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Aule T, Adamgbe MA, Usman MM, Eko AA, John AD, Abdulmumini B, Jock SC, Solomon EO, Musa J, Ugwu BT. An Unusual Presentation of Intestinal Obstruction: Uterine Perforation and Bowel Herniation Following Manual Vacuum Aspiration. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:435-439. [PMID: 39309378 PMCID: PMC11412581 DOI: 10.4103/jwas.jwas_166_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/04/2023] [Indexed: 09/25/2024]
Abstract
Introduction Uterine perforation following manual vacuum aspiration (MVA) of early pregnancy is an uncommon occurrence. It is even more unusual to be complicated by bowel herniation and intestinal obstruction. Proper evaluation and intervention are required to ameliorate the attendant morbidity. Case Report We reported a case of a 39-year-old known retroviral disease P1+[1] nonalive who presented 2 weeks after MVA with clinical and radiological features of complete small bowel obstruction. She was resuscitated and had a laparotomy that revealed a herniated loop of small bowel through a uterine perforation. Resection and anastomosis were done; she made a full recovery and was subsequently discharged on the 7th postoperative day. Conclusion Public enlightenment, safe sex practices, and public access to health care covered by health insurance would reduce the incidence of this uterine perforation.
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Affiliation(s)
- Terna Aule
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Moses Ahangba Adamgbe
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Mary Musa Usman
- Department of Obstetrics & Gynaecology, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Anthony Aboki Eko
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Akut Daniel John
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Busari Abdulmumini
- Department of Obstetrics & Gynaecology, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Sunday Christopher Jock
- Department of Obstetrics & Gynaecology, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Evelyn Oluwatobi Solomon
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics & Gynaecology, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
| | - Benjamin Tagbo Ugwu
- Department of Surgery, P. M. B 2076, Jos University Teaching Hospital, Lamingo, Jos, Plateau State, Nigeria
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Chervenak FA, Stajonevic M, Grünebaum A. The IAPM New York 2024 declaration on professional responsibility and abortion. J Perinat Med 2024; 52:671-673. [PMID: 39029100 DOI: 10.1515/jpm-2024-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
The International Academy of Perinatal Medicine (IAPM) firmly supports abortion as a fundamental reproductive right, as declared at their annual meeting on June 28, 2024, in New York City. This stance, grounded in professional responsibility, respects both autonomy and beneficence-based obligations to pregnant patients and fetal patients. The IAPM asserts that access to safe, legal abortion services is essential for gender equality, public health, and social justice. Their declaration aligns with international human rights standards, advocating for abortion legalization up to fetal viability and beyond in cases of maternal health risks or severe fetal anomalies. This comprehensive approach underscores the critical role of healthcare professionals in providing compassionate reproductive healthcare, aiming to reduce maternal mortality and improve public health outcomes globally.
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Affiliation(s)
- Frank A Chervenak
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, New Hyde Park, NY, USA
| | - Milan Stajonevic
- Department of Obstetrics and Gynecology Medical School University of Zagreb, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Amos Grünebaum
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, New Hyde Park, NY, USA
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Bante SA, Balcha WF, Chekole FA, Kassahun EA, Getu AA, Awoke AM, Tariku MK, Zerihun EE. Health care providers`attitude and associated factors to safe abortion in Ethiopia, 2023: A systematic review and meta-analysis. PLoS One 2024; 19:e0308419. [PMID: 39288144 PMCID: PMC11407664 DOI: 10.1371/journal.pone.0308419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/23/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND In sub-Saharan Africa, the number of maternal deaths due to unsafe abortions has been gradually rising. In Ethiopia, unplanned pregnancies contribute to 25% of births, accounting for 6%-9% of the maternal deaths resulting from unsafe abortions. Despite several disjointed cross-sectional studies that have been carried out in the past, there is no comprehensive data on the attitudes of healthcare practitioners and other related aspects regarding safe abortion in Ethiopia. This study attempted to measure pooled health care providers' attitudes and determinants of safe abortion in Ethiopia. METHODS African Journals Online, Medline/PubMed, EMBASE, Science Direct, Hinari, and Google Scholar were the databases that were accessed. The studies were evaluated critically by using the Joanna Briggs Critical Appraisal methods. The study followed the recommendations set forth by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Data were extracted in an Excel spreadsheet and imported to STATA versions 17 software for meta-analysis. The random- effects model was used to pooled the health care providers' attitudes toward safe abortion. Heterogeneity between studies was evaluated using the Cochrane Q-test and I2 statistics (I squared statistics). To evaluate publication bias, egger's tests and funnel plots were employed. Forest plot was used to present the odds ratio (OR) with a 95% confidence interval. RESULTS In this review and meta-analysis, a total of eight papers with a 2,826 sample size were considered. Overall, 65.49% of Ethiopian health care professionals had a positive attitude towards safe abortion (95%CI: 49.64, 81.34; I2 = 99.20%, P = 0.000). Knowledge of the abortion law (OR = 2.25, 95% CI: 1.06, 3.43), being a male provider (OR = 1.89, 95% CI: 1.23, 2.54), receiving training on abortion (OR = 2.91, 95% CI: 1.17, 4.65), working as a midwife (OR = 3.029, 95% CI: 1.605, 4.453) and practicing abortion procedures (OR = 2.55, 95% CI: 1.32, 3.78) were positively associated with the attitudes of the providers regarding safe abortion in Ethiopia. CONCLUSION In Ethiopia, there was a low pooled prevalence of positive attitude towards safe abortion. Safe abortion services in Ethiopia are more likely to be viewed favorably by health care professionals who have received abortion service training and are familiar with abortion laws. As a result, it is imperative that all healthcare facilities and other relevant parties ensure that health professionals receive training on safe abortion services and are aware of Ethiopia's abortion laws.
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Affiliation(s)
- Simachew Animen Bante
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondu Feyisa Balcha
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fentahun Alemnew Chekole
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eden Asmare Kassahun
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemwork Abie Getu
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amlaku Mulat Awoke
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mengistie Kassahun Tariku
- Department of public health, College of Medicine and Health Sciences, Debre Markose University, Debre Markose, Ethiopia
| | - Endalamaw Erkie Zerihun
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Oyelese Y, Grünebaum A, Chervenak F. Respect for history: an important dimension of contemporary obstetrics & gynecology. J Perinat Med 2024:jpm-2024-0348. [PMID: 39272109 DOI: 10.1515/jpm-2024-0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024]
Abstract
"Those who cannot remember the past are condemned to repeat it." This maxim underscores the importance of historical awareness in medicine, particularly for obstetricians and gynecologists (ObGyns). ObGyns significantly impact societal health through their care for pregnant women, fetuses, and newborns, uniquely positioning them to advocate for health initiatives with lasting societal benefits. Despite its importance, the history of medicine is underrepresented in medical curricula, missing opportunities to foster critical thinking and ethical decision-making. In today's climate of threatened reproductive rights, vaccine misinformation, and harmful ideologies, it is imperative for ObGyns to champion comprehensive historical education. The history of medicine, particularly in relation to societal issues - such as racism, discrimination, genocides, pandemics, and wars - provides valuable context for addressing challenges like maternal mortality, reproductive rights, vaccine hesitancy, and ethical issues. Understanding historical milestones and notable ethical breaches, such as the Tuskegee Study and the thalidomide tragedy, informs better practices and safeguards patient rights. Technological advancements in hygiene, antibiotics, vaccines, and prenatal care have revolutionized the field, yet contemporary ObGyns must remain vigilant about lessons learned from past challenges and successes. Integrating historical knowledge into medical training enhances clinical proficiency and ethical responsibility, fostering innovation and improving health outcomes. By reflecting on historical achievements and their impacts, current and future ObGyns can advance the field, ensuring comprehensive and ethically sound approaches to patient care. This paper highlights the crucial role of historical knowledge in shaping modern ObGyn practices, advocating for its integration into medical education to address contemporary health challenges and ethical considerations.
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Affiliation(s)
- Yinka Oyelese
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 1859 Beth Israel Deaconess Medical Center , Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Division of Fetal Medicine and Surgery, Maternal Fetal Care Center, Boston Children's Hospital, Boston, MA, USA
| | - Amos Grünebaum
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, NY, USA
| | - Frank Chervenak
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, NY, USA
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Pasquier E, Owolabi OO, Powell B, Fetters T, Ngbale RN, Lagrou D, Fotheringham C, Schulte-Hillen C, Chen H, Williams T, Moore AM, Adame Gbanzi MC, Debeaudrap P, Filippi V, Benova L, Degomme O. Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings. Reprod Health 2024; 21:114. [PMID: 39103920 DOI: 10.1186/s12978-024-01835-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). METHODS We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. RESULTS Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. CONCLUSION Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.
