Factors associated with induced abortion in women prostitutes in Asturias (Spain)

Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression

PURPOSE

Despite the evidence of a high rate of unintended pregnancy, there remains limited information about the prevalence and experiences of abortion among female sex workers (FSWs). In response, we aimed to summarize the available evidence on abortion among FSWs.

METHODS

We searched Medline, Embase, PsycINFO, CINAHL, Scopus, and Web of Science from inception to January 29, 2023 . We pooled data from the included studies using random-effects meta-analyses. We also grouped countries for the legality of elective abortion stratified by the United Nations database on abortion laws and policies.

RESULTS

We identified 60 eligible studies from 2031 potentially eligible records. The pooled lifetime prevalence of at least one and multiple induced abortions was 37.7% (95% confidence interval, 31.8-43.7) and 21.7% (14.9-29.2), respectively. Among FSWs recruited in countries where elective abortion is illegal, at least one induced abortion prevalence was 35.1% (28.1-42.4), and multiple induced abortion prevalence was 23.1% (12.4-35.9). In countries where elective abortion is legal, at least one induced abortion prevalence was 44.6% (34.8-54.6), and multiple induced abortion prevalence was 19.9% (11.9-29.3). Among FSWs experiencing abortion, self-managed abortion prevalence was estimated at 32.8% (23.6-42.7) overall, 42.8% (37.2-48.5) for countries where elective abortion is illegal, and 15.6% (3.9-32.7) for countries that legally allow elective abortion.

CONCLUSIONS

Induced abortion is prevalent among FSWs, highlighting the need for interventions to increase access to effective contraception and safe abortion care. While induced abortion prevalence did not significantly differ across the legal grounds for abortion, self-managed abortion prevalence was higher in countries where elective abortion was illegal, highlighting the urgent need for accessible abortion services for FSWs in criminalized settings. Moving forward necessitates implementing and evaluating culturally acceptable models of safe abortion and post-abortion care for FSWs to increase access to the full spectrum of sexual and reproductive health services.

Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020

Purpose

In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.

Methods

This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.

Results

From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.

Conclusion

Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.

Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya

Background

Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives.

Methods

We focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’

Results

Findings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives.

Conclusions

We recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV prevention.

A systematic review of the research evidence on cross-country features of illegal abortions

Background: There are contrasting debates about abortions and prohibitory regulations posed serious public health challenges especially in underdeveloped and developing countries. Due to paucity of the empirical evidences this study was conducted to explore the existent cumulative knowledge with special focus on the applied methodology.

Methods: A comprehensive review of published articles from January 1995 to December 2015 was performed. Several databases including: Embase, PubMed, Cochrane and also databasesof the Iranian medical journals were searched using combinations of relevant Medical Subject Headings (MeSH terms) and their equivalents, i.e., induced abortion, embryotomy, criminal abortion and illegal abortion. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement for appraisal of the cross-sectional studies and Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for the qualitative reports were utilized. After removal of duplicates and irrelevant publications 36 articles remained for data analysis.

Results: A wide heterogeneity was observed in the utilized methodology with no standard data collection tool. Face to face interview and self-administered questionnaire were the most common reported data collection/tool respectively. Married and unemployed women of 26-30 years old age group with low socioeconomic backgrounds were the most typical illegal abortees in the included studies.

Conclusion: Despite limitation in accessing all relevant publications and including only those reports written in English or Persian languages, the accumulated knowledge might be applicable to develop a potentially inclusive data collection tool and hence, improve the quality of data collection and/or application of a more robust study design in future investigations.

Factors associated with induced abortion among female entertainment workers: a cross-sectional study in Cambodia

OBJECTIVE

To explore risk factors associated with induced abortion among sexually active female entertainment workers (FEWs) in Cambodia.

DESIGN

Cross-sectional study.

SETTING

Phnom Penh and Siem Reap, Cambodia.

PARTICIPANTS

This study included 556 FEWs aged 18-47 years randomly selected from entertainment establishments in the two cities in 2014 using a two-stage cluster sampling method. Data were collected through face-to-face interviews using a structured questionnaire.

PRIMARY OUTCOME MEASURE

History of induced abortion during the time working as a FEW.

