Exploring the pathways of unsafe abortion in Madhya Pradesh, India

Abstract Nearly 40 years after enactment of the Medical Termination of Pregnancy Act of 1971, unsafe abortion continues to be a neglected women's health issue in India. This prospective study of women presenting for post-abortion care in 10 selected hospitals in Madhya Pradesh, India, aimed to understand the incidence, types and severity of post-abortion complications, probable causes of complications and consequences to women in terms of hospitalisation and incurred costs. Among 1565 women presenting for induced abortion-related services between July and November 2007, 381 women with post-abortion complications consented to participate. Data reveal a high prevalence of post-abortion complications (29%). Approximately half of women originally attempted to induce abortion at home using medication, home-made concoctions or traditional methods. Ninety percent sought care from either qualified (37%) or unqualified providers. More than half of the women were hospitalised as a result of post-abortion complications. This study suggests that supporting access to safely induced abortion services and improving community awareness on legal aspects, safe methods and approved providers are all necessary to reduce morbidity associated with unsafe abortion.     

Private individual ambulatory health care providers in Madhya Pradesh province, India

Background  Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim  This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India’s largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method  A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results  There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion  Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations’ needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.     

流产后关爱对流产妇女避孕知识和行为的影响及效果

目的 探讨临床上开展流产后关爱（PAC）服务,对流产妇女的避孕知识和行为的影响及效果。方法 选择湖南省湘潭市妇幼保健院开展PAC服务前后在该院门诊行人工流产（人流）手术患者各160例,比较两组干预前后1个月及6个月对避孕知识掌握,有效避孕措施落实率,重复流产率。比较口服避孕药研究对象与未避孕对象术后阴道流血时间、流血量。结果 通过PAC流程,人流后女性对避孕知识认知度明显提高,有效避孕率明显上升,重复流产率明显降低,差异有统计学意义（P〈0.05）。另外,实行人流后口服避孕药,不但可以实现高效避孕,同时可减少术后阴道出血,促进子宫恢复,有效改善育龄女性生殖健康,差异有统计学意义（P〈0.05）。结论 流产后关爱对普及女性避孕知识、落实有效避孕及降低重复流产率效果明显,可保护女性生殖健康。     

Examining the association between motivations for induced abortion and method safety among women in Ghana

This article draws on data from 552 women interviewed in the 2007 Ghana Maternal Health Survey to examine the association between motivations for women’s pregnancy terminations and the safety of methods used. Women’s reasons for induced abortions represented their vulnerability types at the critical time of decision making. Different motivations can result in taking various forms of action with the most vulnerable potentially resorting to the most harmful behaviors. Analysis of survey data pointed to spacing/delaying births as the main reason for abortion. Furthermore, women were more likely to terminate pregnancies unsafely if their main motivation for abortion was financial constraints. Especially among rural women, abortions for any reason were more likely associated with safe methods than if for financial reasons. These findings suggest a theme of vulnerability, resulting from poverty, as the motivations for women to resort to harmful abortion methods. Therefore, interventions formulated to reduce instances of unsafe pregnancy terminations should target reducing poverty and capacity building with the aim of economic advancement, in addition to curbing the root of the problem: unintended pregnancy.     

海淀区46492例人工流产不同手术方法现状分析

目的了解人工流产女性不同手术方法选择情况,为制定相应政策提供依据。方法对2008年10月至2011年9月海淀区计划生育技术服务年报表和2010年10月至2011年9月在海淀区29所计划生育技术服务机构实施早孕人工流产的《计划生育门诊人工流产手术登记本》登记信息进行统计分析。结果2008年10月至2011年9月人工流产手术46492例,4年中,每年无痛人工流产在孕早期人工终止妊娠手术中所占比例分别为54．27％、59．99％、65．30％、68．20％,呈逐年上升趋势,差异有统计学意义（χ2＝2736．074,P＜0．001）;就诊医院级别、年龄、婚姻、人工流产次数、是否有手术高危因素为不同手术方法选择的影响因素,就诊医院为二级医院、未婚、有高危因素、年龄＜35岁更容易选择无痛人工流产;人工流产次数为1次者更容易选择普通人工流产,流产次数2次、3次者（与≥4次者相比）选择人工流产的方法没有差别。结论无痛人工流产已成为孕早期人工终止妊娠手术的主要方法;各级管理部门、各级开展无痛人工流产手术的机构要不断加强对无痛人工流产的规范管理与操作,做好流产后妇女避孕节育的健康教育工作。     