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Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, Paris, France.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | - Richard Norbert Ngbale
- Ministère de la Santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, Paris, France
| | - Timothy Williams
- Epicentre - Médecins Sans Frontières, Abuja, Jigawa State, Nigeria
| | | | | | - Pierre Debeaudrap
- CEPED, Institut de Recherche pour le Développement, Université Paris Descartes, INSERM 1244, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
| | - Olivier Degomme
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Mohd Tohit NF, Haque M. Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus 2024; 16:e66723. [PMID: 39139803 PMCID: PMC11319820 DOI: 10.7759/cureus.66723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.
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Affiliation(s)
- Nor Faiza Mohd Tohit
- Department of Community Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
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Adekola PO, Adedini SA. Sexual Violence, Disclosure Pattern, and Abortion and Post-Abortion Care Services in Displaced People's Camps in Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1001. [PMID: 39200614 PMCID: PMC11353391 DOI: 10.3390/ijerph21081001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 09/02/2024]
Abstract
Violent social and political conflicts have caused several challenges to internally displaced persons (IDPs), especially girls and young women, among which is sexual violence (SV). Despite extensive records on SV in humanitarian contexts, studies to assess the level, examine the disclosure pattern (DP) and evaluate the availability of abortion care in these settings have received inadequate attention. This scoping review sought to synthesise the current African-based research on SV, DP, and abortion and post-abortion care (APAC) in humanitarian contexts. We conducted a systematic search of five databases: MEDLINE, PubMed, Scopus, Embase and Google Scholar, where the articles retrieved met the criteria for inclusion. The review adhered to PRISMA guidelines and the Critical Appraisal Skills Programme (CASP), containing ten questions to help confirm the validity of the research design and the originality of the results in comparison with similar studies. A series of inclusion and exclusion criteria were applied after the search, and 35 eligible articles from ten African countries with evidence of sexual violence, disclosure patterns, and APAC in camp settings were included in the study. Results described situations of SV in humanitarian settings in Africa as "terrible", "bad", "an epidemic", and "severe" as girls were used as sex objects, for profile enhancement and as a weapon of war. We also found that the illegality of APAC in Africa is causing a high occurrence of clandestine abortions in conflict contexts. Disclosing SV among IDPs in Africa did not follow a clear-cut pattern but was generally determined by socio-demographic characteristics. Sexual health is a fundamental right of all, as enshrined in SDG 3, which makes this topic a major public health issue. We therefore conclude that although disclosure may aggravate stigmatisation in some instances due to adverse reactions, it is still crucial to the healing processes.
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Affiliation(s)
- Paul O. Adekola
- Department of Political Science and International Relations, School of Social Sciences, University of Geneva, 1211 Geneva, Switzerland
- Department of Population, Family and Reproductive Health, School of Public Health, University of Medical Sciences (UNIMED), Ondo City PMB 536, Nigeria
| | - Sunday A. Adedini
- Department of Demography and Social Statistics, Federal University, Oye-Ekiti PMB 373, Nigeria;
- Demography and Population Studies Programme, School of Public Health and Social Sciences, University of the Witwatersrand, Private Bag 3, Wits, Johannesburg 2050, South Africa
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Mabetha K, Soepnel LM, SSewanyana D, Draper CE, Lye S, Norris SA. A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective. Reprod Health 2024; 21:109. [PMID: 39044292 PMCID: PMC11265480 DOI: 10.1186/s12978-024-01852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18-28 years, and ii) factors characterising the decision to terminate. METHODS In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach. RESULTS An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants' decisions through detrimental changes in interpersonal support and financial situation. CONCLUSIONS Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women's needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
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Affiliation(s)
- Khuthala Mabetha
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa.
| | - Larske M Soepnel
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Derrick SSewanyana
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine E Draper
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa
| | - Stephen Lye
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shane A Norris
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa
- School of Health and Human Development, University of Southampton, Southampton, UK
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9
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Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank. HEALTH DATA SCIENCE 2024; 4:0147. [PMID: 39011272 PMCID: PMC11246836 DOI: 10.34133/hds.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/13/2024] [Indexed: 07/17/2024]
Abstract
Background: Concerns have been raised about the increasing prevalence of both spontaneous and induced abortions worldwide, yet their effect on premature mortality remains poorly understood. We aimed to examine the associations between abortion and all-cause and cause-specific premature mortality, and the potential effect modification by maternal characteristics. Methods: Women aged 39 to 71 years at baseline (2006 to 2010) with prior pregnancies were derived from the UK Biobank and categorized as no abortion history, spontaneous abortion alone, induced abortion alone, and both spontaneous and induced abortions. All-cause and cause-specific mortality were ascertained through linkage to death certificate data, with premature death defined as occurring before the age of 70. Results: Of the 225,049 ever gravid women, 43,418 (19.3%) reported spontaneous abortion alone, 27,135 (12.1%) reported induced abortion alone, and 10,448 (4.6%) reported both spontaneous and induced abortions. During a median of 14.4 years of follow-up, 5,353 deaths were recorded, including 3,314 cancer-related and 1,444 cardiovascular deaths. Compared with no abortion history, spontaneous abortion alone was associated with an increased risk of all-cause premature mortality (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 1.02 to 1.17), and induced abortion alone was associated with increased risks of all-cause (aHR 1.12, 95% CI 1.04 to 1.22) and cardiovascular mortality (aHR 1.27, 95% CI 1.09 to 1.48). The aHRs for all-cause and cardiovascular mortality were higher for recurrent abortions, whether spontaneous or induced (P trend < 0.05). The increased risk of all-cause mortality associated with induced abortion was higher in women with hypertensive disorders of pregnancy than in those without (40% vs. 9%, P interaction = 0.045). Conclusions: Either spontaneous or induced abortion alone was associated with an increased risk of premature mortality, with induced abortion alone particularly linked to cardiovascular death. Future studies are encouraged to explore the underlying mechanisms.
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Affiliation(s)
- Shaohua Yin
- Department of Medical Engineering,
Peking University Third Hospital, Beijing, China
| | - Yingying Yang
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine,
Tongji University, Shanghai, China
| | - Qin Wang
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Wei Guo
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Qian He
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Lei Yuan
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Environmental Health, School of Public Health,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Jibat N, Tadele G, Haukanes H, Blystad A. "We need to confirm at least from two or three": Healthcare workers' discretion as gatekeepers in the context of the Ethiopian abortion law. Int J Equity Health 2024; 23:127. [PMID: 38907223 PMCID: PMC11193265 DOI: 10.1186/s12939-024-02203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Women's access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women's access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky's theory of street-level bureaucrats, the article discusses healthcare workers' discretion and the substantial authority they hold as gatekeepers to safe abortion services. METHODS The study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers' perspectives were examined with reference to the national abortion legislation and guidelines. RESULTS The findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women's access to legally-endorsed abortion services. CONCLUSIONS Healthcare workers' practices in this rural area were found to challenge the basic provisions laid out in Ethiopia's abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Addis Ababa University, Jimma, Ethiopia.
| | - Getnet Tadele
- Department of Sociology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haldis Haukanes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Astrid Blystad
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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11
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Wang X, Deng M, Wu S, Mao Q. Induced abortion and ectopic pregnancy: A systematic review and meta-analysis. J Evid Based Med 2024; 17:360-369. [PMID: 38858302 DOI: 10.1111/jebm.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP). METHODS We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software. RESULTS A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81-2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92-1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88-15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38-2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001-2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution. CONCLUSION This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women's fertility.
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Affiliation(s)
- Xin Wang
- Social Medical Research Center, National Research Institute for Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Mengcong Deng
- Social Medical Research Center, National Research Institute for Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Shangchun Wu
- Social Medical Research Center, National Research Institute for Family Planning, Beijing, China
| | - Qunxia Mao
- Social Medical Research Center, National Research Institute for Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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12
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Haile TG, Abraha TH, Gebremeskel GG, Zereabruk K, Welu TH, Grum T, Asres N. Induced abortion in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0302824. [PMID: 38713662 PMCID: PMC11075855 DOI: 10.1371/journal.pone.0302824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/10/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND One of the main factors contributing to maternal morbidity and mortality is induced abortion. The WHO estimates that over 44 million induced abortions take place annually around the world. The majority of these abortions-about 50%-are unsafe, significantly increasing maternal morbidity and contributing to 13% of maternal deaths. Thus, this review aimed to estimate the pooled prevalence of induced abortion and its associated factors in Africa. METHODS To find literature on the prevalence of induced abortion and its associated factors, a thorough search of the internet databases such as PubMed/MEDLINE, African Journals Online, and Google Scholar was conducted. The data were extracted using a structured method of data collection. Software called STATA 14 was used to do the analysis. funnel plot and Egger regression test were used to evaluate potential publication bias. I2 statistics and Cochrane's Q were used to measure the heterogeneity at a p-value < 0.05. RESULTS 976 studies were found through a thorough search of electronic databases. Finally, 46 full-text abstract papers were included in this study. The estimated pooled prevalence of induced abortion was 16% (95% CI: 13%-19%). According to the sub-group analysis, most studies were conducted in Ethiopia, and the pooled prevalence was 19% (95% CI: 10%-30%). Similarly, the subgroup analysis by year of study showed that the prevalence of induced abortion was 39% (95% CI: 17%-64%) among studies conducted in 2019. CONCLUSION The results of this study thus imply that the pooled prevalence of induced abortion is higher than that of earlier studies that were published in some nations. the data from this study are needed to support reproductive and adolescent health programmers and policymakers and to formulate recommendations for future clinical practice and guidelines.
