351
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Shaaban OM, Fathalla MM, Shahin AY, Nasr A. Emergency contraception in the context of marriage in Upper Egypt. Int J Gynaecol Obstet 2011; 112:195-9. [DOI: 10.1016/j.ijgo.2010.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 09/08/2010] [Accepted: 11/29/2010] [Indexed: 11/30/2022]
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352
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Szarewski A, Mansour D, Shulman LP. 50 years of "The Pill": celebrating a golden anniversary. ACTA ACUST UNITED AC 2010; 36:231-8. [PMID: 21067639 DOI: 10.1783/147118910793048665] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The past 50 years have seen great advances in combined oral contraceptives (COCs) that have resulted in reduced risks of adverse events and improved cycle control. The most important changes in COCs over time include repeated lowering of the estrogen dose, development of new progestogens, and the reduction or elimination of the pill-free interval. Most recently, formulations that deliver estradiol in lieu of ethinylestradiol have been introduced. The advantages of COCs generally far outweigh the disadvantages. Current options in oral contraception include a wide spectrum of products that enable clinicians to choose the most appropriate formulation for individual women. This article summarises the advances in oral contraceptives over time and describes the most current clinical data regarding the use of COCs.
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Affiliation(s)
- Anne Szarewski
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London, UK.
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353
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Camargo RS, Santana DS, Cecatti JG, Pacagnella RC, Tedesco RP, Melo EF, Sousa MH. Severe maternal morbidity and factors associated with the occurrence of abortion in Brazil. Int J Gynaecol Obstet 2010; 112:88-92. [DOI: 10.1016/j.ijgo.2010.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 08/13/2010] [Accepted: 10/27/2010] [Indexed: 11/17/2022]
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354
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Silva DFDO, Bedone AJ, Faúndes A, Fernandes AMDS, Moura VGADLE. Aborto provocado: redução da frequência e gravidade das complicações. Consequência do uso de misoprostol? REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2010. [DOI: 10.1590/s1519-38292010000400004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: verificar a frequência e a gravidade das complicações por abortos provocados e suas possíveis associações com o uso de misoprostol. MÉTODOS: estudo de corte transversal. Durante dez meses aplicou-se uma lista de verificação (critérios da World Health Organization) a todas as 543 mulheres internadas por aborto em dois hospitais na cidade de Campinas, São Paulo. Àquelas classificadas como aborto possível, provável ou certamente provocado foi aplicado também um questionário. RESULTADOS: dentre todas as mulheres internadas, 259 (48%) foram classificadas como aborto possível, provável ou certamente induzido e responderam ao questionário; 25 mulheres declararam a indução do aborto e, destas, nove referiram uso de misoprostol. Complicações infecciosas e hemorrágicas ocorreram respectivamente em 10% e 13% das 259 mulheres. As que usaram misoprostol se complicaram menos que as que usaram outros métodos, porém essa diferença não foi estatisticamente significativa, talvez pela baixa freqüência de complicações. CONCLUSÕES: os dados mostram redução da freqüência e da gravidade das complicações do aborto, mas não permitem avaliar o papel do misoprostol.
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Affiliation(s)
| | | | - Aníbal Faúndes
- Centro de Pesquisas em Saúde Reprodutiva de Campinas, Brasil
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355
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Oral misoprostol as an alternative to surgical management for incomplete abortion in Ghana. Int J Gynaecol Obstet 2010; 112:40-4. [PMID: 21122848 DOI: 10.1016/j.ijgo.2010.08.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/24/2010] [Accepted: 10/29/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether 600-μg oral misoprostol is an effective alternative to manual vacuum aspiration (MVA) for the treatment of incomplete abortion. METHODS From June 16, 2004, to July 20, 2005, 230 women of reproductive age presenting with incomplete abortion were randomized in an open-label trial to either 600-μg oral misoprostol or MVA for the treatment of incomplete abortion. RESULTS Regardless of the assigned method, more than 98% of participants experienced complete uterine evacuation following initial treatment. Efficacy, acceptability, and satisfaction ratings were similar and high for both methods. CONCLUSION 600-μg oral misoprostol is a safe, effective, and acceptable alternative to MVA for the treatment of incomplete abortion.
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356
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Somigliana E, Sabino A, Schrettenbrunner C, Nkurunziza R, Okello E, Manenti F. A comprehensive and integrated project to improve reproductive health at Oyam district, northern Uganda: insights from maternal death review at the district hospital. Arch Gynecol Obstet 2010; 283:645-9. [PMID: 21113718 DOI: 10.1007/s00404-010-1780-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/12/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To perform a district hospital-based maternal death review aimed at assessing the benefits and limits of an integrated and comprehensive project for reproductive health in Oyam district, northern Uganda. METHODS From April 01, 2009 to March 31, 2010, all cases of maternal death occurring in the hospital were prospectively recorded using a specific questionnaire. A clinical review of these maternal deaths was systematically done. The hospital is located in a rural area and it offers the possibility to perform cesarean sections, obstetrics ultrasounds, and blood transfusions. No emergency room and pathological services are available. RESULTS Seventeen cases were recorded. Thirteen (76%) were classified as direct obstetrics deaths (post-partum hemorrhagia in five cases, unsafe abortion in five cases, eclampsia in two cases and ante-partum hemorrhagia for placenta previa in one case). The remaining cases (n = 4, 24%) were indirect obstetrics deaths (meningitis HIV-related in two cases, cardiopathy in one case and cerebral malaria in one case). An important negligence of the health staff of the health centers was evident in three cases. The availability of an emergency room service was estimated to potentially prevent death in six cases. CONCLUSIONS Three main targets for future interventions were identified: improving the quality of assistance in the health centers, implementing an emergency room service in the hospital and counteract unsafe abortion.
