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Autorino T, Mattioli F, Mencarini L. The impact of gynecologists' conscientious objection on abortion access. SOCIAL SCIENCE RESEARCH 2020; 87:102403. [PMID: 32279862 DOI: 10.1016/j.ssresearch.2020.102403] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/04/2019] [Accepted: 01/16/2020] [Indexed: 06/11/2023]
Abstract
Although abortion in Italy is free of charge and legal in a broad set of circumstances, 71% of gynecologists are registered as conscientious objectors, i.e. they are exempted from performing abortions for reasons of religious or moral beliefs. To assess whether this practice limits abortion access, we analyze aggregate regional data on abortion and a dataset of over one million clinical records of single interventions performed between 2002 and 2016. Results, from both cross-regional panel data and microdata analysis, suggest that conscientious objection hampers abortion access at the local level, being a significant driver of a woman's decision of having an abortion out of the region of residence and leading to longer waiting times to have one. Conscientious objection appears to have a stronger impact on women living in lower-income regions or experiencing other forms of economic disadvantage.
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Affiliation(s)
- Tommaso Autorino
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy
| | - Francesco Mattioli
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy
| | - Letizia Mencarini
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy.
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Gijbels I, Prosdocimi I. Smooth estimation of mean and dispersion function in extended generalized additive models with application to Italian induced abortion data. J Appl Stat 2011. [DOI: 10.1080/02664763.2010.550039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Parazzini F, Cipriani S, Chiaffarino F, Sandretti F, Bortolus R, Chiantera V. Induced abortion and risk of small-for-gestational-age birth. BJOG 2007; 114:1414-8. [PMID: 17803719 DOI: 10.1111/j.1471-0528.2007.01226.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant. DESIGN Case-control study. SETTING General and university hospitals. METHODS Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal characteristics and habits, gynaecological and obstetric history, general anamnesis, family history of obstetric and gynaecological diseases, and the age of the father of the child. Further information on current pregnancy and delivery was also collected. We used conditional multiple logistic regression (with age as the matching variable), with maximum likelihood fitting, to obtain odds ratios and their corresponding 95% CIs. Included in the regression equations were terms for education, plus terms significantly associated in this data set with the risk of SGA birth (smoking in pregnancy, history of SGA, gestational hypertension and parity). POPULATION Women admitted to a general and a university hospital. RESULTS No significant increase in the risk of SGA birth was observed in women with a previous induced abortion [odds ratio (OR) 1.0; 95% CI 0.6-1.7]. The OR for SGA birth was 1.2 (95% CI 0.7-2.1) for preterm and 1.0 (95% CI 0.7-1.4) for term SGA births. CONCLUSION This study found no association between risk of SGA birth and induced abortion.
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Affiliation(s)
- F Parazzini
- Seconda Clinica Ostetrico Ginecologica, Università di Milano, Fondazione Policlinico, Mangiagalli Regina Elena, Milano, Italy.
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Zuanna GD, De Rose A, Racioppi F. Low fertility and limited diffusion of modern contraception in Italy during the second half of the twentieth century. JOURNAL OF POPULATION RESEARCH 2005. [DOI: 10.1007/bf03031802] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uria M, Mosquera C. Legal abortion in Asturias (Spain) after the 1985 law: sociodemographic characteristics of women applying for abortion. Eur J Epidemiol 1999; 15:59-64. [PMID: 10098997 DOI: 10.1023/a:1007541904470] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE To describe the use of induced abortion (IA) in Asturias after its legalisation as well as the socio-demographic characteristics of women applying for abortion. DESIGN AND SETTING Descriptive study, population-based, using data collected by the regional abortion surveillance system for the period 1988 1994. MAIN RESULTS The number of IA and the abortion rate (AR) (10 per 1000 women aged 15-49) have been stable in Asturias during the study period. The highest ARs were found for women in the age group 20-34, for divorced/separated, for women with a higher educational level and for women with only one child. The proportion of pregnancies which ended in abortion was one in four; for teenagers and women over 34 years it was one in two. This proportion was also higher for women not married, students and women with two or more children. Ninety-eight percent of all abortions took place in private clinics, the woman's physical/mental health being the medical indication for these abortions. Abortion was most often performed within eight weeks of gestation (65%). Late abortion ocurred more frequently among teenagers and women of low educational level. Eighteen percent of women had repeated abortions. A high proportion (61%) of women applying for abortion had not used the Family Planning (FP) services in the previous two years; adolescents and women of low educational level had the lowest frequencies of FP use. CONCLUSIONS Compared with that of other European countries, the AR in Asturias was intermediate. The results regarding adolescents show the need for evaluation and promotion of sex education and contraceptive programmes. The lower and later use of abortion by women of low educational level shows inequalities that call for specific action.
