1
|
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.
Collapse
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
| |
Collapse
|
2
|
Specialist follow-up contraceptive support after abortion-Impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial. PLoS One 2019; 14:e0217902. [PMID: 31185058 PMCID: PMC6559659 DOI: 10.1371/journal.pone.0217902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/18/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the impact of specialist contraceptive support after abortion on effective contraceptive use at six months and subsequent abortions within two years. METHODS Multicentre randomised controlled trial among women undergoing induced abortion in three London boroughs. Allocation was through electronically concealed stratified randomisation by centre, blinding clinicians and participants to arm allocation until interventions. Control group received standard care, comprising advice to follow up with their general practitioner or contraceptive clinic as needed. Intervention group additionally received specialist contraceptive support via telephone or face-to-face consultation at 2-4 weeks and 3 months post-abortion. Primary outcome was rate of effective contraceptive use at six months post-abortion. Secondary outcomes were subsequent abortions within two years. RESULTS 569 women were recruited between October 2011 and February 2013, randomised to intervention (282) and control (287) groups; 290 (142 intervention, 148 control) were available for primary outcome analysis. Intention-to-treat analysis showed no significant difference between the two groups in effective contraceptive use after abortion (62%, vs 54%, p = 0·172), long-acting contraceptive use (42% versus 32%, p = 0·084), and subsequent abortion (similar rates, at 1 year: 10%, p = 0·895, between 1-2 years: 6%, p = 0·944). Per-protocol analysis showed those who received the complete intervention package were significantly more likely to use effective contraception (67% versus 54%, p = 0·048), in particular long-acting contraception (49% versus 32%, p = 0·010) and showed a non-significant reduction in subsequent abortions within 2 years (at 1 year: 5% versus 10%, p = 0·098; and between 1-2 years: 3% versus 6%, p = 0·164, respectively). CONCLUSIONS Structured specialist support post-abortion did not result in significant use of effective contraception at six months or reduction in subsequent abortions within two years. Participants engaging with the intervention showed positive effect on effective contraception at six months post-abortion. The potential benefit of such intervention may become evident through further studies with increased patient participation.
Collapse
|
3
|
Liu J, Wu S, Xu J, Temmerman M, Zhang WH. Is Repeat Abortion a Public Health Problem among Chinese Adolescents? A Cross-Sectional Survey in 30 Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050794. [PMID: 30841501 PMCID: PMC6427833 DOI: 10.3390/ijerph16050794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Abstract
The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have limited access. This cross-sectional study aims to identify risk factors related to repeat abortions in Chinese adolescents receiving abortions. Data were collected using a questionnaire for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in 297 participating hospitals randomly selected across 30 provinces of China in 2013. Only the adolescents (younger than the minimum legal married age of 20 years) were included in this study. Of the 2370 adolescents who were receiving abortions, 927 (39%) were undergoing repeat abortions. The primary reason for the current unintended pregnancies was non-use of contraception (68%). Adolescents receiving abortions who had an increased risk of repeat abortions were those who had children (OR 2.57, 95% CI 1.80⁻3.67), those who resided in a middle-developed region (OR 1.81, 95% CI 1.30⁻2.50), those who resided in a relatively poor region (OR 2.40, 95% CI 1.78⁻3.23), and those who had used contraception during the 6 months preceding the survey (OR 1.38, 95% CI 1.12⁻1.71 for condom use). The occupation as a student was a protective factor for adolescents (OR 0.64, 95% CI 0.50⁻0.83). Adolescents should be offered equal access to FP to that of married women in China to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice should be promoted.
Collapse
Affiliation(s)
- Jinlin Liu
- Department of Public Health and Primary Care, International Centre for Reproductive Health (ICRH), Ghent University, 9000 Ghent, Belgium.
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Shangchun Wu
- The National Research Institute for Family Planning (NRIFP), Beijing 100081, China.
| | - Jialin Xu
- Chengde Nursing Vocational College, Chengde 067000, China.
| | - Marleen Temmerman
- Department of Public Health and Primary Care, International Centre for Reproductive Health (ICRH), Ghent University, 9000 Ghent, Belgium.
- The Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi 00100, Kenya.
| | - Wei-Hong Zhang
- Department of Public Health and Primary Care, International Centre for Reproductive Health (ICRH), Ghent University, 9000 Ghent, Belgium.
- Research Laboratory for Human Reproduction, Faculty of Medicine, School of Public Health Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium.
