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Sikaluzwe M, Phiri M, Lemba M, Shasha L, Muhanga M. Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018). BMC Pregnancy Childbirth 2024; 24:148. [PMID: 38383354 PMCID: PMC10880343 DOI: 10.1186/s12884-024-06311-7] [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: 09/07/2022] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. METHODS This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15-49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. RESULTS Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25-29 years and 30-34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. CONCLUSIONS The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.
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Affiliation(s)
- Milika Sikaluzwe
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Million Phiri
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Musonda Lemba
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Liness Shasha
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Mikidadi Muhanga
- Department of the Development and Strategic Studies, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania
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2
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Rossier C, Owolabi O, Kouanda S, Bangha M, Kim CR, Ganatra B, Feehan D, Breen C, Zan M, Compaoré R, Baguiya A, Ouédraogo R, Oduor C, Bagnoa V, Athero S. Describing the safety of abortion at the population level using network-based survey approaches. Reprod Health 2022; 19:231. [PMID: 36575489 PMCID: PMC9795788 DOI: 10.1186/s12978-022-01518-3] [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: 04/14/2021] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. OBJECTIVE This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. METHODS This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. DISCUSSION This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.
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Affiliation(s)
- Clémentine Rossier
- Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d'Arve, 1211, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | - Onikepe Owolabi
- grid.417837.e0000 0001 1019 058XGuttmacher Institute, New York, USA
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | - Martin Bangha
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Caron R. Kim
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Dennis Feehan
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Casey Breen
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Moussa Zan
- grid.8591.50000 0001 2322 4988Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d’Arve, 1211 Geneva, Switzerland
| | | | - Adama Baguiya
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | | | - Clement Oduor
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Vincent Bagnoa
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
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Cohen MA, Kapp N, Edelman A. Abortion Care Beyond 13 Weeks' Gestation: A Global Perspective. Clin Obstet Gynecol 2021; 64:460-474. [PMID: 34323228 DOI: 10.1097/grf.0000000000000631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of abortions are performed early in pregnancy, but later abortion accounts for a large proportion of abortion-related morbidity and mortality. People who need this care are often the most vulnerable-the poor, the young, those who experience violence, and those with significant health issues. In settings with access to safe care, studies demonstrate significant declines in abortion-related morbidity and mortality. This review focuses on evidence-based practices for induced abortion beyond 13 weeks' gestation and post-abortion care in both high- and low-resource settings. We also highlight key programmatic issues to consider when expanding the gestational age for abortion services.
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Affiliation(s)
- Megan A Cohen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | | | - Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
- Ipas, Chapel Hill, North Carolina
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4
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Enden MR, Tolla MT, Norheim OF. Providing universal access to modern contraceptive methods: An extended cost-effectiveness analysis of meeting the demand for modern contraception in Ethiopia. Soc Sci Med 2021; 281:114076. [PMID: 34116422 DOI: 10.1016/j.socscimed.2021.114076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
Despite recent advances in access to and use of modern contraception in Ethiopia, further improvement is needed, particularly among poorer women. This extended cost-effectiveness analysis investigated the health outcomes, their distribution, and financial risk protection associated with meeting the demand for modern contraception for all Ethiopian women. We developed five Markov models with wealth quintile-specific input data to investigate the effects of meeting this demand and followed a hypothetical cohort of 1,252,000 women through their reproductive lives from ages 15-49 years. The health outcomes are reported in quality-adjusted life years (QALYs) gained and in intermediate health outcomes, such as the total number of induced abortions, unintended pregnancies, and pregnancy-related deaths averted. The economic effect of meeting the demand for modern contraception was assessed by estimating the financial risk protection benefits in terms of averted out-of-pocket payments and the reduction in the number of cases of catastrophic health expenditure by quintile. Meeting the demand for modern contraception was deemed highly cost effective, with an incremental cost-effectiveness ratio of $96.60/QALY gained per woman. A total of 676,300 QALYs were gained, and approximately 1,900,000 unintended pregnancies, 250,000 induced abortions, and 9000 pregnancy-related deaths were averted over the 35-year period. Most of these gains were achieved among low-income groups. When the demand for modern contraception was met, almost 40,000 cases of catastrophic health expenditure were averted in the poorest quintile. The total governmental cost was higher in all quintiles when the demand for modern contraception was met compared to the baseline scenario, with the largest percentage increase in governmental spending in the poorest quintiles. Meeting the demand for modern contraception fulfills the priority-setting criteria established by the Ethiopian Ministry of Health and makes the Ethiopian health care system more equitable.
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Affiliation(s)
- M R Enden
- Bergen Centre for Ethics and Priority Setting, Institute of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5009, Bergen, Norway.
| | - M T Tolla
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States.
| | - O F Norheim
- Bergen Centre for Ethics and Priority Setting, Institute of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5009, Bergen, Norway; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States.
