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Unsafe Abortion: Worldwide Estimates for 2000
Abstract
Unsafe abortion is preventable and yet remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the last decade, the World Health Organization has developed a systematic approach to estimate the regional and global incidence of unsafe abortion. Estimates based on figures around the year 2000 indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies ended in an unsafe abortion, giving a ratio of one unsafe abortion to about seven live births. Almost all unsafe abortions take place in the developing world. In Latin America and the Caribbean, 3.7 million unsafe abortions are estimated to take place each year, with an abortion rate of 26 per 1000 women of reproductive age, almost one unsafe abortion to every three live births. Asia has the lowest unsafe abortion rate at 11 per 1000 women of reproductive age, but 10.5 million unsafe abortions take place there each year, almost one unsafe abortion to every seven live births. However, excluding East Asia, where most abortions are safe and accessible, the ratio for the rest of Asia is one unsafe abortion to five live births. In Africa, 4.2 million abortions are estimated to take place per year, with an unsafe abortion rate of 22 per 1000 women, or one unsafe abortion per seven live births. In contrast, there is one unsafe abortion per 25 live births in developed countries.
... Between 1995 and 2008, the rate of unsafe abortion worldwide remained essentially unchanged, at 14 abortions per 1000 women aged 18 to 45 years. But during the same period, the proportion of all abortions that were unsafe increased from 44% to 49% [1] [2]. ...
... Ninety five percent of all induced abortions occur in developing countries [2]. According to the WHO, 400 -600 deaths/100,000 abortions occur in Asia and Africa as compared to 0.6/100,000 in developed countries. ...
... Induced septic abortions have significant negative consequences beyond its immediate effects on women's health. For example, complications from unsafe abortion may reduce women's productivity, increasing the economic burden on poor families; cause maternal deaths that leave children motherless; cause long-term health problems, such as infertility and may result in further strain on scarce medical resources especially in developing countries [2] [5]. ...
... Co roku niemal 68 000 kobiet umiera z powodu niebezpiecznej aborcji. Jest to jedna z głównych przyczyn śmiertelności matek (13%) [8]. ...
... It is estimated that 19 million unsafe abortions are performed worldwide each year, which corresponds to one procedure per seven live births. Nearly 68,000 women die each year after undertaking unsafe abortions, which account for 13% of all maternal deaths [8]. ...
Aim:
Analysis of different methods of performing illegal abortions and causes of death in women who underwent the procedure during the interwar period.
Material and methods:
The study was based on the autopsy protocols from 1920-1939 archived at the Department of Forensic Medicine, Jagiellonian University Collegium Medicum in Krakow, Poland. The analysis comprised the deaths of women during pregnancy or in the perinatal period. The cases in which abortion was performed legally, for medical indications, were excluded.
Results:
A total of 101 cases of illegal abortion were identified during the period studied, including 21 abortions performed by midwives, and three abortions carried out by qualified medical personnel. In 19 cases, abortion was done using a catheter or wire, while in eight cases the procedure was performed by injecting an abortion-inducing substance into the uterus or administering an injection into the foetus. Vaginal or uterine injury (27 cases), or vaginal or uterine wall perforation (10 cases), were the most common genital tract lesions indicative of abortion.
Conclusions:
The majority of deaths (71) were caused by peritonitis or sepsis originating from an infection involving the genital tract.
... In a study done in Morocco, it was estimated that almost more than 50% of Moroccan women did not seek any medical help during pregnancy because their pregnancies went out without noticed difficulties. (27) In addition, socio-cultural barriers might as well play an important role in preventing women in quest for reproductive health services. Many of them have a preference to seek medical help from a female doctor, the case in which a shortage is reported. ...
... (105) The best efficient approach to avert women's death is to deliver her by a skilled and professional service provider which might include someone or a staff qualified enough to manage such circumstances as medical doctors, an officially registered nurses or a midwife. (27) Health problems associated with unsafe abortion specially if caused by non-spontaneous type or performed by non-medical are also a main reason of maternal death. Abortion is a somewhat safe procedure if carried out by trained medical doctors using proper hygienic practices. ...
Reproductive health and maternal and child care are at the top of global and worldwide organizations being a key aspect of sustainable human progress and a requirement for attaining the Millennium Development Goals. However, even though reproductive health topic is very crucial in population Health in general, in Iraq little empirical data exists to support it. Therefore, the present study focuses on filling one of the most glaring gaps in our understanding of reproductive health programmes in Basrah.
Furthermore, it is important to review the degree to which policies and procedures correspond with the National Health Strategy and plan of action for reproductive health and maternal and child care. The study provides information on the knowledge and perception of the policy and decision makers and the service providers in Basrah on reproductive health, together with exploring the current available structure, service utilization and patient satisfaction on the provided services
The study is a cross sectional, conducted for the period from 1st of December 2012- 31st March 2015. It consisted of five parts: 1. Review and analysis of existing data, policy documents on reproductive health. 2. Qualitative assessment with 13 policy and decision makers in Basrah 3. Structure evaluation of the current available reproductive health services in 53 health facilities from all health districts in Basrah 4. Interviews with 159 of the health care providers at the health facilities 5. Interview with 265 women in reproductive age seeking reproductive health service at the health facilities.
The basic infrastructure was found to be available in almost all the studied facilities with a clear shortage in the availability of working guidelines and service provision was found to be in: delivery services, screening for AIDS/HIV, postmenopausal problems and infertility management.
On the service providers' side, the study found that deficiency of professional training and continuous medical education were the main factors influencing their performance in addition to shortage of human resources and inadequately allocated place for providing the services. While on the service users' side, the majority of them were found to be satisfied with the provided services with a main reason for dissatisfaction is overcrowding.
The study also concluded that knowledge and perception of health policy makers in relation to reproductive health was less than expected in spite of their belief of improvement of reproductive health in Basrah. Therefore it is important to update them with data and information related to reproductive health with special focus on the current status of reproductive health in the governorate compared to the national targets and Millennium Development Goals.
Finally, in spite of the availability of work standards, guidelines, and protocols at the central level, the study recommends that more efforts should be done by Basrah Directorate of Health to guarantee better dissemination and use at the district and sub-district levels.
... A contentious issue that many family planning programmes prefer to avoid is the issue of abortion. Ahman and Shah (2002) estimate that in the year 2000, there were 19 million unsafe abortions and of these, over 50 per cent (10.5 million) occurred in Asia. Unsafe abortion is a major contributor to maternal mortality, with annually over 80,000 deaths of women, the vast majority in developing countries, attributed to unsafe abortions (WHO 1998). ...
... Increased levels of sexual relations among the young, subsequent increases in levels of premarital pregnancy and the spread of sexually transmitted diseases among the young are of concern to many policy makers. Increases in levels of unsafe abortion among the unmarried (Ahman and Shah 2002) and high proportions of adolescents among those persons infected with HIV are further indications of the dire need for reproductive and sexual health services for the unmarried. It should be noted, however, that where adolescent reproductive health services are provided, in the majority of instances, activities have been confined to providing adolescents with "family values education". ...
... Cada año, se embarazan unas 210 millones mujeres en todo el mundo y alrededor de una de cada cinco decide abortar. De los 46 millones de abortos que se realizan cada año, unos 20 millones se realizan en condiciones inseguras (Ahman y Shah, 2002). Reducir el número de abortos que se realizan en condiciones de riesgo contribuirá directamente a la consecución del quinto Objetivo de Desarrollo del Milenio referido a la mortalidad materna. ...
... Las normas de la sociedad, la condición económica, los obstáculos legales y otros factores sistémicos influyen profundamente en la decisión de una mujer de recurrir a un aborto y, en particular, a un aborto en condiciones de riesgo. La pobreza, por ejemplo, es un factor determinante en esta decisión cuando una mujer sopesa las consecuencias financieras del embarazo no deseado (Ahman y Shah, 2002). Las cifras de abortos en condiciones inseguras ilustran cómo las cuatro barreras (ingreso, género, edad y geografía) inciden en el acceso a los servicios de salud. ...
