Advances in research on abortion in sub-Saharan Africa

Previous research on sex selective abortions has ignored the interactions between fertility, birth spacing and sex selection. This paper presents a novel approach that jointly estimates the determinants of sex selective abortions, fertility and birth spacing, using data from India's National Family and Health Surveys. For well educated Indian women the predicted number of abortions during childbearing is six percent higher after sex selection became illegal than before while their predicted fertility is eleven percent lower and around replacement level. Women with less education have substantially higher fertility and do not appear to use sex selection.

Purpose: This study aimed to assess the key factors predicting admission of unmarried young women to medical facilities for abortion services in China.
Methods: The National Survey on Sexual and Reproductive Health for Unmarried Youth (15-24 years) was conducted in 2009 in China. Of the female respondents (n=10,970), 270 reported needing abortion services in 2009. Classification by random forest was applied to select the most important of 34 variables.
Results: Among the 270 unmarried young women who were in need of abortion services, 165 were admitted to medical facilities, and 105 were not. Psychosocial competence ranked highest and was verified as most important of nine perspectives in predicting admission to medical facilities for abortion services (accuracy rate 89.2%, sensitivity 90.2%, and specificity 86.2%).
Conclusions: Psychosocial competence stands out as an important component of the utilization of abortion services among unmarried young women.

This study aimed to assess the association between polygyny and the occurrence of spontaneous abortion in sub-Saharan Africa. The data are from the Family Health and Wealth Study (FHWS) 2010 closed-cohort study of 784 Nigerian and 495 Ugandan couples living in Ipetumodu, Nigeria and Kyengera Parish, Uganda respectively. Logistic regression model was used to adjust for the effects of socioeconomic factors, use of oral contraceptive pills, gravidity, parity, health conditions, and marital relationship quality. Among the 744 Nigerian and 427 Ugandan women ever pregnant, 19.4% and 23.4% had co-wives; and 20.8% and 27.4% had suffered miscarriage, respectively. The risk of ever having a miscarriage was significantly increased by 74% (OR= 1.74; 95% CI – 1.05-2.89) and 235% (OR=2.35; 95% CI - 1.25-4.41) in women in polygynous union compared to women in monogamous union among Nigerian and Ugandan women, respectively. It was concluded that polygyny significantly increases the risk of miscarriage among our study population; more research is needed on the effect of marital structure on women’s health and its clinical implications.

Public interest to issue of abortions availability in Russia became actively discussed though ones are legalized since 1920. The increase in birth rates at depopulation and abortions number reduction are considered to be the main. The increase of traditional family values is result of confessional influence. The ideas of restrictive abortions’ legislation are always heard although the official data testifies more than its triple reduction in 1991-2011 to 1124880. «The WHO Strategic Assessment of Policy, Programs and Services in Abortions and Contraception in the RF» (22 focus-groups+549 respondents, 3 Regions), «The Attitudes of Russian Women in making the decision on the childbirth» (1007 respondents, 7 Federal Districts) showed that nonetheless of contraception, abortion ceases to be an individual family size regulator, remaining compulsory measure of «unnecessary» pregnancies termination. Only every seventh respondent is ready to keep unintended pregnancy at state prohibition. Others will achieve abortion by all means (traditional medicine, «abortion-tourism» etc). This decision doesn't connect with social, age, confessional parameters causing only by the desire. Women are looking to «improvement of financial situation» (51%), «support of the husband/partner» (48%) in addition to quality medical care for reproductive choice.

Abortion, in India is generally stigmatized and is thus subject to considerable underreporting. An attempt has therefore been made in this study to estimate the extent of these clandestine abortions by using Bongaart's model from the data on MTPs available from the National Family Health Survey for four major states of India viz., Punjab, Gujarat, West Bengal and Tamil Nadu as well as the country as a whole. The estimated value of Ca or index of induced abortion was found to be 0.918 for NFHS I and 0.929 for NFHS II. The findings show that the estimated number of abortions has declined during the six-year period i.e. from NFHS I to NFHS II. The underreported abortions have been found to be 5,59220 for NFHS I and 4,15489 for NFHS II. Out of every 100 officially reported abortions 92 are underreported in NFHS I and 81 in NFHS II.

