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Jones RK. An estimate of lifetime incidence of abortion in the United States using the 2021-2022 Abortion Patient Survey. Contraception 2024; 135:110445. [PMID: 38574943 DOI: 10.1016/j.contraception.2024.110445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES The Guttmacher Institute estimated that, in 2014, 24% of US women of reproductive age would have an abortion by age 45 if the 2014 abortion rate was maintained. This study updates the estimated lifetime incidence of abortion in the year(s) just prior to the Dobbs decision, which removed federal protections for abortion. STUDY DESIGN We used data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey and population data for 2020 and 2021 from the Census Bureau, as well as abortion counts from the Guttmacher Institute's 2020 Abortion Provider Census, to estimate abortion rates, first-abortion rates, and cumulative abortion rates, all by age group. We calculated multiple estimates of lifetime incidence under varying hypothetical conditions as tests of sensitivity. RESULTS We estimate that 24.7% (95% CI: 22.9-26.3) of women aged 15-44 in 2020 would have had an abortion by age 45 if abortion rates in 2020 remain constant. These figures changed slightly when we examined scenarios assuming a 5% increase in abortion between 2020 and 2021 (25.9, 95% CI: 24.0-27.6) and when we adjusted for the potential overrepresentation of adolescent and young adult respondents in the 2021-2022 Abortion Patient Survey (23.9, 95% CI: 22.2-25.6). CONCLUSIONS In the year(s) prior to the Dobbs decision, one-quarter of US women would have been expected to have at least one abortion in their lifetime if abortion rates for those years stayed the same. IMPLICATIONS Significant numbers of individuals are being affected by abortion bans, but we are unable to predict how these restrictions will impact abortion incidence or the lifetime incidence in the coming years.
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Affiliation(s)
- Rachel K Jones
- Research Division, Guttmacher Institute, New York, NY, United States.
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Yeboah I, Okyere J, Klu D, Agbadi P, Agyekum MW. Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey. BMC Public Health 2024; 24:1420. [PMID: 38807108 PMCID: PMC11131185 DOI: 10.1186/s12889-024-18948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Repeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women. METHODS We used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15-49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables. RESULTS Of the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25-34 years (AOR:2.16;95%CI = 1.66-2.79) or 35-49 years (AOR:2.95;95%CI:2.18-3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25-12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03-2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33-1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07-1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49-0.93), Northern (AOR:0.46;95%CI:0.24-0.88), Upper West (AOR:0.24; 95%CI: 0.12-0.50) and Upper East (AOR:0.49; 95%CI = 0.24-0.99) regions were less likely to have repeat induced abortion. CONCLUSION The study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.
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Affiliation(s)
- Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana.
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Desmond Klu
- Institute of Heath Research (IHR), University of Health and Allied Sciences, Ho, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, SAR, Hong Kong, China
| | - Martin Wiredu Agyekum
- Institute for Educational Research and Innovation Studies (IERIS), University of Education, Winneba, Ghana
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Axelson SM, Steiner RJ, Jones RK. Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade. Womens Health Issues 2024; 34:142-147. [PMID: 38102056 DOI: 10.1016/j.whi.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
CONTEXT In light of the Dobbs v. Jackson Women's Health Organization decision overturning Roe v. Wade, the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access. METHODS We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state. RESULTS Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61-0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20-0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33-0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29-2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15-0.47). CONCLUSION Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.
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Affiliation(s)
- Sarah M Axelson
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
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Ehrenreich K, Baba CF, Raifman S, Grossman D. Perspectives on Alternative Models of Medication Abortion Provision Among Abortion Patients in the United States. Womens Health Issues 2023; 33:481-488. [PMID: 37105836 DOI: 10.1016/j.whi.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC). STUDY DESIGN Between October 2017 and August 2018, we conducted 30 in-depth interviews with abortion patients who indicated support for alternative models. We recruited patients from 10 abortion clinics in states with a range of policy environments. We analyzed interviews using inductive and deductive iterative techniques. RESULTS Participants identified logistical benefits of these alternative models, including eliminating travel to a clinic and multiple appointments, and increased privacy around decision-making. Participants were interested in advance provision for its convenience and the sense of preparedness that would come with having the pills available at home, yet some had concerns about the pills being found or stolen. Privacy was the key factor considered for OTC access, including both the privacy benefits of avoiding a clinic and the concern of having one's privacy compromised within the community if purchasing the medications in public. CONCLUSIONS People who have previously had a medication abortion are interested in alternative methods of provision for reasons concerning convenience, privacy, and avoiding burdens related to hostile policy environments, such as long travel distances to clinics and multiple appointments. Concerns around these models were primarily safety concerns for young people. Further research is needed to evaluate the safety, effectiveness, acceptability, and feasibility of these alternative models of providing medication abortion.