Factors associated with second trimester abortion in rural Maharashtra and Rajasthan,India

Abstract

Many married women in India experience abortion in their second trimester of pregnancy. While there is an impression that second trimester abortions are now overwhelmingly used for sex selection, little is known about the extent to which second trimester abortions are indeed associated with son preference and sex selection motives, relative to other factors. Using data from a community-based study in rural Maharashtra and Rajasthan, research highlights the role of limited access in explaining second trimester abortion. While women with a single child who was a daughter were indeed more likely than other women to have terminated a pregnancy carrying a female foetus in the second trimester, more strikingly, exclusion from abortion-related decision-making, unsuccessful prior attempts to terminate the pregnancy, and distance from the facility in which their abortion was performed, were significantly associated with second trimester abortion, even after controlling for confounding factors. The study calls for greater efficiency in implementing the PCPNDT Act and addressing deep-rooted son preference. At the same time, findings that poverty and limited access to facilities are as, if not more, important drivers of second trimester abortion, highlight the need to meet commitments to ensure accessible abortion facilities for poor rural women.     

计划生育技术服务机构人工流产状况及服务能力分析

目的：基于2012年度海淀区29家计划生育技术服务机构实施非意愿妊娠人工流产手术情况,了解妇女的生殖健康状况,为制定干预措施提供理论依据。方法根据医疗机构级别,从71家从事计划生育技术服务的医疗机构中抽取29家不同级别的计划生育技术服务机构,将《计划生育门诊人流手术登记本》登记信息进行数据录入及统计分析。结果29家医疗机构人工流产总例数为46492例,占人工流产总例数（52031）的89．35％。未婚者选择无痛人工流产的人群明显高于已婚者,差异有统计学意义（χ2＝1280．569,P＜0．01）;人工流产次数多者,选择无痛人工流产终止妊娠的比率高于人工流产次数少者,差异有统计学意义（χ2＝227．602,P＜0．01）。未婚人群选择在二级医疗保健机构就医多于其他机构,差异有统计学意义（χ2＝25．903,P＜0．01）;非本市户籍人群选择在一级医疗机构就医的比例高于本市人群,差异有统计学意义（χ2＝646．112,P＜0．01）。结论非户籍人口流产率高、未婚人群流产率高,计划生育技术服务机构应拓展服务范围,加强避孕知识普及和人工流产术后的避孕指导,有效降低非意愿妊娠和重复人工流产。     

Women and reproductive control: the nexus between abortion and contraceptive use in Madhya Pradesh, India

This article examines the determinants of contraceptive and abortion behavior and how each of these influences the other, with an emphasis on the role of women's life-course stage and experience. We base our approach on life-course theory, which argues that behavior is influenced by current circumstances as well as experiences over the life course. We use data collected for every pregnancy experienced by 2,444 women in Madhya Pradesh, India, to explore use of temporary contraceptive methods (both modern and traditional) and sterilization, as well as abortion attempts. We use logistic regression to model whether women took these actions in a given pregnancy interval, including past experience with contraception in the abortion analyses and with abortion in the contraceptive analyses. The results suggest that life-course factors play a role in shaping behavior. Moreover, past use of contraceptives has a significant effect on attempted abortion and vice versa. Finally, we find that this relationship changes as women age and accumulate experience.     

人工流产术后即时口服避孕药妈富隆的临床观察

目的探讨复方短效口服避孕药妈富隆在人工流产后的应用价值。方法 240例人工流产患者随机分成两组,观察组120例,人工流产术后即日起服用妈富隆1片/d,连服21天;对照组120例,人工流产术后不服用妈富隆。观察两组术后阴道出血量、出血时间、转经时间,术后并发症以及转经后避孕方法选择情况。结果阴道出血量少于月经量、似月经量和多于月经量的比例观察组和对照组分别为88.2%、8.8%、2.9%和74.8%、17.8%、7.5%;阴道出血时间<4d,4～7d,>7d的比例分别为63.7%、21.6%、14.7%和42.1%、32.7%、25.2%;术后转经时间<31d,31～37d,>37d的比例分别为72.5%、20.6%、6.9%和48.6%、31.8%、19.6%。术后并发症以及再次妊娠的发生率观察组明显低于对照组;人工流产转经后选择使用口服避孕药避孕的比例观察组明显高于对照组;以上各项两组比较差异均有统计学意义(P<0.05)。结论人工流产后即时应用复方短效口服避孕药能减少阴道出血量、缩短出血时间,促进月经恢复,降低近期和远期并发症,提高避孕药的使用率,减少重复流产。     

