Abortion rate and contraceptive practices in immigrant and native women in Sweden

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review

BACKGROUND

Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia.

METHODS

The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care.

RESULTS

A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling.

CONCLUSIONS

There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

Association of migration and family planning use among women in Malawi: Evidence from 2019/2020 Malawi Multiple Indicators Survey

BACKGROUND

Family planning (FP) is known to bring multiple benefits to people both individually and collectively. Individually, FP has been associated with reduction in risk of unintended pregnancy which also correlates with low child mortality rates. Child mortality rates in women with child spacing of less than two years are 45% higher compared to their counterparts with child spacing of more than two years. Several factors that predict FP utilisation among women of childbearing age have been identified but there is limited literature on how migration impacts FP utilisation in Malawi. Our current study aimed at assessing the association between migration and modern contraceptive use among women of childbearing age in Malawi.

METHODS

Data for this study came from a nationally representative 2019/20 Malawi multiple cluster indicator survey (MICS). At total of 24,543 women aged 15 to 49 participated in the survey. Contraceptive prevalence rate (CPR) analyses were conducted separately on all women of childbearing age and married women. The data was analysed using the complex survey data approach by applying sampling weights to correct unequal representation of participants at cluster, district, and regional level. We used binary logistic regression to assess association between migration status and modern contraceptive use among all women of childbearing age and married women separately. We included age, age at first sex, age at marriage, region of residence, education, residence wealth index and presence of disability as confounders in our final multivariable models.

RESULTS

The overall CPRs for married women and for all women of childbearing age were 64.7% and 40.5% respectively. The CPRs for all women of childbearing age were 40.5% for non-migrants and 33.0% for migrant women. For married women, CPRs were 51.5% for migrant women and 65.5% for non-migrant women. The fully adjusted odds ratios for the association between migration status and modern contraceptive use were 0.62 (0.49-0.78) for married women and 0.65 (0.52-0.80) for all women of childbearing age.

CONCLUSIONS

We conclude from our findings that migrant women were significantly less likely to utilize modern contraceptive methods for both married women and all women of childbearing age. Deliberate efforts are required to ensure that migrant women of childbearing age have equal access to sexual and reproductive health services which includes family planning.

Perceptions of family planning among some Somali men living in Sweden: A phenomenographic study

OBJECTIVE

A growing body of research in Sweden has focused on migration and reproductive health, particularly on women's perspectives, including family planning and contraception. However, knowledge is limited on how immigrant men perceive family planning. The topic is important because women's use of family planning has been shown to be influenced by their partners and community. Therefore, this study aims to explore perceptions of family planning among Somali men living in Sweden.

METHODS

A qualitative phenomenographic approach was used. Four focus group discussions were conducted with 41 men aged 28-59 years. Data were analysed using phenomenographic analysis.

FINDINGS

The following four categories were identified in the analysis: 1) a happier and more sustainable family; 2) ideal family size versus cultural commitment; 3) fears of using modern family planning methods; and 4) a need to be included in family planning. The findings illuminated the complexities of perceptions of family planning. Although Somali men understood the benefits of family planning, they seemed to prefer a large family. However, due to their new social context in Sweden, they had also changed their views on having as large a family as in their home country.

CONCLUSION

Our findings suggest that Somali men living in Sweden want to be involved in family planning counselling, which may increase women's use of contraception. However, healthcare providers must ensure that the woman desires her partner's involvement and be culturally sensitive about couples' needs.

Improving care for immigrant women before, during, and after childbirth - what can we learn from regional interventions within a national program in Sweden?

Background

Migration has increased the number of immigrant women in western countries, which has led to a need to adapt sexual and reproductive health (SRH) care to a larger variety of experiences. Examples of problems are poor access/utilization of SRH services among migrants and a comparatively higher rate of mortality and morbidity in relation to pregnancy, especially among those from low- and middle-income settings. Attempts to improve SHR care must consider the complexity of both the problem and the system. A national program to improve women’s health in Sweden provided opportunities to study interventions aimed at immigrant women, using a complexity theory lens. The purpose was to explore the characteristics and complexity of regional interventions aiming to improve care and health of immigrant women before, during and after childbirth, and provide knowledge on how regional healthcare actors perceive and address problems in these areas.

Methods

This archival research study is based on qualitative data from detailed yearly reports of all regional program interventions (n = 21 regions) performed between January 2017 and January 2019. The archival data consists of the regional actors’ answers to an extensive questionnaire-like template, where the same questions were to be filled in for each reported intervention. Data analyses were performed in several steps, combining classic and directive content analysis.

Results

Six problem categories were addressed by 54 regional interventions, 26 directed at immigrant women and their families, 11 at healthcare staff, and 17 at the organizational system. The simple level interventions (n = 23) were more unilateral and contained information campaigns, information material and translation, education, mapping e.g., of genital mutilation, and providing staff and/or financial resources. The complicated interventions (n = 10) concerned increasing communication diversity e.g., by adding iPads and out-reach visits. The complex interventions (n = 21), e.g., health schools, integration of care, contained development, adaptions, and flexibility with regards to the immigrant women’s situation, and more interaction among a diversity of actors, also from the wider welfare system.