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Affiliation(s)
- Katherine Ehrenreich
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| | - C Finley Baba
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Liu J, Duan Z, Zhang H, Tang L, Pei K, Zhang WH. A global systematic review and meta-analysis of prevalence of repeat induced abortion and correlated risk factors. Women Health 2023:1-13. [DOI: 10.1080/03630242.2023.2195018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Obern C, Ekstrand Ragnar M, Tydén T, Larsson M, Niemeyer Hultstrand J, Gemzell-Danielsson K, Sundström-Poromaa I, Makenzius M. Multiple induced abortions - implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden. EUR J CONTRACEP REPR 2023; 28:119-124. [PMID: 36803482 DOI: 10.1080/13625187.2023.2178257] [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: 02/22/2023]
Abstract
OBJECTIVES To investigate factors associated with multiple induced abortions. MATERIALS AND METHODS A multi-centre cross-sectional survey among abortion-seeking women (n = 623;14-47y) in Sweden, 2021. 'Multiple abortions' was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions. RESULTS 67.4% (n = 420) reported previous experience of 0-1 abortion, and 25.8% (n = 161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n = 109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n = 27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n = 65/161), compared to those with 0-1 abortion (n = 131/420), p=.034. CONCLUSION Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence.
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Affiliation(s)
- Cerisa Obern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Ekstrand Ragnar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Margareta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO centre, Karolinska University Hospital, Stockholm, Sweden
| | | | - Marlene Makenzius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Upadhyay UD, Foster DG, Gould H, Biggs MA. Intimate relationships after receiving versus being denied an abortion: A 5-year prospective study in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:156-165. [PMID: 36414233 DOI: 10.1363/psrh.12216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT When an individual seeking an abortion cannot obtain one, carrying that pregnancy to term may affect both her relationship with the man involved in the pregnancy and her prospects for new intimate relationships. We aimed to assess the impact of receiving versus being denied a wanted abortion on women's intimate relationships, up to 5 years after seeking an abortion in the United States. METHODS Using mixed-effects regression models, we compared relationship outcomes among women who presented for abortion care just under facilities' gestational age limits ("Near-limit abortion patients," n = 452) with those who presented just over, were denied an abortion ("Turnaways," n = 146) at 30 US facilities. RESULTS At 1 week post-abortion seeking, the predicted probability of being in a relationship with the man involved in the pregnancy was 58%, gradually declining to 27% at 5 years with no significant differences between those who received and those who were denied an abortion. However, from 2 to 5 years post-abortion seeking, participants who were denied an abortion had double the odds (aOR = 2.01, 95% CI: 1.09-3.69) of being in a poor intimate relationship, with a predicted probability of being in a poor relationship of 14% among those denied an abortion compared with 9% among those who received one (p < 0.05). CONCLUSIONS Carrying an unwanted pregnancy to term does not increase the chance of being in an intimate relationship with the man involved in the pregnancy but may have negative implications for the quality of future relationships up to 5 years post-abortion seeking.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - Heather Gould
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
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Wang T, Jiang Q. Recent trend and correlates of induced abortion in China: evidence from the 2017 China Fertility Survey. BMC Womens Health 2022; 22:469. [PMID: 36434604 PMCID: PMC9700931 DOI: 10.1186/s12905-022-02074-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although there are more than 10 million induced abortions per year in China, there are few comprehensive, systematic, and characteristic-based data on induced abortions among Chinese women. This study aims to examine the overall trend in induced abortions in China and to analyze the correlation between induced abortions and some socio-economic factors. METHODS Drawing from the 2017 China Fertility Survey, this study analyzed induced abortions using multiple indicators from period and cohort perspectives on a sample of 240,957 women. The indicators include the abortion rate and proportion, average age at the time of induced abortion, age-specific cumulative proportions, and the number of induced abortions by cohort. The analysis also differentiated based on residency, ethnicity, education level, and marital status. A binomial logistic regression model was used to examine the association between induced abortions and socio-economic factors. RESULTS Between 2006 and 2016, among women aged 15-49, there was an increase in the induced abortion rate and the average age of women who had induced abortions, but a decline in the proportion of abortions. The proportion of induced abortion was higher among premarital than post-marital pregnancies, among unintended than planned pregnancies. Women with induced abortion experiences accounted for less than 30% of all cohorts, and the cumulative number of induced abortions per woman in each cohort was less than 0.45. These indicators varied with birth cohort, residence, ethnicity, education level, and marital status. The results of binomial logistic regression confirmed the association between induced abortion and these socio-economic variables. Sex-selective abortions of female fetuses still exist, despite the government's considerable efforts to eliminate them. CONCLUSION The practice of induced abortions differs by cohort and socio-economic characteristics. The profile of women who resort to abortions in China has shifted from well-educated urban women to rural, less-educated women. More effective measures should be taken by the government to reduce the number of induced abortions among women with higher abortion risks.
