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OBJECTIVE: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

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BACKGROUND:  Health service readiness is a prerequisite to accessing quality services. This study analyzes the readiness of health facilities in Nepal to provide comprehensive abortion services by focusing on the availability and quality of care.   Methods:  This is a cross-sectional study, and a multi-stage sampling approach was used to select health facilities. A total of 767 health facilities were surveyed from 30 Municipalities across the country.   Results: In a study of 767 health facilities surveyed, only 223 (29%) offered abortion services. Among them, 92% offered medical abortion, 48% provided manual vacuum aspiration, 18% offered dilation and evacuation and 18% offered medical induction. Approximately 7% of health facilities lacked trained providers yet still provided services and 29% of health facilities providing abortion services were not compliant with legal requirements. Interestingly, 13% of these facilities lacked short-acting contraceptives.   Conclusions:  Most health facilities in Nepal lack readiness for Safe Abortion Services (SAS), failing to meet minimum criteria, including to provide abortion legally. Urgent collaborative efforts among policymakers, administrators, and healthcare providers are needed to align with Nepal's Sustainable Development Goals and address gaps in safe abortion service availability. This includes policy updates, strengthening Public-Private Partnerships (PPPs), and ensuring comprehensive SAS implementation and financing as part of essential health services.

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BACKGROUND: Abortion was legalized by the 2002 Muluki Ain to combat the surging rates of maternal mortality and morbidity. By 2021, the Maternal Mortality Rate plummeted to 151 from 539 in 1996. The decline in the abortion-related maternal mortality attributes to the implication of progressive abortion policies that includes expanded safe abortion services introduction of medical abortion, constitutional recognition of abortion, the mandates by Safe Motherhood and Reproductive Health Rights Act, and free-of-cost abortion services in government health facilities. This review study delves into exploring the contemporary abortion policies and its implications on women's access to safe abortion services as well as the factors that affect the access. METHODS: This study incorporates findings from extensive desk review of abortion services in Nepal. RESULTS: The 2021 safe abortion services Program Implementation Guideline aims to expand safe abortion sites; however, the Nepal's challenging geography ensues its inequitable distribution, especially in mountainous area. Policy provisions on information and financial accessibility to abortion are well navigated by the Safe Motherhood and Reproductive Health Rights Act and regulation but consistent to sporadic gaps in its implementation were comprehended in this study. This paper further discussed the Safe Motherhood and Reproductive Health Rights Act's regressive mandate of 28-week gestational limit at any condition and the role of gender in abortion decision-making under the pretext of factors influencing safe abortion services. CONCLUSIONS: The review study recommends strategies: improving capacity for abortion services under federalism, combating stigma, improving the private sector's readiness, and building a resilient health system.

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Background: Of the 55.7 million abortions that were performed globally, 25.1 million (45.1%) were not safe. Nearly 97% of these took place in developing countries. Approximately 71% of economically developed countries allow safe abortion care (SAC) services, whereas only 16% of developing countries permit it. In sub-Saharan Africa, 92% of mothers live in 43 countries where SAC services are restricted by law. Most Ethiopian women continue to self-terminate unwanted pregnancies in hazardous conditions. The aim of this evaluation was to assess input, care providers' compliance with national guidelines, and clients' satisfaction. Methods: A multicenter cross-sectional study design with a mixed-methods approach was used. Seven public health facilities were randomly selected where 75 health caseworkers were directly observed; 296 clients and 14 key informants were interviewed, respectively. A resource inventory checklist was used to assess all inputs. The overall SAC services evaluation was summarized from 40 indicators: 13 resource availability indicators, 14 healthcare workers' compliance to national guidelines indicators, and 13 clients' satisfaction toward SAC services indicators. A multivariate logistic regression model was fit to determine factors that affect client satisfaction at a p-value <0.005. Results: There were 75 healthcare providers in the maternal and child health departments in the study area. Except for the interruption of water and electricity, maternal waiting area, counseling, and procedural room, all are available making 94% of resources availability. All healthcare workers were compliant in providing anti-pain medication during procedures, identifying clients if they were targeted for an HIV/AIDS test, and providing their test results as per the guideline. Nevertheless, they were poorly compliant in respecting the clients (9, 12%) and taking vital sign (33, 44%). The overall compliance was 62.3%, while only 51% were satisfied with waiting time and privacy of counseling room. The overall client satisfaction was 65%. The overall evaluation of SAC services was 72.9%. Conclusion: Resource availability was excellent, which was in line with national SAC expectations while the healthcare workers' compliance to national guidelines was fair, which deviated from expectations. The clients' satisfaction and the overall evaluation were good, which was below the hypothesized expectation.