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... Studies have noted that women with a history of abortion are more likely to face recurrent abortions and have an increased risk of spontaneous preterm birth and perinatal death in subsequent pregnancies [6][7][8]. In low-and middle-income countries including India, abortions are a notable cause of morbidity and mortality among women [4,[9][10][11][12]. Recent estimates from the UNFPA indicate unsafe abortions as the third leading cause of maternal mortality in India [4]. ...
Post-abortion contraceptive use is a critical element of reproductive healthcare aimed at preventing unintended pregnancies and promoting reproductive agency. This study investigates changes in post-abortion contraceptive use and factors associated with that use. We use reproductive calendars implemented in 2015–16 and 2019–21 National Family Health Surveys (NFHS) to investigate changes in post-abortion contraceptive use among currently married women age 15–49 in India. We then use 2019–21 NFHS to examine the factors associated with post-abortion contraceptive use. Our analysis is based on a weighted sample of 5,473 women from NFHS-4 and 5,103 women from NFHS-5. The study employs a two-stage estimation procedure using the Inverse Mills Ratio (IMR) framework to address potential biases in abortion reporting. In the second stage, we used a multinomial probit regression model to assess factors influencing post-abortion contraceptive use. Post-abortion contraceptive use increased from 49% in NFHS-4 to 57% in NFHS-5. Multinomial probit regression analysis revealed that gestational age of abortion was negatively associated with post-abortion contraceptive use, while factors such as having a son or prior contraceptive use increased the likelihood. Women who had abortions in private or non-health facilities were less likely to use post-abortion Long-Acting Reversible Contraceptives (LARC), compared to public health facilities. Those who reported unplanned pregnancy or contraceptive failure as the reason for abortion were more likely to use traditional methods of post-abortion contraception. Our findings highlight the importance of integrating family planning services into abortion care and ensuring comprehensive information and counselling on contraceptive options during the post-abortion period, as crucial measures to improve women’s health.
... The national acts of Japan require doctors who perform induced abortions to submit relevant information to a state governor; those who violate the obligation or submit false information are subject to criminal and administrative sanctions. Furthermore, these data cover almost all induced abortions performed in Japan, because most abortions are safe there [30]. Although these data are relatively old, their use can be justified to examine past events [31]. ...
Background: Prostitutes are at high risk of unintended pregnancy, and induced abortions are widely practised among this cohort.Aims: This study examined the effects of prostitution bans on the prevalence of induced abortions. We focused particularly on the bans on juvenile prostitution, which were introduced by 32 states of Japan between 1975 and 1998.Methods: This was a cross-sectional study employing event-study analyses and a difference-in-difference-in-differences methodology. We compared the changes in numbers of induced abortions before and after the bans were introduced, among women under 20 years of age and among those aged 20―24 years, over states.Results: The number of induced abortions among women under 20 years of age increased after the juvenile prostitution bans were implemented. In the fifth year of implementation, the number increased by 56.79 percentage points (p < 0.001) compared with the previous year.Conclusion: The number of induced abortions among adolescents increased after juvenile prostitution was banned. As to its mechanism, the outcomes of our additional identification suggest that former juvenile prostitutes who retired due to the bans contributed to the increase.
... Educating policymakers and stakeholders about this issue is intended to reduce the burden of unsafe abortions, protect women's health, and ensure their reproductive rights. [6] ...
... In Kenya majority (34.5%) of the participants were between the ages 25-29 while in other five (5) Table 2 summarizes the prevalence of pregnancy termination across countries in six sub-Saharan African countries. The overall prevalence of pregnancy termination among these countries was 6.3%. ...
Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15–29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value < 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15–29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20–24 as compared to women aged 15–19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20–24 & 25–29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.
... Annually, an esumated 46 million women involved in induced abortion globally, with 36 million of the cases taking place in developing countries. About 19 million of these abortions, mostly in the developing world, are carried out by quacks in unhygienic conditions (Benson, 2005;WHO, 2004;Cu Le et al., 2004;Ahman and Shah, 2002). ...
The lbani of Rivers State, Nigeria, have a high incidence ef maternal and infant mortality/morbidity, which has been linked to the perception, attitude and practices of the people with regard to pregnancy and childbirth. This study examines the process leading to pregnancy outcomes among the Ibani. Through an interdisciplinary approach, it provides an in-depth and comprehensive understanding of the association between pregnancy outcome and child spacing; source of antenatal care; and access to and use of antenatal health care facilities. Data was collected through in-depth interviews, focus group discussions, case studies, observation and survey questionnaires. The findings indicate that pregnancy outcome among the Ibani is not necessarily derived from spousal communication and gender discourse, because women whose husbands were solely responsible for decision making on child spacing recorded higher type-I (mother and child survival) outcome (87.7 per cent) than those who shared decision making with their spouse. There is no consistent relationship between the amount of time spent on getting to the source of antenatal care and pregnancy outcomes because Thani women who spent between 31 and 59 minutes to get to the source of antenatal had more type-I] outcomes thin those who spent about 30 minutes. Other factors affecting pregnancy outcomes, among the Ibani of Rivers State, include communal and individual values, norms and practices, and their persistent influence signals a need to investigate their separate and combined influences on pregnancy outcomes. The study contributes to a demographic understanding of hove macro-level factors impinge upon individual-level events like pregnancy outcomes.
... In the absence of emergency obstetric care, complications arising from unsafe abortions can also be a major cause of maternal mortality. Over half of all unsafe abortions worldwide take place in Asia -10.5 million a year, or one unsafe abortion to every seven live births (Ahman and Shah, 2002). ...
... Almost all abortion-related deaths are preventable when performed by a qualified provider using correct techniques under sanitary conditions. 6 Recognizing the preventable nature of most maternal morbidity and mortality related to unsafe abortion [7][8][9] the Indian parliament passed the Medical Termination of Pregnancy (MTP) Act in 1971 [10] . This relatively liberal law permits a woman to seek an abortion to save her life, preserve her physical and mental health, for economic or social reasons, and in cases of rape or incest, fetal impairment, or when pregnancy results from contraceptive failure. ...
... There are several decades of evidence on contraceptive prevalence rates in most countries, e.g. from the Demographic and Health Surveys [13]. There are global data based on best estimates, e.g. on maternal deaths [14] and unsafe abortions [15]. Fortney and Smith have outlined the different sources of data on maternal morbidity, but conclude that while there are important reasons to obtain better estimates of prevalence and incidence, ''there are already sufficient data from existing measures for resource allocation to proceed, and for policies and services to be modi-fied, extended and improved'' [16]. ...
... Abortion refers to the removal of conception products before 20th week, when the gestational weight is about 500 g [1]. According to the World Health Organization (WHO), unsafe abortion is a method used to terminate unwanted pregnancy by non-experts or in an environment that lacks minimum medical standards or both [2][3][4]. Today, unsafe abortion is one of the most important global challenges in terms of Public Health and Human Rights [5,6]. Statistics indicate that, 56% of the abortions in developing countries are done using unsafe methods while only 6% of the abortions in developed countries are done unsafely. ...
Objective:
The present study aimed to investigate the prevalence and the reasons of issuing permission for therapeutic abortion in department of forensic medicine, Kermanshah-Iran.
Results:
There were a total number of 428 applications for issuing permits. The most common reasons of issuing permit for therapeutic abortion were fetal and maternal problems, specifically cerebral abnormalities (70.8%), and anencephaly (30.3%). Furthermore, 354 (82/7%) out of 428 applications were able to get the legal permit and 17.3% of the applications did not receive permission, which was mainly due to "the lack of maternal indication". Increased knowledge of physicians and clinical personnel on indications of therapeutic abortions and related regulations would lead to the implementation of strategies which prevent void referrals to the department of forensic medicine and a better execution of therapeutic abortion law. By improving the health condition of pregnant women who seek pregnancy termination, informing them about indications of therapeutic abortions, and developing proper strategies to make pregnant women more acquainted with legal cases of abortion, we can take a significant step towards helping pregnant women and promoting their health.
... Every year, an estimated 210 million women throughout the world become pregnant and about one in five of them resort to abortion. Out of 46 million abortions performed annually, 19 million are estimated to be unsafe [1]. The World Health Organization (WHO) defines unsafe abortion as a method of terminating an unwanted pregnancy either by untrained individuals, or in an environment with compromised medical standards, or both [2]. ...