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Affiliation(s)
- Teklehaimanot Gereziher Haile
- Department of Maternity and Neonatal Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Teklehaymanot Huluf Abraha
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Gebreamlak Gebremedhn Gebremeskel
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Kidane Zereabruk
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Tesfay Hailu Welu
- Department of Midwifery, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Teklit Grum
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Negasi Asres
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
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13
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Santry HP, Lee C, Charles A, Angelos P, Crandall M. Academic surgery after the overturning of Roe vs. Wade. Am J Surg 2024; 231:134-136. [PMID: 38143215 DOI: 10.1016/j.amjsurg.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Heena P Santry
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Clara Lee
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anthony Charles
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Marie Crandall
- University of Florida College of Medicine, Jacksonville, FL, USA.
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14
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Zhang S, Tang H, Zhou M. Association between previous surgical termination of pregnancy and pregnancy outcomes in frozen-thawed embryo transfer cycles of IVF/ICSI: a retrospective cohort study. Sci Rep 2024; 14:6579. [PMID: 38503837 PMCID: PMC10951247 DOI: 10.1038/s41598-024-57377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
This study aimed to evaluate the effect of previous surgical termination of pregnancy (STP) on pregnancy outcomes in women undergoing FET cycles of IVF/ICSI. Retrospective cohort study. Reproductive Center of Maternal and Child Health Care Hospital in Lianyungang city. Data were selected from all IVF/ICSI FET cycles performed between January 2014 and December 2020. A total of 761 cycles met the criteria were included in this study. The primary outcome measures were clinical pregnancy and live birth rates. Secondary outcome measures were biochemical pregnancy rate, spontaneous abortion rate, and preterm birth rate. After adjustments for a series of potential confounding factors, the previous STP was an influential factor in reducing FET cycle clinical pregnancy rate compared with women who had not previously undergone STP (OR = 0.614, 95% CI 0.413-0.911, P = 0.016). The effect of the previous STP on the live birth rate was not statistically significant. (OR = 0.745, 95% CI 0.495-1.122, P = 0.159). Also, an increase in the number of previous STPs relative to only 1-time abortion was an independent risk factor in reducing clinical pregnancy rate and live birth rate (OR = 0.399,95% CI 0.162-0.982, p = 0.046; OR = 0.32,95% CI 0.119-0.857, p = 0.023). Previous STP was an independent factor contributing to the decline in FET cycle clinical pregnancy rates.
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Affiliation(s)
- Shuai Zhang
- Clinical Center of Reproductive Medicine, Lianyungang Maternal and Child Health Hospital, Qindongmen Avenue, Haizhou District, Lianyungang City, 22200, China.
| | - Hanhan Tang
- Graduate School of Xuzhou Medical University, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou City, 221004, China
| | - Minglian Zhou
- Clinical Center of Reproductive Medicine, Lianyungang Maternal and Child Health Hospital, Qindongmen Avenue, Haizhou District, Lianyungang City, 22200, China
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15
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Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:288. [PMID: 38541288 PMCID: PMC10970290 DOI: 10.3390/ijerph21030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Globally, about half of all induced abortions have been estimated to be unsafe, which results in 13% of maternal deaths yearly. Of these induced abortions, 41% of unsafe abortions have been reported in young women who are dependent on their parents for their livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (1) characterize and map factors that influence abortion decision-making of adolescents and young women, and (2) identify the care and support that they need in their decision-making process. METHODS We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), Embase, Cochrane Library, CINAHL, and PsycInfo, and hand searched publications in the Google Scholar database between November 2021 and October 2023. The search included all English language qualitative and mixed methods research articles published on the database up to October 2023 that included participants aged 10-24 years. The CASP checklist was used as a guide for the qualitative analysis. NVivo was used to synthesize the findings. RESULTS There were 18 studies from 14 countries (N = 1543 young women) that met the inclusion criteria. Three domains and eleven categories were included as follows: personal (desire for self-realization and unwanted pregnancy), interpersonal (parental impact, reaction of partner, roles of peers and friends, existence of own child, and lack of support), and social circumstances (sexual crime, financial problem, limitation of choice, and underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. CONCLUSION The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to accessing these services. To improve such access, the following are required: staff training to provide adolescent and youth-friendly health services, counseling based on women's needs, counseling including the parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.
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Affiliation(s)
- Yui Koiwa
- Makita General Hospital, Nishikamata, Ota-ku, Tokyo 144-8501, Japan;
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
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16
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Onadja Y, Compaoré R, Yugbaré DB, Thomas HL, Guiella G, Lougué S, Ouedraogo HG, Bazie F, Kouanda S, Moreau C, Bell SO. Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data. BMC Health Serv Res 2024; 24:84. [PMID: 38233874 PMCID: PMC10792903 DOI: 10.1186/s12913-023-10538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. METHODS Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15-49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. RESULTS PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. CONCLUSIONS Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level-the main source of care for many women-which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.
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Affiliation(s)
- Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso.
| | - Rachidatou Compaoré
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso
| | - Siaka Lougué
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Fiacre Bazie
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, F-94800, France
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Woldetsadik MA, Yoseph Y, Degu M. Exploring barriers to using modern contraceptives and accessing safe abortion care in women who terminated unintended pregnancies in Southern Ethiopia. BMC Womens Health 2024; 24:46. [PMID: 38229066 PMCID: PMC10792934 DOI: 10.1186/s12905-023-02793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Unsafe abortion is a major medical and public health problem in Ethiopia and contributes significantly to abortion-related morbidity and mortality in the country. We explored women's experiences with modern contraceptives and identified barriers to accessing safe abortion care and other sexual and reproductive health services. METHODS We recruited participants from six health clinics and a public hospital in southern Ethiopia. We conducted one-on-one interviews with 34 women aged 18-49 years who sought abortion care within the past twelve months of the study. Interviews were recorded, transcribed verbatim, translated to English, and imported into Dedoose software. We analysed the data using a directed content analysis. RESULTS Our findings show prevailing belief among participants that contraceptives caused infertility, abnormalities in subsequent pregnancies, and other side effects. Some of the women suggested that medical or unsafe abortions were a better alternative to using modern contraceptives for terminating unplanned pregnancies. Barriers to accessing safe abortion care included costs of services, lack of privacy, and fear of judgment from providers. Women who had negative experiences with providers were more likely to seek unsafe abortion the second time around. CONCLUSION Providers need to address women's concerns about using modern contraceptives, educate their clients about the best ways to prevent unwanted pregnancies, and provide non-judgemental services. In addition, comprehensive counselling services that include contraceptive counselling should be made available to women before, during, and after abortion care. Finally, providers should strive to be facilitators of, not barriers to, safe abortion care.
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Affiliation(s)
| | | | - Mekonnen Degu
- Family Guidance Association of Ethiopia, Hawassa, Ethiopia
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18
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Wollum A, De Zordo S, Zanini G, Mishtal J, Garnsey C, Gerdts C. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds. Reprod Health 2024; 21:7. [PMID: 38221617 PMCID: PMC10789034 DOI: 10.1186/s12978-023-01729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. METHODOLOGY We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. RESULTS Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. DISCUSSION These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care.
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Affiliation(s)
- Alexandra Wollum
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA.
| | - Silvia De Zordo
- Department of Anthropology, University of Barcelona, Montalegre 6-8, 08001, Barcelona, Spain
| | - Giulia Zanini
- Department of Philosophy and Cultural Heritage, Ca' Foscari University of Venice, Venice, Italy
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, 4297 Andromeda Loop, Orlando, FL, 32816, USA
| | - Camille Garnsey
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
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Omondi GA, Both J, Ouedraogo R, Kimemia G, Juma K. "I wasn't sure it would work. I was just trying": an ethnographic study on the choice of abortion methods among young women in Kilifi County, Kenya, and Atlantique Department, Benin. Reprod Health 2023; 20:181. [PMID: 38057868 DOI: 10.1186/s12978-023-01720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin. METHODS We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process. RESULTS Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality). CONCLUSION Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.
