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1.
Dolorès Pourette Chiarella Mattern Rila Ratovoson Patricia Raharimalala 《Contraception》2018,97(2):116-121
Objective
The objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use.Study design
This was a qualitative study in 2015–2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what treatment they received postuse. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the subset of 19 women who had used misoprostol.Results
The 19 women were aged 16–40, with an average age of 21–26 at interview and average age of 18–21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and health care providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain and/or infection.Conclusions
This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Health care providers need training in correct misoprostol use and how to treat complications. Law and policy reforms are needed to support such training and to ensure the provision of safe abortion services in the public health system.Implications
Health care providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reforms are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration. 相似文献2.
Abigail R.A. Aiken Katherine A. Guthrie Marlies Schellekens James Trussell Rebecca Gomperts 《Contraception》2018,97(2):177-183
Objective
To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.Study design
We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help.Results
Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control.Conclusion
Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks.Implications
The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals. 相似文献3.
Irma Palma Manríquez Claudia Moreno Standen Andrea Álvarez Carimoney Alondra Richards 《Contraception》2018,97(2):100-107
Objectives
To explore the ways in which medical abortion pills are obtained and used by university students in Chile in a clandestine context.Study design
Using a qualitative approach, we conducted in-depth interviews with 30 young women who had had a medical abortion between 2006 and 2016 while attending university. We recorded the details of their pathways to abortion and their experience of abortion, and how they used networks in the university to find the pills and learn how to use them. The interviews were analyzed using narrative content analysis.Results
The findings show that medical abortion did not take place completely outside the healthcare system for these students, who accessed ultrasound scans pre- and post-abortion and post-abortion care. However, even with help and support from contacts, partners and friends, the clandestine situation created uncertainty and fear, which dominated the whole process, from finding and purchasing the pills, to uncertainty about correct doses and whether the abortion was going as it should and was complete or not. There was a high perception that failure and complications might be occurring, which led many of them to seek post-abortion care. The process was very demanding, requiring information, time, privacy to have the abortion, support and resources, and the ability to deal with risk.Conclusions
Medical abortion allowed these young women to have safe abortions in terms of reduced risks to health and autonomy through self-management. However, clandestinity made them physically, socially and emotionally vulnerable and exposed them to the risk of normative, violent judgments during post-abortion care.Implications
Access to medical abortion has transformed the experience of abortion in Chile, where abortion is illegal, because it is possible to use it safely and effectively outside healthcare settings. However, uncertainty, fear and risk will continue to dominate the experience, which can only be transformed by making abortion legal and available. 相似文献4.
Carine Baxerres Ines Boko Adjara Konkobo Fatoumata Ouattara Agnès Guillaume 《Contraception》2018,97(2):130-136
Objectives
This study aimed to document the means women use to obtain abortions in the capital cities of Benin and Burkina Faso, and to learn whether or not use of misoprostol has become an alternative to other methods of abortion, and the implications for future practice.Study design
We conducted in-depth, qualitative interviews between 2014 and 2015 with 34 women – 21 women in Cotonou (Benin) and 13 women in Ouagadougou (Burkina Faso) – about their pathways to abortion. To obtain a diverse sample in terms of socio-demographic characteristics, we recruited the women through our own knowledge networks, in health facilities where women are treated for unsafe abortion complications, and in schools in Benin.Results
The 34 women had had 69 abortions between them. Twenty-five of the women had had 37 abortions in the previous 5 years; the other abortions were 5–20 years before. Pathways to abortion were very different in the two cities. Lengthy and difficult pathways with unsafe methods often led to complications in Ougadougou, whereas most Cotonou women went to small, private health centers. Six of the 37 abortions in the previous 5 years involved misoprostol use, and were all among educated women with significant social and economic capital and personal contact with clinicians.Conclusions
Use of misoprostol for abortion has appeared in both Cotonou and Ougadougou in the past 5 years. Evidence that the use of misoprostol for abortion occurred among women with the most access to information and resources in this study suggests that increased awareness of and use of misoprostol in both countries is likely in the coming years.Implications
Although no pharmaceutical company that produces misoprostol has as yet tried to obtain marketing authorization in either Burkina Faso or Benin for gynecological-obstetric indications, making its use more potential than actual for the time being, international advocacy for access to medical abortion is growing rapidly and is likely to lead to many changes in this picture in the coming years. 相似文献5.
6.
