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Requena M, Stanek M. Differential rates of induced abortion in Spain: educational attainment and age among native and immigrant women. GACETA SANITARIA 2024; 38:102419. [PMID: 39128445 DOI: 10.1016/j.gaceta.2024.102419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Analyzing the variations in induced abortion (IA) rates across different subpopulations in Spain based on country of origin, while considering educational and age composition. METHOD Using 2021 Voluntary Termination of Pregnancy register and 2021 Spanish Census microdata, we calculated crude IA rates and age-specific abortion rates. We used age-standardized IA rates (ASIAR) to account for the confounding effect of age composition. We compared seven subpopulations residing in Spain, taking into account simple ages and educational levels aggregated into four categories. RESULTS Immigrant women, especially those from Sub-Saharan and Latin American countries, consistently had higher IA rates compared to native Spanish women. According to age-specific IA rates, university-educated women had considerably fewer abortions than women with other education levels at any age. Age-standardized rates stratified by migratory origin revealed that native Spanish women with primary education or less had higher IA rates than their immigrant counterparts. There was a clear non-linear, association between educational level and IA rates among immigrants. The highest propensity for IA was found among secondary school graduates, while university graduates had the lowest IA rate. CONCLUSIONS The study demonstrated that variability in sociodemographic characteristics had an impact on IA rates. Young women with middle educational attainment and immigrant background had a higher likelihood of undergoing IA in Spain. The relationship between educational level and IA rates was complex, with variations observed among different groups and changes over time.
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Affiliation(s)
- Miguel Requena
- Grupo de Estudios "Población y Sociedad", Departamento de Sociología II, Universidad Nacional de Educación a Distancia, Spain
| | - Mikolaj Stanek
- Departamento de Sociología y Comunicación, Universidad de Salamanca, Salamanca, Spain.
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Zhang Y, Sun F, Yuan K, Du Y, Wu L, Ge Y, Zhang Z, Sun S, Cao W. Ambient temperature and major structural anomalies: A retrospective study of over 2 million newborns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 882:163613. [PMID: 37087019 DOI: 10.1016/j.scitotenv.2023.163613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Maternal exposure to ambient heat may be associated with congenital anomalies, but evidence is still limited. OBJECTIVES We aimed to estimate the association between maternal exposure to ambient heat during the 3-12 weeks post-conception (critical window of organogenesis) and risk of total and various diagnostic categories of major structural anomalies among live singleton births in the contiguous United States (US). METHODS We included data on 2,352,529 births with the first day of critical developmental windows falling within months of May through August from 2000 to 2004 across 525 US counties. We used a validated spatial-temporal model to estimate daily county-level population-weighted temperature. We used logistic regression to estimate the association between ambient temperature and risk of diagnostic categories of anomalies during the critical window after adjusting for individual and county-level factors. We conducted subgroup analysis to identify potential susceptible subpopulations. RESULTS A total of 29,188 anomalies (12.4 per 1000 births) were recorded during the study period. Maternal exposure to extreme heat (> 95th percentile) was associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies with an odds ratio (OR) of 1.05 (95 % CI: 1.00, 1.11), 1.17 (95 % CI: 1.01, 1.37), and 1.16 (95 % CI: 1.04, 1.29) compared with minimum morbidity temperature, respectively. The associations were homogeneous across subgroups defined by maternal age, maternal race/ethnicity, marital status, educational attainment, and parity, but were more pronounced among mothers residing in more socially vulnerable counties and births with multiple anomalies. CONCLUSIONS Among US live singleton births, maternal exposure to ambient heat may be associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies. We suggest additional research is carried out to better understand the relations between maternal heat exposure and congenital anomalies in the presence of global warming.
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Affiliation(s)
- Yangchang Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Kun Yuan
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Ying Du
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Lizhi Wu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou 310051, China
| | - Yang Ge
- School of Health Professions, University of Southern Mississippi, Hattiesburg 39402, MS, USA
| | - Zhenyu Zhang
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China.
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China.