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Affiliation(s)
- Gladys Akinyi Omondi
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya.
| | | | - Ramatou Ouedraogo
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya
| | | | - Kenneth Juma
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya
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20
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Fernández JJ, Juif D. Does Abortion Liberalisation Accelerate Fertility Decline? A Worldwide Time-Series Analysis. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2023; 39:36. [PMID: 38051427 PMCID: PMC10697910 DOI: 10.1007/s10680-023-09687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Since WWII, the two most important global trends in family planning have been fertility decline and abortion liberalisation. But are they related? Specifically: Does abortion liberalisation affect changes in fertility rates? The demographic literature has yet to answer this important question and instead offers two opposing predictions. Some studies argue that liberalisation of this medical procedure reduces fertility rates. By contrast, others note that such legal reforms may merely have an average, negligible effect on fertility levels. We adjudicate between the two approaches by conducting, in our view, the most comprehensive global, quantitative analysis of the relationship between those legal reforms and changing fertility rates. The analysis relies on two-way fixed models and three different indicators of abortion policy liberalism created by independent research teams to estimate the relationship between abortion liberalisation and total fertility changes. The data cover 185 independent states between 1970 and 2019. Fertility rates are significantly related to average public education levels and alternative contraceptive use. Using multiple model specifications, however, abortion reforms do not have a robust association with the outcome. Replication materials for this article can be found at https://figshare.com/s/5336a4422f47c8c39228 .
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Affiliation(s)
| | - Dácil Juif
- Universidad Carlos III of Madrid, Madrid, Spain
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21
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Thomas HL, Alzouma S, Oumarou S, Moreau C, Bell SO. Postabortion care availability, readiness, and accessibility in Niger in 2022: results from linked facility-female cross-sectional data. BMC Health Serv Res 2023; 23:1171. [PMID: 37891572 PMCID: PMC10612209 DOI: 10.1186/s12913-023-10107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Postabortion care (PAC), which is an essential element of emergency obstetric care, is underresearched in Niger. The study aims to assess the availability, readiness, and accessibility of facility-based PAC services in Niger. METHODS This study uses female and facility data from Performance Monitoring for Action Niger. The female data include a nationally representative sample of women aged 15-49 (n = 3,696). Using GPS coordinates, these female data were linked to a sample of public and private facilities (n = 258) that are expected to provide PAC. We assessed PAC availability and facility readiness to provide basic and comprehensive PAC using the signal functions framework, overall and by facility type. We then calculated the distance between women and their closest facility and estimated the proportion of women living within five kilometers (5 km) of a facility providing any PAC, basic PAC, and comprehensive PAC, overall and by women's background characteristics. RESULTS Only 36.4% and 14% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Oxytocics and laparotomy were the most missing signal function for basic and comprehensive PAC, respectively. Private facilities were the least ready to provide the full range of PAC services. While 47% of women lived within 5 km of a facility providing any PAC services, only 33.4% and 7.9% lived within 5 km of a facility providing all basic and all comprehensive PAC signal functions, respectively. Women who were divorced/widowed, had higher levels of education, and were living in urban areas had increased odds of living within 5 km of a facility with any or basic PAC. Women who were never married had increased odds of living within 5 km of a facility with comprehensive PAC, while urban residence was fully predictive of living within 5 km of a facility with comprehensive PAC. CONCLUSIONS This study found PAC availability and readiness to be insufficient in Niger, with inadequate and disparate accessibility to facilities providing PAC services. We recommended stakeholders ensure stock of essential commodities and availability of PAC services at primary facilities in order to mitigate the negative maternal health repercussions of unsafe abortion in this setting.
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Affiliation(s)
- Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA.
| | | | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, F-94800, France
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA
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McLean E, Blystad A, Mirkuzie AH, Miljeteig I. Health workers' experience of providing second-trimester abortion care in Ethiopia: a qualitative study. Reprod Health 2023; 20:154. [PMID: 37848942 PMCID: PMC10580537 DOI: 10.1186/s12978-023-01698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Second-trimester abortions are less common than abortions in the first trimester, yet they disproportionately account for a higher burden of abortion-related mortality and morbidity worldwide. Health workers play a crucial role in granting or denying access to these services, yet little is known about their experiences. Ethiopia has been successful in reducing mortality due to unsafe abortion over the past decade, but access to second trimester abortion remains a challenge. The aim of this study is to better understand this issue by exploring the experiences of second-trimester abortion providers working in Addis Ababa, Ethiopia. METHODS A qualitative study with 13 in-depth semi-structured interviews with 16 health workers directly involved in providing second-trimester abortions, this included obstetrician and gynaecologist specialists and residents, general practitioners, nurses, and midwives. Data was collected at four public hospitals and one non-governmental clinic in Addis Ababa, Ethiopia and analysed using Malterud's text-condensation method. RESULTS The providers recognized the critical need for second-trimester abortion services and were motivated by their empathy towards women who often sought care late due to marginalisation and poverty making it difficult to access abortion before the second trimester. However, service provision was challenging according to the providers, and barriers like lack of access to essential drugs and equipment, few providers willing to conduct abortions late in pregnancy and unclear guidelines were commonly experienced. This led to highly demanding working conditions. The providers experienced ethical dilemmas pertaining to the possible viability of the fetus and women desperately requesting the service after the legal limit. CONCLUSIONS Second-trimester abortion providers faced severe barriers and ethical dilemmas pushing their moral threshold and medical risk-taking in efforts to deliver second-trimester abortions to vulnerable women in need of the service. Effort is needed to minimize health system barriers and improve guidelines and support for second-trimester abortion providers in order to increase access and quality of second-trimester abortion services in Ethiopia. The barriers forcing women into second trimester abortions also need to be addressed.
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Affiliation(s)
- Emily McLean
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5020, Bergen, Norway.
| | - Astrid Blystad
- Global Health Anthropology Research Group, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5020, Bergen, Norway
| | - Alemnesh H Mirkuzie
- John Snow Research and Training, Inc, Edna Mall Area, Addis Ababa, Ethiopia
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave, Seattle, WA, 98195, USA
| | - Ingrid Miljeteig
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5020, Bergen, Norway
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Bell SO, Oumarou S, Larson EA, Alzouma S, Moreau C. Abortion incidence and safety in Niger in 2021: Findings from a nationally representative cross-sectional survey of reproductive-aged women using direct and indirect measurement approaches. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002353. [PMID: 37831640 PMCID: PMC10575533 DOI: 10.1371/journal.pgph.0002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023]
Abstract
Niger is a country in which legal restrictions and a dearth of research has long limited our understanding of the extent and safety of induced abortion. The current study is the first national study of induced abortion in Niger. It uses direct (self-report) and indirect (best friend method) to provide nationally representative estimates of induced abortion incidence and safety and evaluates the performance of the indirect measurement approach. We used cross-sectional, representative survey data on women aged 15-49 in Niger collected between January and May 2022; final sample included 3,696 women. The survey included questions on respondents' and their closest female friends' experience with abortion, including methods and sources used. We calculated one-year abortion incidence and the proportion of abortions involving non-recommended methods and/or sources to determine safety separately for respondents and friends, overall and by background characteristics. The fully adjusted one-year friend abortion rate was 6.7 abortions per 1,000 women in 2021, which was substantially higher than the corresponding respondent rate of 0.4 per 1,000 women. Confidence intervals were wide, but friend estimates suggest higher abortion rates among women in their 20s, those with secondary or higher education, and those with no children. Nearly all abortions were unsafe (97% respondents, 100% friends), involving non-recommended methods and/or sources. While abortion numbers were small, unsafe abortion appeared more common among older women, married women, those with children, and those residing in rural areas. Our findings indicate that, despite legal restrictions, some women undergo abortions in Niger at great risk to their physical safety. Ensuring adequate access to quality voluntary family planning services to prevent unintended pregnancy and postabortion care to treat complications is essential to reducing the risk of unsafe abortion in the country.
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Affiliation(s)
- Suzanne O. Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sani Oumarou
- Institut National de la Statistique, Niamey, Niger
| | - Elizabeth A. Larson
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Soins Primaires et Prévention, Centre de Recherche en Epidémiologie et Santé des Populations, U1018, Inserm, Villejuif, France
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24
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Ilyas MA, Ayyan M, Zahid A, Ehsan M, Athar F, Cheema HA. The demise of Roe v. Wade and the ramifications of legal barriers to abortion. Public Health 2023; 222:e23-e24. [PMID: 36517298 DOI: 10.1016/j.puhe.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- M A Ilyas
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan; Department of Community Medicine, King Edward Medical University, Lahore, Pakistan.
| | - M Ayyan
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan; Department of Community Medicine, King Edward Medical University, Lahore, Pakistan.
| | - A Zahid
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan.
| | - M Ehsan
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan.
| | - F Athar
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan.
| | - H A Cheema
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan.