Jennifer L Kerns Biftu Mengesha Blair C McNamara Arianna Cassidy Geffan Pearlson Miriam Kuppermann 《Contraception》2018,97(6):520-523
Objective
We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications.Study design
We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes.Results
We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, p<.0001), as were posttraumatic stress and grief scores (r=0.7, p<.0001). In the adjusted analysis, higher decision satisfaction was associated with lower grief and posttraumatic stress scores (p=.02 and p=.01, respectively) and higher shared decision making was associated with lower posttraumatic stress scores (p=.01).Conclusions
Decision satisfaction and shared decision making have a positive effect on psychological outcomes after second-trimester abortion for pregnancy complications. Counseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications.Implication
These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. 相似文献7.
Kari P Braaten Richard D Urman Rie Maurer Jennifer Fortin Alisa B Goldberg 《Contraception》2018,97(6):490-496
Objective
The objective was to compare the safety and efficacy of an algorithm for abortion intravenous sedation dosing (AAID) to standard dosing during first-trimester surgical abortion.Study design
This was a randomized, single-blinded, controlled trial in which women undergoing first-trimester surgical abortion received fentanyl and midazolam dosed per either an algorithm or clinic standard. Patient-level factors including weight, airway risk, anxiety, and drug and alcohol use determined AAID doses. The primary outcome was pain with suction curettage measured immediately on a 21-point verbal numerical rating scale ranging from 0 to 100. Secondary outcomes included pain with cervical dilation and postprocedure, intraoperative pain as recalled postprocedure, need for additional doses of medication, oxygen saturation<93%, sedation level, adverse events, side effects and patient satisfaction.Results
We enrolled 196 women and randomized 98 to the AAID and 98 to standard care. Baseline factors were similar between groups. Median intraoperative pain scores did not differ between groups when measured immediately (47.5 vs. 50, p=.81) or on recall (30 in both arms, p=.68). There were no significant differences in other secondary outcomes. Women with a body mass index (BMI) 30–35 trended toward improved pain control with the algorithm (60 vs. 27.5, p=.07).Conclusions
Intravenous sedation determined by an algorithm did not produce differences in pain scores in a setting with highly experienced providers.Implications
An intravenous sedation algorithm did not demonstrate significant benefit for the general population of surgical abortion patients. Providers with less experience titrating intravenous sedation might find it a helpful tool to guide sedation dosing. A possible benefit in obese patients warrants further study. 相似文献8.
Objective
The Midwest Access Project (MAP) offers opt-in training to students, residents and practicing clinicians in reproductive health care including abortion. We surveyed MAP alumni to identify current practice characteristics and assess predictors of reproductive health service provision.Study design
We sent an online survey to alumni of MAP's Individual Clinical Training program, 2007–2015 (n=127). The primary outcome was current provision of any abortion service. Secondary outcomes included providing specific abortion services and other reproductive services.Results
We received responses from 61% of eligible MAP alumni (n=77 out of 127). The majority reported a specialty of Family Medicine (68%) and current location in the Midwest (52%). Among current residents, fellows or clinicians practicing in a field whose scope includes abortion (n=56), 50% provide abortion. Most (84%) provide outpatient miscarriage management, and nearly all (≥96%) provide pregnancy options counseling and full scope contraception. Respondents who received the most advanced training in medication abortion as part of their MAP training were more likely to report providing abortion in their current practice than those who did not (63% vs. 32%, p=.027), as were those who completed more than one MAP rotation compared to those who completed one rotation (100% vs. 44%, p=.009).Conclusions
Half of MAP's alumni provide some abortion care. Nearly all provide comprehensive counseling and contraceptive services.Implications
Opt-in training is a promising strategy to develop providers of comprehensive reproductive health care. 相似文献9.
