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Tsulukidze M, Reardon DC, Craver C. Effects of prior reproductive losses on risk of cardiovascular diseases within six months of a first live birth. Int J Cardiol Cardiovasc Risk Prev 2024; 21:200260. [PMID: 38525098 PMCID: PMC10957406 DOI: 10.1016/j.ijcrp.2024.200260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Objective There is emerging evidence suggesting that pregnancy loss (induced or natural) is associated with an increased risk of cardiovascular diseases (CVD). This prospective longitudinal study investigates the effect of prior pregnancy losses on CVD risk during the first six months following a first live birth. Methods Medicaid claims of 1,002,556 low-income women were examined to identify history of pregnancy losses, CVD, diabetes, and hyperlipidemia prior to first live birth. The study population was categorized into five groups: A: women with no pregnancy loss or CVD history prior to first live birth; B: women with pregnancy loss and no CVD prior to first live birth. C: women with a first CVD diagnosis after a first pregnancy ending in a loss and before their first live birth. D: women with CVD prior to first live birth and no history of pregnancy loss. E: women with both CVD and pregnancy loss prior to their first live birth. Results After controlling for age, race, state of residence, and history of diabetes and hyperlipidemia, the risk of CVD in the six-month period following a first live birth were 15%, 214%, 79% and 129% more common for Groups B, C, D and E, respectively, compared to Group A. Conclusions Pregnancy loss is an independent risk factor for CVD risk following a first live birth, both for women with and without a prior history of CVD. The risk is highest when CVD is first diagnosed after a pregnancy loss and prior to a first live birth.
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Affiliation(s)
| | - David C. Reardon
- Elliot Institute, Gulf Breeze, FL, USA
- Charlotte Lozier Institute, Arlington, VA, USA
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Carvajal B, White H, Brooks J, Thomson AM, Cooke A. Chilean midwives' experiences while providing induced abortion care after the enactment of a law decriminalising abortion. Women Birth 2024; 37:101586. [PMID: 38331633 DOI: 10.1016/j.wombi.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care. METHODS A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study. RESULTS This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'. CONCLUSION Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives.
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Affiliation(s)
- Bielka Carvajal
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; Departamento de Promocion de la Salud de la Mujer y el Recien Nacido, Universidad de Chile, Chile.
| | - Helen White
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK
| | - Jane Brooks
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK
| | - Ann M Thomson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK
| | - Alison Cooke
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK; Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
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Carvajal B, White H, Brooks J, Thomson AM, Cooke A. Navigating a maze: Midwives' identity response to the enactment of an abortion law in Chile. Midwifery 2024; 131:103938. [PMID: 38309123 DOI: 10.1016/j.midw.2024.103938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/23/2023] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. OBJECTIVE To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. METHODS This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. FINDINGS Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements. CONCLUSION Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.
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Affiliation(s)
- Bielka Carvajal
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; Departamento de Promocion de la Salud de la Mujer y el Recien Nacido, Universidad de Chile, Chile.
| | - Helen White
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK.
| | - Jane Brooks
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK.
| | - Ann M Thomson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK.
| | - Alison Cooke
- Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK; Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhou X, Liu X, Xiong C, Gu X, Lv W, Wang B, Hou C, Zhao Y. Safety and effectiveness evaluation of a uterine direct visualization system in induced abortion. A multicenter clinical trial. Taiwan J Obstet Gynecol 2024; 63:214-219. [PMID: 38485317 DOI: 10.1016/j.tjog.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES While the decision of abortion is undeniably complex, there are situations where it becomes a necessary choice. In such circumstances, a secure abortion procedure is essential to safeguard the physical and mental well-being of women. A uterine direct visualization system was designed to fulfill the requirements and this study undertook an assessment of the system's safety and effectiveness within a medical facility setting. MATERIALS AND METHODS Induced abortion requested women in 17 institutions across the country between December 2016 and February 2017 were enrolled. Subjects were separated to the study and control group randomly. Induced abortion was conducted by a uterine direct visualization system and an ultrasound-guided system in the study and control group, respectively. The clinical indexes collected during intra- and post-procedures were analyzed and compared between groups. RESULTS Overall, 392 and 339 subjects were included in the study and control group, respectively. The baseline demographic and clinical characteristics were similar between two groups. Subjects in the study group had significant smaller number of uterine cavity entry (p < 0.001), less 2-h and 14-days postoperative bleeding (all p < 0.001), and less 14-days postoperative abdominal pain (p < 0.001). Significantly higher ratio of normal menstruation, in terms of incidence and duration after 60-days of operation, was observed in the study group (all p < 0.001). CONCLUSIONS Induced abortion with uterine direct visualization system generate better outcome and less complication than the conventional ultrasound-guided abortion procedures.
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Affiliation(s)
- Xiaofei Zhou
- Department of Obstetrics and Gynecology, School of Medicine Renji Hospital Shanghai Jiaotong University, Shanghai, China
| | - Xinyan Liu
- Department of Obstetrics and Gynecology, Beijing Union Medical College Hospital, Beijing, China
| | - Chengliang Xiong
- Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science Technology, Wuhan, China.
| | - Xiangying Gu
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen Lv
- Department of Gynecology, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Banglan Wang
- Department of Gynecology, Anhui Maternal and Child Health Hospital, Hefei, China
| | - Chunmei Hou
- Department of Obstetrics and Gynecology, School of Medicine Renji Hospital Shanghai Jiaotong University, Shanghai, China
| | - Yong Zhao
- Marketing Center, Chongqing Jinshan Science & Technology (Group) Co., Ltd, Chongqing, China
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Klemets L, Makenzius M. Exposure to violence and associated factors among abortion-seeking women - A multicentre study in Sweden during the Covid-19 pandemic. Sex Reprod Healthc 2024; 39:100927. [PMID: 38039662 DOI: 10.1016/j.srhc.2023.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/13/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
This study aimed to investigate factors associated with exposure to violence over the past 12 months among women seeking abortion. MATERIALS AND METHODS We conducted a cross-sectional study, nested within a multi-center questionnaire survey, involving 623 abortion-seeking women in Sweden from January to June 2021. Descriptive statistics, bivariate analyses, and multivariate regression analysis (using odds ratios [OR] and 95% confidence intervals [CI]) were employed. RESULTS Out of the 623 women, 9.9% (n = 59) reported exposure to physical, psychological, and/or sexual violence in the past 12 months. Several factors were correlated with being a victim of violence. However, after adjustment in the regression model, the significant factors included: age 16-26 (OR 2.37, 95% CI; 1.24-4.52, p <.009), poor physical and mental well-being prior to pregnancy (OR 3.29; CI 1.69-6.40, p <.001), having had ≥ 2 previous abortions (OR 2.27, 95% CI; 1.16-4.44, p =.017), and being single (OR 4.70, 95% CI; 2.51-8.77, p <.001). CONCLUSION Nearly one in ten women seeking abortion reported exposure to violence in the preceding year. Being young, having poor physical and mental health, undergoing multiple abortions, and singlehood emerge as risk factors for violence exposure. Abortion providers have a crucial role and should consistently identify women exposed to violence, offering them the necessary guidance and referrals for further support.
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Affiliation(s)
- L Klemets
- Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden
| | - M Makenzius
- Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Xu S, Zhao W, Zhang Y, Qiang C, Zhang C. The effect of previous induced abortion history on the assisted reproduction outcomes. Arch Gynecol Obstet 2024; 309:469-474. [PMID: 36708427 DOI: 10.1007/s00404-023-06928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To study whether the history of induced abortion has an effect on the assisted reproduction outcomes in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS 3045 patients who underwent IVF-ET in the Department of Human Reproductive Center of Renmin Hospital from January 2017 to June 2021. They were divided into two groups according to whether there was a history of induced abortion in the past, and the outcomes were compared between the two groups. RESULTS The clinical pregnancy rate in the group with induced abortion history was lower than that in the group without induced abortion history (63.1% vs 67.1%), but the difference was not statistically significant (P = 0.059). The spontaneous abortion rate in the group with induced abortion history was higher than that in the group without induced abortion history (14.9% vs 11.2%) (P = 0.044). The live birth rate in the group with induced abortion history was lower than that in the group without induced abortion history (52.8% vs 59.0%) (P = 0.006). Stepwise logistic regression analysis showed that endometrial thickness (OR = 0.928, 95% CI = 0.886 ~ 0.972, P = 0.002) and live birth rate (OR = 0.682, 95% CI = 0.495 ~ 0.939, P = 0.019) were negatively correlated with induced abortion history. The rate of spontaneous abortion (OR = 1.452, 95% CI = 1.042 ~ 2.024, P = 0.028) was positively correlated with the history of induced abortion. CONCLUSIONS The previous history of induced abortion is related to the outcomes of IVF /ICSI-ET, the endometrial thickness on HCG trigger day decreased, the risk of spontaneous abortion increased and the live birth rate decreased in patients with induced abortion history when undergoing IVF/ICSI-ET.
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Affiliation(s)
- Shaoyuan Xu
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Wenxian Zhao
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Ying Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Cancan Qiang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.
| | - Changjun Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
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Sun H, Mao J, Su X, Du Q. Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies. BMC Public Health 2023; 23:2360. [PMID: 38031055 PMCID: PMC10685546 DOI: 10.1186/s12889-023-17264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND At present, there are several studies on abortion history and perinatal outcomes, but there is no unified conclusion whether the history of abortion and different types of abortion are related to perinatal complications of subsequent pregnancy. We aim to study the impact of different types of abortion history on perinatal outcomes of singleton pregnancies. METHODS This was a retrospective study from a maternity and infant hospital in Shanghai, China from 2016 to 2020. Pregnant women who gave birth to live singleton infant were included (n = 75,773). We classified abortion into spontaneous abortion (SAB) and induced abortion (IA). We compared the perinatal outcomes of singleton pregnancies with different abortion histories and used Logistic regression analysis to evaluate the associations between pre-pregnancy abortion history with perinatal outcomes. RESULTS We observed that pregnant women with a history of abortion were more likely to have a premature delivery (0.99% VS 0.45%), gestational diabetes mellitus (GDM) (13.40% VS 10.29%), placenta abnormality (8.16% VS 5.06%), placenta previa (5.65% VS 3.75%), placenta accreta (0.18% VS 0.04%), and placenta adhesion (2.79% VS 1.03%) than those who obtained singleton pregnancies without a history of abortion. When confounding factors were adjusted, differences in placenta abnormality still existed (excluding placenta abruption). The odds ratios and 95% confidence interval of placenta previa, placenta accreta, and placenta adhesion in pregnant women with only SAB history, only IA history, and both abortion history were 1.294(1.174-1.427), 1.272(1.159-1.396), and 1.390(1.188-1.625), 2.688(1.344-5.374), 2.549(1.268-5.125), and 5.041(2.232-11.386), 2.170(1.872-2.515), 2.028(1.738-2.366), and 3.580(2.917-4.395), respectively. CONCLUSIONS Our research showed that pregnant women who have a history of abortion before pregnancy were more likely to have premature birth, GDM, placenta previa, placenta accreta, and placenta adhesion. After adjusting for confounding factors, we found that the history of SAB, IA, and both SAB and IA history were related to the increased risk of placenta previa, placenta accreta, and placenta adhesion.