Conclusions

It is important that complex problems, such as ensuring equal care and health among a diverse population, are addressed with a mix of simple, complicated, and complex interventions. To enhance intended change, we suggest that pre-requisites e.g., communication channels and knowledge on behalf of immigrant women and staff, are ensured before the launch of complex interventions. Alternatively, that simple level interventions are embedded in complex interventions.

Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden

OBJECTIVE

This trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.

METHODS

A cluster randomised controlled trial was conducted in 2017-2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants.

RESULTS

We involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04-3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048).

CONCLUSIONS

Structured contraceptive counselling increased LARC choice, initiation and use, controlled for participants' migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods.

TRIAL REGISTRATION NUMBER

NCT03269357.

Intendedness of pregnancies and preconception contraceptive use in women of Swedish and non-European origins seeking emergency care in early pregnancy

INTRODUCTION

Unintended pregnancies in Europe have been estimated to constitute 43% of all pregnancies, with the proportion in Sweden being unknown. In striving for equitable healthcare, increased knowledge about unintended pregnancies among women born outside Europe is needed. We aimed to estimate the proportion of unintended pregnancies in women born in Sweden compared with women born outside Europe in an unselected population seeking gynaecological emergency care in early pregnancy. Our secondary aim was to compare contraceptive use at the time of conception in unplanned pregnancies between women born in Sweden and women born outside Europe.

METHODS

Pregnant women seeking gynaecological emergency care in early pregnancy at a tertiary hospital were asked to fill out a questionnaire in their native language. The questionnaire contained questions from the London Measure of Unplanned Pregnancy (LMUP) and questions regarding sociodemographic data, gynaecological health and previous contraception.

RESULTS

Of 180 pregnancies, 66 were unintended (36.7%) according to the LMUP. Among patients born in Sweden, 49/129 (38.0%) of the pregnancies were unintended compared with 17/51 (33.3%) among patients born outside Europe (p=0.56). 86% of participants with unintended pregnancy did not use any form of contraception during the month of conception, with no difference between women born in Sweden and those born outside Europe.

CONCLUSIONS

Among women seeking gynaecological emergency care in early pregnancy, unintended pregnancies are common. Women with unintended pregnancies had low use of preconception contraceptives, which highlights a need for further interventions aimed at avoiding unintended pregnancies.

Childhood Origins, Migration, and First Modern Contraceptive Use in Turkey

This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration is positively associated with age of first modern contraceptive use. As women's migration is quickly followed by family formation, women also take up modern contraception after first childbirth, likely due to new encounters with medical professionals, differing contraceptive access and other social exposures. We also find that women whose childhoods were spent in urban areas have a higher risk of first modern contraception relative to women from rural areas, thus suggesting the enduring importance of socialization. These results show how selection processes, life-cycle factors, and sociocultural norms jointly shape modern contraceptive behavior in Turkey. Our results also demonstrate a need for increased reproductive care in rural areas and suggest continued fertility decline with urban migration.

Migration and Contraception among Mexican Women: Assessing Selection, Disruption, and Adaptation

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women's contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands' solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants' reproductive health should recognize the deleterious effect of policies encouraging family separation. Healthcare must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Understanding the needs and use of sexual and reproductive health services among Thai women: a descriptive cross-sectional study in Sweden

Background Immigrants are at increased risk of HIV infection in Europe and at risk of delayed diagnosis. In Sweden, Thailand belongs to one of the three most common countries of origin among immigrants diagnosed with HIV. This study investigated the need and use of sexual and reproductive health (SRH) services among Thai women residing in Sweden. Use of contraceptives and HIV testing in Thailand was also investigated to understand if this influences utilisation of SRH services in Sweden.

METHODS

A cross-sectional study using postal questionnaire to all Thai-born women (age 23-60) in Stockholm, residing in Sweden since 2014. The response rate was 52.3% (n= 266). Bivariate and multivariate logistic regression analyses were used.

RESULTS

The majority reported a significant need for information related to SRH services. Most of the women using contraception (70%) bought their contraceptives in Thailand. In total, 60% of the women had been HIV-tested at some point in their lives; the majority were tested in Thailand. Women who had been HIV-tested in Thailand were more likely to also have been tested in Sweden. Significant differences in contraception use, participation in contraceptive counselling and having had an HIV test were found between groups of younger and older women.

CONCLUSIONS

Our findings imply that age is an important factor to understand women's need and use of SRH services in Sweden versus Thailand. Furthermore, women's lack of knowledge and reported need for SRH information needs to be considered when making policies and strategies to increase access to SRH services.

The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health

Background

Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women.

Methods

Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors.

Results

Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion.

Conclusion

This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

What are the social correlates of subsequent abortions in Flanders, Belgium?

