Table 1 Study characteristics of relevant data* and critical appraisal skills programme (CASP) quality assessment of included studies

Appiah-Agyekum [47]

Ghana

Highlight the abortion experiences of university students with particular reference to pharmaceutical drugs

University campuses in Ghana

2015

Qualitative

In-depth interviews (n = 32 university students)

Aged 18 + years; first -second year (18), third year (8), fourth year (6); single (9), married (4), dating (19)

Medium

Atakro et al. [31]

Ghana

Assess contributing factors to unsafe abortion practices in the Ashanti Region

Four district hospitals in the Ashanti Region of Ghana

2018

Qualitative

Semi structured interviews (n = 35 patients)

Patients aged 15–49 years; (5) no education, (15) primary to secondary, (15) postsecondary education; (33) single, (2) divorced

Medium

Baum et al. [43]

Brazil, Nigeria

Explore women’s expectations and experiences with the service they received, the role of stigma and their perceptions of quality care, and how their knowledge and attitudes toward medication abortion shifted in the process

Helplines that provide services to women living in legally restrictive settings

2017

Qualitative

Interviews with women who had been associated with the project helplines (n = 30)

Mean age 31; married (n = 13), were currently paid for work (n = 17), had one or more children (n = 16)

Medium

Baxerres et al. [45]

Benin

Burkina Faso

Document the means women use to obtain abortions and to learn whether use of misoprostol has become an alternative to other methods of abortion

One health center in Cotonou (Benin); one health center in Ouagadougou (Burkina Faso)

2014–2015

Qualitative

In-depth interviews (n = 34) [21 Cotonou (Benin) and 13 Ouagadougou (Burkina Faso)]

(14) aged 18–25 years,

(14) aged 26–36 years, (6) aged 37–43 years; Single with no children (14), had children and not living with partner (8), had

children, and living with a partner (12)

Medium

Berry-Bibee et al. [68]

Haiti

Learn about illegal abortion access, methods, and perceived barriers to abortion-related care, and to identify the proportion of unscheduled antepartum visits to a public hospital that were attributable to unsafe abortion

University hospital in Cap-Haitien

2013–2014

Mixed methods

Cross sectional survey (n = 255 women) and

focus group discussion (n = 62 women)

Survey participants: (82) aged 18–24 years, (118) aged 25–35 years, (55) aged 35 + years; (70) primary school or less, (161) some secondary school, (24) secondary school or beyond; (155) married/cohabitating, (99) single/divorced/widowed

Focus group participants: Mean age: 28 years (20–50 years)

High

Biney and Atiglo [67]

Ghana

Examine the motivations for women’s preference for abortion to resolve unwanted or unintended pregnancy; and investigate the linkages between reasons for abortion and safety of the method employed with a goal to identify which motives warranted safe or unsafe abortion methods

Ghana Maternal Health Survey

2007

Quantitative

Secondary analysis (n = 552 women who terminated a pregnancy within the last 5 years)

Age at the time of abortion: (147) aged 15–19 years, (279) aged 20–29, (127) aged 30 + years; (174) none to primary education, (379) secondary or higher

High

Brack et al. [33]

Colombia

Identify the key barriers to legal abortion and to explore the ways they may work separately and together to delay the receipt of high quality, legal abortion care

4 health clinics in Bogota, Colombia

2014

Qualitative

In-depth interview (n = 17)

Participant age: (7) aged 18–24 years, (8) aged 25–31 years, (2) aged 32–39 years; (0) primary education, (14) secondary education, (3) university education; (9) single, (8) in a relationship

High

Burkhardt et al. [69]

Democratic Republic of Congo

Examine women’s perception of and access to abortion of sexual violence-related pregnancies in armed conflict context

Bukavu, DRC

2012

Qualitative

In-depth interviews (n = 55 women but only 17 women who had an induced abortion)

Participants in parenting and termination group: mean age 33.7 years; (28) no education, (17) any primary school, (7) any secondary school; (16) divorced or separated, (13) widowed, (11) married, (11) single, (4) husband missing

High

Bury et al. [58]

