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Rodgers YVDM, Coast E, Lattof SR, Poss C, Moore B. The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PLoS One 2021; 16:e0250692. [PMID: 33956826 PMCID: PMC8101771 DOI: 10.1371/journal.pone.0250692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although abortion is a common gynecological procedure around the globe, we lack synthesis of the known macroeconomic costs and outcomes of abortion care and abortion policies. This scoping review synthesizes the literature on the impact of abortion-related care and abortion policies on economic outcomes at the macroeconomic level (that is, for societies and nation states). METHODS AND FINDINGS Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined one of the following macroeconomic outcomes: costs, impacts, benefits, and/or value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 189 data extractions with macroeconomic evidence, costs at the national level are the most frequently reported economic outcome (n = 97), followed by impacts (n = 66), and benefits/value (n = 26). Findings show that post-abortion care services can constitute a substantial portion of national expenditures on health. Public sector coverage of abortion costs is sparse, and individuals bear most of the costs. Evidence also indicates that liberalizing abortion laws can have positive spillover effects for women's educational attainment and labor supply, and that access to abortion services contributes to improvements in children's human capital. However, the political economy around abortion legislation remains complicated and controversial. CONCLUSIONS Given the highly charged political nature of abortion around the global and the preponderance of rhetoric that can cloud reality in policy dialogues, it is imperative that social science researchers build the evidence base on the macroeconomic outcomes of abortion services and regulations.
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Affiliation(s)
- Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
- * E-mail:
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
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Soleimani Movahed M, Husseini Barghazan S, Askari F, Arab Zozani M. The Economic Burden of Abortion and Its Complication Treatment Cares: A Systematic Review. J Family Reprod Health 2021; 14:60-67. [PMID: 33603795 PMCID: PMC7865195 DOI: 10.18502/jfrh.v14i2.4354] [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] [Indexed: 11/24/2022] Open
Abstract
Objective: Abortion related procedures contribute to a significant economic burden because it resulted in prolonged hospital stays for patients. We aimed to gather available evidence on the economic burden of abortion and post-abortion complication treatment cares worldwide. Materials and methods: PubMed, Web of Science, Scopus, and Embase databases were searched through November 2019. Two researchers independently conducted the quality assessment and data extraction process. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2016 $US). Results: Totally, 2082 records were retrieved and 32 studies were deemed eligible for qualitative synthesis. The mean total costs per patient with abortion or post-abortion care ranged from $23 to $564. The annual costs ranged from 189,000 $US to 134 million $US. Conclusion: Abortion and post-abortion care impose a substantial economic burden on society. Understanding the burdensome of abortion or pregnancy termination among policymakers provides vital information and enables informed decisions to be made to establish health care priorities and allocating scarce resources.
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Affiliation(s)
- Maryam Soleimani Movahed
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Husseini Barghazan
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Askari
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Arab Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Lattof SR, Coast E, Rodgers YVDM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One 2020; 15:e0237227. [PMID: 33147223 PMCID: PMC7641432 DOI: 10.1371/journal.pone.0237227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies. METHODS AND FINDINGS Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources. CONCLUSIONS The evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.
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Affiliation(s)
- Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
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Rana J, Sen KK, Sultana T, Hossain MB, Islam RM. Prevalence and determinants of menstrual regulation among ever-married women in Bangladesh: evidence from a national survey. Reprod Health 2019; 16:123. [PMID: 31412951 PMCID: PMC6694470 DOI: 10.1186/s12978-019-0785-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh. METHODS Data for this study have been extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. The survey followed a two-stage stratified sampling procedure and the study used a sub-sample of 8084 ever-married women aged 15 to 49 years extracted from survey sample of 17,863. Univariate and multivariate mixed-effect logistic regression analyses were used to identify risk factors for MR accounting for potential between-clusters variations. RESULTS The weighted prevalence of MR was 12.3% (95% CI: 11.1-13.4%) among (991/8084) ever-married women. Women were less likely to have MR if they were from Chittagong (AOR 0.74, 95% CI: 0.57-0.96; p = 0.026) and Sylhet (AOR 0.53, 95% CI: 0.36-0.77; p = 0.001) divisions. Women were more likely to have MR if they were from high (AOR 1.47, 95% CI: 1.18-1.83; p = 0.001) and the highest (AOR 1.62, 95% CI: 1.27-2.05; p < 0.001) socioeconomic status (SES) group; being employed (AOR 1.35, 95% CI: 1.16-1.56; p < 0.001), having one or two children (AOR 1.73, 95% CI: 1.24-2.40: p = 0.001) and ≥ 3 children (AOR 2.56, 95% CI: 1.82-3.58; p < 0.001), and having membership of non-government organization (NGO) (AOR 1.18, 95% CI: 1.02-1.38; p = 0.030). CONCLUSION MR is prevalent among Bangladeshi women and independently associated with geographic location, SES, parity, employment and NGO membership status. Health policy should prioritize in reducing spatial and socioeconomic inequalities in relation to MR services by ensuring accessibility and availability of MR services, especially in suburban divisions. Furthermore, abortion should be legalized in Bangladesh that will ultimately reduce the morbidity and mortality associated with unsafe abortion.