Naomi Lince-Deroche Jane Harries Deborah Constant Chelsea Morroni Melanie Pleaner Tamara Fetters Daniel Grossman Kelly Blanchard Edina Sinanovic 《Contraception》2018,97(2):167-176
Objective(s)
To estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used.Study design
We conducted a budget impact analysis using public sector abortion statistics and published cost data. We estimated the total costs to the public health service over 10 years, starting in South Africa's financial year 2016/17, given four scenarios: (1) holding service provision constant, (2) expanding public sector provision, (3) changing the abortion technologies used (i.e. the method mix), and (4) expansion plus changing the method mix.Results
The public sector performed an estimated 20% of the expected total number of abortions in 2016/17; 26% and 54% of all abortions were performed illegally or in the private sector respectively. Costs were lowest in scenarios where method mix shifting occurred. Holding the proportion of abortions performed in the public-sector constant, shifting to more cost-effective service provision (more first-trimester services with more medication abortion and using the combined regimen for medical induction in the second trimester) could result in savings of $28.1 million in the public health service over the 10-year period. Expanding public sector provision through elimination of unsafe abortions would require an additional $192.5 million.Conclusions
South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided. More research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions.Implications
South Africa can provide more safe abortions for less money in the public sector through shifting to more first-trimester methods, including more medication abortion, and shifting to a combined mifepristone plus misoprostol regimen for second trimester medical induction. Expanding access in addition to method mix changes would require additional funds. 相似文献10.
Objective
The purpose of this systematic review was to evaluate the efficacy of pretreatment with letrozole prior to either a first- or second-trimester medical termination of pregnancy.Study design
We searched letrozole, femara, aromatase inhibitors, abortifacient agents, termination of pregnancy and labor induction in MEDLINE, EMBASE, Cochrane Database, Google Scholar and PubMed from inception of each database until September 2015 with no language limitation. A systematic review of all randomized controlled trials (RCTs) was performed where women received either letrozole and misoprostol or placebo and misoprostol for termination of pregnancy. The primary outcome was complete abortion rate, defined as complete evacuation of the products of conception from the uterus. Relative risk with 95% confidence intervals was used to report data.Results
Our systematic review identified 7 studies; 4 RCTs were included in the review. Two RCTs evaluated terminations of pregnancy up to 9 weeks’ gestation, while 2 evaluated terminations over 9 weeks’ gestation. For each gestational age group, one trial supported an increase in complete abortion rate, while the other showed no difference, with letrozole and misoprostol compared with placebo and misoprostol. Time-to-abortion interval for terminations up to 9 weeks’ gestation was not improved with the addition of letrozole to misoprostol. For terminations over 9 weeks’ gestation, one trial supported and one trial refuted a decrease in time-to-abortion interval with letrozole and misoprostol. Similarly, for each gestational age group, one study supported a decrease and one study showed no difference in rate of dilation and curettage (D&C) with letrozole and misoprosol. Medication side effects were similar between both treatment groups. There was significant heterogeneity between the trials, and therefore, the results were not meta-analyzed.Conclusions
Some studies and trials report better outcomes (i.e., complete abortion rates, time-to-abortion and D&C rates) in women exposed to letrozole and misoprostol compared to placebo and misoprostol, while other trials demonstrate no difference. Further research exploring letrozole pretreatment prior to medical abortion is required.Implications
This systematic review demonstrated that a combination of letrozole and misoprostol increased the rate of complete abortion compared to misoprostol alone in some studies but not in others; additional well-designed RCT's are needed. 相似文献11.
Introduction
The lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misoprostol for early abortion, with the aim of providing safe and free abortion care in this low-resource and legally restricted setting.Methods
We conducted 16 in-depth, in-person interviews with women from Burma residing on both sides of the border who accessed misoprostol through the community-based distribution initiative. We analyzed interviews for content and themes using deductive and inductive methods.Results
Overall, women felt positively about their abortion experiences and the initiative. Previous abortion experiences and the recommendations of others shaped women's access. All participants, including those who remained pregnant after taking the misoprostol, would recommend the initiative to others.Conclusion
Community-based distribution of misoprostol is an effective and culturally appropriate method of improving safe abortion care on the Thailand-Burma border. Supporting efforts to expand the harm reduction program to more communities and provide regular reproductive health and safe abortion trainings appears warranted.Implications
In recent years, a number of organizations have launched programs dedicated to misoprostol-alone for early abortion. However, few have documented the experiences and perspectives of women. Our findings indicate providing misoprostol through lay provision in a legally restricted context is not only safe and effective but also culturally resonant. 相似文献12.
Katherine Whitehouse Tiana Fontanilla Leslie Kim Mary Tschann Reni Soon Jennifer Salcedo Bliss Kaneshiro 《Contraception》2018,97(6):500-503
Objective
Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.Study design
We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.Results
One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24 weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.Conclusion
We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.Implications
We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions. 相似文献13.
14.
