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Published on: January 17, 2019
Healthcare professionals' and students' willingness to perform abortion: A systematic review and meta-analysis,
Nityanand Jain1, Anne-Fleur Fahner2, Jessica Kumah3
1Independent Statistical Consultant, Chandigarh Capital Region, India.
Background:
Healthcare professionals' and students' willingness to provide abortion influences access to care and workforce readiness.
Objective:
We conducted a literature synthesis to identify patterns in willingness across various clinical scenarios.
Design:
Systematic review and meta-analysis.
Data Sources:
We searched five databases (PubMed, Scopus, Web of Science, Medline, and CINAHL) and gray literature for studies (January 2014 to February 2025) without language restrictions. Eligible studies reported cross-sectional data on providers' willingness, while we excluded conditionally framed scenarios. Willingness was defined as the intent, readiness, or affirmative response to provide abortion.
Methods:
Summary-level data on theme-specific willingness were extracted and re-coded into binary or proportional format (yes/no or n/N). Estimates were pooled using random-effects models. Meta-regression and publication bias assessments were performed. Study quality was assessed using a novel in-house tool tailored for survey-based research.
Results:
We included 36 studies (n = 18,779), reporting 137 estimates across 24 themes. Willingness to provide was highest for lethal fetal anomalies (88.7%, 95% CI: 76.1%-95.1%) and maternal physical health risks (88.6%, 95% CI: 55.7%-98.0%) but substantially lower for on-request scenarios (33.1%, 95% CI: 14.9%-58.4%), surgical abortion (32.1%, 95% CI: 11.6%-63.0%), and social reasons (range 20.1%-32.0%). Multilevel modeling captured both converging and diverging response patterns across categories. Meta-regression indicated that students had consistently higher willingness than professionals. Dominant religion was also observed to be more strongly associated than legal status and other country-level indices. Evidence of small-study effects was limited apart from in a few themes. Risk of bias was high in 31% of studies, with our tool showing strong structural overlap with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) frameworks.
Conclusions:
Providers often prioritized abortion in life-threatening contexts but hesitated in non-urgent scenarios. Values-based training and systemic reforms are needed for equitable access to and expansion of abortion care.
Registration:
PROSPERO: CRD42025634868.
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