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.

Barriers and facilitators to contraceptive use among Somali immigrant women in Oslo: A qualitative study

Background

The European Action Plan for Sexual and Reproductive Health emphasizes the importance of improving access to contraceptive services for disadvantaged groups. However, a prior study showed that the prevalence of abortion is two times higher among refugees compared to non-immigrants in Norway. Similarly, a recent study reported that 50% of Somali women in Oslo had unintended childbirth on one occasion or more. These findings are supported by several studies in Europe that showed immigrant and refugee women have higher rates of unintended pregnancy and abortion than Non-immigrant women, and more than half of immigrants, who seek abortion are not using any form of contraception, raising concerns about their access to utilization of modern contraception. However, none of these studies have explored reasons underlying immigrant women’s underutilization of modern contraception. The present study aimed to explore the barriers and facilitators to contraceptive usage among Somali immigrant women in Oslo area.

Methods

A qualitative study using unstructured in-depth interviews with twenty one Somali women of reproductive age, >18 years, was conducted in Oslo from May—August 2018. The participants were recruited using purposive sampling method. Interviews began with a general question and were followed with some probing questions, and were continued until data saturation was reached. Data were analyzed using thematic analysis.

Results

Although the majority of the participants were educated, aware of the importance of contraceptive methods and interested in child spacing, systemic and socio-cultural barriers were found to be hindering their access to contraception. Several barriers were identified, including: language problems, lack of adequate information, religious beliefs, gender roles and social pressure.

Conclusion

Eliminating the barriers which prevent women from receiving their desired form of contraception will have important public health implications, including lengthening inter-pregnancy intervals, and fewer unplanned pregnancies and abortions. These findings can support policy makers, civil society organizations and health providers to develop cultural sensitive programmes and educational interventions, which help Somali immigrant women overcome the identified barriers to contraception.

Induced Abortion and Migration to Metropolitan Paris by Sub-Saharan African Women: The Role of Intendedness of Pregnancy

Migration can affect reproductive outcomes due to different socioeconomic and cultural contexts before and after migration, to changes in the affective and conjugal status of women and to their life conditions. The aim of this study is to investigate the association between international migration and abortion. The data came from a retrospective life-event survey from sub-Saharan African women living in Île-de-France. Differences in abortion distribution before and after migration were assessed using the Pearson chi-square test, and the association between the predictor and the outcome was investigated using Generalized Estimating Equations. A total of 363 women and 1377 pregnancies were investigated. Among these pregnancies, 15.6% that occurred before and 11.0% that occurred after migration was reported as ended in abortion (p = 0.011). The odds of reporting having had an abortion was lower after migration (OR 0.59, 95% CI 0.42-0.84), even after adjustment. However, after including intendedness of pregnancy in the model, this association lost its significance. The difference in induced abortion occurrence between before and after migration is almost entirely due to a change in the intendedness of pregnancy. Thus, socioeconomic and cultural issues have a greater weight in the decision to abort than the legal interdiction of this practice.

Unmet needs for contraception: A comparative study among Somali immigrant women in Oslo and their original population in Mogadishu, Somalia

Introduction

Unmet need for contraception is defined as the proportion of fertile individuals who do not use contraceptives despite wanting to space or limit their childbearing. Studies show that immigrant women in Europe, have higher rates of unintended pregnancies and abortion than native born women. Somali women, have the highest fertility rate in Norway which is much higher than the total fertility rate in Norway (4.0 vs. 1.7). This study investigates the unmet need for contraception among Somali immigrant women in Oslo, Norway, compared to their original population in Mogadishu, Somalia.

Methods

A community based, cross sectional study was carried out among Somali women in Oslo (N = 228) and Mogadishu (N = 229) from May to December 2018. Pre-structured questionnaires were given to women who were recruited through snow-ball sampling. Data was analyzed using SPSS version 25. We performed a chi-square test for the analyses of categorical variables, a t-test for continuous variables and multivariate logistic analysis to determine the association between exposure and outcome variable.

Results

The unmet needs for contraception among Somali women in Oslo was 20.2%, which is similar to unmet needs for contraception of women in many sub-Saharan African countries. The unmet needs for Somali immigrant women in Oslo (20.2) is two times lower than that of their original population in Somalia (48.5). The odds of having unmet needs for contraception was nearly, three times higher among Somali women in Mogadishu compared to those in Oslo (OR: 2.6, CI: 2.56–7.68). The mean intended fertility was 4 among the women in Oslo and 10.8 in Mogadishu. About 13.4% of study participants in Oslo and 86.6% of those in Mogadishu consider modern contraception irrelevant for women’s health. Nearly 50% of women in both places had unintended childbirth on one or more occasion.