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Affiliation(s)
- Juwel Rana
- South Asia Institute for Social Transformation (SAIST), Dhaka, Bangladesh and Environmental and Occupational Health Sciences, EHESP French School of Public Health, Paris, France
| | | | - Toufica Sultana
- Department of Sociology, University of Saskatchewan, Saskatoon, Canada
| | | | - Rakibul M. Islam
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Mutua MM, Manderson L, Musenge E, Achia TNO. Policy, law and post-abortion care services in Kenya. PLoS One 2018; 13:e0204240. [PMID: 30240408 PMCID: PMC6150499 DOI: 10.1371/journal.pone.0204240] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/14/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Unsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy. METHODS A cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality. RESULTS The provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge. DISCUSSION Legal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination. CONCLUSION Greater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.
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Affiliation(s)
- Michael Mbithi Mutua
- African Population and Health Research Center (APHRC), Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute at Brown for Environment & Society (IBES), Brown University, Providence, Rhode Island, United States of America
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas Noel Ochieng Achia
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centers for Disease Control and Prevention, Nairobi, Kenya
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'We have the internet in our hands': Bangladeshi college students' use of ICTs for health information. Global Health 2018; 14:31. [PMID: 29554929 PMCID: PMC5859416 DOI: 10.1186/s12992-018-0349-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers' control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students' usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this. METHODS This study relies on two surveys: a 2013-2014 General Survey that randomly sampled 854 households drawn from the general population and a 2015 Student Survey that randomly sampled 436 students from two Mirzapur colleges. Select focus group discussions and in-depth interviews were undertaken with students. Icddr,b's Ethical Review Board granted ethical clearance. RESULTS The data show that Mirzapur's college students are economically relatively well positioned, more likely to own mobile and smart phones, and more aware of the internet than the general population. They are interested in health information and use phones and computers to access information. Moreover, they use digital technology to share previously-discreet information, adding value to that information and bypassing former gatekeepers. But access to health information is not entirely unfettered, affecting male and female students differently, and powerful gatekeepers, both old and new, can still control sources of information. CONCLUSION Personal searches for SRH and the resultant online information shared through discrete, personal face-to-face discussions has some potential to challenge social norms. This is particularly so for women students, as sharing information may enable them to bypass gatekeepers and make decisions about reproduction. This suggests that digital health information seeking may be exercising a disruptive effect within the health sector. However, the extent of this disruption may depend, not on students' mobile phone usage, but on the degree to which powerful new gatekeepers are able to retain control over and market SRH information through students' peer-to-peer sharing.
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Lince-Deroche N, Harries J, Constant D, Morroni C, Pleaner M, Fetters T, Grossman D, Blanchard K, Sinanovic E. Doing more for less: identifying opportunities to expand public sector access to safe abortion in South Africa through budget impact analysis. Contraception 2017; 97:167-176. [PMID: 28780240 DOI: 10.1016/j.contraception.2017.07.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/17/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) To estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. STUDY DESIGN We conducted a budget impact analysis using public sector abortion statistics and published cost data. We estimated the total costs to the public health service over 10 years, starting in South Africa's financial year 2016/17, given four scenarios: (1) holding service provision constant, (2) expanding public sector provision, (3) changing the abortion technologies used (i.e. the method mix), and (4) expansion plus changing the method mix. RESULTS The public sector performed an estimated 20% of the expected total number of abortions in 2016/17; 26% and 54% of all abortions were performed illegally or in the private sector respectively. Costs were lowest in scenarios where method mix shifting occurred. Holding the proportion of abortions performed in the public-sector constant, shifting to more cost-effective service provision (more first-trimester services with more medication abortion and using the combined regimen for medical induction in the second trimester) could result in savings of $28.1 million in the public health service over the 10-year period. Expanding public sector provision through elimination of unsafe abortions would require an additional $192.5 million. CONCLUSIONS South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided. More research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions. IMPLICATIONS South Africa can provide more safe abortions for less money in the public sector through shifting to more first-trimester methods, including more medication abortion, and shifting to a combined mifepristone plus misoprostol regimen for second trimester medical induction. Expanding access in addition to method mix changes would require additional funds.
