Women's experiences of facility-based abortion care: A WHO qualitative evidence synthesis

The World Health Organization's Abortion Care Guideline requires abortion care to be not only safe but also effective, efficient, accessible, equitable, acceptable, and person centered. We synthesized qualitative evidence from 111 papers from 42 countries selected from a systematic search of literature published between January 1996 and September 2023. We developed a typology of experiences experienced by abortion seekers engaging with facility-based abortion care services at any stage of the abortion care pathway; factors that modify the experience as well as the consequences of these experiences for the abortion seeker. The resulting typology characterized positive experiences as offering emotional support and protection against harm; mixed experiences of care i.e. care of variable quality but not considered negative; and negative experiences, such as intentionally obstructing women as decision makers; behavior intended to judge, shame, or punish, care lacking in dignity, delay or denial of care and care leading to harm unrelated to the clinical condition. The abortion context, or the woman's personal characteristics exacerbated negative experiences which were often accepted as unactionable or led to seeking alternative types of care. On the other hand, emotionally supportive care decreased internalized stigma, increased confidence, and substituted for lack of social support. The typology provides a basis for determining whether the quality of abortion care aligns with WHO recommendations and provide a basis for bridging the policy -program gap, to improve quality of abortion care and to inform monitoring efforts.