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Affiliation(s)
- Tian Wang
- grid.43169.390000 0001 0599 1243School of Public Policy and Administration, Institute for Population and Development Studies, Xi’an Jiaotong University, Xi’an, China
| | - Quanbao Jiang
- grid.43169.390000 0001 0599 1243School of Public Policy and Administration, Institute for Population and Development Studies, Xi’an Jiaotong University, Xi’an, China
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Studnicki J, Longbons T, Reardon DC, Fisher JW, Harrison DJ, Skop I, Cirucci CA, Craver C, Tsulukidze M, Ras Z. The Enduring Association of a First Pregnancy Abortion with Subsequent Pregnancy Outcomes: A Longitudinal Cohort Study. Health Serv Res Manag Epidemiol 2022; 9:23333928221130942. [PMID: 36246345 PMCID: PMC9554127 DOI: 10.1177/23333928221130942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Multiple abortions are consistently associated with adverse health consequences. Prior abortion is a known risk factor for another abortion. Objective To determine the persistence of the association of a first-pregnancy abortion with the likelihood of subsequent pregnancy outcomes. Methods Data was extracted for a study population of 5453 continuously eligible Medicaid beneficiaries in states which funded and reported elective abortions 1999-2015. Women age 16 in 1999 were organized into three cohorts based upon the first pregnancy outcome: abortion, birth, natural loss. Results Women in the abortion cohort are more likely than those in the birth cohort to experience another abortion rather than a birth or natural loss, and less likely to experience a live birth rather than an abortion or natural loss, for every subsequent pregnancy. The tendency toward abortion (OR 2.99, CL 2.02-4.43) and away from birth (OR 0.49, CL 0.39-0.63) peaks at the sixth pregnancy, but persists throughout the reproductive period ages 16-32. The pattern is reversed, but similarly consistent, for women in the birth cohort. They remain likelier to have another birth rather than an abortion or natural loss in subsequent pregnancies. Compared to the birth cohort, the abortion cohort had 1.35 times as many pregnancies: 4.31 times the abortions, 1.53 times the natural losses, but only 0.52 times the births. They were 4.3 and 5.0 times as likely to have 2-plus and 3-plus abortions, but only 0.47 times and 0.31 times as likely to have 2-plus and 3-plus births. Of the abortion cohort, 37.1% had no births. By contrast, 73.6% of the birth cohort had no abortions. Conclusion The first-pregnancy abortion maintains a strong and persistent association with the likelihood of another abortion in subsequent pregnancies, enabling a cascade of adverse events associated with multiple abortions.
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Affiliation(s)
- James Studnicki
- Charlotte Lozier Institute, Arlington, VA, USA,James Studnicki, Charlotte Lozier Institute, 2800 Shirlington Rd., Ste. 1200, Arlington, VA, 22206, USA.
| | | | | | | | - Donna J. Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | | | - Maka Tsulukidze
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Zbigniew Ras
- Computer Science Department, University of North Carolina at Charlotte, Charlotte, NC, USA
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Thill Z, Charles D, Bennett AH, Paul A, Gold M. Abortion Aftercare Instructions in the United States: A Content Analysis of Patient Handouts. Womens Health Issues 2022; 32:470-476. [PMID: 35428568 DOI: 10.1016/j.whi.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/05/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND At the clinical visit for abortion care, patients typically receive a handout with information about what to expect and how to care for themselves after the abortion. Published guidelines give little to no guidance regarding the content of postabortion instructions. METHODS We collected aftercare instruction handouts for first trimester procedural and medication abortion from abortion clinics throughout the United States. Instructions were coded and analyzed using conventional content analysis. RESULTS Of the 84 unique aftercare handouts we received, most included information about symptoms to expect (included in 98% of procedural handouts, 97% of medication handouts), how to manage symptoms (included in 100% of procedural handouts, 100% of medication handouts), and specific behaviors to avoid (included in 94% of procedural handouts, 66% of medication handouts). The most common behavioral avoidance instructions were "pelvic rest" (included in 90% of procedural handouts, 63% of medication handouts), avoiding strenuous activity (included in 61% of procedural handouts, 29% of medication handouts), and avoiding submersion in water (included in 41% of procedural handouts, 26% of medication handouts). Handouts varied with regard to the extent and duration of specific recommendations. They also varied in tone, word choice, and other characteristics. CONCLUSIONS There exists a wide range of abortion aftercare instructions throughout the United States. Inconsistency among instructions may reflect a lack of published, evidence-based clinical guidelines. Standardizing aftercare instruction handouts based on patient-oriented evidence could improve patient experience after abortion.