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BACKGROUND: A negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia. OBJECTIVE: This study aimed to assess health care provider's attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia. METHODS: A health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. RESULTS: The response rate of the study was 99.3%, and 70.2% [95% CI: 65.6-74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25-29, 30-34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03-10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43-19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55-6.60], midwives [AOR = 6.50, 95% CI = 2.40-17.44], working at hospital [AOR = 4.77, 95% CI = 1.53-14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29-11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13-5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23-16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15-13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52-24.26] were associated with a favorable attitude towards safe abortion care. CONCLUSIONS: Healthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units.

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Background: Unsafe abortion is a serious reproductive health problem in developing countries including Ethiopia. The attitude of healthcare providers toward abortion is one of contributing factors to unsafe abortion. This study aimed to determine the pooled effect of healthcare workers' attitudes toward safe abortion care and its determinants factors in Ethiopia. Methods: Search engines such as Scopus, CINAHL, EMBASE, PubMed, Web of Science, and CAB Abstracts were used to find published studies where as Google and Google Scholar were used to find unpublished research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The analysis was performed using STATA 14 and the random-effects model was used to calculate the odds ratios of medical professionals' attitudes regarding safe abortion services. Study heterogeneity was assessed by using I2 and P-values. To evaluate the stability of pooled values to outliers and publication bias, respectively, sensitivity analysis and funnel plot were also performed. Results: A total of 15 published and unpublished articles with a sample size of 4060 were incorporated in this Review. The overall pooled prevalence of this study was 56% (95% CI: 45-67). Sex of participants (AOR: 2.37; 95% CI: 1.57, 3.58), having training (AOR: 2.86; 95% CI: 1.58, 5.17), Professional type (AOR: 1.55; 95% CI: 1.04, 4.46), and knowledge of abortion law (AOR:2.26; 95% CI: 1.14, 4.46) were the determinants factors that significantly associated with health care workers' attitude toward safe abortion care. Sensitivity analysis shows that the pooled odds ratios were consistently stable throughout all meta-analyses, and the funnel plot shows no evidence of publication bias. Conclusion: Half of health care providers sampled among the pooled studies have favorable attitudes toward abortion services in Ethiopia; which could hamper women's access to safe abortion care. Sex, training, type of profession, and knowing abortion law were determinants of health care workers' attitudes toward safe abortion services. Stakeholders should emphasize improving the attitude of healthcare workers toward safe abortion care which has a vital role in reducing maternal mortality. Moreover, working on modifiable factors like training, assigning personnel whose professions align with the service, and updating care providers about abortion law is also the essential key point to improve their intentions to deliver the services.

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The Maputo Protocol, adopted over 20 years ago, is a promising regional treaty for advancing gender equity and sexual and reproductive health and rights. This instrument has driven progress in women's health and rights across Africa, with much remaining to achieve to realize its full potential for women and girls, including access to safe abortion. The present paper shares the strategies and lessons from the Democratic Republic of Congo's (DRC) reform centered on the domestication of the Protocol, specifically applying its commitments on abortion decriminalization and access. With a vision of addressing maternal mortality and rectifying the impacts of widespread sexual violence against women during war, abortion as a human right and health imperative was at the heart of the DRC's reform. Governmental commitment, broad coalition building, evidence generation, and an intersectional advocacy agenda were critical to overcoming opposition, stigma, and other challenges. This paper shares key learnings from the DRC's complex yet collaborative reform strategies and its processes. The strategy prioritized domestication of the Protocol for numerous reforms, including paving the path to legal abortion on the broad grounds of rape or incest, and saving women's health and/or life. With a commitment to maximizing quality, access, task sharing, and equity, progressive national comprehensive abortion guidelines were created alongside an implementation roadmap for accountability. The DRC's experience leveraging the Maputo Protocol's obligations to advance abortion rights and access offers valuable insights for consideration globally.

