Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.

Southeast Asia: a community of diversity

The region known as the Southeast provides the basis for a broad political community characterized by cultural and ethnic diversity, disparities in economic performance, and differences in regime and constitutional foundations. In recent years, the Association of Southeast Asian Nations (ASEAN) group of nations has made strides toward building a community based on respect for these differences. Despite a growing acceptance for democratic processes and human rights, the influence of these values over existing institutions and state behavior remains incomplete. The future development of the ASEAN region, and the nations that comprise it, is likely to be based on the strength and character of the relationships these states forge with one another and with more powerful external actors.

Interest, nations, and the state in development: Instability in archipelic Southeast Asia

The Southeast Asian archipelago has become marked by divisions
within existing states, placing significant local constraints upon
the process of ‘development’. These divisions include ‘vertical’
challenges to the state, i.e. they have the capacity to split the state
into geographic divisions based on proto-nationalist identity, and
‘horizontal’ challenges to the state, defined by ethnic and
communal rivalry and conflict. This brief paper will canvas some
issues in such divisions.

Compositional connections : temple form in early Southeast Asia

The temples of Southeast Asia are remarkable and intriguing in their architecture, in that they are obviously derivative from Indic canon and yet
profoundly original and different from the corpus of the subcontinent. Further, the regional nuances of these temples, whether in Java, Cambodia or Champa, defy obvious and linear connections within these traditions and with the pan-Indic corpus. While epigraphists, Sanskritists and historians have made significant connections between these temple building traditions, much work remains to be done on the compositional and architectural linkages along the trading routes of South and Southeast Asia. This paper is an early attempt at understanding the compositional connections, as evident in the temple forms of early southeast Asia. To elucidate the complex material, the authors deploy a comparative method on two levels. Between ideal notions of the Hindu temple and shared cosmogony on one hand and individual temples as a realization of the ideal on the other. The consideration of the compositional material yields some surprisingly rich and varied connections. For example, the affinities between 7th century cellas in Cambodia and early Gupta models from central India are difficult to ignore. Further, the linkages between these cellas and the early Deccan experiments in structural stone raise questions about both idioms. The range of experimentation in Cambodia
(in plan forms, superstructure and construction methods are discussed with reference to their Indic antecedents. The findings of the paper raise questions about the relation between temple and treatise; between theory and practice and between the individual temple and its collective corpus.