... According to WHO [2] two of every unsafe abortions globally occur among women aged 15-30 and 14% occur among women not yet 20 years old. It is estimated that over four million of the world's unsafe abortions take place in Africa each year, killing approximately 34, 000 African women [4] and 44% of the world's deaths from unsafe abortion laws occur in Africa [5] this is not very clear, maybe rephrase. The number of deaths from unsafe abortions is rising in Africa women who experience unsafe abortions and survive; suffer short and long term injuries and disabilities such as uterine perforation, chronic pelvic pain and secondary infertility which are all too frequent [6]. ...
The purpose of this article is to analyze and identify the main challenges which hinder the implementation of the abortion policy in Zambia. Abortion is a major public health challenge that could be a contributory factor the high maternal mortality rate in the country. despite abortion being legal, access to the service is still difficult for some women in need of the service.
... [2][3][4][5] About 47,000 women die every year due to complications from unsafe abortions, 86% of which occur in developing countries. [6][7][8] Unsafe and clandestine abortions represent a great risk for women and therefore are an urgent public health matter. ...
Objectives
To describe the epidemiology of abortion in Ecuador from 2004 to 2014 and compare the prevalence between the public and the private health care systems.
Methods
This is a cross-sectional analysis of the overall mortality and morbidity rate due to abortion in Ecuador, based on public health records and other government databases.
Results
From 2004 to 2014, a total of 431,614 spontaneous abortions, miscarriage and other types of abortions were registered in Ecuador. The average annual rate of abortion was 115 per 1,000 live births. The maternal mortality rate was found to be 43 per 100,000 live births.
Conclusions
Abortion is a significant and wide-ranging problem in Ecuador. The study supports the perception that in spite of legal restrictions to abortion in Ecuador, women are still terminating pregnancies when they feel they need to do so. The public health system reported >84% of the national overall prevalence.
... Every year, about 205 million women worldwide become pregnant and nearly one in five (40-50 million) choose to terminate the pregnancy for various reasons 1 This figure corresponds to approximately 125,000 abortions per day of which close to 20 million are estimated to be unsafe 2,3 Globally induced abortion rates have slightly changed between 2003 and 2008. 4 This is due to improved access to family planning education and contraception. ...
Empirical and anecdotal evidence indicate that the gestation of a pregnancy at termination in Ghana can be influenced by circumstances surrounding onset of pregnancy or challenges arising during pregnancy. This study examined determinants of gestational age at termination of pregnancy in Accra, Ghana. The study design was cross-sectional and used a mixed-method approach. Four hundred and one (401) women who had induced abortion in designated hospitals between January and December 2010 were randomly sampled and interviewed using interviewer-administered questionnaires. Additional 30 women were engaged in in-depth interviews. Descriptive and multinomial logistic regression analyses were used to analyze the quantitative data. The qualitative data was thematically analyzed based on responses obtained. The study found that, about76% of respondents had an abortion during the first trimester (1-3 months) of pregnancy. Marital status (2 =29.59; p <0.001) and age (2 =32.71; p=0.008) were significantly associated with gestations at termination. Persons responsible for a pregnancy were noted to have influenced gestations at termination. Mid-trimester abortion (4+ months) decisions were painfully taken to escape situations that negatively affected respondents' health, education, social life and/or carrier development goals. There was significant associations (OR=1.47; 95% CI=0.488-4.413) between occupation and gestation at termination. Pregnant women who are students/apprentices are more likely (-2log-likelihood of-100.7) to have an abortion at an earlier gestations than women of other occupation categories mainly to avoid workplace/institutional sanctions. Women need education and support on gestations for safe abortion as permitted by the Ghanaian abortion law. Ultimately, public health policies and women's right dialogues should frown on workplace/institutional sanctions on pregnancy that push women to have an abortion against their wish and regardless of the gestation to achieve their carrier and reproductive intentions. This may contribute directly to a decrease in unsafe abortion fatalities in Ghana.
... In several Asian countries young women are also less likely to use maternal and child health services than older women (Reynolds, Wang and Tucker, 2006). Women, particularly the unmarried, often resort to abortion to end an unwanted pregnancy (Ahman and Shah, 2002), and in a number of Asian countries (Thailand, Viet Nam), the unmarried constitute a higher proportion of women who seek abortion (Centre for Reproductive Rights, 2005). Young people are also at higher risk of contracting sexually transmitted infections, including HIV, owing to biological reasons, the dynamics of their sexual relations and their sexual behaviour. ...
The Asian and Pacific region has made significant progress in expanding access to sexual and reproductive health with more effective collaboration between Governments, international agencies and civil society organizations. Most countries have in place policies and strategies for reproductive and sexual health information and services, but their translation into programmes remains a challenge, especially in reaching out to the poor and marginalized. Assessing the progress of the region as a whole and within countries is difficult owing to their huge diversity and disparity, the complexities of the broad sexual and reproductive health agenda and difficulties in obtaining a reliable set of quantifiable indicators. Challenges faced during this period with competing funding for HIV and AIDS, opposing voices of conservative and religious forces and the reinstating of the Mexico City Policy (through rescinded by President Obama in January 2009) have affected resources critical to achieving the International Conference on Population and Development goals. However, with the additional target under Millennium Development Goal 5 to provide universal access to reproductive and sexual health, there is renewed hope to move ahead to achieve both sets of goals. This paper traces the various components of sexual and reproductive health (SRH), emphasizing the areas where progress has been made as in contraceptive prevalence and usage of modern contraception methods, and addresses some of the challenges faced. The paper also calls for countries to take affirmative action to address issues which are contentious and/or neglected but that are important public health concerns. Strengthening of health infrastructure and ensuring that health-care systems are fully functioning are vital for effective implementation of comprehensive quality SRH services. Finally, it is the political will and allocation of adequate, national resources that will make a difference to saving women's lives and improving their sexual and reproductive health.
... Of the estimated 46 million induced abortions that take place each year 27 million take place within the legal system. The remainder, approximately 19 million, occur outside the legal system (Ahman, 2002;Ahman, 2004), often performed by unskilled providers or under unhygienic conditions or both. The resulting immediate and longer term sequel of unsafe abortion is a major component of maternal mortality and morbidity and a neglected public health issue in many parts of the world (Ahman, 2006). ...
Introduction: Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive use and unplanned pregnancies in two completely different groups; Iran as developing region and New Zealand as developed region with different family planning services and different culture. Materials and Methods: This is a cross sectional study That aims to investigate the extent and the causes of unplanned pregnancies, the use of contraceptive methods and the reasons for not using them in order to explore the risk factors of unplanned pregnancies and measuring the rate of unmet needs that all affect on the control of population growth rate. A random sample of 336 pregnant women (168 of each of the countries) was interviewed using a structured questionnaire. The questionnaires were completed by the participants. The data were analysed by Fisher Exact Test, χ2, Logistic Regression using SPSS software program and the significance level was based at P<0.05. Result: According to the results, the response rates were 89.3% and 75.0% in the group of Iran and New Zealand respectively. Among the respondents, 47(36.5) and 46 (31.3%) said that their pregnancy had been unplanned. About 23 (49%) and 36 (78.3%) of respondents were using contraception to prevent this pregnancy and the current pregnancy is from the failure of the contraceptive method or the users of contraceptives. Also 24 (51.1%) and 9 (19.6%) of them said that they did not plan to pregnant but they were not using contraception for some reasons. The low prevalence of contraceptive use in Tehran's sample indicates the failure of family planning clinic to motivate their target group. Also the high prevalence of unplanned pregnancies while using contraceptive methods In Wellington indicates the need for education to improve the women knowledge about how to use the methods. Depending on the condition of the societies, the risk factors of unplanned pregnancies are different. For example, in Wellington some demographic characteristics of women (age, marital status, and education) were associated with their unplanned pregnancies. Therefore the role of women in using family planning programmes is still very important. In Tehran, as a theocratic state, the demographic characteristics of women were not associated with unplanned pregnancies. The partner's educational status was the only risk factor from the demographic variables. In Iran, family planning programmes are based on the religious support of the leaders and the flexibility of Islam in dealing with social issues that is one of the most important reasons for the growth of the family planning programmes in the country. Therefore the role of the government is more important than of the individuals.
