城市未婚青少年免费人工流产及避孕情况调查

目的:了解杭州市进行免费人工流产的青少年避孕情况。方法:对2004～2008年间在杭州市生殖健康服务中心申请免费人工流产的青少年情况进行问卷调查。共调查青少年720名。调查内容包括年龄、学历、人工流产史、避孕情况以及初次性生活年龄等。此外,还对166名陪同就诊的同学进行避孕情况和知识的调查。结果:在720名申请人工流产者中,年龄14～24岁,以18～20岁为多,占54%。本次流产原因79%为未避孕,21%为避孕失败。有多次人工流产史的占32%。初次性生活年龄平均17岁,最小13岁。在调查的避孕情况886人中,选择不避孕和避孕的分别占59.5%和40.1%;避孕方式选择安全期、避孕药、避孕套、体外射精的比例分别为64.9%、15.3%、4.7%、2.5%。结论:高中学生是未婚人工流产的主要群体,应尽快将性教育纳入到思想道德教育体系中,加强对青少年生殖健康知识的普及,开展对青少年的生殖健康服务。     

Characteristics of U.S. women having abortions, 1982-1983

In 1982 and 1983, as in previous years, the majority of abortions in the United States were obtained by young women (62 percent), white women (70 percent) and unmarried women (81 percent). Half of all abortions were performed eight or fewer weeks after the last menstrual period, and 91 percent, at 12 weeks or earlier. The proportion of abortions that were repeat procedures continued to rise, to 37 percent in 1982 and 39 percent in 1983. The rate of abortion, 29 per 1,000, has remained essentially the same since 1981. Women aged 18-19 continue to have the highest abortion rate of any age-group (60 per 1,000). While most abortions are obtained by white women, the nonwhite abortion rate is more than twice that of whites. Thirty percent of all pregnancies were terminated by abortion in 1983, the same proportion as in 1982 and 1981. The highest abortion ratios are found among unmarried women (63 percent), women 40 and older (51 percent), teenagers (42 percent) and nonwhites (40 percent). Teenage nonwhites and whites have about the same abortion ratios. After rising during the 1970s, the adolescent pregnancy rate peaked around 1980-1981 and fell slightly in 1982-1983. The relative differentials between the pregnancy, birth and abortion rates of nonwhite and white teenagers narrowed somewhat between 1978 and 1981, but then widened slightly between 1981 and 1983.     

Race-specific patterns of abortion use by American teenagers.

Between 1972 and 1978, as legal abortion became more widely available nationally, abortion rates (abortions per 1,000 women) and ratios (abortions per 1,000 live births) increased for all American teenagers; from 1972 to 1975, the rates and ratios for teenagers for Black and other races increased faster than those for White teenagers. For all seven years, abortion rates were higher for teenagers of Black and other races than for white teenagers. This reflected both higher proportions of sexually active teenagers of Black and other races and a greater risk of pregnancy in these teenagers compared with White teenagers. Race-specific differences in legal abortion ratios narrowed during the seven-year interval, as did differences in alternative outcomes of teenage premarital pregnancies (term births, illegal abortions).     

Estimating the probability of spontaneous abortion in the presence of induced abortion and vice versa.

An integrated approach to estimate the total number of pregnancies that begin in a population during one calendar year and the probability of spontaneous abortion is described. This includes an indirect estimate of the number of pregnancies that result in spontaneous abortions. The method simultaneously takes into account the proportion of induced abortions that are censored by spontaneous abortions and vice versa in order to estimate the true annual number of spontaneous and induced abortions for a population. It also estimates the proportion of pregnancies that women intended to allow to continue to a live birth. The proposed indirect approach derives adjustment factors to make indirect estimates by combining vital statistics information on gestational age at induced abortion (from the 12 States that report to the National Center for Health Statistics) with a life table of spontaneous abortion probabilities. The adjustment factors are applied to data on induced abortions from the Alan Guttmacher Institute Abortion Provider Survey and data on births from U.S. vital statistics. For the United States in 1980 the probability of a spontaneous abortion is 19 percent, given the presence of induced abortion. Once the effects of spontaneous abortion are discounted, women in 1980 intended to allow 73 percent of their pregnancies to proceed to a live birth. One medical benefit to a population practicing induced abortion is that induced abortions avert some spontaneous abortions, leading to a lower mean gestational duration at the time of spontaneous abortion.     