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Affiliation(s)
- Zoey Thill
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York.
| | | | - Ariana H Bennett
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
| | - Allison Paul
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
| | - Marji Gold
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
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SENSO SOFÍAGARCÍA, CARA RODRíGUEZ MARTA, RODRíGUEZ-ARENAS MARÁNGELES. Factors related to the voluntary interruption of pregnancy in Spain. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E69-E75. [PMID: 35647389 PMCID: PMC9121663 DOI: 10.15167/2421-4248/jpmh2022.63.1.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Introduction The voluntary interruption of pregnancy (VIP) is a complex process, influenced both by health and psychosocial factors, which in turn affect the health and well-being of the women. The objective of this study is to determine the factors related to the voluntary interruption of pregnancy in Spain, in women with more than one interruption, according to their origin. Methods A cross-sectional study of the VIP episodes carried out at the request of the women themselves in Spain during 2018. The factors related to repeat VIPs are described according to the origin of the women, estimating the crude and adjusted prevalence odds ratio (OR). Results The highest rates of VIP occurred in women aged 20 to 24 years. The probability of a second VIP, both in Spanish women and those of foreign origin, increased with age, with the size of the population (> 50,000 inhabitants), and with dependent children. Conclusions All women should have the possibility of planning their reproductive life, for which they have the right to have access to adequate information, to effective contraceptive methods, and to be able to interrupt an unplanned pregnancy with all the guarantees of quality, confidentiality and safety.
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Affiliation(s)
- SOFÍA GARCÍA SENSO
- Department of Preventive Medicine, Complejo Hospitalario de Cáceres, Cáceres, Spain
| | - MARTA CARA RODRíGUEZ
- Department of Preventive Medicine, Complejo Hospitalario de Cáceres, Cáceres, Spain
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Li C, Gao J, Liu J. Repeat abortion and associated factors among women seeking abortion services in northwestern China: a cross-sectional study. BMC Public Health 2021; 21:1626. [PMID: 34488713 PMCID: PMC8422724 DOI: 10.1186/s12889-021-11653-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Repeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners. Methods This cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi’an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson’s chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed. Results Of 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08–1.73 for 31–35 years; 1.82, 1.29–2.57 for ≥36 years), received a low-level education (1.86, 1.42–2.43 for ≤senior high school; 1.46, 1.17–1.83 for junior college), were jobless (2.46, 1.18–5.13), had one child (1.54, 1.10–2.17), had a general (1.60, 1.28–1.98) or no (2.51, 2.02–3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09–1.61), withdrawal (1.43, 1.12–1.84), and emergency measures (1.48, 1.09–1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06–1.68 for 31–35 years; 2.13, 1.56–2.91 for ≥36 years), attained a low-level education (1.66, 1.28–2.15 for ≤senior high school; 1.38, 1.10–1.74 for junior college), received a high-level monthly income (1.34, 1.08–1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42–19.33) were more likely to have a repeat abortion. Conclusions The study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11653-4.
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Affiliation(s)
- Chen Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Jianmin Gao
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Jinlin Liu
- School of Public Policy and Administration, Northwestern Polytechnical University, Xi'an, 710129, Shaanxi, China.
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Studnicki J, Fisher JW, Longbons T, Reardon DC, Harrison DJ, Craver C, Tsulukidze M, Skop I. Estimating the Period Prevalence of Mothers Who Have Abortions: A Population Based Study of Inclusive Pregnancy Outcomes. Health Serv Res Manag Epidemiol 2021; 8:23333928211034993. [PMID: 34368402 PMCID: PMC8312161 DOI: 10.1177/23333928211034993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: The prevalence of induced abortion among women with children has been estimated indirectly by projections derived from survey research. However, an empirically derived, population-based conclusion on this question is absent from the published literature. Objective: The objective of this study was to describe the period prevalence of abortion among all other possible pregnancy outcomes within the reproductive histories of Medicaid-eligible women in the U.S. Methods: A retrospective, cross-sectional, longitudinal analysis of the pregnancy outcome sequences of eligible women over age 13 from the 17 states where Medicaid included coverage of most abortions, with at least one identifiable pregnancy between 1999 and 2014. A total of 1360 pregnancy outcome sequences were grouped into 8 categories which characterize various combinations of the 4 possible pregnancy outcomes: birth, abortion, natural loss, and undetermined loss. The reproductive histories of 4,884,101 women representing 7,799,784 pregnancy outcomes were distributed into these categories. Results: Women who had live births but no abortions or undetermined pregnancy losses represented 74.2% of the study population and accounted for 87.6% of total births. Women who have only abortions but no births constitute 6.6% of the study population, but they are 53.5% of women with abortions and have 51.5% of all abortions. Women with both births and abortions represent 5.7% of the study population and have 7.2% of total births. Conclusion: Abortion among low-income women with children is exceedingly uncommon, if not rare. The period prevalence of mothers without abortion is 13 times that of mothers with abortion.
