Advances in research on abortion in sub-Saharan Africa

In Burkina Faso, abortion is legally restricted. It is permitted only in some few cases (incest, rape, fetal defect or when the woman's life is endangered). Socially, the practice is censured and women are often stigmatized when they have an abortion. To estimate the prevalence of abortion, two surveys are conducted since 2001. Two methodologies are used to estimate abortion incidence: the Health Facility Complications Method (HFCM) and the Anonymous Third Party Reporting (ATPR) method (Rossier C., 2006). It is found that the rate of abortion was high in Ouagadougou in 2002 and 60% of women who had an abortion had adverse health consequences, and 14% were treated in hospitals (Guiella. G, 2006).

The first data cover Ouagadougou (2001) and the second one all the country (2009). These two data sources permit the analysis of the trend and the change in Ouagadougou. With a method of analysis of change (decomposition method), we want to understand where the change comes and how it appends. An analysis of women’s attitude and opinions related to abortion will give us a good understanding of the change.

As of 2010, Kenya has a new constitution in Kenya which allows access to safe abortion services under a broader set of circumstances than previously allowed. Yet operationalization and implementation are slow and controversial, and unsafe abortion continues to occur. This study aims to estimate the incidence of induced abortion in Kenya in 2012 using both retrospective (n=328) and prospective (n=326) data from a nationally representative sample of health facilities. The annual incidence of induced abortion in Kenya was calculated using both the Abortion Incidence Estimation Methodology and the Prospective Data Capture method. An estimated 146 427 women were treated with post-abortion complications in Kenya in 2012. Unmet need remains high at 26% and wanted fertility (TFR of 3.4) remains higher than actual fertility (TFR of 4.6). As in other sub-Saharan African countries, unsafe abortion continues to be a major health concern for women in Kenya.

In the late 1980s the East-West division by birth control was identified in Europe as the characteristics of women who had abortions differed sharply between the countries of Eastern and Western Europe. In the EE countries the abortion rates were high and abortion was used to limit family size once certain parity had been reached .Thus it was requested by married women with two or more children. In WE countries most women who had abortions were young, childless and unmarried. Since the early 1990s the incidence of abortions in EE countries rapidly decreased although with different intensity. As a result, cross-national variations in abortion level have been reduced by 2009. Has the East-West division remained or has a new one emerged? Can we distinguish new patterns of abortion behaviour? What was the role of birth control method in transition of reproduction patterns? The relationship between the changes in abortion and contraceptive behaviour in EU countries was studied. 21 EU members were selected for comparative analysis. Cluster analysis of birth control indicators and multivariate statistical analysis of GGS data was used to give more detailed insight into current typology of birth control. Finally, factors behind the recent diversification were identified.

The objective of this paper is to present an update of estimates of induced abortion in Brazil based on the statistics of hospitalization for abortion in national and regional levels, using as a data source the Hospital Information System of the Unified Health System (SIH-SUS) for the years 2000 to 2010. The estimation of the incidence of abortion is carried out by the method known as AICM, proposed by Singh and colleagues, after the necessary adjustments for the Brazilian data. The results indicates that induced abortion rates are declining in Brazil in all regions (except the North), although the incidence of induced abortion is still high for a country where contraceptive use is high, which indicates the existence of significant flaws in the use of contraception and the need to correct them. 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).

The objective of this work is to study the political discussion on the issue of abortion in Uruguay, with the guiding idea that the democratization of the country played a fundamental role to make the discussion about abortion more visible, to expand the debate and to prepare new public policies. Regarding the methodological procedure, the historical perspective - including the description of the demographic scenario – uses as sources of information official documents, of the civil society and of media and literature, in two periods: from the beginning of the military dictatorial period to the beginning of the democratic transition, 1973 to 1985, and from the beginning of the democratic transition to the present democracy, 1985 to 2012. The latter, in turn, is divided in two: from the beginning of democracy to the rise to power of socialist governments, 1985 to 2004, and from the beginning of socialist governments until the present day, 2005 to 2012. The discussion of the subject, on the political agenda since the 1980s, was emphasized in the first decade of this century, culminating in 2012 with the approval by the Parliament of the Law of Voluntary Interruption of Pregnancy, which won on October the presidential approval.

Globally more than 350,000 women annually die from complications of pregnancy or child birth. The problem of unsafe abortion is complicated by limited availability of services and restrictive laws. It is estimated that over 97% of all unsafe abortions occur in sub-Saharan Africa due unsafe facilities, untrained providers or both. Understanding the burden and potential areas for intervention is complicated by the lack of data. Data used here came from 292 public and private facilities and 2,680 women seeking post abortion care over a one month period.