Teenage abortion and pregnancy statistics by state, 1996

CONTEXT: State-level teenage pregnancy rates, birthrates and abortion rates are needed for state-specific programs and policies. Accurate and complete state-level data were last published in 1992. METHODS: Teenage abortion rates according to state of residence, race and ethnicity were calculated from the results of The Alan Guttmacher Institute's survey of abortion providers and from information compiled by state health statistics agencies and the Centers for Disease Control and Prevention. Natality data were obtained from the National Center for Health Statistics, and population denominators from the Census Bureau. RESULTS: In 1996, some 97 pregnancies, 54 births and 29 abortions occurred per 1,000 U.S. women aged 15-19. At the national level and in virtually all states, these rates have fallen since 1992, yet they remain higher than rates in most other developed countries. The decline in the teenage abortion rate (from 36 per 1,000 in 1992) has been proportionately greater than the drop in the birthrate (from 61 per 1,000), indicating that an increasing proportion of pregnant teenagers are continuing their pregnancies. Pregnancy rates, birthrates and abortion rates vary enormously among the states for reasons that are largely unexplained. Pregnancy rates and birthrates tend to be highest in the South and Southwest, while abortion rates are highest in the most urban states. CONCLUSIONS: Teenage pregnancy is declining in all parts of the country. Although rates have fallen, further progress is possible, as is indicated by the low rates in certain states and in other developed countries. More research is needed to identify the factors influencing the reproductive behavior of adolescents.     

Trends in rates of live births and abortions following state restrictions on public funding of abortion

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.     

1826例住院分娩妇女人工流产状况及影响因素研究

目的了解武汉市育龄妇女人工流产状况,分析人工流产的影响因素,为有关部门采取有效措施降低人工流产率、提高母婴健康水平提供科学依据。方法采用横断面调查的方法,对2003年5~11月在6所医疗保健机构住院分娩的产妇进行问卷调查,对其人工流产状况进行描述性分析,并运用非条件Logistic回归分析方法对人工流产的影响因素进行单因素和多因素分析。结果在1826例调查对象中,49.40%有人工流产史。人工流产者在行首次人工流产时年龄集中在20~29岁年龄段,占86.47%。首次人工流产时已婚者为52.61%,未婚者47.39%。人工流产的首要原因是意外妊娠,占41.10%。多因素分析显示人工流产的危险因素按贡献大小依次为产妇年龄大和家庭经济状况好;保护因素按贡献大小依次为产妇文化程度高、知晓紧急避孕法和掌握较多的避孕知识。结论武汉市育龄妇女人工流产比例高,有向年轻、未婚妇女发展的趋势,且影响因素多。应以20~30岁妇女为重点对象开展健康教育,采取科学有效地干预措施降低人工流产率,提高妇女生殖健康水平。     

A portrait of American women who obtain abortions

In 1981, as in 1980, most abortions in the United States were obtained by young women, unmarried women and white women, and were performed in the first eight weeks following the last menstrual period (approximately six weeks after conception). The proportion of abortions obtained by unmarried women has increased slightly, and the fraction obtained by teenagers has decreased, mainly because of shifts in the distribution of these groups in the population. The percentage of abortions that are repeat procedures has increased, representing more than one-third of all abortions. The increase is due largely to the rise in the number of women who have had a first abortion, and who are, therefore, exposed to the risk of having a second procedure. Eighty-five percent of all abortions are performed by vacuum aspiration. Dilatation and evacuation is the method used in two-thirds of abortions performed more than 12 weeks past the last menstrual period, and in nine out of 10 abortions that are performed between the 13th and the 15th week. About three percent of women aged 15-44 obtained abortions in 1981, and 26 percent of pregnancies were terminated by abortion--the same fractions as in 1980. About six percent of 18-19-year-olds had abortions--the highest rate of any age-group. The abortion rate (the number of abortions per 1,000 women aged 15-44) and ratio (the number of abortions per 100 live births and abortions) are much higher for unmarried than for married women.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in therapeutic abortion in San Francisco.

Positive and negative aspects of therapeutic abortion are discussed upon review of trends found in the 6201 abortions performed in San Francisco between 1968 and 1970 (since Abortion was legalized in California in 1967). On the positive side, legalized abortion appears to have reduced the septic abortion rate (68 per 1000 live births in 1967 to 22 per 1000 in 1969) indicating a decline in criminal abortion. Maternal mortality has also declined from 8 per 100,000 to just over 3 per 100,000 from 1967 to 1969. Patients requesting abortion have averaged in age from 20-24 (26% were less than 19) and approximately half have been nulliparous. 37% of teenagers had saline abortions. Negative aspects have included the increasing morbidity rate associated with saline abortion, a second-trimester method. Compared to abortions performed at 12 weeks' gestation or less (usually done by vacuum aspiration), saline abortions required 5.7% second admissions (only 1.2% of the early abortions required readmission) and necessitated transfusion 3 times as often (in 2.3% of the cases). Regardless of the procedure used, later abortion involved a greater risk of hermorrhage and infection (2.7% incidence at 5-6 weeks' gestation compared to 12.9% at 11-12 weeks). Morbidity accompanying saline abortion was similar at 15 and 20 weeks however. Fortunately a trend toward earlier abortion is indicated. (74% of abortions were by suction and 22% by saline in 1970). Hysterotomy plus tubal ligation and hysterectomy accounted for only 4% of abortions but were accompanied by hemorrhage rates of 31% and 27% respectively and had respective infection rates of 13% and 22%. Private patients received abortions 3 times more often than ward patients although ward patients were subjected to more traumatic procedures: hysterectomies for ward patients were 2.0% vs .9% for private patients; sterilization by tubal ligation following suction abortion was 3.5% vs 1.7%. Additionally, black women had later abortions more often than white patients (33% of the black women were seen after 14 weeks gestation compared to 20% of the white women). Obstructions to early abortion must be eliminated to avoid such discrepancies in opportunity. Psychiatric examinations are unnecessary and causes for administrative delays must be remedied. Cost still presents a barrier for some women. The long-term effects of abortion now suggested by data from countries such as Czechoslovakia indicate that abortion is best viewed as a back-up measure to contraception making increased sex education, counseling and contraceptive practice essential.     

