Induced abortion in a Southern European region: examining inequalities between native and immigrant women

Assessing knowledge of migrant sexual reproductive health and rights: a national cross-sectional survey among health professionals in Sweden

Introduction

Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to the delivery of suboptimal care. Therefore, the objective of this study was to assess the level of knowledge of Swedish healthcare providers on global and Swedish migrant Sexual Reproductive Health and Rights.

Methods

A national cross-sectional study was conducted using a questionnaire consisting of seven questions related to global and Swedish migrant Sexual Reproductive Health and Rights. The questionnaire was distributed among midwives, nurses, gynecologists and obstetricians, and hospital social workers (N = 731). The analysis was guided by the Factfulness framework developed by Hans Rosling to identify disparities between healthcare providers' viewpoints and evidence-based knowledge.

Results

There was an overall lack of knowledge among the health care providers on these issues. The highest correct responses were on the question on abandonment of female genital cutting/mutilation after migration (74%). The findings indicated that healthcare providers originating from Sweden, physicians, those with fewer years of clinical experience, and exhibiting more migrant-friendly attitudes, demonstrated a higher level of knowledge regarding global and Swedish migrant Sexual and Reproductive Health and Rights.

Conclusion

This study demonstrates that healthcare providers lacked knowledge of global and Swedish migrant Sexual Reproductive Health and Rights, which was almost uniformly distributed, except among those with more comprehensive and recent education. Contrary to expectations, healthcare professionals did not primarily rely on their education and experiences but were influenced by their personal values and opinions. The study underscores the importance of upgrading knowledge in Sexual Reproductive Health and Rights and encourages policymakers, professionals, and students to base their opinions on well-founded facts, particularly in the context of a diverse and globalized society.

Induced abortion according to immigrants' birthplace: a population-based cohort study

BACKGROUND

Most abortions occur due to unintended pregnancy. Unintended pregnancies are linked to poor health outcomes. Canada receives immigrants from countries with disparate sexual and reproductive health contexts which may influence abortion rates post-migration. We examined the association between abortion and region of birth and birth order among Canadian immigrants.

METHODS

We conducted a population-based person-years (PY) cohort study in Ontario, Canada using administrative immigration (1991-2012) and health care data (1991-2013). Associations between induced abortion and an immigrant's region of birth were estimated using poisson regression. Rate ratios were adjusted for age, landing year, education, neighborhood income quintile and refugee status and stratified by birth order within regions.

RESULTS

Immigrants born in almost all world regions (N = 846,444) were 2-5 times more likely to have an induced abortion vs. those born in the US/Northern & Western Europe/Australia & New Zealand (0.92 per 100 PY, 95% CI 0.89-0.95). Caribbean (Adjusted Rate Ratio [ARR] = 4.71, 95% CI 4.55-4.87), West/Middle/East African (ARR = 3.38, 95% CI 3.26-3.50) and South American (ARR = 3.20, 95% CI 3.09-3.32) immigrants were most likely to have an abortion. Most immigrants were less likely to have an abortion after vs. prior to their 1st birth, except South Asian immigrants (RR = 1.60, 95% CI 1.54-1.66; RR = 2.23, 95% CI 2.12-2.36 for 2nd and 3rd vs 1st birth, respectively). Secondary analyses included further stratifying regional models by year, age, education, income quintile and refugee status.

CONCLUSIONS

Induced abortion varies considerably by both region of birth and birth order among immigrants in Ontario.

Induced abortions by woman's country of origin in Finland 2001-2014

Aims: Understanding the differences in reproductive-health behaviours between native and migrant populations helps provide good reproductive-health services. We investigate the differences in induced abortion rates, pregnancy histories and use of contraceptives between native and migrant populations in Finland. Methods: The Finnish Register on Induced Abortions was linked with Population Register data from years 2001-2014 to identify first- and second-generation immigrants. The data included 142,708 induced abortions. Results: Abortion and contraceptive use varied between women of Finnish and foreign origins. Native women had a lower abortion rate than women born abroad. Women born in Somalia and India had the highest likelihood for having an abortion shortly after birth. The highest risk for having an abortion soon after previous induced abortion was among women born in Iran, Iraq, Somalia and former Yugoslavia. The risk for having more than two induced abortions was the highest for women born in Russia/the former Soviet Union and Estonia. Second-generation immigrants had a lower abortion rate than first-generation immigrants. Lack of contraceptive use prior to abortion was more common among women born abroad. Conclusion: There were differences in pregnancy histories and in the use of reliable contraceptive methods before an induced abortion by country of birth. The higher likelihood for abortion after a recent birth among first-generation immigrants highlights the need for more targeted counselling immediately after childbirth. Although the abortion rate is lower among second-generation immigrants, the neglect of contraceptive use calls for additional education in sexual and reproductive health.

[Repeat induced abortion: A multicenter study on medical abortions in France in 2014]

OBJECTIVES

To describe the social characteristics of women seeking a medical abortion, and the conditions of that abortion, according to whether they had one or more previous induced abortions.

METHODS

An observational study was carried out in 11 French units in 2013-2014, among women 18 years or older. A self-administered questionnaire on the abortion context and social situation was given to them, as well as a diary to record the pain level for each of five days following the mifepristone intake. The sample included 453 women.

RESULTS

Among the respondents, 22% had had one previous abortion and 8% had had two or more. Women having had a previous voluntary abortion were more often isolated and in a poorer social situation than women having their first abortion.

CONCLUSION

Better support for contraception after abortion could reduce the number of repeated abortions.

The role of birthplace and educational attainment on induced abortion inequalities

BACKGROUND

Induced abortion (IA) has shown social inequality related to birthplace and education with higher rates of IAs in immigrant and in less educated women relative to their native and highly educated counterparts. This study examined the independent and joint effects of birthplace and education on IA, repeated and IA performed during the 2nd trimester of pregnancy among women residing in the Basque Country, Spain.

METHODS

We conducted a cross-sectional population-based study of IA among women aged 25-49 years residing in the Basque Country, Spain, between 2011 and 2013. Log-binomial regression was used to quantify the independent and joint effects of birthplace and education attainment on all outcomes.

RESULTS

Immigrant women exhibited higher probability of having an IAs (PR: 5.31), a repeated (PR: 7.23) or a 2nd trimester IAs (PR: 4.07) than women born in Spain. We observed higher probabilities for all outcomes among women with a primary or less education relative to those with a graduate education (All IAs PR: 2.51; repeated PR: 6.00; 2nd trimester PR: 3.08). However, no significant heterogeneity was observed for the effect of education on the association of birthplace with IAs, repeated or 2nd trimester IAs.

CONCLUSIONS

Birthplace and education are key factors to explain not only an IA decision but also having a repeated or a 2nd trimester IA. However, the effects of birthplace and education may be independent from each other on these outcomes. A better understanding of these factors on IAs is needed when designing programs for sexual and reproductive health aimed to reduce inequalities among women.