Advances in research on unsafe abortion and its consequences

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.

In India, abortion is legal under Medical termination of Pregnancy Act Since 1971. As per the evidence, around 9% of total maternal deaths are caused by unsafe abortion. Though Medical Abortion (MA) drugs are prescription-only-products, in reality, it is often obtained without doctor’s prescription through pharmacists. The pharmacists often have limited knowledge of safe use of drugs that may result in complications. Population Services International’s intervention on safe medical abortion aims at educating pharmacists to improve their knowledge and dispensing practices related to MA drug regimen. Using Lot Quality Assurance Sampling method, a mystery client or simulated patient survey was conducted on MA drug Dispensing behaviour among 380 pharmacists. The study revealed that 55% of pharmacists recommended correct dose of MA drug and 45% pharmacists suggested correct route of administering MA drug, while only 25% of the pharmacists asked for doctor’s prescription for dispensing MA drug. The findings also revealed that only 42% of the pharmacists behaved correctly on all three key indicators (asked for doctors’ prescription, recommended correct dose and route for administration) pertaining to MA drug regimen. The study helped to identify the low performing areas for further attention by program managers.

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 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.