Contraception, unintended pregnancy and induced abortion

Understanding sexual and reproductive health of adolescents is of utmost importance and carries with it implications for improving individual health outcomes especially reduction in unintended pregnancies and STIs such as HIV/AIDS. Using data from poor urban youths in the slums Nairobi, we try in this paper to comprehensively look at the individual level factors that may influence contraceptive use and pregnancy outcomes among adolescents as they transition to adulthood, in a bid to understand the needs and challenges that they face. Preliminary results point to the fact that there is a diversity of experiences among adolescents with regards to knowledge, attitude and behavior. Age, education and marital status were often strongly associated with SRH experiences of adolescents, pointing to fact that targeted programs are needed to reach them with range of SRH info and services at different stages – before they initiate sex, as sexually active unmarried youth, or as married individuals and couples.

Utilizing the 2011 UDHS, we study the influence of perceived partner’s desire for more children and its effect on current contraceptive use among married women in Uganda. Data herein is based on 5352 married and was weighted before analysis. Descriptive statistics of women’s background characteristics were computed. Multinomial logistic regression models were run to establish the relationship between husbands’ desire for more children with different socioeconomic variables. Overall the variables found to be highly significant with husband’s desire for more children were; modern contraceptive use, wealth, religion, fertility intentions. Women who perceived their husbands to want more children and those who did not know their husbands desired number of children were less likely to use modern contraceptives. In addition, wealth, religion, respondents’ education and husbands’ education levels and are a key determinant for perceived husbands’ desire for more children. Muslim respondents were less likely to know the number of children their husbands desired. we conclude that recurrent couple communication is pertinent in reduction of high fertility levels, promotion of small families and modern contraceptive usage.

In Bangladesh, fertility was high in the 1950s and declined to fewer than five births per woman in the early or mid-1990s like other developing countries. After that the level of fertility is stalled. The aim of this study is to assess the extent of unmet need for family planning among married women of reproductive age group in Bangladesh and to study the factors related to it. Bangladesh Demographic and Health Survey data were used for the study. The results suggest that unmet need for family planning has increased during the last 3 years from time of the survey. The percentage of total unmet need is especially high among rural women, non working women, Muslim women, and women not exposed to media messages on family planning. The regression analysis shows that age, husband-wife communication, sex composition and visitation status of satellite clinic appear to be significant predictor for limiting unmet need. If we can reduce the current unmet need to zero then current met need will be 73 percent which is the required rate of achieving replacement fertility in Bangladesh. New program strategies are required to fulfill the conventional demand for family planning program in Bangladesh.

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.

This study aims to investigate the determinants of female sterilization in Brazil. Our analysis is innovative because it adds the time of exposure to the risk of sterilization into survival models. We control the models by postpartum duration, age at delivery, parity at delivery, place of delivery, region of residence, color/race, years of schooling, frequency of involvement in religious activities, and religion at the time of interview. We use data from the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). The strongest probability that sterilization might occur was observed among women who gave birth at private hospitals and received support from a health insurance company, between zero and two months after childbirth. These results are an indication of a frustrated demand for female sterilization at public hospitals. Unlike previous studies, our findings suggest color/race and years of schooling do not predict the risk of sterilization.

Unintended pregnancies constitute a major public health challenge in most – developing and developed - countries, yet there is no convincing theory to explain their occurrence. Existing theoretical explanations are largely ad hoc, and surprisingly pay little attention to sex, the raison d'e ̂tre for contraception. This paper develops a theory of contraception based on sex and the degree of undesirability of the consequences of sexual activity. Defining sexual activity in terms of the human sexual response cycle, we note that sex is motivated by a desire for sexual pleasure, social relationships, and procreation. Variation in the desirability of these three consequences of sex, along with clear differences in the timing of their appearance, and differences in the uncertainty of their occurrence, provides the relevant sexual context for contraceptive use. While contraception is clearly aimed at avoiding conception, its underlying reasons may be very specific (health or desired family size) or non-specific and aimed quite simply at maintaining existing life styles. We model these aspects of sex and contraception using a model of human behaviour wherein behaviour and its constitutive actions are the result of varying degrees of deliberation; some more reflexive, others more reflective.

We examine the hypothesis that unintended pregnancies are associated with negative health outcomes for both mothers and children using data from the 2011 Nepal Demographic and Health Survey that showed that 30% of the births in 2011 were unintended (including unwanted and mistimed births). The results, showed that mothers were more likely to receive inadequate prenatal care (OR = 1.29; p<.05) and were also more likely to opt for home births (OR = 1.30; p<.05) when the pregnancy was unintended compared to when it was intended. Likewise, the resultant newborns were more likely to receive inadequate immunization (OR = 1.17; p<.05) and remain stunted (OR = 1.21; p<.05) when the pregnancy was unintended compared to when it was intended. The results underscore the importance of adopting a two-prong approach: reducing unintended pregnancies through effective family planning programs and paying special attention to the mothers who have an unintended pregnancy.

The present research proposes to provide a conceptual framework linking the antecedent variables that affect reproductive intentions, which in turn, ultimately affect fertility through its proximate determinants (intermediate variables). Such an exercise would help to answer questions like how people construct their family size preferences and intentions to have ( or not have) a child, how strongly it affects fertility behaviour at the micro and macro level, is there a significant gap between intended and realized fertility, etc. The study also aims to examine the impact of macro-level factors on micro level decision making and behaviour, so as to understand the implications for policy. The proposed conceptualization has been tested at the macro and micro level, in a developing country like India, which has witnessed a substantial fall in fertility, despite strong traditional values like son preference, during the last two decades. The availability of data from three rounds of National Family Health Surveys (NFHS) conducted during 1992-93, 1998-99 and 2005-06 across all the states in India provides a unique opportunity to undertake this exercise over time.

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.