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Affiliation(s)
- Hanxiang Sun
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jing Mao
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qiaoling Du
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Wang T, Si L, Jiang Q. Induced abortions among Chinese adolescent girls. BMC Womens Health 2023; 23:597. [PMID: 37957592 PMCID: PMC10644521 DOI: 10.1186/s12905-023-02754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Induced abortion among adolescent girls is a global public health issue and a serious challenge in China, but still remains under-examined. We aimed to examine the overall trend and characteristics of induced abortions among Chinese adolescent girls and to investigate the factors associated with induced abortion. STUDY DESIGN Based on the 2017 China Fertility Survey, this study examined the trend and characteristics of induced abortions among adolescent girls with statistical analysis and multiple indicators of descriptive statistics from period and cohort perspectives, including induced abortion proportion and rate, age-specific cumulative proportion, and age-specific cumulative number of induced abortions in adolescent girls. RESULTS Between 1996 and 2016, the proportion and rate of adolescent induced abortions first increased and then decreased, and the mean age at the time of induced abortions among adolescent girls declined. The cumulative proportion of women who had experienced induced abortion at the age of 15-19 in a cohort is less than 2.5% but shows an upward trend. Over 70% of all adolescent induced abortions are premarital. The proportion of women with unintended pregnancy experiences increased and is higher among rural, less educated, and ethnic minority women. Similarly, the prevalence of induced abortion is higher among adolescent girls who live in rural areas, are less educated, and come from ethnic minorities. The cumulative number of induced abortions and premarital abortions increased with later cohorts. CONCLUSIONS This study shows an upward trend in adolescent-induced abortion and a decline in the age at the time of the induced abortion. Women in later birth cohort have a higher proportion of having experienced adolescent induced abortion. Adolescent girls who live in rural areas, who are less educated, or who are from ethnic minorities, are more likely to undergo induced abortions at the age of 15-19. More appropriate educational efforts and interventions are urgently needed to reduce the incidence of adolescent induced abortions.
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Affiliation(s)
- Tian Wang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Quanbao Jiang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China.
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Wojcicki J, Wawrysiuk S, Sochacki-Wojcicka N, Podlinska O, Pietrych L, Szpotanska-Sikorska M. More than a hundred thousand respondents within 48 h: How the power of social media helped to understand pregnancy loss in Poland - A retrospective population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 289:29-35. [PMID: 37625286 DOI: 10.1016/j.ejogrb.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Miscarriage is defined as the loss of pregnancy before 20-24 weeks of gestation, and it is the most common complication of early pregnancy. The aim of the study was to determine the prevalence and risk factors of spontaneous abortion in the population of Polish females to provide a reference for clinical work. METHODS A cross-sectional self-administered on-line survey was distributed between 4th and 5th of October 2019 in the social media across Poland. A total of 100,026 recipients responded to the questionnaire and 93,636 valid respondents were included in the analyses. RESULTS Among respondents who had ever been pregnant, 31.2% reported at least one spontaneous abortion. The prevalence of miscarriage varied based on age, parity, place of residence and the education level. The first symptom of miscarriage was a vaginal bleeding (56.2%) and abdominal cramps (25.8%), while 43% of respondents had no symptoms and found out during doctor's visit. No medical assistance was required after complete spontaneous abortion in 39.2% of cases. CONCLUSIONS Miscarriage is a common complication of pregnancy, but it is not yet fully understood. The goal of future medicine is to minimize the medicalization of spontaneous abortion and excessive medical intervention by raising awareness about natural miscarriage route.
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Affiliation(s)
- Jakub Wojcicki
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Sara Wawrysiuk
- 2nd Department of Gynaecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Nicole Sochacki-Wojcicka
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Olga Podlinska
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Lukasz Pietrych
- Department of Econometrics and Statistics, Warsaw University of Life Sciences - SGGW, Nowoursynowska 166, 02-787 Warszawa, Poland
| | - Monika Szpotanska-Sikorska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
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Seyoum K, Mengistu S. Prevalence and determinants of repeat induced abortion in Ethiopia: A systematic review and meta-analysis. Heliyon 2023; 9:e20277. [PMID: 37810839 PMCID: PMC10550621 DOI: 10.1016/j.heliyon.2023.e20277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Repeat-induced abortion is the termination of pregnancy for more than one time using drugs or surgical intervention before the fetus reaches the age of viability. This study aimed to estimate the pooled prevalence of repeat-induced abortion and its determinants among women in Ethiopia. Materials and methods PubMed, HINARI and Google Scholar were systematically searched for eligible studies. A random effect model was used to estimate the pooled prevalence. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity between included studies. Results The estimated pooled prevalence of repeat-induced abortion was 30.89% (95% CI: 28.88-32.91). Alcohol consumption (POR = 3.60, 95%CI: 2.26-5.74), assuming the procedure painless (POR = 2.79, 95%CI: 1.77-4.39), no fertility awareness (POR = 3.45, 95% CI: 1.05-11.36), and women with multiple sexual partners (POR = 4.31, 95% CI: 3.36-5.53) were significantly associated with repeat-induced abortion. Conclusion The study revealed that about one in ten women who had a history of abortion experienced repeat-induced abortion. Alcohol consumption, no fertility awareness, assuming the procedure is painless, and having multiple sexual partners were significantly associated with repeat-induced abortion.
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Affiliation(s)
- Kenbon Seyoum
- Department of Midwifery, Goba General Hospital, School of Health Science, Madda Walabu University, P.O.box: 247, Bale Robe, Goba, Ethiopia
| | - Sheleme Mengistu
- Department of Midwifery, Goba General Hospital, School of Health Science, Madda Walabu University, P.O.box: 247, Bale Robe, Goba, Ethiopia
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Armour S, Keedle H, Gilkison A, Dahlen HG. Midwifery care for late termination of pregnancy: Integrative review. Sex Reprod Healthc 2023; 37:100889. [PMID: 37454584 DOI: 10.1016/j.srhc.2023.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role.
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Affiliation(s)
- Susanne Armour
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
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13
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Gouret G, Faucher P, Kayem G, Pinton A. [ Induced abortion between 14 and 16th: Clinical context and complications]. Gynecol Obstet Fertil Senol 2023; 51:415-419. [PMID: 37406810 DOI: 10.1016/j.gofs.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE This study aims to characterize the women's health care pathway and to evaluate the rate of complications during a surgical abortion according to the technique of dilatation and evacuation between 14 and 16 SA. METHOD Single-center prospective study at the Armand Trousseau Hospital with inclusion of women who had an abortion between 14 and 16 GA in the Obstetrics & Gynecology Department of the Armand Trousseau Hospital between March 2 and October 31, 2022. RESULTS Forty-six women underwent an abortion during this 8-month period. The average gestational age at which the abortions were performed was 15 weeks' gestation with an median delay of 14.0 days between the date of discovery of the pregnancy and the date of the abortion with more than half of the women (65.2 %, N=30) having consulted for the first time for an abortion request before 14 weeks' gestation. Of these women, 22 (48.9%) had to consult several hospitals before being treated. One woman (2.2% 95% CI [0.0-6.4]) had a haemorrhage defined by bleeding more than 500ml. Cervical suture for cervical tear was performed in four women (8.7% 95% CI [0.0-16.8]). There were no complications such as perforation, postoperative infection or surgical revision. No women were transfused. CONCLUSION The introduction in our center of surgical abortion using the dilatation and evacuation technique performed between 14 and 16 weeks' gestation wasn't accompanied by significant morbidity. The women's pathway before the procedure probably contributed to the later performance of the abortion.
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Affiliation(s)
- Gladys Gouret
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Philippe Faucher
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Gilles Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France
| | - Anne Pinton
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France.
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Kc S, Gissler M, Heino A, Klemetti R. Factors influencing the risk of repeat termination of pregnancy: A register-based study in Finland. Sex Reprod Healthc 2023; 37:100876. [PMID: 37307625 DOI: 10.1016/j.srhc.2023.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to assess how factors such as sociodemographic characteristics, termination of pregnancy (TOP) related factors and contraception affect the risk of repeat TOP. MATERIALS AND METHOD This is a nationwide register-based study of 193,741 women who had TOP(s) during 1987-2015, using the Finnish Register of Induced Abortions. The risk of various factors, such as age, marital status, residence, parity, TOP related factors and contraception, was assessed separately for each repeat TOP. Cox proportional hazard model was used to estimate risk of different factors for repeat TOPs. RESULTS 21% of the women having TOP had repeat TOPs during the years 1987-2015. Among women with repeat TOPs, more than 70% had one repeat TOP and the rest had two or more. Older, married and rural or semi-urban women had reduced risk of repeat TOPs. Adjusted risk for one repeat TOP was higher among parous women (HR 1.67, 95% CI 1.61-1.72). No significant risk for repeat TOP was observed by method in sub-analysis for the recent period after 2006. Women using less reliable (HR 1.14, 95% CI 1.06-1.23) and unreliable (HR 1.33, 95% CI 1.23-1.43) contraception had increased risk of repeat TOP than women using reliable contraception. CONCLUSION Older age, being married, residing in rural or semi-urban areas and using reliable contraception were found to be protective factors for repeat TOPs whereas, parous women had higher risk for repeat TOPs. Proper counselling regarding contraception and use of reliable contraception immediately after TOP should be encouraged.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland.
