Implementation of safe abortion care policy in africa: a scoping review of readiness and outcomes

BACKGROUND: Unsafe abortion is a significant cause of maternal deaths worldwide. Most of these abortions are induced. Sub-Saharan Africa accounted for approximately 70% of global maternal deaths. In legalized context, implementation strategies ensure the access to safe abortion services. Several studies carried out in Europe, North America, and Asia, highlight strategies of implementation of access to safe abortion care and its outcomes. The objective of this review was to explore current knowledge on readiness and outcomes of implementation of safe abortion care policy in Africa. METHODS: We conducted a systematic scoping review using the Joanna Briggs Institute (JBI) approach to synthesize findings. We searched in PubMed, Scopus, and ProQuest Central databases. The inclusion criteria were articles published from January 2004 to the present, conducted in African countries, reporting readiness and outcomes of implementation of safe abortion care policy, and using quantitative, qualitative or both methodologies. Data were extracted and assessed concurrently by two researchers. RESULTS: In total, 639 articles were identified from databases. Of these, only 9 articles met the inclusion criteria and were included in the review (7 qualitative and 2 mixed methods). These studies focused on implementation of safe abortion care policies with variations in the legal status of abortion across countries, from total to partial or no legality. The readiness of implementation was based necessarily on providers training, on communication through development of guidelines and protocols, on sensitization of stakeholders during training sessions, workshops or informational campaigns and on the leadership shown by the health system managers. The outcomes of implementation such as acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability depended on good readiness for implementation. No study clearly has carried out a cost analysis of the implementation process. CONCLUSION: Available evidence show that implementation of abortion policies implementation needs structured and coordinated readiness for effective and sustainable results. The involvement of all stakeholders is important for the successful implementation of safe abortion care services. Therefore, in Africa, advocacy efforts are needed for more commitment to standardized implementation strategies for access to safe abortion care with legalized abortion laws.