Conclusion

The study results show the prevalence of unmet needs for contraception among Somali immigrant women Oslo, is 4 fold higher than that of Norway (20.2 vs 5.5). Information Education Communication to both men and women, may reduce the high unmet need for contraception and also improve partner communication on family planning among Somali immigrants in Oslo. Training primary health providers for provision of tailored information about the modern contraception to immigrant women, which includes an individualized counselling may improve partners’ knowledge, demand and uptake of modern contraception.

Magnitude and associated factors of repeat induced abortion among reproductive age group women who seeks abortion Care Services at Marie Stopes International Ethiopia Clinics in Addis Ababa, Ethiopia

Background

Repeated induced abortion is important public health concern both in the developing and developed world that increases maternal morbidity and mortality. The aim of this study was to determine the magnitude and associated factors of repeated induced abortion among abortion care service seekers at Marie Stopes International Ethiopia clinics in Addis Ababa, Ethiopia.

Methods

A cross sectional study was conducted among 429 women seeking abortion care at Marie Stopes International Ethiopia clinics. Simple random sampling technique was used to select study participants. Data were collected by trained data collectors using pretested structured questionnaires. Data were checked for completeness, consistency, coded and entered and analyzed through SPSS version 20. Bivariate and multivariate logistic regression analysis was computed to test the strength of association and the p-value < 0.05 was considered as statistical significant.

Result

The magnitude of repeat induced abortion was 33.6%. Based on this study age groups 20–24 years (AOR = 1.2; CI: 1.1–2.3), 25–29 years (AOR = 5.4; CI: 3.1–6.2) and 30–34 years (AOR = 1.1; CI: 1.02–2.6); respondents with the educational level of primary (AOR = 0.2; CI: 0.070.6), secondary (AOR = 0.4; CI: 0.2–0.8) and college diploma and above (AOR = 0.4; CI: 0.2–0.6); those with the monthly income of 1001–2000 Ethiopian birr (AOR = 4.2; CI: 1.8–9.4) and 2001–3000 Ethiopian birr (AOR = 0.3; CI: 0.2–0.9); those with years in marriage with 1–2 years (AOR = 2.4; CI: 1.2–4.9) and those with last time of abortions of 1–2 years, 2–3 years and above 3 years, (AOR = 0.2; CI: 0.1–0.5), (AOR = 0.1; CI: 0.05–0.4), (AOR = 0.4; CI: 0.2–0.9), respectively were found to be significantly associated with repeat induced abortions.

Conclusion and recommendation

The magnitude of repeat induced abortion is similar with the reports from developing countries but it was lower than that of developed countries. Age group (20–24, 25–29 and 30–34 were positively associated with repeat induced abortion), educational level (primary, secondary and collage diploma and above were negatively associated with repeat induced abortion), monthly income (earn 1001–2000 Ethiopian birr were positively where as monthly income between 2001 and 3000 Ethiopian birr negatively associated), years in marriage (1–2 years was negatively associated) and time of last abortion (1–2 years, 2-3 years and above the three years were negatively associated) were the associated factors for repeat induced abortion. Health promotion messages are needed to focus to improve the knowledge of women about contraceptives as a primary prevention of repeated induced abortion.

Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research

OBJECTIVE

'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

DESIGN

Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

FINDINGS

We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

CONCLUSION

We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

IMPLICATIONS FOR PRACTICE

This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

A Qualitative Exploration of Somali Refugee Women's Experiences with Family Planning in the U.S

The purpose of our study was to explore the knowledge, attitudes, and experiences of Somali refugee women with family planning in the U.S. We conducted focus groups of Somali refugee women and used grounded theory methodology to identify emergent themes. Fifty-three women, aged 18-49 years, participated. Somali refugee women's cultural and religious beliefs and social identities strongly influence their conceptualization of family planning. Participants agreed that a woman's fertility is ultimately decided by Allah and identified environmental changes after immigration and the desire to optimize maternal health as facilitators to modern contraceptive use. Misconceptions about and fear of side effects of modern contraceptive methods, including a fear of infertility, were identified as barriers to use. To deliver patient-centered family planning counseling to Somali refugee women, it is essential that healthcare providers approach these discussions with cultural humility and consider employing community partners or cultural brokers to help provide family planning education.

Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden

INTRODUCTION

The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women.

METHODS

The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015.

RESULTS

The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception.

CONCLUSIONS

Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.

A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden

OBJECTIVE

Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access, or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual and reproductive healthcare services among immigrant women in Sweden.

METHOD

A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed among immigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants. Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests, and logistic regressions were used for the analysis.

RESULTS

About one-third of the immigrant women reported lack of knowledge of where to go for contraceptive counselling. Experiencing lack of emotional social support and not having had children was associated with this lack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and this was associated with not having participated in a health examination. Almost 25% stated that their culture kept them back from using contraception.

CONCLUSION

Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women participating in Swedish language schools for immigrants could be considered as a missed opportunity, as all citizens in Sweden have free access to these services. New health policies and strategies should aim to increase knowledge of SRH services among immigrants. Swedish language schools could play an important role in increasing knowledge of SRH-related information as many new immigrants become students during their first years in Sweden.

