Contraception and abortion in times of crisis: results from an online survey of Venezuelan women

IntroductionIn the last decade, Venezuela has experienced a complex humanitarian crisis that has limited access to healthcare. We set out to describe Venezuelan women's experiences accessing sexual and reproductive health services, including abortion, which is heavily restricted by law.MethodsWe fielded an online survey in July of 2020 among Venezuelan women recruited through social media advertisements. We conducted descriptive statistical analyses using Excel and STATA SE Version 16.0.ResultsWe received 851 completed survey responses. Almost all respondents experienced significant hardship in the last year, including inflation (99%), worries about personal safety (86%), power outages (76%), and lack of access to clean water (74%) and medications (74%). Two thirds of respondents used contraception in the last two years, and almost half (44%) of respondents had difficulty accessing contraception during that same time period. About one fifth of respondents reported having had an abortion; of these, 63% used abortion pills, and 72% reported difficulties in the process. Half of those who had an abortion did it on their own, while the other half sought help – either from family members or friends (34%), from providers in the private health sector (14%), or from the Internet (12%).ConclusionsVenezuelan women who responded to our survey describe a harsh context with limited access to sexual and reproductive health services. However, they report relatively high rates of contraceptive use, and abortion seems to be common despite the restrictive legal setting

Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I.

BACKGROUND: Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. OBJECTIVE: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women's preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. METHODS: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women's abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. RESULTS: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. CONCLUSIONS: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion

Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design.

BACKGROUND: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. OBJECTIVE: The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. METHODS: The study design was based on the "development-evaluation-implementation" process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. RESULTS: We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. CONCLUSIONS: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care

Reducing the Harms of Unsafe Abortion: A Systematic Review of the Safety, Effectiveness and Acceptability of Harm Reduction Counselling for Pregnant Persons Seeking Induced Abortion

BACKGROUND: Globally, access to safe abortion is limited. We aimed to assess the safety, effectiveness and acceptability of harm reduction counselling for abortion, which we define as the provision of information about safe abortion methods to pregnant persons seeking abortion. METHODS: We searched PubMed, EMBASE, ClinicalTrials.gov, Cochrane, Global Index Medicus and the grey literature up to October 2021. We included studies in which healthcare providers gave pregnant persons information on safe use of abortifacient medications without providing the actual medications. We conducted a descriptive summary of results and a risk of bias assessment using the ROBINS-I tool. Our primary outcome was the proportion of pregnant persons who used misoprostol to induce abortion rather than other methods among those who received harm reduction counselling. RESULTS: We included four observational studies with a total of 4002 participants. Most pregnant persons who received harm reduction counselling induced abortion using misoprostol (79%-100%). Serious complication rates were low (0%-1%). Uterine aspiration rates were not always reported but were in the range of 6%-22%. Patient satisfaction with the harm reduction intervention was high (85%-98%) where reported. We rated the risk of bias for all studies as high due to a lack of comparison groups and high lost to follow-up rates. DISCUSSION: Based on a synthesis of four studies with serious methodological limitations, most recipients of harm reduction counselling use misoprostol for abortion, have low complication rates, and are satisfied with the intervention. More research is needed to determine abortion success outcomes from the harm reduction approach. FUNDING: This work did not receive any funding. PROSPERO REGISTRATION NUMBER: We registered the review in the PROSPERO database of systematic reviews (ID number: CRD42020200849)

There\u27s an App for It: A Systematic Review of Mobile Apps Providing Information About Abortion Using a Revised MARS Scale

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: would you recommend this app to people who may benefit from it? Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802)

PRISMA Flowchart.

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: “would you recommend this app to people who may benefit from it?” Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802).</div

Mean revised-MARS scores of reviewed abortion apps.

Mean revised-MARS scores of reviewed abortion apps.</p

PRISMA Checklist.

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: “would you recommend this app to people who may benefit from it?” Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802).</div

Flowchart of Abortion App Search.

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: “would you recommend this app to people who may benefit from it?” Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802).</div

Characteristics of apps included in a systematic review of apps providing information about abortion.

Characteristics of apps included in a systematic review of apps providing information about abortion.</p