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Luukkonen J, Junna L, Remes H, Martikainen P. The association of lowered alcohol prices with birth outcomes and abortions: A population-based natural experiment. Addiction 2023; 118:836-844. [PMID: 36791778 DOI: 10.1111/add.16119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/05/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND AIMS Alcohol use during pregnancy remains an important risk factor for adverse birth outcomes, but little is known regarding how alcohol prices affect pregnancy outcomes on the population level. We assess the associations between decreased alcohol prices with birth outcomes and abortions. DESIGN Using national registers, we used interrupted time-series modelling to compare outcomes of pregnancies conceived before and after a tax cut, resulting in 33% mean decrease of off-premise alcohol prices on 1 March 2004. We also addressed possible heterogeneity of the associations by maternal age and household income. SETTING Finland. PARTICIPANTS All registered pregnancies starting 2 years before and 1 year after the alcohol price cut (analysis sample consisted of 169 735 live births and 32 441 abortions). MEASUREMENTS The outcomes were birth weight, gestational age, the probability of low birth weight (< 2500 g at birth), preterm birth (< 37 weeks of gestation), any congenital malformations and share of registered abortions of pregnancies. FINDINGS On the population level, lowered alcohol prices were associated with an increase in abortions immediately after the price cut [+0.84 percentage points; 95% confidence interval (CI) = 0.2, 1.4]. For birth outcomes, negative associations were observed among women in the lowest income quintile; for example, increased probabilities of low birth weight (+1.5 percentage points; 95% CI = 0.4, 2.6) and preterm birth (+1.98 percentage points; 95% CI = 0.8, 3.2). All changes were strongest immediately after the price cut and attenuated during the course of the following year. CONCLUSIONS Lowered alcohol prices in Finland were associated with a short-term increase in adverse birth outcomes among low-income mothers and an overall increase in abortions.
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Affiliation(s)
- Juha Luukkonen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Liina Junna
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hanna Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Public Health Sciences, University of Stockholm, Stockholm, Sweden
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Väisänen H, Batyra E. Unintended pregnancy resolution among parous women in twelve low- and middle-income countries. J Biosoc Sci 2022; 54:698-724. [PMID: 34024306 DOI: 10.1017/s0021932021000225] [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] [Indexed: 11/07/2022]
Abstract
Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women's pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women's propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.
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Affiliation(s)
- Heini Väisänen
- Institut national d'études démographiques (INED), France
- Department of Social Statistics and Demography, University of Southampton, UK
| | - Ewa Batyra
- Population Studies Center, University of Pennsylvania, USA
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Saloranta T, Gyllenberg F, But A, Gissler M, Laine MK, Heikinheimo O. Use of universally offered family planning services - a cohort study in the city of Vantaa, Helsinki metropolitan area, Finland. Scand J Public Health 2021; 50:454-462. [PMID: 33818219 DOI: 10.1177/14034948211002745] [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] [Indexed: 11/15/2022]
Abstract
Aims: Knowledge about the women reached by public family planning services is scarce. The means for provision of these services that are pivotal for women's health and empowerment varies globally. In Finland, family planning services are offered free of charge, but often separately for different age groups. City of Vantaa offers these services for all female residents without age limit. The aim of this study was to describe the characteristics of the women using public family planning services. Methods: We assessed the sociodemographic and reproductive characteristics of women aged 15-44 using (n = 11,790) and not using (n = 42,931) these services in 2013-2014. We obtained adjusted odds ratios (AORs) and 95% confidence intervals (95%CIs) for service use by multivariate logistic regression. Results: Women under 35 years of age had higher odds of service use compared with those over 35 (AORs ranging from 2.79 [95%CI 2.54-3.07] for 15-19 year-olds to 1.81 [95%CI 1.69-1.95] for 30-34 year-olds). Women speaking a foreign native language used services less when aged under 30 and more when aged 35-44 compared with women speaking the national languages. Women with a history of delivery, induced abortion or sexually transmitted infections, or with a lower socioeconomic or educational status were more likely to use the services. Conclusions: Young women in general were more likely to use free-of-charge family planning services. In contrast, young women speaking a foreign native language were underrepresented among service users. It is important to recognise and actively reach underrepresented groups, such as young women with a foreign background, to optimise equal access to family planning services.