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

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

Use of hormonal contraceptives among immigrant women and their daughters in Norway: Data from the Norwegian Prescription Database

INTRODUCTION

Immigrants and their offspring constitute 16.3% of the population in Norway. Knowledge about their contraceptive use is important in order to inform adequate family planning services. Prior research has shown less use of contraception among first-generation immigrants than among non-immigrant women. Our aim is to compare the use of hormonal contraceptives between immigrants and their adult daughters.

MATERIAL AND METHODS

Information from the Norwegian Prescription Database on all hormonal contraceptives dispensed at all pharmacies in Norway in 2008 was merged with demographic, socioeconomic and immigration data from the National Population Register and information from the Regular General Practitioner Database and the Medical Birth Registry Norway. A total of 10 451 women aged 16-30 from five countries with relatively large numbers of immigrants and adult daughters living in Norway in 2008 were included in the study. Descriptive statistics and logistic regression analyses were conducted. The main outcome measure was use of any hormonal contraceptive.

RESULTS

More daughters of immigrants from Vietnam compared with immigrant women from these countries (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.8-2.8) and Poland (OR 2.3, 95% CI: 1.6-3.3) used hormonal contraceptives. However, no adjusted differences between generations were detected for immigrants from Pakistan (OR 1.2, 95% CI 1.0-1.4), Morocco (OR 1.0, 95% CI 0.7-1.4) or Chile (OR 1.3, 95% CI 0.8-1.9).

CONCLUSIONS

Further research should explore the reasons for heterogeneity in use of contraception among daughters of immigrants from different origins and explore whether daughters of immigrant mothers from some areas have unmet needs of contraception.

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

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.

Social and demographic drivers of trend and seasonality in elective abortions in Denmark

BACKGROUND

Elective abortions show a secular decline in high income countries. That general pattern, however, may mask meaningful differences-and a potentially rising trend-among age, income, and other racial/ethnic groups. We explore these differences in Denmark, a high-income, low-fertility country with excellent data on terminations and births.

METHODS

We examined monthly elective abortions (n = 225,287) from 1995 to 2009, by maternal age, parity, income level and mother's country of origin. We applied time-series methods to live births as well as spontaneous and elective abortions to approximate the denominator of pregnancies at risk of elective abortion. We used linear regression methods to identify trend and seasonal patterns.

RESULTS

Despite an overall declining trend, teenage women show a rising proportion of pregnancies that end in an elective termination (56% to 67%, 1995 to 2009). Non-Western immigrant women also show a slight increase in incidence. Heightened economic disadvantage among non-Western immigrant women does not account for this rise. Elective abortions also show a sustained "summer peak" in June, July and August. Low-income women show the most pronounced summer peak.

CONCLUSIONS

Identification of the causes of the increase over time in elective abortion among young women, and separately among non-Western immigrant women, represents key areas of further inquiry. The unexpected increase over time in elective abortions among teens and non-Western immigrants in Denmark may signal important social and cultural impediments to contraception. The summer peak in abortions among low-income women, moreover, conflicts with the conventional assumption that the social and demographic composition of mothers who electively end their pregnancy remains stable within a calendar year.

The role of birthplace and educational attainment on induced abortion inequalities

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Drivers of maternity care in high-income countries: can health systems support woman-centred care?

In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.

Contextual determinants of induced abortion: a panel analysis

OBJECTIVE

Analyze the contextual and individual characteristics that explain the differences in the induced abortion rate, temporally and territorially.

METHODS

We conducted an econometric analysis with panel data of the influence of public investment in health and per capita income on induced abortion as well as a measurement of the effect of social and economic factors related to the labor market and reproduction: female employment, immigration, adolescent fertility and marriage rate. The empirical exercise was conducted with a sample of 22 countries in Europe for the 2001-2009 period.

RESULTS

The great territorial variability of induced abortion was the result of contextual and individual socioeconomic factors. Higher levels of national income and investments in public health reduce its incidence. The following sociodemographic characteristics were also significant regressors of induced abortion: female employment, civil status, migration, and adolescent fertility.

CONCLUSIONS

Induced abortion responds to sociodemographic patterns, in which the characteristics of each country are essential. The individual and contextual socioeconomic inequalities impact significantly on its incidence. Further research on the relationship between economic growth, labor market, institutions and social norms is required to better understand its transnational variability and to reduce its incidence.

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

OBJECTIVES

To examine induced abortion (IA) inequalities between native and immigrant women in a Southern European region and whether these inequalities depend on a 2010 Law facilitating IA.

METHODS

We conducted two analyses: (1) prevalence of total IAs, repeat and second trimester IA, in native and immigrant women aged 12-49 years for years 2009-2013 according to country of origin; and (2) log-binomial regression was used to quantify the association of place of origin with repeat and second trimester IAs among women with IAs.

