Guttmacher Institute

The displaced Rohingya population residing in Cox’s Bazar, Bangladesh, must navigate their reproductive lives in this fragile context. This study examines the knowledge, attitudes and use of menstrual regulation/pregnancy termination services in four displaced persons' camps to understand women’s engagement with these services and barriers to safe services using Bandura’s social cognitive theory. We conducted a household, community-based survey with women of reproductive age in 2022 (n = 1173). Ninety-two percent of respondents knew that health facilities provide pregnancy terminations, yet knowledge about when access is permissible is incomplete. Only one-third knew that this service could be provided 11−12 weeks after last menstrual period, with most respondents believing that the cutoff was earlier. The respondents believed that menstrual regulation was provided only under certain conditions, and 99% stated that a husband’s consent should be required for a woman to end a pregnancy (always or sometimes). One in five respondents (n = 223) knew someone who had ended a pregnancy since arriving in the camps. While knowledge about and support for pregnancy termination services are high, there is room for improvement in education about the conditions under which it can be accessed. The results fill a knowledge gap regarding the acceptability and use of pregnancy termination in the Bangladesh camps of displaced Rohingya.

Low self-efficacy related to reproductive health care seeking is an area of concern that may lead women to access unsafe abortion in developing regions. There is limited data on self-efficacy on specific health care services, such as safe abortion, in Ethiopia. A cross-sectional study employing mixed methods was conducted from February to May 2024 among 815 systematically sampled and 14 purposely selected participants to assess the perceived self-efficacy on safe abortion among women of reproductive age in Wolaita zone. Logistic regression was computed to identify the associated factors, while the qualitative data were analyzed thematically to triangulate with quantitative findings. The results show that only one-third of participants had high self-efficacy on safe abortion. Being employed, receiving information from the media, believing abortion to be legal among unmarried women, knowing someone who has induced an abortion, and having favorable attitudes toward abortion were identified as associated self-efficacy factors. These findings enhance our understanding of activities to improve self-efficacy on abortion care and warrants further research to deepen an understanding of the socio-cultural determinants.

Unintended pregnancy compromises many women’s and girls’ ability to pursue the lives that they want. The conditional unintended pregnancy rate (CUPR) is a measure of unintended pregnancy among women who wish to avoid getting pregnant. Using the CUPR, we explore the relationship between gender inequality and unintended pregnancy across 132 countries. We used gender inequality indicators from the UNDP Human Development Report and estimates of the incidence of unintended pregnancy published by the Guttmacher Institute and WHO. We regressed the CUPR on several measures of gender inequality using least squares with a percentile bootstrap to account for sampling error and the additional uncertainty in the model-based unintended pregnancy estimates. We find that unintended pregnancy is positively correlated with multiple composite measures of gender inequality, even after controlling for countries’ levels of economic development. Of the components of gender inequality, gender disparities in educational attainment were most strongly correlated with unintended pregnancy in multivariable regressions. We also find that female educational attainment is a stronger predictor of the CUPR than male educational attainment. Analyses with the standard unintended pregnancy rate, a measure that does not take into account differences across settings in the proportion of women who wish to avoid getting pregnant, obscured the strength of the observed relationships. Further exploration of the factors underlying this relationship can inform policies to improve the quality of women’s lives.

BackgroundSustainable Development Goal (SDG) Indicator 5.6.2 is the “Number of countries with laws and regulations that guarantee full and equal access to women and men aged 15 years and older to sexual and reproductive health care, information, and education.” This indicator plays a key role in tracking global progress toward achieving gender equity and empowerment, ensuring its validity is essential. Significant challenges related to the indicator’s calculation have been noted, which have important implications for the indicator’s validity in measuring progress towards meeting the SDG target. Recommendations have been made to revise the scoring of the indicator. This study examines the indicator’s validity by proposing a revision to the indicator’s calculation that addresses these global concerns and comparing the resulting values.Methods and findingsThis is an observational, validation study which used secondary data from the 2022 United Nations Population Fund’s Sexual and Reproductive Health and Rights Country Profiles from 75 countries. To address global recommendations, we proposed making 2 changes to the indicator’s calculation. First, we re-expressed all barriers and enablers to take positive values. Second, we used a weighted additive approach to calculate the total score, rather than the mean of the 13 individual component scores, which assigns equal weight to the substantive domains rather than the components. Our main outcome measures are the indicator values obtained from both scoring approaches examined. We assessed the indicator’s convergent validity by comparing the value obtained using the indicator’s current formula to the proposed formula using the Bland–Altman approach. We examined and interpreted changes in the indicator’s overall score that result from comparing the existing indicator with the proposed alternative. Differences in the total value of the indicator comparing the alternative versus the current formulation range from −7.18 percentage points in Mali to 26.21 percentage points in South Sudan. The majority of countries (n = 47) had an increase in total indicator score as a result of the alternative formula, while 27 countries had a decrease in score. Only 1 country, Sweden, saw no change in score, as it scored 100% of the possible indicator value under both rubrics. The mean difference between the scores produced by the 2 measures is 2.28 suggesting that the 2 methods may produce systematically different results. Under the alternative formulation, the most substantial changes were observed in the scores for “Component 3: Abortion.” The indicator’s current calculation results in 16 countries being assigned a score of zero, for “Component 3: Abortion” which masks important differences in the number of legal barriers present and whether women can be criminally charged for illegal abortion. After re-expressing barriers on a positive scale following the proposed formulation, only 4 countries have a score of zero for Component 3. The main limitation of our methodology is that there is no gold standard for measurement of the phenomenon under study, and thus we are unable to specify with total certainty which indicator performs better.ConclusionsOur results illustrate underlying challenges with the current indicator formulation that impact its interpretability. The proposed changes could alter the way the current legal landscape governing sexual and reproductive health is understood, thereby pointing to different programmatic and policy priorities that may better support countries in achieving full and equal access to sexual and reproductive health and rights globally.

