最常见的原因(分别为46.1%和21.9%)。能够使用其首选提供者/地点的妇女和那些无法实施其首选选择的妇女之间的社会人口特征在统计上没有显著差异，但居住国除外。这些发现提供了对尼日利亚堕胎护理障碍的洞察，表明谨慎是许多妇女选择堕胎地点的关键，而成本和距离阻碍了许多人寻求自己喜欢的护理提供者/地点。结果还突出了妇女在法律限制的环境中的堕胎护理偏好的多样性。许多因素影响着妇女堕胎的途径，即使在严格的法律禁止堕胎的情况下也是如此。这项研究旨在探讨尼日利亚妇女更愿意和实际上在哪里堕胎，她们可以或不能使用其首选的提供者/地点的原因，以及能够和不能使用其首选的提供者/地点的妇女之间的差异。研究结果显示，大多数女性会选择使用临床来源，如政府或私立医院，特别是在没有使用首选来源的女性中。隐私/机密性、便利性和朋友或伴侣等人的推荐推动了女性对堕胎护理的偏好，尽管这些影响因提供者/地点的类型(临床、药房/药剂师或其他非临床)而不同。成本、距离和缺乏隐私等问题是阻碍女性使用她们首选的提供者/地点，而不是从不太愿意的提供者那里堕胎的障碍。然而，除各州外，使用和不使用其首选提供者/地点的妇女的社会人口统计特征没有显著差异。这些发现为尼日利亚安全堕胎护理的障碍提供了见解，表明社会安全促使许多女性在医疗体系之外寻求护理，而成本和距离阻碍了许多女性寻求临床服务。调查结果还强调，在堕胎受到法律限制的情况下，妇女堕胎偏好的多样性。
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. Many factors influence a woman’s pathway to obtaining an abortion, even in a setting with strict laws prohibiting the practice. This study aims to explore where women in Nigeria would prefer to and actually obtain their abortions, reasons why they could or could not use their preferred provider/location, and differences between women who were and were not able to use their preferred provider/location. The findings show that most women would opt to use a clinical source, such as a government or private hospital, especially among women who did not use their preferred source. Privacy/confidentiality, convenience, and recommendation from someone like a friend or partner drove women’s abortion care preferences, although these influences differed by type of provider/location (clinical, pharmacy/chemist, or other non-clinical). Issues like cost, distance, and lack of privacy were barriers that prevented women from using their preferred provider/location, instead obtaining their abortion from a less desired provider. However, the sociodemographic characteristics of women who did and did not use their preferred provider/location did not differ significantly, except by state. These findings provide insights on barriers to safe abortion care in Nigeria, suggesting social safety drives many women to seek care outside of the healthcare system, while cost and distance prevented many from seeking clinical services. Results also highlight the diversity of women’s abortion preferences in a setting where abortion is legally restricted.
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影响因子：
3.8
作者：
Kahabuka, Catherine;Pembe, Andrea;Meglioli, Alejandra
通讯作者：
Meglioli, Alejandra
影响因子：
168.9
作者：
Kassebaum, N. J.;Bertozzi-Villa, A.;Coggeshall, M. S.
通讯作者：
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DOI：
10.1016/j.ijgo.2013.10.009
发表时间：
2014-04-01
影响因子：
3.8
作者：
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通讯作者：
Winikoff, Beverly
DOI：
10.3390/ijerph15020329
发表时间：
2018-02-01
影响因子：
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作者：
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通讯作者：
Decat, Peter
影响因子：
34.3
作者：
Say, Lale;Chou, Doris;Alkema, Leontine
通讯作者：
Alkema, Leontine