RESULTS

Immigrants were more likely to have an IA than Spanish women, with the highest probability in Sub-Saharan Africa (PR 8.32 95 % CI 3.66-18.92). Immigrant women with an IA from countries other than Maghreb and Asia have higher probabilities of a repeat IA than women from Spain. Women from Europe non-EU/Romania were 50 % (95 % CI 0.30-0.79) less likely to have a second trimester IA, while women from Central America/Caribbean were 45 % (95 % CI 1.11-1.89) more likely than Spanish women. The 2010 Law did not affect these associations.

CONCLUSIONS

There is a need for parenthood planning programs and more information and access to contraception methods especially in immigrant women to help decrease IAs.

Postpartum Contraception: a Comparative Study of Berlin Women with and without Immigration Background

Research Questions: Are there differences in postpartum contraceptive use between women with and without immigration background? Do women more commonly use contraception following a high-risk pregnancy or caesarean section? What role does current breastfeeding play and, amongst immigrants, what is the effect of acculturation level on the frequency of contraceptive use? Study Population and Methods: Data collection was carried out as part of a larger study in three Berlin delivery units using standardised interviews (questionnaires covering e.g. sociodemographics, immigration history/acculturation and use of antenatal care); telephone interviews comprising 6 questions on postpartum contraception, breastfeeding and postpartum complications were conducted on a sample of the study population six months after delivery. Results: 247 women with, and 358 women without a background of immigration were included in the study (total study population n = 605, response rate 81.1 %). 68 % of 1st generation immigrants, 87 % of 2nd/3rd generation women and 73 % of women without immigration background (non-immigrants) used contraception. In the logistical regression analysis 1st generation immigrants were less likely than non-immigrants to be using contraception six months postpartum, and 1st generation immigrants with low acculturation level were significantly less likely to use contraception than 2nd/3rd generation women with low acculturation level. Conclusion: In the extended postpartum period there was no major difference in contraceptive use between immigrants in general and non-immigrants. It remains unclear whether the differing contraceptive behaviour of 1st generation immigrants is the result of less access to information, sociocultural factors or differing contraceptive requirements and further targeted, qualitative study is required.

Contraceptive practices and induced abortions status among internal migrant women in Guangzhou, China: a cross-sectional study

BACKGROUND

China is facing the unprecedented challenges of internal migration. Migrants tend to have poorer utilization of health and family planning services as compared to the local residents. Migrant women are at greater risk of induced abortions due to their poor contraceptive knowledge and attitude. This study aims to understand the contraceptive practices and history of induced abortions, explore the potential factors influencing induced abortions, and evaluate the utilization of family planning services among migrant women in Guangzhou, China.

METHODS

An anonymous, self-administered questionnaire survey was conducted with 1003 migrant women aged 18-49 in Guangzhou, China in 2013. A multi-stage sampling method was employed. Binary logistic regression model was used for analyzing risk factors of induced abortions.

RESULTS

Among the 1003 participants, 810 (80.8 %) reported having sex in the past 6 months, including 715 (88.3 %) married and 95 (11.7 %) unmarried. The most reported contraceptive method was male condom (44.9 %), while 8.1 % never used any contraceptive methods. Only 10.4 % reported having attained free condoms from family planning service stations (FPSSs) and 39.3 % reported having acquired contraceptive knowledge from family planning workers. Of all the participants, 417 (41.6 %) had a history of induced abortion. Of married and unmarried women, 389 (49.1 %) and 28 (14.0 %) had induced abortion respectively. Of these, 152 (36.5 %) had repeated abortions. The most reported reason for having induced abortion was failure of contraception (31.9 %), followed by nonuse of any contraceptives (21.1 %). Migrants who had induced abortion tended to be older, have household registration outside Guangdong province, receive no annual health checkup, have lower education, have urban household registration, have lived longer in Guangzhou and have children (P < 0.05).

CONCLUSIONS

The prevalence rate of induced abortion, especially repeated abortions among migrant women was high in Guangzhou, China. There is an urgent need to improve the awareness of regular and appropriate use of contraceptives. The utilization of FPSSs among migrant women was reportedly low. Family planning system should be improved to provide better access for migrants and better integrated with the general health services.

Use of hormonal contraceptives among immigrant and native women in Norway: data from the Norwegian Prescription Database

OBJECTIVE

To examine the use of hormonal contraceptives among immigrant and native women in Norway.

DESIGN

Nationwide registry-based study based on merged data from the Norwegian Prescription Database, the Norwegian Population Registry, the Regular General Practitioner Database and the Medical Birth Registry.

SETTING

Norway.

SAMPLE

All women born abroad to two foreign-born parents (immigrants), or born in Norway to two Norwegian-born parents (natives) aged 16-45 years, who lived in Norway in 2008.

METHODS

Data on all collected supplies of hormonal contraceptives in 2008 were merged with demographic, socio-economic and immigration data, information on any delivery and women's general practitioners.

MAIN OUTCOME MEASURES

User rates of hormonal contraception and predictors of contraceptive use.

