Persistent knowledge-to-action gaps in sexual and reproductive health and rights (SRHR) limit the translation of evidence into policy and practice. Knowledge platform Share-Net International (SNI) uses Communities of Practice (CoPs) to support knowledge exchange, yet little is known about how CoPs facilitate knowledge translation.This study examined how CoPs across SNI's hubs translate SRHR knowledge into action and identified contextual factors shaping these processes. A transdisciplinary qualitative study (October 2024-January 2025) was conducted across eight SNI hubs. CoP members and facilitators with at least three months of involvement were purposely sampled. Data were transcribed verbatim and analysed inductively using thematic analysis in Atlas.ti (http://atlas.ti/) guided by the knowledge-to-action framework and triangulated through member-checking. Outcomes included knowledge translation processes, CoP functioning, and contextual factors. CoPs create context-specific knowledge, facilitate learning spaces, and produce knowledge products. However, significant gaps were observed in dissemination planning and M&E, limiting the ability to assess impact. Political resistance, conservative norms, power dynamics, and crises were challenges to effective functioning, while supportive policies, activism, and cross-hub learning created opportunities. Strategies to strengthen CoP effectiveness were proposed. CoPs hold strong potential to advance knowledge translation for SRHR, but their effectiveness depends on structured dissemination, learning-oriented M&E, and approaches responsive to local contexts. As CoPs operate within power structures, their ability to contribute to equitable SRHR outcomes is shaped by the environments in which they function. Strengthening facilitation, resources, and cross-hub collaboration may enhance effectiveness, and longitudinal research is recommended to assess sustained policy and practice change.
This article analyses national legal frameworks that regulate young people’s access to abortion, focusing on how different approaches to decision-making authority can either facilitate or obstruct access to care. It explores how countries that have recently liberalised their abortion laws, namely Colombia, Argentina, and Mexico, have acknowledged the need to lower the ages of consent below 18 and integrate the principles of the “evolving capacities of the child” or “progressive autonomy” into their legislation. Each country’s approach, whether lowering the age of consent in specific circumstances (Mexico), establishing differentiated age brackets with varying degrees of autonomy (Argentina), or removing age-based restrictions altogether (Colombia), offers a different mechanism for increasing young people’s autonomy in decision-making involving abortion. The article also considers how a country that has experienced a recent regression in abortion rights, namely the United States, has also rolled back young people’s ability to autonomously consent to abortion care and increased parental involvement in such decisions. Through a comparative analysis of these four countries’ legal frameworks, the article concludes that sweeping changes to abortion law and policy - whether progressive or regressive in nature - can fundamentally alter young people’s ability to consent to and access such care. It also issues a series of recommendations for the regulation of young people’s abortion decision-making, including grounding relevant laws and policies in international human rights principles and linking them to laws and policies geared towards protecting young people’s rights in general.
An enabling environment is essential for delivering quality, comprehensive abortion care. According to the WHO, abortion should be treated like other healthcare services, regulated by healthcare law, and evidence-based standards and guidelines. This paper examines abortion regulations across 183 countries drawing on data from the Global Abortion Policies Database, up to May 2025. It divides sources relevant to the regulation of abortion care, into seven categories: Criminal/Penal Code, Abortion-specific Law, Health Regulation/Clinical Guidelines, Constitution, Case Law, Essential Medicines List /Registered List, and other sources. The findings of this paper indicate that abortion is regulated through an often complex and fragmented framework, characterised by over-reliance on the general criminal law, the use of multiple and sometimes contradictory sources, and information gaps in certain key areas. 169 countries regulate abortion through their Criminal or Penal Code, with general criminal law the only source regulating abortion in 27 countries. Information about grounds and gestational limits for abortion can be found in the general criminal law in 123 countries. 46 countries have abortion-specific laws; 16 countries include relevant provisions in their Constitution; in 90 countries, abortion-related information is spread across five or more source documents; and the status of conscientious objection is not regulated by any document in 109 countries. This landscape risks exacerbating existing barriers to abortion care, including stigma and inadequate access to information, and reinforces abortion exceptionalism. These findings raise questions about how reforming the regulation of abortion, including the nature and number of source documents involved, can shape an enabling environment for abortion care. They also highlight the need to identify effective strategies for safeguarding the health and rights of people seeking abortions.