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357
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de Kok B, Hussein J, Jeffery P. Joining-up thinking: Loss in childbearing from inter-disciplinary perspectives. Soc Sci Med 2010; 71:1703-10. [DOI: 10.1016/j.socscimed.2010.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 11/26/2022]
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358
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da Ramos KS, Ferreira ALCG, de Souza AI. [Women hospitalized due to abortion in a maternity teaching hospital in Recife, Brazil]. Rev Esc Enferm USP 2010; 44:605-10. [PMID: 20964034 DOI: 10.1590/s0080-62342010000300008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study was performed with 160 women between 2005-2006. The objective was to describe the social-demographic and reproductive characteristics of women hospitalized due to abortions, and their knowledge about contraceptive methods and abortion induction. In order to determine the association between the abortion classification and social-demographic variables, Pearson's chi-square test was used, with a significance level of 5%. A frequency of 56.3% was found for probably induced abortions. Most cases of abortion occurred before 12 weeks (55.7%). As for the women's profiles: 48.9% were between 20-29 years old, 72.0% had eight years or more of schooling, 90.1% had a partner, 52.0% had 1-3 children, 100% knew about oral contraceptives and condoms and 80.0% had heard about misoprostol. The social-demographic and reproductive profile of women hospitalized at the referred service due to abortion did not change over the last years. Misoprostol remains the most known method for abortion induction.
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359
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Baggaley RF, Burgin J, Campbell OMR. The potential of medical abortion to reduce maternal mortality in Africa: what benefits for Tanzania and Ethiopia? PLoS One 2010; 5:e13260. [PMID: 20948995 PMCID: PMC2952582 DOI: 10.1371/journal.pone.0013260] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 09/15/2010] [Indexed: 01/23/2023] Open
Abstract
Background Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. Methods By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios) and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. Results Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia). Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. Conclusions This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.
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Affiliation(s)
- Rebecca F Baggaley
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
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360
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Reis BY, Brownstein JS. Measuring the impact of health policies using Internet search patterns: the case of abortion. BMC Public Health 2010; 10:514. [PMID: 20738850 PMCID: PMC2936430 DOI: 10.1186/1471-2458-10-514] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 08/25/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internet search patterns have emerged as a novel data source for monitoring infectious disease trends. We propose that these data can also be used more broadly to study the impact of health policies across different regions in a more efficient and timely manner. METHODS As a test use case, we studied the relationships between abortion-related search volume, local abortion rates, and local abortion policies available for study. RESULTS Our initial integrative analysis found that, both in the US and internationally, the volume of Internet searches for abortion is inversely proportional to local abortion rates and directly proportional to local restrictions on abortion. CONCLUSION These findings are consistent with published evidence that local restrictions on abortion lead individuals to seek abortion services outside of their area. Further validation of these methods has the potential to produce a timely, complementary data source for studying the effects of health policies.
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Affiliation(s)
- Ben Y Reis
- Children's Hospital Informatics Program, Harvard-MIT Division of Health Sciences and Technology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
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361
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Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev 2010; 32:152-74. [PMID: 20570955 PMCID: PMC3115338 DOI: 10.1093/epirev/mxq012] [Citation(s) in RCA: 241] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2010] [Indexed: 01/09/2023] Open
Abstract
Family planning is hailed as one of the great public health achievements of the last century, and worldwide acceptance has risen to three-fifths of exposed couples. In many countries, however, uptake of modern contraception is constrained by limited access and weak service delivery, and the burden of unintended pregnancy is still large. This review focuses on family planning's efficacy in preventing unintended pregnancies and their health burden. The authors first describe an epidemiologic framework for reproductive behavior and pregnancy intendedness and use it to guide the review of 21 recent, individual-level studies of pregnancy intentions, health outcomes, and contraception. They then review population-level studies of family planning's relation to reproductive, maternal, and newborn health benefits. Family planning is documented to prevent mother-child transmission of human immunodeficiency virus, contribute to birth spacing, lower infant mortality risk, and reduce the number of abortions, especially unsafe ones. It is also shown to significantly lower maternal mortality and maternal morbidity associated with unintended pregnancy. Still, a new generation of research is needed to investigate the modest correlation between unintended pregnancy and contraceptive use rates to derive the full health benefits of a proven and cost-effective reproductive technology.
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Affiliation(s)
- Amy O Tsui
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W4041, Baltimore, MD 21205, USA.
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362
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Preventing infective complications relating to induced abortion. Best Pract Res Clin Obstet Gynaecol 2010; 24:539-49. [PMID: 20542471 DOI: 10.1016/j.bpobgyn.2010.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/12/2010] [Accepted: 03/30/2010] [Indexed: 11/21/2022]
Abstract
Infective complications following induced abortions are still a common cause of morbidity and mortality. This review focusses on defining the strategies to improve care of women seeking an induced abortion and to reduce infective complications. We have considered the evidence for screening and cost-effectiveness for antibiotic prophylaxis. Current evidence suggests that treating all women with prophylactic antibiotics in preference to screening and treating is the most cost-effective way of reducing infective complications following induced abortions. The final strategy to prevent infective complications should be individualized for each region/area depending on the prevalence of organisms causing pelvic infections and the resources available.
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363
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Unintended pregnancy in the amazon basin of Ecuador: a multilevel analysis. Int J Equity Health 2010; 9:14. [PMID: 20525237 PMCID: PMC2894842 DOI: 10.1186/1475-9276-9-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 06/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been estimated that each year 80 million women in the world experience an unintended pregnancy. In Ecuador, recent research has revealed that 36.3% of total births are unintended; the research also details significant geographical, ethnic and socioeconomic variations. These studies focused on individual risk factors and were based on large national surveys where local samples, particularly from rural remote areas, were small. The purpose of this study was to investigate the influence of contextual and individual factors on unintended pregnancies in the Amazon Basin of Ecuador. METHODS Women aged 15-44 were selected through an ongoing community-based cross-sectional survey conducted in the Orellana province between May and December 2006. Data were fitted using multilevel logistic regression, adjusting for both individual-level and community-level factors as fixed effects and allowing for heterogeneity between communities. RESULTS The overall prevalence of unintended pregnancy was 62.7%. Two-thirds (73.7%) of indigenous women reported having had at least one unintended pregnancy. Being young, single, and indigenous were significant risk factors for unintended pregnancy, alongside having low access to education and having more than two children. No relationship was found between socioeconomic status and the use of contraceptives. All the variation between communities was explained by individual-level factors. CONCLUSIONS This study showed the significance of individual factors in increasing the risk of unintended pregnancy, while the role of community factors was found to be negligible. In order for all women to be able to realize their right to reproductive autonomy, there needs to be a diverse range of solutions, with particular attention paid to cultural issues.