... Unsafe abortion is defined by the World Health Organization as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both [6]. ...
Background: In Cameroon, induced abortion is permitted when a woman's life is at risk, to pre- serve her physical and mental health and on the grounds of rape or incest. Objectives: The aim of this study was to determine the prevalence, reasons and complications of voluntary induced abor- tion among women attending the obstetrics and gynecology services in an urban area, Yaounde and in a rural area, Wum in Cameroon. Methods: We carried out a cross sectional study, with 509 women recruited between August 1, 2011 and December 31, 2011 in three health facilities in Ca- meroon. We appreciated the frequency, complications and reasons for Voluntary induced abor- tions. Results: The prevalence of voluntary induced abortion was 26.3% (134/509) globally; 25.6% (65/254) in urban area and 27.1% (69/255) in rural area. One hundred and eleven (83%) cases of induced abortions were carried out in a health structure and 23 (17%) cases in private homes. Medical doctors and nurses were the most frequent abortion providers in both urban (84.7%) as well as rural setting (77.2%). The three main reasons for induced abortion were to pursue their studies (34.3%), not yet married (22.6%) and fear of parents (13.9%). Complications were re- ported by 20% (27/134) of respondents who had carried out voluntary induced abortion. Exces- sive bleeding was the most reported complication (70.4%). Conclusion: Despite its illegality in Cameroon, the prevalence of voluntary induced abortion was high in this study.
... There are about 30 million unwanted pregnancies each year in developing countries (Kumar, 2001). About 19 million unsafe abortions take place worldwide each year, where approximately one in ten pregnancies ended in an unsafe abortion (Ahman & Shah, 2002). Nearly 80,000 ...
The aim of this study is to asses the knowledge, attitude and practice of modern family planning among husbands in Mukalla, Yemen. This study was a cross-sectional study involving 400 husbands living in Alamol and Almustagbal quarters in Mukalla. These husbands were selected from households randomly selected from the two quarters. Husbands who do not meet pre-determined criteria were replaced with those from the nearest house. The selected husbands were interviewed using a structured questionnaire. The prevalence of family planning practice among the husbands were 39.0% and 44.3% among their wives. Only 44 (11.0%) of the husbands and 83 (20.8%) of the wives were currently practicing modern family planning. There were only 77 couples (19.3%) where both husbands and wives have practiced family planning, 79 (19.8%) of couples where husbands practice but their wives do not, 100 (25.0%) of couples where husbands do not practice but wives do and 144 (36.0%) where both husbands and wives do not practice any family planning. Among users, the condom was the most common method used by the husbands (88.6%), while the pill was the most common method used by wives (54.2%) followed closely by intra-uterine devices (43.4%). More than 90% of husbands knew about pills, intra-uterine devices and condoms. Most of the husbands (89.3%) have positive attitudes towards family planning and agreed that modern methods are more effective than traditional methods. The majority of husbands (51.3%) agree that husbands should also practice family planning. However, 172 husbands (43.0%) felt that family planning should be practiced only by the wife. About 282 husbands (70.5%) believed that the decision regarding practice of family planning should be decided by husbands and 225 (56.3%) felt the wife only should decide on practicing family planning. The results indicate ambivalence by some husbands on the main decision maker for family planning practice.
Nearly all husbands (>90%) were aware of the common types of family planning except for male sterilization (51.0%). Male sterilization is uncommon in this study compared to female sterilization, which may explain the lower level of awareness. Very few husbands (2.0%) had poor attitude scores towards family planning. Among the positive attitude husbands, 132 (33.0%) had moderate scores while 247 (61.8%) had good scores and only 13 (3.3%) of the husbands had very good scores indicating that the husbands generally have positive attitudes towards family planning.
Multiple regression analysis of the total knowledge score revealed significant association with years completed education of husband, years completed education of wife and the number of living children. For the attitude score, multiple linear regression analysis revealed a significant association with years completed education of husbands, the number of living children and monthly income of the wives.
Family planning programs in Yemen should also focus on Yemeni husbands to participate as joint decision makers in modern family planning practice. This can be achieved through targeted family planning education and promotion programs to Yemeni husbands. Religious leaders must be involved in clarifying religious issues regarding family planning.
... Unsafe abortion is defined as a procedure for termination of unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standard or both [1]. It is an important cause of maternal morbidity and mortality. ...
... In Latin America and the Caribbean, abortion accounts for at least 12% of maternal deaths, and in some regions of Latin America for up to 30% 10 . Depending on the location, complications resulting from abortions in Latin America account for 50% of maternal deaths 11 . ...
Despite its illegality in Brazil, about 31% of all pregnancies end in abortion. Most abortions are performed by unskilled personnel and under unsafe conditions, resulting in increased female mortality. This study used data from a cross-sectional representative sample of 3,047 puerperal women, in 1999-2000, part of a national multicenter study on the prevalence of syphilis in Brazil. Of these, 1,838 women with at least one previous pregnancy before the reference pregnancy were included in the analysis. The outcomes studied were voluntary prior fetal loss, spontaneous prior fetal loss, and no prior fetal loss. The analysis was carried out using multinomial logistic regression. The results indicated a high number of fetal losses per woman (up to six); and 31% of the losses were voluntary. The absence of prenatal care, history of STD in the reference pregnancy, and absence of living children were factors that increased the odds of fetal loss. For voluntary fetal loss, being non-white, having more than one partner in the previous year, and an early age at first sexual intercourse also increased the odds of fetal loss. These data confirm the public health relevance of abortion in Brazil. Characteristics related to women´s vulnerability should be considered in family planning programs in order to reduce the number of abortions and their consequences. Counseling must also be provided, targeting women with a previous abortion.
... About 19 million unsafe abortions take place annually all over the world; almost all of these in the developing world (Ahman & Iqbal 2002:13). In Africa, 4.2 million abortions are estimated to take place per year, with an unsafe abortion rate of 22 per 1000 women (Ahman & Iqbal 2002:19). It is estimated that about 40% of maternal deaths are from abortion and its complications; 68.8% of unwanted pregnancies end in induced abortion, and 80% of women who present with complications from induced abortions are adolescents (Okonofua et al 1999:67-77). ...
... With the largest population of any region, Asia has the highest absolute number of unsafe abortions -about 10.5 million each year -although the estimated rate of unsafe abortion is the lowest in the developing world, at 11 per 1000 women. In Western Europe and North America the number of unsafe abortion is negligible (Ahman and Shah 2002). ...
DEATH from unsafe abortion is the easiest and least expensive to prevent of the five leading causes of maternal mortality. Yet globally an estimated 67,000 women each year die as a result of complications of unsafe abortion. Tens of thousands more suffer serious injuries, including infection, haemorrhage, cervical laceration and uterine perforation (World Health Organization 2003). Unsafe abortion and related deaths and morbidity occur despite international agreements stating that where abortion is legal, it should be safe and accessible, and legislation in almost every country globally permitting abortion for some indication. This paper reviews political, legal and medical aspects of the abortion issue, and provides programmatic examples and recommendations for preventing the unnecessary and tragic loss of lives and health as a result of unsafe abortion. It is critical for governments worldwide to acknowledge and fulfil obligations to reduce abortion related morbidity and mortality, particularly in the face of conservative movements working to reverse recent achievements in reproductive health policy and abortion-related care.
... Poverty is considered a key determinant which affects women's decision making about unintended pregnancy as well as their access to safe post abortion care (PAC). Many women choose to terminate a pregnancy because of economic hardship and their inability to support a child [5]. ...
Background
While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria.
Methods
The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care.
Results
The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand.
Conclusion
The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion care is daunting. There is the need for policymakers to intensify public education against indiscriminate abortion and to reduce unwanted pregnancies. In effect, there is need for effective alternative family planning methods. This is likely to reduce the demand for abortion. Further, with income found as a major constraint, post abortion services should be made accessible to both the rich and poor alike so as to prevent unnecessary maternal deaths as a result of abortion related complications.
