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Shirdel E, Asadisarvestani K, Kargar FH. The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022. BMC Public Health 2024; 24:1885. [PMID: 39010012 PMCID: PMC11247811 DOI: 10.1186/s12889-024-19249-4] [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: 01/10/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.
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Affiliation(s)
- Elham Shirdel
- Department of Social Sciences Faculty of Literature and Humanities, University of Sistan and Baluchestan, Zahedan, Iran.
| | - Khadijeh Asadisarvestani
- Department of Social Sciences Faculty of Literature and Humanities, University of Sistan and Baluchestan, Zahedan, Iran
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia & Department of Social Sciences Faculty of Literature and Humanities, University of Sistan and Baluchestan, Zahedan, Iran
| | - Fatemeh Hami Kargar
- Department of Social Sciences. Faculty of Humanities, Kashan University, Kashan, Iran
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Estimating the Size of Hidden Groups. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 34339010 DOI: 10.1007/978-3-030-75464-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
NSU studies have been applied in different countries. For example, this technique has been used in the United States to estimate the number of women who had been raped in the last year.
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Rossier C, Marchin A, Kim C, Ganatra B. Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review. Reprod Health 2021; 18:114. [PMID: 34098958 PMCID: PMC8186048 DOI: 10.1186/s12978-021-01165-0] [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: 08/24/2020] [Accepted: 05/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited. Main body This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others. Conclusion Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01165-0. Women seeking an induced abortion in LMICs often face inexistent or inadequate, difficult to find and/ or stigmatizing legal services, leading to the use of informal methods and providers, and unsafe abortions. A growing number of studies have shown that abortion seekers contact social network members beyond their intimate circle when seeking care. However, results have been inconsistent. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in restrictive LMICs. We screened 4101 references, yielding 79 articles with data from 33 countries for extraction. We grouped countries (or social groups within countries) into four types of settings: (1) anonymous access possible, hyper stigma; (2) anonymous access possible, high stigma; (3) non-anonymous access, high stigma; (4) non-anonymous access, hyper stigma. Most studies fitted Type 3. Disclosing to network members increased across setting types: no women confided in network members in Type 1 settings, a minority in Type 2 and a majority in Type 3. No setting fitted Type 4. The informal use of medical abortion did not modify disclosure to others. Abortion seekers in restrictive LMICs frequently contact their social network in some settings/groups but less frequently in others, depending on the availability of anonymous access to abortion care and the level of stigma. This knowledge is useful for designing interventions to improve information on safe abortion and for developing network-based data collection strategies.
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Affiliation(s)
- Clémentine Rossier
- Université de Genève, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | | | - Caron Kim
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Baneshi MR, Zolala F, Zamanian M, Zarei N, Heydari MR. Estimating the Visibility Rate of Alcohol Consumption: A Case Study in Shiraz, Iran. ADDICTION & HEALTH 2020; 12:18-24. [PMID: 32582411 PMCID: PMC7291901 DOI: 10.22122/ahj.v12i1.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Network Scale Up (NSU) is applied in many settings to estimate the size of hidden populations. The visibility of alcohol consumption - as a hidden behavior - in Iran has not been yet set. Our aim is to estimate the visibility factor (VF) of alcohol consumption in Iran which is an Islamic country in the Middle East. METHODS Ninety persons who had a history of alcohol consumption were recruited. Relationships in network were aligned in three main subgroups: immediate family, extended family, and non-family. According to the game of contact methodology, participants answered questions about total and aware number of persons they know in each relationship category. VF was calculated by dividing total number of people aware about the respondent's alcohol consumption by total number of respondent's social network. The 95% confidence intervals (CIs) were computed through bootstrapping. FINDINGS The mean and standard deviation (SD) of participants' age was 32.9 ± 10.2, the sex ratio was 3. Overall VF (95% CI) was 40% (33% to 47%). VF was estimated at 44% and 23% among men and women's network, respectively. The immediate family was the highest informed group, followed by non-family and extended family members. CONCLUSION The visibility of alcohol consumption in Iran was not high. This is due to religious and legal prohibitions around it.
