Advances in research on abortion in sub-Saharan Africa

Background: In 2002, Pakistani women experienced 2.4 million unintended pregnancies; nearly 900,000 were terminated by induced abortion. Each year 200,000 women experience serious health complications in Pakistan due to unsafe abortions. This paper will use data from 2 national studies to analyze the changes in pattern of resort to PAC services over time. Methods: 2 cross sectional surveys conducted in 2002 & 2012. Face to face interviews conducted on a structured questionnaire with 154 & 102 health professionals (HPs) & service providers (SP) of 261 & 266 health facilities (HFs). The data is drawn from the HP’s study. Results: The probability of receiving PAC has increased for women; more so for poor. Less % of HPs now thought that women would resort to doctors in government facilities for PAC compared to 2002. Difference is more pronounced for urban poor (79% v 91%) & rural poor (78% v 86%). Even for urban & rural non-poor the trend has shifted downwards (37% v 46% and 51% v 59%). More women would resort to doctor in private facilities except rural poor who would seek traditional service providers e.g. TBAs. Conclusions: There is a possible shift in pattern of resort for seeking PAC from public to private service providers by HPs perspective. Rural poor women are resorting to less skilled providers for PAC.

Abortion is highly restricted by law in Nigeria, yet it is commonly used to end an unwanted pregnancy. Sustained low contraceptive prevalence and increasing levels of unmet need continue to prevent women from attaining their fertility desires. Furthermore, because of their clandestine nature, many abortions take place under unsafe conditions, contributing to Nigeria’s high maternal mortality ratio of 630 deaths per 100,000 live births. A landmark 1996 abortion incidence study estimated 610,000 annual abortions and 25 abortion per 1000 women. Using the same methodology: indirect estimation technique through a nationally representative survey of public and private health facilities (n=1032) and a purposeful sample of Nigerian health professionals (n=194), we update abortion estimates for 2012 at the national and regional level.

Background: Young women often face social, economic, logistical, policy and health system barriers to access to sexual and reproductive health services, including safe abortion care.
Method: An OR project is launched in Jharkhand to assess the strategy of using youth leaders to link young women to SRH issues including safe abortion services. Using quasi-experimental longitudinal design a baseline household survey is conducted in July-August 2012 and interviewed 1381 young women (15-24 years) to assess the knowledge, attitude, and skills on SRH issues and barriers and forces of influence that lead to any particular behavior, decision, or service utilization.
Results: Even with high levels of literacy (66%-91%) and mass media exposures (65%-80%), the composite knowledge score on SRH (2.4 of 6), contraception (2.4 of 8), and abortion (0.5 of 8) related issues were significantly low. Multivariate analyses revealed age, education, family composition, living standard, and exposure to mass media as the influencing attributes of knowledge level. Around 4% of married young women reported experiencing induced abortion; one-third of them had no role in taking decision. 92% of them had approached private and illegal providers. Findings of this study had major policy implication for guiding the youth focused intervention strategy.

Since the dissolution of the Soviet Union, the Russian Federation has been characterized by extremely low levels of fertility, very high rates of induced abortion, and a lack of consistent use of effective contraception by Russian couples. These characteristics, particularly fertility rates leading to negative population growth, have been a major cause for concern in Russia. A recently completed national survey has found, however, that fertility has risen substantially while abortion utilization has fallen sharply. In late 2011, the Russia Reproductive Health Survey (RRHS) was carried out, providing Russia with its first nationally representative estimates of a wide range of reproductive health indicators. The RRHS, with a national sample of over 10,000 women, found the total fertility rate for Russia to have increased substantially, while the total abortion rate fell even more dramatically. In this paper we decompose information from the 2011 RHS and earlier data sources to analyze the interplay between fertility, fertility intentions, various aspects of contraceptive use, and other reproductive behaviors and decisions to better understand how such factors have served to increase fertility and reduce induced abortion recently.

The purpose of this paper is to reassess the ideas and knowledge of grade V and VI medical students about induced abortion. Data was collected through using a standard questionnaire under observation from 301 students (51.0%).This is a descriptive epidemiologic study . SPSS 15.0 Statistical Package Program for Social Sciences was used for the analyses. Descriptive frequencies, t-test, chi-square and ANOVA tests were used. The study was approved by the Hacettepe University of Noninvasive Researches Ethique Commity. 47.2% students were male, 53.8% were grade VI and 40.9 of them have taken a family planning course. Religious view 12.1% and personal views 18.2% were major reasons of the medical students’ whom will not be making abortion for their patient when everything is suitable with the procedure. 61.9% said thet they are goig to consider the time and the conditions if they had to make abortion for themselves. Four thirds wanted a course about abortion. Male students’ 67.6%, female students’ 81.2% want to have a course about abortion (p<0.05). 19.3% of male and 10.3% of female students said that they are going to be disliked at the society if they make abortion as a part of their job (p<0.05). This shows that there are some students who have taken the course but feels insufficient. Education methods and headdings can be viewed.