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364
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Ngwena CG. Protocol to the African Charter on the Rights of Women: implications for access to abortion at the regional level. Int J Gynaecol Obstet 2010; 110:163-6. [PMID: 20546748 DOI: 10.1016/j.ijgo.2010.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Article 14(2)(c) of the Protocol to the African Charter on the Rights of Women enjoins States Parties to take appropriate measures "to protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus." This paper considers the implications of Article 14 for access to safe, legal abortion. It is submitted that Article 14 has the potential to impact positively on regional abortion law, policy, and practice in 3 main areas. First, it takes forward the global consensus on combating abortion as a major public health danger. Second, it provides African countries with not just an incentive, but also an imperative for reforming abortion laws in a transparent manner. Third, if implemented in the context of a treaty that centers on the equality and non-discrimination of women, Article 14 has the potential to contribute toward transforming access to abortion from a crime and punishment model to a reproductive health model.
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Affiliation(s)
- Charles G Ngwena
- Department of Constitutional Law, University of the Free State, Bloemfontein, South Africa.
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365
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Prata N, Passano P, Sreenivas A, Gerdts CE. Maternal mortality in developing countries: challenges in scaling-up priority interventions. ACTA ACUST UNITED AC 2010; 6:311-27. [PMID: 20187734 DOI: 10.2217/whe.10.8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.
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Affiliation(s)
- Ndola Prata
- University of California, Berkeley, School of Public Health, Berkeley, CA 94720-6390, USA.
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366
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Ferreira ALCG, Souza AI, Lima RA, Braga C. Choices on contraceptive methods in post-abortion family planning clinic in the northeast Brazil. Reprod Health 2010; 7:5. [PMID: 20459754 PMCID: PMC2883537 DOI: 10.1186/1742-4755-7-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 05/10/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Brazil, a Ministry of Health report revealed women who underwent an abortion were predominantly in the use of contraceptive methods, but mentioned inconsistent or erroneously contraceptive use. Promoting the use of contraceptive methods to prevent unwanted pregnancies is one of the most effective strategies to reduce abortion rates and maternal morbidity and mortality. Therefore, providing post-abortion family planning services that include structured contraceptive counseling with free and easy access to contraceptive methods can be suitable. So the objective of this study is to determine the acceptance and selection of contraceptive methods followed by a post-abortion family planning counseling. METHODS A cross-sectional study was carried out from July to October 2008, enrolling 150 low income women to receive post-abortion care at a family planning clinic in a public hospital located in Recife, Brazil. The subjects were invited to take part of the study before receiving hospital leave from five different public maternities. An appointment was made for them at a family planning clinic at IMIP from the 8th to the 15th day after they had undergone an abortion. Every woman received information on contraceptive methods, side effects and fertility. Counseling was individualized and addressed them about feelings, expectations and motivations regarding contraception as well as pregnancy intention. RESULTS Of all women enrolled in this study, 97.4% accepted at least one contraceptive method. Most of them (73.4%) had no previous abortion history. Forty of the women who had undergone a previous abortion, 47.5% reported undergoing unsafe abortion. Slightly more than half of the pregnancies (52%) were unwanted. All women had knowledge of the use of condoms, oral contraceptives and injectables. The most chosen method was injectables, followed by oral contraceptives and condoms. Only one woman chose an intrauterine device. CONCLUSION The acceptance rate of post-abortion contraceptive methods was greater and the most chosen method was the best-known one. Implementing a specialized family planning post abortion service may promote an acceptance, regardless of the chosen method. Most important is they do receive contraception if they do not wish for an immediate pregnancy.
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Affiliation(s)
- Ana Laura CG Ferreira
- Instituto de Medicina Integral Prof Fernando Figueira (IMIP) - Research Department - Rua dos Coelhos, 300 Boa Vista 50.070-550, Recife, Brazil
| | - Ariani I Souza
- Instituto de Medicina Integral Prof Fernando Figueira (IMIP) - Research Department - Rua dos Coelhos, 300 Boa Vista 50.070-550, Recife, Brazil
| | - Raitza A Lima
- Instituto de Medicina Integral Prof Fernando Figueira (IMIP) - Research Department - Rua dos Coelhos, 300 Boa Vista 50.070-550, Recife, Brazil
| | - Cynthia Braga
- Instituto de Medicina Integral Prof Fernando Figueira (IMIP) - Research Department - Rua dos Coelhos, 300 Boa Vista 50.070-550, Recife, Brazil
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367
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Mbizvo MT, Zaidi S. Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): the case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions. Int J Gynaecol Obstet 2010; 110 Suppl:S3-6. [PMID: 20451907 DOI: 10.1016/j.ijgo.2010.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The new target for achieving universal access to reproductive health was integrated within the revised Millennium Development Goal framework in October 2008, following reaffirmation of this ICPD goal at the 2005 World Summit. To achieve this goal, the Alliance for Women's Health identified 3 issues needing urgent attention: (1) adolescent sexual and reproductive health; (2) unsafe abortions and related mortality and morbidity; and (3) HIV prevention and care. These themes were discussed in Cape Town at the FIGO 2009 Precongress Workshop convened by the Alliance. The critical gaps identified by the Workshop included: the lack of information on sexual and reproductive health (SRH) issues for adolescents, such as safe sexual practices, contraception, risks related to early childbearing; unsafe abortion and its adverse consequences; and inadequate linkages between sexual and reproductive health and HIV interventions that result in missed opportunities for addressing both. Recommendations included the use of innovative information dissemination techniques, ensuring access to family planning and comprehensive abortion care to the full extent allowed by national laws, in accordance with FIGO and WHO guidelines, and promotion of universal HIV counseling and testing with opt-out strategies within SRH services and information on SRH in all HIV services.