Bolivia

Understand the knowledge and attitudes of women regarding abortion, their responses to an unwanted pregnancy, and what they experience when they seek to induce abortion

Peri-urban areas of Sucre, Santa Cruz, Cochabamba, La Paz, and El Alto

2010

Mixed-Methods

Focus group discussion (n = 115 women)

In-depth interviews (n = 50 women)

Not available for FGD and IDI participants

Medium

Byrne et al. [65]

Nigeria

Examine factors that influence women’s decisions about where to terminate their pregnancy and their corresponding preferences regarding abortion provider/location. Examine the reasons that hindered women’s ability to operationalize their preference and to compare characteristics of women who were able and unable to use their preferred abortion provider

Six states (Anambra, Kaduna, Lagos, Nasarawa, Rivers, and Taraba)

2018 and 2019–2020

Quantitative

n = 1144 women who reported having done something to remove a pregnancy or bring back a period when they were worried they were pregnant in the 2018 survey

At the time of their abortion, most women were under the age of 30 years and at peak childbearing: 2.8% were under 15 years, 18.3% were 15–19 years, 29.2% were 20–24 years, and 22.0% were 25–29 years. Over half of women were married (53.0%) 28.8% were attending school, 48.6% had children, and 69.0% were living in an urban setting

High

Chareka et al. [49]

Zimbabwe

Understand the economic and social influences on abortion decision-making behavior and abortion practices amongst a group of young women who sell sex

Urban and peri-urban areas of Harare and Bulawayo

2019

Qualitative

42 IDIs with young women who sell sex (some of whom had had an induced abortion)

Not available for IDI participants

Medium

Cleeve et al. [53]

Uganda

Explore reproductive agency in relation to unsafe abortion among young women seeking post abortion care

Mulago Hospital in Kampala, Uganda

2013

Qualitative

In-depth interviews (n = 18 women)

17 participants: (7) aged 16–18 years, (6) aged 19–20 years, (4) aged 21–25 years; (4) primary education, (11) secondary education, (2) missing; (16) unmarried, (1) married

Medium

DePiñeres et al. [34]

Colombia

Examine the delays and barriers among women denied abortion care; and explore the factors that enabled or prevented women from seeking safe and legal services after being denied care and whether women used or considered using informal sector abortion methods outside the formal health system after denial

Fundación Oriéntame in Bogota, Colombia

2013

Qualitative

In-depth interviews round one (n = 21 women)

Round two (n = 8 women)

Most participants were aged 19–24, (3) aged 16–17 years

High

Domingos et al. [72]

Brazil

Understand the experience of women who induced an abortion during adolescence as demanded by their mothers

Minas Gerais, Brazil

2010

Qualitative

In-depth interviews (n = 3 women)

Aged 18–27 years, all women were single and did not finish high school

Low

Esia et al. [55]

Ghana

Examine the pre and post abortion experiences among young women

Planned Parenthood Association of Ghana

2011

Qualitative

In-depth interviews (n = 21 women)

(14) aged 11–16 years, (7) aged 17–21 years, (1) no education, (9) junior high school, (8) senior high school, (1) tertiary education, (6) completed education

Low

Ferrari et al. [50]

Brazil

Critique of the invisibility of illegal abortions among adolescents and discuss the specificities of the practice in this life cycle stage

South Zone of Rio de Janeiro

Not stated

Qualitative

Ten in-depth interviews with young girls ages 15 to 17 who had undergone an abortion between 12 and 17

Five reported “no religion.” Nine declared themselves to be “black” or “brown” and only one declared herself to be “white”. All adolescents lived with their mothers, who became pregnant during adolescence or early adulthood, between the ages of 15 and 24. Three adolescents (1, 2, 3) did not live with their fathers and four (1, 2, 3 and 6) also lived with their grandmothers.” Of the participants, nine were students at the time of the abortion, and they were attending between the 7th and 11th grades, which was compatible with their ages. Only one adolescent (10) was not a student, due to having started working as a salesperson after her first pregnancy, at age 15, which she carried to term

Medium

Frederico et al. [61]

Mozambique

Explore the individual, interpersonal and environmental factors behind the abortion decision-making process