... This best practice is not available to a vast majority of Rhesus negative women in SSA. However, unsafe abortion, defined by the World Health Organization as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both, is prevalent and continues to put Rh-negative women who cannot afford anti- D immunoglobulin at risk of Rh isoimmunisation in many settings in SSA [47]. A broad array of personnel perform unsafe termination of pregnancy in SSA. ...
The implementation of a program on routine antenatal anti-D prophylaxis (RAADP) in the developed world has led to a significant decline in the residual numbers of Rhesus negative women becoming sensitized. However, a significant number of Rhesus D negative women in SSA are not fortunate because of lack of access to prophylactic immunoglobulin D and thus they continue to be affected. The management of Rhesus negative pregnancy in Sub-Saharan Africa is associated with several daunting challenges: absence of a policy on universal access to Rh D immunoglobulin, lack of fetomaternal testing facilities, unaffordability of prophylactic anti-D immunoglobulin, poor uptake of quality antenatal care, poor health infra- structure, sub optimal management of potentially sensitizing events during pregnancy, shortage of qualified medical personnel, poor data management, high incidence of illegal abortion and quackery. There is a need for the formulation of necessary guidelines on Rhesus immunoprophylaxis in SSA. Health authorities need to implement evidenced-based policy on universal access to anti-D immunoglobulin. There is also the need to optimize the knowledge of obstetricians on anti-D prophylaxis, implementation of the readily available and affordable Kleihauer fetomaternal haemorrhage testing for all women who experience a potentially sensitizing event antenatally post 20 weeks gestation and postnatally. These factors can facilitate the effective management of Rh negative pregnancy in the region and reduce the risk of Rhesus D immunization and Rhesus D haemolytic disease of the foetus and newborn.
The sub-continent of West Africa is made up of 16 countries: Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia and Togo. As of 2018, the population of the sub-continent was estimated at about 381 million. The main challenge associated with blood transfusion service delivery across the sub-region concerns adequacy and safety. In this chapter, we highlighted the challenges associated with the delivery of a quality blood transfusion service in countries in the sub-region including: implementation of component therapy rather than whole blood transfusion, effective cold chain management of blood and blood products, alloimmunization prevention, implementation of column agglutination and automation rather than the convention manual tube method in blood transfusion testing, effective management of major haemorrhage, optimization of screening for transfusion transmissible infections, optimizing blood donation, implementation of universal leucodepletion of blood and blood products, effective management of transfusion-dependent patients, pre-operative planning and management of surgical patients, management of Rhesus D negative pregnancy and women with clinically significant alloantibodies, implementation of haemovigilance system, implementation of alternatives to allogenic blood, availability Blood Donation and Transfusion 2 and use of specialized blood products, optimizing safe blood donation, enhancing blood transfusion safety, operating a quality management system-based blood transfusion service and implementation of non-invasive cell-free foetal DNA testing. There is the urgent need for the implementation of evidence-based best practices in blood transfusion service delivery across the sub-region to allow for excellent, safe, adequate and timely blood transfusion service delivery across the sub-region.
Background: Rural India experienced a high frequency of unsafe abortions; therefore more research is needed to understand the regional patterns and socio-demographic factors of unsafe abortion by place of residence. The present study aims to explore the predisposing, enabling, and need factors of unsafe abortion in India.
Methods: In the National Family Health Survey, 2015-16, women aged 15–49 who had their last pregnancy terminated by induced abortion during the five years prior to the survey (N = 9113) were included in the study. The present study computed the rural-urban divide in percentage of unsafe abortions by respondents’ background characteristics. Predisposing, enabling, and need factors for unsafe abortion in India by place of residence were investigated using multivariate logistic regression models.
Results: In India, 27.3% of responders performed unsafe abortions out of 9113 induced abortions in 2015-16. Furthermore, the rural-urban divide was found to be considerable (7.2%), particularly among women aged 35-39 (15%). In terms of predisposing factors, there was a substantial difference in adjusted odds of unsafe abortions across the regions, with the risk of unsafe abortions being much higher in the urban eastern region (aOR:5.90, 95% CI:3.96,8.80) compared to the urban south region. In India, the likelihood of unsafe abortions increased with decreasing age, regardless of where the woman lived. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (aOR:1.92 CI:1.27,2.90). In India, poor households were more likely to undergo unsafe abortions, whereas it was found more likely in rural settings (aOR:1.26 95% CI:1.10,1.50). Similarly, SCs/STs more likely performed unsafe abortion in rural settings. In both rural and India, unmet need for family planning was revealed to be a significant need factor for unsafe abortion.
Conclusion: Despite the fact that abortion is legal, India's high estimated frequency of unsafe abortion reveals a serious public health issue. Large numbers of women are at risk of unsafe abortion due to socioeconomic vulnerability, unmet family planning needs, and a lack of awareness.
In Mexico, recent political events have drawn increased public attention to the subject of abortion. In 2000, using a national probability sample, we surveyed 3,000 Mexicans aged 15—65 about their knowledge and opinions on abortion. Forty-five per cent knew that abortion was sometimes legal in their state, and 79% felt that abortion should be legal in some circumstances. A majority of participants believed that abortion should be legal when a woman’s life is at risk (82%), a woman’s health is in danger (76%), pregnancy results from rape (64%) or there is a risk of fetal impairment (53%). Far fewer respondents supported legal abortion when a woman is a minor (21%), for economic reasons (17%), when a woman is single (11%) or because of contraceptive failure (11%). In spite of the influence of the Church, most Mexican Catholics believed the Church and legislators’ personal religious beliefs should not factor into abortion legislation, and most supported provision of abortions in public health services in cases when abortion is legal. To improve safe, legal abortion access in Mexico, efforts should focus on increasing public knowledge of legal abortion, decreasing the Church’s political influence on abortion legislation, reducing the social stigma associated with sexuality and abortion, and training health care providers to offer safe, legal abortions.
Résumé
Au Mexique, de récents événements ont mis l’avortement au centre de l’attention publique. En 2000,àpartir d’un échantillon aléatoire national, nous avons interrogé 3000 Mexicains âgés de 15à65 ansàpropos de leurs connaissances et leurs opinions sur l’avortement. Ils étaient 45%àsavoir que l’avortement est parfois légal dans leur Átat et 79% pensaient qu’il devait l’Átre dans certaines circonstances. Une majorité de répondants estimaient que l’avortement doit Átre autorisé si la vie (82%) ou la santé (76%) de la femme est en danger, si la grossesse résulte d’un viol (64%) ou si le Fatus présente des anomalies physiques ou mentales (53%). Nettement moins de personnes approuvaient l’avortement légal pour une mineure (21%), pour des motifs financiers (17%), si la femme est célibataire (11%) ou en raison d’un échec de la contraception (11%). Malgré le pouvoir de l’Áglise, la plupart des catholiques jugeaient que l’Áglise et les convictions des législateurs ne devaient pas peser sur la législation, et la plupart approuvaient la pratique d’avortements par les services de santé publics dans les cas autorisés par la loi. Pour améliorer l’accèsàl’avortement légal et médicalisé au Mexique, il faut informer la population, diminuer l’influence politique de l’Áglise sur la législation relativeàl’avortement, atténuer la stigmatisation associéeàla sexualité etàl’avortement, et former les prestataires de soins de santéàproposer des avortements légaux et médicalisés.
Resumen
En México, los últimos sucesos poláticos originaron una atención amplia del público hacia el tema del aborto. En el 2000, mediante una muestra de probabilidad nacional, encuestamos a 3,000 mexicanos entre los 15 y 65 años acerca de sus conocimientos y opiniones sobre el aborto. El 45% sabáa que el aborto a veces es legal en su estado, y el 79% estimaba que el aborto debe ser legal en algunos casos. La mayoráa estimó que el aborto debe ser legal cuando la vida de la mujer está en riesgo (82%), la salud de la mujer está en peligro (76%), el embarazo es producto de una violación (64%) o el feto tiene defectos mentales o fásicos (53%). Un número mucho menor de respondedores apoyaron la interrupción legal del embarazo cuando la mujer es menor de edad (21%), por motivos económicos (17%), cuando la mujer es soltera (11%) o debido a falla anticonceptiva (11%). A pesar de la influencia de la Iglesia, la mayoráa de los mexicanos católicos estiman que la Iglesia y las creencias religiosas de los legisladores no deberáan incidir en la legislación sobre el aborto, y la mayoráa apoyó la prestación de servicios por la salud pública en casos en los que éste es legal. A fin de mejorar el acceso al aborto seguro y legal en México, los esfuerzos deben centrarse en crear mayor conciencia entre el público respecto al aborto legal, disminuir la influencia polática de la Iglesia sobre la legislación de aborto, reducir el estigma social asociado con la sexualidad y el aborto, y capacitar a los profesionales de la salud para que provean abortos seguros y legales.