流产后关爱服务对高效避孕方法使用的影响

目的:探讨流产后关爱(PAC)服务对高效避孕方法使用的影响。方法:选取2014年1~6月在郑州大学第一附属医院妇科门诊行人工流产的763名健康妇女,随机分为两组,PAC组375例在接受人工流产服务的同时接受流产后关爱服务,对照组388例接受传统的人工流产服务,比较两组术后即刻及术后3、6、12个月高效避孕方法的使用率、续用率以及术后1年内重复流产率。结果:PAC组术后即刻及术后3、6、12个月高效避孕方法的使用率优于对照组(P0.05),PAC组术后1年内重复流产率明显低于对照组(P0.05)。结论:PAC服务可促进女性术后选择高效避孕方法,提高短期内续用率,降低1年内重复流产率。     

人工流产术后即服妈富隆的临床观察

目的观察人工流产术后口服妈富隆的临床效果。方法选择2011年11月至2012年11月在中山市南朗医院行人工流产术的健康早孕受术者200例,随机分成两组,治疗组(100例)于人工流产术后当日即口服妈富隆,1片/d,连用21 d,新生化颗粒按常规服用。对照组(100例)于术后当天开始仅按常规口服新生化颗粒。结果治疗组出血量少、出血时间短、月经恢复时间快,子宫内膜修复快,重复流产率低,盆腔炎、宫腔粘连等并发症少(P0.05)。结论人工流产术后口服妈富隆能减少阴道流血量,缩短流血时间,降低重复流产率,加快月经恢复时间,促进月经正常,减少术后并发症,值得临床推广应用。     

青少年人工流产现状及避孕方式的选择

目的了解目前年龄≤25岁青少年人工流产现状和PAC服务前后对避孕方式的选择,分析LARC在该人群中的应用状况。方法对2018年四川省妇幼保健院行非意愿妊娠人工流产的年龄≤25岁青少年实施术前问卷调查和术后流产后关爱(post-abortion care,PAC)服务,统计分析该人群对避孕方式的选择。结果年龄≤25岁青少年占非意愿妊娠人工流产总人数的38.43%。实施PAC服务后避孕意识增强,未采取避孕措施的比例较PAC服务前明显降低,差异有统计学意义(P<0.05);且选择高效避孕措施的比例明显增高,如复方口服避孕药(76.46%vs 1.03%),LARC(12.13%vs 0),差异均有统计学意义(P<0.05)。结论年龄≤25岁青少年人工流产率高;PAC服务后青少年能更好地选择高效的避孕措施,但目前LARC在该人群中并不受青睐。     

Evaluation of a network of medical abortion providers in two districts of Maharashtra,India

Abstract

The objective of this study was to examine experiences and service delivery of private medical doctors participating in a professional network designed to improve knowledge and service quality of medical abortion (MA) procedures. A cross-sectional assessment of 87 Medical Abortion Provider Network (MAPnet) participants was conducted between December 2006 and January 2007 to describe participants’ service delivery and network experiences. After participating in MAPnet, providers reported a statistically significant amount of more MA services (92%), national protocol adherence for timing of drug administration (93%) and drug dosage protocols (82%) when compared to their reports before MAPnet affiliation. In addition, MAPnet providers offered contraceptive counselling (100%) and pain management (54%). Nearly three-quarters of providers were interested in continuing their association with the network initiatives. However, the network failed to adequately facilitate inter-network sharing of knowledge and experiences. These findings suggest that establishing and nurturing a network of private medical doctors can improve availability and quality of safe and early abortion services through MA.     

A Comparative Emission Profile of an Urban Area in Madhya Pradesh,India

This paper emphasizes on mathematical and field work approach to diagnosing the environmental pollution for Indore, India. These applications are based on the time-series statistics and for three semi-industrial as well as residential areas. The generalized additive models finds as a best fit-model in terms of autocorrelation and reduction of over-dispersion. The interdisciplinary study works on the principal of pollutant source, meteorological parameters, pollutant types, emission rates and various chemical processes. Several chemical or industrial processes like iron and steel production, combustion of fossil fuels, biomass burning, thermal power plants are major polluter in most of the mega cities.     

