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Hogmark S, Rydelius J, Envall N, Teleman P, Gemzell-Danielsson K, Kopp Kallner H. Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial. Am J Obstet Gynecol 2024:S0002-9378(24)00627-6. [PMID: 38796039 DOI: 10.1016/j.ajog.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND International guidelines recommend placement of intrauterine devices immediately after second-trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. OBJECTIVE This study aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at 2 to 4 weeks after second-trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at 2 to 4 weeks after the abortion, in terms of the proportion of intrauterine device use after 6 months, with maintained safety and acceptability. STUDY DESIGN In this open-label, randomized, controlled, superiority trial, we recruited participants at 8 abortion clinics in Sweden. Eligible participants were aged ≥18 years, requesting medical abortion with gestation ≥85 days, and opting for use of a postabortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in nonnormal continuous variables were analyzed with the Mann-Whitney U test, and differences in dichotomous variables with the chi-square or Fisher exact tests. A P value <.05 was considered statistically significant. Group differences are presented by modified intention-to-treat and per-protocol analyses. RESULTS Between January 2019 and June 2022, we enrolled 179 participants, of whom 90 were assigned to the intervention and 89 to the control arm. Enrollment was prematurely stopped after an interim analysis exceeded a predefined intrauterine device expulsion rate of 20%. According to modified intention-to-treat analysis, use of intrauterine device after 6 months was 50.7% (34/67) in the intervention group vs 71.6% (48/67) in the control group (proportion difference, 20.9%; 95% confidence interval, 4.4%-35.9%; P=.02). The intrauterine device expulsion rate was 30.1% (22/73) in the intervention group vs 2.9% (2/70; P<.001) in the control group. Other adverse events were rare and patient acceptability was high in both groups. CONCLUSION Intrauterine device placement within 48 hours after second-trimester medical abortion was nonsuperior in terms of the proportion of intrauterine device use after 6 months when compared with placement after 2 to 4 weeks. Placement within 48 hours after second-trimester abortion can be used in selected individuals after counseling on expulsion risk.
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Affiliation(s)
- Sara Hogmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden.
| | - Johanna Rydelius
- Department of Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Envall
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pia Teleman
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Gynaecology and Obstetrics, Skåne University Hospital, Lund, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; World Health Organization Collaborating Centre for Research and Research Training in Human Reproduction, Karolinska University Hospital, Stockholm, Sweden, (j)Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
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Kc S, Gissler M, Heino A, Klemetti R. Factors influencing the risk of repeat termination of pregnancy: A register-based study in Finland. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100876. [PMID: 37307625 DOI: 10.1016/j.srhc.2023.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to assess how factors such as sociodemographic characteristics, termination of pregnancy (TOP) related factors and contraception affect the risk of repeat TOP. MATERIALS AND METHOD This is a nationwide register-based study of 193,741 women who had TOP(s) during 1987-2015, using the Finnish Register of Induced Abortions. The risk of various factors, such as age, marital status, residence, parity, TOP related factors and contraception, was assessed separately for each repeat TOP. Cox proportional hazard model was used to estimate risk of different factors for repeat TOPs. RESULTS 21% of the women having TOP had repeat TOPs during the years 1987-2015. Among women with repeat TOPs, more than 70% had one repeat TOP and the rest had two or more. Older, married and rural or semi-urban women had reduced risk of repeat TOPs. Adjusted risk for one repeat TOP was higher among parous women (HR 1.67, 95% CI 1.61-1.72). No significant risk for repeat TOP was observed by method in sub-analysis for the recent period after 2006. Women using less reliable (HR 1.14, 95% CI 1.06-1.23) and unreliable (HR 1.33, 95% CI 1.23-1.43) contraception had increased risk of repeat TOP than women using reliable contraception. CONCLUSION Older age, being married, residing in rural or semi-urban areas and using reliable contraception were found to be protective factors for repeat TOPs whereas, parous women had higher risk for repeat TOPs. Proper counselling regarding contraception and use of reliable contraception immediately after TOP should be encouraged.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland.