Objective
The objective was to describe the efficacy of medical abortion using mifepristone and misoprostol for gestations less than 6 weeks.Study design
We searched PubMed and Cochrane databases for articles in any language that examined the success of mifepristone and misoprostol abortion at gestational ages <42 days. Data were independently abstracted by two authors and graded for evidence quality. A pooled analysis of efficacy and a summary odds ratio of abortion failure of <42 days’ gestation compared with gestational week 42–49 days were performed for randomized trials as well as for prospective studies.Results
Six randomized controlled trials and nine prospective observational studies met inclusion criteria. Included studies varied greatly in regimens of mifepristone and misoprostol used, and assessment of and timing of outcome of abortion. A pooled proportion of the randomized trials estimated a proportion of unsuccessful abortion of 0.02 (95% confidence interval 0.01–0.03). In the prospective studies, the proportions ranged between 0.02 and 0.17, with considerable heterogeneity in the pooled estimate. However, the two largest observational studies reflected the estimates of the randomized trials (range 0.02–0.03). The summary odds ratios indicated that the odds of unsuccessful abortion were not significantly different between gestational age groups (<42 days versus >42–49 days).Discussion
These analyses support the use of medical abortion at gestational ages <42 days. Efficacy rates are high overall and appear to reflect those observed during the seventh week of pregnancy. Women who prefer to initiate treatment as soon as early pregnancy is diagnosed may do so without delay.Implications
Women can expect success using medical abortion regimens as soon as pregnancy is diagnosed; further research of abortion outcomes disaggregated by gestational age and visualization of the gestational sac is warranted. 相似文献15.
Anand Tamang Mahesh Puri Sazina Masud Deepak Kumar Karki Diksha Khadka Minal Singh Poonam Sharma Subash Gajurel 《Contraception》2018,97(2):137-143
Objectives
To examine the treatment efficacy, safety and satisfaction of women using medical abortion (MA) pills provided by pharmacists following an education intervention based on a harm reduction approach.Study design
This was an operations research study over a six-month period in 2015, using a non-inferiority design. We provided training to dispense MA pills, based on a harm reduction approach, to a group of pharmacy workers in Makwanpur district (GROUP 2). We compared selected outcomes with women who bought the pills from pharmacy workers in Chitwan district (GROUP 1), who had received similar training in 2010. The primary endpoint measured in 992 women in both districts was complete abortion within 30 days of using the pills. We assessed the efficacy of MA (self-reported complete abortion) and safety (no reported adverse event). To determine complete abortion, we asked women about passage of the products of conception, cessation of abdominal cramps, vaginal bleeding, need for manual vacuum aspiration or repeated doses of misoprostol. We used a four-point Lickert Scale to determine level of satisfaction with MA use. Pearson Chi-Square test was used to examine any differences in proportion of complete abortions between women who were served by the two groups of pharmacy workers.Results
The difference in the rate of complete abortions between the two groups of women, 96.9% and 98.8%, was not statistically significant. The women reported no serious complications, and there was little difference in their satisfaction levels.Conclusions
Trained pharmacy workers dispensed MA safely and effectively to the satisfaction of almost all women clients, and the positive results of training had continued several years later.Implications
The role of pharmacy workers as providers of correct and complete information on safe and effective use of MA needs to be recognized and policies formulated to allow them to provide MA drugs for first trimester use. 相似文献16.
Molly McCarthy Ushma Upadhyay M. Antonia Biggs Renaisa Anthony Jennifer Holl Sarah CM Roberts 《Contraception》2018,97(4):303-308
Objective
Earlier pregnancy discovery is important in the context of prenatal and abortion care. We evaluated characteristics associated with later pregnancy discovery among women seeking abortion care.Study design
Data come from a survey of women seeking abortion care at four family planning facilities in Utah. The participants completed a survey during the state-mandated abortion information visit they are required to complete prior to having an abortion. The outcome in this study was pregnancy discovery before versus after 6 weeks since respondents' last menstrual period (LMP). We used logistic regression to estimate the relationship between sociodemographic and health-related independent variables of interest and pregnancy discovery before versus after 6 weeks.Results
Among the 458 women in the sample, 28% discovered their pregnancy later than 6 weeks since LMP. Most (n=366, 80%) knew the exact date of their LMP and a significant minority estimated it (n=92, 20%). Those who estimated the date of their LMP had higher odds of later pregnancy discovery than those who knew the exact date (adjusted odds ratio (aOR) = 1.81[1.07–3.07]). Those who used illicit drugs weekly, daily, or almost daily had higher odds of later pregnancy discovery (aOR=6.33[2.44, 16.40]).Conclusion
Women who did not track their menstrual periods and those who frequently used drugs had higher odds of discovering their pregnancies later.Implications
Women who estimated the date of their LMP and who frequently used drugs may benefit from strategies to help them recognize their pregnancies earlier and link them to care when they discover their pregnancies later. 相似文献17.
