Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review

Abstract

Introduction: Unmet need for contraception, unintended pregnancy, and access tosafe abortion remain global challenges preventing adolescent girls and young women(AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficultiesnavigating sexual autonomy, lack of agency or experience negotiating sexual acts, andchallenges accessing sexual health information and services. The aim of this systematicreview is to assess the psychosocial outcomes of AGYW who have experienced anabortion with particular focus on sub-Saharan Africa, which bears the global burden ofunintended pregnancy and risk of death due to unsafe abortion.Materials and Methods: The systematic review was registered and used search termsto identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescentgirls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Indexto Nursing and Allied Health Literature. Examples of psychosocial experiences includequality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020)was used by two reviewers to assess the relevance of each article to psychosocialoutcomes of AGYW any time after an abortion or accessing post-abortion services.Analysis was conducted with a focus on data from Africa and comparisons are madeto non-African settings.Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Sixselected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, andthe remaining articles were from other regions. Themes around stigma, shame, andabandonment associated with the experience of abortion were prevalent in all regions.Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight socialisolation as well as learned resilience among young women who abort.Discussion: Navigating abortion as an AGYW involves managing internalized andperceived stigma, fear of violence, secrecy, and growing resilient in order to overcomethe significant barriers that society and culture place on access to an essential servicein sexual and reproductive health. Post-abortion psychosocial outcomes highlight theneed for support services and investigation of contexts that perpetuate and necessitateunsafe abortion. Empowerment of AGYW may present an important opportunity tobuild self-agency and positive coping mechanisms to withstand social pressures duringstigmatizing circumstances associated with abortion.