Comparative situational analysis of comprehensive abortion care in four Southern African countries

• Published in: Global public health Vol. 18; no. 1; p. 2217442
• Main Authors: Macleod, Catriona Ida, Reuvers, Megan, Reynolds, John Hunter, Lavelanet, Antonella, Delate, Richard
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 2023; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Abortion; Abortion, Induced; Abortion, Legal; Access; Africa South of the Sahara; Birth control; Budgets; Comparative analysis; Comparative studies; Contraception; Data collection; Female; Gender roles; Gender-based violence; Health care access; HIV; Human immunodeficiency virus; Humans; Justice; Legislation; Literature reviews; Management systems; Policy making; post-abortion care; Pregnancy; Rape; Reproductive health; Reproductive Health Services; reproductive justice; Southern Africa; Stigma; Unsafe; Africa South of the Sahara; Lesotho; Botswana; Eswatini; post-abortion care; reproductive justice; Abortion; Southern Africa
• ISSN: 1744-1692; 1744-1706
• DOI: 10.1080/17441692.2023.2217442

We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15−17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change.