This article examines the representation of unplanned pregnancy in contemporary Spanish cinema between 2014 and 2024, with the aim of identifying the dominant narratives surrounding this experience. Drawing on a mixed-methods approach that combines quantitative and qualitative analysis of a selected corpus of films, the study investigates the narrative evolution of unplanned pregnancy, the diversity of the characters depicted, the reproductive agency of female protagonists, and the visibility of voluntary termination of pregnancy. The findings reveal that socio-economic conditions exert a decisive influence on how protagonists experience and negotiate unplanned pregnancy, shaping both their interpretive frameworks and their available choices. Despite this, the socio-demographic diversity of characters remains notably limited, particularly in relation to class, race, and other structural determinants, reflecting a homogenised representation of reproductive experiences in Spanish cinema. A key result of the study is the marginalisation of abortion as a reproductive option: legal abortion is explicitly represented in only two of the 14 films analysed, while most narratives emphasise either motherhood that is ultimately accepted or failed attempts to end the pregnancy. This pattern suggests that Spanish cinema continues to privilege conventional reproductive frameworks, offering few portrayals that normalise abortion as a legitimate and accessible choice. By critically engaging with these cinematic trends, the article contributes to broader debates on reproductive rights, gendered agency, and media representations of women’s health. It highlights the need for more diverse and realistic depictions of unplanned pregnancy to challenge dominant narratives and expand cultural understandings of reproductive justice.
This study analysed the relationship between menstrual health and self-reported depression and anxiety in women and people who menstruate (PWM) (≥18 years) in Spain, from a critical gender perspective. An online survey was used to collect data in 32 healthcare centres in 2023. Descriptive and ordinal logistic regression models were performed with 1,404 participants. Menstrual bleeding of over 80 ml was associated with higher odds of more severe depression (aOR=1.61; 95%CI: 1.45-1.79; p < 0.001) and anxiety (aOR=1.67; 95%CI: 1.35-2.06; p < 0.001). Higher menstrual pain intensity was also linked to higher odds of more severe depression (aOR = 2.05; 95%CI: 1.82-2.31; p < 0.001) and anxiety (aOR=1.82; 95% CI: 1.43-2.30; p < 0.001). A higher frequency of premenstrual symptoms was associated with increased odds for more severe depression (aOR=14.54; 95% CI: 10.73-19.70; p < 0.001) and anxiety (aOR=12.95; 95%CI: 9.10-18.44; p < 0.001). In addition, higher reports of menstrual taboo, stigma and discrimination were associated with higher odds of more severe depression (aOR=2.23; 95%CI: 1.81-2.76; p < 0.001) and anxiety (aOR=2.34; 95%CI: 1.91-2.87; p < 0.001). Reports of more severe depression (aOR=2.50; 95%CI: 1.65-3.78; p < 0.001) and anxiety (aOR = 2.55; 95%CI: 1.70-3.83; p < 0.001) increased with the severity of menstrual poverty. Greater impact on social participation during menstruation was strongly associated with higher odds of more severe depression (aOR=7.41; 95%CI: 4.90-11.191; p < 0.001) and anxiety (aOR=6.69; 95%CI: 5.22-8.59; p < 0.001). Sociodemographic factors may mediate the menstrual-mental health relationship. Our study sheds light on the interplay between menstrual and mental health in our context, from a gender and social health inequities perspective.