An effective health management information system plays a pivotal role in evidence-based decision-making and strengthening health service delivery in a country. The Directorate General of Health Services and the Directorate General of Family Planning of Bangladesh have adopted digital health management information system platforms named district health information system and management information system, respectively. Despite its significance, health management information system data has numerous issues, such as missing values, inaccuracies, lack of internal consistency, and the presence of outliers. This study aims to assess the data quality of reproductive health indicators in the health management information system of the Directorate General of Health Services and the Directorate General of Family Planning. The study examined two aspects of data quality: a) completeness of data, subdivided into completeness of facility reporting (report submission rate) and completeness of indicator data (presence of missing values); b) internal consistency of reported data, subdivided into presence of outliers, inter-indicator consistency, and consistency between reported data and original records (accuracy rate). The study utilised retrospective monthly data gathered from July 2021 to June 2022, covering 21 reproductive health indicators. Multi-stage cluster sampling was employed to select 112 health facilities for data collection, including 48 facilities from Directorate General of Health Services and 64 from Directorate General of Family Planning, representing various administrative levels across the country. The report submission rate for Directorate General of Health Services facilities was 98%, while for the Directorate General of Family Planning facilities, it was 86%. However, 35% of data points were missing in the district health information system server of Directorate General of Health Services, whereas no missing values were observed in the management information system server of Directorate General of Family Planning. Less than 3% of outliers were detected in the server data of both directorates. Inter-indicator consistency was maintained at a high rate of 98% in health facilities under both directorates. The accuracy of reported data varied across indicators and facility types: Directorate General of Health Services facilities showed accuracy rates ranging between 75 and 92%, with an aggregated rate of 86%. Different tiers of the Directorate General of Family Planning facilities had accuracy rates ranging from 92 to 96%. This research emphasises the significance of rectifying missing values, ensuring consistency, and improving reporting systems, with a particular focus on lower-tier health facilities, to enhance the validity and reliability of reproductive health data in Bangladesh.

Achieving the sexual health components of sexual and reproductive health and rights as outlined in the sustainable development goals (SDGs) is integral to overall physical and mental well-being and a core part of universal health coverage. However, tracking national and global progress towards advancing the sexual health and rights of people is challenging because of the paucity of indicators to examine many of its components. To assess the state of sexual health in populations, determine service provision needs, evaluate the effectiveness of health system interventions and monitor progress in optimizing health, a comprehensive set of indicators is needed to cover every component of sexual health. Without comparable global indicators for each component of sexual health across the individual, health systems and policy levels, and disaggregated across subgroups including all genders, there is a considerable lack of insight into people’s sexual health needs and progress towards meeting those needs. This article explores the availability of global indicators for the different components of sexual health by analysing two key sources: the global indicator framework of the SDGs and the indicator index of the Global Health Observatory. We summarize the indicators for each component of sexual health using the Guttmacher–Lancet Commission framework, highlighting gaps in current indicators, and recommend areas where additional indicators are needed along with strategies on how to improve data availability, quality and inclusiveness.

BACKGROUND: Due to restrictive laws and limited service provision, globally the majority of induced abortions are unsafe and remain largely undocumented, despite their negative impact on women’s health. OBJECTIVE: The purpose of this study is to test Respondent-Driven Sampling – used previously in HIV research – for abortion, and to measure abortion safety characteristics in the small town of Kaya and surrounding villages (Burkina Faso) and in the slums of Nairobi (Kenya). METHODS: A preliminary qualitative study confirmed that women disclose to network members when seeking an abortion. Using RDS, we recruited 481 abortion-seekers from 12 seeds in Kaya (in max. 10 waves) and 551 abortion-seekers from 8 seeds in Nairobi (in max. 5 waves) in 2021. These respondents reported 487 (Kaya) and 595 (Nairobi) abortions in the previous 3 years. RESULTS: Standard diagnostics showed that the safety characteristics of the abortions of the recruited women were independent of those of the seeds, but sample-wide convergence was reached at relatively high sample sizes (around 300 in Kaya and 400 in Nairobi). More advanced checks indicated convergence (or tendency towards convergence) across seeds, except for one indicator in one site. In Kaya, most women used plant-based methods (50%) and unidentified pills (Medical Abortion (MA) in appearance) (33%). In Nairobi, women used unidentified pills (likely MA) (38% of abortions), followed by plant-based (21%) and known harmful methods (19%); pharmacists were frequent providers (45%). In Kaya, abortions occurred in the first trimester (98%), but less so in Nairobi (70%). The level of reported likely infected complications was similar across sites (6.2% in Kaya versus 9.6% in Nairobi). CONCLUSIONS: While the RDS misses non-networked abortion-seekers (an arguably small share of abortion-seekers in the sites), the different available quality checks yielded positive signals as to the possibility of using RDS to obtain data representative of networked abortions. The data revealed contrasting safety characteristics and abortion-seeker profiles across sites. CONTRIBUTION: RDS is cheap, yields large and diverse samples of abortion-seekers, and is equipped with built-in quality tests: it is a promising avenue for collecting data on abortions in restrictive settings where abortion-seekers are highly networked, although a number of limitations remain and further development is needed.