- Research Centre for Public Health, Tsinghua University, Beijing 100084, China.
| |
Collapse
|
4
|
Parra Ribes I, Rascón Poza JJ, Pérez Campos E, Bugella Yudice I, Rodríguez Domingo MJ. Economic Burden of Contraception Management in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2018; 6:63-74. [PMID: 32685572 PMCID: PMC7309956 DOI: 10.36469/9785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. OBJECTIVES This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. METHODS A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. RESULTS Reversible contraception costs in Spain amount to €12.5 billion over a 5-year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women's age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. CONCLUSIONS LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.
Collapse
|
5
|
Purcell C, Riddell J, Brown A, Cameron ST, Melville C, Flett G, Bhushan Y, McDaid L. Women's experiences of more than one termination of pregnancy within two years: a mixed-methods study. BJOG 2017; 124:1983-1992. [PMID: 28922538 PMCID: PMC5725730 DOI: 10.1111/1471-0528.14940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the experiences of women seeking more than one termination of pregnancy (TOP) within 2 years. DESIGN Mixed methods study. SETTING Six TOP services across Scotland. SAMPLE Women presenting for TOP between July and December 2015. METHODS Descriptive and inferential analysis of quantitative survey data, thematic analysis of qualitative interview data and integrative analysis. In quantitative analysis, multinomial logistic regression was used to compare three groups: previous TOP within 2 years, previous TOP beyond 2 years and no previous TOP. MAIN OUTCOME MEASURES Characteristics and experiences of women seeking TOP. RESULTS Of 1662 questionnaire respondents, 14.6% (n = 242) and 19.8% (n = 329) reported previous TOP within and beyond 2 years, respectively. The previous TOP within 2 years group was significantly less likely to own their accommodation than the no previous TOP group (adjusted odds ratio [aOR] 0.34, 95% CI: 0.18-0.62) and previous TOP beyond 2 years group (aOR: 0.44, 95% CI: 0.23-0.85); and more likely to report inconsistent (aOR: 1.63, 95% CI: 1.04-2.57; aOR: 1.95, 95% CI: 1.16-3.28) and consistent (aOR: 2.13, 95% CI: 1.39-3.26; aOR: 1.71, 95% CI: 1.07-2.76) contraceptive use than the no previous TOP and previous TOP within 2 years groups, respectively. Twenty-three women from the previous TOP within 2 years group were interviewed. Qualitative and integrative analyses highlight issues relating to contraceptive challenges, intimate partner violence, life aspirations and socio-economic disadvantage. CONCLUSIONS Women undergoing more than one TOP within 2 years may experience particular challenges and vulnerabilities. Service provision should recognise this and move away from stigmatising discourses of 'repeat abortion'. FUNDING Scottish Government. TWEETABLE ABSTRACT Women having two or more terminations of pregnancy in 2 years may face key challenges/vulnerabilities including intimate partner violence and socio-economic disadvantage.
Collapse
Affiliation(s)
- C Purcell
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - J Riddell
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - A Brown
- NHS Greater Glasgow and Clyde Sexual and Reproductive HealthSandyford CentralGlasgowUK
| | | | - C Melville
- True Relationships & Reproductive HealthWindsorQLDAustralia
| | - G Flett
- NHS Grampian Sexual and Reproductive HealthAberdeen Community Health and Care VillageAberdeenUK
| | - Y Bhushan
- NHS Tayside Gynaecology Assessment UnitNinewells HospitalDundeeUK
| | - L McDaid
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| |
Collapse
|
6
|
Leeners B, Bieli S, Huang D, Tschudin S. Why prevention of repeat abortion is so challenging: psychosocial characteristics of women at risk. EUR J CONTRACEP REPR 2016; 22:38-44. [DOI: 10.1080/13625187.2016.1258053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Brigitte Leeners
- Clinic for Reproductive Endocrinology, University Hospital of Zürich, Zürich, Switzerland
| | - Simone Bieli
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dorothy Huang
- Division of Social Medicine and Psychosomatics, Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | - Sibil Tschudin
- Division of Social Medicine and Psychosomatics, Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Strøm-Roum EM, Lid J, Eskild A. Use of contraception among women who request first trimester pregnancy termination in Norway. Contraception 2016; 94:181-6. [PMID: 27091722 DOI: 10.1016/j.contraception.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Among women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used. STUDY DESIGN We included all requests for pregnancy termination in Norway during the years 2007-2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level. RESULTS In total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20-24years old had used contraception, compared to 29.9% of women 40-44years old (odds ratio 0.55, 95% confidence interval 0.51-0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use. CONCLUSION Among women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant. IMPLICATIONS A large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use.