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Affiliation(s)
- Tuire Saloranta
- Health Center, City of Vantaa, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Frida Gyllenberg
- Health Center, City of Vantaa, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Biostatistics consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Seidu AA, Ahinkorah BO, Agbemavi W, Amu H, Bonsu F. Reproductive health decision-making capacity and pregnancy termination among Ghanaian women: Analysis of the 2014 Ghana demographic and health survey. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Korjagina M, Hakkarainen KM, Burkill S, Geissbühler Y, Sabidó M, Everage N, Suzart-Woischnik K, Klement R, Hillert J, Verkkoniemi-Ahola A, Bahmanyar S, Montgomery S, Korhonen P. Prevalence of adverse pregnancy outcomes after exposure to interferon beta prior to or during pregnancy in women with MS: Stratification by maternal and newborn characteristics in a register-based cohort study in Finland and Sweden. Mult Scler Relat Disord 2020; 48:102694. [PMID: 33429303 DOI: 10.1016/j.msard.2020.102694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/06/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies reported no increase in the prevalence of adverse pregnancy outcomes after exposure to interferon-beta (IFN-beta). However, no study has investigated if the prevalence of these outcomes after IFN-beta exposure is modified by maternal and newborn characteristics. Our objective was to describe the stratified prevalence of adverse pregnancy outcomes among women with multiple sclerosis (MS) exposed only to IFN-beta or unexposed to any MS disease modifying drugs (MSDMDs). METHODS This population-based cohort study using Finnish (1996-2014) and Swedish (2005-2014) register data included pregnancies of women with MS exposed only to IFN-beta 6 months before or during pregnancy (n=718) or unexposed to MSDMDs (n=1397). The outcome prevalences were described stratified by maternal and newborn characteristics, with 95% confidence intervals (CIs). Confounder-adjusted analyses were performed if the prevalence results indicated modified effect of IFN-beta in specific strata. RESULTS The stratified analysis indicated that the prevalence of serious (anomaly or stillbirth) and other adverse pregnancy outcomes was similar among the exposed and unexposed, with no statistically significant difference. Among women treated for MS >5 years, serious adverse pregnancy outcomes occurred in 4.3% (95%CI: 1.9-8.3%) of pregnancies exposed only to IFN-beta 6 months before or during pregnancy and in 2.7% (95%CI: 1.2-5.0%) of unexposed pregnancies. The confounder adjusted analyses did not support the hypothesis that MS treatment duration before pregnancy would modify the risk of adverse pregnancy outcomes after exposure to IFN-beta 6 months before or during pregnancy. CONCLUSION The prevalence of adverse pregnancy outcomes was not increased after IFN-beta exposure, when pregnancies of women with MS were stratified by maternal and newborn characteristics. The stratified results were similar to the unstratified results in the same population.
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Affiliation(s)
- Marta Korjagina
- StatFinn-EPID Research, Paldiski mnt 29, 10612, Tallinn, Estonia
| | | | - Sarah Burkill
- Karolinska Institute, Solnavägen 1, 171 77 Solna, Sweden
| | - Yvonne Geissbühler
- Novartis Pharma AG, Evidence and Launch Excellence, Asklepios 8-3, Postfach, CH-4002 Basel, Switzerland
| | | | | | | | - Riho Klement
- StatFinn-EPID Research, Narva maantee 3, 51009 Tartu, Estonia
| | - Jan Hillert
- Karolinska Institute, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Auli Verkkoniemi-Ahola
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden; Centre for Psychiatry Research, Karolinska Institutet, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden; Stockholm Health Care Services, Solnavägen 1 E, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Solnavägen 1, 171 77 Solna, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Fakultetsgatan 1, 701 82 Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Pasi Korhonen
- StatFinn-EPID Research, Metsänneidonkuja 6, 02130 Espoo, Finland
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What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys. PLoS One 2020; 15:e0235329. [PMID: 32702035 PMCID: PMC7377410 DOI: 10.1371/journal.pone.0235329] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). Materials and methods We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. Results The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17–1.24). We also found that women aged 45–49 (AOR = 5.54, 95% CI = 5.11–6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20–1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04–1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02–1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27–1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39–1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18–1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20–1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04–1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54–0.60) of terminating a pregnancy. Conclusion We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.
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De Kort L, Wood J, Van de Velde S. What are the social correlates of subsequent abortions in Flanders, Belgium? EUR J CONTRACEP REPR 2020; 25:387-393. [PMID: 32683990 DOI: 10.1080/13625187.2020.1792877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study whether the social correlates of subsequent abortions vary depending on the order of the abortion. Methodology: Drawing upon the Flemish abortion centres' anonymized patient records (2010-2019), discrete-time hazard models were used to examine whether individual abortion experiences across women's reproductive life course have different social correlates. RESULTS Overall, women who were in their twenties, of foreign origin, single, had non-tertiary education, were not in paid employment, had children, did not (consistently and without errors) use contraception and had a previous abortion through medication, had an elevated probability to experience subsequent abortions. While single women and women with a vulnerable socioeconomic status were more likely to have a second or third abortion, this difference is no longer prevalent when considering higher-order abortions. The hazard for higher-order abortions was more pronounced in women with a migration background, regardless of the order considered. Contraceptive use was unrelated to fourth or higher-order abortions. CONCLUSION Using discrete-time hazard models, we unpack individual abortion experiences across women's reproductive life courses. By studying the transitions into different orders of subsequent abortions separately, we provide a more detailed understanding of risk factors compared to other European studies. The social correlates vary by the order considered: A certain profile emerges for women who have a second or third abortion, but disintegrates when considering higher-order abortions. This knowledge enables clinicians and policymakers to better understand women who experience subsequent abortions and to tailor services best suited to their needs.
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Affiliation(s)
- Leen De Kort
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
| | - Jonas Wood
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
| | - Sarah Van de Velde
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
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Ulbricht S, Beyer A, John U. Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study. BMC WOMENS HEALTH 2019; 19:120. [PMID: 31627718 PMCID: PMC6798342 DOI: 10.1186/s12905-019-0821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
Background To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered. Methods We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression. Results There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model. Conclusions Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.