Globally, 19 million women are estimated to undergo unsafe abortions each year. Age patterns of unsafe abortion are critical for tailoring effective interventions to prevent unsafe abortion and for providing post-abortion care. This paper estimates the incidence and the rate of unsafe abortion among women aged 15—44 in the Africa, Asia (excluding Eastern Asia), and Latin America/Caribbean regions, where a woman is likely to have close to one unsafe abortion by age 44. For developing regions as a whole, two-thirds of unsafe abortions occur among women aged 15—30 and 14% among women under age 20. The age pattern of unsafe abortions differs markedly between regions, however. Almost 60% of unsafe abortions in Africa are among women under age 25 and almost 80% are among women under 30. In Asia 30% of unsafe abortions are in women under 25 and 60% in women under 30. In Latin America and the Caribbean, women aged 20—29 account for more than half of unsafe abortions with almost 70% in women under 30. Over 40% of unsafe abortions among adolescents in the developing world occur in Africa, where one in four unsafe abortions takes place during adolescence. Young (under age 25) women in Africa, those over age 25 in Asia and women aged 20—35 years in Latin America and the Caribbean are in the greatest need of interventions to prevent unsafe abortion and good quality post-abortion care.
Résumé
On estime que, chaque année, 19 millions de femmes subissent un avortementàrisque dans le monde. Pour intervenir efficacement, il faut connaître la ventilation des avortements par groupes d’âge. L’article évalue l’incidence et le taux d’avortementàrisque chez les femmes de 15à44 ans en Afrique, en Asie (sauf l’Asie de l’Est), en Amérique latine et aux Caraébes, régions où une femme aura subi près d’un avortementàrisque avant 44 ans. Les deux tiers des avortementsàrisque concernent des femmes de 15à30 ans et de 14% des moins de 20 ans. Néanmoins, les âges diffèrent selon les régions. En Afrique, près de 60% des avortementsàrisque se produisent chez des femmes de moins de 25 ans et près de 80% chez les moins de 30 ans. En Amérique latine et aux Caraébes, les femmes âgées de 20à29 ans représentent plus de la moitié des avortementsàrisque, avec près de 70% chez les moins de 30 ans. Plus de 40% des avortementsàrisque chez les adolescentes de pays en développement se produisent en Afrique, où un avortementàrisque sur quatre est pratiqué sur une adolescente. En Afrique, les interventions doivent se centrer sur les femmes de moins de 25 ans, en Asie sur les plus de 25 ans, et en Amérique latine et aux Caraébes, sur les femmes de 20à35 ans.
Resumen
Se estima que, a nivel mundial,cada año aproximadamente 19 millones de mujeres se someten a abortos. Los patrones de edad del aborto inseguro son fundamentales para adaptar las intervenciones de manera eficaz. En este artáculo se calcula la incidencia y tasa de abortos inseguros en las mujeres de 15 a 44 años de edad en África, Asia (excluida Asia Oriental), Latinoamérica y el Caribe, donde es probable que cada mujer experimente un aborto inseguro antes de cumplir 44 años. Dos terceras partes de los abortos inseguros ocurren entre las mujeres de 15 a 30 años, y el 14% entre las menores de 20 años. No obstante, el patrón de edades de los abortos inseguros difiere marcadamente entre regiones. Casi el 60% de los abortos inseguros en África ocurre entre las mujeres menores de 25 años, y casi el 80% entre aquéllas menores de 30. En Asia, el 30% de abortos inseguros ocurre entre las mujeres menores de 25 y el 60% entre aquéllas menores de 30. En Latinoamérica y el Caribe, casi la mitad de los abortos inseguros se presentan en mujeres de 20 a 29 años; casi el 70% son menores de 30. Más del 40% de los abortos inseguros entre las adolescentes en los paáses en desarrollo ocurren en África donee uno de cuatro abortos inseguros ocurre entre las adolescentes. Para las poláticas y los programas, las intervenciones en África deben centrarse en aquéllas menores de 25; en Asia, en las mayores de 25; y en Latinoamérica y el Caribe, en las de 20 a 35 años.
Objectives
Despite liberal abortion laws, unsafe abortions remain a public health challenge in Ghana. This study examines implications of financial cost of abortion in assessing safer services for young people in Ghana.
Study design
This is a retrospective cross-sectional mixed-method study.
Methods
Questionnaires (401) and in-depth interviews (21) were used to collect data from women seeking elective abortions (320) and those treated for postabortion complications (81) in 6 health facilities comprising non-governmental organizations (2) and public (2) and private (2) hospitals from January to December 2018 in Accra.
Results
Results suggest high hospital abortion charges as major barriers to accessing safe abortion care in Accra as the surgical procedures cost three times more than that of other methods because of cost of anesthetics and antibiotics.
Conclusions
Standardizing costs of abortion services across hospitals and integrating these costs into the National Health Insurance Scheme is highly recommended.
Background
Induced abortion accounts for 1 in 8 of approximately 600000 maternal deaths that occur annually worldwide. Induced abortion rate can be considered as one of the indicators for assessing availability of the appropriate reproductive health plans for women and identifying needs for appropriate related health policies and programs.
Material and Methods
Researchers searched Pubmed, Google Scholar, CINAHL, Embase, PsycINFO, Cochrane, Iranian Scientific Information Database (SID), Iranian biomedical journals (Iranmedex), and Iranian Research Institute of Information and Documentation (Irandoc) between January 2000 and June 2013, which reported induced abortion. Search terms from two categories including abortion and termination of pregnancy were compiled. The search terms were “induced abortion”, “illegal abortion”, “illegal abortion”, “unsafe abortion”, and “criminal abortion”. The search was also conducted with “induced termination of pregnancy”, “illegal termination of pregnancy”, “illegal termination of pregnancy”, “unsafe termination of pregnancy” and “criminal termination of pregnancy”. Meta-analysis was carried out by using OpenMeta software. Induced abortion rates were calculated based on the random effect model.
Results
Overall induced abortion rate was obtained 58.1 per 1000 women (95%CI: 55.16-61.04). In continental level, rate of induced abortion was 14 per 1000 women (95%CI: 11-16). Nation-wide and local rates were obtained 67.27 per 1000 women (95% CI: 60.02-74.23) and 148.92 (95% CI: 140.06-157.79) respectively.
Discussion and Conclusion
Induced abortion is a major public health problem that occurs worldwide whether under the legal restriction or freedom, and it remains as reproductive health concern globally. To eliminate the need for induced abortion is at the core of any effort for preventing this issue. Option with the highest priority is to prevent unwanted pregnancies through promoting reproductive health plans for women of reproductive age. In case the prevention strategies fail, universal provision of safe abortion services should be put in place.
Global statistics show that nearly a third of the world’s girls and women will be the victims of violence. Women who are victimized have long known that they live in communities that blame them for their injuries due to patriarchal values. Global trends suggest that increasingly this victim blaming is being formally incorporated into law. This chapter explores the women’s criminalization of women’s victimizations in four areas: the merging of religion and law to criminalize female sexuality and sexual expression; the demonization and sexualization of “enemy” women as a justification for mass rape in wartime; the criminalization of reproductive rights; and the use of courts to punish victims of sexual abuse who run away from their abusers. Through this discussion, the authors suggest that the pattern of criminalizing women and girls’ victimization requires both research to document and action to challenge the “legal” abuse of women and enforcement of patriarchal privilege.
