Contraception, unintended pregnancy and induced abortion

Using the 2004 Cameroon Demographic and Health Survey, we examine the association between various women's status variables and contraception use. We find that certain dimensions of female autonomy are indeed important for contraception use in the Cameroonian context, while there is no clear relationship for other dimensions. We find that the decision-making index is the most important dimension of female autonomy in predicting a woman’s use of modern contraception. The mobility index and the gender role index are respectively the second and third most important dimensions of women’s autonomy that predict a woman’s modern contraception use. Surprisingly, none of the financial autonomy variables are significant. We conclude that although certain women’s autonomy variables predict a woman’s modern contraception use, a place of residence and regional level of development is a much stronger predictor.

Abortion was legalised in Nepal in 2002 and the government began providing comprehensive abortion care services in 2004. Prior to that, the sex ratio at birth remained within normal limits, though other indicators suggested high levels of son preference. Changes in the sex ratio at birth since 2004 may indicate the extent to which sex selection has resulted from the introduction of abortion services.
Birth-order specific conditional sex ratios (CSRs) were calculated using data from four Nepal Demographic and Health Survey (NDHS). CSRs were looked at over time as well as for different sub-groups in order to assess trends and see which women were most likely to have sex selective abortions.
During 2007-10 the CSR for second-order births where the first born was a girl was just 742 (girls per 1,000 boys). Before abortion was legalised the same CSR was 1021. The CSR was lowest amongst educated women and richer women, especially in urban areas.
The fall in CSRs witnessed post legalisation indicates that sex-selective abortion is increasing. This change is likely driven by both supply and demand factors. Falling fertility has intensified the need to bear a son sooner, while legal abortion services have reduced the costs and risks associated with obtaining an abortion.

Globally, about 7 million under-five children die every year. Meanwhile, family planning is recognized as the pillar of safe motherhood and improved child health outcomes. Evidence showed that promotion of family planning has the potential of averting 32% of all maternal deaths and 10% of childhood deaths. Thus, the relevant question would seem to suggest whether unmet needs for contraception could lead to increased risk of under-five mortality. The objective of this paper is to examine whether unmet needs for contraception could result in increased risk of under-five mortality in Nigeria. The study draws on 2008 Nigeria Demographic and Health Survey. Cox regression analysis was performed on a nationally representative sample of 28,647 children to examine the effect of contraceptive use and unmet need on child survival; while adjusting for the effects of other important covariates. Findings indicate a significantly lower risk of death for children whose mothers were using contraceptives (hazard ratio: 0.54,p<0.001); and for children whose mothers had no unmet need for contraception (hazard ratio 0.89,p<0.05) compared with those in the reference category. The findings of this study suggest the importance of contraceptive use in the pursuit of the Millennium Development Goal four in Nigeria.

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.

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.

Issues of abortion are critical in Ghana largely due to its consequences on sexual and reproductive health. While the practice is generally regarded illegal, the negative perception society attaches to it makes it difficult for young people to access the service and share their experiences. This paper explores the pre and post abortion experiences of young people; a subject scarcely researched in the country. Clients of Planned Parenthood Association of Ghana (PPAG) Clinic at Cape Coast constituted the study population. The interview guide was used to collect data from twenty-one respondents between the ages of thirteen and twenty-four. Guided by the bio-psychosocial model, the study revealed that thoughts of causing ‘murder’, guilt, fear of societal stigma, shame, and loss of partners, leaving with the guilt of ‘murder’ as well as self-imposed stigma were the pre and post abortion experiences the respondents encountered. Bleeding, severe abdominal pains and psychological pain were also reported. Research must focus more in this area. PPAG Clinic must integrate psychosocial treatment in its abortion services while intensifying behaviour change communication and community-based stigma-reduction education in the Metropolis.

This study aims to establish the relative importance of lack of access and attitudinal resistance towards use of family planning in accounting for unmet need among different population strata in Kenya and Senegal. Using 10 DHS data from the two countries, the main analysis extends and adapt the approach used in an investigation of progress in family planning need, access and attitude in Africa (Cleland, Ndugwa et al. 2011). Preliminary results from the most surveys show that in Kenya lack of access is a minor problem and that unmet need stems largely from abandonment of hormonal methods; the central problem is health concerns and side effects. In Senegal, both unfavourable attitudes and lack of access are barriers to use; over 60% of those with unmet need have an unfavourable attitude and one-third have no access to methods. Infrequent sex is deployed as an alternative contraception. Trends in access, attitude and reasons for non-use will be assessed.

In Bangladesh, the short term methods especially the pill is gaining popularity with respect to long term methods, such as sterilization but it is worthwhile to mention that female sterilization unintentionally shortens the length of fecund life span of female and thus total fertility. This study has been conducted to identify the effects of some selected socioeconomic and demographic covariates on female age at sterilization, by applying Weibull regression model using data from standard 2004 Bangladesh DHS. Weibull survival models with and without Gamma heterogeneity have been used to find out the effect of different co-variates on the timing of age of sterilization. The findings show that the propensity of sterilization is higher among urban women than rural women in Bangladesh. The average failure time for sterilization is higher among older women in than their younger counterparts. The hazard model analyses demonstrate that education, religion, age at marriage and residence are the important significant covariates in explaining early timing of sterilization. The study shows that a significant amount of heterogeneity is present in the population with respect to timing of age at sterilization even controlling some demographic and socio-economic variables.

Unintended pregnancies often have negative effects on the well-being of women and families. Estimates of the distribution of pregnancies by intention status and outcomes (induced abortions and planned and unplanned births and miscarriages) for world regions and subregions were previously estimated for 1995 and 2008. It is important to monitor change in this key measure of reproductive behavior. Updated data are now available on the main components - abortion estimates, demographic and health surveys, UN population and birth estimates - allowing us to develop updated estimates of unintended pregnancies worldwide for 2012.This paper will answer the question of whether and by how much unintended pregnancy levels have changed since 2008, after a period of decline from 1995 to 2008. Differences in levels and trends of unintended pregnancy across regions and subregions will be examined, and trends will be assessed in the context of fertility, contraception and unmet need.

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.