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25
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Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
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26
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Jayaweera RT, Gerdts C, Wesson P, Motana R, Muñoz I, Bessenaar T, McFarland W, Ahern J. Respondent-Driven Sampling for Estimation of the Cumulative Lifetime Incidence of Abortion in Soweto, Johannesburg, South Africa: A Methodological Assessment. Am J Epidemiol 2023; 192:1081-1092. [PMID: 37016442 DOI: 10.1093/aje/kwad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/01/2022] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
Respondent-driven sampling (RDS) is a potential strategy for addressing challenges in accurate estimation of abortion incidence, but it relies on often untested assumptions. We conducted an RDS study to estimate the cumulative lifetime incidence of abortion in Soweto, Johannesburg, South Africa (April-December 2018), to evaluate whether RDS assumptions were met, and to compare RDS estimates of incidence with estimates adjusted for employment and age based on census data. A total of 849 participants were recruited from 11 seed participants between April and December 2018. The assumption that individuals can identify target population members and the assumption of approximation of sampling with replacement was met. There were minor violations of the assumptions of seed independence from the final sample and reciprocity of ties. Assumptions of accurate degree reporting and random recruitment were not met. Failure to meet assumptions yielded a study sample with different employment characteristics than those of the target population; this could not be resolved by standard RDS methods. The RDS estimate of cumulative lifetime abortion incidence was 12.1% (95% confidence interval: 9.8, 14.3), and the employment-adjusted estimate was 16.9% (95% confidence interval: 12.8, 22.1). We caution researchers in using RDS for representative estimates of abortion incidence. Use of postsurvey weights to adjust for differences in characteristics between the sample and the target population may yield more representative results.
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27
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Hamui RM, Aquino EML, Menezes GMS, Velho Barreto de Araújo T, Seabra Soares de Britto E Alves MT, Valongueiro Alves S, Almeida MDCC. Delays in obtaining hospital care and abortion-related complications within a context of illegality. PLoS One 2023; 18:e0286982. [PMID: 37315058 DOI: 10.1371/journal.pone.0286982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes. This study, nested within the GravSus-NE, analyzed healthcare delays and their association with abortion-related complications in three cities of northeastern Brazil (Salvador, Recife and São Luís). Nineteen public maternity hospitals were involved. All eligible women ≥18 years old hospitalized between August and December 2010 were evaluated. Descriptive, stratified and multivariate analyses were performed. Youden's index was used to determine delay. One model was created with all the women and another with those admitted in good clinical conditions, thus determining complications that occurred during hospitalization and their associated factors. Of 2,371 women, most (62.3%) were ≤30 years old (median 27 years) and 89.6% reported being black or brown-skinned. Most (90.5%) were admitted in good condition, 4.0% in fair condition and 5.5% in poor/very poor condition. Median time between admission and uterine evacuation was 7.9 hours. After a cut-off time of 10 hours, the development of complications increased considerably. Black women and those admitted during nightshifts were more likely to experience a wait time ≥10 hours. Delays were associated with severe complications (OR 1.97; 95%CI: 1.55-2.51), including in the women admitted in good condition (OR 2,56; 95%CI: 1.85-3.55), and even following adjustment for gestational age and reported abortion type (spontaneous/induced). These findings corroborate the literature, highlighting the social vulnerability of women hospitalized within Brazil's public healthcare system in a situation of abortion. The study strongpoints include having objectively measured the time between admission and uterine evacuation and having established a cut-off time defining delay based on conceptual and epidemiological criteria. Further studies should evaluate other settings and new measurement tools for effectively preventing life-threatening complications.
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Affiliation(s)
- Romina M Hamui
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Greice M S Menezes
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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28
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Lee AG, Maley J, Hibbert K, Akgün KM, Hauschildt KE, Law A, Kaminski N, Hayes M, Gesthalter Y, Bosslet GT, Santhosh L, Witkin A, Hills-Dunlap K, Çoruh B, Gershengorn HB, Hardin CC. Medical Societies Must Choose Professional Meeting Locations Responsibly in a Post- Roe World. Ann Am Thorac Soc 2023; 20:781-784. [PMID: 36812378 PMCID: PMC10257035 DOI: 10.1513/annalsats.202211-928ip] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Maley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kathryn Hibbert
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kathleen M. Akgün
- Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Katrina E. Hauschildt
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anica Law
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Margaret Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yaron Gesthalter
- Division of Pulmonary, Critical Care, Allergy and Sleep, University of San Francisco, San Francisco, California
| | - Gabriel T. Bosslet
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lekshmi Santhosh
- Division of Pulmonary, Critical Care, Allergy and Sleep, University of San Francisco, San Francisco, California
| | - Alison Witkin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kelsey Hills-Dunlap
- Pulmonary Sciences and Critical Care, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida; and
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - C. Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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30
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Hinojosa-Millán S, Suarez-Orozco L, Gómez-Jaramillo V, Sánchez-Duque JA. La pandemia ignorada del aborto inseguro: una llamada a la acción. Semergen 2023; 49:101909. [PMID: 36527752 DOI: 10.1016/j.semerg.2022.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Affiliation(s)
- S Hinojosa-Millán
- Semillero de investigación Ginecología y Obstetricia. Departamento de Obstetricia y Ginecología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - L Suarez-Orozco
- Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - V Gómez-Jaramillo
- Facultad de Ciencias Jurídicas, Sociales y Humanísticas, Fundación Universitaria del Área Andina, Sede Pereira, Pereira, Risaralda, Colombia
| | - J A Sánchez-Duque
- Grupo de Investigación Salud, Familia y Sociedad, Departamento de Medicina Social y Salud Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia.
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Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, Williams T, Chen H, Fotheringham C, Lagrou D, Schulte-Hillen C, Powell B, Baudin E, Filippi V, Benova L. High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study). BMC Pregnancy Childbirth 2023; 23:143. [PMID: 36871004 PMCID: PMC9985077 DOI: 10.1186/s12884-023-05427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
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Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | - Richard Norbert Ngbale
- Ministère de la santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | | | | | | | | | - Elisabeth Baudin
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
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32
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Stein RA, Katz A, Chervenak FA. The far-reaching impact of abortion bans: reproductive care and beyond. EUR J CONTRACEP REPR 2023; 28:23-27. [PMID: 36369860 DOI: 10.1080/13625187.2022.2140008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.
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Affiliation(s)
- Richard A Stein
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
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33
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Aronoff DM, Marrazzo JM. Infections caused by Clostridium perfringens and Paeniclostridium sordellii after unsafe abortion. THE LANCET. INFECTIOUS DISEASES 2023; 23:e48-e55. [PMID: 36155670 DOI: 10.1016/s1473-3099(22)00590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
After the legalisation of abortion in the USA in 1973, the risk of infectious morbidity and mortality from this procedure notably decreased. With increasingly restrictive legislation targeting access to safe abortion services, reviewing infectious complications of unsafe pregnancy termination is crucial, particularly the diagnosis and management of life-threatening clostridial (and related anaerobic bacterial) infections that can complicate unsafe abortion. This Review deals with two especially devastating infections that are well-documented causes of septic abortion: the anaerobic, spore-forming pathogens Clostridium perfringens and Paeniclostridium sordellii. We seek to familiarise the reader with these bacteria, the clinical syndromes they can cause (with a focus on toxic shock syndrome), and provide a review of diagnosis and treatment options.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jeanne M Marrazzo
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Kefale B, Damtie Y, Arefaynie M, Yalew M, Adane B, Dilnesa T, Zewdie S, Wasihun Y, Adane M. Induced abortion among female students in higher education institutions in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0280084. [PMID: 36662902 PMCID: PMC9858066 DOI: 10.1371/journal.pone.0280084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 12/12/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Female students in institutions of higher education are at higher risk of abortion and its consequences. There is no nationally representative data on induced abortion among students in higher education institutions in Ethiopia. Hence, this study aimed to estimate the pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia. METHODS This study used a systematic review and meta-analysis of studies conducted from January 1, 2010, to June 30, 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health electronic databases were searched. The analysis was performed using STATA 14 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis using the random effect model. RESULTS This systematic review and meta-analysis included a total of 10 studies and 4656 study participants. The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was 5.06% (95%CI: 2.16, 7.96). The rate of induced abortion was 51 per 1000 women. CONCLUSIONS The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was high. Thus, concerned bodies should design and implement an effective strategy to realize friendly and non-judgmental family planning and comprehensive abortion care service to curb the problem.
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Affiliation(s)
- Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tenagnework Dilnesa
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Hadley M, Powell A. Severely Restricting Abortion Threatens Equitable Health Outcomes for People With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:152-154. [PMID: 36062333 PMCID: PMC10202428 DOI: 10.1093/cid/ciac721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023] Open
Abstract
Equitable access to abortion is a critical component of reproductive care. Women with human immunodeficiency virus (HIV) in the United States are disproportionately Black and will be disproportionately affected by abortion bans following the Supreme Court's decision to overturn Roe v Wade. We argue that this decision is directly in conflict with the National HIV/AIDS Strategies and Centers for Disease Control and Prevention's goals to eliminate perinatal HIV transmission.