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Affiliation(s)
| | | | | | | | - Donna J Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | | | | | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
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14
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Liu J, Duan Z, Zhang H, Wen C, Tang L, Pei K, Zhang WH. Prevalence and risk factors for repeat induced abortion among Chinese women: a systematic review and meta-analysis. EUR J CONTRACEP REPR 2021; 26:513-522. [PMID: 34184608 DOI: 10.1080/13625187.2021.1944618] [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: 10/21/2022]
Abstract
OBJECTIVES Repeat induced abortion is a significant public health problem in China. International knowledge about repeat induced abortion and its associated risk factors in Chinese women is scarce, and existing studies are hard to access for international scholars because most are published in Chinese. A systematic review was conducted to analyse the prevalence of repeat induced abortion among Chinese women and determine correlated risk factors. METHODS Seven electronic databases were systematically searched. Data on the prevalence of repeat induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach. RESULTS Of 2458 articles retrieved from seven databases, 21 were included in the study. The overall pooled prevalence of repeat induced abortion was 43.1% (95% confidence interval 36.7%, 49.5%). Of 25 exposures extracted, 15 factors were significantly correlated with repeat induced abortion, comprising seven individual demographic factors (i.e., age, education, employment, migrant status, parity, unhealthy lifestyle habits and region of residence), four reproductive health- and contraception-related factors (i.e., age at sexual debut, history of sexual activity, contraceptive knowledge and having a regular sexual life) and four sexual partner-related factors (i.e., multiple sexual partners, age of sexual partner, educational level of sexual partner and cohabitation with sexual partner). CONCLUSION The study findings highlight the problem of repeat induced abortion in China and suggest the need for government and civil society to increase efforts to reduce the alarming risks of repeat induced abortion in Chinese women and make them and their sexual partners more aware and protective of their sexual and reproductive health.
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Affiliation(s)
- Jinlin Liu
- School of Public Policy and Administration, Northwestern Polytechnical University, Xi'an, China
| | - Zhuqing Duan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Hairui Zhang
- Institute for Research on Health Information and Technology, School of Public Health, Xi'an Medical University, Xi'an, China
| | - Chunmei Wen
- Department of Maternal and Child Health, Health Commission of the Shaanxi Province, Xi'an, China
| | - Longmei Tang
- School of Public Health, Hebei Medical University, Shijiazhuang, China.,International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kaiyan Pei
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
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15
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Studnicki J, Fisher JW, Longbons T, Reardon DC, Craver C, Harrison DJ. Estimating the Period Prevalence of Publicly Funded Abortion to Space Live Births, 1999 to 2014. J Prim Care Community Health 2021; 12:21501327211012182. [PMID: 33957810 PMCID: PMC8114245 DOI: 10.1177/21501327211012182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Although a majority of women who have an abortion report having 1 or more children, there is no published research on the number of abortions which occur between live births, after a first child but before the last. The objectives of this research, therefore, were to estimate the period prevalence of an induced abortion separating live births in a population of Medicaid eligible enrollees and to identify the characteristics of enrollees significantly associated with the use of abortion to enable child spacing. METHODS A retrospective, cross-sectional, longitudinal analysis of the pregnancy outcome sequences of eligible enrollees over age 13 from the 17 states where Medicaid included coverage of all abortions, with at least one identifiable pregnancy outcome between 1999 and 2014. Eligibles with a defined sequence of birth-abortion-birth within up to 5 consecutive pregnancies were identified to estimate the number of eligibles who could have practiced birth spacing by abortion. Logistic regression was applied to identify the significant predictor variables of the birth-abortion-birth sequence. RESULTS There were 50 012 (1.02%) of 4 875 511 Medicaid eligible enrollees exhibited a birth-abortion-birth sequence. Eligibles with the birth-abortion-birth sequence are more likely to be Black than White (OR 2.641, CL 2.581-2.702), less likely to be Hispanic than White (OR 0.667, CL 0.648-0.687), and more likely to have received contraceptive counseling (OR 1.14, CL 1.118-1.163). Increases in months of Medicaid eligibility (OR 1.004, CL 1.003-1.004) and months from first pregnancy to second live birth (OR 1.015, CL 1.015-1.016) are associated with the likelihood of undergoing live births separated by one or more induced abortions. Increases in the age at first pregnancy are associated with a decreased likelihood of the birth-abortion-birth sequence (OR 0.962, CL 0.959-0.964). CONCLUSION Birth spacing via abortion is uncommon among a low-income population for whom the financial barriers to abortion are somewhat alleviated.
