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Tebeje TM, Seifu BL, Seboka BT, Mare KU, Chekol YM, Tesfie TK, Gelaw NB, Abebe M. Trends, spatiotemporal variation and decomposition analysis of pregnancy termination among women of reproductive age in Ethiopia: Evidence from the Ethiopian demographic and health survey, from 2000 to 2016. Heliyon 2024; 10:e34633. [PMID: 39130402 PMCID: PMC11315203 DOI: 10.1016/j.heliyon.2024.e34633] [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: 04/15/2024] [Revised: 06/08/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background Pregnancy termination is a major public health problem, and complications of unsafe abortion are among the proximate and major causes of maternal mortality. Mapping the trend and spatiotemporal variation and identifying factors that are responsible for the changes in pregnancy termination help achieve the sustainable development goal of reducing maternal mortality in Ethiopia by understanding the epidemiology and regional variations. Methods Data from the 2000-2016 Ethiopian Demographic and Health Survey were analyzed with a total weighted sample of 40,983 women of reproductive age. Variables with a p-value <0.05 in a logit multivariable decomposition analysis were considered significant predictors of the decline in pregnancy termination over time. Spatial analysis was used separately for each survey to show the changes in regional disparities in pregnancy termination in Ethiopia. Results The magnitude of pregnancy termination among women of reproductive age decreased by 39.5 %, from 17.7 % in 2000 to 10.7 % in 2016. The difference in the effects of literacy, working status, marital status, age at first intercourse, age at first cohabitation, knowledge about contraceptives, and knowledge of the ovulatory cycle were the significant predictors that contributed to the change in pregnancy termination over time. Significant clusters of pregnancy terminations were observed in central and northern Ethiopia (Addis Ababa, eastern Amhara, and Tigray regions). Conclusions Despite the substantial decrease in terminated pregnancies over time in Ethiopia, the magnitude is still high. The government should focus on promoting education for girls and women, providing reproductive health education, including access to contraceptives, and raising the minimum age for girls to engage in sexual activities or marriage by implementing policies.
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Affiliation(s)
- Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Mohapatra V, Panda N, Misra S. Family planning practices among women seeking induced abortion: An institution-based cross-sectional study from Eastern India. J Family Med Prim Care 2022; 11:6339-6344. [PMID: 36618191 PMCID: PMC9810879 DOI: 10.4103/jfmpc.jfmpc_495_22] [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: 03/01/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Unmet need for contraceptive use indicates the gap between women's reproductive intentions and their contraceptive behavior. It is a direct contributor to the increased incidence of unwanted pregnancies leading to abortion. Abortions, particularly septic abortions constitute an important cause of maternal morbidity and mortality. Objective This study was conducted to determine the pattern of family planning practices among women seeking an induced abortion. The study also aimed to assess the awareness and attitude towards contraceptive methods along with reasons for the nonuse of contraceptives in this study population. Methods An institution-based cross-sectional study was conducted during October 2020 to October 2021. Data was collected using a preformed validated structured questionnaire. Descriptive statistics was used to describe data. The Chi-square test was used to find the significance of differences between categorical variables. Results A total of 256 pregnant women seeking induced abortion were recruited. Despite high knowledge (99.2%) and attitude (63.7%), a history of contraceptive use could be elicited in 43.8% of study subjects. The most common contraceptive methods used previously were oral contraceptive pills followed by the barrier method of contraception. A significant association was found between contraceptive use and age of the woman, urban or rural background, and marital status. Unplanned sex or infrequent sex was the most common reason for the nonuse of contraceptives followed by fear of side effects. Conclusion Enhancement of knowledge of contraceptive users through adequate information by health care providers can be helpful. Consideration of socio-demographic characteristics of women and contraceptive barriers is indispensable in implementing family planning interventions.