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Affiliation(s)
- Megan Hadley
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna Powell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Puri MC, Raifman S, Daniel S, Karki S, Maharjan DC, Ahlbach C, Diamond-Smith N, Foster DG. Denial of legal abortion in Nepal. PLoS One 2023; 18:e0282886. [PMID: 36943824 PMCID: PMC10030013 DOI: 10.1371/journal.pone.0282886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system. We sought to investigate the extent to which patients are denied an abortion at clinics legally able to provide services and factors associated with presenting late for care, being denied, and receiving an abortion after being denied. METHODS We used data from a prospective longitudinal study with 1835 women aged 15-45. Between April 2019 and December 2020, we recruited 1,835 women seeking abortions at 22 sites across Nepal, including those seeking care at any gestational age (n = 537) and then only those seeking care at or after 10 weeks of gestation or do not know their gestational age (n = 1,298). We conducted interviewer-led surveys with these women at the time they were seeking abortion service (n = 1,835), at six weeks after abortion-seeking (n = 1523) and six-month intervals for three years. Using descriptive and multivariable logistic regression models, we examined factors associated with presenting for abortion before versus after 10 weeks gestation, with receiving versus being denied an abortion, and with continuing the pregnancy after being denied care. We also described reasons for the denial of care and how and where participants sought abortion care subsequent to being denied. Mixed-effects models was used to accounting clustering effect at the facility level. RESULTS Among those recruited when eligibility included seeking abortion at any gestational age, four in ten women sought abortion care beyond 10 weeks or did not know their gestation and just over one in ten was denied care. Of the full sample, 73% were at or beyond 10 weeks gestation, 44% were denied care, and 60% of those denied continued to seek care after denial. Nearly three-quarters of those denied care were legally eligible for abortion, based on their gestation and pre-existing conditions. Women with lower socioeconomic status, including those who were younger, less educated, and less wealthy, were more likely to present later for abortion, more likely to be turned away, and more likely to continue the pregnancy after denial of care. CONCLUSION Denial of legal abortion care in Nepal is common, particularly among those with fewer resources. The majority of those denied in the sample should have been able to obtain care according to Nepal's abortion law. Abortion denial could have significant potential implications for the health and well-being of women and their families in Nepal.
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Affiliation(s)
- Mahesh C Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Sarah Raifman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Sara Daniel
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sunita Karki
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Dev Chandra Maharjan
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Chris Ahlbach
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Diana Greene Foster
- Department of Obstetrics, Gynecology, Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, California, United States of America
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Accounting for Misclassification and Selection Bias in Estimating Effectiveness of Self-managed Medication Abortion. Epidemiology 2023; 34:140-149. [PMID: 36455250 DOI: 10.1097/ede.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Studies on the effectiveness of self-managed medication abortion may suffer from misclassification and selection bias due to self-reported outcomes and loss of follow-up. Monte Carlo sensitivity analysis can estimate self-managed abortion effectiveness accounting for these potential biases. METHODS We conducted a Monte Carlo sensitivity analysis based on data from the Studying Accompaniment model Feasibility and Effectiveness Study (the SAFE Study), to generate bias-adjusted estimates of the effectiveness of self-managed abortion with accompaniment group support. Between July 2019 and April 2020, we enrolled a total of 1051 callers who contacted accompaniment groups in Argentina and Nigeria for self-managed abortion information; 961 took abortion medications and completed at least one follow-up. Using these data, we calculated measures of effectiveness adjusted for ineligibility, misclassification, and selection bias across 50,000 simulations with bias parameters drawn from pre-specified Beta distributions in R. RESULTS After accounting for the potential influence of various sources of bias, bias-adjusted estimates of effectiveness were similar to observed estimates, conditional on chosen bias parameters: 92.68% (95% simulation interval: 87.80%, 95.74%) for mifepristone in combination with misoprostol (versus 93.7% in the observed data) and 98.47% (95% simulation interval: 96.79%, 99.39%) for misoprostol alone (versus 99.3% in the observed data). CONCLUSIONS After adjustment for multiple potential sources of bias, estimates of self-managed medication abortion effectiveness remain high. Monte Carlo sensitivity analysis may be useful in studies measuring an epidemiologic proportion (i.e., effectiveness, prevalence, cumulative incidence) while accounting for possible selection or misclassification bias.
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Magreta Chakhame B, Darj E, Mwapasa M, Kafulafula U, Chiudzu G, Maluwa A, Malata A, Odland JØ, Odland ML. Effectiveness of a training intervention in increasing the use of misoprostol in postabortion care in Malawi: a quasi-experimental study. BMJ Open 2022; 12:e061886. [PMID: 36517095 PMCID: PMC9756167 DOI: 10.1136/bmjopen-2022-061886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The study was conducted to determine effectiveness of a training intervention in increasing use of misoprostol in management of incomplete abortions. DESIGN A quasi-experimental study with training intervention on use of misoprostol in treatment of incomplete abortion. SETTING Five secondary-level public hospitals in Malawi, one in urban and four in semiurban settings. Three intervention and two control sites. PARTICIPANTS Records of women treated for first-trimester incomplete abortion from March to May 2020 (baseline) and April to June 2021 (endline). Clinical data were collected from 865 records, 421 before and 444 after the intervention in all study sites. INTERVENTION Three-hour theoretical training sessions for 81 healthcare workers were conducted in July 2020 at the three intervention sites. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of women with incomplete abortion treated with misoprostol before and after the intervention. The proportion of women treated with sharp curettage at the study sites. RESULTS At the intervention sites, there was a significant increase in use of misoprostol from 22.8% (95% CI 17.9% to 28.0%) to 35.9% (95% CI 30.5% to 41.6%) and significant reduction in use of sharp curettage from 48.1% (95% CI 41.9% to 54.3%) to 39.4% (95% CI 35.3% to 42.6%) p<0.01 at baseline and endline, respectively. The use of misoprostol was significantly higher at the intervention sites with OR of 5.02 (95% CI 1.7 to 14.7) p<0.05 compared with control sites at the endline in multivariable models, and there was a difference in the difference of 14.4% ((95% CI 10.4% to 18.2%) p<0.001) between the intervention and control sites after the intervention. CONCLUSIONS A training intervention effectively increased the use of misoprostol in the treatment of incomplete abortions. Increasing misoprostol use will make treatment of incomplete abortion cheaper, easier and more easily accessible. Making quality postabortion care accessible to more women may reduce maternal morbidity and mortality. Further training interventions are recommended.
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Affiliation(s)
- Bertha Magreta Chakhame
- School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Darj
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Mphatso Mwapasa
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Ursula Kafulafula
- School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Grace Chiudzu
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Alfred Maluwa
- Department of Research and Postgraduate Outreach, Malawi University of Science and Technology, Thyolo, Malawi
| | - Address Malata
- Department of Research and Postgraduate Outreach, Malawi University of Science and Technology, Thyolo, Malawi
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
- Department of Public Health, University of Pretoria, Pretoria, South Africa
| | - Maria Lisa Odland
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, St. Olav's Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Wagenheim CA, Savosnick H, Chakhame BM, Darj E, Kafulafula UK, Maluwa A, Odland JØ, Odland ML. Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi. BMC Health Serv Res 2022; 22:1471. [DOI: 10.1186/s12913-022-08878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
In Malawi, abortion is only legal to save a pregnant woman’s life. Treatment for complications after unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester, surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health care providers’ perceptions on this matter are crucial.
Methods
A qualitative approach was used to explore health care providers’ perceptions of misoprostol for the treatment of incomplete abortion using semi-structured in-depth interviews. Ten health care providers were interviewed at one urban public hospital. Each interview lasted 45 min on average. Health care providers of different cadres were interviewed in March and April 2021, nine months after taking part in a training intervention on the use of misoprostol. Interviews were recorded, transcribed verbatim and analyzed using ‘Systematic Text Condensation’.
Results
The health care providers reported many advantages with the increased use of misoprostol, such as reduced workload, less hospitalization, fewer infections, and task-shifting. Availability of the drug and benefits for the patients were also highlighted as important. However, some challenges were revealed, such as deciding who was eligible for the drug and treatment failure. For these reasons, some health care providers still choose surgical treatment as their primary method.
Conclusion
Findings in this study support the recommendation of increased use of misoprostol as a treatment for incomplete abortion in Malawi, as the health care providers interviewed see many advantages with the drug. To scale up its use, proper training and supervision are essential. A sustainable and predictable supply is needed to change clinical practice.
Plain English Summary
Unsafe abortion is a major contributor to maternal mortality worldwide. Unsafe abortion is the termination of an unintended pregnancy by a person without the required skills or equipment, which might lead to serious complications. In Malawi, post-abortion complications are common, and the maternal mortality ratio is among the highest in the world. Retained products of conception, referred to as an incomplete abortion, are common after spontaneous miscarriages and unsafe induced abortions. There are several ways to treat incomplete abortion, and the drug misoprostol has been successful in the treatment of incomplete abortion in other low-income countries. This study explored perceptions among health care providers using misoprostol to treat incomplete abortions and whether the drug can be fully embraced by Malawian health care professionals. Health personnel at a Malawian hospital were interviewed individually regarding the use of the drug for treating incomplete abortions. This study revealed that health care providers interviewed are satisfied with the increased use of misoprostol. They highlighted several benefits, such as reduced workload and that it enabled task-shifting so that various hospital cadres could now treat patients with incomplete abortions. The health care workers also observed benefits for women treated with the drug compared to other treatments. The challenges mentioned were finding out who was eligible for the drug and drug failure. This study supports scaling up the use of misoprostol in the treatment of incomplete abortions in Malawi; the Ministry of Health and policymakers should support future interventions to increase its use.