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden and Region Stockholm, Academic Primary Health Care Centre, S-14183 Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
| | - Reija Klemetti
- Department of Public Welfare, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
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15
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Shahrokhi SN, Salmani H, Ahmadi M. The Role of Electronic Health Tools in Unwanted Pregnancy Prevention, Abortion and Post-Abortion Follow-Up: A Systematic Review. Iran J Nurs Midwifery Res 2023; 28:487-503. [PMID: 37869688 PMCID: PMC10588920 DOI: 10.4103/ijnmr.ijnmr_312_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/14/2020] [Accepted: 11/18/2022] [Indexed: 10/24/2023]
Abstract
Background More than 30% of women experience at least one abortion. To date, there has been no comprehensive mobile health project on the impact of technology on access to abortion, contraception, and post-abortion follow-up. The purpose of this study was to review published studies on the role of electronic health in the prevention of unwanted pregnancy, abortion, and post-abortion follow-up. Materials and Methods The Web of Science, PubMed, ScienceDirect, and EMBASE databases were searched to find relevant articles published between 2008 and 2018. A systematic review study was conducted on 33 relevant articles. All studies related to the use and impact of electronic health on unwanted pregnancy prevention, abortion and post-abortion follow-up in English from January 2008 to December 2018 were included. The quality of the studies was evaluated using the PRISMA-S. Results Thirty-three studies met the inclusion criteria for the review. The Studies were divided into four main groups of women's experiences on the use of mobile health and telemedicine technologies for at-home medical abortion, unwanted pregnancy prevention, abortion, and post-abortion follow-up. The results showed the significant impact of using electronic health on unwanted pregnancy prevention, abortion, and post-abortion follow-up. Conclusions Health technologies have the potential to be used as a low-cost and accessible method to replace abortion services. They can facilitate remote care and quick access to information to complete the gaps in access to abortion. Therefore, it is necessary for health service providers to be aware of the possibility of the client's access to electronic health tools.
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Affiliation(s)
- Seyedeh Nafiseh Shahrokhi
- Department of Health Information Management, Iran University of Medical Sciences, School of Health Management and Information Sciences, Tehran, Iran
| | - Hosna Salmani
- Department of Health Information Management, Iran University of Medical Sciences, School of Health Management and Information Sciences, Tehran, Iran
| | - Maryam Ahmadi
- Department of Health Information Management, Iran University of Medical Sciences, School of Health Management and Information Sciences, Tehran, Iran
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16
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Li Q, Wang H, Sun L, Wang P, Yin W, Ma S, Tao R, Ge J, Zhu P. The mediating role of inflammation in the association between pregnancy loss history and gestational diabetes mellitus. Diabetol Metab Syndr 2023; 15:132. [PMID: 37340501 DOI: 10.1186/s13098-023-01106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND To assess the association of pregnancy loss history with an elevated risk of Gestational diabetes mellitus (GDM) and to investigate whether this association was mediated by high-sensitivity C-reactive protein (hs-CRP). METHODS We prospectively collected venous blood and pregnancy loss history information from 4873 pregnant women at 16-23 weeks of gestation from March 2018 to April 2022. Hs-CRP concentrations were measured from collected blood samples. A 75 g fasting glucose test was performed at 24 to 28 weeks of gestation for the diagnosis of GDM, with data obtained from medical records. Multivariate linear or logistic regression models and mediation analysis were used to examine the relationships between pregnancy loss history, hs-CRP, and GDM. RESULTS A multivariable-adjusted logistic regression analysis revealed that compared with pregnant women with no induced abortion history, subjects with 1 and ≥ 2 induced abortions had a higher risk for GDM (RR = 1.47, 95% CI = 1.19-1.81; RR = 1.63, 95% CI = 1.28-2.09). Additionally, the mediation analysis indicated this association was mediated by an increased hs-CRP level with a 20.4% of indirect effect ratio. However, no significant association between a history of miscarriage and the prevalence of GDM was observed. CONCLUSIONS A history of induced abortion was significantly associated with an increased risk of GDM, and this association occurred in a dose-response effect. Hs-CRP may be accounted for a mediation effect in the pathways linking induced abortion history with GDM.
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Affiliation(s)
- Qiong Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Haixia Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Lijun Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Peng Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Wanjun Yin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Shuangshuang Ma
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Ruixue Tao
- Department of Gynecology and Obstetrics, Hefei First People's Hospital, Hefei, China
| | - Jinfang Ge
- School of Pharmacy, Anhui Medical University, Hefei, China.
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
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17
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Stowers P, Heck R, Csiszar K, Kaneshiro B. Just-word beliefs and community-level abortion stigma: An exploratory survey. Contraception 2023; 122:109979. [PMID: 36804051 PMCID: PMC10149599 DOI: 10.1016/j.contraception.2023.109979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES This study aimed to evaluate whether belief in a just world is associated with community-level abortion stigma. STUDY DESIGN From December 2020 to June 2021, we conducted a national U.S. survey of 911 adults using Amazon Mechanical Turk. Survey respondents completed both the Community-Level Abortion Stigma Scale and Global Belief in a Just World Scale. We used linear regression to evaluate the association between just-world beliefs, demographic characteristics, and community-level abortion stigma. RESULTS The mean Global Belief in a Just World Scale score was 25.8. The mean Community-Level Abortion Stigma Scale score was 2.6. The strength of just-world beliefs (β = 0.7), male gender (β = 4.1), a history of a previous pregnancy (β = 3.1), post college education (β = 2.8), and strength of religious beliefs (β = 0.3) were associated with higher community-level abortion stigma. Asian race was associated with lower community-level abortion stigma (β = -7.2). CONCLUSIONS After controlling for demographic characteristics, strong just-world beliefs were associated with higher community-level abortion stigma. IMPLICATIONS Understanding just-world beliefs may provide a potential target for stigma-reduction strategies.
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Affiliation(s)
- Paris Stowers
- University of Hawaii, John A. Burns School of Medicine, Department of Obstetrics, Gynecology & Women's Health, 82 Puuhonu Place #205, Hilo, HI, USA.
| | - Ronald Heck
- University of Hawaii, College of Education, 1776 University Avenue Wist Hall Rm 220, Honolulu, HI, USA
| | - Katalin Csiszar
- University of Hawaii, John A. Burns School of Medicine, Department of Quantitative Health Sciences, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu, HI, USA
| | - Bliss Kaneshiro
- University of Hawaii, John A. Burns School of Medicine, Department of Obstetrics, Gynecology & Women's Health, 1356 Lusitana St. Ste 514, Honolulu, HI, USA
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18
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Miller M, Lindley AR, West JD, Thayer EK, Godfrey EM. Does lower use of academic affiliation by university faculty in top U.S. newspapers contribute to misinformation about abortion? J Commun Healthc 2023; 16:7-20. [PMID: 36919808 DOI: 10.1080/17538068.2022.2150166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND University faculty are considered trusted sources of information to disseminate accurate information to the public that abortion is a common, safe and necessary medical health care service. However, misinformation persists about abortion's alleged dangers, commonality, and medical necessity. METHODS Systematic review of popular media articles related to abortion, gun control (an equally controversial topic), and cigarette use (a more neutral topic) published in top U.S. newspapers between January 2015 and July 2020 using bivariate analysis and logistic regression to compare disclosure of university affiliation among experts in each topic area. RESULTS We included 41 abortion, 102 gun control, and 130 smoking articles, which consisted of 304 distinct media mentions of university-affiliated faculty. Articles with smoking and gun control faculty experts had statistically more affiliations mentioned (90%, n = 195 and 88%, n = 159, respectively) than abortion faculty experts (77%, n = 54) (p = 0.02). The probability of faculty disclosing university affiliation was similar between smoking and gun control (p = 0.73), but between smoking and abortion was significantly less (Ave Marginal Effects - 0.13, p = 0.02). CONCLUSIONS Fewer faculty members disclose their university affiliation in top U.S. newspapers when discussing abortion. Lack of academic disclosure may paradoxically make these faculty appear less 'legitimate.' This leads to misinformation, branding abortion as a 'choice,' suggesting it is an unessential medical service. With the recent U.S. Supreme Court landmark decision, Dobbs v. Jackson Women's Health Organization, and subsequent banning of abortion in many U.S. states, faculty will probably be even less likely to disclose their university affiliation in the media than in the past.
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Affiliation(s)
- Madison Miller
- Medical Student, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexa R Lindley
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Jevin D West
- Information School, Co-Founder of the Center for an Informed Public, University of Washington, Seattle, WA, USA
| | - Erin K Thayer
- Department of Family Medicine, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
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19
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Nguyen M, Cartwright AF, Upadhyay UD. Fear of procedure and pain in individuals considering abortion: A qualitative study. Patient Educ Couns 2023; 108:107611. [PMID: 36603469 PMCID: PMC10152982 DOI: 10.1016/j.pec.2022.107611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To explore concerns about procedural abortion and abortion-related pain in a cohort searching for abortion online. METHODS The Google Ads Abortion Access Study was a national longitudinal cohort study that recruited people searching for abortion online. Participants completed a baseline demographic survey and a follow-up survey four weeks later evaluating barriers and facilitators to abortion. This qualitative study utilized thematic analysis to produce a descriptive narrative based on overarching themes about procedural abortion and abortion-related pain. RESULTS There were 57 separate mentions from 45 participants regarding procedural abortion or abortion-related pain. We identified two main themes: 1) concerns about the procedure (with subthemes, fear of procedural abortion, comparison to medication abortion, lack of sedation) and 2) abortion-related pain (with subthemes fear of abortion-related pain, experiences of pain, fear of complications and cost-barriers to pain control). CONCLUSIONS This study highlights the need for improved anticipatory guidance and accessible resources to assuage potential fears and misconceptions regarding abortion. PRACTICE IMPLIACTIONS Abortion resources, particularly online, should provide accurate and unbiased information about abortion methods and pain to help patients feel more prepared. Providers should be aware of potential concerns surrounding procedural abortion and pain when counseling patients presenting for care.
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Affiliation(s)
- May Nguyen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA; Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA, USA.