RESULTS

Of the total sample, 45.6% reported currently using a contraceptive method with condom (42.4%) being the most common method, followed by pills (25.6%). One-fourth (25%) of the respondents reported having been pregnant at least once, and 21.4% reported having at least one induced abortion during the time working as a FEW. After controlling for other covariates in a multivariate logistic regression model, FEWs with a history of induced abortion remained significantly more likely to be currently working in a karaoke bar (AOR=1.75, 95% CI 1.10 to 2.78), to have worked longer as a FEW (AOR=1.42, 95% CI 1.06 to 1.43), to have had a greater number of sexual partners in the past 12 months (AOR=1.86, 95% CI 1.02 to 1.54), to be currently using a contraceptive method (AOR=1.52, 95% CI 1.01 to 2.29), to be able to find condoms when they needed them (AOR=2.03, 95% CI 1.09 to 3.82), and to report inconsistent condom use with non-commercial partners in the past 3 months (AOR=1.62, 95% CI 1.06 to 3.44).

CONCLUSIONS

This study highlights the high rates of unwanted pregnancies that ended in induced abortions among FEWs in Cambodia. Access of FEWs to quality sexual and reproductive healthcare services is deemed a high priority. Integrated interventions to improve sexual and reproductive health among these vulnerable women should be tailored to reach the most-at-risk groups.

Prevalence and associated factors of induced abortion among rural married women: a cross-sectional survey in Anhui, China

AIM

This study aims to assess the prevalence of and factors associated with induced abortion among married women in rural areas of Anhui Province, China.

MATERIAL AND METHODS

A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18-49 years in rural areas of Anhui Province, China. All women were interviewed in the form of a standardized questionnaire.

RESULTS

We found that 32.0% (16,800) of these women had had at least one induced abortion: 21.1% (11,090) of women had had one; 7.6% (3976) of women had had two; and 4.1% (1734) of women had had at least three. The number of induced abortions per 100 pregnancies was found to be 22.0. Multivariate analysis showed that education, the age of a woman at her first marriage, number of total births, number of total pregnancies, and contraceptive methods were significant predictors for induced abortion after controlling for women's current age, employment and family yearly income.

CONCLUSION

The study shows that the prevalence of induced abortion is still very high among married women in rural China, and highly effective methods of contraception (sterilization, intrauterine device) decrease women's recourse to induced abortion.

Induced abortion and associated factors in health facilities of Guraghe zone, southern Ethiopia

Unsafe abortion is one of the major medical and public health problems in developing countries including Ethiopia. However, there is a lack of up-to-date and reliable information on induced abortion distribution and its determinant factors in the country. This study was intended to assess induced abortion and associated factors in health facilities of Guraghe zone, Southern Ethiopia. Institution based cross-sectional study was conducted in eight health facilities in Guraghe zone. Client exit interview was conducted on 400 patients using a structured questionnaire. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with induced abortion. Out of 400 women, 75.5% responded that the current pregnancy that ended in abortion is unwanted. However, only 12.3% of the respondents have admitted interference to the current pregnancy. Having more than four pregnancies (AOR = 4.28, CI: (1.24–14.71)), age of 30–34 years (AOR = 0.15, CI: (0.04–0.55)), primary education (AOR = 0.26, CI: (0.13–0.88)), and wanted pregnancy (AOR = 0.44, CI: (0.14–0.65)) were found to have association with induced abortion. The study revealed high level of induced abortion which is underpinned by high magnitude of unwanted pregnancy. There is requirement for widespread expansion of increased access to high quality family planning service and post-abortion care.

Aborto induzido entre prostitutas: um levantamento pela técnica de urna em Teresina - Piauí

Este artigo avalia a prevalência do aborto induzido entre prostitutas e caracteriza as práticas para abortar mais comuns. Realizou-se levantamento com 310 prostitutas de 18 a 39 anos, através de amostra por cotas de idade nas 05 zonas territoriais de Teresina-Piauí. Foram empregados 02 questionários: o primeiro, pela técnica de urna, com perguntas sobre a prática do aborto; o segundo, preenchido pelo pesquisador, com informações sociodemográficas. A prática do aborto induzido foi relatada por 163 (52,6%) mulheres. A maior parte realizou 01 aborto (50,3%), mas 16,5% delas relatou 3 ou mais. O misoprostol foi empregado isoladamente em 68,1% dos relatos e associado com chás e/ ou sondas em 9,2%. O uso único de chás foi descrito em 13,4% das vezes, sondas em 3,7% e curetagem uterina em clínicas clandestinas em 3,7%. Houve relato de internação hospitalar pós-aborto por 47,8% delas. Após ajuste no modelo de regressão logística múltipla, a variável que permaneceu associada significativamente ao aborto foi ter tido 3 ou mais gestações. Estes resultados indicam que o aborto induzido é evento de grande prevalência entre prostitutas em Teresina. O misoprostol é o método predominante para abortar, sendo a internação hospitalar necessária em quase metade dos casos.