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Affiliation(s)
- Vandana Mohapatra
- Department of Obstetrics and Gynecology, Fakir Mohan Medical College and Hospital (FMMCH), Balasore, Odisha, India,Address for correspondence: Dr. Vandana Mohapatra, Department of Obstetrics and Gynecology, Fakir Mohan Medical College and Hospital (FMMCH), Balasore - 756 019, Odisha, India. E-mail:
| | - Nalinikanta Panda
- Department of Obstetrics and Gynecology, Fakir Mohan Medical College and Hospital (FMMCH), Balasore, Odisha, India
| | - Sujata Misra
- Department of Obstetrics and Gynecology, Fakir Mohan Medical College and Hospital (FMMCH), Balasore, Odisha, India
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Hoffman JR, Delaney MA, Valdes CT, Herrera D, Washington SL, Aghajanova L, Smith JF, Herndon CN. Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers. FERTILITY RESEARCH AND PRACTICE 2020; 6:15. [PMID: 32821417 PMCID: PMC7429753 DOI: 10.1186/s40738-020-00084-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Background Few studies have examined health literacy and fertility knowledge among women from low income, socio-culturally diverse communities presenting for fertility care in the United States. Our study sought to examine demographic predictors of fertility-related knowledge among infertile women from low and high-resource communities in two major metropolitan centers in the United States. Methods Fertility Knowledge Assessments were administered to women presenting for fertility care at county medical centers serving low-resource, largely immigrant patients and to women from largely affluent populations presenting to comprehensive fertility centers in two cities. The influence of demographic predictors on fertility knowledge was examined through regression analysis. Results A total of 143 women were included in our analysis. In the county hospital/low resource clinic (LR, n = 70), the mean age was 32.8 ± 6.1 years vs 35.0 ± 5.0 years in the fee-for-service/high resource clinic (HR, n = 73). Among the LR patients, 74% were immigrants, 71% had an annual income <$25,000 and 52% had completed high school. Among HR patients, 36% were immigrants, 60% had an annual income >$100,000, and 95% had some college or above. On average, women from HR settings scored 3.0 points higher on the Fertility Knowledge Assessment than their LR counterparts (p < 0.001). Upon multivariate analysis, education level remained the sole independent factor associated with fertility knowledge assessment score (p < 0.001). Stratifying by resource level revealed that income was highly associated with fertility knowledge (p < 0.01) among high resource individuals even when adjusting for education level. Conclusions Women from low resource, largely immigrant communities, seeking fertility care have greater disparities in fertility knowledge and lower health literacy compared to women from high resource clinical settings. Further studies are needed to understand these barriers and to develop targeted inventions to lower disparities and improve care for these vulnerable populations.
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Affiliation(s)
- Jacquelyn R Hoffman
- University of Arizona College of Medicine-Tucson, 1501 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Meaghan A Delaney
- Department of Obstetrics & Gynecology, Baystate Medical Center, 759 Chestnut Street, Office S1661, Springfield, MA 01199 USA
| | - Cecilia T Valdes
- Department of Obstetrics & Gynecology, One Baylor Plaza, BCM 610, Houston, TX 77030 USA
| | - Diana Herrera
- Department of Obstetrics & Gynecology, The Houston Methodist Hospital, 1401 St. Joseph Pkwy. Susan K. Strake Building, 1st Floor SKS1106A, Houston, TX 77002 USA
| | - Samuel L Washington
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology & Infertility Services, Department of Obstetrics & Gynecology, Stanford University School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA 94087 USA
| | - James F Smith
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA.,UCSF Philip R. Lee Institute for Health Policy Studies, 3333 California St, San Francisco, CA 94118 USA
| | - Christopher N Herndon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356460, Seattle, WA 98195-6460 USA
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Rogers C, Sapkota S, Tako A, Dantas JAR. Abortion in Nepal: perspectives of a cross-section of sexual and reproductive health and rights professionals. BMC WOMENS HEALTH 2019; 19:40. [PMID: 30808340 PMCID: PMC6390627 DOI: 10.1186/s12905-019-0734-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 02/15/2019] [Indexed: 11/11/2022]
Abstract
Background Globally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services. Methods This qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework. Results Thematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society. Conclusion Effective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised.