This article examines the history of national human rights institutions (NHRIs) in general including their establishment in Africa. Using examples from three countries - Malawi, Nigeria and South Africa - it critically analyses the promotional and protective mandates of these institutions in Africa and then argues that their experience over the years in promoting human rights in their domains can similarly be useful in advancing adolescents' sexual and reproductive rights. In doing this, NHRIs may face some challenges including poor funding, undue interference from the executive, shortage of personnel and so on. Therefore some of these challenges are discussed and subsequently some suggestions for the way forward. © Netherlands Institute of Human Rights (SIM), Printed in the Netherlands.
Introduction: abortion is one of the most controversial topics at the end of the 20th century and at the beginning of the 21st century. However, this is not a new situation since it has existed in every recognized culture, either primitive or modern, with or without written alphabet. In the last few years, the role of the menstrual regulation to empty the uterus in the early pregnancy has been recognized. Objective: to describe the behavior of the menstrual regulation method in adolescents from the health area of Parraga neighborhood. Methods: an observational, cross-sectional and descriptive study was conducted. The universe of study was 370 female adolescents, who went to the Menstrual Regulation Service in "Parraga" polyclinics. The final sample was made up of 360 patients who were performed the endometrial aspiration method. These patients were followed up for 7 days to observe their recovery. The following variables were under analysis: age, schooling, marital status, obstetric history, use of contraceptive methods and immediate complications. Results: the group of late adolescents with 220 cases predominated. The age of onset of sexual relations was 14 to 17 years, with 249 (69.1 %) adolescents, and the main reason for not using some contraceptive method was they forgot to do it in 183 (50.8 %) cases in this sample. The most frequent complications sere vagal reactions in 54 (15.0 %) patients. Conclusions: a large number of female adolescents turn to menstrual regulation because it is a quicker, safer method than abortion, does not require anesthesia and has no further complications.
Aims and objective is to determine the reason why woman seek abortion, and to see the complications and outcome of unsafe abortion. Method: This descriptive study was conducted at the Department of Obstetrics and Gynaecology, Jinnah Hospital Lahore from 01.07.2009 to 30.06.2010. The data of 41 patients admitted as emergency cases with history of unsafe abortion outside the hospital were collected. Patient's bio data, treatment given, post operative care, complications and associated morbidity and mortality was taken into account and results were compiled. Results: 95% patients were married, 85% patients were multi gravidae. In 75% of cases it was women's choice for termination. All terminations were attempted at home or other small centers by untrained staff. 78% had history of surgical interference. For abortion 78% patients needed surgical managements including evacuation and curettage or laparotomy. 10% of the patients expired because of associated complications and 34% patient had long term morbidity. Conclusion: in spite of legal and religious restrictions abortion for unwanted pregnancies is common and being conducted by untrained staff resulting in high maternal morbidity and mortality. The effective way to reduce it will be by improving awareness and availability of contraceptive facilities all over the country.
Across the world, millions of women unintentionally become pregnant and decide to terminate the pregnancy. Despite progressive abortion laws in South Africa (SA), evidence suggests that many women of all ages still resort to unsafe terminations outside legal, designated facilities. Media reports alert the public to an increase in the illegal dumping of fetuses and abandoned babies, suggesting an increase in unsafe termination practices as well as concealed births.
To examine mortality data to identify trends in the dumping of aborted fetuses and abandoned babies in SA.
This study utilised data from the National Injury Mortality Surveillance System in two provinces, namely Gauteng and Mpumalanga. A total sample of mortality data was used to analyse trends associated with this phenomenon from 2009 to 2011. Descriptive, exploratory statistics were used and included the calculation of crude population incidence rates for abortions and abandoned babies as well as figures (n) and percentages (%) for each category under investigation.
An increase in the rate of discovery of non-viable fetuses was noted for both provinces over the 3-year period, while there was a significant decrease in the discovery of deceased abandoned babies in Gauteng only.
The illegal dumping of fetuses and babies is a very real public health concern in both Gauteng and Mpumalanga. Information is insufficient for adequate surveillance, and improved data collection systems should be prioritised.
Emergency contraception (EC) can be used as a backup contraceptive to help prevent unintended and unplanned pregnancies after unprotected sexual intercourse. These methods include the use of emergency contraceptive pills (ECPs) or copper containing intrauterine devices (IUD). These ECPs should not be used as regular contraception. Mifepristone (not available in South Africa as EC) and levonorgestrel are very effective, with few adverse effects, and are preferred to combined oestrogen and progestogen administration. Levonorgestrel can be used in a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. A Copper IUD can be retained for ongoing contraception. Despite the proven efficacy of ECP, increased access to ECPs enhances use but has not been shown to reduce unintended pregnancy rates at a population level. Further research is needed to explain this finding and to define the best ways to use EC to produce a public health benefit. Efforts should be targeted at vulnerable groups such as adolescents and women presenting for urgent care. At the time of the visit regular contraception should be promoted and initiated.
Unwanted pregnancy (UP), which may lead to unsafe abortion, is common among young women. Unwanted pregnancy can occur due to missed pills, forced sex, method failures, and condom breakage. To prevent such problem, Emergency Contraceptives (EC) are the only method that can be used after unprotected sex. This cross-sectional study has thus aimed at investigating the level of awareness, knowledge and attitudes of young female students of Haramaya University (HU) on EC. The study generated the required data from a representative sample of 572 female students drawn from the study population through multistage sampling. Data were collected using survey questionnaire, and subsequent analysis was done using simple descriptive statistics and multivariate analysis (logistic regression model).The findings of the study revealed that 47.6% of the respondents had ever heard about EC; 25.7 % had good knowledge of EC, and 76.5% had favorable attitude toward EC. In the multivariate analysis, certain variables have become significant predictors of awareness of EC including: age, previous place of residence, religion, grade level, knowing other methods preventing unwanted pregnancy, sex education, chewing 'Khat', and consuming alcohol. Similarly, religion, grade level, father's educational level, knowing other methods of preventing unwanted pregnancy, and currently chewing Khat were found to significantly predict attitude toward EC. Finally, the study has forwarded some recommendations based on the key findings.
Introduction: abortion is one of the most controversial topics at the end of the 20th century and at the beginning of the 21st century. However, this is not a new situation since it has existed in every recognized culture, either primitive or modern, with or without written alphabet. In the last few years, the role of the menstrual regulation to empty the uterus in the early pregnancy has been recognized. Objective: to describe the behavior of the menstrual regulation method in adolescents from the health area of Parraga neighborhood. Methods: an observational, cross-sectional and descriptive study was conducted. The universe of study was 370 female adolescents, who went to the Menstrual Regulation Service in "Parraga" polyclinics. The final sample was made up of 360 patients who were performed the endometrial aspiration method. These patients were followed up for 7 days to observe their recovery. The following variables were under analysis: age, schooling, marital status, obstetric history, use of contraceptive methods and immediate complications. Results: the group of late adolescents with 220 cases predominated. The age of onset of sexual relations was 14 to 17 years, with 249 (69.1 %) adolescents, and the main reason for not using some contraceptive method was they forgot to do it in 183 (50.8 %) cases in this sample. The most frequent complications sere vagal reactions in 54 (15.0 %) patients. Conclusions: a large number of female adolescents turn to menstrual regulation because it is a quicker, safer method than abortion, does not require anesthesia and has no further complications.