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden and Region Stockholm, Academic Primary Health Care Centre, S-14183 Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
| | - Reija Klemetti
- Department of Public Welfare, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
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Kebede K, Gashawbeza B, Gebremedhin S, Tolu LB. Magnitude and Determinants of the Late Request for Safe Abortion Care Among Women Seeking Abortion Care at a Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study. Int J Womens Health 2021; 12:1223-1231. [PMID: 33447088 PMCID: PMC7802331 DOI: 10.2147/ijwh.s285282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Second-trimester abortions disproportionately contribute to the increased medical cost, maternal morbidity, and mortality compared to the first trimester. Therefore, the aim of the current study was to determine the magnitude and determinants of late presentation for safe abortion care at a tertiary hospital in Ethiopia. METHODS We conducted a cross-sectional study among pregnant women who requested safe abortion care from January 2019 to April 2020. Participants were selected using systematic sampling and data were collected using the interviewer-administered questionnaire. P-value adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the association between variables. RESULTS The prevalence of second-trimester abortion was 53.4%. Young age, ≤ 19 years (AOR= 6.37, 95% CI=1.84-22.06), decision ambivalence (AOR=5.64, 95% CI=1.71-18.61), delay to suspect pregnancy (AOR= 8.56, 95% CI=2.11-34.57), delay to diagnose pregnancy (AOR=3.83, 95% CI=1.51-9.75), lack of awareness on pregnancy signs and symptoms (AOR=4.22, 95% CI=1.59-11.23), delay to get the service (AOR =4.43, 95% CI=1.43-13.67), and lack of information where to get the abortion service (AOR=3.90, 95% CI=1.53-9.96) were significantly associated with presentation in second trimester. CONCLUSION More than half of women who request safe abortion at Saint Paul's Hospital Millennium Medical College do so in the second trimester. Young age, delay in diagnosis of pregnancy, delayed decision, and lack of information where to get service were contributing factors. Therefore, comprehensive adolescent sexuality education, increasing access to contraception, and safe abortion service including self-care interventions are very imperative to avert late gestation abortion and its consequences.
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Affiliation(s)
- Kidus Kebede
- Saint Paul New Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Lemi Belay Tolu
- Saint Paul New Millennium Medical College, Addis Ababa, Ethiopia
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Kc S, Gissler M, Klemetti R. The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study. Acta Obstet Gynecol Scand 2020; 99:651-659. [PMID: 32128786 DOI: 10.1111/aogs.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. MATERIAL AND METHODS First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). RESULTS Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI 1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. CONCLUSIONS The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Reija Klemetti
- Department of Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Van de Velde S, Van Eekert N, Van Assche K, Sommerland N, Wouters E. Characteristics of Women Who Present for Abortion Beyond the Legal Limit in Flanders, Belgium. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:175-183. [PMID: 31509652 DOI: 10.1363/psrh.12116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Women who seek abortion care beyond the first trimester of gestation are often in a vulnerable socioeconomic position with limited social support, and in Belgium, the details of their circumstances are insufficiently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the first trimester. METHODS Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are non-hospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women's characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study. RESULTS A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20-24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8-3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), having irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively associated with presenting beyond, rather than before, the limit. CONCLUSIONS A fuller consideration of patients' characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed.
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Affiliation(s)
- Sarah Van de Velde
- Centre for Population, Family and Health and the Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Nina Van Eekert
- Centre for Population, Family and Health and the Department of Sociology, University of Antwerp, Antwerp, Belgium
- Centre for Population, Family and Health
- Department of Sociology, University of Antwerp, and International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | | | - Nina Sommerland
- Centre for Population, Family and Health and the Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health and the Department of Sociology, University of Antwerp, Antwerp, Belgium
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Hognert H, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Milsom I, Lidegaard Ø, Lindh I. Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries. BMJ Open 2018; 8:e022473. [PMID: 30381312 PMCID: PMC6224744 DOI: 10.1136/bmjopen-2018-022473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/10/2018] [Accepted: 09/14/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Compare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between countries. DESIGN Ecological study using national registry data concerning births and abortions among all women aged 15-19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008-2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008-2015 were obtained from national databases in Denmark, Norway and Sweden. SETTING Denmark, Finland, Iceland, Norway and Sweden. PARTICIPANTS Women 15-19 years old in all Nordic countries (749 709) and 13-19 years old in Denmark, Norway and Sweden (815 044). RESULTS Both annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15-19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18-19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden. CONCLUSIONS Birth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers.
