Comparative situational analysis of comprehensive abortion care in four Southern African countries

• Main Authors: Catriona Ida Macleod (Author), Megan Reuvers (Author), John Hunter Reynolds (Author), Antonella Lavelanet (Author), Richard Delate (Author)
• Format: Book
• Published: Taylor & Francis Group, 2023-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1744-1692; 1744-1706; 10.1080/17441692.2023.2217442
• Keywords: abortion; post-abortion care; southern africa; reproductive justice; Public aspects of medicine; RA1-1270
• Source: Global Public Health, Vol 18, Iss 1 (2023)

We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15−17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change.