Background In South Africa the Choice on Termination of Pregnancy Act (Act 92 of 1996) replaced the Abortion and Sterilization Act (Act No 2 of 1975). The Abortion and Sterilization Act allowed for termination of pregnancy for specific reasons and conditions. The current Act of 1996 allows for termination of pregnancy at the mother's request up until the 12th week of pregnancy and under specific conditions up to and including the 20th week of pregnancy. The existence of legal abortion does not mean that the abortion is safe. An unsafe abortion, also referred to as an illegal abortion, is a procedure to terminate an unwanted pregnancy performed either by individuals lacking the necessary skills or in an environment that does not have basic medical standards, or both. Objectives The objective of this systematic review was to critically appraise, synthesize and present the best available evidence in relation to why women choose to undergo an "illegal" or "unsafe" abortion when abortion is legal and readily available in South Africa. Inclusion criteria Types of participants This systematic review considered any qualitative study where the focus was on pregnant women of childbearing age who have had an illegal abortion and who lived in Southern Africa. Types of intervention(s)/phenomena of interest The phenomena of interest of this review were the reasons why women choose illegal abortions in situations where abortion is freely available. Social and demographic data of participants were extracted from studies where possible. For the purpose of this systematic review, studies that use terms such as "unsafe" abortion, or abortions conducted in "non-medical settings" were considered to be illegal abortions and were considered for inclusion in the review. Types of studies This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. This review also considered non-research papers such as text and opinion-based papers and reports. Types of outcomes Studies that were conducted in public or private health care settings were considered for inclusion in the review. Health care settings may include hospitals, clinics and non-governmental organizations that offer supportive services to women who have had an abortion. Search strategy The following initial key words were used: Childbearing women, illegal abortions, unsafe abortions, backstreet abortions, qualitative research, Southern Africa The following search strategy was undertaken: 1. A limited search of PubMed and CINAHL to identify relevant keywords contained in the title, abstract and subject descriptors 2. Terms identified in this way and the synonyms used by respective databases were used in an extensive search of the literature. Databases searched in this stage included PubMed, CINAHL, SABINET, Scopus, Africa Journal Online, PsychINFO, SocINDEX, SAePublications and Global Health. 3. Reference lists and bibliographies of the articles chosen from those identified in stage 2 were searched. 4. Gray literature identified through reference lists were searched and where African journals of health care were not identified in databases, appropriate hand searching was done. Methodological quality Assessment of methodological data Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI)). Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data collection Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. The data extracted included specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis Qualitative research findings, where possible, were pooled using JBI-QARI. This involved the aggregation or synthesis of findings to generate a set of statements that represented that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorizing these findings on the basis of similarity in meaning (Level 2 findings). These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings (Level 3 findings) that can be used as a basis for evidence-based practice. Results JBI-QARI was used to extract findings relevant to the review question from the two included studies. No text and opinion papers were found. Based on similarity of findings, categories were identified and then used to construct a synthesis. Each finding was graded based on its credibility. Only those findings that provided a direct quote from the participant were classed as unequivocal and were given more weight in the synthesis. There were no findings that were classed as credible or unsupported. The nine findings were grouped into three categories and the latter into one synthesized statement. Conclusions The evidence as to why women choose unsafe or illegal abortions when legal abortions are available is scarce. Current evidence suggests that reasons are multifactorial and complex. Women seek abortions for personal reasons such as wishing to pursue an education, not being financially secure, being afraid of parental and partner response to the news of a pregnancy, and denial of the pregnancy either by the partner or the woman herself.
Unplanned pregnancy is one the most severe public health risk which affects many women all around the world. Surveys indicated among 210 million pregnancies that occur throughout the world each year 38% are unintended. In this cross-sectional study, a sample of 305 female were selected using cluster sampling design from women referred to health centers of Bandar Abbas city where is located in south of Iran. The data was analyzed using chi-square, fisher exact test, odds ratio and multiple logistic regression in SPSS 16. The prevalence of unwanted pregnancy was reported 42.3% in this study. Based on logistic regression, spouse's age, gravidity, experiencing unwanted pregnancy and marriage duration was significant factors on unwanted pregnancy. The results of this study show the importance of improving contraceptive usage among women aged between 20 and 29, which are more vulnerable. Also, using long acting contraceptive methods can prevent unwanted pregnancies among people who use them inconsistently and incorrectly.
The Termination of Pregnancy (TOP) Act in South Africa (SA) allows women to request TOP for social reasons. A retrospective record review was done on all (85) women who were admitted with complications arising from TOP over a 1-year period in 2008, at the Charlottee Maxeke Johannesburg Academic (CMJA) Hospital, SA. The demography, methods and place of TOP, presenting complications and final management was discussed. Morbidity such as severe blood loss (39%), sepsis (26%), multiple organ dysfunctions (4%) and organ injuries (5%) were observed. A correct guideline for TOP was followed in only 33% of women. Self-induced TOP remained common practice. There is a need for accelerated training among healthcare workers providing TOP in SA to prevent this costly and preventable maternal morbidity.
In countries where abortion is illegal, a range of approximate levels of induced abortion can be calculated from data on the number of women hospitalized for treatment of abortion complications, after correcting for underreporting and misreporting and adjusting to eliminate spontaneous abortions. An estimated 550,000 women are hospitalized each year as a result of complications from induced abortion in Brazil, Chile, Colombia, the Dominican Republic, Mexico and Peru. About 2.8 million abortions are estimated to occur in these countries annually when women not hospitalized as a result of induced abortion are taken into account. If the situation in the six countries is assumed to be typical of the entire region, then about 800,000 women are probably hospitalized because of complications of induced abortion in Latin America in a given year, and an estimated four million abortions take place. The abortion rate most likely ranges from 23 abortions per 1,000 women aged 15-49 in Mexico to 52 per 1,000 in Peru, and the absolute number ranges from 82,000 in the Dominican Republic to 1.4 million in Brazil. From 17% of pregnancies in Mexico to 35% in Chile are estimated to end in induced abortion.
Although research on reproductive behavior depends heavily on information from surveys, abortions are characteristically underreported in such data. Estimates of the level of reporting are made for each of the recent major surveys of U.S. women: the 1976, 1982, and 1988 cycles of the National Survey of Family Growth, the 1976 and 1979 National Surveys of Young Women, and the National Longitudinal Surveys of Work Experience of Youth. The estimates are based on comparisons with external counts of abortions taking place. We examine variation by characteristics of women, trends over time, and the possible effects of length of recall and of the way in which questions about abortion are asked. Abortion reporting is found to be highly deficient in all the surveys, although the level varies widely. Whites are more likely to report their abortions than nonwhites. Special, confidential questioning procedures hold promise for improving the results.
This article describes a study designed to test a method for assessing the cost to the health services of illegally induced abortion and the feasibility of estimating the incidence of induced abortion by a field interviewing approach. The participating centers included three hospitals in Ankara, Turkey; three hospitals in Ibadan, Nigeria; one hospital in Caracas and one in Valencia, Venezuela; and two hospitals in Kuala Lumpur, Malaysia.
Hospitalized abortion cases were classified as induced or spontaneous or as “probably induced,” “possibly induced,” or “unknown” according to a classification scheme comprising certain medical criteria. The sociodemographic characteristics of induced and spontaneous abortion cases were subjected to discriminant function analysis and the discriminating variables best characterizing the induced versus the spontaneous abortion groups were identified for each center. On the basis of this analysis, the “probably” and “possibly” induced and “unknown” categories were further classified as induced or spontaneous abortion, with stated probabilities. Thus an overall estimate is made of the proportion of all hospitalized abortions that can be considered illegally induced outside the hospital. Selected results on costs of induced and spontaneous abortion are shown.
The method further tested the feasibility of obtaining valid survey data on abortion from the communities studied by re-interviewing the women hospitalized for induced and spontaneous abortion six months later in their homes. This exercise showed a degree of under-reporting of abortion that varied widely among centers, even among women who had admitted illegal induction at the time of hospitalization. The feasibility of estimating the incidence of illegal abortion by field studies is discussed in the light of these findings.
Data regarding spontaneous abortion are more easily obtained retrospectively than prospectively. However, the comparable quality of data obtained by these two approaches is not known. Retrospective data are difficult to validate because spontaneous abortions are not routinely documented. In this study, the quality of retrospective data was evaluated by comparing them with prospective data collected incidentally in a long-term study of menstrual cycles. A total of 348 women recorded one or more spontaneous abortions while participating in the Menstrual and Reproductive Health Study and were resurveyed regarding their pregnancy histories. Seventy-five per cent of recorded abortions were recalled. Gestational age at time of abortion was the major determinant of recall, with early abortions less often remembered. Time since abortion also affected recall, but less so. Other factors such as parity or maternal age were not related to completeness of recall. Recall of three fourths of recorded abortions among this group of women sensitized to their reproductive functions probably represents an upper limit of recall for other populations. While retrospective abortion data often are more accessible than medical records or prospective data, there may be limits to the usefulness of recalled abortion data in certain settings.
Abortion, fertility and changing legislation: an international review
- J Van Der Tak
Aborto incompleto: caracteristicas de las pacientes tratadas en el Hospital O'Horan de Merida, Yucatan. Salud Pública de México
- T E Canto De Cetina