South Sudan has extremely high maternal mortality, driven in part by an underfunded health system and a shortage of trained health workers. Skilled birth attendants are essential to reducing maternal mortality. International Medical Corps supports competency-based midwifery education in three schools in South Sudan, offering a 2.5-year certificate and a 3-year diploma aligned with international standards for midwifery practice. A mixed methods evaluation was conducted to assess the strengths and challenges of the midwifery education program to inform program improvement. This manuscript presents data on midwife graduates' perspectives on the training and their work as midwives. A survey was conducted with 314 graduates, complemented by in-depth interviews (n = 15) and daily task diaries (n = 21). Most graduates (76.4%) were currently working as midwives, with nearly half (47.5%) based in rural areas. They reported high satisfaction with their training, felt largely prepared for their roles, and expressed pride in their profession. Graduates felt most competent in providing antenatal care, safe childbirth services and short-acting contraceptives, and least competent providing prevention of mother-to-child transmission of HIV and long-acting reversible contraceptives. Commonly reported challenges included inadequate infrastructure and insecurity. Given the limited evidence on midwifery graduates' experiences in conflict-affected settings, these findings offer valuable insights for strengthening midwifery education and workforce support. Graduates work throughout the country, including in rural areas, supporting women through safe and healthy pregnancies. Strong partnerships between ministries of health and partners are essential to address challenges, support midwives and strengthen health systems, while upholding women's rights to good quality, respectful care.
Despite decades of sustained advocacy, Malawi retains one of the world's most restrictive criminal abortion laws. A draft Termination of Pregnancy Bill, developed in 2015 to propose semi-liberal reform to Malawi's abortion law, has yet to be enacted. In contrast, similar or less intensive advocacy efforts have resulted in liberalisation of abortion laws in other low- and middle-income countries (LMICs), including Zambia, South Africa, and Ethiopia. This qualitative case study examines the policy processes adopted by advocates and identifies potential pathways for abortion law reform in Malawi. Employing a multi-method approach, we conducted document analysis using the READ approach and semi-structured interviews with 14 key informants actively or formerly involved in Malawi's abortion law reform process. Data was analysed thematically using Bacchi's (2009) "What's the problem represented to be?" (WPR) theoretical framework. The findings revealed evidence-informed strategies aimed at strengthening future advocacy efforts: coordinated advocacy integrating established and emerging organisations; ongoing demographic and lived-experience evidence to counter stereotypes and expose harms; careful reframing of language (e.g. replacing "Termination of Pregnancy Bill" with motherhood-aligned titles); intensive community engagement via trusted local champions; strategic timing mindful of political cycles and U.S. funding pressures (including the reinstated Global Gag Rule); further litigation to clarify and expand existing legal scope; and adequate funding to counter well-resourced opposition and sustain rural outreach. Drawing comparative insights from surrounding Sub-Saharan African countries, we discuss drivers of reform and propose targeted strategies to advance abortion law liberalisation in Malawi and reduce mortality related to unsafe abortion. DOI: 10.1080/26410397.2026.2702233.
Abortion is a common reproductive healthcare process that is often stigmatised. Research on abortion stigma has grown significantly since the last major review over a decade ago, and there is a pressing need for an updated, comprehensive systematic review. The purpose of this review is to examine the extent and subjective experiences of abortion stigma among those seeking an abortion in high-income countries. We aim to explore the theoretical conceptualisations of abortion stigma in relevant studies. We conducted a mixed-method systematic review following the JBI and PRISMA guidelines. PubMed, CINHAL, PsychINFO, LIVIVO, and the Cochrane Library were searched for peer-reviewed articles. Quantitative studies were summarised narratively. Qualitative studies were synthesised using the JBI meta-aggregative approach. We included 41 qualitative, nine quantitative, and three mixed methods studies. Most studies lacked a substantial theoretical conceptualisation of abortion stigma. Quantitative studies reported prevalence rates of perceived abortion stigma ranging from 37% to 60%, suggesting that stigma remains a common experience among abortion seekers. Findings also indicate associations between abortion stigma and various sociodemographic factors (e.g., religion, race, age), as well as adverse mental health outcomes. In the qualitative studies, people seeking abortion care reported experiencing and anticipating judgment from healthcare professionals, anti-abortion activists, and their close social circle. Their experiences also centered on the internalisation of shame and guilt. Some studies highlighted the mitigating effect of social support. Longitudinal and mixed methods approaches with consistent assessment would be useful to better understand the developmental pathways of abortion stigma. This understanding is necessary to provide individual and structural support for people seeking abortion care.