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Affiliation(s)
- Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Kristina Gemzell-Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki, University Hospital, Helsinki, Finland
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
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Exploring Canadian Women's Multiple Abortion Experiences: Implications for Reducing Stigma and Improving Patient-Centered Care. Womens Health Issues 2018; 28:327-332. [DOI: 10.1016/j.whi.2018.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
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8
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Korjamo R, Heikinheimo O, Mentula M. Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy. EUR J CONTRACEP REPR 2018. [DOI: 10.1080/13625187.2018.1440385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Riina Korjamo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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9
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Korjamo R, Mentula M, Heikinheimo O. Expulsions and adverse events following immediate and later insertion of a levonorgestrel-releasing intrauterine system after medical termination of late first- and second-trimester pregnancy: a randomised controlled trial. BJOG 2017; 124:1965-1972. [DOI: 10.1111/1471-0528.14813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- R Korjamo
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M Mentula
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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10
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Korjamo R, Mentula M, Heikinheimo O. Immediate versus delayed initiation of the levonorgestrel-releasing intrauterine system following medical termination of pregnancy - 1 year continuation rates: a randomised controlled trial. BJOG 2017. [DOI: 10.1111/1471-0528.14802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R Korjamo
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M Mentula
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynaecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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11
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Heino A, Niinimäki M, Mentula M, Gissler M. How reliable are health registers? Registration of induced abortions and sterilizations in Finland. Inform Health Soc Care 2017; 43:310-319. [PMID: 28388252 DOI: 10.1080/17538157.2017.1297306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Finland's population-based health registers are widely used in health-monitoring and research. We assessed the quality of the Finnish Register on Induced Abortions and Sterilisations and compared it to the Hospital Discharge Register. Ten hospitals out of 67 public hospitals performing induced abortions and sterilizations and three randomly selected months in 2011 were included. This data was compared to the data in the Register on Induced Abortions and Sterilisations. The sample presented 43.1% of all induced abortions and sterilizations during the study months. The coverage on data on induced abortions was excellent: 97.0% of induced abortions were found in the register. Coverage on data on sterilizations was good: 89.4% of sterilizations performed were found in the register. More detailed comparisons of the variable data showed good to very good validity. The coverage of the Hospital Discharge Register was found also to be good. The validity of Finland's Register on Induced Abortions and Sterilisations makes it a good base for research and health-monitoring. The Hospital Discharge Register was a good source in measuring volumes of hospital use as well as the main diagnoses or procedures, but the registration of single diagnoses or procedures may be less ideal for research.
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Affiliation(s)
- Anna Heino
- a National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Maarit Niinimäki
- c Department of Obstetrics and Gynaecology , University Hospital of Oulu, PEDEGO Research Unit, Medical Research Center and University of Oulu , Oulu , Finland
| | - Maarit Mentula
- b Department of Obstetrics and Gynaecology , University of Helsinki and Helsinki University Central Hospital , Helsinki , Finland
| | - Mika Gissler
- a National Institute for Health and Welfare (THL) , Helsinki , Finland
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12
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Kabiru CW, Ushie BA, Mutua MM, Izugbara CO. Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis. BMC Pregnancy Childbirth 2016; 16:104. [PMID: 27180102 PMCID: PMC4867193 DOI: 10.1186/s12884-016-0894-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12–24 years seeking abortion-related care in Kenya. Methods We used data on 1,378 young women aged 12–24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. Results Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %). Conclusions Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.
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Affiliation(s)
- Caroline W Kabiru
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya. .,John C Caldwell Population, Health and Development Visiting Fellow, the National Centre for Epidemiology & Population Health (NCEPH) and School of Demography, Australian National University, 9 Fellows Road, Acton, ACT, 2601, Australia.
| | - Boniface A Ushie
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.,Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael M Mutua
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.,School of Public Health, University of Witwatersrand, Wits Education Campus, 27St. Andrews Road, Parktown, 2193, Johannesburg, South Africa
| | - Chimaraoke O Izugbara
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
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13
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EDUCATIONAL INEQUALITIES IN REPEAT ABORTION: A LONGITUDINAL REGISTER STUDY IN FINLAND 1975-2010. J Biosoc Sci 2016; 48:820-32. [PMID: 27128981 DOI: 10.1017/s002193201600016x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The proportion of repeat abortions among all abortions has increased over the last decades in Finland. This study examined the association of education with the likelihood of repeat abortion, and the change in this association over time using reliable longitudinal data. A unique set of register data from three birth cohorts were followed from age 20 to 45, including about 22,000 cases of repeat abortion, and analysed using discrete-time event-history models. Low education was found to be associated with a higher likelihood of repeat abortion. Women with low education had abortions sooner after the preceding abortion, and were more often single, younger and had larger families at the time of abortion than more highly educated women. The educational differences were more significant for later than earlier cohorts. The results show a lack of appropriate contraceptive use, possibly due to lack of knowledge of, or access to, services. There is a need to improve access to family planning services, and contraceptives should be provided free of charge. Register data overcome the common problems of under-reporting of abortion and attrition ensuring the results are reliable, unique and of interest internationally.
