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Hamui RM, Aquino EML, Menezes GMS, Velho Barreto de Araújo T, Seabra Soares de Britto E Alves MT, Valongueiro Alves S, Almeida MDCC. Delays in obtaining hospital care and abortion-related complications within a context of illegality. PLoS One 2023; 18:e0286982. [PMID: 37315058 DOI: 10.1371/journal.pone.0286982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes. This study, nested within the GravSus-NE, analyzed healthcare delays and their association with abortion-related complications in three cities of northeastern Brazil (Salvador, Recife and São Luís). Nineteen public maternity hospitals were involved. All eligible women ≥18 years old hospitalized between August and December 2010 were evaluated. Descriptive, stratified and multivariate analyses were performed. Youden's index was used to determine delay. One model was created with all the women and another with those admitted in good clinical conditions, thus determining complications that occurred during hospitalization and their associated factors. Of 2,371 women, most (62.3%) were ≤30 years old (median 27 years) and 89.6% reported being black or brown-skinned. Most (90.5%) were admitted in good condition, 4.0% in fair condition and 5.5% in poor/very poor condition. Median time between admission and uterine evacuation was 7.9 hours. After a cut-off time of 10 hours, the development of complications increased considerably. Black women and those admitted during nightshifts were more likely to experience a wait time ≥10 hours. Delays were associated with severe complications (OR 1.97; 95%CI: 1.55-2.51), including in the women admitted in good condition (OR 2,56; 95%CI: 1.85-3.55), and even following adjustment for gestational age and reported abortion type (spontaneous/induced). These findings corroborate the literature, highlighting the social vulnerability of women hospitalized within Brazil's public healthcare system in a situation of abortion. The study strongpoints include having objectively measured the time between admission and uterine evacuation and having established a cut-off time defining delay based on conceptual and epidemiological criteria. Further studies should evaluate other settings and new measurement tools for effectively preventing life-threatening complications.
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Affiliation(s)
- Romina M Hamui
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Greice M S Menezes
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Jubert A, Bayen M, Serman F, Robin G, Catteau-Jonard S, Ollivon J, Tilly A, Messaadi N, Bayen S. Medical tourism for late abortion: Women's profile and circumstances. A quantitative study among women who travelled within Europe for late abortion. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100824. [PMID: 36893521 DOI: 10.1016/j.srhc.2023.100824] [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: 08/17/2022] [Revised: 01/15/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND In France, women seeking abortion must do so before the maximum legal limit of 12 weeks of pregnancy (14 Gestational Weeks). Women seeking abortion after the 12-week limit tend to travel to the Netherlands, where the maximum legal limit is 22 weeks of pregnancy. The purpose of this study was to identify the profile and circumstances of women who travel from France to the Netherlands for a late abortion. METHODS A descriptive, monocentric study was conducted in a Dutch abortion clinic, where a standardized, anonymous questionnaire was administered to women from France, holding an appointment for late abortion. Data was collected from July 2020 to December 2020. Data analysis was performed with R 4.0.3 software. RESULTS Thirty-seven women participated in the study. Most of the women were young (15-25 y. o.), without any prior pregnancy, single, in paid employment, with an educational level less than or equal to a high school degree. Most of the women had regular gynaecological follow-up, used contraception, mostly birth control pills, and had already discussed emergency contraception or abortion with a healthcare professional. The women had delayed awareness of their pregnancy and visited the clinic at 18 weeks of pregnancy or later, beyond the 12-week French legal limit for abortion. CONCLUSION Risk factors likely to lead to medical tourism for late abortion include young age (15-25 y. o.), first pregnancy, being insufficiently informed about available contraceptive methods.
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Affiliation(s)
- Amandine Jubert
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
| | - Marc Bayen
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
| | - Fanny Serman
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
| | - Geoffroy Robin
- Univ. Lille, CHU Lille, Department of Gynecology, F- 59000 Lille, France.
| | | | - Judith Ollivon
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
| | - Anita Tilly
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
| | - Nassir Messaadi
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France; MSPU, University of Lille, Lille, France.
| | - Sabine Bayen
- Univ. Lille, CHU Lille, Department of General Practice, F- 59000 Lille, France.
