Experiences and self-reported outcomes of abortion care in Sub-Saharan countries: a mixed methods systematic review

Access to safe abortion remains a public health concern in sub-Saharan countries, where restrictive policies and limited access to quality healthcare contribute to preventable maternal morbidity and mortality related to unsafe abortion. This study synthesised the available evidence on abortion care experiences and self-reported outcomes of people seeking abortion care. And explored the existing tools to assess abortion care experiences and outcomes in sub-Saharan Africa (SSA).

We searched eight databases: Embase, Cochrane Library, CINAHL, Global Health, PsycINFO, Scopus, Medline, and Web of Science, to include studies published between 1 January 2010 and 18 October 2025. All original (quantitative, qualitative, and mixed methods) studies that focused on induced abortion care and assessed people's experiences and outcomes of abortion care in SSA were included. The Joanna Briggs Institute (JBI) data extraction tool and critical appraisal checklist were adapted. We undertook narrative synthesis for data analysis. The review protocol was registered in PROSPERO: CRD42023461963.

Of 20,180 records retrieved, 35 were eligible for the final review. Eighteen studies reported both experiences and outcomes of abortion care, nine reported abortion care experiences, seven reported abortion care outcomes, and one reported the development of a tool. The included studies identified negative experiences such as delays in obtaining care, stigmatisation, concerns about privacy and confidentiality, misinformation, and overstating risks, as well as psychological and emotional outcomes such as feeling guilt, sadness, and worry about future pregnancies. The findings also showed positive outcomes, including feelings of relief, happiness, and satisfaction with the services received. The review also identified the absence of reliable tools to assess patient-reported experiences and outcomes of abortion care in SSA.

People experienced undesirable challenges while receiving abortion care. Despite negative psychological and emotional outcomes, satisfaction with care, relief, and happiness after abortion revealed in this review may indicate that abortion care is supportive in reducing the consequences of unwanted birth, which is not easily accessible in countries with restrictive abortion policies. A lack of validated measurement tools assessing abortion care experiences and outcomes requires the development of tools in this area.