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Affiliation(s)
- Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzaneh Zolala
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Zamanian
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Nooshin Zarei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Heydari
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Zamanian M, Zolala F, Haghdoost AA, Baneshi MR. Estimating The Annual Abortion Rate in Kerman, Iran: Comparison of Direct, Network Scale-Up, and Single Sample Count Methods. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2019; 13:209-214. [PMID: 31310075 PMCID: PMC6642432 DOI: 10.22074/ijfs.2019.5721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/28/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abortion is a sensitive issue surrounded by social, cultural and religious stigmata. Therefore, estimation of its prevalence involves methodological challenges. The aim of this manuscript is to estimate the abortion prevalence, stratified by type, using a direct and two indirect methods. MATERIALS AND METHODS This cross-sectional study was done in 2016, we recruited 1020 women aging 18-49 years. Three methods were applied to estimate the abortion prevalence: direct question, network scale-up (NSU), and single sample count (SSC). In the direct method, to guarantee anonymity, data were collected by means of a self-administered questionnaire. In other methods, data were collected through gender-matched street-based interviews. RESULTS The annual rate of abortion estimated by direct and NSU methods were 2 respectively 9 (10 intentional, 4 therapeutic and 15 spontaneous) and 23 (9 intentional, 3 therapeutic, and 11 spontaneous) per 1000 women aging 18- 49 years. The annual rate of intentional abortion estimated based on SSC method was higher (15 per 1000) women than other methods. CONCLUSION The present estimates are higher than previously reported ones. The results of three methods more or less supported each other confirming the internal validity of our estimates.
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Affiliation(s)
- Maryam Zamanian
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzaneh Zolala
- Social Determinants in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Increasing misreporting levels of induced abortion in Turkey: is this due to social desirability bias? J Biosoc Sci 2019; 52:213-229. [PMID: 31203820 DOI: 10.1017/s0021932019000397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Women tend to under-report or misreport their abortion experiences, mainly because abortion is considered a sensitive issue for cultural, religious, political or other reasons in many countries across the world. Turkey, where induced abortion is an increasingly sensitive issue due to intense statements against induced abortion on religious grounds by influential politicians, and a hidden agenda to prohibit the practice, especially in public health facilities, in recent years, is no exception. This study focused on the increase in level of misreporting of induced abortion in Turkey and its link to social desirability bias using pooled data from 1993 and 2013 Turkish Demographic and Health Surveys. A probabilistic classification model was used to classify women's reported abortions. The findings confirmed that the level of misreporting of induced abortions has increased from 18% to 53% among all terminated pregnancies over the period 1993-2013 in Turkey. This marked increase, especially among women in the lower socioeconomic sections of society, may be largely associated with the prevailing political environment, and increase in social stigmatization against induced abortion in Turkey over recent decades.
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Methodological considerations in using the Network Scale Up (NSU) for the estimation of risky behaviors of particular age-gender groups: An example in the case of intentional abortion. PLoS One 2019; 14:e0217481. [PMID: 31185067 PMCID: PMC6559635 DOI: 10.1371/journal.pone.0217481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/13/2019] [Indexed: 12/05/2022] Open
Abstract
Background Network Scale Up (NSU) is a promising tool for size estimation of sensitive issues. In this study we investigated the important methodological considerations to employ this method for estimating behaviors, such as abortion, which happens in a particular age-gender group. Methods We recruited 1250 males and 1250 females aged 18 to 50. Abortion rate was calculated through direct question and NSU methodology. The NSU was applied on three sub-samples (male, female and aggregate). Integrating replies to 25 reference groups, we estimated the network size (C) of respondents and its age-gender structure. To calculate the part of network that is subject to abortion, we compared two approaches: proportional and data based. The Visibility Factor (VF) was calculated through 222 females who had abortion. Direct estimate was considered as gold standard. Results Using C’s derived from proportional method, the Relative Bias (RB) in the male and female samples was 33% and 84%. Applying the data-based C’s, the RB in the gender-specific and aggregate samples was 5% and 2%. Conclusion The proportional method overestimates the prevalence. The data-based method to calculate the C is superior. The determination of the age-sex distribution of the network and the specific VF is essential.
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Haghdoost A, Ahmadi Gohari M, Mirzazadeh A, Zolala F, Baneshi MR. A review of methods to estimate the visibility factor for bias correction in network scale-up studies. Epidemiol Health 2018; 40:e2018041. [PMID: 30121969 PMCID: PMC6280069 DOI: 10.4178/epih.e2018041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/16/2018] [Indexed: 11/09/2022] Open
Abstract
Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.
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Affiliation(s)
- Aliakbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Ahmadi Gohari
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Farzaneh Zolala
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Mirzamoradi M, Saleh M, Jamali M, Bakhtiyari M, Pooransari P, Saleh Gargari S. Factors related to unwanted pregnancies and abortion in the northern district of the city of Tehran, Iran. Women Health 2017; 58:714-728. [DOI: 10.1080/03630242.2017.1342738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Masoumeh Mirzamoradi
- Department of Gynecology and Obstetrics, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Saleh
- Department of Gynecologys & Obstetric, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieyeh Jamali
- School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Bakhtiyari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parichehr Pooransari
- Department of Gynecology & Obstetric, Shohada Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran Iran
| | - Soraya Saleh Gargari
- Department of Gynecology & Obstetric, Shohada Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran Iran
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