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Zahedi-Spung LD, Huysman BC, Madden T, Bebbington M, Raghuraman N, Stout M. Missouri's Abortion law: Access to care for Patients with Lethal Fetal Anomalies at a Midwest Tertiary care Center. Matern Child Health J 2023; 27:468-75. [PMID: 36352286 DOI: 10.1007/s10995-022-03511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Missouri passed an 8-week gestational age abortion in August 2019. The objective of this study was to compare distance and time from referral to evaluation between patients who continued their pregnancy and those who terminated in patients with severe and lethal fetal anomalies and estimate the impact of the Missouri gestational age abortion ban on distance to abortion care in this patient population. METHODS This is a retrospective cohort study of patients seen at the Washington University in St. Louis (WUSTL) Fetal Care Center (FCC) with a severe or lethal fetal anomaly between July 2018 and June 2019. Patient characteristics including gestational age at referral and distance traveled to the FCC were compared between patients who underwent abortion and who continued their pregnancies. RESULTS From July 2018 to June 2019, 463 patients were seen in the Fetal Care Center and 13% (60/463) were diagnosed with severe or lethal fetal anomalies comprising the study population for this analysis. Of these, 21 (35%) patients underwent an abortion, and 39 (65%) patients continued their pregnancy. Patients who underwent abortion were referred at a significantly earlier gestational age (median 19 weeks [IQR 17, 20 weeks] v. 20 weeks [IQR 18, 24 weeks]), p = 0.04. There was a statistically significant difference between the median latency time between patients who underwent an abortion and who continued their pregnancy (median 8 days [IQR 4,13 days] v. 14 days [IQR 9, 22 days], p < 0.01). CONCLUSION Patients with severe or lethal fetal anomalies are often evaluated at later gestational ages, which may preclude their access to abortion services.
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Mutru M, Kivelä P, Ollgren J, Liitsola K, Gissler M, Aho I. Induced abortions of women living with HIV in Finland 1987-2019: a national register study. BMC Pregnancy Childbirth 2023; 23:120. [PMID: 36800943 PMCID: PMC9938577 DOI: 10.1186/s12884-023-05430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987-2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented. METHODS A retrospective nationwide register study of all WLWH in Finland 1987-2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland. RESULTS Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987-1997 to 2009-2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998-2019 were being foreign-born (OR 3.09, 95% CI 1.55-6.19), younger age (OR 0.95 per year, 95% CI 0.90-1.00), previous induced abortions (OR 3.36, 95% CI 1.80-6.28), and previous deliveries (OR 2.13, 95% CI 1.08-4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008-0.029%. CONCLUSIONS Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.
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Affiliation(s)
- Mikaela Mutru
- University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland. .,Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland. .,Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Pia Kivelä
- grid.7737.40000 0004 0410 2071University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014 Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Liitsola
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland ,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Inka Aho
- grid.7737.40000 0004 0410 2071University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014 Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
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Sesay FR, Anaba EA, Manu A, Maya E, Torpey K, Adanu RMK. Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Survey. BMC Womens Health 2023; 23:44. [PMID: 36726133 PMCID: PMC9890786 DOI: 10.1186/s12905-023-02175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Worldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, particularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study findings could be used to improve the country's maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion. METHODS We analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion. RESULTS The results showed that a minority (9%) of the participants had induced abortion in both surveys. Abortion was significantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p < 0.05). For instance, women aged 45-49 years (AOR = 7.91; 95% CI: 5.76-10.87), married women (AOR = 2.52; 95% CI: 1.95-3.26), and working women (AOR = 1.65; 95% CI: 1.45-1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary education (AOR = 1.27; 95% CI:1.11-1.46) and those who watch television once a week (AOR = 1.29; 95% CI: 1.11-1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR = 0.40; 95% CI: 0.31-0.52) were less likely to terminate a pregnancy compared to those with no child. CONCLUSION The study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was influenced by age, marital status, employment status, education, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status.
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Affiliation(s)
- Foday Robert Sesay
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Emmanuel Anongeba Anaba
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Adom Manu
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Maya
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwasi Torpey
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard M. K. Adanu
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Obiyan MO, Olaleye AO, Oyinlola FF, Folayan MO. Factors associated with pregnancy and induced abortion among street-involved female adolescents in two Nigerian urban cities: a mixed-method study. BMC Health Serv Res 2023; 23:25. [PMID: 36627625 DOI: 10.1186/s12913-022-09014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10-19 years in two urban cities in South-west, Nigeria. METHODS The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion. RESULTS Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19-0.91), while 15-19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02-0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion. CONCLUSION A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.
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Kücükyildiz AS, Berner-Hansen V, Nguyen H, Nguyen T, Meaidi A. Ultrasonographic features of the endometrium following successful medical termination of early pregnancy. Eur J Obstet Gynecol Reprod Biol 2023; 280:102-107. [PMID: 36446257 DOI: 10.1016/j.ejogrb.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ultrasonographic features of the endometrium are often assessed when deciding the necessity of surgical intervention following early medical abortion. Knowledge is therefore needed on the ultrasonographic appearance of the endometrium following successful medical abortion in order to avoid unnecessary surgical interventions. We aimed to assess endometrial thickness and echogenicity at multiple time points following successful early medical abortion. STUDY DESIGN We conducted a retrospective study in the largest office-based abortion providing clinic in Denmark. Using archived ultrasonographic images, we assessed endometrial thickness and echogenicity following all early medical abortions that did not need surgical intervention or repeated medication for completion during the years 2014-2017. RESULTS Ultrasonographic endometrial features were assessed 1854 times following 1074 early medical abortions. Median endometrial thickness in the 1st week from induction was 13 milimeters (mm; lower-upper quartile 11-17 mm). For the 2nd, 3rd, 4th, and >4th week, the median endometrial thickness was found to be 11 mm (9-15 mm), 11 mm (8-14 mm), 12 mm (9-16 mm), and 11 mm (8-14 mm), respectively. Of the ultrasonographic examinations performed in the 1st week from medical induction, 24.7 % showed a heterogenous endometrium. For 2nd, 3rd, 4th, >4th week, the frequency of heterogeneity was 23.9 %, 16.3 %, 21.3 %, 18.9 %, respectively. A total of 151 abortions (14.1 %) were each examined three times, median time of examination being day 7, 15, and 26 following induction. Among these abortions, the three most common patterns of change in endometrial thickness were "decreasing" (37.7 %), "increasing-decreasing" (23.2 %), and "decreasing-increasing" (21.9 %). Further, 49.7 % of the 151 abortions showed a homogenous endometrium at all three examinations, 17.2 % showed a heterogenous endometrium at first examination and a homogenous endometrium the following two examinations, and 9.9 % showed a heterogenous endometrium at the first two examinations followed by a homogenous endometrium. CONCLUSION In early medical abortions completed without secondary intervention, endometrial thickness and echogenicity varied clinically significantly for weeks following the medical induction. Every possible pattern of change in endometrial thickness and echogenicity was observed.
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Affiliation(s)
| | | | - Henriette Nguyen
- Gynecology Clinic Hvidovre, Gammelkoege Landevej 272, 2650 Hvidovre, Denmark
| | - Tri Nguyen
- Gynecology Clinic Hvidovre, Gammelkoege Landevej 272, 2650 Hvidovre, Denmark
| | - Amani Meaidi
- Gynecology Clinic Hvidovre, Gammelkoege Landevej 272, 2650 Hvidovre, Denmark; Department of Gynecology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Ajayi AI, Ahinkorah BO, Seidu AA, Adeniyi OV. Prevalence and correlates of induced abortion: results of a facility-based cross-sectional survey of parturient women living with HIV in South Africa. Reprod Health 2022; 19:220. [PMID: 36471337 PMCID: PMC9721078 DOI: 10.1186/s12978-022-01520-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/01/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa. METHODS We analysed cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics. RESULTS The prevalence of induced abortion was 19% (95% CI: 17.2-20.9%), but varied by women's socio-demographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), than among women aged less than 25 years (11.0%). Those ever married or cohabiting (26.8%) reported a higher level of induced abortion than those never-married women (15.6%). Those already diagnosed HIV positive before their index pregnancy (20.2%) had a higher prevalence of induced abortion than those diagnosed during their index pregnancy (14.1%). In the adjusted logistic regression, women were more likely to have ever induced abortion if they were ever married or cohabiting (aOR; 1.86 95% CI; 1.43-2.41), ever smoked (aOR: 1.51; 95% CI: 1.01-2.28) and diagnosed with HIV before their index pregnancy (aOR:1.44; 95% CI: 1.02-2.05) but less likely if younger than 25 years (aOR; 0.51 95% CI:0.35-0.73). CONCLUSION About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this group of women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- grid.413355.50000 0001 2221 4219Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Bright Opoku Ahinkorah
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
| | - Abdul-Aziz Seidu
- grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Oladele Vincent Adeniyi
- grid.412870.80000 0001 0447 7939Department of Family Medicine, East London Hospital Complex, Walter Sisulu University/Cecilia Makiwane Hospital, East London, South Africa
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Wang T, Jiang Q. Recent trend and correlates of induced abortion in China: evidence from the 2017 China Fertility Survey. BMC Womens Health 2022; 22:469. [PMID: 36434604 PMCID: PMC9700931 DOI: 10.1186/s12905-022-02074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although there are more than 10 million induced abortions per year in China, there are few comprehensive, systematic, and characteristic-based data on induced abortions among Chinese women. This study aims to examine the overall trend in induced abortions in China and to analyze the correlation between induced abortions and some socio-economic factors. METHODS Drawing from the 2017 China Fertility Survey, this study analyzed induced abortions using multiple indicators from period and cohort perspectives on a sample of 240,957 women. The indicators include the abortion rate and proportion, average age at the time of induced abortion, age-specific cumulative proportions, and the number of induced abortions by cohort. The analysis also differentiated based on residency, ethnicity, education level, and marital status. A binomial logistic regression model was used to examine the association between induced abortions and socio-economic factors. RESULTS Between 2006 and 2016, among women aged 15-49, there was an increase in the induced abortion rate and the average age of women who had induced abortions, but a decline in the proportion of abortions. The proportion of induced abortion was higher among premarital than post-marital pregnancies, among unintended than planned pregnancies. Women with induced abortion experiences accounted for less than 30% of all cohorts, and the cumulative number of induced abortions per woman in each cohort was less than 0.45. These indicators varied with birth cohort, residence, ethnicity, education level, and marital status. The results of binomial logistic regression confirmed the association between induced abortion and these socio-economic variables. Sex-selective abortions of female fetuses still exist, despite the government's considerable efforts to eliminate them. CONCLUSION The practice of induced abortions differs by cohort and socio-economic characteristics. The profile of women who resort to abortions in China has shifted from well-educated urban women to rural, less-educated women. More effective measures should be taken by the government to reduce the number of induced abortions among women with higher abortion risks.
