Ethics challenges and guidance related to research involving adolescent post-abortion care: A scoping review

Joseph M. Zulu, Joseph Ali, Kristina Hallez, Nancy Kass, Charles Michelo, Adnan A. Hyder

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: An increase in post abortion care (PAC) research with adolescents, particularly in low-and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature. Methods: Following a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges. Results: The literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers. Conclusion: Addressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international levels. Overall, despite the documentation of challenges in the published literature, guidance on handling several of these ethics challenges is sparse. We encourage further research to clarify the identified challenges and support the development of formal guidance in this area.

Original languageEnglish (US)
Article number71
JournalReproductive health
Volume15
Issue number1
DOIs
StatePublished - May 2 2018

Keywords

  • Adolescents
  • Ethics guidance
  • Post abortion care
  • Reproductive ethics
  • Research ethics

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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