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Affiliation(s)
| | | | | | | | | | - Donna J Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
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16
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Luo H, Wu S, Wang K, Xu J, Tang L, Temmerman M, Zhang WH. Repeat induced abortion in 30 Chinese provinces: A cross-sectional study. Int J Gynaecol Obstet 2021; 154:532-539. [PMID: 33492670 DOI: 10.1002/ijgo.13620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/30/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To report the proportion and determinants of repeat induced abortions in China. METHODS Cross-sectional data were collected of 79 954 women who received an induced abortion from 297 hospitals across 30 Chinese provinces in 2013, using a stratified cluster sampling design. Logistic and Poisson regression models were fitted to identify characteristics associated with repeat abortion. Putative factors included age, household registration (hukou) status, marital status, education, occupation, reproductive history, and current contraceptive practices. RESULTS Of all abortions, 65.2% were repeat induced abortions. The proportion of repeat abortions varied substantially across provinces, from 36.9% in Qinghai to 85% in Hubei. The strongest factors associated with repeat induced abortion were being older than 40 years (adjusted odds ratio [ORadj ] 7.0, 95% confidence interval [CI] 6.2-7.9), divorced or widowed (ORadj 2.1, 95% CI 1.6-2.7), and using oral contraceptives (ORadj 2.1, 95% CI 1.9-2.3). CONCLUSION A high proportion of repeat induced abortion was observed across many Chinese provinces, highlighting the need to reduce the incidence of unwanted pregnancy. Several sociodemographic and clinical factors were found to be significantly associated with repeat abortions and should be considered in post-abortion family planning services.
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Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Shangchun Wu
- National Research Institute for Family Planning, Beijing, China
| | - Kun Wang
- National Research Institute for Family Planning, Beijing, China
| | - Jialin Xu
- Chengde Nursing Vocational College, Chengde, China
| | - Longmei Tang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Public Health, Hebei Medical University, Hebei, China
| | - Marleen Temmerman
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,The Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.,Research Centre for Public Health, Tsinghua University, Beijing, China
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Tolu LB, Tufa TH, Abas F, Kahn C, MacAfee L, Prager S, Bell JD. Intra-cardiac lidocaine administration to induce fetal demise before late second-trimester abortion: Retrospective review. Int J Gynaecol Obstet 2020; 153:125-129. [PMID: 33043458 DOI: 10.1002/ijgo.13419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/15/2020] [Accepted: 10/09/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of intra-cardiac lidocaine administration to induce fetal demise before second-trimester medication abortion in a teaching hospital in Addis Ababa, Ethiopia. METHODS We performed a retrospective chart review to collect selected sociodemographic and clinical information. All patients who received fetal intra-cardiac lidocaine between January 1, 2019 and April 30, 2019 were included in the study. Fetal demise was considered successful if achieved within 24 hours after fetal intra-cardiac lidocaine administration. We analyzed the data using SPSS version 20. We used frequency tables to describe the data and performed a multivariable analysis to determine associations between variables. RESULTS A total of 80 fetuses were given intra-cardiac lidocaine.The mean gestational age was 23+1 weeks (range 21+0 -27+5 weeks). Twenty-four hours after lidocaine administration 76 (95%) pregnancies showed negative fetal cardiac activity. Fetuses at gestational ages of 21-23+6 weeks were five times more likely to have negative cardiac activity compared with those with gestational ages between 24 and 28 weeks (P=0.001). Two women developed nausea, vomiting, and a metallic taste, but no serious adverse events were reported. CONCLUSIONS Intra-cardiac lidocaine is effective at inducing fetal demise before late second-trimester medication abortion with no associated serious adverse events or complications.
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Affiliation(s)
- Lemi Belay Tolu
- Department of Obstetrics & Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye H Tufa
- Department of Obstetrics & Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ferid Abas
- Department of Obstetrics & Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Chavi Kahn
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Lauren MacAfee
- Department of Obstetrics, Gynecology and Reproductive Science, University of Vermont, Burlington, VT, USA
| | - Sarah Prager
- Department of Obstetrics & Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Jason D Bell
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
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Ahrens KA, Hutcheon JA. Time for Better Access to High-Quality Abortion Data in the United States. Am J Epidemiol 2020; 189:640-647. [PMID: 32219373 DOI: 10.1093/aje/kwaa048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/03/2023] Open
Abstract
Despite considerable lay attention on the regulation and legislation of abortion in the United States, important gaps remain in our understanding of its incidence and health and social consequences since its legalization in 1973. Many of these gaps in knowledge can be attributed to a lack of access to high-quality, individual-level abortion data over the past 46 years. Herein, we review the strengths and limitations of different, currently available methods for enumerating abortions in the United States and discuss how lack of access to high-quality data limits our surveillance and research activities of not only abortion but other important reproductive and perinatal health outcomes. We conclude by discussing some potential opportunities for improved access to high-quality abortion data in the United States.