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Affiliation(s)
| | - Jane Harries
- Women's Health Research Unit, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Deborah Constant
- Women's Health Research Unit, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chelsea Morroni
- Women's Health Research Unit, School of Public Health, University of Cape Town, Cape Town, South Africa; EGA Institute for Women's Health and Institute for Global Health, University College London, London, UK
| | - Melanie Pleaner
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Daniel Grossman
- Ibis Reproductive Health, Oakland, CA, USA; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | | | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Pearson E, Andersen KL, Biswas K, Chowdhury R, Sherman SG, Decker MR. Intimate partner violence and constraints to reproductive autonomy and reproductive health among women seeking abortion services in Bangladesh. Int J Gynaecol Obstet 2017; 136:290-297. [PMID: 28099690 PMCID: PMC5324615 DOI: 10.1002/ijgo.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/12/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand intersections between intimate partner violence (IPV) and other constraints to women's reproductive autonomy, and the influence of IPV on reproductive health. METHODS A secondary analysis examined cross-sectional data from a facility-based sample of women seeking abortion care (for spontaneous or induced abortion) between March 1 and October 31, 2013. Women aged 18-49 years, who received abortion services and selected a short-acting contraceptive method or no contraception completed an interviewer-administered survey after treatment. Adjusted prevalence ratios (aPRs) were calculated for associations between IPV experience and potential constraints to reproductive autonomy and health outcomes. RESULTS There were 457 participants included in the present analysis and 118 (25.8%) had experienced IPV in the preceding year. IPV was associated with discordance in fertility intentions with husbands/partners and in-laws, with in-law opposition to contraception, with perceived religious prohibition of contraception, and with presenting unaccompanied (all P<0.05). IPV was also associated with receiving post-abortion care after an induced abortion compared with accessing legal menstrual regulation, and with the use of medication abortion compared with manual vacuum aspiration (both P<0.05). CONCLUSION Intimate partner violence was associated with additional constraints on reproductive autonomy from husbands/partners, in-laws, and religious communities. Seeking induced abortion unaccompanied and using medication abortion could be strategies to access abortion covertly among women experiencing IPV. Ensuring women's reproductive freedom requires addressing IPV and related constraints.
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Affiliation(s)
- Erin Pearson
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | - Kamal Biswas
- Research and Evaluation UnitIpas BangladeshDhakaBangladesh
| | | | - Susan G. Sherman
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Michele R. Decker
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Pearson E, Biswas KK, Andersen KL, Moreau C, Chowdhury R, Sultana S, Shahidullah SM, Surkan PJ, Decker MR. Correlates of contraceptive use 4 months postabortion: findings from a prospective study in Bangladesh. Contraception 2016; 95:279-287. [PMID: 27743769 DOI: 10.1016/j.contraception.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels. STUDY DESIGN This prospective study assessed correlates of contraceptive use 4 months postabortion and timing of initiation using a facility-based sample of 398 abortion clients who selected pills, condoms, injectables or no method immediately following the procedure. We measured potential correlates immediately following abortion, inclusive of spontaneous or induced abortion, and assessed contraceptive use outcomes 4 months postabortion. Multivariable logistic regression models identified correlates at each level. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling. RESULTS Reported contraceptive use 4 months postabortion was high (85.4%). Contraceptive use at the index pregnancy (resulting in abortion) was the primary correlate of contraceptive use 4 months postabortion (adjusted odds ratio=2.9; 95% confidence interval: 1.5-5.9). Delayed contraceptive initiation was more common among women who reported past year IPV (36.8% vs. 19.5%; p=.03) particularly with spousal accompaniment for abortion, those in relationships with discordant fertility intentions (44.4% vs. 21.9%; p=.04) and those receiving medication abortion (56.7%) or dilation and curettage (57.1%), compared to manual vacuum aspiration (12.6%; p<.01). CONCLUSIONS Contraceptive use at the index pregnancy was the primary correlate of contraceptive use 4 months postabortion. Abortion procedure type and relationship dynamics were correlated with delayed postabortion contraceptive initiation. Women who reported IPV delayed initiation when accompanied by their spouse for abortion. IMPLICATIONS Postabortion contraceptive counseling should assess previous use patterns and provide information on using contraception effectively. Delayed initiation among women reporting IPV could be addressed through comprehensive, confidential counseling that includes violence screening, support for contraceptive initiation and offer of woman-controlled methods.