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Noémie VB, Rozenberg S, Gilles C, Bomboir I, Joris A, Rousseau C, Manigart Y. Impact of Covid-lockdown on abortion management at a family planning in Brussels. EUR J CONTRACEP REPR 2022; 27:278-283. [PMID: 35727186 DOI: 10.1080/13625187.2022.2085682] [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: 11/03/2022]
Abstract
INTRODUCTION In response to the Covid-19 lockdown, we developed a new abortion protocol in a family planning in Brussels. This study evaluates the effects of the lockdown on the abortion management and its impact on patients' characteristics. METHODS A retrospective study compared the characteristics and management of patients who terminated their pregnancies at the same family planning (CHU Saint-Pierre Brussels) between 14 March and 6 May 2020 and during the same time period in 2019. RESULTS Patients having an abortion in 2020 (n = 87) were in average two years older compared to patients having abortions in 2019 (n = 93) (31 years ± 13 vs 29 years ± 13 p < .011), the number of abortions was similar to those of previous years, and the characteristics of the population were identical. The management of abortions has changed significantly as the patients terminated their pregnancies earlier in 2020 than in 2019 (7 W and 1 day ± 3 days versus 8 W and 5 days ± 3 days p < .01), mostly with medication and at home (61.4% versus 2% p < .001), but with similar effectiveness. CONCLUSION Due to the lockdown, we have accelerated the time required to obtain an appointment and shortened the delay between the abortion request and the pregnancy termination, permitting an earlier management mainly through the use of medical- and at home abortion. Given the satisfactory results, we consider now to implement this new protocol beyond the lockdown period.
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Affiliation(s)
- Vanden Berghe Noémie
- Department of Obstetrics and Gynecology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Chrsitine Gilles
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Isabelle Bomboir
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Aurélie Joris
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Charlotte Rousseau
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Yannick Manigart
- Department of Obstetrics and Gynecology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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De Kort L, Wood J, Wouters E, Van de Velde S. Abortion care in a pandemic: an analysis of the number and social profile of people requesting and receiving abortion care during the first COVID-19 lockdown (March 16 to June 14, 2020) in Flanders, Belgium. ACTA ACUST UNITED AC 2021; 79:140. [PMID: 34344468 PMCID: PMC8331997 DOI: 10.1186/s13690-021-00665-6] [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] [Received: 05/13/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The COVID-19 pandemic and the national COVID-19 measures might have increased potential barriers to abortion care and created new ones, especially for vulnerable groups. This study documents the impact of the pandemic and the lockdown measures on the profile of people going through the abortion process. METHODS Using anonymized patient records from a Belgian abortion centre, we first compared the number of abortion requests and procedures during the first COVID-19 lockdown with the same months in the five preceding years. Next, we analysed the social profile of people requesting an abortion in those two time periods and looked at the number of long-acting reversible contraceptive devices (LARC) placed after curettage. RESULTS The abortion centre saw a drop in the number of abortion requests during the lockdown. This difference was more pronounced for people in paid employment and people using (modern) contraception. People were also more likely to request an abortion earlier in their pregnancy. The drop in abortion procedures and LARC's placed after curettage was proportionate to the drop in abortion requests and did not differ according to clients' characteristics. CONCLUSION Questions arose concerning the potential selectivity with which COVID-19 influenced the need for abortion care and accessibility to services. Although there was a general drop in abortion requests and procedures during the first COVID-19 lockdown in the studied abortion centre, our results suggest that the profile of people requesting and receiving an abortion did only slightly change during the lockdown, and did not affect vulnerable groups visibly harder.
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Affiliation(s)
- Leen De Kort
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium.
| | - Jonas Wood
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
| | - Sarah Van de Velde
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
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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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Baird B, Millar E. Abortion at the edges: Politics, practices, performances. WOMENS STUDIES INTERNATIONAL FORUM 2020; 80:102372. [PMID: 32346206 PMCID: PMC7186192 DOI: 10.1016/j.wsif.2020.102372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
This article provides a brief overview of the state of discourse, politics and provision of abortion in the Anglophone West, including developments in the wake of the COVID-19 pandemic. It then surveys three promising directions for feminist abortion scholarship. The first is work inspired by the Reproductive Justice Movement, that points to the intersectional axes of inequality that shape abortion discourse and position us in relation to reproductive choice and access issues. The second is work that examines the particularity of the constitution of the aborting body, reflecting the particularity of the pregnant body. This is a specific body, with a specific history; abortion discourse draws from and makes a significant contribution to the meaning and lived experience of this body. The third area of scholarship we highlight is that which seeks to amplify the meaning of abortion as a social good. Much abortion scholarship is attuned to a critique of negative aspects of abortion-from its representation in popular culture to restrictive law and access issues. This is critical work but/and the performative nature of abortion scholarship, like all discourse, means that it can amplify the association of negativity with abortion. The article concludes by introducing the articles contained in the special section of Women's Studies International Forum, 'Abortion at the edges: Politics, practices, performances'.
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Affiliation(s)
- Barbara Baird
- Women's Studies, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Erica Millar
- Crime, Justice and Legal Studies, La Trobe University, Bundoora, Victoria 3086, Australia
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