药物与人工流产终止早期妊娠的临床比较

目的比较药物流产和人工流产两种不同方式在终止早期妊娠上的被接受程度以及临床效果。方法选取2008~2012年在茂名市人口和计划生育综合服务中心终止早期妊娠的286例受术者,根据终止妊娠方式的不同,分为药物流产组(128例)和人工流产组(158例),比较两组受术者终止妊娠的临床效果以及再次意外妊娠后会选择的终止妊娠方式。结果两组在完全流产率、不完全流产率、人工流产综合征发生率、流产后阴道出血时间上比较差异无统计学意义(P0.05)。两组再次意外妊娠后会选择的终止妊娠方式比较,差异有统计学意义(P0.05)。结论药物流产和人工流产在终止早期妊娠中有各自的优点和缺点,可根据受术者的具体情况和既往流产病史选择流产方式,在终止早期妊娠中取得比较好的临床效果。     

Unsafe abortion: regulation of the social body even beyond time and space

This paper offers an analysis of women's performance of unsafe abortion in rural Ghana despite significant cultural sanctions that forbid the practice. Findings demonstrate how women in the study balance sanctions inherent in traditional belief structures against their own immediate physical and social best interests. In rural Ghana, a woman's body is not always her own to do with as she would wish. It is also a social body, which is embedded in multiple sets of relationships and subject to social regulation. Traditional authority over a woman's body belongs not only to the community elders in the immediate physical environment of the village but also extends beyond time and space to immaterial ancestral persons who watch over the actions and behaviours of those on earth. Authority resides also with Mawu, the Ewe God, who is offended by the practice of abortion. Data from this study reveal that the performance of unsafe abortion in this Ewe community is a desperate act in which the women must not only risk their physical lives, but must also step outside the boundaries of ideological cultural conformity to traditional values and carry the risk of their actions even into life after death.     

未婚女青年人工流产现状分析

目的了解未婚女青年人工流产现状,为未婚女青年生殖健康保健提供依据。方法对2012年1至12月在西安市中心医院妇产科门诊和西安交通大学医学院第一附属医院妇产科门诊行人工流产和药物流产（以下统称为人工流产）的未婚女青年进行问卷调查,以既往有过至少1次人工流产史定义为重复人工流产（研究组）,本次为第1次人工流产者为对照组,比较两组的社会人口学、性行为、人工流产原因等方面的差异。结果本次为第1次人工流产者（对照组）121例（36．01％）,重复人工流产者（研究组）215例（63．99％）。研究组平均年龄低于对照组（t＝2．80,P＜0．05）,且在校学生及外来务工者比例高、文化程度偏低、首次性行为年龄小、多个性伴比例高,经比较有显著性差异（χ2值分别为18．22、12．60、21．57、7．44,均P＜0．05）。结论重复人工流产者性生活开始较早,在校学生和外来务工人员比例较高,学历偏低,多性伴比例较高。因此建议开展流产后避孕咨询服务,促进未婚女青年的生殖健康。     

Access,equity and costs of induced abortion services in Australia: a cross‐sectional study

Objectives: To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation. Methods: Cross‐sectional survey of 2,326 women aged 16+ years attending for an abortion at 14 Dr Marie clinics. Associations with later presentation assessed using multivariate logistic regression. Results: Over a third of eligible women opted for a medical abortion. More than one in 10 (11.2%) stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560, compared to $470 for a surgical abortion at ≤9 weeks. Beyond 12 weeks, costs rose considerably. More than two‐thirds (68.1%) received financial assistance from one or more sources. Women who travelled ≥4 hours (AdjOR: 3.0, 95%CI 1.2–7.3), had no prior knowledge of the medical option (AdjOR: 2.1, 95%CI 1.4–3.1), had difficulty paying (AdjOR: 1.5, 95%CI 1.2–1.9) and identified as Aboriginal and/or Torres Strait Islander (AdjOR: 2.1, 95%CI 1.2–3.4) were more likely to present ≥9 weeks. Conclusions: Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health: Policy reform should focus on reducing costs and enhancing early access.