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Affiliation(s)
- Erin Pearson
- Ipas, P.O. Box 9990, Chapel Hill, NC, USA 27515; Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205.
| | - Kamal Kanti Biswas
- Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000
| | | | - Caroline Moreau
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
| | - Rezwana Chowdhury
- Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000
| | - Sharmin Sultana
- Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000
| | - S M Shahidullah
- Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000
| | - Pamela J Surkan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
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Ilboudo PGC, Greco G, Sundby J, Torsvik G. Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso. BMC Health Serv Res 2016; 16:559. [PMID: 27717356 PMCID: PMC5055714 DOI: 10.1186/s12913-016-1822-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. METHODS The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. RESULTS Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. CONCLUSIONS The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010.
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Affiliation(s)
- Patrick G. C. Ilboudo
- Département de Santé Publique, Unité de Recherche Politiques et Systèmes de Santé, Centre MURAZ, 2054 Avenue Mamadou Konaté, 01 BP 390, Bobo-Dioulasso, Burkina Faso
- Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Giulia Greco
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Health Economics and Systems Analysis Group, London, UK
| | - Johanne Sundby
- Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Gaute Torsvik
- University of Bergen and Chr Michelsen Institute, Bergen, Norway
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Mutua MM, Maina BW, Achia TO, Izugbara CO. Factors associated with delays in seeking post abortion care among women in Kenya. BMC Pregnancy Childbirth 2015; 15:241. [PMID: 26445973 PMCID: PMC4597436 DOI: 10.1186/s12884-015-0660-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 09/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Delays in seeking quality post abortion care services remain a major contributor to high levels of mortality and morbidity among women who experience unsafe abortion. However, little is known about the causes of and factors associated with delays in seeking care among women who suffer complications of unsafe abortion. This study looks at factors that are associated with delays in seeking post-abortion care among women in Kenya. Methods Data for this study were from a nationally representative sample of 350 healthcare facilities that participated in the 2012 Incidence and Magnitude of Unsafe Abortion study in Kenya. Data included socio-demographic characteristics, reproductive health and clinical histories from all women treated with PAC during a one-month data collection period. Results Delay in seeking care was associated with women’s age, education level, contraceptive history, fertility intentions and referral status. Conclusions There is need to improve women’s access to quality sexual and reproductive health information and services, contraception and abortion care. Improving current PAC services at lower level facilities will also minimize delays resulting from long referral processes.
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Affiliation(s)
- Michael M Mutua
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya. .,School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Beatrice W Maina
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Thomas O Achia
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Chimaraoke O Izugbara
- African Population and Health Research Center, 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
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Jahan R, Afsana K. Commentary: Sustaining progress towards comprehensive reproductive health services in Bangladesh. Glob Public Health 2014; 10:180-2. [PMID: 25515587 PMCID: PMC4318119 DOI: 10.1080/17441692.2014.986164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rounaq Jahan
- a Centre for Policy Dialogue (CPD) , Dhaka , Bangladesh
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13
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Huda FA, Ngo TD, Ahmed A, Alam A, Reichenbach L. Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey. Int J Gynaecol Obstet 2013; 124:164-8. [PMID: 24268354 DOI: 10.1016/j.ijgo.2013.07.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/22/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the availability and provision of misoprostol and other medicines for menstrual regulation (MR) among pharmacies in Bangladesh. METHODS Between March and November 2011, a cross-sectional study using mystery client visits was conducted among pharmacy workers in Dhaka and Gazipur Districts, Bangladesh. Mystery clients were trained to present 1 of 4 pre-developed situations to pharmacy workers to elicit information on the regimen, adverse effects, and complications of misoprostol use. RESULTS Mystery clients visited 331 pharmacies. Among the 331 pharmacy workers, 45.8% offered the mystery clients misoprostol and/or other medicines for MR; 25.7% referred them to private clinics or hospitals. Only 7% recommended an effective regimen of misoprostol for MR; 65% suggested administering vaginal and oral misoprostol together. Overall, 72.4% did not provide any advice on complications; the remainder suggested visiting trained providers for complications. Counseling on excessive bleeding as a danger sign was provided by 46% of pharmacy workers. Most (94%) did not provide or refer for post-MR family planning. CONCLUSION Pharmacy workers in urban Bangladesh are providing ineffective drugs and regimens for MR. A training package is needed to strengthen service delivery by providing accurate information, high-quality products, and referral mechanisms for women seeking MR through pharmacies.