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5
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Yeshambel Wassie A, Berhe Lemlem S, Boka A. Knowledge, Practice and Associated Factors Towards Medication Abortion Among Reproductive-Age Women in Sexual and Reproductive Health Clinics of Addis Ababa, Ethiopia, 2018: Cross-Sectional Study. Int J Womens Health 2021; 13:489-499. [PMID: 34079386 PMCID: PMC8163624 DOI: 10.2147/ijwh.s297626] [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: 12/16/2020] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Abortion rates following unintended pregnancies are increasing in developing countries, and unsafe abortion is a commonly neglected reproductive health-care problem. In Ethiopia, the number of women receiving treatment for complications from unsafe abortion is increasing. Improving the level of knowledge of reproductive-age women on medication abortion contributes to the prevention of unsafe abortion. Therefore, the purpose of this study was to assess knowledge, and practice of medication abortion and associated factors among women in SRH clinics of Addis Ababa, Ethiopia, 2018. Methods A cross-sectional quantitative study design was conducted to collect data from 30th February to March 30, 2018. Study participants were selected by using a convenient sampling technique. The data were coded and entered into EpiData version 4.2, and SPSS version 23 was used for analysis. Bivariate and multivariate analysis with 95% CI were employed. The strength of association was declared at a P value <0.05. Results The overall knowledge and practice of medication abortion were 72.1%, and 33%, respectively. Participants level of education (AOR=3.54, 95% CI (1.02, 12.26)), father education (AOR=2.80, 95% CI (1.42, 5.52)), participants way of living (AOR=6.08, 95% CI (2.41, 15.33)), income (AOR=2.19, 95% CI (1.02, 4.75)), and history of unwanted pregnancy (AOR=11.7, 95% CI (1.11, 12.46)) were some of the factors associated with knowledge and practice of medication abortion. Conclusion This study provided that women were relatively knowledgeable but their practice on medication abortion was low. The low practice of medication abortion call health-care providers to give due attention to awareness creation and strengthened action to provide quality maternal care for childbearing mothers towards medication abortion and unsafe abortion in particular.
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Affiliation(s)
- Addisu Yeshambel Wassie
- Department of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Semarya Berhe Lemlem
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abdisa Boka
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Moseson H, Shaw J, Chandrasekaran S, Kimani E, Maina J, Malisau P, Musa Y, Nmezi S, Philipo K, Borjas EB, Young YY. Contextualizing medication abortion in seven African nations: A literature review. Health Care Women Int 2019; 40:950-980. [DOI: 10.1080/07399332.2019.1608207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Esther Kimani
- Trust for Indigenous Culture and Health, Nairobi, Kenya
| | - Jedidah Maina
- Trust for Indigenous Culture and Health, Nairobi, Kenya
| | | | - Yiga Musa
- Community Health Rights Network (COHERINET), Kampala, Uganda
| | - Sybil Nmezi
- Generation Initiative for Women and Youth Network, Lagos, Nigeria
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Cresswell JA, Owolabi OO, Chelwa N, Dennis ML, Gabrysch S, Vwalika B, Mbizvo M, Filippi V, Campbell OMR. Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia. BMJ Glob Health 2018; 3:e000897. [PMID: 30233831 PMCID: PMC6135439 DOI: 10.1136/bmjgh-2018-000897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Zambia is one of the few countries in Africa to permit termination of pregnancy (TOP) on a wide range of grounds. However, substantial barriers remain to TOP and postabortion care (PAC). Methods We conducted a census of 153 facilities between March and May 2016. We defined facilities according to whether they met basic and/or comprehensive signal functions criteria for TOP and PAC. We linked our facility data to census data to estimate geographic accessibility under different policy scenarios. Results Overall, 16% of facilities reported they had performed a TOP and 39% performed a PAC in the last year. Facilities were twice as likely to use medical methods for TOP compared with surgical methods, and four times more likely for PAC. Considerably more facilities had performed TOP or PAC than met the basic or comprehensive signal functions criteria, indicating services were being performed in facilities below essential quality standards. Under current Zambian law for non-emergency scenarios, 21% of women in Central Province lived within 15 km of a facility with basic capability to provide TOP; if midlevel providers were trained to provide TOP, this would increase to 36%. Conclusion A supportive legislative framework is essential, but not in itself sufficient, for adequate access to services. Training midlevel providers, in line with WHO guidance, and ensuring equipment is available in primary care can increase accessibility of TOP and PAC. While both medical and surgical methods need to be available, medical abortion is a safe and effective method that can be provided in low-resource settings.
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Affiliation(s)
- Jenny A Cresswell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Onikepe O Owolabi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mardieh L Dennis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | | | | | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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8
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Polis CB, Mhango C, Philbin J, Chimwaza W, Chipeta E, Msusa A. Incidence of induced abortion in Malawi, 2015. PLoS One 2017; 12:e0173639. [PMID: 28369114 PMCID: PMC5378324 DOI: 10.1371/journal.pone.0173639] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background In Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. Methods We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. Results We estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. Conclusions The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.