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Affiliation(s)
- Tian Wang
- grid.43169.390000 0001 0599 1243School of Public Policy and Administration, Institute for Population and Development Studies, Xi’an Jiaotong University, Xi’an, China
| | - Quanbao Jiang
- grid.43169.390000 0001 0599 1243School of Public Policy and Administration, Institute for Population and Development Studies, Xi’an Jiaotong University, Xi’an, China
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Bettahar K, Koch A, Deruelle P. [Medical strategy for abortions between 14 and 16 weeks of gestation]. Gynecol Obstet Fertil Senol 2022; 50:735-740. [PMID: 36183986 DOI: 10.1016/j.gofs.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To adapt the protocols for the management of voluntary termination of pregnancy following the new law extending the practice to 16 weeks of gestation. MATERIAL AND METHOD A systematic review of the literature in French and English concerning the management of patients requesting medically induced abortion was performed on PubMed, Cochrane Library and on the recommendations of international learned societies. RESULTS The efficacy of the medical method is greater than 95% when the protocols are adapted to the gestational age. The combination of mifepristone and misoprostol currently represents the "gold standard" of drug-based management. Mifepristone 200mg is sufficient, followed 24 to 48hours later by misoprostol 800μg administered sublingually or buccally. After the first dose, 400μg should be administered every 3hours buccally or sublingually until expulsion. Adverse effects (digestive and thermoregulatory disorders) during medical abortion are usually mild and short-lived. An anti-emetic treatment should be proposed as a prophylactic measure. For pain, ibuprofen is the analgesic treatment of choice, with the addition of level 2 analgesics if necessary. CONCLUSION Medical abortion is a safe and effective method up to 16 weeks of gestation, provided that the protocols, which differ according to gestational age, are respected. Women must be informed of the advantages and disadvantages of the methods according to the term and the side effects, which will allow them to choose the method that fits them best.
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Affiliation(s)
- K Bettahar
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
| | - A Koch
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
| | - P Deruelle
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Diakiese BM, Féron V. [ Induced abortion and COVID-19 : What changed with the pandemic in 2020]. Rev Epidemiol Sante Publique 2022; 70:277-285. [PMID: 36123204 PMCID: PMC9452417 DOI: 10.1016/j.respe.2022.06.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Contexte L'année 2020 a été marquée par la pandémie du SARS-CoV2 dont les mesures de gestion ont fortement perturbé l'organisation de la société en général et particulièrement l'organisation du système de soins. Cette étude avait pour objectif d'analyser l’évolution des indicateurs des interruptions volontaires de grossesse (IVG) dans la région parisienne au cours de l'année 2020 et d'analyser particulièrement ce qui a changé au cours du premier confinement. Méthode Les données issues du Système national des données de santé (SNDS) ont été analysées pour comparer les indicateurs de 2020 à ceux de 2016–2019. En 2020, les indicateurs ont été étudiés mensuellement. L’âge des femmes, la méthode utilisée pour interrompre la grossesse, le terme de la grossesse au moment de l'IVG et le département de résidence de la femme ont été analysés. Résultats Après cinq années consécutives d'augmentation du taux de recours à l'IVG, l'année 2020 a été marquée par un recul du nombre d'IVG (50 615), soit une baisse de 5,6 % par rapport à 2019 (53 601). Le taux de recours est passé de 17,3 IVG/1000 femmes de 15–49 ans en 2019 à 16,3 ‰ en 2020. Ce recul a été observé dans les quatre semaines ayant suivi le premier confinement. Il concernait plus particulièrement les IVG réalisées à l'hôpital et les IVG des femmes jeunes (< 25 ans). En 2020, les proportions des IVG médicamenteuses et des IVG instrumentales sous anesthésie locale ont augmenté comparativement aux quatre années précédant la crise sanitaire. Par ailleurs, on a dénombré moins d'IVG tardives en 2020 (IVG sur grossesse > 12 semaines d'aménorrhée). Cette analyse met également en évidence une baisse du nombre de naissances dans les huit à neuf mois ayant suivi le premier confinement. Discussion et conclusion La crise liée à la COVID-19 a entraîné d'autres conséquences sanitaires non imputables directement au virus. En termes de reproduction, la crise sanitaire, particulièrement le premier confinement, est associée à un recul des conceptions se traduisant par une baisse du nombre de grossesses, qu'elles soient désirées ou non, avec comme conséquence une baisse de recours à l'IVG dans les semaines suivant le premier confinement et un recul de la natalité dans les neuf mois suivants.
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Affiliation(s)
- B Matulonga Diakiese
- Observatoire régional de santé Île-de-France, 75015, Paris, France; Institut Paris Région, 75015, Paris, France.
| | - V Féron
- Observatoire régional de santé Île-de-France, 75015, Paris, France; Institut Paris Région, 75015, Paris, France
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Alabiad MA, Said WMM, Gad AH, Sharaf ElDin MTA, Khairy DA, Gobran MA, Shalaby AM, Samy W, Abdelsameea AA, Heraiz AI. Evaluation of Different Doses of the Aromatase Inhibitor Letrozole for the Treatment of Ectopic Pregnancy and Its Effect on Villous Trophoblastic Tissue. Reprod Sci 2022; 29:2983-2994. [PMID: 35701686 PMCID: PMC9537218 DOI: 10.1007/s43032-022-00993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
Abstract
Letrozole, an aromatase inhibitor, has recently been introduced as a favorable medical treatment for ectopic pregnancy. We aimed at evaluating the effects of different doses of letrozole for termination of ectopic pregnancy and study their effects on villous trophoblastic tissue. Sixty patients with undisturbed ectopic pregnancy were classified into three equal groups. Group I: the control group that contained women who underwent laparoscopic salpingectomy, Group II: patients who received letrozole (5 mg day−1) for 10 days, and Group III: patients who received letrozole (10 mg day−1) for 10 days. Subsequently, the β-hCG levels were determined on the first day and after 11 days of treatment. Group IV consisted of patients of GII and GIII; their β-hCG did not drop below 100 mIU/ml within 11 days, and underwent salpingectomy. Placental tissues from patients undergoing salpingectomy either from the control group or GIV were processed for the evaluation of estrogen (ER) and progesterone (PR) receptors, vascular endothelial growth factor (VEGF), and cleaved caspase 3 (CC-3) expression. Cases exposed to high dose letrozole 10 mg day−1 resulted in a higher ectopic pregnancy resolution rate of 85% (17/20), while the resolution rate of the low dose letrozole-treated group (5 mg day−1) was 65% (13/20), and also showed a significant reduction in β-hCG levels on the 11th day, 25.63 ± 4.29 compared to the low dose letrozole group 37.91 ± 7.18 (P < 0.001), Meanwhile, the letrozole-treated group GIV showed markedly reduced expression of ER, PR, and VEGF and a significant increase in the apoptotic index cleaved caspase-3 compared to the control group (P < 0.001). The utilization of letrozole at a dose of 10 mg day−1 for medical treatment of ectopic pregnancy results in a high-successful rate without any severe side effects. Letrozole depriving the placenta of estrogen that had vascular supporting signals resulted in destroying the vascular network with marked apoptosis.
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Affiliation(s)
- Mohamed Ali Alabiad
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Warda M. M. Said
- Department of Pathology, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Abdalla Hassan Gad
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Dina Ahmed Khairy
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mai Ahmed Gobran
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Amany Mohamed Shalaby
- Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Walaa Samy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed Ismail Heraiz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Cabedo-Ferreiro R, Vicente-Hernández MM, Manresa-Domínguez JM, Gómez-Masvidal M, Montero-Pons L, Reyes-Lacalle A, Falguera-Puig G. Validation of a Spanish-language scale for evaluating perceived quality of care of medical abortions before 9 weeks gestation. BMC Womens Health 2022; 22:196. [PMID: 35643523 PMCID: PMC9148507 DOI: 10.1186/s12905-022-01763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Spanish Organic Law 2/2010 legalizes abortion within 14 weeks of gestation. Medical abortion with mifepristone and misoprostol is around 97% effective and is offered at primary care centers during the first 9 weeks of gestation. It consists of the administration of 200 mg of mifepristone by a healthcare professional and of the self-administration 800 mg of misoprostol by the patient at home, along with prescribed analgesics. However, the quality of this process as perceived by patients has never been assessed. This study aims to validate a scale designed to assess the perceived quality of the entire process, structure and results of at-home medical abortion. Methods Validation study of a Spanish adaptation of the SERVPERF scale. In total, 289 patients completed a self-administered questionnaire consisting of 26 items previously evaluated by a group of experts. A re-test was performed on 53 of these patients 15 days later to assess interobserver consistency. Results The highest non-response rate for any single item was 2.1%. The floor effect was 26% and the ceiling effect did not surpass 83%. The linearly weighted Kappa coefficient was good to excellent, in general. An exploratory factor analysis was performed with Varimax rotation, obtaining a total of 7 dimensions that explain 65.9% of the variability. The internal consistency (Cronbach's alpha) for all items was 0.862. Conclusion This psychometric instrument is valid and reliable for assessing the quality of care of medical abortion. Medical abortion is efficient, effective and eliminates the need for hospital care, anesthesia and surgical risk. However, user satisfaction has yet to be determined. This study offers a validated scale to assess perceived quality of care, their quality experience and person-centered care for abortion as a fundamental part of overall service quality as a fundamental part of overall service quality.
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Affiliation(s)
- Rosa Cabedo-Ferreiro
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Granollers, Barcelona, Spain.,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain
| | - Maria-Mercedes Vicente-Hernández
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain.,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain
| | - Josep-Maria Manresa-Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari de Investigació en Atenció Primaria (IDIAPJGol), Cerdanyola, Barcelona, Spain.,Departament d'Infermeria, Universitat Autònoma de Barcelona, Cerdanyola, Barcelona, Spain
| | - Miriam Gómez-Masvidal
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Mataró, Barcelona, Spain.,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain
| | - Laura Montero-Pons
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain. .,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain. .,, Sabadell, Spain.
| | - Azahara Reyes-Lacalle
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Sabadell, Barcelona, Spain.,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain
| | - Gemma Falguera-Puig
- Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Sabadell, Barcelona, Spain.,GRASSIR Research Group, IDIAPJGol, Generalitat de Catalunya (SGR 2014-2016), Barcelona, Spain
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Moayedi G, Stevens K, Fontanilla T, Tschann M, Bednarek PH, Salcedo J, Kaneshiro B, Soon R. Intranasal Fentanyl for First-Trimester Uterine Aspiration Pain:A Randomized Controlled Trial. Contraception 2022; 113:101-107. [PMID: 35472333 DOI: 10.1016/j.contraception.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration. STUDY DESIGN We conducted a multicenter, randomized, double-blind, placebo-controlled trial of patients with pregnancies less than or equal to 14 weeks gestation seeking uterine aspiration for induced abortion, early pregnancy loss, or failed medication abortion. We randomized participants 1:1 to either intranasal fentanyl 100 mcg or intranasal placebo. All participants received ibuprofen and a standardized paracervical block. The primary outcome was pain indicated at the time of uterine aspiration on a 100 mm visual analog scale (VAS). We designed the study to detect a 15 mm difference in mean pain scores, which required 53 people in each arm for a total of 106 participants. Secondary outcomes included post-procedure pain and patient satisfaction with pain control. RESULTS From March 2017 through June 2018, we screened 355 people for eligibility and enrolled 107 participants. Those who received intranasal fentanyl reported similar uterine aspiration pain to participants receiving placebo (58.4±28.0 fentanyl vs 58.6±24.5 placebo, p=0.97). Participants receiving intranasal fentanyl also reported similar post-procedure pain scores compared to participants receiving placebo (19.1±19.4 fentanyl vs 17.2±19 placebo, p=0.63), and were equally satisfied with procedure pain control (66.8±31.2 fentanyl vs 63.3±29.2 placebo, p=0.57). CONCLUSION Intranasal fentanyl did not decrease reported pain with first-trimester uterine aspiration, nor did it decrease post-procedure pain compared to placebo. As an adjunct to ibuprofen and paracervical block, intranasal fentanyl did not improve patient satisfaction with pain control.