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Valencia K, Moayedi G, Raidoo S, Soon R, Kaneshiro B, Tschann M. Survival Analysis of Patient Contraceptive Choice Method at Time of Abortion - Honolulu, Hawai'i, May 2010-December 2016. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:272-278. [PMID: 32914094 PMCID: PMC7477704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The relationship between contraceptive method choice at the time of abortion and risk for subsequent abortions is not well understood. This article uses an existing data set from the University of Hawai'i Women's Options Center between May 2010 and December 2016 to examine if such a relationship exists. A multivariate Cox proportional hazards regression survival analysis was used to evaluate contraceptive method prescribed or provided at index abortion encounters and likelihood of additional abortions. Patients who received a prescription of oral contraceptive pills, patches or rings at their index abortion were 61% more likely to have an additional abortion than those who had no contraceptive method recorded (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14-2.28). Patients who received a long-acting reversible contraceptive method at their index abortion were 59% less likely to have an additional abortion when compared with a patient receiving no method (HR, 0.41; 95% CI, 0.20-0.86). The findings show that patients who were prescribed oral contraceptives pills, patches, or rings were more likely than patients who had no contraceptive method prescribed or provided to have more than one abortion during the data collection period. Contraceptive method choice at time of abortion is complex and providers should be thorough in their counseling about failure rates, while also remaining vigilant in supporting patient autonomy and avoiding coercive or stigmatizing language.
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Affiliation(s)
- Kristen Valencia
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
| | - Ghazaleh Moayedi
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
| | - Shandhini Raidoo
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
| | - Reni Soon
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
| | - Mary Tschann
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (KV, GM, SR, RS, BK, MT)
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20
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De Kort L, Wood J, Van de Velde S. What are the social correlates of subsequent abortions in Flanders, Belgium? EUR J CONTRACEP REPR 2020; 25:387-393. [PMID: 32683990 DOI: 10.1080/13625187.2020.1792877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study whether the social correlates of subsequent abortions vary depending on the order of the abortion. Methodology: Drawing upon the Flemish abortion centres' anonymized patient records (2010-2019), discrete-time hazard models were used to examine whether individual abortion experiences across women's reproductive life course have different social correlates. RESULTS Overall, women who were in their twenties, of foreign origin, single, had non-tertiary education, were not in paid employment, had children, did not (consistently and without errors) use contraception and had a previous abortion through medication, had an elevated probability to experience subsequent abortions. While single women and women with a vulnerable socioeconomic status were more likely to have a second or third abortion, this difference is no longer prevalent when considering higher-order abortions. The hazard for higher-order abortions was more pronounced in women with a migration background, regardless of the order considered. Contraceptive use was unrelated to fourth or higher-order abortions. CONCLUSION Using discrete-time hazard models, we unpack individual abortion experiences across women's reproductive life courses. By studying the transitions into different orders of subsequent abortions separately, we provide a more detailed understanding of risk factors compared to other European studies. The social correlates vary by the order considered: A certain profile emerges for women who have a second or third abortion, but disintegrates when considering higher-order abortions. This knowledge enables clinicians and policymakers to better understand women who experience subsequent abortions and to tailor services best suited to their needs.
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Affiliation(s)
- Leen De Kort
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
| | - Jonas Wood
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
| | - Sarah Van de Velde
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium
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21
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Taft AJ, Powell RL, Watson LF, Lucke JC, Mazza D, McNamee K. Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women's Health. Aust N Z J Public Health 2019; 43:137-142. [PMID: 30727034 DOI: 10.1111/1753-6405.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/01/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A trend analysis of associations with induced abortion. METHODS Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women's Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. RESULTS New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less-effective contraceptives (aOR2.18 CI 1.65-2.89); increased risky drinking (aOR1.65 CI 1.14-2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28-4.19); or recent partner violence (aOR2.42 CI 1.61-3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31-3.56) or illicit drugs <12 months (aOR2.69 CI 1.77-4.09). Women aspiring to be fully- (OR1.58 CI 1.37-1.83) or self-employed (OR1.28 CI 1.04-1.57), with no children (OR1.41 CI 1.14-1.75) or further educated (OR 2.08 CI 1.68-2.57) were more likely to terminate than other women. CONCLUSIONS Abortion remains strongly associated with factors affecting women's control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.
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Affiliation(s)
| | | | | | - Jayne C Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria.,School of Public Health, University of Queensland
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kathleen McNamee
- Department of Obstetrics and Gynaecology, Monash Health, Victoria
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22
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Society of Family Planning clinical recommendations: contraception after surgical abortion. Contraception 2019; 99:2-9. [DOI: 10.1016/j.contraception.2018.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 11/22/2022]
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Temmerman M. Missed opportunities in women's health: post-abortion care. LANCET GLOBAL HEALTH 2018; 7:e12-e13. [PMID: 30503403 DOI: 10.1016/s2214-109x(18)30542-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Marleen Temmerman
- Aga Khan University, 00100 Nairobi, Kenya and Ghent University, Ghent, Belgium.