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Wall LL, Yemane A. Infectious Complications of Abortion. Open Forum Infect Dis 2022; 9:ofac553. [PMCID: PMC9683598 DOI: 10.1093/ofid/ofac553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
This article reviews the infectious complications of abortion (both spontaneous and induced) and the management of this condition. The key points are: (1) Making abortion illegal does not reduce its incidence or prevalence; rather, it only makes abortions unsafe, increasing the likelihood of infectious complications. (2) Timely recognition of developing sepsis in the pregnant patient is critical. This requires constant vigilance and a high index of suspicion. (3) Rapid intravenous administration of broad-spectrum antibiotics targeted to the likely intrauterine source of infection as soon as sepsis is diagnosed is critical to prevent severe sepsis, septic shock, and multisystem organ failure. (4) The mainstay of treatment is prompt evacuation of any residual products of conception from within the uterine cavity under broad-spectrum antibiotic cover targeting the likely intrauterine source of infection. (5) Prompt engagement of specialists in both critical care and obstetrics-gynecology is necessary to optimize outcomes in patients with septic abortion.
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Affiliation(s)
- L Lewis Wall
- Correspondence: L. Lewis Wall, Departments of Obstetrics & Gynecology and Anthropology, Washington University in St Louis, 1036 Dautel Ln, St Louis, MO 63146 ()
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Yang ST, Chang WH, Chao WT, Lai TJ, Lin WL, Lim HC, Liu CH, Wang PH. The timing of intravenous oxytocin administration is crucial to minimize perioperative blood loss during first-trimester suction curettage for missed abortion. J Chin Med Assoc 2022; 85:1061-1067. [PMID: 36083636 DOI: 10.1097/jcma.0000000000000808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Oxytocin is commonly used to reduce blood loss during suction curettage for missed abortion. However, the potential of oxytocin to mitigate blood loss in early pregnancy remains controversial. Based on the hypothesis that the "timing" of oxytocin administration may be a critical factor, we investigated whether the timing of intravenous (IV) administration is associated with reduced perioperative blood loss during first-trimester suction curettage for missed abortion. METHODS The medical charts of 146 patients with ultrasound-confirmed first-trimester missed abortion who underwent suction curettage with IV oxytocin administration were retrospectively reviewed. RESULTS Among the patients, 67 received 10 IU of IV oxytocin before suction curettage (early-oxytocin administration group), while 79 patients received 10 IU of IV oxytocin after suction curettage (late-oxytocin administration group). The demographic features between the two groups did not significantly differ. However, there was a lower proportion of nulliparous patients in the early-oxytocin administration group than in the late-oxytocin administration group (38.8% vs 60.8%, p = 0.006). The perioperative blood loss amount was significantly lower in the early-oxytocin administration group than in the late-oxytocin administration group (60 [range: 50-100] vs 100 [range: 30-250] mL, p = 0.001). Moreover, the multivariate logistic regression analysis showed that the early-oxytocin administration group had a lower risk for a perioperative blood loss amount of ≥100 mL than the late-oxytocin administration group (0.23 [range: 0.10-0.55], p = 0.001); a gestational age of 9-12 weeks ( p = 0.009) was found to be associated with an increased risk for a perioperative blood loss amount of ≥100 mL. CONCLUSION Compared with late-oxytocin administration, early-oxytocin administration could reduce perioperative blood loss during first-trimester suction curettage for missed abortion. However, the results require further investigation.
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Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ting-Jung Lai
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC
| | - Wei-Lin Lin
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Hong-Ci Lim
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
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Rivera Rodriguez G, Tamayo Acosta J, Sosa Gomez AE, Marcucci Rodriguez RE, Rodriguez Cintron GA, Acosta M. The Medical and Financial Burden of Illegal Abortion. Cureus 2022; 14:e30514. [PMID: 36415416 PMCID: PMC9675393 DOI: 10.7759/cureus.30514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
More than a heated debate subject, abortion is a matter that has been present in human history for a very long time. As our society evolves and advances in medicine and socioeconomic systems are made, the subject of the medical procedure known as abortion appears to be a differentiator in our behaviors as a society. This article highlights the known effects and medical complications of illegal abortion and the financial impact of the procedure's legal status. A retrospective search using EBSCO, PubMed/Medline, Cochrane, EMBASE: Excerpta Medica Database, and DARE electronic databases was conducted, focused on detailing the risks of illegal abortion, the financial cost of complications, the socioeconomic impact of unwanted progeny, and the rationale behind seeking the procedure, legally or otherwise. Each author independently reviewed and extracted data to write up each assigned section, and group collaborations occurred to create the final draft. Out of the 87 resources reviewed, 16 sources were deemed eligible for this article, and their data are herein outlined.
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Affiliation(s)
- Grecia Rivera Rodriguez
- General Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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Tiew A, Berro Pizzarossa L, Jastaniah I, Jayaweera RT. The impact of COVID-19 on safe abortion access in Africa: An analysis through a framework of reproductive justice and lens of structural violence. Front Glob Womens Health 2022; 3:958710. [PMID: 36247111 PMCID: PMC9563014 DOI: 10.3389/fgwh.2022.958710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
The SARS-CoV-2 virus causing the coronavirus disease (COVID-19) global pandemic heightened restrictions on sexual and reproductive health and rights (SRHR), especially concerning safe abortion access. The African region has been particularly susceptible to the impact of COVID-19 on sexual and reproductive health services. Using a framework of reproductive justice, we interviewed key informants from the Mobilizing Action around Medication Abortion (MAMA) Network regarding the impacts of structural violence and COVID-19 on SRHR programming in Africa, particularly programming on self-managed abortion. We identified themes of lacking infrastructures of support, emergent marginality, and neocolonial funding environments as facets of structural violence within the context of the MAMA Network, as heightened by the COVID-19 global pandemic.
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Affiliation(s)
- Amanda Tiew
- The International Network for the Reduction of Abortion Discrimination and Stigma (inroads), Seattle, WA, United States
| | - Lucía Berro Pizzarossa
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, United States
| | | | - Ruvani T. Jayaweera
- Ibis Reproductive Health, Oakland, CA, United States
- *Correspondence: Ruvani T. Jayaweera
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Shukla A, Vazquez-Quesada L, Vieitez I, Acharya R, RamaRao S. Quality of care in abortion in the era of technological and medical advancements and self-care. Reprod Health 2022; 19:191. [PMID: 36109756 PMCID: PMC9479303 DOI: 10.1186/s12978-022-01499-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Discussions around quality of abortion care have been focused mainly on service-delivery aspects inside healthcare facilities. More recently, with availability of medical abortion (MA), increase in its self-use, and emergence of other delivery platforms such as telemedicine, the responsibility of quality care has broadened to actors outside of facilities.
Body of text
This commentary discusses the meaning of quality of abortion care with the paradigm shift brought by medical and technological advancement in abortions, and raises questions on the role of the state in ensuring quality in abortion management—especially in settings where abortion is decriminalized, but also in countries where abortion is permitted under certain circumstances. It consolidates the experience gained thus far in the provision of safe abortion services and also serves as a forward-thinking tool to keep pace with the uptake of newer health technologies (e.g., availability of medical abortion drugs), service delivery platforms (e.g., telemedicine, online pharmacies), and abortion care providers (e.g., community based pharmacists).
Conclusions
This commentary provides context and rationale, and identifies areas for action that different stakeholders, including health advocates, policymakers, program managers, and women themselves, can adopt to fit into an alternative regime of abortion care.
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Klu D, Yeboah I, Kayi EA, Okyere J, Essiaw MN. Utilization of abortion services from an unsafe provider and associated factors among women with history of induced abortion in Ghana. BMC Pregnancy Childbirth 2022; 22:705. [PMID: 36100858 PMCID: PMC9469529 DOI: 10.1186/s12884-022-05034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), numerous studies have examined women's choice of abortion methods and services using hospital-based data, community-based surveys and nationally representative data. Little research focuses on the factors influencing a woman's choice of abortion provider. This study sought to identify factors that are associated with why a woman seeks abortion care services from an unsafe provider in Ghana. METHODS We used nationally representative data of women from the 2017 Ghana Maternal Health Survey (GMHS). Data analysis was restricted to women aged 15-49 with a recent history of induced abortion. Analyses focused on a weighted sample of 1,880. Descriptive analysis and the chi-square test were used to examine the proportion of women utilizing abortion services from unsafe providers. Factors hypothesized to affect the utilization of abortion services from unsafe providers were examined using both bivariable and multivariable logistic regression analyses. RESULTS The proportion of survey respondents who reported that they utilize abortion service from unsafe providers were 57.5%. After adjusting for confounders, those who have knowledge of abortion legality [aOR: 0.381 (0.271-0.541)] and those who have attained secondary or higher education [aOR: 0.613 (0.411-0.914)] were less likely to use abortion services from unsafe providers. On the other hand, women belonging to the Ewe ethnic group [aOR: 0.696 (0.508-0.953)], those residing in the middle belt zone [aOR: 1.743 (1.113-2.728)], younger women aged 15-29 years [aOR: 2.037 (1.234-3.362)] were more likely to use abortion services from unsafe abortion providers. CONCLUSIONS This research suggests that increasing the knowledge of women on the legal status of abortion through public education and encouraging more women to pursue secondary or higher education can contribute to reducing the use of abortion services from unsafe providers. These interventions should be targeted among younger women and those who reside in the middle belt zones of Ghana.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, P.O. Box LG 149, Legon, Accra, Ghana.