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Cameron ST, Riddell J, Brown A, Thomson A, Melville C, Flett G, Caird L, Laird G. Characteristics of women who present for abortion towards the end of the mid-trimester in Scotland: national audit 2013-2014. EUR J CONTRACEP REPR 2015; 21:183-8. [PMID: 26568404 DOI: 10.3109/13625187.2015.1111326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Women in Scotland who request an abortion (for non-medical reasons) within the legal gestational limit (up to 24 weeks) but beyond the gestational limit of all abortion facilities in Scotland (only up to 20 weeks) must travel to England if they wish to terminate the pregnancy. We wished to determine the number and characteristics of women presenting at ≥16 weeks' gestation for abortion, and compare the characteristics of those proceeding to abortion with those continuing the pregnancy. METHODS Over a period of 12 months we conducted a prospective audit of women presenting at ≥16 weeks' gestation to abortion services throughout Scotland. The characteristics of women proceeding to abortion and those continuing the pregnancy were compared. RESULTS A total of 267 women presented for abortion at ≥16 weeks' gestation. Their median age was 22 years (range 14 to 47 years); 231 were from deprived areas (86.5%), 128 (47.9%) already had a child and 73 (27.3%) had previously undergone abortion. A total of 175 women (65.5%) proceeded to abortion, locally (n = 125; 46.8%) or in England (50; 18.7%). Those at ≥20 weeks' gestation were statistically more likely to continue the pregnancy than those at earlier gestations (p < 0.001). CONCLUSIONS Relatively few women present for abortion in Scotland at ≥16 weeks' gestation. Those who are over 20 weeks' gestation and would need to travel to England for abortion are more likely to continue the pregnancy, suggesting that travel is a barrier to accessing legal abortion for this group of women. Provision of abortion services up to 24 weeks' gestation should be considered within Scotland.
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Affiliation(s)
| | | | | | | | | | | | - Lucy Caird
- f NHS Highland , Inverness , Scotland, UK
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15
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Bayrami R, Javadnoori M. Comparison of the contraceptive use and its related factors among women seeking repeat and first-time induced abortions in iran. Nurs Midwifery Stud 2015; 4:e17529. [PMID: 25830153 PMCID: PMC4377525 DOI: 10.17795/nmsjournal17529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 11/25/2022] Open
Abstract
Background: Abortion in Iran, like other Islamic countries is severely restricted except in a few exceptions. However, some women who have an unwanted or mistimed pregnancy are seeking abortion. Objectives: This study aimed to compare the contraceptive use and its related factors among repeat and first- time induced abortion seekers in Iran. Patients and Methods: In this cross-sectional study, 417 married women (age range, 15-49 years) seeking abortion services at either a hospital or private office in Maku City, the northwest of Iran, were selected through convenience sampling between December 2010 and March 2011. All the subjects were asked about the contraceptive methods used during the three months before the current pregnancy and the use of any emergency contraception and forced sex. Women who mentioned reasons except than completing family size for their applying for abortion were excluded from the analysis. Characteristics of women were examined using chi-square and t test. T test and Mann-Whitney U test were used to compare contraceptive methods and the regularity of contraceptive use between repeat and first-time abortion seekers, respectively. Results: About 33.8% of the repeat abortion-seekers and 76.8% of first-time abortion seekers were using male methods (withdrawal and condom). Utilization of an intrauterine device for birth control was higher among women seeking repeat abortion than in first-time abortion seekers (P = 0.003). All of 31 pill users in the repeat abortion-seeking group missed three or more pills per month for three times during the three months before contraception. The repeat abortion seekers had used condom more regularly than those in the first-time abortion seekers. Forced sex was more prevalent in the abortion seekers who had used male method. Conclusions: Using male methods are prevalent in abortion-seeker women. An increased focus is needed on training the regular use of pills and using the emergency contraception for all of the couples who are first-time abortion-seekers. Moreover, information about the role of forced sex might be efficacious in decreasing illegally induced repeat abortion in couples who use condom or withdrawal methods.
