Intersecting Supply- and Demand-Side Barriers to Accessing Safe Abortion Care among Adolescents and Young Women in Southern Ethiopia: Insights from Levesque’s Access Framework.
1
Public Health, Arba Minch University, Arba Minch, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Unsafe abortion remains a major contributor to maternal morbidity and mortality among adolescents and young women in low- and middle-income countries, including Ethiopia. Despite the legal provisions for safe abortion under specific conditions, access remains limited. Understanding how health system (supply-side) and individual (demand-side) barriers interact is critical for improving equitable access. This study explored the intersecting supply- and demand-side barriers and facilitators influencing adolescents’ and young women’s access to safe abortion care in Southern Ethiopia, guided by Levesque’s Access Framework
METHODS:
A qualitative study was conducted among adolescents and young women who sought abortion-related care, healthcare providers, and health facility managers in public health facilities across Southern Ethiopia. Data were collected through in-depth interviews and focus group discussions, and analyzed thematically using Levesque’s five dimensions access framework.
RESULTS:
Barriers to safe abortion care emerged at the intersection of supply- and demand-side factors across all dimensions of access. Limited awareness of legal abortion services, stigma, and misinformation reduced approachability and the ability to perceive available care. Judgmental attitudes of providers and sociocultural taboos constrained acceptability and the ability to seek care. Shortage of trained staff, inadequate privacy, and poor service organization limited availability and the ability to reach services. Hidden and indirect costs undermined affordability and the ability to pay. Finally, poor follow-up care and provider bias affected appropriateness and the ability to engage. However, supportive providers, confidential services, and adolescent-friendly spaces served as key facilitators.
CONCLUSIONS:
Access to safe abortion care for adolescents and young women in Southern Ethiopia is hindered by the dynamic intersection of health system constraints and individual-level challenges. Addressing both supply- and demand-side barriers simultaneously through stigma reduction, provider capacity building, and adolescent-responsive service design will be essential to improving equitable and timely access to safe abortion care.
Unsafe abortion remains a major contributor to maternal morbidity and mortality among adolescents and young women in low- and middle-income countries, including Ethiopia. Despite the legal provisions for safe abortion under specific conditions, access remains limited. Understanding how health system (supply-side) and individual (demand-side) barriers interact is critical for improving equitable access. This study explored the intersecting supply- and demand-side barriers and facilitators influencing adolescents’ and young women’s access to safe abortion care in Southern Ethiopia, guided by Levesque’s Access Framework
METHODS:
A qualitative study was conducted among adolescents and young women who sought abortion-related care, healthcare providers, and health facility managers in public health facilities across Southern Ethiopia. Data were collected through in-depth interviews and focus group discussions, and analyzed thematically using Levesque’s five dimensions access framework.
RESULTS:
Barriers to safe abortion care emerged at the intersection of supply- and demand-side factors across all dimensions of access. Limited awareness of legal abortion services, stigma, and misinformation reduced approachability and the ability to perceive available care. Judgmental attitudes of providers and sociocultural taboos constrained acceptability and the ability to seek care. Shortage of trained staff, inadequate privacy, and poor service organization limited availability and the ability to reach services. Hidden and indirect costs undermined affordability and the ability to pay. Finally, poor follow-up care and provider bias affected appropriateness and the ability to engage. However, supportive providers, confidential services, and adolescent-friendly spaces served as key facilitators.
CONCLUSIONS:
Access to safe abortion care for adolescents and young women in Southern Ethiopia is hindered by the dynamic intersection of health system constraints and individual-level challenges. Addressing both supply- and demand-side barriers simultaneously through stigma reduction, provider capacity building, and adolescent-responsive service design will be essential to improving equitable and timely access to safe abortion care.
| eISSN: | 2654-1459 |
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