People who use medically assisted reproduction (MAR) outside the legal and/or medical framework are generally on the margins of the dominant procreative norm, making them particularly vulnerable to a wide range of reproductive violence such as legal restriction to medical care, discrimination or mistreatment. The aim of this study was to explore experiences of reproductive violence among people living in France who sought MAR either abroad or without medical assistance. Semi-structured interviews were conducted between 2022 and 2023. Almost half of the interviewees (n = 28/69) had been confronted with reproductive violence during their MAR journey. Although the French bioethics law extended access to MAR to single women and female same-sex couples in 2021, participants described how the shortage of gametes fuelled all forms of reproductive violence, encompassing psychological, economic and physical violence. Our findings revealed an intersectional dimension to these experiences, particularly affecting individuals with non-heterosexual identities, older age or higher body weight. Single women appeared particularly exposed to such violence. However, faced with reproductive violence, many participants demonstrated resilience and empowerment, notably through support from social networks and associations. This solidarity helped them to develop strategies of resistance and avoidance. From personal difficulties and experiences of violence at the institutional level and in care, people moved on to awareness of systemic violence, encouraging them to support their peers. Awareness led them to denounce reproductive injustice and even to demand changes in MAR organisation and care. DOI: 10.1080/26410397.2026.2694254.
In South Africa, adolescent girls and young women (AGYW) are engaged in early, condomless, and unprotected (from pregnancy) sex, which puts them at risk of unintended pregnancies and sexually transmitted infections. At the individual, interpersonal, and structural levels, AGYW experience barriers to their access to and use of contraception and condoms. This study employed a cluster-randomised factorial design to examine the impact of a multi-level intervention on contraceptive use behaviours among 802 women ages 16-24 in Tshwane, South Africa. The two intervention components were the Young Women's Health CoOp (YWHC), an intervention to increase participants' knowledge and skills, and a stigma and discrimination (S&D) reduction training at the facility level. Study facilities were randomised into the four study arms: YWHC only; S&D only; both YWHC and S&D; and control (standard of care). The study demonstrated that AGYW in the YWHC arm (RRR: 2.45; 95% CI: 1.05-5.70, p = 0.038) and those in the YWHC and S&D arm (RRR: 3.65; 95% CI: 1.56-8.50, p = 0.003) were more likely to have started a contraceptive method than to remain a non-user compared to those in the control arm over the 9-month follow-up period. However, those in the S&D training-only arm had lower odds of adopting a method over the follow-up period (OR: 0.63; 95% CI: 0.41-0.97, p = 0.037). These results demonstrate the importance of supporting AGYW with tailored messaging in a safe environment as part of sexual and reproductive health services.DOI: 10.1080/26410397.2026.2696689.
Evidence suggests that the number, scale, and severity of emergencies exceed the international humanitarian system's existing capacity and available resources to meet humanitarian needs, especially for the health sector of which sexual and reproductive health (SRH) is an essential component. Since 1997, the Inter-Agency Working Group on Reproductive Health in Crises's Minimum Initial Service Package (MISP) for SRH has been the standard of care for SRH interventions in emergencies, aimed to protect the health, dignity, and rights of women and girls living in humanitarian emergencies. Humanitarian response organisations, national governments, and donors increasingly recognise the importance of MISP implementation at the onset of an emergency. However, an effective humanitarian response demands rapid mobilisation of resources, including the deployment of trained professionals capable of navigating complex scenarios. Roster systems are a human resource tool that maintains a diverse range of qualified professional profiles for emergency preparedness, response, and recovery efforts. Recent trends indicate a shift from a global to an increasingly geographic-specific roster management and recruitment model, which we argue is vital in localising and sustaining humanitarian response. Organisations should channel investments into further strengthening national and regional response capacities, including community-level readiness for SRH, and reconsider international standby roster models. As first responders, communities are best positioned to initiate community-based responses when integrated into all levels of health disaster risk management systems. Fostering robust partnerships between international, regional, national, sub-national, and community levels is critical to ensuring preparedness and response efforts for SRH, resilient recovery strategies, and building back better.