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Affiliation(s)
- Ghazaleh Moayedi
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826.
| | - Katelyn Stevens
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Tiana Fontanilla
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Mary Tschann
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Paula H Bednarek
- Department of Obstetrics and Gynecology, Oregon Health & Science University; 3181 SW Sam Jackson Park Rd; Portland, OR, 97239; Planned Parenthood Columbia Willamette; 3727 NE Martin Luther King Jr Blvd; Portland, OR, 97212
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Reni Soon
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
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Abebe M, Mersha A, Degefa N, Gebremeskel F, Kefelew E, Molla W. Determinants of induced abortion among women received maternal health care services in public hospitals of Arba Minch and Wolayita Sodo town, southern Ethiopia: unmatched case-control study. BMC Womens Health 2022; 22:107. [PMID: 35397584 PMCID: PMC8994190 DOI: 10.1186/s12905-022-01695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background About 210 million women become pregnant per year, with one out of every ten pregnancies terminating unsafely worldwide. In developing countries, unsafe induced abortion is a leading cause of maternal mortality and morbidity. In addition, the burden of public health is also greatest in developing regions. In Ethiopia, abortion was responsible for 8.6% of maternal deaths. Despite the problem's significance, little is known about the factors that lead to women terminating their pregnancies. Therefore, this study aims to identify the factors associated with having induced abortion in public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia. Methods An institutional-based unmatched case–control study was conducted among 413 women from 15th April to 15th June 2021 in selected public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia. Cases were women who received induced abortion care services or who received post-abortion care services after being presented to the selected public hospital with an attempt of induced abortion whereas controls were women who came for maternal health care (antenatal or postnatal care) services in selected public hospitals and never had history of induced abortion. The data were collected by pretested and structured questionnaires with face-to-face interviews via Kobo Collect v3.1 mobile tools and analyzed by STATA version14. Logistic regression model was used to identify factors associated with induced abortion. In this study P-value less than 0.05 with 95% CI was declared a result as statistically significant. Results In this study, 103 cases and 309 controls were participated. Urban residence (AOR = 2.33, 95%CI:1.26, 4.32), encountered first sex at age of 20–24 years (AOR = 0.51, 95%CI:0.27,0.97), multiple sexual partner (AOR = 5.47, 95%CI: 2.98,10.03), women who had one child (AOR = 0.32, 95%CI: 0.10, 0.99), and good knowledge of contraceptives (AOR = 0.12, 95%CI: 0.03, 0.46) were identified as determinants of induced abortion. Conclusions Interventions focusing on those identified factors could probably reduce the burden and consequences of induced abortion. Sexual and reproductive health education and family planning programs would target urban dwellers, women who start sexual intercourse between the ages of 15 and 19, women with more than one sexual partner, women with a desire to limit childbearing, and women with poor contraceptive knowledge in order to reduce induced abortion. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01695-0.
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Affiliation(s)
- Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
| | - Abera Mersha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nega Degefa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Feleke Gebremeskel
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Etenesh Kefelew
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Martínez P, Nazif-Munoz JI, Rojas G, Magaña I. Structural gender inequalities and symptoms of postpartum depression in 40 countries. J Affect Disord 2022; 297:381-385. [PMID: 34656672 DOI: 10.1016/j.jad.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role of structural gender inequality in macro-level differences in women's perinatal mental health remains largely unexplored. This short communication explores structural gender inequalities and their potential as a macro-level, upstream social determinant of postpartum depression (PPD). METHODS We compiled meta-analytically derived national-level prevalence estimates of PPD symptoms - based on the Edinburgh Postnatal Depression Scale - with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries. Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. RESULTS Income inequality (β = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (β = 0.02, 95% CI = 0.00 to 0.03) were the only variables selected in the final, adjusted model, accounting for 60.7% of cross-national variations in PPD symptoms. LIMITATIONS Study quality of primary studies was not assessed and some national-level meta-analytical estimates were based on few primary studies. A fifth of world countries and territories could be included, with high-income regions overrepresented. High rate of missing national-level data for potential predictors of PPD. Cross-sectional analyses precludes causal inferences. CONCLUSIONS Abortion policies are a significant macro-level social determinant of PPD, and its liberalization might be associated with women's mental health at a population level. Our findings should be a relevant argument for clinicians to advocate for changing discriminatory social norms against women.
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Affiliation(s)
- Pablo Martínez
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada; Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada.
| | - José Ignacio Nazif-Munoz
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada; Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada
| | - Graciela Rojas
- Hospital Clínico Universidad de Chile, Carlos Lorca 999, Santiago 8380456, Chile; Millennium Nucleus in Social Development (DESOC), Diagonal Paraguay 257, Santiago 8330015, Chile
| | - Irene Magaña
- Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Av. Ecuador 3650, Santiago 9170197, Chile
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Geta G, Seyoum K, Gomora D, Kene C. Repeat- induced abortion and associated factors among reproductive-age women seeking abortion services in South Ethiopia. Womens Health (Lond) 2022; 18:17455057221122565. [PMID: 36128990 PMCID: PMC9500254 DOI: 10.1177/17455057221122565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/18/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite the advances in modern health care, maternal morbidity and mortality remain major problems in Ethiopia. Repeat-induced abortion is an indispensable contributor to this problem. Even though there are adverse effects on health, a significant proportion of Ethiopian women procure more than one abortion during their reproductive lifetime. This study aimed to determine the prevalence and associated factors of repeat-induced abortion in South Ethiopia, in 2020. METHODS An institution-based cross-sectional study design and a systematic random sampling technique were used to collect data from 410 samples of women. Data were collected using pre-tested and semi-structured interviewer-administered questionnaires. The data were coded and entered into EpiData version 4.6.2.0 before being exported to Statistical Package for Social Sciences (SPSS) version 26 for analysis. Variables with a p-value of less than 0.05 in binary logistic regressions were exported into multivariate logistic regression analysis. Finally, variables with a p-value of less than 0.05 in the multivariate logistic regression analysis were used to declare statistical significance. RESULT The prevalence of repeat-induced abortion was found to be 35.4% (95% confidence interval = 30.7-40). Not facing a complication in prior abortion care, having more than two partners in the last 12 preceding months, perceiving abortion procedure as non-painful, having a sexual debut before the age of 18 years, and consuming alcohol have higher odds of repeat-induced abortion when compared with their counterparts. CONCLUSION The prevalence of repeat-induced abortion in Hawassa city is high compared to studies conducted in other parts of Ethiopia. Not facing complications during previous abortion care, perceiving the abortion procedure as non-painful, alcohol consumption, having multiple sexual partners, and having a sexual debut before the age of 18 years are found to increase the chance of repeat-induced abortion.
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Affiliation(s)
- Girma Geta
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Robe, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Robe, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Robe, Ethiopia
| | - Chala Kene
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Robe, Ethiopia
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Auger N, Ghadirian M, Low N, Healy-Profitós J, Wei SQ. Premature mortality after pregnancy loss: Trends at 1, 5, 10 years, and beyond. Eur J Obstet Gynecol Reprod Biol 2021; 267:155-160. [PMID: 34773878 DOI: 10.1016/j.ejogrb.2021.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little is known on the long-term risk of mortality following pregnancy loss. We assessed risks of premature mortality up to three decades after miscarriage, induced abortion, ectopic or molar pregnancy, and stillbirth relative to live birth. STUDY DESIGN We carried out a longitudinal cohort study of 1,293,640 pregnant women with 18,896,737 person-years of follow-up in Quebec, Canada, from 1989 to 2018. We followed the women up to 29 years after their last pregnancy event to determine the time and cause of future in-hospital deaths before age 75 years. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of miscarriage, induced abortion, ectopic pregnancy, molar pregnancy, and stillbirth with premature mortality, compared with live birth. RESULTS Premature mortality rates were higher for most types of pregnancy loss than live birth. Compared with live birth, pregnancy loss was associated with an elevated risk of premature mortality (HRmiscarriage 1.48, 95% CI 1.33, 1.65; HRinduced abortion 1.50, 95% CI 1.39, 1.62; HRectopic 1.55, 95% CI 1.35, 1.79; and HRstillbirth 1.68, 95%. CI 1.17, 2.41). Molar pregnancy was not associated with premature mortality (HR 0.87, 95% CI 0.33, 2.32). Miscarriage and induced abortion were associated with most causes of death, whereas ectopic pregnancy was associated with cardiovascular (HR 2.18, 95 % CI 1.39, 3.42), cancer (HR 1.38, 95 % CI 1.11, 1.73), and suicide-related mortality (HR 4.94, 95 % CI 2.29, 10.68). Stillbirth was associated with cardiovascular mortality (HR 4.91, 95 % CI 2.33, 10.36). CONCLUSION Pregnancy loss is associated with an elevated risk of premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Mona Ghadirian
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
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Agula C, Henry EG, Asuming PO, Agyei-Asabere C, Kushitor M, Canning D, Shah I, Bawah AA. Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana. BMC Womens Health 2021; 21:300. [PMID: 34399739 PMCID: PMC8365972 DOI: 10.1186/s12905-021-01444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Background Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra. Methods Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services. Results About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies. Conclusions The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01444-9.
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Affiliation(s)
- Caesar Agula
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana.
