“One’s life becomes even more miserable when we hear all those hurtful words.” A mixed methods systematic review of disrespect and abuse in abortion care.

Abstract

Abstract Background Disrespect and abuse during facility-based abortion and postabortion care (PAC) manifests in various forms, including disrespect, abuse (physical, verbal, and sexual), stigma, discrimination, failure to meet standards of care, neglect, breaches in privacy and confidentiality, misinformation or a lack of information, mistreatment or undignified care, and protests. The objective of this mixed methods systematic review was to describe the various forms of disrespect and abuse that women face during abortion or PAC. Methods We conducted a comprehensive literature search in Embase, Medline, and PubMed using Medical Subject Headings (MeSH) and text-based terms targeting disrespect and abuse in facility-based abortion care. The initial search was conducted in 2019, followed by an updated search in 2023. Thirty-eight articles conducted in 20 countries met inclusion criteria and were included in this review. Results The most frequently observed form of disrespect and abuse, identified in 31 studies, was the failure to meet care standards in providing quality abortion care or PAC, particularly in terms of offering adequate and accurate information to women before, during and after the procedures. Additionally, stigma was reported in 20 studies, disrespect in 19 studies, discrimination in 10 studies, and both verbal and physical abuse, as well as humiliation and condescension, each in 8 studies. The presence of abortion protestors was also noted in 8 studies. Conclusions Our results indicate the need for multi-level strategies to transform healthcare providers' perceptions and attitudes towards women seeking abortion care, and other actions at the individual, institutional, and policy levels to provide quality, respectful abortion care. We found that providers sometimes highlighted caste or other markers of vulnerability as part of disrespectful care. The systematic measurement of disrespect and abuse in abortion care and PAC could help understand the distribution of experiences across different groups.