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Affiliation(s)
- Michael Takura Mbizvo
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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368
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Role of induced abortion in attaining reproductive goals in Kyrgyzstan: a study based on KRDHS-1997. J Biosoc Sci 2010; 42:477-92. [PMID: 20350342 DOI: 10.1017/s002193201000009x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Estimates indicate that about 42 million pregnancies are voluntarily terminated every year at the global level, of which more than 80% occur in developing countries. Abortion has been one of the major reproductive health concerns in post-Soviet nations, especially when it is commonly used as a means of fertility regulation. On average, every woman has had around 1.6 abortions in Kyrgyzstan. This paper attempts to measure the role of abortion in fertility regulation using data from the Kyrgyz Republic Demographic and Health Survey (KRDHS), 1997. The analysis reveals that Kyrgyzstan can attain replacement level fertility in the absence of induced abortion by raising the contraceptive prevalence to 70% at the current level of effectiveness. The study also shows that women's attitude towards becoming pregnant and their partner's perception about abortion are significantly associated with the propensity to opt for an induced abortion. Reproductive health programmes need to address these issues, including the enhancement of male involvement in family planning.
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369
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Hill ZE, Tawiah-Agyemang C, Kirkwood B. The context of informal abortions in rural Ghana. J Womens Health (Larchmt) 2010; 18:2017-22. [PMID: 20044865 DOI: 10.1089/jwh.2008.1123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This qualitative study explores the context of unsafe abortion in rural Ghana with the aim of identifying areas that should be considered when operationalizing abortion-related reproductive health strategies. METHODS Data come from eleven narratives about planned or attempted abortions and seven narratives of abortion-related deaths. These individual data are supplemented by data from ten focus group discussions. RESULTS Communities describe abortions as dangerous and, if they become public knowledge, shameful. Despite this, abortions were understood as necessary for some women in some situations, but secrecy was paramount. Women carefully chose their confidants based on the anticipated reaction and did so for advice about cheap and effective methods or for financial assistance. Complications were usually managed at home. When complications were taken to the health facility, the abortion was often not disclosed. Women reported trying sequential abortion methods, starting with cheaper milder methods and, if these attempts failed, resorting to harsher more expensive methods. Access to pharmaceuticals and finances also determined the method used. Financial hardship, interruption of education, and being unmarried were the most frequently cited reasons for abortions. CONCLUSIONS Unsafe abortion is an important public health issue in Ghana. Current strategies to reduce abortion-related deaths include increasing the provision of safe abortion services. For the strategy to be successful, services should be accessible, affordable, and confidential, and discourse with communities and health workers to break the public silence about abortion is needed.
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Affiliation(s)
- Zelee Elizabeth Hill
- Centre for International Health and Development, Institute of Child Health, and University College London, UK.
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370
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Abstract
Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where infection-related tubal damage is the commonest cause. Most infections causing tubal damage are preventable and assisted conception can treat the infertility. However, assisted conception, despite being available for nearly three decades is either unavailable or inaccessible to most residents of resource poor countries. Infertility has social, economic and personal effects, which go beyond childlessness, and women bear the major brunt of the burden. There is urgent need for a comprehensive sexual and reproductive healthcare initiative involving maternal and child health, safe abortions, family planning and infertility prevention and management. The provision of low cost assisted reproduction for couples in poorly resourced countries also needs to be revisited.
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Affiliation(s)
- S Sharma
- Southport and Ormskirk NHS Trust, Southport, UK.
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371
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Sousa A, Lozano R, Gakidou E. Exploring the determinants of unsafe abortion: improving the evidence base in Mexico. Health Policy Plan 2009; 25:300-10. [PMID: 20008904 DOI: 10.1093/heapol/czp061] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the realized importance of unsafe abortion as a global health problem, reliable data are difficult to obtain, especially in countries where abortion is illegal. Estimates for most developing countries are based on limited and incomplete sources of data. In Mexico, studies have been undertaken to improve estimates of induced abortion but the determinants of unsafe abortion have not been explored. METHODS We analysed data from the 2006 Mexican National Demographic Survey. The sample comprises 14 859 reported pregnancies in women between 15 and 55 years old, of which 966 report having had an abortion in the 5 years preceding the survey. We use logistic regression to explore the relationship between unsafe abortion and various socio-economic and demographic characteristics. FINDINGS We estimate that 44% of abortions have been induced and 16.5% of those were unsafe. We find three variables to be positively and significantly associated with the probability of having an induced abortion: (1) whether the woman reported that the pregnancy was mistimed (OR = 4.5, 95% CI = 1.95-10.95); (2) whether the woman reported that the pregnancy was unwanted (OR = 2.86, 95% CI = -1.40-5.88); and (3) if the woman had three or more children at the time of the abortion (OR = 3.73, 95% CI = 1.20-11.65). There is a steep socio-economic gradient in the probability of having an unsafe abortion: poorer women are more likely to have an unsafe abortion than richer women (OR = 2.48, 95% CI = 1.09-5.63); women with 6-9 years of education (OR = 0.30, 95% CI = 0.11-0.81) and with more than 13 years of education are less likely to have an unsafe abortion (OR = 0.065, 95% CI = 0.01-0.43), and women with indigenous origin are more likely to have an unsafe abortion (OR = 5.44, 95% CI = 1.91-15.51). Thus, the probability for poor women with less than 5 years of education and indigenous origin is nine times higher compared with rich, educated and not indigenous women. We also find marked geographical inequities as women living in the poorest states have a higher risk of having an unsafe abortion. INTERPRETATION This analysis has explored the determinants of unsafe abortion and has demonstrated that there are large socio-economic and geographical inequities in unsafe abortions in Mexico. Further efforts are required to improve the measurement and monitoring of trends in unsafe abortions in developing countries.