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Affiliation(s)
- Claire Rogers
- International Health Programme, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, 6102, Western Australia.
| | | | - Anita Tako
- Independent Sexual and Reproductive Health Consultant, Bhaktapur, Nepal
| | - Jaya A R Dantas
- International Health Programme, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, 6102, Western Australia
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Calikoglu EO, Yerli EB, Yilmaz S, Kavuncuoglu D, Kosan Z, Aras A. Fertility Preferences of Women in a Province Center. Eurasian J Med 2018; 50:187-192. [PMID: 30515041 DOI: 10.5152/eurasianjmed.2018.17236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Fertility preferences and status are important parameters involved in reproductive health. The aim of the present study was to define some characteristics of the fertility preferences of women aged 15-49 years in our region. Materials and Methods This cross-sectional study was conducted between 2013 and 2015. The study population consisted of 627 married women aged 15-49 years living in a city center. A questionnaire about socio-demographic characteristics, pregnancy and birth traits, and fertility preferences was applied. Chi-square, Mann-Whitney U, and Spearman correlation tests were analyzed using Statistical Package for Social Sciences (SPSS) version 20.00 (IBM, SPSS Corp.; Armonk, NY, USA) software for statistical analyses. A p<0.05 was considered statistically significant. Results The mean age of the women participating in the survey was 33.03±7.1 years. Median age at marriage was 20 years, mean age at first pregnancy was 21 years, and mean number of pregnancies was 3.07 years, with 14.6% having had more than five pregnancies and 34.6% having experienced previous miscarriages. The mean number of live births was 2.2, and 21.5% of women had waited 24 months between pregnancies. Additionally, 77.7% reported using family planning of any kind, with 62.1% using the modern method. Women's ages at first marriage varied significantly depending on education (p<0.001) and working status (p<0.001), whereas ages at first pregnancy varied significantly depending on educational status (p<0.001). The total number of pregnancies varied significantly depending on level of education, working status, and family income (p<0.001). Times between two pregnancies among women with histories of more than two pregnancies differed significantly depending on educational status (p<0.05). Conclusion The most important factors in women's fertility preferences are education, work, and income. Increasing women's educational levels can lead to safe and healthy pregnancies and births.
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Affiliation(s)
| | | | - Sinan Yilmaz
- Erzurum Provincial Public Health Directorate, Erzurum, Turkey
| | | | - Zahide Kosan
- Department of Public Health, Atatürk University, Erzurum, Turkey
| | - Aysun Aras
- Department of Public Health, Atatürk University, Erzurum, Turkey
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Yu C, Wu J, Li Y, Zhou Y, Zhao R, Ji H, Li YR, Han Y, Tong Q. The Other Side: How does Informed Choice Affect Induced Abortions among Reproductive-Age Immigrant Women in China-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1038. [PMID: 27783059 PMCID: PMC5086777 DOI: 10.3390/ijerph13101038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
This study attempted to explore how informed choice on contraceptive methods influenced induced abortions among reproductive-age immigrant women in China. A total of 3230 participants were recruited in Beijing, Shanghai, and Chongqing. Information on informed choice was collected by questionnaires. The annual incidence rate (spells) of induced abortions was 0.46 (1500/3230) among the participants. The sequence from the highest score to the lowest was long-term, short-term and natural contraceptive methods (p < 0.0001). Significant differences of rates in induced abortions were found in region, occupation, length of the first immigration up to now (year), purpose for immigration, number of children, marital status, sex preference, contraceptive methods, deciders of contraceptive methods and side effects. In the zero-inflated negative binomial model, the joint impacts showed when a participant with one child employed condoms or family planning service providers as the deciders of contraceptive methods introduced intrauterine devices, the occurrence of induced abortions was more likely to be reduced. Women who underwent side effects using pills were more likely to have had induced abortions.
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Affiliation(s)
- Chuanning Yu
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
- Guizhou Center for Disease Control and Prevention, Guiyang 550002, China.
| | - Junqing Wu
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Yuyan Li
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Ying Zhou
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Rui Zhao
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Honglei Ji
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Yi-Ran Li
- School of Public Health, Fudan University, Shanghai 200032, China.
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Ying Han
- Health and Family Planning Commission, Dong Cheng District, Beijing 100005, China.
| | - Qi Tong
- Institute for Population and Family Planning, Chongqing 400000, China.
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