Male partner support during pregnancy has been linked to positive outcomes and can enhance women's rights to reproductive health and well-being. Such involvement can, however, have gendering effects. In addition, the role of other men in pregnancy support is under-researched. In an exploratory convergent mixed methods study, we investigated the gender dynamics evident in pregnant women's reporting of, and stories concerning, support from male partners and other significant men. We administered the Pregnancy Supportability Research Kit in two health districts of the Eastern Cape, South Africa. The closed-ended information questionnaire component was completed by 558 women, and open-ended information narrative interviews were conducted with 40 women. In the quantitative data, 12.1% of women indicated that they received no support from their partners, which, in the qualitative data, was reportedly underpinned by abandonment, paternity denial and abuse. Just under one in five (18.7%) reported that their partners were somewhat supportive. Qualitative data revealed men reluctantly taking on feminised tasks such as cooking, judgementally sharing pregnancy information, and providing support inconsistently. Of the 69.2% reporting supportive partners, emotional support was mentioned most frequently. In relation to support provided by significant others - people living in the same household, family members living outside the household, and friends - women were reported as significantly more likely to provide support than men. These findings point to the importance of nuanced understandings of the gendered dynamics in men's support during pregnancy, particularly in programmes that engage men in confronting and undermining negative gendered norms. DOI: 10.1080/26410397.2026.2689806.
Reproductive autonomy, the power to make decisions about and to control matters related to contraceptive use, pregnancy, and childbirth, is essential for women to attain their sexual and reproductive health and rights. We explored barriers and facilitators of reproductive autonomy among adolescent girls in western Uganda, a region marked by high rates of adolescent pregnancy and HIV prevalence. This qualitative inquiry involved 31 in-school and out-of-school adolescent girls aged 15-19 years, purposively selected from diverse communities within Fort Portal city, western Uganda. Data were collected through individual interviews between September and November 2024 and analysed using framework thematic analysis guided by the three dimensions of reproductive autonomy: decision-making, communication, and freedom from coercion. The findings show an intricate interaction of individual, relational, and structural factors that shape adolescent girls' reproductive autonomy, with commonalities and uniqueness based on schooling status. Key barriers included control by parents and partners in communication and decision-making, limited knowledge of girls on sexual and reproductive health, low self-efficacy to decide and implement decisions, financial dependence, and lack of life basics. Conversely, supportive relationships and schooling emerged as critical facilitators. In conclusion, enhancing reproductive autonomy requires multi-level and multi-faceted interventions to address the barriers while leveraging the facilitators. These should include household economic empowerment, parenting support programmes, and policies that promote universal access to education. DOI: 10.1080/26410397.2026.2683272.