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Affiliation(s)
- Angelica Sousa
- Harvard Initiative for Global Health, Cambridge, MA 02138, USA.
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372
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Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study. BMC Public Health 2009; 9:462. [PMID: 20003411 PMCID: PMC2801510 DOI: 10.1186/1471-2458-9-462] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 12/14/2009] [Indexed: 11/24/2022] Open
Abstract
Background Maternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and women's rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries. Methods An ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP. Results Maternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health. Conclusions Education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others.
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Affiliation(s)
- Jose Luis Alvarez
- Area of Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain.
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373
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Makuch MY, Petta CA, Osis MJD, Bahamondes L. Low priority level for infertility services within the public health sector: a Brazilian case study. Hum Reprod 2009; 25:430-5. [DOI: 10.1093/humrep/dep405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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374
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HIV disease progression by hormonal contraceptive method: secondary analysis of a randomized trial. AIDS 2009; 23:1377-82. [PMID: 19448528 DOI: 10.1097/qad.0b013e32832cbca8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-infected women need access to safe contraception. We hypothesized that women using depomedroxyprogesterone acetate (DMPA) contraception would have faster HIV disease progression than women using oral contraceptive pills (OCPs) and nonhormonal methods. METHODS In a previously reported trial, we randomized 599 HIV-infected women to the intrauterine device (IUD) or hormonal contraception. Women randomized to hormonal contraception chose between OCPs and DMPA. This analysis investigates the relationship between exposure to hormonal contraception and HIV disease progression [defined as death, becoming eligible for antiretroviral therapy (ART), or both]. RESULTS Of the 595 women not on ART at the time of randomization, 302 were allocated to hormonal contraception, of whom 190 (63%) initiated DMPA and 112 (37%) initiated OCPs. Women starting IUD, OCPs, or DMPA were similar at baseline. Compared with women using the IUD, the adjusted hazard of death was not significantly increased among women using OCPs [1.24; 95% confidence interval (CI) 0.42-3.63] or DMPA (1.83; 95% CI 0.82-4.08). However, women using OCPs (adjusted hazard ratio (AHR) 1.69; 95% CI 1.09-2.64) or DMPA (AHR 1.56; 95% CI 1.08-2.26) trended toward an increased likelihood of becoming eligible for ART. Women exposed to OCPs (AHR 1.67; 95% CI 1.10-2.51) and DMPA (AHR 1.62; 95% CI 1.16-2.28) also had an increased hazard of meeting our composite disease progression outcome (death or becoming ART eligible) than women using the IUD. CONCLUSION In this secondary analysis, exposure to OCPs or DMPA was associated with HIV disease progression among women not yet on ART. This finding, if confirmed elsewhere, would have global implications and requires urgent further investigation.
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375
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Rasch V, Kipingili R. Unsafe abortion in urban and rural Tanzania: method, provider and consequences. Trop Med Int Health 2009; 14:1128-33. [PMID: 19573141 DOI: 10.1111/j.1365-3156.2009.02327.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe unsafe abortion methods and associated health consequences in Tanzania, where induced abortion is restricted by law but common and known to account for a disproportionate share of hospital admissions. METHOD Cross-sectional study of women admitted with alleged miscarriage: 278 in rural Tanzania and 473 in urban Tanzania. Women who had undergone a clandestinely induced abortion were identified by an empathetic approach and interviewed in detail about the procedure. Information about complications was obtained from the patient file. RESULTS Sixty-two per cent in rural Tanzania and 63% in urban Tanzania stated that they had had an unsafe induced abortion. The abortion had been induced by an unskilled provider in 46% of rural women and 60% of urban women. Herbs and roots had commonly been used for induction, in 42% of rural and 54% of urban women. The method most often associated with abortion complications was catheter/roots, whereas the method least often associated with complications was herbs. CONCLUSION The large number of women identified as having had unsafe abortion together with the prevalent use of herbs calls for attention.
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Affiliation(s)
- Vibeke Rasch
- Department of International Health, Immunology & Microbiology, University of Copenhagen, Copenhagen K, Denmark.
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376
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Reproductive healthcare systems should include accessible infertility diagnosis and treatment: an important challenge for resource-poor countries. Int J Gynaecol Obstet 2009; 106:168-71. [PMID: 19535067 DOI: 10.1016/j.ijgo.2009.03.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infertility is a central issue in the lives of many couples who suffer from it. In resource-poor countries the problem of childlessness is even more pronounced compared with Western societies owing to different sociocultural circumstances. It often leads to severe psychological, social, and economic suffering, and access to infertility treatment is often limited to certain procedures and certain costumers. The issue of infertility in resource-poor countries is underestimated and neglected, not only by local governments but also by the international nonprofit organizations. Simplification of the diagnostic and therapeutic procedures, minimizing the complication rate, and incorporating fertility centers into existing reproductive healthcare programs are essential measures to take in resource-poor countries if infertility treatment is to be accessible for a large part of the population. For reasons of social justice, a search for strategies to implement simplified methods of infertility diagnosis and treatment in resource-poor countries is urgently warranted.
