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      “I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria

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          Abstract

          This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients’ own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.

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          Most cited references44

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          Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.

          Information about the incidence of induced abortion is needed to motivate and inform efforts to help women avoid unintended pregnancies and to monitor progress toward that end. We estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014, and abortion rates in subgroups of women. We use the results to estimate the proportion of pregnancies that end in abortion and examine whether abortion rates vary in countries grouped by the legal status of abortion.
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            Unsafe abortion: the preventable pandemic.

            Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19-20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women's health; in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. Access to safe abortion improves women's health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol, an oxytocic agent, have improved the care of women. Access to safe, legal abortion is a fundamental right of women, irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women.
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              Abortion Stigma: A Systematic Review.

              Although stigma has been identified as a potential risk factor for the well-being of women who have had abortions, little attention has been paid to the study of abortion-related stigma.
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                Author and article information

                Contributors
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 February 2022
                2022
                : 17
                : 2
                : e0263072
                Affiliations
                [1 ] Ibis Reproductive Health, Oakland, CA, United States of America
                [2 ] University of California, Berkeley, School of Law, Berkeley, CA, United States of America
                [3 ] Generation Initiative for Women and Youth Network, Lagos, Nigeria
                [4 ] Ipas Nigeria, Lagos, Nigeria
                Vital Strategies, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-2500-9688
                https://orcid.org/0000-0002-5805-1084
                Article
                PONE-D-21-22868
                10.1371/journal.pone.0263072
                8820635
                35130269
                366cf577-e254-4862-a50b-2e3233ac75a0
                © 2022 Katz et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 July 2021
                : 10 January 2022
                Page count
                Figures: 0, Tables: 1, Pages: 16
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100010409, children's investment fund foundation;
                Funded by: funder-id http://dx.doi.org/10.13039/100000008, david and lucile packard foundation;
                This study was funded as part of the Abortion Service Quality Initiative by the Children’s Investment Fund Foundation ( https://ciff.org/) and The David and Lucile Packard Foundation ( https://www.packard.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Termination of Pregnancy
                People and Places
                Geographical Locations
                Africa
                Nigeria
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Medicine and Health Sciences
                Health Care
                Quality of Care
                Biology and Life Sciences
                Psychology
                Relaxation (Psychology)
                Social Sciences
                Psychology
                Relaxation (Psychology)
                Computer and Information Sciences
                Network Analysis
                Social Networks
                Social Sciences
                Sociology
                Social Networks
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Custom metadata
                We are unable to share data publicly because of ethical and legal restrictions. First, the dataset contains potentially identifying and sensitive patient information. Second, the ethics committees that have approved this study restrict data availability to members of the research team named in the Institutional Review Board protocol. Interested researchers can request access to the data by contacting our data access committee, chaired by Caitlin Gerdts, Vice President for Research, Ibis Reproductive Health ( cgerdts@ 123456ibisreproductivehealth.org ).

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