We sought to understand, "What are the contraception access experiences, beliefs, attitudes, knowledge and needs of youth in Canada, from the perspectives of youth and youth service providers?" We explore person-centred contraception care and highlight the importance of fostering trust, autonomy, and informed consent. We conducted one-on-one semi-structured interviews with youth (aged 15-25) and healthcare providers (HCPs) across Canada, representing a diversity of rural and urban settings, gender, age, and ethnicities. Using social constructivist grounded theory, we identified key themes related to reproductive autonomy, trust, and informed consent. We analysed data from 79 youth and 27 HCPs, identifying five themes: (1) Valuing shared decision making; (2) "Pushing" contraception: putting a stop to paternalism; (3) Seeking anti-oppressive care; (4) Contraception care is all about trust; (5) Practising control over my own body. Participants valued shared decision-making and wanted to feel that "we're in this together". Both youth and HCP participants shared stories of HCPs "pushing contraception" on youth and experiences of medical discrimination which impeded feelings of safety and autonomy. In response, youth advocated for anti-oppressive care and identified the importance of "therapeutic relationship building," emphasising that fostering safety with HCPs is "all about trust." Finally, youth reported practising advocating for their reproductive autonomy to have control over their own body. Our research highlights the importance of shared decision-making, informed consent, and anti-oppressive care in fostering supportive and safe contraception access for youth. Results have implications for jurisdictions where youth face increasing barriers to contraception access. DOI: 10.1080/26410397.2026.2678063.
Self-care interventions for family planning encourage women to play a central role in their own health care. This study assesses women's interests and preferences related to mobile access to information and products amenable to self-administration, and examines factors associated with preferred place of access. We added a module to the female questionnaire of the cross-sectional Performance Monitoring for Action survey in Kenya (n = 9,489) and in two Nigerian states (Kano (n = 1,144) and Lagos (n = 1,426)) between November 2021 and January 2022. We analysed data on interests and preferences related to mobile access to information and various places of access for oral contraceptive pills, emergency contraception, and DMPA subcutaneous self-injection and fitted multinomial regression models to examine the factors associated with preferred place of access for each contraceptive product. Across sites, 69-85% of women were interested in accessing family planning and fertility information on their own. Among them, 88-90% were interested in receiving information via voice/text and 49-72% through social media. The preferred access point across products and sites was the health facility (56-82% of women), with some interest in other sources. Across sites, 71% or more of respondents said engaging with a provider was "very/somewhat important" when starting or while using all three methods. Multivariable analyses revealed differences in preferred place of access between subgroups of potential end users. Findings highlight opportunities for self-care interventions through health facilities and other access points and the need for multipronged tailored interventions that offer a range of touchpoints with the health system to enable choice.
Online sexual, reproductive, and transgender healthcare can overcome barriers to care among lesbian, gay, bisexual, trans, queer/questioning, intersex, and other (LGBTQI+) youth and address disproportionately poor sexual and reproductive health outcomes. However, LGBTQI+ youth are heterogenous and online healthcare spans broad health topics and online platforms. To map recent research and identify gaps, we conducted a scoping review, following Joanna Briggs Institute methodology, using the Participants (LGBTQI+ youth aged 10-35 years), Concept (online sexual, reproductive, and transgender healthcare), Context (high-income countries) eligibility framework. We searched nine databases for recent literature (2018-2024), two reviewers screened studies using Rayyan, and data were extracted to Excel and analysed descriptively (N = 132 included papers). Most papers (89/132) were from distinct studies; 43/132 were from 15 studies. There were quantitative (57/132), qualitative (41/132), and mixed methods studies (34/132). Most focused on sexual healthcare (95/132) including HIV/STI prevention (68/95) and HIV management (10/95); 30/132 on transgender healthcare; and only 3/132 on reproductive healthcare. Most targeted young men who have sex with men (79/132) or trans and gender-diverse youth (44/132). Only 4/132 targeted young sexual minority women. Almost all were from the US (119/132). Amid a global shift to delivering healthcare online, this timely review provides the first comprehensive map of critical blind spots, highlighting the urgency of research on reproductive health, sexual wellbeing, and sexual minority women. Addressing these gaps is essential for providing equitable healthcare and reducing health disparities. These findings can guide the delivery of online healthcare that meets the needs of all LGBTQI+ youth.
TRIAL REGISTRATION NUMBER:https://doi.org/10.17605/OSF.IO/2XPJD.