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377
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Yarnall J, Swica Y, Winikoff B. Non-physician clinicians can safely provide first trimester medical abortion. REPRODUCTIVE HEALTH MATTERS 2009; 17:61-9. [DOI: 10.1016/s0968-8080(09)33445-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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378
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McDougall J, Fetters T, Clark KA, Rathavy T. Determinants of Contraceptive Acceptance Among Cambodian Abortion Patients. Stud Fam Plann 2009; 40:123-32. [DOI: 10.1111/j.1728-4465.2009.00195.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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379
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Hu D, Grossman D, Levin C, Blanchard K, Goldie SJ. Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City. BJOG 2009; 116:768-79. [DOI: 10.1111/j.1471-0528.2009.02142.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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380
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Plummer ML, Wamoyi J, Nyalali K, Mshana G, Shigongo ZS, Ross DA, Wight D. Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people's beliefs and practices. Stud Fam Plann 2009; 39:281-92. [PMID: 19248715 DOI: 10.1111/j.1728-4465.2008.00175.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The World Health Organization estimates that 3.1 percent of East African women aged 15-44 have undergone unsafe abortions. This study presents findings regarding abortion practices and beliefs among adolescents and young adults in Tanzania, where abortion is illegal. From 1999 to 2002, six researchers carried out participant observation in nine villages and conducted group discussions and interviews in three others. Most informants opposed abortion as illegal, immoral, dangerous, or unacceptable without the man's consent, and many reported that ancestral spirits killed women who aborted clan descendants. Nonetheless, abortion was widely, if infrequently, attempted, by ingestion of laundry detergent, chloroquine, ashes, and specific herbs. Most women who attempted abortion were young, single, and desperate. Some succeeded, but they experienced opposition from sexual partners, sexual exploitation by practitioners, serious health problems, social ostracism, and quasi-legal sanctions. Many informants reported the belief that inopportune pregnancies could be suspended for months or years using traditional medicine. We conclude that improved reproductive health education and services are urgently needed in rural Tanzania.
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Affiliation(s)
- Mary L Plummer
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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381
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Tilley IB, Shaaban OM, Wilson M, Glasier A, Mishell DR. Breastfeeding and contraception use among women with unplanned pregnancies less than 2 years after delivery. Int J Gynaecol Obstet 2009; 105:127-30. [PMID: 19232605 DOI: 10.1016/j.ijgo.2009.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 12/17/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine breastfeeding and contraceptive use after the lactational amenorrhea method (LAM) criteria were no longer met. METHODS Two hundred and thirty-three parous Egyptian women with unplanned pregnancies less than 2 years after delivery completed a questionnaire examining breastfeeding practice and contraceptive use. RESULTS The majority of women (81.5%) with unplanned pregnancies within 2 years of delivery were breastfeeding at conception. Of these women, 36.3% had used a method of contraception other than LAM compared with 60.5% of women who had weaned (P<0.05). Among the breastfeeding women, 61.2% failed to use contraception because they believed breastfeeding would prevent pregnancy. CONCLUSION Breastfeeding women with unplanned pregnancies were less likely to have used contraception than women who had weaned, suggesting that prolonged breastfeeding contributes to unmet contraceptive need.
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Affiliation(s)
- Ian B Tilley
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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382
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Turner KL, Hyman AG, Gabriel MC. Clarifying values and transforming attitudes to improve access to second trimester abortion. REPRODUCTIVE HEALTH MATTERS 2009; 16:108-16. [PMID: 18772091 DOI: 10.1016/s0968-8080(08)31389-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Access to safe second trimester abortion services is poor in many countries, sometimes despite liberal laws and policies. Addressing the myriad factors hindering access to safe abortion care requires a multi-pronged strategy. Workshops aimed at clarifying values are useful for addressing barriers to access stemming from misinformation, stigmatization of women and providers, and negative attitudes and obstructionist behaviours. They engage health care providers and administrators, policymakers, community members and others in a process of self-examination with the goal of transforming abortion-related attitudes and behaviours in a direction supportive of women seeking abortion. This is especially important for women seeking second trimester abortion, which tends to be even more stigmatized than first trimester abortion. This paper reports on some promising experiences and results from workshops in Viet Nam, Nepal and South Africa. Some recommendations that emerge are that values clarification should be included in abortion training, service delivery and advocacy programmes. Evaluations of such interventions are also needed.
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383
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Silva RDSE, Vieira EM. Frequency and characteristics of induced abortion among married and single women in São Paulo, Brazil. CAD SAUDE PUBLICA 2009; 25:179-87. [DOI: 10.1590/s0102-311x2009000100019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 11/23/2007] [Indexed: 11/21/2022] Open
Abstract
This article presents the results of a study in the city of São Paulo, Brazil, aimed at estimating the frequency of induced abortion among women 15 to 49 years of age. The objective was to characterize the occurrence of induced abortion by comparing the ideal number of children, age, and contraceptive use between married and single women. Based on random sampling, 1,749 interviews were held, including 764 married women, 658 single women, and 327 with other marital status. The analysis included: mean number of abortions per woman by analysis of variance and proportions of abortions and pregnancy, using the chi-square test. The mean abortion rate for married women (45 per thousand) did not differ statistically from that of single women. However, the pregnancy rate was much lower in single women, and when single women became pregnant they used abortion more frequently; while fewer than 2% of pregnancies in married women ended in induced abortions, among single women the abortion rate exceeded 18%. Therefore, the priority in the reproductive health field should be to invest in the supply and dissemination of appropriate contraceptive methods for women's early sexually active life.
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384
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Gebrehiwot Y, Liabsuetrakul T. Trends of abortion complications in a transition of abortion law revisions in Ethiopia. J Public Health (Oxf) 2008; 31:81-7. [DOI: 10.1093/pubmed/fdn068] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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385
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Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008; 14:605-21. [PMID: 18820005 PMCID: PMC2569858 DOI: 10.1093/humupd/dmn042] [Citation(s) in RCA: 347] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries. METHODS Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of 'affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'. RESULTS The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes. CONCLUSIONS Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels.
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Affiliation(s)
- Willem Ombelet
- Department of Obstetrics and Gynaecology, Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium.