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Patrick O Asuming
- University of Ghana Business School (UGBS), University of Ghana, Accra, Ghana
| | | | - Mawuli Kushitor
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ayaga A Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
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Wang H, Li J, Liu H, Guo F, Xue T, Guan T, Li J. Association of maternal exposure to ambient particulate pollution with incident spontaneous pregnancy loss. Ecotoxicol Environ Saf 2021; 224:112653. [PMID: 34411818 DOI: 10.1016/j.ecoenv.2021.112653] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Maternal exposure to ambient fine particulate matter (PM2.5) is a potential risk factor for pregnancy loss, but the extant findings are inconsistent. One reason for the inconsistency is the difficulty of distinguishing spontaneous from induced pregnancy losses, particularly in countries with planning policies. OBJECTIVE To examine the association between maternal PM2.5 exposure and spontaneous incident pregnancy loss in China. METHODS A total of 18,513 women of reproductive age was recruited from Jiangsu Province, China, in 2007. Among them, 2451 women reported 2613 valid records of incident pregnancies from 2007 to 2010. We used Cox regression to link the outcomes (live birth, spontaneous pregnancy loss, or induced abortion) of those incident pregnancies with maternal PM2.5 exposures, assessed using well-developed estimates of historical concentrations at the county level. RESULTS Among the 2613 incident pregnancies, 69 spontaneous pregnancy losses, 596 induced abortions, and 1948 live births occurred. According to the adjusted model, each 10-μg/m3 increment in the average PM2.5 concentration during pregnancy was associated with a 43.3% (95% confidence interval, 6.6-92.5%) increased probability of spontaneous pregnancy loss. Advanced maternal age, a potential competing risk factor, weakened the association between PM2.5 and spontaneous pregnancy loss. The association was nonsignificant for unintended pregnancies. CONCLUSION Maternal PM2.5 exposure was associated significantly with incident spontaneous pregnancy loss. Our findings provide insight into the harmful effect of air pollution on human reproduction.
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Affiliation(s)
- Huiyu Wang
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jiajianghui Li
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Hengyi Liu
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Fuyu Guo
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Tao Xue
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
| | - Tianjia Guan
- Department of Health Policy, School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiwei Li
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang 310027, China; Shannon.AI, Beijing 100080, China
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Kandahari N, Merchant M, Aronow-Werner SP, Weintraub MLR, Zaritsky E, Goldsmith C. Prophylactic transdermal scopolamine for the reduction of postoperative length of stay after uterine aspiration at Kaiser Permanente Northern California from 2017-2018. Contraception 2021; 105:37-41. [PMID: 34400153 DOI: 10.1016/j.contraception.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if transdermal scopolamine is associated with decreased postoperative nausea and vomiting and shorter length of stay in the postoperative care unit among patients undergoing uterine aspiration for abortion or early pregnancy loss. STUDY DESIGN We conducted a retrospective cohort study at an integrated medical center that initiated a protocol to prescribe transdermal scopolamine to patients undergoing uterine aspiration under moderate sedation. We compared outcomes among patients who underwent uterine aspiration in 2017, before the institution enacted the protocol, with their counterparts in 2018, immediately after the institution instated the protocol. We reviewed patient charts for data on the postoperative length of stay, use of additional antiemetics, and a standardized clinician designated postoperative nausea and vomiting score. We analyzed outcomes by relevant demographic and clinical characteristics using chi-square or Fisher's exact tests for categorical variables and t tests for continuous variables. RESULTS The final sample included 386 patients; 228 who did not receive scopolamine and 158 who did. The cohorts were comparable in terms of demographic and clinical characteristics. The cohort that received transdermal scopolamine had a similar mean postoperative length of stay (75.4 ± 54.1 vs 71.1 ± 50.8 minutes; p = 0.43). There were no differences in the proportions of patients who were provided additional antiemetics (26 ± 11.4 vs 17 ± 10.8; p = 0.84) or had transient vomiting and retching (3 ± 1.9 vs 3 ± 1.3; p = 0.69) between the cohorts. CONCLUSION We found no evidence that prophylactic transdermal scopolamine reduces postoperative nausea, vomiting, or length of stay among patients undergoing uterine aspiration. IMPLICATIONS Among patients who underwent uterine aspiration under moderate sedation, use of prophylactic transdermal scopolamine was not associated with shorter postoperative length of stay or lesser use of antiemetics. Prophylactic transdermal scopolamine is not likely to be useful for patients undergoing uterine aspiration and could be an unnecessary cost.
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Affiliation(s)
- Nazineen Kandahari
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland CA, United States
| | - Sarah Pearl Aronow-Werner
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California Oakland Medical Facility, Oakland, CA, United States
| | - Miranda L Ritterman Weintraub
- Department of Graduate Medical Education, Kaiser Permanente Northern California Oakland Medical Facility, Oakland, CA, United States
| | - Eve Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California Oakland Medical Facility, Oakland, CA, United States
| | - Crystal Goldsmith
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California Oakland Medical Facility, Oakland, CA, United States.
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Ahrens KA, Skjeldestad FE. Trends in initiation of hormonal contraceptive methods among teenagers born between 1989 and 1997 in Norway and the United States. Contraception 2021; 104:635-641. [PMID: 34329611 DOI: 10.1016/j.contraception.2021.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess initiation of hormonal contraception among women aged 15-19 in the US and Norway by birth cohort. STUDY DESIGN We used population-based survey (US) and administrative (Norway) data to estimate the cumulative probability of age at first use of hormonal contraception for female residents born between 1989 and 1997 in 3-year birth cohorts. Differences between countries were assessed using confidence intervals, and differences between birth cohorts were assessed using survival analysis. RESULTS At age 15, first use of any hormonal method was higher among US respondents (16%-17% US vs 10%-13% Norway), whereas for ages 16 to 19 use was higher among Norwegian women (by age 19, 60%-64% US vs 76%-78% Norway). Similar patterns were observed for pill use; however, depot medroxyprogesterone acetate (DMPA), implant, and intrauterine device (IUD) use tended to be higher among US women. In both countries, cumulative first use of the pill, patch, ring, and DMPA declined across birth cohorts while first use of implants and IUDs increased. CONCLUSION Age at initiation and type of first hormonal method use differed between US and Norwegian teenagers. These differences may contribute to the lower teen birth rate in Norway.
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Affiliation(s)
- Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME United States.
| | - Finn Egil Skjeldestad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Goyal V, Madison AM, Powers DA, Potter JE. Impact of contraceptive counseling on Texans who can and cannot receive no-cost post-abortion contraception. Contraception 2021; 104:512-517. [PMID: 34077749 DOI: 10.1016/j.contraception.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess optimal timing, patient satisfaction, and 1-year contraceptive continuation associated with contraceptive counseling among Texans who could and could not receive no-cost long-acting reversible contraception (LARC) via a specialized funding program. STUDY DESIGN In this prospective study conducted between October 2014 and March 2016, we evaluated participants' desire for contraceptive counseling during abortion visits, impact of counseling on change in contraceptive preference, satisfaction with counseling, and 1-year postabortion contraceptive continuation. We stratified participants into 3 groups by income, insurance status, and eligibility for no-cost LARC: (1) low-income eligible, (2) low-income ineligible, and (3) higher-income and/or insured ineligible. We examined the association between contraceptive counseling rating and 1-year method continuation by program eligibility and post-abortion contraceptive type. RESULTS Among 428 abortion patients, 68% wanted to receive contraceptive counseling at their first abortion visit. Counseling led to a contraceptive preference change for 34%. Of these, 21% low-income eligible participants received a more effective method than initially desired, 10% received a less effective method, and 69% received the method they initially desired. No low-income ineligible participants received a more effective method than they initially desired, 55% received a less effective method, and 45% received the method they initially desired. Five percent of higher-income eligible participants received a more effective method than they initially desired, 48% received a less effective method, and 47% received the method they initially desired. Highest counseling rating was reported by 51%. Compared to those providing a lower rating in each group, highest counseling rating was significantly associated with lower 1-year contraceptive discontinuation for low-income eligible participants (aHR 0.34, 95% CI 0.14, 0.81), but not for low-income ineligible (aHR 1.56, 95% CI 0.83, 2.91) and higher-income (aHR 0.73, 95% CI 0.47,1.13) participants. Additionally, 1-year contraceptive continuation was associated with highest counseling rating (OR 1.72, 95% CI 1.09, 2.72) and post-abortion LARC use (OR 11.70, 95% CI 6.37, 21.48) in unadjusted models, but only postabortion LARC in adjusted models (aOR 1.55, 95% CI 0.90, 2.66 for highest counseling rating vs. aOR 11.83, 95% CI 6.29, 22.25 for postabortion LARC use). CONCLUSIONS In Texas, where access to affordable postabortion contraception is limited, high quality contraceptive counseling is associated with 1-year contraceptive continuation only among those eligible for no-cost methods. IMPLICATIONS State policies which restrict access to affordable post-abortion contraception limit the beneficial impact of patient-centered counseling and impede patients' ability to obtain their preferred method.
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Affiliation(s)
- Vinita Goyal
- Population Research Center, University of Texas at Austin, Austin, TX.
| | - Anita M Madison
- Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, LA
| | - Daniel A Powers
- Population Research Center, University of Texas at Austin, Austin, TX
| | - Joseph E Potter
- Population Research Center, University of Texas at Austin, Austin, TX
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Väisänen H, Batyra E. Unintended pregnancy resolution among parous women in twelve low- and middle-income countries. J Biosoc Sci 2021;:1-27. [PMID: 34024306 DOI: 10.1017/S0021932021000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women's pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women's propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.
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Garnsey C, Zanini G, De Zordo S, Mishtal J, Wollum A, Gerdts C. Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people's experiences crossing borders to obtain care. Reprod Health 2021; 18:103. [PMID: 34022888 PMCID: PMC8141157 DOI: 10.1186/s12978-021-01158-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments.
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Affiliation(s)
- Camille Garnsey
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Giulia Zanini
- Department of Anthropology, University of Barcelona, Montalegre, 6-8 08001, Barcelona, Spain
| | - Silvia De Zordo
- Department of Anthropology, University of Barcelona, Montalegre, 6-8 08001, Barcelona, Spain
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, 4297 Andromeda Loop, Orlando, FL, 32816, USA
| | - Alexandra Wollum
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA.