Maputo and Quelimane

2016–2017

Qualitative

In-depth interviews (n = 14 women)

n = 9 women in Maputo

n = 5 women in Quelimane

Median age 21; (4) primary education, (8) secondary education, (2) university

Medium

Freeman [52]

Chile

Peru

Use the concept of biopolitics to analyze how the governing of women’s bodies forces them into certain spatial movements namely the crossing of international borders for abortion services

Arica, Chile and Tacna, Peru

2013

Qualitative

In-depth interviews (n = 1 woman)

Not described

Low

Hess [70]

Gabon

Explore the reasons women chose to terminate their pregnancies, the methods used to induce abortions and post abortion effects experienced by these women

Hospital in Ngounie province

2002

Qualitative

In-depth interviews (n = 5 women)

Aged 18–34 years; (3) single and (2) married

Low

Hill [35]

Ghana

Explore the context and methods used in unsafe abortions with the aim of identifying areas that governments must consider when operationalizing their strategies to reduce deaths from unsafe abortions

Kintampo, Ghana

2005

Qualitative

Focus group discussions (n = 8 groups with women)

Not described

Low

Izugbara et al. [36]

Kenya

Address the knowledge gap regarding the social dimensions of abortion safety

Health facilities providing post abortion care in Kenya

2012–2013

Qualitative

In-depth interviews (n = 50 women treated for complications due to unsafe abortions)

(12) Aged 18 or less years, (24) aged 19–24 years, (11) aged 25–30 years, (1) aged 31–34 years, (2) aged 35 + years; (25) primary education, (13) secondary education, (12) tertiary education; (32) never married, (12) married, (5) separated/divorced/deserted, (1) widowed

High

Juarez et al. [32]

Mexico

Explore women’s experiences of induced abortion in three federal entities with very different legal contexts, and investigate if abortion-seeking patterns and experiences differ across these settings

Three states: Queretaro, Tabasco and the State of Mexico (to compare three degrees of restrictiveness of abortion legislation)

2014–2015

Qualitative

Semi-structured interviews (n = 60) among women 18–44 who were low to middle income

Most women were between the ages of 25 and 29 (n = 18). Half were single and half were married. The majority had finished high school (n = 25). Nineteen women had zero children and 27 had two or more

High

Katz et al. [62]

Nigeria

Examine how abortion clients from a range of care models in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers

Lagos and Ogun states from two healthcare clinics a safe abortion hotline and four proprietary and patent medicine vendors

2018–2019

Qualitative

Semi-structured, in-depth interviews (part of a larger study in four countries) (n = 25)

The mean age of participants was 25 years, with a range of 16–41 years. Half of the participants had one or more children and nearly two-thirds were unmarried

Medium

Kebede et al. [51]

Ethiopia

Explored abortion-seeking safety considerations in social and cultural detail by exploring the routes to abortion undertaken by young, unmarried women in particular, whose social situation with regard to abortion differs significantly from that of married women with unwanted pregnancies

Addis Ababa

2006–2007

2009–2010

Qualitative

Interviews: (n = 25 women)

Age: 18 (20 years or younger), 2 housemaids with primary education, 4 day laborers with 2–3 years primary education, 3 students in tertiary institutes, 6 high school students, 2 junior high students and waitresses, 3 4–5 years of schools and taking vocational training, 1 assistant cook without formal education, 4 high school graduates looking for a job

High

Keefe-Oates et al. [37]

Colombia

Aimed to gain a deeper understanding of women’s concerns before arriving to abortion careas well as describe women’s experiences receiving support for those concerns during their abortion service, particularly through abortion counselling

International Planned Parenthood/Western Hemisphere Region (IPPF/WHR):

Mexfam in Mexico and Profamilia in Colombia

2015–2016

Qualitative

In-depth interviews (n = 30 women of which 15 were from Colombia)

Colombian women age 19—38 years

High

Lafaurie et al. [41]

Mexico

Colombia

Ecuador

Peru

Collect information about women’s experiences using misoprostol or methotrexate plus misoprostol under clinical supervision