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386
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Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann 2008; 39:18-38. [PMID: 18540521 DOI: 10.1111/j.1728-4465.2008.00148.x] [Citation(s) in RCA: 586] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article provides a critical review of studies assessing the effects of unintended pregnancy on the health of infants, children, and parents in developed and developing countries. A framework for determining and measuring the pathways between unintended pregnancy and future health outcomes is outlined. The review highlights persistent gaps in the literature, indicating a need for more studies in developing countries and for further research to assess the impact of unintended pregnancy on parental health and long-term health outcomes for children and families. The challenges in measuring and assessing these health impacts are also discussed, highlighting avenues in which further research efforts could substantially bolster existing knowledge.
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Affiliation(s)
- Jessica D Gipson
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe Street, Room E4008, Baltimore, MD 21205, USA.
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387
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Fetters T, Vonthanak S, Picardo C, Rathavy T. Abortion-related complications in Cambodia. BJOG 2008; 115:957-68; discussion 968. [PMID: 18651879 DOI: 10.1111/j.1471-0528.2008.01765.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although termination of pregnancy (termination) has been legal in the Kingdom of Cambodia since 1997, a number of barriers to safe termination services persist and many women continue to induce their own terminations or seek unsafe services that result in complications requiring 'post-abortion' care. OBJECTIVE To describe the complications of miscarriage and failed terminations and document the magnitude of the resulting morbidity in the Cambodian public sector. DESIGN Cross-sectional descriptive study. SETTING Public sector hospitals and health centres. SAMPLE Stratified multistage sampling design included all hospitals (n = 71), 14% of eligible high-level health centres (n = 58) and 22% of eligible low-level health centres (n = 57). METHODS Data collectors used a standardised questionnaire to record information on diagnosis, reproductive history and treatment from 629 women seeking care for termination or miscarriage-related complications in study facilities over a 3-week period. MAIN OUTCOME MEASURES Annual estimate of cases, clinical symptoms, severity distribution of morbidity, ratio of complications to live births and incidence of abortion complications for Cambodian public health facilities. RESULTS In 2005, an estimated 31,579 women with complications of miscarriage or terminations were treated in Cambodian government facilities; 80% of these women sought care at a health centre. Forty percent of all women seeking care for complications either reported or showed strong clinical evidence of prior attempted terminations. Nearly 17% of these women were in the second trimester of pregnancy and 42% of them presented with high severity complications. The annual incidence of termination and miscarriage complications (abortion complications) was 867 per 100,000 women of reproductive age. The projected ratio of complications was 93 per 1000 live births. CONCLUSIONS To reduce maternal morbidity in Cambodia, women must be encouraged to seek safe termination services or seek postabortion care without delay. Additionally, providers need further training, and facilities greater commitment, to provide safe terminations and care for complications of unsafe terminations and miscarriage.
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Affiliation(s)
- T Fetters
- Research Evaluation, Ipas, Chapel Hill, NC, USA.
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388
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Gipson JD, Hindin MJ. "Having another child would be a life or death situation for her": understanding pregnancy termination among couples in rural Bangladesh. Am J Public Health 2008; 98:1827-32. [PMID: 18703439 DOI: 10.2105/ajph.2007.129262] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a mixed-method study in rural southwestern Bangladesh, a country in which an estimated 730,000 elective pregnancy terminations occur each year, to explore women's and couples' motivations to terminate pregnancies. METHODS Quantitative data derived from a 1998 cross-sectional survey and a longitudinal demographic surveillance system (1998-2003) were combined with qualitative data gathered through 84 in-depth interviews conducted with 19 couples during 2004-2005. RESULTS Quantitative results indicated that 11% of couples reported a pregnancy termination in the study period; the rate was highest among couples who reported in 1998 that they wanted no more children (29%). Both wives' and husbands' fertility preferences independently and significantly predicted pregnancy termination. Qualitative findings showed that more than half of the participants had attempted to terminate a pregnancy at least once in their lifetime. CONCLUSIONS Our results highlight the importance of collecting data from both partners and the influence of husbands' fertility preferences on reproductive decisionmaking. The prevalence of reported pregnancy terminations in our population, along with the use of informal methods in termination attempts, highlights the need for continued provision of contraceptives and access to safe and affordable pregnancy termination services in this setting.
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Affiliation(s)
- Jessica D Gipson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E4008, Baltimore, MD 21205, USA.
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389
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390
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Gomperts RJ, Jelinska K, Davies S, Gemzell-Danielsson K, Kleiverda G. Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services. BJOG 2008; 115:1171-5; discussion 1175-8. [DOI: 10.1111/j.1471-0528.2008.01787.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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391
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Rasch V, Yambesi F, Massawe S. Medium and long-term adherence to postabortion contraception among women having experienced unsafe abortion in Dar es Salaam, Tanzania. BMC Pregnancy Childbirth 2008; 8:32. [PMID: 18667094 PMCID: PMC2529258 DOI: 10.1186/1471-2393-8-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 07/31/2008] [Indexed: 11/12/2022] Open
Abstract
Background Postabortion contraceptive service is considered an effective means in addressing the problem of unsafe abortion; in spite this fact this component remains one of the weakest parts of postabortion care. In this context, the paper aims to describe the impact of a postabortion contraceptive service intervention among women admitted with complications from unsafe abortions and to explore the women's long-term contraceptive adherence. Methods 392 women having experienced unsafe abortion were identified by an empathetic approach and offered postabortion contraceptive service, which included counselling on HIV and condom use. Questionnaire interviews about contraceptive use were conducted at the time of inclusion and 12 months after the abortion. Additionally, in-depth interviews were performed 6–12 months after the abortion. Results Eighty-nine percent of the women accepted postabortion contraception. Follow-up information was obtained 12 months after the abortion among 59 percent of the women. Among these, 79 percent of the married women and 84 percent of the single women stated they were using contraception at 12 months. Condom use among the single women increased significantly during the 12 months follow up. Conclusion Postabortion contraceptive services appear to be well accepted by women who are admitted with complications after an unsafe abortion and should thus be recognized as an important means in addressing the problem of unsafe abortion. In addition, counselling about HIV and condom use should be considered an essential aspect of postabortion care.
