Contraception, unintended pregnancy and induced abortion

This analysis will examine the patterns of temporary contraceptive method use among a representative sample of urban women from Uttar Pradesh, India. In particular, differences between women that use condoms, other temporary modern methods (pills, IUD, or injectables), and traditional methods will be explored, including socio-demographic characteristics of users, fertility desires, patterns of switching between methods, and pregnancy outcomes within a two year period. Patterns of multiple method use during a two year period will also be examined. The data come from baseline and midterm surveys conducted in four cities of Uttar Pradesh, India in 2010 and 2012 by the Measurement, Learning & Evaluation (MLE) project as part of the evaluation of the Urban Health Initiative. The midterm survey included a two year calendar of contraceptive use, discontinuation, switching, and pregnancy, which will be used for the analysis. The authors aim to add to the evidence base on the use of temporary methods and birth spacing, specifically among condom users. The analysis will also contribute to the body of research on urban health by considering wealth and slum/non-slum residence among the characteristics that differentiate temporary method users.

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.

Considerations around repositioning family planning emphasize the need to integrate FP counseling and services with maternal and child health services particularly postpartum and post-abortion care. This paper examines the effect of the exposure to FP counseling and services during antenatal care, delivery and postpartum care on the use of contraceptives in four cities of Uttar Pradesh. Using midterm data collected in 2012 as part a longitudinal study, this paper focuses on women who had delivered in last two years (n=975). Among these, 36 percent reported adopting modern contraceptive postpartum, while 21 percent adopted traditional. Further, data reveals that only a small proportion of women received FP information and services during ANC (18%), delivery (22%) and PNC (13%), though large proportion had come in contact with providers. Multivariate analysis shows that women who delivered at facility and received counseling/services at that time are more likely to use contraceptive post-partum, than those who delivered either at home or did not receive any information in the facility. Clearly, the opportunity to reach potential FP clients with information and services during antenatal and delivery care services is largely missed, which needs to be strengthened to improve use of modern contraceptive methods.

Depot medroxyprogesterone acetate (DMPA) is a widely used injectable contraceptive given by the intramuscular (IM) route. A subcutaneous formulation, depo-subQ in Uniject (SAYANA PRESS®), has been developed. It is anticipated that this method will be a valuable innovation in family planning (FP) service delivery. This outcome hinges on the method being affordable and acceptable to decision makers, FP providers, and clients. This study assessed acceptability of depo-subQ in Uniject among clients and providers, including community health workers (CHWs). User trials in FP clinics and with clients of CHWs were conducted in Uganda and Senegal. Pre- and post-injection questionnaires were administered to 360 experienced DMPA clients who received the subcutaneous injection. The participants were followed three months post-injection to further assess experience with depo-subQ in Uniject. Eligible DMPA clients who decline to receive depo-subQ in Uniject were invited to complete a questionnaire about their reasons for declining. Interviews were conducted with 80 CHWs and 20 clinic-based providers to assess their experiences providing the method. The results will inform the introduction of depo-subQ in Uniject on three levels — country, community, and health facility.

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.

Adolescent pregnancies are most often the result of sexual risk taking. Adolescent birth rates in low and middle income countries lag behind those of higher income countries. The review’s objective was to present the best available evidence on facilitators and barriers to programs targeting a reduction in pregnancies among adolescents in low and middle income countries. Qualitative studies focused on interventions to persons aged 10 to 19 years residing in low and middle income countries of the world and factors that could influence those interventions were considered.
The review identified 8 perceived barriers and 3 perceived facilitators from 11 synthesized findings. Some perceived barriers were inadequate adult/parental support, negative perceptions about contraception, sex as a resource, lack of open sexual discourse, subordination of females to males and non-friendly institutions. Perceived facilitators were supportive institutions, families and parents, and adolescents’ determination not to be pregnant early in life.
A friendly approach to care, societal support and open discourse on sexual issues could facilitate a reduction of unintended pregnancies. Further research of myths against contraception use, cultural norms encouraging female subordination among others could guide pregnancy prevention programs.

Background: High levels of fertility in Nigeria are a function of both low demand for and low use of contraceptive methods. Method choice is an important determinant of sustained contraceptive use and a number of barriers have been identified. However, our understanding of how clients themselves perceive their choice of method is very limited.
Methods: This study uses qualitative data to examine attitudes and norms surrounding decision-making for method choice.
Results: Choosing a contraceptive method was presented as a medical decision. Participants often mentioned the issue of whether a method is compatible with a woman’s “body system”. This compatibility is determined by tests conducted by a doctor and dictates the method chosen, with the assumption that there will be no side effects.
Discussion: This level of medical mystery placed on family planning is problematic. A belief that a test exists to predict side effects would likely result in disappointment by the user, and possibly a reluctance to switch methods, when side effects do occur. Messages need to be crafted to increase understanding among current and potential family planning users about the process of choosing a contraceptive method, the potential for side effects, and the choice of switching methods.

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.

The research focused on establishing the causes of low contraceptive use in the West Nile. Uganda. The study aimed at providing a clear basis for policy measures so as to reduce or curb down the high and rapidly growing population growth rate levels. The study used secondary data from the 2006 Uganda Demographic Health Surveys (UDHS). In this study, the sample size of 8369 women aged 15-49years from the districts, Adjumani, Arua, Koboko, Nyadri, Nebbi, and Yumbe was used. The researcher used both univariate and bivariate analysis. In bivariate analysis Correlations and Chi square test was also used to measure the degree of association between the dependant variable and the independent variables.
Results indicate a significant relationship was established between mother’s age at first birth, birth interval and infants dead for those which were demographic in nature, as well as education level, religion, marital status and wealth index for socio-economic variables of which all factors were statistically significant with infant mortality. The researcher recommended increasing the number of health facilities so as to supplement the few existing government and private facilities. This would increase the level of accessibility to contraceptives and family planning facilities especially to the rural majority.Our findings also sug