RESULTS

A total of 893,073 women were included, of whom 130,080 were immigrants. More native women (38%) used hormonal contraceptives compared with all immigrant groups (15-24%). The odds ratios for any use of hormonal contraceptives for immigrants compared with Norwegian-born women were; Nordic countries 0.53, South and Central America 0.53, Western countries 0.39, Asia 0.30, Eastern Europe 0.29, Africa 0.29. Work, education, long stay in Norway and young age of immigration predicted the use of hormonal contraceptives among immigrants.

CONCLUSIONS

The use of hormonal contraceptives varies between natives and immigrant groups. Further work is needed to ascertain whether these differences can be explained by higher desires for fertility, preferential use of non-hormonal contraceptives or other reasons identified through qualitative research.

Australian women's fertility experiences prior to a termination of pregnancy

Objective. This research aimed to investigate the fertility management of women aged over 30 years prior to a termination of pregnancy (TOP) to inform primary health care service delivery providers and policy makers. Design. An ethically approved, two-phase sequential explanatory mixed methods design was used. This paper reports on part of that study. Setting. The study was conducted in five South Australian TOP clinics. Patients. Women aged over 30 years attending for a TOP in 2009 were invited to participate. Interventions. The Contraception Sexual Attitude Questionnaire (modified version) of women attending termination of pregnancy services was used. Main Outcomes Measures. Quantitative data analysis utilized SPSS V16 where simple descriptive statistics were described. Results. There were 101 questionnaire respondents where 70.5% were Australian women, predominantly married and with children. Women used contraception but experienced method failure, were beginning a new method, or were afraid of side effects. Risk-taking behaviours were reported such as putting the possibility of pregnancy out of their mind, getting carried away and not thinking of pregnancy risk, or frequently having unprotected intercourse. Conclusion. Service delivery needs to include age specific programs, and policy makers need to include policies which are adequately funded and evaluated. Further research is required to provide greater depth of knowledge in this area.

"Yo no sabía..."-immigrant women's use of national health systems for reproductive and abortion care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain's government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system-the impact of the changed abortion laws on immigrant's women's access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women's experiences with using national health systems for reproductive healthcare more broadly.

Constructions and experiences of sexual health among young, heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified 'purity versus corruption' as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes 'maintaining ignorance and naivety', 'remaining virginal', 'sex segregation' and 'the fallen woman' capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.

Somali women's use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali immigrants with native-born Swedish women

OBJECTIVES

To describe how Somali immigrant women in a Swedish county use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies.

STUDY DESIGN

Retrospective, case-control study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009.

MAIN OUTCOME MEASURES

Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality).

RESULTS

Compared to the 523 Swedish-born women the 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and a few patients were found to have very serious health conditions. Emergency caesarean section (OR 1.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent.

CONCLUSION

Pregnant Somali immigrant women still constitute a vulnerable group, which implicates that there is a missing link in the surveillance system that needs attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.

Knowledge and attitudes of Swedish politicians concerning induced abortion

OBJECTIVE

Induced abortion is more frequent in Sweden than in many other Western countries. We wanted to investigate attitudes and knowledge about induced abortion among politicians responsible for healthcare in three Swedish counties.

METHOD

A study-specific questionnaire was sent to all 375 elected politicians in three counties; 192 (51%) responded.

RESULTS

The politicians stated that they were knowledgeable about the Swedish abortion law. More than half did not consider themselves, in their capacity as politicians, sufficiently informed about abortion-related matters. Most politicians (72%) considered induced abortion to be primarily a 'women's rights issue' rather than an ethical one, and 54% considered 12 weeks' gestational age an adequate upper limit for induced abortion. Only about a third of the respondents were correctly informed about the number of induced abortions annually carried out in Sweden.

CONCLUSION

Information and knowledge on induced abortion among Swedish county politicians seem not to be optimal. Changes aimed at reducing the current high abortion rates will probably not be easy to achieve as politicians seem to be reluctant to commit themselves on ethical issues and consider induced abortion mainly a women's rights issue.

[Sociodemographic characteristics of induced abortions in Andalusia (Spain): differences between native and foreign populations]

OBJECTIVES

To describe the variables associated with induced abortions in Andalusia (Spain) and the differences between native and foreign populations.

MATERIAL AND METHODS

A cross-sectional population-based study was carried out. The files on deliveries and induced abortions were combined to create a single file for the period 2007-2010. A binary logistic regression model was employed. The dependent variable was whether the pregnancy ended in delivery or induced abortion. The independent variables were the year, province of residence, number of previous children, schooling, cohabitation and nationality. The raw and adjusted odds ratios and the 95% confidence intervals were calculated for native and foreign women.

RESULTS

Of 460,716 pregnancies, 17% ended in an induced abortion and 83% in delivery. The variables most closely associated with the risk of an induced abortion among native and foreign women in Andalusia were having three or more previous children (OR=23.06), being under 25 years old (OR=19.53), living alone (OR=10.04) and being an immigrant (OR=3.95), especially in African women. The rates of abortions, fecundity and fertility were higher in foreigners than in native women, with an increase in abortions and a decrease in fertility and fecundity.