Clinics

2003–2004

Qualitative

In-depth Interviews with women:

urban setting in Colombia (n = 11)

urban (n = 9) and rural (n = 6) setting in Mexico

urban setting in Peru (n = 12)

urban coastal (n = 5)

urban Andean (n = 6) setting in Ecuador

Aged 18–44 years; Primary education (17), secondary/professional (32); Employed (28), In School (18); Living with a partner (18); Has children (22)

High

Larrea et al. [64]

Chile

Understand abortion trajectories leading people to use the service called Women Help Women (WHW), their experiences with self-managed abortion, how they evaluate WHW’s quality of care and how they compare it with gynecological and obstetric services they have accessed in the past

Santiago, who had used the WHW service

2019

Qualitative

Seven phone-based and four in-person (n = 11)

Age ranges from 23 to 36; majority employed and in a relationship with university degrees

Low

Loi et al. [30]

Kenya

Explore decision-making preceding induced abortion among women with unwanted pregnancies

Jaramogi Oginga Odinga Teaching Hospital and Kisumu East District Hospital/ Kisumu, Western Kenya

2014

Qualitative

In-depth interview (n = 15 with 9 women)

7 women from JOOTRH;

2 women from KDH

19–32 years old; Occupation: (3) students; (4) employed; (2) unemployed; Relationship status: (3) partnered; (1) engaged; (2) married; (3) no relationship)

High

Makleff et al., [63]

Kenya

Examine the experiences of women who obtained an abortion with regard to stigma, expectations, and perceptions of abortion quality of care

Thika and Eldoret

2017

Qualitative

Semi-structured interviews (n = 34 with 24 in Kenya)

Mean age in Kenya sample was 26.9; majority (n = 14) had higher level education, were unmarried (n = 15) and had no children (n = 11)

Low

Manriquez et al. [46]

Chile

Document the experience of clandestine use of medical abortion among university

students

10 universities in Santiago Metropolitan Region

2006–2016

Qualitative

In-depth interview (n = 30 women)

Aged 17–26 years; Relationship status: (30) single

Medium

Mitchell et al. [59]

Mozambique

Understand how women evaluate method choices and experiences; how individual women choose whether or not to pursue a home-based abortion method and;how might their perspectives vary based on their personal circumstances, prior experiences, the quality of care rendered, and the clinical outcome

Urban Mozambique

2005–2006

Mixed Methods

In-depth interviews (n = 70 women)

Clinical survey (n = 837)

For IDIs: Mean age 25.6; 56.3%student, 98.9% literate

For Survey: Mean ag25.7; 56.8% students; 98.3% literate

High

Mohamed et al. [60]

Kenya

Understand young Kenyan women’s experiences with induced abortion and PAC services.

Marie Stopes clinics

Not stated

Qualitative

In-depth interviews (n = 15 women)

(2) Aged 18–19 years, (13) 20–24 years; Marital status: (6) single, (9) In a relationship

High

Omideyi et al. [71]

Nigeria

Explore whether abortion options were chosen and how they were perceived in relation to preventing unplanned pregnancies and births

Osun state in southwest Nigeria

Not stated

Qualitative

In-depth interviews (n = 10 women)

Focus group discussion (n = 3 women)

The mean ages of participants were 24.7 years for women (both IDIs and FDGs). Characteristics of IDI participants: Women: 1 primary school, 1 university school graduate, 2 polytechnic student, 2 university student, 4 secondary school; Marital Status: Females: 4 Married, 6 unmarried

High

Osur et al. [73]

Kenya

Understand the role that social networks play in facilitating access to unsafe abortions done clandestinely at community level

Six health facilities in three districts of Siaya County in the southwestern part of Kenya

2011–2012

Mixed methods

Survey (n = 320 women)

Case studies (n = 2 women)

(110) aged below the age of 18 years and another (133) aged 18–24 years

Medium

Ouedraogo and Sundby [44]

Burkina Faso

Demonstrate how social determinants such as personal resources may determine the type of clandestine abortion women are likely to access (safe or unsafe) and the time taken from knowing that a woman is pregnant to the situation of effective abortion within a country where the access to induced abortion is restricted

