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Barghazan SH, Hadian M, Rezapour A, Nassiri S. Economic evaluation of medical versus surgical strategies for first trimester therapeutic abortion: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:184. [PMID: 36003248 PMCID: PMC9393924 DOI: 10.4103/jehp.jehp_1274_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/21/2021] [Indexed: 06/15/2023]
Abstract
Pregnancy termination and abortion-related complications are well-established problems among women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a systematic study was performed to investigate the economic evaluation studies results on costs and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase, Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched through June 2021. Original full-text English language studies that performed an economic evaluation analysis comparing medical and surgical methods of pregnancy termination were included in this review. A critical quality assessment was conducted utilizing the Consolidated Health Economic Evaluation Standards checklist. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2020 $US). Overall, 538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among the reviewed studies, three studies investigated cost-minimization analysis, three studies investigated cost-utility analysis, and 14 studies investigated cost-effectiveness analysis. The directly comparison of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$ 2373 per patient's costs. Medical abortion was cost-effective and cost-saving option in compare to the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of studies received a score of above 85% and had "excellent" quality. According to the results, based on various economic and clinical effectiveness decision-making criteria used in different studies of health economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical methods compared to surgical methods, as well as the advantages of using combinations therapy compared to single therapeutic interventions.
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Affiliation(s)
- Saeed Husseini Barghazan
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Hadian
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
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Agula C, Henry EG, Asuming PO, Agyei-Asabere C, Kushitor M, Canning D, Shah I, Bawah AA. Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana. BMC WOMENS HEALTH 2021; 21:300. [PMID: 34399739 PMCID: PMC8365972 DOI: 10.1186/s12905-021-01444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Background Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra. Methods Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services. Results About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies. Conclusions The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01444-9.
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Affiliation(s)
- Caesar Agula
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana.
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Patrick O Asuming
- University of Ghana Business School (UGBS), University of Ghana, Accra, Ghana
| | | | - Mawuli Kushitor
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ayaga A Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
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Zou L, Hong M, Dai Z, Zhu J, Peng Q, Wang W. The association between previous induced abortion and in vitro fertilization outcomes: A retrospective cohort study in Hefei, China. Eur J Obstet Gynecol Reprod Biol 2021; 262:124-128. [PMID: 34015639 DOI: 10.1016/j.ejogrb.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the association between previous induced abortion and in vitro fertilization (IVF) outcomes among Chinese women. STUDY DESIGN In this retrospective cohort study, a total of 1436 infertility patients treated with IVF for the first time in the reproductive centre of Anhui Province Maternity and Child Health Hospital from February 2014 to April 2018 were selected as the study population, and 95 (6.6 %) had a history of induced abortion. Data were assessed from the hospital electronic database and medical records in the reproductive centre. RESULTS In total, 818 women (57.0 %) achieved clinical pregnancy, and 501 (34.9 %) achieved live birth. After adjustments for a series of potential confounding factors, women with a history of induced abortion had a significantly decreased probability of clinical pregnancy per transfer (OR: 0.71, 95 % CI: 0.53, 0.95, p = 0.037) and live birth per pregnancy (OR: 0.52, 95 % CI: 0.30, 0.90, p = 0.021) and a higher risk of miscarriage per pregnancy (OR: 1.89, 95 % CI: 1.24, 2.88, p = 0.009) than those without. Because relevant information was unavailable, the impacts of different types of previous induced abortion were not assessed. CONCLUSIONS Previous induced abortion may have an adverse effect on IVF outcomes among infertility patients.
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Affiliation(s)
- Linbing Zou
- Reproductive Medicine Centre, Anhui Province Maternity and Child Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, PR China
| | - Mingyun Hong
- Reproductive Medicine Centre, Anhui Province Maternity and Child Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, PR China
| | - Zhijun Dai
- Reproductive Medicine Centre, Anhui Province Maternity and Child Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, PR China
| | - Jiansheng Zhu
- Reproductive Medicine Centre, Anhui Province Maternity and Child Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, PR China
| | - Qingmei Peng
- Department of Obstetrics and Gynecology, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, PR China
| | - Weiye Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, PR China; Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, PR China.
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Masuda C, Oreglia E, Ly S, McLaren M, Free C, Tijamo C, Ou A, van Velthoven MH, Williamson A, Smith C. Family planning practices of women working in the Cambodian garment industry: a qualitative study. Contracept Reprod Med 2020; 5:11. [PMID: 32793378 PMCID: PMC7418303 DOI: 10.1186/s40834-020-00116-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care. METHODS We conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 min and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol. RESULTS We interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women's attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children. CONCLUSION This research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions.
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Affiliation(s)
- Chisato Masuda
- School of Tropical Medicine and Global Health, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523 Japan
| | | | - Sokhey Ly
- Marie Stopes International Cambodia, Phnom Penh, Cambodia
| | | | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT UK
| | - Camille Tijamo
- Marie Stopes International Cambodia, Phnom Penh, Cambodia
| | - Amra Ou
- Marie Stopes International Cambodia, Phnom Penh, Cambodia
| | | | - Amy Williamson
- Marie Stopes International Cambodia, Phnom Penh, Cambodia
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523 Japan
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT UK
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