Protocol for a scoping review of research on abortion in sub-Saharan Africa

Introduction: Unsafe abortion is a leading cause of maternal mortality, and access to safe abortion services remains a public health priority in sub-Saharan Africa (SSA). A considerable amount of abortion research exists in the region; however, the spread of existing evidence is uneven such that some countries have an acute shortage of data with others over-researched. The imbalance reflects the complexities in prioritization among researchers, academics, and funders, and undeniably impedes effective policy and advocacy efforts. This scoping review aims to identify and map the landscape of abortion research in SSA, summarize existing knowledge, and pinpoint significant gaps, both substantive and geographic, requiring further investigation. This review will provide direction for future research, investments, and offer guidance for policy and programming on safe abortion. Materials and methods: We utilize the Joanna Briggs Institute’s methodology for conducting scoping reviews. We will perform the search for articles in 8 electronic databases (i.e., PubMed, AJOL, Science Direct, SCOPUS, HINARI, Web of Knowledge, CINAHL, and WHO Regional Databases). We will include studies written in English or French language, produced or published between January 1, 2011, and July 31, 2021, and pertain directly to the subject of abortion in SSA. Using a tailored extraction frame, we will extract relevant information from publications that meet the inclusion criteria. Data will be analyzed using descriptive statistics and thematic analysis in response to key review questions. Ethics and dissemination: Formal ethical approval is not required, as no primary data will be collected. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. We will apply the Joanna Briggs Institute’s approach for conducting a scoping review [23]. The methodology involves a systematic approach to searching, screening, and reporting that encompasses the following stages: (1) identification of the research question (s); (2) identification of relevant databases and studies; (3) selection of studies; (4) data extraction; (5) interpretation, summarization and dissemination of the results. We will search relevant peer-reviewed, English or French-language articles published between January 1, 2011, and July 31, 2021, without methodological restrictions, in several electronic databases, as well as in general internet sources (Google and Google Scholar). We focus on articles and reports published between aforementioned dates, because we consider 11 years as a reasonable timeframe to reflect on the extent of research and evidence that is within the realm of ’current’ and valid for informing policy processes and debates. Also, focusing on eleven years will yield a manageable number of articles that could be quickly summarized to inform policy processes and discussions on abortion at the continental level and sub-regions. We intend to capture all research papers published on abortion in SSA, including those focusing on women, health providers, policymakers, and community members between January 2011 and December 2020. However, to qualify for inclusion, papers have to be: We will exclude commentaries, conference abstracts, and posters, working papers, policy briefs, editorials, opinion pieces, and debates. Also, we will exclude technical reports and thesis to avoid double counting. We used Table 1 to present our population, intervention, control, outcomes, timeframe, and settings (PICOTS) [22]. We are interested in studies on women and girls, health providers, and community members as well as policymakers on abortion in SSA. We tailored our search and screening approach to mirror the PICOT in Table 1. We will search the following databases PubMed, HINARI, AJOL, Science Direct, SCOPUS, and CINAHL. We have included our search term, developed through our preliminary search and reviewed by an independent researcher with experience in systematic reviews, in S1 Appendix. We have searched PubMed and HINARI using these search terms and will report the number of articles found in these databases. We will use the Covidence software [25]–an online tool that allows reviewers to screen through a plethora of articles simultaneously and for exporting included titles to Excel for analysis. Two researchers will independently assess articles for inclusion by screening the titles, abstracts, and full-texts of studies returned through the search process. Where there are disagreements between the two independent reviewers on the eligibility of a paper for inclusion, a third reviewer will resolve the conflict. We will use a standardized frame (Table 2: Extraction framework) to extract information from the included articles. We will analyze the data using descriptive statistics and thematic analysis, with results organized in tables and charts and presented into themes that reflect the review objectives. Tables will be used to illustrate how abortion research has evolved from January 2011 to December 2020 in terms of volume, themes, study design, African-led papers, and geography. The PRISMA flow chart will be used to summarize our search and studies included and excluded. A summary narrative that synthesizes the information across key themes, including abortion incidence, burden, cost, post-abortion care, and community perception of abortion, will be developed, critically highlighting the advances and gaps in researchers. Supporting figures will also be developed to present the synthesis, with a focus to draw implications for future research. Patients and the public were not involved in the design of this study. This study is will synthesis publicly available publications, which reported on patients’ and public’s experiences. Ethical approval is not required, as we are not collecting primary data but rather analyzing already published papers. The findings of this study will be disseminated through peer-reviewed publications and conferences as well as in relevant stakeholder fora. In case of any amendments to the protocol following its publication, we will provide the date of each amendment, describe the change(s), and report the rationale for the change(s) in future publications arising from this protocol. This scoping review will only look at research and publications over 10 years (2011–2020), yet obviously, there are equally important articles preceding that period. We also intend to review data and articles published in English and French only and within sub-Saharan Africa, thus excluding publications in Arabic, Spanish and Portuguese languages. The keywords to be used in the search strategy are broad and may not identify specialized studies in abortion.