Results show that abortion complications are a major cause of morbidity with 37% of all women seeking post abortion care suffering a severe complication. Interference with pregnancy was associated with 2.9 times higher odds of having a severe complication as compared to those who reported no interference with the pregnancy. Second trimester abortions had about 50% higher odds of a severe complication than first trimester abortions. Delay in reaching facility from onset of symptoms was associated with higher odds of a severe complication. Higher proportion of second trimester abortions and those with severe complications had longer hospitalization. About 65% of all abortion clients are managed using vacuum aspiration, 76% were given oxytocics and 55% received contraception.

This paper presents part of the findings of a large scale qualitative study of practices and attitudes to contraception, unwanted pregnancy and abortion in Burkina Faso, Ghana and Senegal. Findings from interviews reveal that attitudes to abortion are not binary but complex and nuanced. Responses went far beyond religion, capturing a diverse range of views. Analysis of representations of abortion, including attitudes towards its medicalisation and legalization, revealed the ways in which individuals negotiate the relatively common occurrence of abortion and its associated dangers with its illegality and social unacceptability. Importantly, attitudes to abortion were not always consistent with personal experience. Representations of abortion, and the ways in which they were constructed, were shaped by gender roles and gender relations. These representations are therefore powerful revealers of social structures and gender relations, and also of changes within them. This is particularly relevant in a context of economic crisis in much of sub-Saharan Africa, and helps explain gender differences in attitudes to abortion, and the effects of education and generation. This study goes beyond previous research in this area in painting a diverse and complex picture of representations of abortion, from the perspectives of both men and women

This study aims at estimating the incidence of induced abortion in Yogyakarta province, a province located in Central part of Java Island in Indonesia. Yogyakarta province is among the provinces with high coverage of maternal health care indicators, but is also known for high reliance to traditional method of contraception.

Two method estimation are be applied, the Abortion Incidence Complication method (AICM) and the Residual method. Data on abortion hospitalization were obtained from all hospitals in the five districts of the province, through direct data collection to the hospitals as well as from the provincial health office. Adjustment for under-reporting and misreporting were made by comparing the two sources of data.

The preliminary fndings reported 3071 cases of abortion hospitalization in 2009 in Yogyakarta province, or a rate of 3.3 per 1000 women age 15 to 49 years. Access to skilled care for miscarriage and abortion is measured with recent survey data and found to be significantly lower compared to access for other pregnancy related complications. Adjustment factor using the facility data is being explored for adjusting under-report in the survey data. The final step of the AICM process is determining the multiplier for which educated guess and existing literature will be used.

In India, abortion is legal under Medical termination of Pregnancy Act Since 1971. As per the evidence, around 9% of total maternal deaths are caused by unsafe abortion. Though Medical Abortion (MA) drugs are prescription-only-products, in reality, it is often obtained without doctor’s prescription through pharmacists. The pharmacists often have limited knowledge of safe use of drugs that may result in complications. Population Services International’s intervention on safe medical abortion aims at educating pharmacists to improve their knowledge and dispensing practices related to MA drug regimen. Using Lot Quality Assurance Sampling method, a mystery client or simulated patient survey was conducted on MA drug Dispensing behaviour among 380 pharmacists. The study revealed that 55% of pharmacists recommended correct dose of MA drug and 45% pharmacists suggested correct route of administering MA drug, while only 25% of the pharmacists asked for doctor’s prescription for dispensing MA drug. The findings also revealed that only 42% of the pharmacists behaved correctly on all three key indicators (asked for doctors’ prescription, recommended correct dose and route for administration) pertaining to MA drug regimen. The study helped to identify the low performing areas for further attention by program managers.

Despite the amendment of Ghana’s abortion laws in 1985, aimed at increasing access to safe abortion services, these services are not readily available to most women. Abortion has consistently been an important contributor to maternal morbidity and mortality in Ghana. A situation some observers attribute to the sensitivity surrounding pregnancy terminations and the low knowledge about the abortion law and its nuances. Within this context, this paper explores the decision making process of females within the ages of 15-30 years who aborted their pregnancies. The study employed a qualitative research design with 28 females who sought their abortions at an NGO run clinic. Data for the study was analyzed using Mile’s and Huberman’s framework and the social ecological model as guides. Analysis of the interviews show that pragmatic concerns like economic difficulties, child spacing, fear of parental reaction, attitude of partners, impregnation by someone other than the regular partner and health concerns influenced participants in their abortion decisions. The low level of knowledge by participants about Ghana’s abortion laws also emerged as a strong theme. The study therefore concludes that although there are social, cultural and legal prohibitions regarding abortions, pragmatic concerns force some women to act contrary to them.