Official statistics in Russia provides limited information on induced abortion: distribution of annual numbers of abortions either by type of abortion or by 5-year age groups. Such important information as socio-demographic profile of women who had abortion, motivation for abortion, medical facilities in which abortions are performed, post-abortion family planning consulting is available only from sample surveys.
Proposed paper demonstrates that the first nationally representative Russian Reproductive Health Survey 2011 based on individual pregnancy histories of 10 010 female respondents aged 15-44 answers most of the above-mentioned questions. RHS results show that for 35% of women reported ever having one or more abortions,level of education was the most significant factor of induced abortion in Russia, in contrast to place of residence or well-being.
Socio-economic circumstances (33%), desire to stop childbearing (24%), partner opposition to another child (17%), health reasons (11%), and desire to space the next birth (10%) were mentioned as the major reasons of abortion. 62% of respondents who had an abortion in 2006-2011 received family planning consulting around the time of having abortion, meanwhile women who experienced their first abortion in this time period were the most likely to receive counseling and supplies.

The purpose of this paper is to present updated estimates of induced abortion in Brazil based on hospital statistics, which are available at national and regional levels. For the years 2000 to 2010, nearly hospitalizations recorded on the Hospital Information System of the Brazilian public health system (SIH-SUS) were found to be related to abortion. On this ground, the method known as AICM proposed by Singh and colleagues was applied to estimate the total incidence of abortion in Brazil, after necessary basic data adjustments. The results indicate that induced abortion rates are declining in the most populated regions of the country (except the northern region). However, the incidence of induced abortion is still high, taking into account the widespread use of contraceptive methods in the country. This indicates the existence of significant flaws in the use of contraception that need to be corrected. Other important findings relate to age: as the women's age increases, there is also an exponential increase in the number of hospitalizations for abortion in relation to the number of live births, and a decrease in abortion rates in relation to the female population in childbearing age (15-49).

Background: Involvement of FCHVs (Female Community Health Volunteers) in Safe Abortion Services (SAS) provision is eminent. The review of trained FCHVs was conducted in order to explore use of UPT by FCHV in SAS provision.

Methods: Family Health Division (FHD) under MoHP and Ipas Nepal provided 2 days training to FCHVs on early identification of pregnancy using UPT and RH referral in Dhading district in 2009 and 2010. FCHV review meeting was conducted in VDC level. A semi-structured questionnaire was administered to each eligible FCHV.

Findings: Out of 443 FCHVs, 367 (83%) were found to be eligible. About 93% FCHVs performed urine test after SAS training, an average of 8 tests per FCHV. The average cost per client was about Rs. 50 (less than a dollar). Around 92% of the FCHVs sent their clients for further pregnancy tests after obtaining positive results (90%). Around 61% FCHVs sent at least one client (Maximum of 52) for safe abortion services. Around 90% of clients were sent for Family Planning services after negative result.

Conclusion: Use of UPT by FCHVs has helped women of hard to reach rural areas of Nepal creating early action. Continuation of UPT by FCHVs must be ensured. Introduction of similar strategy is needed for other remote districts as well.

Keywords: UPT, FCHV, Nepal, Safe Abortion

Using Matlab Health and Demographic Surveillance database, the study initially selected about 18,000 women who had pregnancy outcome during 2008-09 and interviewed them subsequently in 2011 to examine the knowledge, cost of complication, and decision-making processes of pregnancy termination. The study documented that thirty percent non-abortion pregnancies were unwanted, but the women did not abort it mainly due to disagreement with the family members (3/4th cases). By contrast, over 90% of the aborted pregnancies were unwanted and most of the women (over 90%) received support from the family members to abort it. Those women who aborted the pregnancy were more knowledgeable about abortion procedures, less likely think that there was a risk of complications and also said less monetary cost of obtaining services for complication. Among women those who had abortion, 35% were using contraception before the conception, and 93% of them became pregnant during the method use. By contrast, among women those who had non-abortion pregnancy outcome, only 9.7% were using contraception before the conception, and 88% of them became pregnant during the method use; both groups were mainly using temporary contraceptive methods.

Due to a large unmet need for modern contraception in Uganda, many women resort to abortion to meet their fertility goals. However, abortion in Uganda is legally restricted, making a majority of the abortions in the country clandestine and unsafe. Apart from the dangerous health consequences, unsafe abortions also take an economic toll on the women who resort to it. Not only do these women have to pay for the abortion, they also have to pay for the treatment of its complications, and remain out of productive employment for the duration of their ill-health. Using data from a primary survey in Uganda, we examine the nature of these consequences to women and their households. Preliminary results show that that 61% of the women in our sample obtained an induced abortion. About 72% of them were under age 30, with a quarter being under age 20. Over half the women came from rural areas and were socially and economically disadvantaged. As indicated by our initial results, we expect to find that the negative economic consequences will be the strongest for the poorest women, who are more likely to slip deeper into poverty because of it.