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

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey

BACKGROUND

Repeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women.

METHODS

We used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15-49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables.

RESULTS

Of the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25-34 years (AOR:2.16;95%CI = 1.66-2.79) or 35-49 years (AOR:2.95;95%CI:2.18-3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25-12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03-2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33-1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07-1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49-0.93), Northern (AOR:0.46;95%CI:0.24-0.88), Upper West (AOR:0.24; 95%CI: 0.12-0.50) and Upper East (AOR:0.49; 95%CI = 0.24-0.99) regions were less likely to have repeat induced abortion.

CONCLUSION

The study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

Prevalence of induced abortion among Chinese women aged 18-49 years: Findings from three cross-sectional studies

There are few latest researches about induced abortion in China. We aimed to evaluate the prevalence of induced abortion and the related factors, thereby helping make targeted policies and measures to promote women's health. Three comparable cross-sectional surveys among Chinese women aged 18-49 years were performed in 2016, 2017, and 2021. A total of 14,573 eligible respondents were included in the study. 16.70% (95%CI 16.10%-17.31%) of respondents self-reported having experienced induced abortion, while 6.88% (95%CI 6.46%-7.29%) self-reported repeat induced abortion. Age range of 25-49 years (aOR 2.27-6.31, all P<0.05), living in western (aOR 1.72, 95%CI 1.50-1.98) and central (aOR 1.36, 95%CI 1.21-1.52) regions, having children (aOR 2.85, 95%CI 2.35-3.46) were associated with higher prevalence of induced abortion. Moreover, age range of 25-49 years, living in western and central regions, having children were also related to higher prevalence of repeat induced abortion (aOR 1.67-11.52, all P<0.05). Conversely, educational level of college or higher, household annual income over 80,000 Chinese yuan were associated with lower prevalence of induced abortion and repeat induced abortion (aOR 0.52-0.80, all P<0.05). Induced abortion remains noticeable in China. Sustained efforts are required to reduce unintentional pregnancy, improve reproductive health and post-abortion care services, and promote women's health.

[Induced abortion and COVID-19 : What changed with the pandemic in 2020]

Contexte

L'année 2020 a été marquée par la pandémie du SARS-CoV2 dont les mesures de gestion ont fortement perturbé l'organisation de la société en général et particulièrement l'organisation du système de soins. Cette étude avait pour objectif d'analyser l’évolution des indicateurs des interruptions volontaires de grossesse (IVG) dans la région parisienne au cours de l'année 2020 et d'analyser particulièrement ce qui a changé au cours du premier confinement.

Méthode

Les données issues du Système national des données de santé (SNDS) ont été analysées pour comparer les indicateurs de 2020 à ceux de 2016–2019. En 2020, les indicateurs ont été étudiés mensuellement. L’âge des femmes, la méthode utilisée pour interrompre la grossesse, le terme de la grossesse au moment de l'IVG et le département de résidence de la femme ont été analysés.

Résultats

Après cinq années consécutives d'augmentation du taux de recours à l'IVG, l'année 2020 a été marquée par un recul du nombre d'IVG (50 615), soit une baisse de 5,6 % par rapport à 2019 (53 601). Le taux de recours est passé de 17,3 IVG/1000 femmes de 15–49 ans en 2019 à 16,3 ‰ en 2020. Ce recul a été observé dans les quatre semaines ayant suivi le premier confinement. Il concernait plus particulièrement les IVG réalisées à l'hôpital et les IVG des femmes jeunes (< 25 ans). En 2020, les proportions des IVG médicamenteuses et des IVG instrumentales sous anesthésie locale ont augmenté comparativement aux quatre années précédant la crise sanitaire. Par ailleurs, on a dénombré moins d'IVG tardives en 2020 (IVG sur grossesse > 12 semaines d'aménorrhée). Cette analyse met également en évidence une baisse du nombre de naissances dans les huit à neuf mois ayant suivi le premier confinement.