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Abortion is significantly restricted by law in most Pacific Island countries, impacting the rights, health and autonomy of people who experience pregnancy. We undertook qualitative research between February and August 2022 on Rarotonga, Cook Islands, where abortion is illegal under most circumstances. We conducted interviews with women who had accessed or tried to access abortion services; people who had supported women to access abortion services; health workers; and advocates to understand their experiences regarding abortion. We conducted focus groups to explore broader social perceptions and experiences of sexual and reproductive health and rights, including abortion. Participants described their abortion decisions and methods, and their negotiation of the personal context of their sexual behaviours, pregnancies, and abortions relative to their socio-cultural context and values. As defined by the World Health Organization, safe abortion relates to the methods and equipment used and the skills of the abortion provider. We argue for an expansion of this definition to consider inclusion of reference to individuals' 'abortion safety nets' as the sum of their access to financial, political, health care and socio-cultural resources. These safety nets are shaped by discourses related to abortion and socio-cultural support and values, impacting physical, emotional, psychological, social and spiritual health.

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In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three-level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision-making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services. With the decentralization of certification, the approval process for safe abortion service sites and providers has become simpler, less time consuming, and less expensive by reducing cost of traveling to Kathmandu or approaching authorities at the federal level. This has resulted in expanding safe abortion services across the country including remote areas with marginalized populations. Evidence-based advocacy enabled policy change for decentralization of the approval process. Collaboration among stakeholders has been vital for implementing the policy change, including issuing directives from the federal to provincial levels and capacity strengthening of provincial level officials in understanding the requirements for approval of sites and providers.

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Over the last decade, activists in Latin America have expanded access to safe abortion through processes of accompaniment. Abortion accompaniment is characterised by activism and community-based strategies to facilitate access to, and safe use of, medication abortion, mainly outside clinical contexts. Drawing on findings from a survey of 515 activists who were part of Accompaniment Collectives in Latin America, this study describes the organisation of these collectives, barriers and facilitators to their activism, and how accompaniers perceive the impact and future of abortion accompaniment. Accompaniment Collectives are organised and flexible and operate in diverse social and legal contexts. The main goals of accompaniment are the normalisation and social decriminalisation of abortion culturally (84%); the social construction of autonomy (79%); and the protection of people's freedom (73%), life (71%) and health (67%). Activists in legally restrictive settings identified limited access to abortion medication (73%) and restrictive laws (71%) as the main barriers to accompaniment, while health care personnel objecting to abortion provision on grounds of conscience was most common in legally permissive settings (64%). Collectives have developed strategies to overcome such barriers to and expanding access to abortion care. Activists expect accompaniment to continue regardless of the legal status of abortion.

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BACKGROUND: Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often lack adequate insight to make informed decisions. The purpose of this study was to explore the empowered perspectives of women leaders in Rwanda about the recent policy change for safe abortion. The study identifies women leaders' perceived barriers and their attitudes about resulting consequences toward safe abortion. METHOD: In this qualitative study, seven focus group discussions and eight key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. RESULTS: The emerging theme Strong barriers and numerous consequences of safe abortion illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: (1) Perceived barriers of safe abortion and (2) Consequences of providing safe abortion. The sub-categories for the first category are Reluctance to fully support safe abortion due to perceived unjustified abortions", Abortion-related stigma, Abortion is against cultural and religious beliefs, Emotional attachment to the unborn and Lack of awareness of abortion. The sub-categories for the second category are Perceived physiological trauma, Cause for barrenness/infertility, Increase in services abuse by adolescents/women, Increase of workload for healthcare providers, "Increase in sexual activities and STIs, and Abortion-related physiological trauma. CONCLUSION: The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word 'abortion' disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word 'abortion' outweighs the word 'safe'. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.