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Affiliation(s)
- Chelsea B. Polis
- Guttmacher Institute, New York, New York, United States of America
- * E-mail:
| | - Chisale Mhango
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jesse Philbin
- Guttmacher Institute, New York, New York, United States of America
| | - Wanangwa Chimwaza
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ausbert Msusa
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
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Sedgh G, Filippi V, Owolabi OO, Singh SD, Askew I, Bankole A, Benson J, Rossier C, Pembe AB, Adewole I, Ganatra B, MacDonagh S. Insights from an expert group meeting on the definition and measurement of unsafe abortion. Int J Gynaecol Obstet 2016; 134:104-6. [PMID: 27062249 PMCID: PMC6434901 DOI: 10.1016/j.ijgo.2015.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/03/2015] [Accepted: 02/18/2016] [Indexed: 12/03/2022]
Abstract
Until recently, WHO operationally defined unsafe abortion as illegal abortion. In the past decade, however, the incidence of abortion by misoprostol administration has increased in countries with restrictive abortion laws. Access to safe surgical abortions has also increased in many such countries. An important effect of these trends has been that, even in an illegal environment, abortion is becoming safer, and an updated system for classifying abortion in accordance with safety is needed. Numerous factors aside from abortion method or legality should be taken into consideration in developing such a classification system. An Expert Meeting on the Definition and Measurement of Unsafe Abortion was convened in London, UK, on January 9–10, 2014, to move toward developing a classification system that both reflects current conditions and acknowledges the gradient of risk associated with abortion. The experts also discussed the types of research needed to monitor the incidence of abortion at each level of safety. These efforts are urgently needed if we are to ensure that preventing unsafe abortion is appropriately represented on the global public health agenda. Such a classification system would also motivate investment in research to accurately measure and monitor abortion incidence across categories of safety.
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Affiliation(s)
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Department of Infectious Diseases Epidemiology, London, UK
| | - Onikepe O Owolabi
- London School of Hygiene and Tropical Medicine, Department of Infectious Diseases Epidemiology, London, UK
| | | | - Ian Askew
- At time of expert meeting: Population Council, New York, NY, USA; World Health Organization, Geneva, Switzerland
| | | | | | - Clementine Rossier
- University of Geneva, Institute of Demographic and Life Course Studies, Geneva, Switzerland
| | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Department of Obstetrics and Gynaecology, Dar es Salaam, Tanzania
| | - Isaac Adewole
- University of Ibadan, Department of Obstetrics and Gynaecology College, College of Medicine, Ibadan, Nigeria
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Snow RC, Laski L, Mutumba M. Sexual and reproductive health: progress and outstanding needs. Glob Public Health 2015; 10:149-73. [PMID: 25555027 PMCID: PMC4318113 DOI: 10.1080/17441692.2014.986178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/06/2014] [Indexed: 10/25/2022]
Abstract
We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.
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Affiliation(s)
- Rachel C. Snow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Laura Laski
- Sexual and Reproductive Health Branch, UNFPA, New York, NY, USA
| | - Massy Mutumba
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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11
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MacPherson EE, Richards E, Namakhoma I, Theobald S. Gender equity and sexual and reproductive health in Eastern and Southern Africa: a critical overview of the literature. Glob Health Action 2014; 7:23717. [PMID: 24972916 PMCID: PMC4074359 DOI: 10.3402/gha.v7.23717] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/24/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022] Open
Abstract
Background Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. Design During November 2011, we identified studies relating to SRH and gender equity through a comprehensive literature search. Results We found gender inequalities to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women's vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Conclusions Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.
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Affiliation(s)
- Eleanor E MacPherson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;
| | - Esther Richards
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ireen Namakhoma
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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12
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Tey NP, Yew SY, Low WY, Su'ut L, Renjhen P, Huang MSL, Tong WT, Lai SL. Medical students' attitudes toward abortion education: Malaysian perspective. PLoS One 2012; 7:e52116. [PMID: 23300600 PMCID: PMC3531402 DOI: 10.1371/journal.pone.0052116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 11/14/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students' attitudes toward abortion education and presents a case for including abortion education in medical schools. METHODS AND RESULTS A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students' pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students' attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity. CONCLUSIONS Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights.
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Affiliation(s)
- Nai-peng Tey
- Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia.
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Lathrop E, Rochat R. The GEMMA Seminar: a graduate public health course on global elimination of maternal mortality from abortion. Contraception 2012; 87:6-10. [PMID: 23063340 DOI: 10.1016/j.contraception.2012.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Eva Lathrop
- Emory University School of Medicine, Atlanta, GA 30322, USA.
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