Discussion et conclusion

La crise liée à la COVID-19 a entraîné d'autres conséquences sanitaires non imputables directement au virus. En termes de reproduction, la crise sanitaire, particulièrement le premier confinement, est associée à un recul des conceptions se traduisant par une baisse du nombre de grossesses, qu'elles soient désirées ou non, avec comme conséquence une baisse de recours à l'IVG dans les semaines suivant le premier confinement et un recul de la natalité dans les neuf mois suivants.

Repeat Induced Abortion among Chinese Women Seeking Abortion: Two Cross Sectional Studies

Background: In China, there were about 9.76 million induced abortions in 2019, 50% of which were repeat abortions. Understanding the tendency of repeat induced abortion and identifying its related factors is needed to develop prevention strategies. Methods: Two hospital-based cross-sectional surveys were conducted from 2005–2007 and 2013–2016 in 24 and 90 hospitals, respectively. The survey included women who sought an induced abortion within 12 weeks of pregnancy. The proportion of repeat induced abortions by adjusting the covariates through propensity score matching was compared between the two surveys, and the zero-inflated negative binomial regression model was established to identify independent factors of repeat induced abortion. Results: Adjusting the age, occupation, education, marital status and number of children, the proportion of repeat induced abortions in the second survey was found to be low (60.28% vs. 11.11%), however the unadjusted proportion was high in the second survey (44.97% vs. 51.54%). The risk of repeat induced abortion was higher among married women and women with children [OR_adj and 95% CI: 0.31 (0.20, 0.49) and 0.08 (0.05, 0.13)]; the risk among service industry staff was higher when compared with unemployed women [OR_adj and 95% CI: 0.19 (0.07, 0.54)]; women with a lower education level were at a higher risk of a repeat induced abortion (OR_adj < 1). Compared with women under the age of 20, women in other higher age groups had a higher frequency of repeat induced abortions (IR_adj: 1.78, 2.55, 3.27, 4.01, and 3.93, separately); the frequency of women with lower education levels was higher than those with a university or higher education level (IR_adj > 1); the repeat induced abortion frequency of married women was 0.93 (0.90, 0.98) when compared to the frequency of unmarried women, while the frequency of women with children was 1.17 (1.10, 1.25) of childless women; the induced abortion frequency of working women was about 60–95% with that of unemployed women. Conclusions: The repeat induced abortion proportion was lower than 10 years ago. Induced abortion seekers who were married, aged 20 to 30 years and with a lower education level were more likely to repeat induced abortions.

Repeat induced abortion and adverse childhood experiences in Aquitaine, France: a cross-sectional survey

OBJECTIVE

The aim of the study was to analyse the relationship between adverse childhood experiences (ACEs) and repeat induced abortion, with regard to the potential effects of social deprivation and intimate partner violence.

METHODS

An observational cross-sectional survey was conducted across each of the 25 abortion centres in Aquitaine, France, from 15 June to 15 September 2009. The sample comprised 806 women >18 years who had requested an induced abortion. Data were collected through a self-reported anonymous questionnaire on ACEs and experience of previous abortion. The main outcome measure was the percentage of repeat induced abortions.

RESULTS

Among the participants, 473 (58.7%) were having their first induced abortion and 333 (41.3%) had already had a previous induced abortion. The abortion rank (first, second, third or more) was inversely related to the proportion of women with no ACE exposure (28%, 20% and 9%, respectively) and positively related to the proportion of women with a high ACE exposure (17%, 27% and 32%, respectively). Compared with women with no ACE exposure who were having a first induced abortion, in those with high ACE exposure, the odds of a third or more request for abortion was high: adjusted odds ratio 7.73 (95% confidence interval 3.56, 16.77).

CONCLUSION

We found a strong graded link between the extent of ACE exposure and the occurrence of repeat induced abortion.

Policy, law and post-abortion care services in Kenya

BACKGROUND

Unsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy.

METHODS

A cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality.

RESULTS

The provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge.

DISCUSSION

Legal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination.

CONCLUSION

Greater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.