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24
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Zimmerman LP, Madrigal JM, Jordan LM, Patel A. The Association Between Multiple Abortions Within 1 Year and Previous Postabortal Desired Contraception at an Urban, Public Hospital. J Womens Health (Larchmt) 2018; 28:1266-1271. [PMID: 30394817 DOI: 10.1089/jwh.2018.6944] [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: 11/13/2022] Open
Abstract
Objectives: To determine the proportion of women undergoing multiple abortions within 1 year at an urban, public hospital and the association with desired contraception after the index abortion. Materials and Methods: We conducted a retrospective analysis of all women undergoing abortion up to 13 weeks and 6 days gestation at Stroger Hospital from June 1, 2012 to May 31, 2014. We examined the proportion of women with additional abortions up to 1 year after the index abortion and contraception desired at the index abortion. We also collected data about Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) infection in surgical abortion patients, to assess suitability for intrauterine device insertion immediately postabortion. Results: Of the 5,104 women with an abortion in the study period, 720 (14.1%) had at least one additional abortion within 1 year. Among women with multiple abortions, 153 (21.3%) selected Tier 1 contraception, 359 (49.8%) Tier 2, 103 (14.3%) Tier 3, and 105 (14.6%) were undecided or desired no method. The contraception desired at the index abortion did not differ significantly between women with and without subsequent abortions (p = 0.107). CT/GC coinfection and CT infection alone were associated with having multiple abortions over the 1-year period (p = 0.020 and p = 0.006). Conclusions: Among women presenting for abortion at an urban, public hospital, desired contraception did not differ significantly between women with multiple abortions versus one abortion within 1 year, but prevalence of CT/GC did. Women at high risk for multiple abortions may benefit from immediate postabortion IUD insertion to avoid unintended pregnancy, provided risk of infection is carefully evaluated.
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Affiliation(s)
| | - Jessica M Madrigal
- Division of Family Planning, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.,School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Lauren M Jordan
- Division of Family Planning, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Ashlesha Patel
- Division of Family Planning, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.,Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lindberg L, Scott RH. Effect of ACASI on Reporting of Abortion and Other Pregnancy Outcomes in the US National Survey of Family Growth. Stud Fam Plann 2018; 49:259-278. [PMID: 30040126 PMCID: PMC6166437 DOI: 10.1111/sifp.12068] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abortion is a behavior that is stigmatized and difficult to measure. To improve reporting of abortion and other sensitive behaviors in the United States, the National Survey of Family Growth (NSFG) supplements the interviewer administered face-to-face (FTF) interview with audio computer-assisted self-interviewing (ACASI). This paper estimates differential reporting of abortion and other pregnancy outcomes (miscarriage, live birth) in the NSFG (2002, 2006-2010, 2011-2015) between women's ACASI and FTF interviews. Examining reporting of less stigmatized pregnancy outcomes can help understand the relative contributions of stigma and survey-level factors in reporting of abortions. More women reported abortions, miscarriages and births in the ACASI than the FTF interview. Differences in reporting were moderated by the length of recall. The ACASI elicited relatively more reporting of abortions and miscarriages among non-white and low-income women. Reporting ratios increased over time. ACASI is a tool that may work differently across time, for different measures, and with varying survey contexts.
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Moseson H, Foster DG, Upadhyay UD, Vittinghoff E, Rocca CH. Contraceptive Use over Five Years After Receipt Or Denial of Abortion Services. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:7-14. [PMID: 29329494 PMCID: PMC6657520 DOI: 10.1363/psrh.12047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Nonuse and inconsistent use of contraceptives contribute to a high incidence of unintended pregnancy and abortion among U.S. women. Little is known, however, about how these outcomes shape women's subsequent contraceptive use and unintended pregnancy risk. METHODS Contraceptive use was examined among 880 participants in the Turnaway Study, a five-year longitudinal study of women who sought abortions at 30 U.S. facilities in 2008-2010. Multivariable mixed-effects logistic and multinomial regression models assessed differences in use by whether women received the abortion; results were used to calculate predicted percentages of women using each method. The main groups of interest were 415 women who had an abortion at a gestation near their facility's limit and 160 who were denied abortion because they were beyond the limit, and who consequently gave birth. RESULTS During each of the approximately five years of follow-up, the predicted percentage using any contraceptive method was 86% among women who had the abortion and 81% among those denied it. Over the entire period, the former women were more likely than the latter to use any method (odds ratio, 1.8). However, they were less likely to rely on female sterilization, rather than no method (risk ratio, 0.5), and more likely to use barrier methods (1.7) or short-acting reversible contraceptives (2.6). CONCLUSION Women's elevated risk of unintended pregnancy after abortion is likely due at least partly to reliance on methods with relatively low effectiveness. Factors affecting contraceptive access postabortion, as well as individual characteristics such as fecundability, require research attention.
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Affiliation(s)
- Heidi Moseson
- Epidemiologist, Ibis Reproductive Health, Oakland, CA
| | - Diana Greene Foster
- Professor, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Ushma D Upadhyay
- Associate professors, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Eric Vittinghoff
- Professor, Division of Biostatistics, Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Corinne H Rocca
- Associate professors, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
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