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Abstract

Background: Improving access to and quality of abortion and post-abortion care in Latin America remains a complex challenge, deeply influenced by social, political, and cultural constraints. Even in decriminalized settings, health systems often lack training, value clarification processes, and user-centered approaches, leading to persistent access barriers. Highlighting the voices of abortion and post-abortion care providers in the decision-making process can be critical to improve quality and opportunity of care, however, tools to bridge the knowledge gaps between providers and decision-makers are still lacking. This dissertation aimed to explore how provider perspectives and experiences can inform evidence-based decision-making to improve abortion care quality. Methods: In this dissertation I utilize a multi-method approach: (1) a scoping review of abortion care experiences in Latin America; (2) qualitative interviews with health providers and decision-makers across the region; and (3) co-development of a knowledge translation (KT) toolkit with the MUSA Network, a regional network of 13 sentinel centres engaged in reproductive health care. Results: The scoping review revealed barriers to abortion services across all dimensions of the patient-centered access framework, with limited research on highly restrictive contexts and a notable absence of data on trans and non-binary individuals. In the qualitative study providers described challenges for decision-making including a hyperfocus on the legal nature of abortion, lack of opportunities and openness to talk about abortion in decision-making spaces, and lack of local data. However, the process also highlighted the need for structural support, institutional capacity-building, and contextualized strategies to sustain KT in restrictive environments. Conclusions: This dissertation highlights the importance of centering provider perspectives in efforts to improve abortion and post-abortion care in Latin America. Utilizing KT, sharing and collaboration strategies locally, nationally and regionally are critical steps to improve quality and opportunity of care. To prepare health systems for decriminalization it is critical to spotlight providers’ experiences and knowledge and continue working on creating the capacities needed to provide timely and high-quality abortion and post-abortion care in Latin America.