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Affiliation(s)
- Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany.
| | - Angelika Beyer
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, D-17487, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany
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Educational Attainment and Pregnancy Outcomes: A Danish Register-Based Study of the Influence of Childhood Social Disadvantage on Later Socioeconomic Disparities in Induced Abortion, Spontaneous Abortion, Stillbirth and Preterm Delivery. Matern Child Health J 2019; 23:839-846. [DOI: 10.1007/s10995-018-02704-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Jokela S, Lilja E, Kinnunen TI, Gissler M, Castaneda AE, Koponen P. Births and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland -comparison of self-reported and register data. BMC Pregnancy Childbirth 2018; 18:296. [PMID: 29991354 PMCID: PMC6038285 DOI: 10.1186/s12884-018-1931-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Since reproductive health is often considered a highly sensitive topic, underreporting in surveys and under coverage of register data occurs frequently. This may lead to inaccurate information about the reproductive health. This study compares the proportion of women having births and induced abortions among migrant women of Russian, Somali and Kurdish origin in Finland to women in the general Finnish population and examines the agreement between survey- and register-based data. Methods The survey data from the Migrant Health and Wellbeing Study conducted in 2010–2012 and data from the Health 2011 Survey with corresponding information on women in the general population were used in this study. The respondents were women aged 18–64: 341 Russian, 176 Somali and 228 Kurdish origin women and 630 women in the general population. The survey data were linked to the Finnish Medical Birth Register and the Register of Induced Abortions. Results In the combined (survey and register) data, migrant groups aged 30–64 had a higher proportion (89–96%) compared to the general population (69%) of women with at least one birth. Under-coverage of registered births was observed in all study groups. Among women aged 18–64, 36% of the Russian group and 24% of the Kurdish group reported more births in the survey than in the register data. In the combined data, the proportions of Russian origin (69%) and Kurdish origin (38%) women who have had at least one induced abortion in their lifetime are higher than in the general population (21%). Under-reporting of induced abortions in survey was observed among Somali origin women aged 18–29 (1% vs. 18%). The level of agreement between survey and register data was the lowest for induced abortions among the Somali and Russian groups (− 0.01 and 0.27). Conclusion Both survey- and register-based information are needed in studies on reproductive health, especially when comparing women with foreign origin with women in the general population. Culturally sensitive survey protocols need to be developed to reduce reporting bias.
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Affiliation(s)
- Satu Jokela
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland.
| | - Eero Lilja
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
| | - Tarja I Kinnunen
- Faculty of Social Sciences, University of Tampere, PL 100, Arvo Ylpön katu 34, Tampere, 33520, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, PL 30, Mannerheimintie 166, Helsinki, 00271, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anu E Castaneda
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
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Väisänen H, Koponen P, Gissler M, Kontula O. Contraceptive use among migrant women with a history of induced abortion in Finland. EUR J CONTRACEP REPR 2018; 23:274-281. [PMID: 29939819 DOI: 10.1080/13625187.2018.1483019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Women's contraceptive choices may change after an induced abortion, due to contraceptive counselling or a behavioural change prompted by the experience. The effect may vary between women; sociocultural background, for example, may affect their subsequent reproductive choices. OBJECTIVE We examined whether women's current contraceptive use was differently associated with a history of induced abortion among immigrant groups in Finland (Russian, Kurdish and Somali) and the general Finnish population. METHODS We analysed data from two surveys, the Migrant Health and Wellbeing study and the Health 2011 study, linked to the Finnish register of induced abortions. Propensity score weighted logistic regression was used to analyse the data. RESULTS The likelihood of using contraceptives after an abortion varied depending on women's sociocultural background. A history of induced abortion increased contraceptive use among all groups, except Russian women, in whom there was no effect. The effect was particularly strong for Kurdish women. CONCLUSION Sociocultural background was an important determinant of post-abortion contraceptive use. Some immigrants may struggle to navigate the Finnish health care system due to language or literacy issues. Attention should be paid to improving access to family planning among these groups.
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Affiliation(s)
- Heini Väisänen
- a Department of Social Statistics and Demography , University of Southampton , Southampton , UK
| | - Päivikki Koponen
- b Department of Public Health Solutions , National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Mika Gissler
- c Information Services Department , National Institute for Health and Welfare (THL) , Helsinki , Finland.,d Research Centre for Child Psychiatry , University of Turku , Turku , Finland.,e Department of Neurobiology , Care Services and Society, Karolinska Institute , Stockholm , Sweden
| | - Osmo Kontula
- f Population Research Institute , Family Federation of Finland (Väestöliitto) , Helsinki , Finland
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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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