Gillian Horwitz Danielle Roncari Kari P. Braaten Rie Maurer Jennifer Fortin Alisa B. Goldberg 《Contraception》2018,97(1):48-53
Objective
To determine if obese women experience increased rates of adverse outcomes with moderate intravenous sedation during first trimester surgical abortion compared to normal weight women.Study design
We performed a retrospective cohort study of all first trimester surgical abortions with moderate intravenous sedation at an outpatient facility between September 2010 and June 2015. The primary outcome was supplemental oxygen administration. Secondary outcomes included reversal agent administration, anesthesia-related adverse events, and intraoperative lowest level of consciousness (LLOC). We compared three obesity groups [I (Body Mass Index, BMI=30–34.9), II (BMI=35–39.9), and III (BMI ≥40)] to normal weight women (BMI <25). We exported data from electronic medical records and reviewed adverse outcomes individually.Results
Of 20,381 first trimester surgical abortion procedures, 31 (0.15%) utilized supplemental oxygen, 24 (0.12%) utilized a reversal agent, 40 (0.20%) had a presumed anesthesia-related adverse event and 184 of 19,725 (0.93%) had a documented low intraoperative LLOC. One patient (0.005%) required hospital transfer or hospitalization. Supplemental oxygen administration (obesity versus normal weight: obese I, aOR 0.52, 95% CI 0.12–2.27; II/III, aOR 1.51, 95% CI 0.50–4.54), low intraoperative LLOC, and anesthesia-related adverse events were not associated with obesity. The rate of reversal agent administration was lower among obese I, II and III women combined compared to normal weight women (aOR 0.13, 95% CI 0.02–0.96).Conclusions
Adverse outcomes were rare across all BMI categories with no detectable increased risk among obese women compared to normal weight women.Implications
With appropriate clinical screening, obese women can safely receive moderate intravenous sedation for first trimester surgical abortion in an outpatient clinical setting. Restrictions on moderate intravenous sedation based on BMI alone may be unnecessary. 相似文献18.
Objective
Later second-trimester abortion (gestational age ≥ 19 weeks) is higher risk, more expensive and more difficult to access than abortion earlier in pregnancy. We sought to enumerate barriers to care described by women seeking abortion in the latter half of the second trimester. We also assessed the accuracy of later second-trimester abortion patients’ perceptions of their pregnancies’ gestational ages.Study Design
A retrospective analysis of data from 232 women served by a referral program for women seeking abortion care between 19 and 24 weeks of gestational age was performed. Data collected included demographics, pregnancy history, gestational age by ultrasound, perceived gestational age, barriers to abortion care experienced and time lapsed from pregnancy recognition to presentation for care.Results
Difficulty deciding whether to terminate (44.8%), financial barriers to care (22.0%) and the patient having recently realized she was pregnant (21.6%) were the most common delaying barriers cited. Nearly half (46.6%) of women underestimated their own gestational ages by greater than 4 weeks. Risk factors for experiencing at least 3 months time lapsed from pregnancy recognition to program referral included difficulty deciding whether to terminate [odds ratio (OR) 4.08, 95% confidence interval (CI) 2.51–8.70] and nonwhite race/ethnicity (OR 2.04, 95% CI 1.16–3.57).Conclusions
Women seeking abortion care in the latter half of the second trimester encounter many of the same barriers previously identified among other abortion patient populations. Because many risk factors for delayed presentation for care are not amenable to intervention, abortion must remain available later in the second trimester.Implications
Women presenting for abortion in the later second trimester are delayed by structural and individual-level barriers, and many substantially underestimate their own gestational age. Removing financial barriers may help reduce abortion delay; however, many risk factors are nonmodifiable, underscoring the need to ensure access to later second-trimester abortion. 相似文献19.
Belén Ortiz-Gonçalves Elena Albarrán Juan Elena Labajo González Andrés Santiago-Sáez Bernardo Perea-Pérez 《Gaceta sanitaria / S.E.S.P.A.S》2018,32(4):333-338
Objective
To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment.Method
A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire.Results
The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide.Conclusion
Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid. 相似文献20.