CONCLUSIONS

The women at greatest risk of having an abortion in Andalusia are young foreign women, especially those from Africa, who live alone, have previous children and secondary education and reside in the province of Huelva.

Women's experiences after an induced second trimester abortion

OBJECTIVE

to describe women's experiences of an abortion in the second trimester.

DESIGN

qualitative design using semi-structured interviews.

SETTING/PARTICIPANTS

six women were interviewed after a second trimester abortion.

METHODS

the women were interviewed in person after they were discharged from the hospital. Interviews were recorded, transcribed, and then analysed using qualitative content analysis.

FINDINGS

four categories were identified: to consider and accept the decision; to lack understanding about the abortion procedure; to be in need of support and information; to have memories for life. Findings show that information and support during the whole abortion process is important. Women found it difficult to make the decision and going through abortion left memories for life.

CONCLUSION

information and support is of great importance for women in this vulnerable situation. The need for further support points out the need to have follow-up contacts with women after an induced second trimester abortion.

The effects of group health education on childbearing knowledge, attitude, and behaviour among Southeast Asian immigrant women in Taiwan

OBJECTIVES

to explore the effects of a group health education programme on the childbearing knowledge, attitude, and behaviours among Southeast Asian immigrant women in Taiwan.

DESIGN

a quasi-experimental design with convenience sampling was used.

SETTING

participants living in Kaohsiung County, Taiwan, were randomly divided by districts into either the experimental group or the control group.

PARTICIPANTS

one hundred Southeast Asian immigrant women were recruited as research participants. Among the 100 participants, 50 were in the experimental group and 50 were in the control group. A total of 99 participants completed the entire research procedure.

METHODS

a structured interview was used to evaluate the effects of a group health education programme.

MEASUREMENTS

the interview consisted of four measurements: the Demographic Inventory Scale, the Childbearing Knowledge Scale, the Childbearing Attitude Scale, and the Childbearing Planning Scale.

FINDINGS

after employing the group health education intervention, statistically significant changes from the pre-test to the post-test were found in the experimental group's scores for the Childbearing Knowledge Scale (P<0.0001), the Childbearing Attitude Scale (P<0.01), and the Childbearing Planning Scale (P<0.0001). The study's results indicated that providing education through group learning with guidance and support in childbearing health significantly improved Southeast Asian immigrant women's childbearing health knowledge, attitudes, and behaviours.

CONCLUSION

an appropriate, community-based group health education programme can create awareness for childbearing health among Southeast Asian immigrant women in Taiwan and improve their childbearing attitudes and behaviours.

Legal abortion worldwide in 2008: levels and recent trends

CONTEXT

Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use.

METHODS

Statistics and estimates of legal induced abortions in 2008 were compiled for 64 of the 77 countries in which legal abortion is generally available; the 64 are home to 98% of women aged 15-44 who live in the countries eligible for inclusion. Data sources included reports or completed questionnaires from national statistical offices and nationally representative surveys. The completeness of official figures was assessed by in-country and regional experts. Trends since 1996 and 2003 were examined.

RESULTS

Of the 77 countries with liberal abortion laws, 36 are in the developing world. In 2008, abortion rates in the 25 countries with complete records-all of which were developed-ranged from seven (Germany and Switzerland) to 30 (Estonia) per 1,000 women aged 15-44. Abortion rates declined in about half of the 20 countries with consistently reliable information on trends between 1996 and 2008; declines were generally steeper than increases, although the pace of decline slowed after 2003. The highest observed abortion rates were in developing countries with incomplete estimates. For most developing countries that had liberal laws, the reported abortion rates were incomplete and varied widely.

CONCLUSIONS

High abortion rates in some countries, and small increases in rates in others, indicate a great need for more effective family planning services for these populations. Reliable data collection systems, needed to ensure that trends can be effectively monitored, are lacking in many countries.

Trends in induced abortion among Nordic women aged 40-44 years

Objectives

Women aged 40-44 years in 2005 ought to have been subjected to much more influence on attitudes and knowledge on contraceptive methods during their fertile period than women who were in the same age span in 1975 when the abortion laws were introduced.

Material

From official statistics, the rates of induced abortion and birth rates in women aged 40-44 years were collected for Sweden, Denmark, Norway and Finland for each five-year during the period 1975-2005.

Results

With the exception of Sweden all other studied Scandinavian countries have lowered their abortion rates since 1975 (p < 0.001) and reduced the proportion of induced abortions in relation to birth rate (p < 0.001). In 2005 these countries also had lower rates of induced abortion than Sweden in the age group 40-44 years (p < 0.001).

Conclusion

There is a significant change in rates of induced abortion in women aged 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. This indicates that family planning programs works well in the Nordic countries. The differences found may be assumed to possible diverging focus on attitudes or ethical considerations.