Contraception, unintended pregnancy and induced abortion

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.

Programs aiming to increase the contraceptive prevalence rate, as with the Nigeria Urban Reproductive Health Initiative (NURHI), must address contraceptive supply stock outs in order to ensure that the supply is available to meet the increase in demand. To indicate whether a stock out has occurred or not is absent vital information for prioritizing program activities. We created a summary measure that includes important information about the potential effect of a stock out - the couple years protection lost (CYPL) measure. The CYPL combines information on client flow, stock outs and the published couple year protection for each method – and then is summed and presented as an aggregate measure at the facility level. With the CYPL measure programs can target those family planning facilities with the most damaging stock outs first, to strategically reduce the negative impact of stock outs in an informed order of priority.

This paper uses a unique natural experiment to investigate the sensitivity of American college women’s contraceptive choice and sexual behavior to the price of prescription birth control. In 2005, Congress unexpectedly increased the effective price of birth control pills (“the Pill”) at college health centers more than three-fold, from $5 to $10 a month to between $30 to $50 a month. Using two different data sets, we employ multiple empirical strategies—including interrupted time-series, quasi-difference-in-differences, and fixed effects—for identification, and we find consistent results across data sets and methodologies. Our benchmark estimates show that this policy change reduced use of the Pill by at least 1.5 percentage points, or 3 to 4 percent, among all college women. For college women who lacked health insurance or carried large credit card balances, the decline was two to three times as large. We also find modest but significant decreases in frequency of intercourse and the number of sex partners, suggesting that some women may be substituting away from sexual behavior in general. Finally, supplementing our data with a unique survey on how and where birth control prescriptions are filled, we use a back-of-the-envelope calculation to bound the price elasticity of Pill usage between -0.09 and -0.04.

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.

For reproductive health services, evaluation usually assesses the impact of a project seeking to increase service supply. However, as a result of recent legislative initiatives passed in Texas to curtail the availability of abortion through a two-thirds reduction in public funding for family planning, the subject of the evaluation described here is just the opposite—to assess the impact of measures intended to drastically reduce the supply of these services. We describe the 2011 Texas legislature’s initiatives, the key components of our comprehensive three-year evaluation that will attempt to assess the impact of this legislation on family planning and abortion services, unintended pregnancies, abortions and births, and highlight some of our initial findings. In the first of two waves of interviews with leaders of organizations that provided publicly funded reproductive health services, we found that 22% of the 240 clinics were closed after the funding cuts and an additional 16% of clinics reduced hours. Women in focus groups across Texas stated that it was difficult for them to pay newly instated fees for services, which exacerbated pre-exiting barriers to obtaining reproductive health care. We also review some of the main challenges we face in carrying out this evaluation.

Latino population in the United States has a lower prevalence of vasectomy than the non-Hispanic white population. A body of research has considered that cultural perceptions about masculinity might explain why Latinos are less likely to undergo vasectomy. Latino population has experience a limited access to health care which might explain the lower prevalence of vasectomy among Latino population in the United States. We conducted logistic regression to analyze the relationship between the perception about the decision of men to undergo vasectomy and the frustrated demand for female sterilization. We also observed how other women’s experience might influence attitudes toward partners’ willingness to obtain a vasectomy. Finally, in order to have an insight into attitudes toward vasectomy among Latino men, we analyzed the information from the two focus groups conducted in El Paso, Texas. We find evidence that although some Latino men are willing to undergo vasectomy, they face economic and labor situations that prevent them to obtain the procedure.

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.

Background: Chitungwiza urban PMTCT programme has shown an increase in the number of known HIV-positive pregnant women enrolling in antenatal care (ANC). In 2009, 116 (8.4%) out of 1,376, booked for ANC with known HIV-positive status and in 2010 they were 79 (11.1%) out of 712. It was not known whether these pregnancies were planned or unplanned.

Methods: A descriptive, cross-sectional study was conducted in Chitungwiza from April-September 2011. Multi-gravida women enrolled in the PMTCT programme with known HIV-positive status (n=170) were interviewed using an interviewer-administered questionnaire and focus group discussions of 10-15 women. Quantitative data was analysed using Epi- Info Version 3.3.

Results: Of the 170 respondents, 137 (80.6%) experienced unplanned repeat pregnancies. Reasons for becoming pregnant varied: 75 (44.1%) reported their pregnancy was due to pressure from their partner, 32 (18.8%) were denied the right to use contraception by partners or health workers and 87 (51.2%) respondents could not afford these methods.

Conclusion: The HIV-positive women in this study faced challenges in controlling their fertility and experienced unplanned pregnancies. Chitungwiza municipality should waive fees for contraceptives and make long-acting and permanent FP methods freely available.

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.

Objective: To examine association between social economic attributes (often reported at macro-level) and contraceptive use
Methods: Data were accrued from the Ugandan baseline survey of a multi-country three-year prospective study focusing on the role of family planning on Family Health and Wealth. A total of 500 couples were enrolled in Kyengera-parish, Wakiso district, Uganda.
Inequalities defined as differences in population attributes (wealth, ethnicity, health status-BMI category, parity, education and occupation) were assessed for association with contraceptive use (Yes/No). Analysis used descriptive statistics and at bivariate and multivariate, generalized linear models using binomial family and a log link with robust standard errors to obtain Prevalence Risk Ratios (PRRs) and their 95% CI.
Results: Data of 499 couples are presented. Men were older than women, 34 (7.9) and 27 (6.5) years, respectively. Majority (70%) of women reported being in monogamous unions, of parity 2 or higher (70%), education level of secondary or higher (67%), involved in manual or clerical work (71%) and belonging to Christian-faith (66%). Contraceptive prevalence rate was 52%, and was significantly higher among parity of 2 or higher. Health status, household wealth and education level were not associated with contraceptive use