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Affiliation(s)
- Fauzia A Huda
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Thoai D Ngo
- Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK
| | - Anisuddin Ahmed
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anadil Alam
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Laura Reichenbach
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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14
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Johnston HB, Akhter S, Oliveras E. Quality and efficiency of care for complications of unsafe abortion: a case study from Bangladesh. Int J Gynaecol Obstet 2013; 118 Suppl 2:S141-7. [PMID: 22920618 DOI: 10.1016/s0020-7292(12)60013-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Treating complications of unsafe abortion can be financially draining for health systems. This analysis assessed incremental health system costs of service delivery for abortion-related complications in the Bangladesh public health system and confirmed that providing postabortion care with vacuum aspiration is less expensive than using dilation and curettage (D&C). Implementing several evidence-based best practices, such as replacing D&C with vacuum aspiration, reducing use of high-level sedation, authorizing midlevel providers to offer postabortion care, and providing postabortion contraceptive counseling and services to women while still at the health facility, could increase the quality and cost efficiency of postabortion care in Bangladesh.
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15
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Luis Roberto RS, Carlos Alberto VV, Patricio Reinaldo VG, Herenia Gutiérrez Ponce. Impacto de Dos Métodos Alternativos de Asignación de Costos Indirectos Estructurales de Hospitales Públicos Chilenos en el Costo Final de Producción de Servicios Sanitarios. Value Health Reg Issues 2012; 1:142-149. [DOI: 10.1016/j.vhri.2012.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mbizvo MT, Say L. Global progress and potentially effective policy responses to reduce maternal mortality. Int J Gynaecol Obstet 2012; 119 Suppl 1:S9-12. [PMID: 22883916 DOI: 10.1016/j.ijgo.2012.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Reducing maternal mortality within significant margins is a global imperative that reflects attainment of development goals. Progress in reducing maternal mortality, in particular among countries with notably high maternal mortality ratios (MMRs), has been substantially slower than the Millennium Development Goal target of an annual rate of 5.5% decline. The latest UN maternal mortality estimates show a reduction in MMR in a number of countries between 1990 and 2008. Understanding the factors associated with progress in countries that have reduced maternal mortality provides other countries and development partners with opportunities to consider and implement policies and interventions that could help accelerate progress. This paper reviews 6 countries that have demonstrated marked progress. The policies that have been effective include innovative financing measures; investment in human resources both in terms of strengthening pre-service education and emphasizing in-service training for healthcare providers; strengthening obstetric care by enhancing infrastructure and upgrading equipment, as well as improving quality of services; and investing in the broader determinants of maternal mortality, particularly family planning and women's education and socioeconomic empowerment. This range of actions, which includes a combination of facility and community-based approaches, provides a list of potentially effective strategies that could be considered when developing programs in other countries with slower progress. Strong political will and multistakeholder involvement and interventions are key in the development and implementation of these policies and actions.
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Affiliation(s)
- Michael T Mbizvo
- Department of Reproductive Health and Research includes HRP, UNDP/UNFPA/WHO/World Bank Special Programme of Research in Human Reproduction, World Health Organization, Geneva, Switzerland.
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Sahu B, Hutter I. 'Lived Islam' in India and Bangladesh: negotiating religion to realise reproductive aspirations. CULTURE, HEALTH & SEXUALITY 2012; 14:521-535. [PMID: 22468853 DOI: 10.1080/13691058.2012.672652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper seeks to answer the question of how Muslim women interpret and negotiate religion in order to realise their reproductive aspirations. A close reading of lived experiences of 32 Muslim women from a varied educational background yields a wider perspective of the different interpretations of reproductive norms employed by adherents of the same religion (Islam), situated in two countries (India/Bangladesh) and group (majority/minority) contexts. Further, this comparative study yields a deeper understanding of agency that is employed by Muslim participants in each country. Muslim women - both in India and Bangladesh - are not passive followers of religious norms, but have agency to bring change in their own life and take an active role in planning their family, thereby transgressing religious norms in reproductive matters. Muslim women in India exercise their agency by adopting sterilisation - a method proscribed by Islam - without the knowledge of their significant others. Muslim women in Bangladesh use their agency by making a flexible interpretation of Islam in reproductive matters. A lesson learned from this comparative study is the need to remove barriers that prevent the adoption of contraceptives by Muslim minorities in India and to design family planning programmes that takes into account their religious needs.
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Affiliation(s)
- Biswamitra Sahu
- Population Research Centre, University of Groningen, Groningen, Netherlands.
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