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Affiliation(s)
- Roghieh Bayrami
- Student Research Committee, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mojgan Javadnoori
- Reproductive Health Promotion Research Center, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Trends in teenage termination of pregnancy and its risk factors: a population-based study in Finland, 1987-2009. Hum Reprod 2012; 27:2829-36. [PMID: 22777526 DOI: 10.1093/humrep/des253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the current trends in teenage termination of pregnancy (TOP) and its risk factors? SUMMARY ANSWER The incidence of teenage TOP fluctuated substantially during the study period and the incidence of repeat TOP among adolescents increased markedly in the 2000s. WHAT IS KNOWN ALREADY Teenage pregnancy is associated with difficulties in psychological, sexual and overall health. The proportion of teenage pregnancies resulting in termination varies by country and time, but only few countries have reliable statistics on TOPs. STUDY DESIGN, SIZE, DURATION This nationwide retrospective register study included all the TOPs (n= 52 968) and deliveries (n= 58 882) in Finland between 1987 and 2009 among girls <20 years of age at the beginning of pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHODS The cohorts were divided into three subgroups; 13-15- (n= 6087), 16-17- (n= 18 826) and 18-19- (n= 28 055) year-olds. MAIN RESULTS AND THE ROLE OF CHANCE After an initial steady decline, the incidence of teenage TOP increased by 44% between 1993 (8.0/1000) and 2003 (11.5/1000), and thereafter declined by 16% until 2009 (9.7/1000). The incidence was higher in older adolescents, but the trends were alike in all age groups. Early TOPs (performed at <56 days of gestation) more than tripled from 11 to 36% during the study period. However, the proportion of second-trimester TOPs remained steady at ≈ 7%. Young age [13-15 years: odds ratio (OR) 1.75 (95% confidence interval (CI) 1.57-1.94), 16-17 years: OR 1.13 (1.05-1.23), 18-19 years: OR 1 (reference category)] and non-use of contraception [(OR 11.16 (10.15-12.27)] were related to a higher risk of second-trimester TOP. The incidence of repeat TOP increased by 95% from 1.9/1000 to 3.7/1000 in 18-19-year-olds and by 120% from 0.5/1000 to 1.1/1000 in 16-17-year-olds between 1993 and 2009. Increasing age [13-15 years: OR 0.16 (95% CI 0.14-0.19), 16-17 years: OR 0.49 (0.45-0.52), 18-19 years 1 (Ref)], living in an urban area [rural: OR 0.62 (0.56-0.67), urban: OR 1 (Ref)] and having undergone a second-trimester TOP [OR 1.46 (1.31-1.63)] were risk factors for repeat TOP. The planned use of intrauterine contraception for post-abortal contraception increased from 2.6 to 6.2% and among girls with repeat TOP from 10 to 19%. LIMITATIONS The retrospective nature of the study remains a limitation and the quality of the data is reliant on the accuracy of reporting. We were not able to link repeat TOPs of the same woman in our data set. However, the share of repeat abortions was moderate. WIDER IMPLICATIONS OF THE FINDINGS The rate of teenage TOP seems to rapidly reflect changes in national sexual and reproductive health services and policy. The rising rate of repeat TOP is alarming and may represent a sign of marginalization among these girls. All efforts to maintain a low rate of teenage pregnancy are welcomed.
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Affiliation(s)
- S Leppälahti
- Department of Obstetrics and Gynaecology, Kätilöopisto Hospital, University of Helsinki and Helsinki University Central Hospital, PO Box 610, 00029-HUS, Helsinki, Finland
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Steinberg JR. Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research. Womens Health Issues 2011; 21:S44-8. [PMID: 21530839 DOI: 10.1016/j.whi.2011.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Some abortion policies in the U.S. are based on the notion that abortion harms women's mental health. The American Psychological Association (APA) Task Force on Abortion and Mental Health concluded that first-trimester abortions do not harm women's mental health. However, the APA task force does not make conclusions regarding later abortions (second trimester or beyond) and mental health. This paper critically evaluates studies on later abortion and mental health in order to inform both policy and practice. METHOD Using guidelines outlined by Steinberg and Russo (2009), post 1989 quantitative studies on later abortion and mental health were evaluated on the following qualities: 1) composition of comparison groups, 2) how prior mental health was assessed, and 3) whether common risk factors were controlled for in analyses if a significant relationship between abortion and mental health was found. Studies were evaluated with respect to the claim that later abortions harm women's mental health. RESULTS Eleven quantitative studies that compared the mental health of women having later abortions (for reasons of fetal anomaly) with other groups were evaluated. Findings differed depending on the comparison group. No studies considered the role of prepregnancy mental health, and one study considered whether factors common among women having later abortions and mental health problems drove the association between later abortion and mental health. CONCLUSION Policies based on the notion that later abortions (because of fetal anomaly) harm women's mental health are unwarranted. Because research suggests that most women who have later abortions do so for reasons other than fetal anomaly, future investigations should examine women's psychological experiences around later abortions.
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Affiliation(s)
- Julia R Steinberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California 94143, USA.
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