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Affiliation(s)
- M Uria
- Servicio de Salud Pública, Consejería de Servicios Sociales, Asturias, Spain
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Parazzini F, Chatenoud L, Tozzi L, Di Cintio E, Benzi G, Fedele L. Induced abortion in the first trimester of pregnancy and risk of miscarriage. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:418-21. [PMID: 9609269 DOI: 10.1111/j.1471-0528.1998.tb10127.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the relation between induced abortion and risk of subsequent miscarriage. DESIGN Case-control study conducted between February 1990 and May 1995. PARTICIPANTS Case group included 782 women (median age 32 years, range 14-46) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14-45) were interviewed. RESULTS A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8-1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4-1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage. CONCLUSIONS This study did not find any strong association between induced and spontaneous abortion.
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Affiliation(s)
- F Parazzini
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Abstract
Induced abortion is widely practised in Taiwan; however, it had been illegal until 1985. It was of interest to investigate induced abortion practices in Taiwan after its legalization in 1985 in order to calculate the prevalence rate and ratio of induced abortion to live births and to pregnancies in Taiwan. A study using questionnaires through personal interviews was conducted on more than seventeen thousand women who attended a family planning service in Taipei metropolitan areas between 1991 and 1992. The reproductive history and sexual behaviour of the subjects were especially focused on during the interviews. Preliminary findings showed that 46% of the women had a history of having had an induced abortion. Among them, 54.8% had had one abortion, 29.7% had had two, and 15.5% had had three or more. The abortion ratio was 379 induced abortions per 1,000 live births and 255 per 1,000 pregnancies. The abortion ratio was highest for women younger than 20 years of age, for aboriginal women and for nulliparous women. When logistic regression was used to control for confounding variables, we found that the number of previous live births is the strongest predictor relating to women seeking induced abortion. In addition, a significant positive association exists between increasing number of induced abortions and cervical dysplasia.
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Affiliation(s)
- P D Wang
- Wanhwa District Health Center, Taipei, Taiwan
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Rodríguez Blas C, Sendra Gutiérrez JM, Regidor Poyatos E, Gutiérrez Fisac JL, Iñigo Martínez J. [Proposed method to estimate underreporting of induced abortion in Spain]. GACETA SANITARIA 1994; 8:63-70. [PMID: 7713678 DOI: 10.1016/s0213-9111(94)71174-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In Spain, from 1987 to 1990 the rate of legal abortion reported to the health authorities has doubled; nevertheless, the observed geographical differences suggest to an underreporting of the number of voluntary pregnancy terminations. Based on information on several sociodemographic, economic and cultural characteristics, contraceptive use, availability of abortion services, fertility indices, and maternal and child health status, five homogenEous groups of autonomous region were identified applying factor and cluster analysis techniques. To estimate the level of underreporting, we assumed that all the regions which shape a cluster ought to have the same abortion rate that the region with the highest rate in each group. We estimate that about 18,463 abortions (33.2%) were not reported during 1990. The proposed method can be used for assessing the notification since it allows to identify geographical areas where very similar rates of legal abortion are expected.
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Spinelli A, Grandolfo M, Donati S, Medda E. Family planning in Italy. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1993; 9:153-60. [PMID: 8237568 DOI: 10.1007/bf01990146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the past 5 years, four knowledge, attitude and practice (KAP) surveys on family planning have been organized by the Unit of Population Survey Methodology of the Istituto Superiore di Sanita' (National Institute of Health). These surveys show that during the past 20 years, use of reliable contraceptives in Italy has increased, particularly in the North, encouraged by the more open attitude toward sexual behavior, following legalization of the provision of information on contraception and abortion upon request, and other social and cultural changes. In 1989 and 1991, 25% of women in Central and Southern Italy were using the pill or an IUD. However, the percentage of women not using contraceptives was still high (26% in 1989, and 19% in 1991) and withdrawal was the most widely used method (31% and 33%). The data show large regional differences. The main reasons for not using contraception, in the 1989 study, were fear of side-effects and ignorance, especially in the youngest and oldest women. Those least likely to use modern contraception were the young, the ill-educated and the nulliparous women. Lack of information seems to be the main problem in Italy. In fact, the 5044 women interviewed showed a medium level of knowledge of contraception, with only 63% who could identify correctly the fecund period in the menstrual cycle. However, their attitude toward the use of modern contraception was positive; 65% of the women interviewed said they would recommend the Pill or an IUD to a friend, and 10% of them would recommend condoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Spinelli
- Department of Epidemiology and Biostatistics, Istituto Superiore di Sanita
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D'Avanzo B, Luchini L, Parazzini F, Negri E, La Vecchia C. Descriptive epidemiology of induced abortion in Italy 1979-1990. Contraception 1992; 46:549-59. [PMID: 1493715 DOI: 10.1016/0010-7824(92)90120-i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Trends of induced abortions in Italy from 1979 to 1990 have been analysed in terms of overall age-standardised rates and ratios, and according to various characteristics of the women. Temporal trends were characterised by an increase of rates from 11.3/1,000 women aged 15-49 in 1979 to 16.5 in 1982 and then followed by a steady decrease to 11.1/1,000 in 1990. Ratios increased from 228/1,000 livebirths in 1979 to 389 in 1984 and then declined to 286 in 1990. Thus, the overall declines from the early 1980's to 1990 were 33% in rates and 26% in ratios. The same pattern was followed by rates and ratios in various age groups. The highest rates were observed in women aged 25-29 years (27.0/1,000 in 1982 and 17.9/1,000 in 1988) and 30-34 years (25.5/1,000 in 1982 and 19.0/1,000 in 1988), and the lowest ones were in women aged 45-49 (1.0/1,000 in 1982 and 0.8/1,000 in 1988). Ratios reached the highest values in 1984 in most age groups, particularly in women between 40 and 49 years and under 20 years. Ratios increased constantly with number of previous deliveries. At all levels of education, a decline in rates has been observed since 1982, but in the highest educational level, the decline started earlier and was more substantial. The decline in rates among more educated women from 1982 to 1987 was 36%, but it was only 9% among less educated ones. Scope for further preventive action is indicated by the differences according to education and by the slowing down of the decline in the more recent years. This preventive intervention should be focused particularly to women of lower educational level and to those with two or more births.