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Background: Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. Methods: iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. Results: There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). Conclusions: The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.

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BACKGROUND: Abortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities' capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect. METHODS: We collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities' capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period. RESULTS: In both countries, service coverage was high and improved over time, but facilities' capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%. CONCLUSIONS: The findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.

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[This corrects the article DOI: 10.3389/fgwh.2022.901842.].

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Background: Over-the-counter (OTC) sale of medical abortion (MA) inducing drugs is a common practice. Exploring its impact on women's health and the barriers to avail free MA services at hospital by these women is essential to improve upon policy decision. Methods: A prospective observational study included 112 women following ingestion of MA drugs from nonformal providers. Demography, clinical details, and reasons for not availing free abortion services at hospital were recorded. Results: Among 112 women, mean age was 28.63 (SD 4.7) years. Seventy one (63.39%) women were from rural region; 70.54% were educated below high school; 44 (39.28%) had prior induced abortion; 62.5% had never used any contraception. Majority (101; 90%) took two drugs (Mifepristone and Misoprostol), 28 (25%) used correct dosage. Drugs were consumed beyond 9 weeks of gestation by 25 (22.4%) women. Abnormal vaginal bleeding was commonest 105 (93.75%) presentation. Haemorrhagic shock was noted in 21 (18.75%) women, while 21 (18.7%) women required blood transfusion. "Easy and quick availability of these drugs OTC" was the commonest statement for not attending hospital. Conclusion: Easy and quick availability of OTC drugs, distance to hospital were major barriers. Incorrect dosage and lack of gestational age calculation were two most common errors in the risk assessment protocol. Expanding provider base, by training midlevel providers, can overcome these and unmask the full potential of MA to make abortion safer.

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Objectives: The main aim of this study was to assess health care providers' attitudes toward safe abortion services and its associated factors in public health facilities of Harar city, Eastern Ethiopia. Methods: Facility-based cross-sectional study was conducted among 411 health care providers who were working at public health facilities in Harari regional state, in eastern Ethiopia. A simple random sampling technique was used to select study participants. Data were collected using self-administered questionnaires, and collected data were entered into EpiData version 4.6 and then exported to SPSS version 26 for cleaning and analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were carried out to compute the prevalence of the outcome variables and to identify factors associated with the outcome variable, respectively. Adjusted odds ratio at 95% confidence interval and p-value < 0.05 was used to declare a significant association. Results: More than half (58.4%, 95% confidence interval: 53.8-63.2) of the health care providers had a favorable attitude toward safe abortion care. Being male (adjusted odds ratio = 2.90; 95% confidence interval: 1.80-4.65), ever trained on safe abortion (adjusted odds ratio = 2.55; 95% confidence interval: 1.39-4.66), familiarity with the current abortion law of Ethiopia (adjusted odds ratio = 2.38; 95% confidence interval: 1.40-4.05), preference of unrestricted abortion law (adjusted odds ratio = 1.86; 95% confidence interval: 1.15-3.02), and being medical doctors or health officers (adjusted odds ratio = 1.90; 95% confidence interval: 1.06-3.41) were the factors significantly associated with health care providers' favorable attitude toward safe abortion care. Conclusion: Approximately three in five of the health care providers working at public health facilities had a favorable attitude toward safe abortion care in eastern Ethiopia. We suggest giving pre-service or in-service training on safe abortion care and supporting health care providers to be familiar with the country's abortion laws are crucial to improve health care providers' attitudes toward safe abortion service in Ethiopia.