Collapse
Affiliation(s)
- Ellen Marie Strøm-Roum
- Department of Obstetrics and Gynecology, Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Julie Lid
- Institute of Clinical Medicine, University of Oslo, PO, box 1171 Blindern, 0318 Oslo, Norway.
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, PO, box 1171 Blindern, 0318 Oslo, Norway.
| |
Collapse
|
8
|
Picavet C, Goenee M, Wijsen C. Characteristics of women who have repeat abortions in the Netherlands. EUR J CONTRACEP REPR 2013; 18:327-34. [PMID: 23964847 DOI: 10.3109/13625187.2013.820824] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To explore the demographic characteristics of women having multiple abortions, in order to identify abortion clients who might be at increased risk of repeat abortion. METHODS On the basis of the registration data of most Dutch abortion clinics, responsible for 64% of all such procedures, women who procured a first abortion were compared to those who had one or more previously. Results of bivariate analyses and a multivariate binary logistic regression analysis are presented. RESULTS Of all abortions, 36% were repeat abortions. Women aged over 20 were more likely to have repeat abortions, as were migrants, particularly those with a Caribbean background (from Surinam or the Netherlands Antilles) and women who had children. Effect sizes of other factors were very small. Surprisingly, women who had repeat abortions more often used contraception in the preceding six months than women who had a first abortion, but also this effect size was small as well. A multivariate logistic regression analysis led to similar results. CONCLUSIONS Abortion clients with a Caribbean background should be targeted for the prevention of more unwanted pregnancies. Not only should the use of reliable contraception be promoted, but also compliance and continuation.
Collapse
|
9
|
Moosazadeh M, Nekoei-Moghadam M, Emrani Z, Amiresmaili M. Prevalence of unwanted pregnancy in Iran: a systematic review and meta-analysis. Int J Health Plann Manage 2013; 29:e277-90. [PMID: 23630092 DOI: 10.1002/hpm.2184] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Different studies show that a considerable number of pregnancies are unwanted and can have side effects on mothers'' children's and finally society's health. Accordingly, this meta-analysis study has been carried out to estimate a relatively accurate level of unwanted pregnancies in Iran. METHODS Present studies and published documents were retrieved from Persian and English electronic databases. To increase sensitivity and to select more studies, the reference list of the published studies was checked. After studying the titles and texts of documents, repeated and irrelevant ones were excluded. Data was analyzed using STATA V.11. RESULTS Forty-nine qualified papers were selected with a 43,061 sample size. The meta-analysis of unwanted pregnancy prevalence in Iran equals 30.6% (CI = 28.1-33.1). Also' according to the present meta-analysis' the most common contraceptive methods used by couples prior to unwanted pregnancies are as follows: pills 27.1%' withdrawal 38.6%' IUD 11.4%' injection contraceptives 2.8%' vasectomy 0.28% and no method 24.5%. DISCUSSION AND CONCLUSION The results of meta-analysis showed that about one-third of pregnancies in Iran are unwanted and a high percent of them are among women who had used contraceptives. Therefore' it is necessary to adopt more appropriate policies on the following: education, proper pregnancy age, using contraceptive methods, men's role in family planning programs and quality promotion in family planning services.
Collapse
Affiliation(s)
- Mahmood Moosazadeh
- Research Center for Modeling in Health, Institute of Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | |
Collapse
|
10
|
Serrano I, Doval JL, Lete I, Arbat A, Coll C, Martínez-Salmeán J, Bermejo R, Pérez-Campos E, Dueñas JL. Contraceptive practices of women requesting induced abortion in Spain: A cross-sectional multicentre study. EUR J CONTRACEP REPR 2012; 17:205-11. [DOI: 10.3109/13625187.2012.670889] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
11
|
A need to expand our thinking about “repeat” abortions. Contraception 2012; 85:408-12. [DOI: 10.1016/j.contraception.2011.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 11/22/2022]
|
12
|
Why do women experience untimed pregnancies? A review of contraceptive failure rates. Best Pract Res Clin Obstet Gynaecol 2010; 24:443-55. [PMID: 20335073 DOI: 10.1016/j.bpobgyn.2010.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/04/2010] [Indexed: 12/11/2022]
Abstract
Contraceptive failure contributes to a substantial proportion of unintended pregnancy, particularly in the developed world. A number of socio-demographic factors seem to impact on the risk of a woman experiencing contraceptive failure. Many of the issues exist across cultural boundaries and are complex to address. In discussing the failure rates for individual contraceptive methods, this article will highlight the advantage of improving uptake of long-acting reversible methods of contraception which have a high efficacy and are less user-dependent than many of the other available methods.
Collapse
|