Health facilities in Ouagadougou, Burkina Faso

2011–2012

Qualitative

Case studies (n = 2 women)

26-year-old unmarried woman, law student; a 25-year-old unmarried woman with 2 children

Medium

Oyefara [74]

Nigeria

Investigated the effects of gender and power relations on decision-making regarding induced abortion among undergraduate students

University in Lagos, Nigeria

2014

Qualitative

In-depth interviews (n = 40)

(n = 24 women)

Characteristics of female participants: (13) aged 20–24 years, (11) aged 25–30 years; marital status (21) single, (3) married

Low

Oyeniran et al. [42]

Nigeria

Assess women’s knowledge; their expectation and experiences of the methods employed for abortion; and their health care-seeking decisions following a complicated abortion

Nine health facilities in the south-west geo-political zone of Nigeria

2013–2014

Qualitative

In-depth interviews (n = 31 women)

(58.1%) aged 21 to 30 years,

(29.1%) were students

High

Penfold et al. [56]

Kenya

Explore the decision-making, experiences and preferences of women who attended private clinics for safe abortion services

Nine private clinics in Western Region, Kenya

2016

Qualitative

In-depth interviews (n = 22 women)

22 women who were most commonly in a relationship or married, aged 23–26 years and had children

Medium

Petracci et al. [54]

Argentina

Provide data and reflections on trajectories and scenes lived by women and men in connection with the decision to terminate a pregnancy and the abortion experience

Buenos Aires, Argentina

2007–2008

Qualitative

In-depth interviews (n = 30 women)

10 women aged 18–27 years,

10 women aged 40–49 years; 5 women aged 40–49 years old

Medium

Ramos et al. [57]

Argentina

Explore the experiences of women with the use of misoprostol for inducing an abortion

Public hospital in Buenos Aires metropolitan area

2011–2012

Qualitative

In-depth interviews (n = 45 women)

45 women interviewed were aged 18–40 years; 60% had completed basic education

High

Rominski et al. [38]

Ghana

Understand why young women seeking an abortion in a legally enabling environment chose to do this outside the formal healthcare system

3 hospitals

Not stated

Qualitative

Focus group discussions (n = 8 groups with 29 women)

aged 13–35 years, with a mean

age of 25.7 years

Medium

Seid et al. [39]

Ethiopia

Assess the barriers to accessing safe abortion services from the clients’, health extension workers’ and service providers’ perspective

3 health facilities in Adama and Asella towns in Oromia Region

Not stated

Qualitative

In-depth interviews (n = 38 women)

(8) were below 20 years of age, (24) aged 20–30 years; (20) completed primary school, (7) illiterate; (22) married

High

Solheim et al. [66]

Tanzania

Understand how misoprostol is perceived, accessed and used on the ground as well as explore how the use of misoprostol as an abortion drug is shaped by and in turn shape local practices and social relations

Three urban and suburban areas in Dar es Salaam

2015

Qualitative

In-depth interviews with young women who had used drugs to induce an abortion (n = 15)

Not presented for IDI participants

High

Szulik and Zamberlin [75]

Argentina

Understand the stigmatizing experiences of women related to abortion

Buenos Aires (city and province) and Chubut province

2016

Qualitative

In-depth interviews with 18 women

Not presented

Medium

Szwarc and Vásquez [48]

Argentina

The study set out to investigate the waiting and the temporalities during the abortion process in women's experiences residents in the Metropolitan Area of Buenos Aires

Buenos Aires metropolitan area

2015

Qualitative

In-depth interviews (n = 5 women)

Aged 26–36 years

All attended or completed a tertiary education or university

Medium

Yegon et al. [81]

Kenya

Understand the link between abortion-related stigma and unsafe abortion from the perspective of women seeking induced abortion services or post abortion care (PAC) in health facilities

Machakos County in Eastern Region and Trans Nzoia County in Rift Valley Region

2014

Qualitative

In-depth interviews (n = 26 women)

6 of those that sought PAC were aged above 25 while 5 were aged below 25; 9 aged above 25 years and 6 aged below 25 years of those that sought induced abortion

High