| | - Esinam Afi Kayi
- Department of Adult Education and Human Resource Studies, School of Continuing and Distance Education, University of Ghana, P.O. Box LG 25, Accra, Legon, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, PMB 40, Cape Coast, Ghana
| | - Mary Naana Essiaw
- Institute of Work, Employment and Society, University of Professional Studies, P.O. Box LG 149, Legon, Accra, Ghana
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Aalmneh TS, Alem AZ, Tarekegn GE, Kassew T, Liyew B, Terefe B. Individual and community-level factors of abortion in East Africa: a multilevel analysis. Arch Public Health 2022; 80:184. [PMID: 35941615 PMCID: PMC9361670 DOI: 10.1186/s13690-022-00938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Abortion is one of the top five causes of maternal mortality in low and middle-income countries. It is associated with a complication related to pregnancy and childbirth. Despite this, there was limited evidence on the prevalence and associated factors of abortion in East African countries. Therefore, this study aimed to investigate the prevalence and associated factors of abortion among reproductive-aged women in East African countries. Methods The Demographic and Health Surveys (DHS) data of 12 East African countries was used. A total weighted sample of 431,518 reproductive-age women was included in the analysis. Due to the hierarchical nature of the DHS data, a multilevel binary logistic regression model was applied. Both crude and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was calculated for potential associated factors of abortion in East Africa. In the final model, variables with a p value < 0.05 were declared as statistically significant factors of abortion. Results Around 5.96% (95%CI: 4.69, 7.22) of reproductive-aged women in East Africa had a history of abortion. Alcohol use, tobacco or cigarette smoking, being single, poorer wealth index, currently working, traditional family planning methods, and media exposure were associated with a higher risk of abortion. However, higher parity, having optimum birth intervals, and modern contraceptive uses were associated with lower odds of abortion. Conclusions The prevalence of abortion among reproductive-aged women in East Africa was high. Abortion was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during the intervention to prevent the burdens associated with abortion.
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Rahaman M, Das P, Chouhan P, Das KC, Roy A, Kapasia N. Examining the rural-urban divide in predisposing, enabling, and need factors of unsafe abortion in India using Andersen's behavioral model. BMC Public Health 2022; 22:1497. [PMID: 35932007 PMCID: PMC9356405 DOI: 10.1186/s12889-022-13912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of unsafe abortions significantly varies with geography; therefore, more research is needed to understand the rural-urban differences in unsafe abortion practices in India. The present study aims to explore the rural-urban differences in predisposing, enabling, and need factors of unsafe abortion in India. METHODS The present study used the fourth round of the National Family Health Survey (2015-16) and included the women aged 15-49 who terminated pregnancies by induced abortion during the 5 years prior to the survey (N = 9113) as the study sample. Descriptive statistics, bivariate chi-square significance test and multivariate logistic regression model were used to accomplish the study objectives. RESULTS The findings revealed that almost one-third of pregnancies were terminated through unsafe measures with sharp rural-urban contrast. The likelihood of unsafe abortions increases with decreasing women's age and spousal level of education. Younger women in urban settings were more vulnerable to unsafe abortion practices. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (OR: 1.92). Poor households were more likely to undergo unsafe abortions, which were more common in rural settings (OR: 1.26). The unmet need for family planning was revealed to be a significant need factor for unsafe abortion, particularly in rural settings. CONCLUSION Although abortion is legal, India's high estimated frequency of unsafe abortions reveals a serious public health issue. Due to socio-economic vulnerability, unmet family planning needs, and a lack of awareness, significant numbers of women still practice unsafe abortions in India.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Puja Das
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
| | - Kailash Chandra Das
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Avijit Roy
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India. .,Department of Geography, Malda College, Malda, West Bengal, 732101, India.
| | - Nanigopal Kapasia
- Department of Geography, Malda College, Malda, West Bengal, 732101, India
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Yemane GD, Korsa BB, Jemal SS. Multilevel analysis of factors associated with pregnancy termination in Ethiopia. Ann Med Surg (Lond) 2022; 80:104120. [PMID: 36045825 PMCID: PMC9422069 DOI: 10.1016/j.amsu.2022.104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy termination is a major public health issue that affects maternal mortality around the world. So the study aimed to identify factors that are associated with pregnancy termination in Ethiopia. Methods Community-based crossectional data came from Ethiopia's Mini Demographic and Health Survey 2019. The current study's sample included women who had their pregnancy terminated (aged 15–49) and had complete information on all factors of interest (N = 8885). The binary logistic regression model investigated the factors that contribute to pregnancy termination in Ethiopia and multilevel logistic regression were used to identify regional variation in Ethiopia. Results The current study showed that the prevalence of pregnancy termination in Ethiopia was 8.6%. The likelihood of pregnancy termination in uneducated women was 1.5 times (AOR = 1.479, 95% CI = 1.205–1.816) lower than in women who attended elementary school, 1.5 (AOR = 1.476, 95% CI = 1.107–1.969) lower than Secondary attended women and 1.8 times (AOR = 1.755, 95% CI = 1.270–2.427) lower than Higher school attended women. The likelihood of pregnancy termination in rural women was 0.8 times (AOR = 0.753, 95% CI = 0.573–0.990) higher than in urban women. Conclusion The current study showed that there was regional Variation among women in Ethiopia to terminate the pregnancy. The characteristics of education level, place of residency, marital status and contraceptive knowledge are significant and differ between regions of the country. As a result, increasing contraception use and enhancing women's knowledge are the most effective ways to avert the problem. Pregnancy termination is a major public health issue that affects maternal mortality around the world. •The study aimed to identify factors that are associated with pregnancy termination in Ethiopia. •Community-based crossectional data came from Ethiopia's Mini Demographic and Health Survey 2019. •The current study showed that the prevalence of pregnancy termination in Ethiopia was 8.6%. •The current study showed that there was regional Variation among women in Ethiopia to terminate the pregnancy. •As a result, increasing contraception use and enhancing women's knowledge are the most effective ways to avert the problem.
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49
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Parental Knowledge, Willingness, and Attitude towards Contraceptive Usage among Their Unmarried Adolescents in Ekpoma, Edo State, Nigeria. Int J Reprod Med 2022; 2022:8533174. [PMID: 35783251 PMCID: PMC9246590 DOI: 10.1155/2022/8533174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Adolescence is a time of opportunity, vulnerability, and risk, particularly in relation to health, unsafe sexual activity, and reproductive health. Neglecting their reproductive health issues leads to a great risk of agonizing transition to parenthood, lifetime effects, and early pregnancy, which can compromise educational achievements and economic potentials. Meeting the reproductive health needs of adolescents mostly rests on the parents’ shoulders. Thus, this study explored parental knowledge, willingness, and attitude towards contraceptive use among their unmarried adolescents. Methods. This was an analytical cross-sectional study design. The multistage sampling technique was used to recruit 360 parents from Ekpoma community, Edo State, Nigeria. A structured questionnaire was used to generate data for this study. Data processing and analysis were done using SPSS version 24. In order to determine association with outcome variables, chi-square (
) and Fisher’s exact test statistics were used while statistical significance was set at
. Results. The proportion of parental knowledge on contraceptive methods was at 96.9%, parental willingness for their adolescents’ contraceptive uptake at 31.7%, and positive attitude at 24.2%. Associated factors for parental knowledge of contraceptives include gender (
,
), age (
,
), marital status (
,
), educational level (
,
), religion (
,
), ethnicity (
,
), and duration of marriage (
,
). Factors such as educational level (
,
), marital status (
,
), and religion (
,
) were associated with parental attitude towards contraceptives for their unmarried adolescents. Education level (
,
) was associated with parental willingness for their unmarried adolescents’ use of contraceptives. Conclusion. Although parents have good knowledge of contraception, this knowledge has not been passed on to their adolescents. However, few parents would encourage their adolescents to use contraceptives and advise the use of condoms if they are sexually active. Parents should be advised about contraceptive matters further to influence their adolescents’ attitudes towards its usage. Establishing youth-friendly health centers will also encourage health information use and exposure.
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50
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Jones GL, Mitchell CA, Hirst JE, Anumba DOC. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67. BJOG 2022; 129:1211-1228. [PMID: 35139580 DOI: 10.1111/1471-0528.17044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.
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Affiliation(s)
| | | | - Jane E Hirst
- Royal College of Obstetricians and Gynaecologists, London, UK
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