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Meaidi A, Heimustovu BH, Nguyen H, Nguyen T. Declining risk of surgical intervention following early medical abortion: A time trend analysis. Contraception 2021; 104:492-495. [PMID: 33979650 DOI: 10.1016/j.contraception.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the time trend in risk of surgical intervention following early medical abortion. STUDY DESIGN We conducted a retrospective observational study including all medical abortions induced before a gestational age of 63 days during the period 2008-2012 in a Danish gynecology clinic with a single provider deciding the necessity of subsequent surgical intervention. All included abortions were followed for 8 weeks from first medical administration. We extracted information on surgical intervention during follow-up and potential confounding variables from local and national health registers and assessed these according to calendar time. Multiple logistic regression provided an adjusted odds ratio of the association between calendar time and risk of surgical intervention. RESULTS A total of 1372 abortions were induced on site during the study period. Surgical interventions on site decreased from 10.2% in 2008 to 2.6% in 2012 (p < 0.001). The decline was significant after adjustment of gestational age, maternal age, and reproductive history, odds ratio for 1-year increase 0.71 (95% CI: 0.59-0.86). CONCLUSION Risk of surgical intervention following early medical abortion declined by time independent of known risk factors for surgical intervention in a setting with a single provider deciding the necessity of surgical intervention.
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Affiliation(s)
- Amani Meaidi
- Gynecology Clinic Hvidovre, Hvidovre, Denmark; Department of Gynaecology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Tri Nguyen
- Gynecology Clinic Hvidovre, Hvidovre, Denmark
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Duroseau N, Loh M, Sanders L, Arden M. Options for Teens with No Options: A Self-Managed Second Trimester Abortion. J Pediatr Adolesc Gynecol 2021; 34:226-227. [PMID: 33242593 PMCID: PMC9616640 DOI: 10.1016/j.jpag.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several states have deemed abortions as nonessential services, effectively calling for a halt to abortion care during the COVID-19 pandemic. In response, women might elect for self-managed abortions by obtaining abortion medications online. CASE A 15-year-old girl presented with abdominal cramping and vaginal discharge after taking misoprostol obtained from an online retailer for a self-managed abortion in her second trimester during the COVID-19 pandemic. Her exam showed products of conception protruding from the vagina. The patient was emergently evaluated for an incomplete and possible septic abortion and underwent a dilation and evacuation procedure.
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Affiliation(s)
- Nathalie Duroseau
- Mount Sinai Adolescent Health Center, Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Hospital, New York, New York.
| | - Miranda Loh
- Mount Sinai Adolescent Health Center, Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Hospital, New York, New York
| | - Leslie Sanders
- Mount Sinai Adolescent Health Center, Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Hospital, New York, New York
| | - Martha Arden
- Mount Sinai Adolescent Health Center, Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Hospital, New York, New York
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Ojo IE, Ojo TO, Orji EO. Why do married women procure abortion? Experiences from Ile-Ife, south western Nigeria. Afr Health Sci 2021; 21:327-337. [PMID: 34394314 PMCID: PMC8356588 DOI: 10.4314/ahs.v21i1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Nigeria, about 1.25million induced abortions occur annually and the country accounts for one-fifth of abortion-related deaths globally. Objectives The study aimed to assess the determinants of induced abortion among married women. Methods A mixed methods study was conducted in Ile-Ife, Nigeria. The quantitative component employed a cross-sectional study design while the qualitative aspect comprised focus group discussions. Information on contraceptives use, unintended pregnancy and induced abortion were obtained from 402 married women (with at least one child) aged 18–49 years using a semi-structured questionnaire. Four focus group discussion sessions were conducted among women of reproductive age. Results Majority (67.2%) of respondents had ever used a contraceptive method. However, 34.3% of the women have had unintended pregnancies and 14.2% had induced abortion. FGD findings revealed that non-use of contraceptives and contraceptive failure were major reasons for unintended pregnancies and induced abortion. The significant predictors of induced abortion were non-use of contraceptives, age≥ 40 years and multiparity. Conclusion Induced abortion still occur among married women particularly those not using contraceptives, aged ≥40 years and those with high parity. More emphasis should be placed on making contraceptives more accessible to married women.
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Affiliation(s)
| | | | - Ernest Okechukwu Orji
- Obafemi Awolowo University College of Health Sciences, Department of Obstetrics, Gynaecology and Perinatology
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Ahinkorah BO, Seidu AA, Ameyaw EK, Budu E, Bonsu F, Mwamba B. Beyond counting induced abortions, miscarriages and stillbirths to understanding their risk factors: analysis of the 2017 Ghana maternal health survey. BMC Pregnancy Childbirth 2021; 21:140. [PMID: 33593319 PMCID: PMC7885363 DOI: 10.1186/s12884-021-03633-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Inasmuch as induced abortions, miscarriages and stillbirths constitute common adverse pregnancy outcomes contributing to poor maternal health, there is paucity of literature about these in Ghana. We investigated the factors associated with induced abortions, miscarriages and stillbirths in Ghana. Methods Data derived from the 2017 Ghana Maternal Health Survey was used in this study. Women aged 15–49 constituted the target for the study. This study examined the relationship between socio-demographic characteristics and induced abortions, stillbirths and miscarriages. Subsequently, multivariable binary logistic regression models were fitted to investigate the factors associated with induced abortions, stillbirths and miscarriages at 95 % confidence interval (CI). Results The prevalence of miscarriages, induced abortions and stillbirths in Ghana in 2017 were 10.8 %, 10.4 % and 2 % respectively. Induced abortions (12.9 %) and miscarriages (11.1 %) were found to be higher among urban residents whiles rural residents had more of stillbirths (2.1 %). Compared to women aged 15–24, those in all age categories had lower odds of experiencing induced abortions, with the lowest odds occurring among women aged 35–49 (AOR = 0.26, 95 % CI = 0.21-32). Conversely, women of all age categories had higher odds of experiencing miscarriages compared to those aged 15–24 with the highest odds among those aged 25–34 (AOR = 1.62, 95 % CI = 1.39–1.89). Women with at least primary education were more likely to experience miscarriages than those with no formal education, with those with higher level of education having the highest odds (AOR = 1.42, 95 % CI = 1.13–1.78). While the likelihood of induced abortions was lower among Muslims, compared to Christians (AOR = 0.65, 95 % CI = 0.52–0.82), the odds of miscarriages were higher among Muslims, compared to Christians (AOR = 1.31, 95 % CI = 1.13–1.52). Women with parity 1 or more were less likely to experience induced abortions, miscarriages and stillbirths compared to those with parity 0. Conclusions Our study indicates that efforts to limit induced abortions, miscarriages and stillbirths in Ghana need to focus on the disparities in socio-demographic characteristics of women. Synergy between government health institutions and the private sector cannot be left out if much success can be achieved in efforts to subside the current prevalence of induced abortions, stillbirths and miscarriages confronting the country.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, PMB University Private Mail Bag, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, 4811, Townsville, Queensland, Australia.
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, PMB University Private Mail Bag, Cape Coast, Ghana
| | - Freda Bonsu
- Asutifi South District Health Directorate, Hwidiem, Ghana
| | - Bupe Mwamba
- Centre for Midwifery, Family and Child Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Wang Y, Yang Q. Post Abortion Care and Management After Induced Abortion During the COVID-19 Pandemic: A Chinese Expert Consensus. Adv Ther 2021; 38:1011-1023. [PMID: 33459975 PMCID: PMC7812565 DOI: 10.1007/s12325-020-01610-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
The rapid spread of novel coronavirus (COVID-19) has posed complex challenges to global public health.
During this pandemic period, access to essential services including post-abortion care (PAC) has been disrupted. Along with the clinical management of the disease in women, protection of the healthcare workers and medical staff from nosocomial infection is important to ensure infection control. Thus, in order to implement the proper contraceptive measures and to reduce the rate of repeated abortion, the family planning group of minimally invasive gynecological branch of the Liaoning Medical Association organized a committee of experts to formulate guidance and suggestions to ensure the timely treatment and surgery of women opting for abortion, the implementation of PAC, implementation of safe contraceptive measures after surgery, and the protection of healthcare professionals and medical staff from infection. We believe these guidelines might be helpful for obstetrics and gynecology departments in China and globally, as well for women who wish to undergo abortion during these unprecedented times.
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Affiliation(s)
- Yu Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
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Abstract
Objective To analyze the extent to which task‐sharing to midlevel providers has been implemented as a strategy to increase access to abortion provision in Colombia, and examine the factors that have affected decentralization of services. Methods We conducted a case study based on the World Health Organization's 2015 guideline: Health Worker Roles in Providing Safe Abortion Care and Post‐abortion Contraception. Documentation was collected on the standard and epidemiological landscape of abortion in Colombia, followed by semistructured discussions with groups and individual stakeholders. Results Task‐sharing as a distinct policy to increase access to abortion services has not been implemented in Colombia. However, role distribution toward nonspecialist physicians has been used as a strategy to ensure access. Other professionals, such as nurses, have limited tasks in abortion care despite evidence to support a more expanded role. Conclusion The implementation of task‐sharing as a strategy to increase access to safe abortion services in Colombia is influenced by a wide range of factors and, although it is not policy, nonspecialist and diverse healthcare professionals supervise abortion care. Knowing the evidence‐based guidelines to safely and successfully include other healthcare professionals in abortion provision is a fundamental step in implementing this strategy. Task‐sharing for abortion provision does not exist as policy in Colombia. However, the C‐355 ruling that decriminalized abortion in 2006 paved the way for distribution of tasks to nonspecialist physicians and other healthcare professionals, and the decentralization and simplification of services.
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Abstract
The termination of unwanted pregnancies is a growing health-related issue around the world. This study used the 2017 Ghana Maternal Health Survey to examine the factors associated with the prevalence of induced abortion in Ghana. The study sample included 18,116 women of reproductive age who had a pregnancy in the 5 years preceding the survey. A multivariate logistic regression technique was applied. The prevalence of induced abortion was higher among women aged 25-34 years, those who had secondary-level education, those living in urban areas and in the Ashanti region, those of Akan ethnicity and those belonging to non-Catholic Christian denominations. Moreover, the prevalence was higher among single women, those who had no children, those who started sexual intercourse before the age of 18, those who were currently using a contraceptive, those exposed to media and those who knew about the legality of abortion. The multivariate analysis found that education, place and region of residence, marital status, ethnicity, current contraceptive use, religion, age at sexual debut, media exposure and knowledge about abortion legality were all significant predictors of induced abortion among women in Ghana. The study findings support a call for action to strengthen family planning services and educational programmes on induced abortion in Ghana to reach the target groups identified.
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