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Affiliation(s)
- Vibeke Rasch
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.
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392
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393
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Rosenfield A, Bardfield J. Women's global health. J Pharm Sci 2008; 98:43-5. [PMID: 18618598 DOI: 10.1002/jps.21427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Allan Rosenfield
- Mailman School of Public Health, Columbia University, 722 West 168th St., 14th Floor New York, NY 10032, USA.
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394
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Habbema JDF. Is affordable and cost-effective assisted reproductive technology in low-income countries possible? What should we know to answer the question? ACTA ACUST UNITED AC 2008. [DOI: 10.1093/humrep/den203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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395
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Abstract
Infections in pregnancy and in the postpartum period represent an important knowledge base that emergency physicians should have. Being able to understand the risk that pregnancy-related infections have on maternal and fetal health in addition to the initiation of appropriate treatment for these infections is crucial. In the postpartum period, most infections (94%) are likely to manifest after hospital discharge; therefore, patients frequently present to the emergency department.
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Affiliation(s)
- Diane L Gorgas
- Department of Emergency Medicine, The Ohio State University Medical Center, 164 Means Hall, 1654 Upham Drive, Columbus, OH 43210, USA.
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396
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Delvaux T, Soeur S, Rathavy T, Crabbé F, Buvé A. Integration of comprehensive abortion-care services in a Maternal and Child Health clinic in Cambodia. Trop Med Int Health 2008; 13:962-9. [PMID: 18564349 DOI: 10.1111/j.1365-3156.2008.02102.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To document the pilot experience of provision of safe abortion/post-abortion services implemented in 2002 at the Mother Child Health clinic in Sihanoukville, Cambodia, and to profile clients and assess their uptake of post-abortion contraception. METHODS The initial package of safe abortion/post-abortion clinics (SAPAC) services included counselling on family planning and prevention of sexually transmitted infections, pain management, Manual Vacuum Aspiration procedure and standard universal precautions at an affordable price (US$12.5). SAPAC services became operational in August 2002. The data of medical records from 1 August 2002 to 31 December 2005 (2224 clients) were analysed. RESULTS The mean number of clients per month attending SAPAC services ranged from 26 in 2002 to 64 in 2005. Fifty-three per cent were housewives, 24% worked in sales or services, 8% in factories, 11% in bars or karaoke lounges and 3% were brothel-based sex workers. Ninety-three per cent of clients came for induced abortion and 7% sought post-abortion care. Pain management was used in 99% of cases. The overall rate of complications during intervention was 2.1% and dropped from 9.4% in 2002 to 1.3% in 2005. After SAPAC implementation, fewer women in Sihanoukville sought abortion services without any quality control and a safer technique was used. On average, 40% of patients took up contraception after the abortion. CONCLUSIONS Integrating comprehensive abortion-care services at a peripheral government health facility is feasible. There is a demand for such services provided at an affordable price in Sihanoukville, Cambodia.
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Affiliation(s)
- Thérèse Delvaux
- Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
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397
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Abstract
Is cheap and effective, yet its availability remains restricted
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398
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Shaaban OM, Glasier AF. Pregnancy during breastfeeding in rural Egypt. Contraception 2008; 77:350-4. [PMID: 18402851 DOI: 10.1016/j.contraception.2008.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 11/26/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
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399
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Eyakuze C, Jones DA, Starrs AM, Sorkin N. From PMTCT to a more comprehensive AIDS response for women: a much-needed shift. Dev World Bioeth 2008; 8:33-42. [PMID: 18315723 DOI: 10.1111/j.1471-8847.2008.00230.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Half of the 33.2 million people living with HIV today are women. Yet, responses to the epidemic are not adequately meeting the needs of women. This article critically evaluates how prevention of mother-to-child transmission (PMTCT) programs, the principal framework under which women's health is currently addressed in the global response to AIDS, have tended to focus on the prevention of HIV transmission from HIV-positive women to their infants. This paper concludes that more than ten years after their inception, PMTCT programs still do not successfully ensure the adequate treatment, care and support of HIV-infected women. Of particular concern is the continued widespread use of single-dose nevirapine despite World Health Organization recommendations to employ more effective combination therapies that do not potentially jeopardize women's future treatment outcomes. In response, the article calls for a more comprehensive approach that places women's health needs at the centre of AIDS responses. This is critical in settings where the pandemic is generalized and there is a push to greatly expand PMTCT programs, as a more effective and equitable way of meeting the needs of women in the context of HIV. Without such a comprehensive approach, women will continue to be impacted disproportionately by the pandemic, and current strategies for prevention, including PMTCT, and treatment will not be as effective and responsive as they need to be.
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400
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Abstract
Unsafe abortions refer to terminations of unintended pregnancies by persons lacking the necessary skills, or in an environment lacking the minimum medical standards, or both. Globally, unsafe abortions account for 67,900 maternal deaths annually (13% of total maternal mortality) and contribute to significant morbidity among women, especially in under-resourced settings. The determinants of unsafe abortion include restrictive abortion legislation, lack of female empowerment, poor social support, inadequate contraceptive services and poor health-service infrastructure. Deaths from unsafe abortion are preventable by addressing the above determinants and by the provision of safe, accessible abortion care. This includes safe medical or surgical methods for termination of pregnancy and management of incomplete abortion by skilled personnel. The service must also include provision of emergency medical or surgical care in women with severe abortion complications. Developing appropriate services at the primary level of care with a functioning referral system and the inclusion of post abortion contraceptive care with counseling are essential facets of abortion care.
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Affiliation(s)
- Susan R Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, South Africa.
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