This qualitative study examines the work process of feminist activists who provide accompaniment for self-managed abortions in a major urban centre in Brazil, where abortion remains criminalised in most circumstances. Based on in-depth interviews with eight accompaniers, and drawing on Brazilian collective health and feminist ethics of care, it analyses how they integrate technique, ethics, political commitment, and social awareness, thereby transforming accompaniment into a genuine practice of care. Findings show that accompaniment recognises those cared for as subjects with knowledge, desires, and evolving needs, rather than as passive recipients. Care is organised collectively but always tailored and responsive to the needs of each person, in an interactive, critical, and reflexive manner. In doing so, accompaniers combine technical-scientific knowledge with experiential knowledge built through prior care and exchanges within trusted networks. By engaging across all stages of the process, and guided by a project whose ultimate purpose is to make abortion a good experience for those accompanied, accompaniers prevent the fragmentation and alienation of care work. Accompaniment thus emerges as a model of care grounded in radical needs: needs that arise within existing social conditions but cannot be fully satisfied within them. Once recognised and collectively articulated, these needs expose the limits of the existing order and become a source of pressure for social transformation. The high personal cost of this activism, marked by overload, insecurity, and invisibility, challenges its sustainability and expansion. By describing its constitutive elements, this study broadens understanding of abortion accompaniment and underscores the need for public policies that integrate community-based knowledge, values and practices to foster more humanised, justice-oriented models of care. DOI: 10.1080/26410397.2026.2676395.
This systematic review investigates the impact of participatory health-sector led interventions on female adolescent sexual and reproductive health and rights (ASRHR) in Sub-Saharan Africa. Adolescents face many challenges, including high rates of HIV and other risk factors. Interventions to promote ASRHR are therefore critical for enhancing their overall wellbeing. Our peer-reviewed search yielded 6225 articles from online databases, which we imported to Covidence. 2619 duplicates were removed, leaving 3606 articles that two authors screened by title and abstract. 3545 articles not meeting our inclusion criteria were removed, and 61 full-text articles were screened, also by two authors. Only four articles met our eligibility criteria. The interventions in the selected studies included HIV testing preferences in Zambia, layered interventions in Malawi, peer support for HIV testing and adherence in Uganda, and a participatory curriculum in Zimbabwe. Important results included the value adolescents attached to interventions delivered by health providers; the need for interventions to address ASRHR issues in a comprehensive way; and the need for more rigorous indicators of the nature and role of peer support in ASRHR interventions. Several unexpected findings included the paucity of studies on participatory youth-friendly interventions delivered by the health sector, the dominance of adolescent research on HIV issues and the neglect of other priorities, and the limited research attention to adolescent rights. We conclude that investing in the formation and sensitisation of African health workers to adolescent needs can have a positive and sustainable impact, although further research is needed to validate these findings.
The public plays a central role in producing and sustaining abortion stigma by shaping dominant narratives, reinforcing moral norms, and passing judgment on individuals associated with abortion. These collective attitudes are expressed through social exclusion and symbolic condemnation - practices that shape both personal experiences and structural access to care. This mixed-methods systematic review updates the state of research by synthesising recent evidence from high-income countries (HICs), with particular focus on how the public enact and experience abortion stigma. We conducted a mixed-methods systematic review of peer-reviewed quantitative and qualitative studies published since 2015, following international standards for systematic reviews. Due to heterogeneity in measurement, quantitative and qualitative data were narratively synthesised. Methodological quality was assessed using standardised appraisal tools for both quantitative and qualitative research. Nineteen studies were included (12 qualitative, 7 quantitative). Quantitative findings reveal that abortion stigma in HICs persists at moderate levels and is associated with religiosity, political conservatism, lower income, and male gender. Qualitative studies demonstrate how stigma is enacted, perceived, and anticipated across diverse social settings, highlighting prevailing stereotypes and uncovering experiences of verbal harassment and social exclusion. Abortion stigma remains deeply embedded within the public. By updating and expanding on the previous work, this review underscores the need for targeted, group-specific stigma reduction strategies and more robust instruments for capturing stigma.
