Advances in research on abortion in sub-Saharan Africa

Abortion has been legal in Nepal since 2002. However, parental consent is required for women under age 16. Because of inappropriate knowledge, young women rarely utilize safe abortion service to terminate unwanted pregnancies. This study seeks to examine community level information on young women’s knowledge, attitudes and skills concerning comprehensive abortion care. A household survey among 600 women age 16 to 24 year in Rupandehi revealed that, knowledge of Nepal’s abortion law among young women is very low and attitudes towards abortion among young women are mostly positive. However, confidentiality and positive/supportive attitude of provider is a key facilitator in seeking abortion care. Young women also perceive that there is a bias against unmarried women in need of reproductive health care. Partner support is high, but young women lack reproductive independence and confidence. Friends are a large source of support for abortion among young women and media, health providers and interpersonal relationships are important source of information for abortion. The study highlights need to Increase knowledge and awareness of abortion, need to decrease stigma around reproductive health care for unmarried women, empower married women to make positive reproductive health choices, increase community support for safe abortion.

Based on the theory of fertility control this paper estimates the effect of gender preference on induced abortions. Using data from the 2003 Korean National Fertility Survey, KLIPS and Population Census, we examine the effect of number of sons and benefits from sons over daughters on induced abortion in Korea. Contraceptive methods are also introduced into the model. The results suggest a positive correlation between the number of sons and induced abortions for the group who intended to have a child. Besides, the relative importance between two motives for induced abortion is correlated with the choice of contraception. In addition, contraceptive failure is proved to be one of the reasons for induced abortion.

People selectively reveal secrets to or withhold secrets from each other and this behavior affects listeners’ perceptions of the people with whom they interact. I examine secret-keeping and telling using the test cases of abortion and miscarriage in the United States. I exploit their demographic similarities and that they vary with regard to stigma; miscarriage being a near-random event is analytically fruitful. Through a unique survey representative of American adults, I document that abortion secrets are told to sympathetic people and kept from those who may react negatively to the information -- even within families. As such, though abortion is a more common event that affects more women, more Americans come into knowing contact with a woman who has had a miscarriage. Consequently, people with positive attitudes toward abortion hear these secrets and will hence perceive and experience a heterogeneous network whereas people with negative attitudes will not hear about the abortions of the women they know and hence perceive and experience a homogeneous network, even if they live within the same circles. If individuals effectively exist in networks tailored by others to not offend them then the social change predicted by contact with diverse individuals will be thwarted.

Medical complications resulting from unsafe abortion constitute a serious economic burden for the health-care system in many developing countries. In Rwanda, little is known about induced abortion. However, a 2010 nationally representative study found that about 60,000 abortions occurred annually. Since the legal basis for abortion is highly restrictive in Rwanda, most of these abortions are unsafe, and contribute substantially to maternal morbidity and mortality levels. Our paper builds on the incidence study by documenting the cost of post-abortion care to the health system in Rwanda. Through a 2012 survey of 39 randomly selected health facilities we collected data on personnel inputs, overhead costs and capital costs as well as inputs of drugs, supplies and materials. The cost estimates provided by this study are the most complete available from any study done to date on this subject and are the first estimates of the cost of unsafe abortion in Rwanda.

Since 2006, in Colombia abortion is permitted under three limited circumstances. Nonetheless, many women still have limited access to legal abortion. Recent evidence shows that less than 1% of the 400,000 induced abortions in 2008 were legal. Moreover, evacuation by D&C is still the standard of care for abortion services and for treating abortion complications, rather than the WHO-recommended method of MVA. In addition, administrators of health care enterprises are claiming that legal abortion services are a cost burden to the health care system, with no evidence to support their claims. The aim of this study, the first of its kind in Colombia, is to document the comparative costs of a) legal abortion vs. the cost of treating complications due to unsafe abortion, and b) document the costs of using modern (MVA) vs. older (D&C) techniques. Findings will allow us to provide evidence to dispel erroneous allegations associated with the provision of legal abortions, to help remove barriers for accessing safe abortion services, to investigate the extent to which using a modern (MVA) vs. older (D&C) technique represents lower costs to the health system and to fill out the knowledge gaps to deal more directly with barriers to legal abortion services.

The main objective of this paper is to review the first 40 years’ experience of induced abortion in South Australia and to examine its demographic implications. So far South Australia is the only State where induced abortion is legal in Australia.

Information on abortion was obtained from the annual abortion reports presented to the South Australian Parliament.

The average annual number of abortions was 2,451 in 1970-74, reaching a peak of 5,555 in 1995-99 and has since declined to 4,948 in 2005-09. The corresponding abortion rates were 9.8, 17.3 and 13.2 abortions per 1,000 women of reproductive ages. The increase in abortion rates has affected most age groups – particularly among women under 30 years of age. With the increasing adoption of vacuum aspiration and provision of improved services, complications have been greatly reduced. Concurrent sterilisation has markedly declined from more than 16% in 1970-74 to <1% in 2005-09.

During the first 7-8 years of legalisation of abortion the fertility rates declined substantially. However, since then they have been more or less constant at below replacement levels despite the upward trend in abortion rates. This is probably because of the increasing availability and use of contraception.

The research work shows the characteristics of the practice of underground pharmacological abortion. The use of medicines that contain misoprostol has become popular in Argentina for the voluntary interruption of pregnancy in a context where abortion is only legal in some circumstances.

We enquired about the representations and practices of women using misoprostol in the city of Cordoba, Argentina, as well as the first level doctors in the health public sector.

The methodology consisted in questionnaires and in-depth interviews in order to know the characteristics of pharmacological abortion carried out by women autonomously and reported by themselves. Concurrently, we interviewed professional doctors on their practices about their using misoprostol in public health institutions.
Preliminary results show that women consider the method beneficial mainly because they gain autonomy and because it presents little risk of them being charged with a crime. Most doctors do not prescribe the drug in the fear that they are accused and due to religious and/or moral conditionings. More advanced results will show that a restrictive law does not stop the number of abortions but it stigmatizes women and health professionals.

Background:Without accurate measurement we cannot effectively target programs to reduce the dangerous consequences of unsafe abortion.Here we undertook a multiple-bias analysis approach to quantify the effect of systematic error on abortion-related maternal mortality estimates and outline a simple framework for investigators interested in replicating a multiple-bias analysis in their own data. Methods: This analysis employed Monte-Carlo based, probabilistic, multiple bias-analysis techniques to evaluate the influence of selection bias and misclassification in three studies of abortion related mortality. The prior distributions chosen for selection bias and misclassification differed by study, but a common analysis plan was followed.Results:For each study, the proportion of abortion related deaths (median) increased significantly after multiple bias analysis.Conclusions:These findings have broad reaching implications for the way we understand the distribution of cause of maternal death.If, as our data suggest, abortion related deaths account for a larger proportion of maternal deaths than previously thought, these methods can be used to more accurately determine the range of potential burden of abortion related mortality, and can also be used to help target funds towards increasing access to family planning and safe abortion.