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BACKGROUND: Despite the 2005 expansion in abortion legal indications in Ethiopia, which provided for abortions in cases of rape, incest, or fetal impairment and other circumstances, nearly half of abortions occurred outside health facilities in 2014. The purpose of this study is to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care, as a means to generate evidence that could be used to improve access to and quality of abortion services. METHODS: Thirty-two focus group discussions with both men and women were held in four different regions of Ethiopia: Addis Ababa; Amhara; Oromia; and the Southern Nations, Nationalities, and Peoples' Region. The study team recruited participants (n = 193) aged 18-55 in each region using a purposive sample with snowball recruitment techniques. We conducted discussions in Amharic or Afaan Oromo using a semi-structured guide and transcribed and translated them into English for analysis. We used deductive coding and analysis to categorize findings into emergent themes around stigma, barriers, and the changing nature of attitudes around abortion. RESULTS: Despite changes in abortion law, findings show that women with unwanted pregnancies and those seeking abortions are still heavily stigmatized and sanctioned in a number of communities across Ethiopia. Abortion was deemed unacceptable in most cases, though respondents were more tolerant in cases of risk to the mother's life and of rape. We saw promising indications that changes are taking place in Ethiopian society's view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws and tightly held gender-based social norms, particularly in rural areas. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. CONCLUSION: Policymakers should create further awareness in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. Such efforts should be based on principles of gender equality, as a means of ensuring enduring changes for women's reproductive choice throughout the country.

We conducted a study to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care in Ethiopia. We implemented focus group discussions with both men and women in four different regions of Ethiopia. We analyzed our findings into themes around stigma, barriers, and the changing nature of attitudes around abortion. Our results show that women seeking abortions are still heavily stigmatized. We found that abortion was deemed unacceptable in most cases. However, we also saw promising indications that changes are taking place in Ethiopian society's view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. We concluded that further awareness is needed in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. These efforts should consider gender equality to ensure enduring changes for women's reproductive choice throughout the country.

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BACKGROUND: The standard of treatment in developing countries is harmed by a complex political landscape, an uncertain economic climate, rapid population growth, and clients are constantly complaining about the poor health system. Patients' assessments of the benefits and shortcomings of the service provided to them are expressed as satisfied or dissatisfied. The objective of this study was to determine the magnitude of women's satisfaction on quality of safe abortion and factors associated with it in Northwest Ethiopia. METHODS: Institution-based cross-sectional study design was done to collect data from 618 women in the selected health facilities in Northwest Ethiopia. Women having the gestational trophoblastic disease (partial mole) and those who cannot hear or are seriously ill during the data collection period were excluded. The study subjects were chosen using a randomization process, and each participant was questioned after receiving all necessary abortion treatment and giving verbal consent. Both bivariable and multivariable logistic regression analysis was carried out to determine covariates significantly associated with women's satisfaction on quality of abortion. RESULTS: The highest proportion of women who were reasoned out to terminate the fetus in the current pregnancy was due to financial problems (29.36%) and partner coercion (23.85%). Client satisfaction with safe abortion services in the study region was 25.10% (95% CI; 21.81-28.70). Women were 53.2% satisfied with the art of treatment/interpersonal abilities, 59.2% satisfied with the professional quality of care professionals, 54.5% satisfied with the physical environment, and 49.8% satisfied with the structure of the health care system, respectively. In the multivariable logistic regression analysis, women's living solely 0.47(0.26-0.87) & living with 2 to 4 people 0.11(0.04-0.29), college and above level of education 1.78(1.01-3.15), wanted the status of pregnancy 0.44(0.23-0.85) and post-abortion contraceptive users 1.70(1.01-2.89) were factors significantly associated with women's satisfaction level. CONCLUSION: In this study, one-fourth of the women were satisfied with the quality of safe abortion services. Family size, women's educational status, maternity status, and post-abortion contraception use were predictors of women's satisfaction with the quality of abortion. Ethiopia's government should concentrate on addressing contraception needs in order to prevent women from having multiple abortions.