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Affiliation(s)
- B D'Avanzo
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Spinelli A, Osborn JF. The effects of the Chernobyl explosion on induced abortion in Italy. Biomed Pharmacother 1991; 45:243-7. [PMID: 1912380 DOI: 10.1016/0753-3322(91)90024-n] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Four regression models have been fitted to data of the monthly number of induced abortions in Italy between January 1984 and April 1986, in order to predict the number which would have occurred in the 5 months following the Chernobyl explosion. In model I the average number of abortions per day in each month was the dependent variable and calendar months, a linear time trend and previous month's value were the independent variables. Model II included a quadratic time trend term in addition to the independent variables used in model I. Models III and IV were like models I and II except that the dependent variable was the average number of abortions per working day in each month and the effect of the previous month's value was omitted. The 4 models all implied that an excess number of abortions were performed in the 5 months following the Chernobyl accident. The mean daily excess was estimated to be 28 and 52 per day for models I and II and the mean excess per working day was estimated to be 20 and 30 by models III and IV, respectively. Clearly the estimated magnitude of the excess depends on whether the quadratic time trend is included among the explanatory variables, but these results imply that the excess is unlikely to be merely due to chance.
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Affiliation(s)
- A Spinelli
- Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy
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Umeki S. Points: Angiotensin converting enzyme inhibition and cough. West J Med 1988. [DOI: 10.1136/bmj.296.6615.136-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Douglas JDM. Points: Hyperlipidaemia and life insurance. West J Med 1988. [DOI: 10.1136/bmj.296.6615.136-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jones M. Points: Peritoneal lavage in acute appendicitis. West J Med 1988. [DOI: 10.1136/bmj.296.6615.136-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fisher JM. Points: Disasters and BASICS. West J Med 1988. [DOI: 10.1136/bmj.296.6615.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zolese G, Henryk-Gutt R. Points: Mania induced by biochemical imbalance. West J Med 1988. [DOI: 10.1136/bmj.296.6615.136-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wilson N. Points: Easing pain or hastening death? West J Med 1988. [DOI: 10.1136/bmj.296.6615.136-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Parazzini F, La Vecchia C, Fasoli M, Cecchetti G, Mezzanotte G. Trends in ectopic pregnancies and use of intrauterine devices in Lombardy, Italy 1979-1983. Contraception 1988; 37:29-38. [PMID: 3365982 DOI: 10.1016/0010-7824(88)90146-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The frequency of ectopic pregnancies in Lombardy (a region in Northern Italy with a population of about 9 million inhabitants) over the period 1979-1983 was estimated using the Regional Hospital Discharge Registration System, where information is collected on all discharges from public and private hospitals. The ratio of ectopic pregnancies rose from 4.43/1000 pregnancies in 1979 to 4.93/1000 pregnancies in 1982 and flattened off in 1983 (4.78/1000 pregnancies). The frequency of ectopic pregnancies increased with maternal age from 2.30/1000 pregnancies in teenagers to 6.01/1000 pregnancies in women 30-39 years old, but remained constant thereafter (5.84/1000 pregnancies in women aged 40 or older). These trends were consistent with available information on intrauterine device (IUD) sales over the same calendar period. On the basis of a random subsample of the same dataset, we evaluated by means of a case-control approach, the relative risk of ectopic pregnancy in relation to IUD use. Current IUD users had an estimated age-adjusted relative risk of ectopic pregnancy of 3.6 (95% confidence interval = 1.4-8.0) in comparison with an hospital-based control group of non-pregnant women. In etio-pathological terms, the interpretation of this finding is not obvious since it is possible that IUD users are simply less protected than pill, barrier or other traditional method users against ectopic pregnancy. Nonetheless, on a public health scale, the impact of IUD on the incidence of ectopic pregnancy should be evaluated in relative terms of comparison with other methods and their utilisation in different populations.
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Affiliation(s)
- F Parazzini
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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