In contrast to declining trend of the share of traditional methods in developing world, India has witnessed a gradual increase in traditional method use from 4% in 1992-93 to 8% in 2005-06 (shares 44% of spacing method use). The experience of accidental pregnancy among traditional method users is much high (one-fourth experienced failure within a year) than the modern spacing method. In addition, the use and continuity of modern spacing methods remained low and varies across users and methods in the country. A substantial proportion of method failures result into abortion or still birth posing serious consequences to the women.
In this context, this paper measures the level of abortion as a result of method failure among reversible method users and examines the correlates of abortion. Calendar data from the National Family Health Survey-3 (2005-06) were analyzed. Binary logit models were applied to analyze the determinants of fetal loss. The findings suggest that 75% of the pregnancies preceded by a method failure were carried to term and about 54% of them were reported as unintended. Fetal loss was found to be associated with age, early marriage, parity of the woman, fertility intentions, educational attainment, wealth status and duration of use.

The contentious issue of induced abortion has been a major stumbling block in the promotion of women's reproductive and sexual health and rights around the world. In Islamic societies the debates about the secular and religious dimensions of pregnancy termination have referenced a number of schools of Islamic law and teachings. In this paper we compare Iran, the largest Shi'ite society, and Indonesia, the largest Sunni society and largest national population of Muslims in the world, to identify the dimensions and dynamics of the debates over abortion. Both countries display differences of opinion among clerics and some confusion about the place of secular law in regulating the medical practice of abortion. It is difficult to analyze the demographic dimensions of abortions rates, ratios and trends, without valid and reliable data and many of the parliamentary and religious debates are thus riven with misinformation. Demographic techniques to calculate numbers of abortions in each country have failed to achieve valid or reliable estimates. It appears that the main determinants of local policies arise from a general sense of propriety and morality rather than any specific religious doctrines specific to the two streams of Islam. Women's rights are constrained by primordial culture entwined with Islamic legal arguments.

After the liberalization of the abortion law, awareness of the legalization status and place of abortion has increased among Nepali women of reproductive age. As of 2006, nationally, 32.3% (95% CI: 31.4, 33.2) of the women ages 15-44 were aware of the legal status of abortion and 56.5% (95% CI: 55.5, 57.4) knew of a place where they could obtain an abortion (Thapa and Sharma, 2012). Similarly, in 2011, overall, 38.7% (CI: 37.8%, 39.6%) and 59.8% (CI: 58.9%, 60.7%) of women 15-44 were aware of the legal status of the abortion law and a place to have an abortion, respectively. Percentage of women ending their pregnancy using induced abortion has also increased from 5% in 2006 to 7% in 2011. This paper examines demographic and socioeconomic differentials in the change in knowledge and use of induced abortion and examines the extent to which the trend in knowledge and use of induced abortion vary among demographic and socioeconomic groups. Bivariate and multivariate analysis will be used to examine the relationship. Ecological and development sub-region, place of residence, wealth quintile, education, age and number of living children will be used as demographic and socioeconomic independent variables in the bivariate and multivariate analyses of the determinants of knowledge and use of induced abortion.

This paper describes how intimate partner violence (IVP) is associated with unintended pregnancy and abortion in a primarily Muslim community of 500,000 peoples in Mumbai. In-depth interviews were conducted with randomly selected 45 married women visiting at urban health center across various domains during 2009-2010. Out of all, 31 women reported frequent verbal and 19 physical violence in past one year. The most frequent reported forms of violence included, high tone abusive, beatings, and forced sex. Out of all, 39 women reported virginal discharge, 6 miscarriages, 3 infant deaths and 41 mental distresses. A “Women’s Health Clinic” was organized at urban health center under RISHTA program to treat women’s gynecological problems. Individual women presenting vaginal discharge at the WHC are randomized into receiving individual counseling (IC), group couples intervention (CI), both (IC and CI) and a control group. The 886 Women’s Structured Survey (WSS) was administered to assess women at baseline, six-month and one-year post intervention from 2009-2012. On the major outcome variables have shown that the intervention group shows better Reproductive Health (p <.001), greater knowledge about STIs (p <.001), less sexual problems, (p <.001) better treatment seeking in health problems (p <.001) and no miscarriages and infant death.

Abortion has been legalized long before in India. Still it has been big issues as a considerable number of maternal deaths occur either due to the fact, that it is done illegally under unsafe procedures or direct/indirect effect of gynecological morbidity on women’s health. The study focuses on the association between abortion and gynecological morbidity in India. District level household and facility survey (2007-08) is used for the study. Bivariate and multivariate analyses are used.
The women who have experienced induced abortion are 2 times more likely to have gynecological morbidity as compare to live birth. Those women have spontaneous abortion are around 2 times more likely to have gynecological morbidity as compare to live birth. Encourage awareness programs on reproductive health issues mainly focusing on abortion and related health problems and gynecological morbidity can play an important role to reduce the severity of the problem in India.