Estimating abortion incidence in Burkina Faso using two methodologies

Abortion is illegal in Burkina Faso except in cases of incest, rape, fetal defect, or when the woman's life or physical health is endangered. As a result, abortion procedures are often conducted illegally and unsafely and measuring incidence proves difficult. We estimate incidence of abortion and associated morbidity using two methodologies. The first is the Abortion Incidence Complications Method (AICM), which uses information on women hospitalized for abortion-related complications as well as health professionals' assessments of the proportion of women who seek treatment for complications from unsafe abortions. The second is the Anonymous Third Party Reporting (ATPR) method, which entails surveying women about their confidantes' abortions. We conclude that the AICM yields a more accurate result. We estimate that 87,200 abortion procedures were carried out in 2008, representing 25 for every 1,000 women aged 15-49. More than one in four procedures resulted in complications treated at a health facility. The abortion rate estimated using the ATPR approach was 72 percent of that estimated with the AICM. The ATPR method yields information on the characteristics of the women who have abortions as well as the providers and methods they use.     

Profile of women presenting for abortions in Singapore at the National University Hospital

The study was conducted to profile women seeking abortions at the National University Hospital, with particular interest in the trend of teenage pregnancies with the aim of identifying risk factors for late presentation for abortions. All patients who underwent an abortion at our center from January 1, 1996 to December 31, 2000 were recruited. Data were entered into a prepared questionnaire during the mandatory pre-abortion counseling sessions and completed at the 6-week post-abortion follow-up. This was then keyed into a database (SPSS Version 10), and the results were analyzed. Multivariate analysis was used in identifying risk factors associated with late presentation for abortions. Chi-square analysis of variables was used where relevant. A total of 1370 women presented for induced abortions during the period of study. The mean age of women was 29.6 years. Most women were either homemakers (35.3%) or semi-skilled workers (28.5%) with at least a secondary school education (58.3%). The majority were married (75.5%). There was a significant trend in the proportion of single women seeking abortions, from 18.3% in 1996 to 27.8% in 2000 (p < 0.05). At the same time, the proportion of women presenting for repeat abortions also increased from 13.8% in 1996 to 33.2% in 2000 (p < 0.05). Teenage abortions made up 117 (8.5%) of the study group, of which 95% were single women. Significant proportions (52.1%) were students at the time of abortion. In contrast to women above 20 years of age, pregnant teenagers were more likely not to have used any contraception (67.1% vs. 37.3%) and more likely to present late for abortion (18.8% vs. 10.4%). Teenage pregnancies are a major risk factor for late presentation for abortions. This emphasizes the need for availability and easy access to early abortion counseling, and the need for sex education with use of contraception starting in schools, to reduce abortions among teenagers.     

Illegal abortion in Latin America

In Latin American countries abortion on demand is legal only in Cuba and must be performed there in hospitals within the 1st 12 weeks of pregnancy. After the 1st trimester, it can be performed only for medical reasons. With regard to the other 18 Latin American countries, abortion is illegal in 2 of them even for saving the life of the pregnant women. In 9 countries therapeutic abortion is permitted only to save the woman's life. It is allowed in 4 countries in the case of severe disease that will be aggravated if the pregnancy continues. In the 3 remaining countries, in addition to medical reasons, it is legal if pregnancy is the consequence of incest or rape. Despite the law, induced abortion is often performed. The complications of illegal abortion are reviewed along with mortality and morbidity and abortions in adolescents. In Colombia in 1974, 58,717 women were hospitalized for complications of abortion. 42,160 women were hospitalized in Chile in 1974 with the same diagnosis. As Colombia and Chile both have family planning programs and effecive contraceptives are easily obtained, the rate could be even higher in those countries without programs or contraceptive availability. From surveys conducted in these 2 countries, it may be concluded that only 1 out of 3 induced abortions is complicated and requires hospitalization. The hospitalization for complications of abortion/1000 women of fertile age in Colombia and Chile suggests that there is an annual average of 15 hospitalized cases/1000 women of fertile age throughout Latin America. Presuming reasonable accuracy for these surveys, the rate of induced abortion in the entire continent can be estimated to be at least 45/1000 women of fertile age. From this, without considering Cuba, a conservative estimate of 3.4 million illegal induced abortions are performed annually in Latin America. It seems that illegal abortions are performed at an even higher rate than that observed in countries where abortion is legal and effective contraceptives are easily available. According to Tietze, in the U.S. between 1968 and 1972 the case fatality rate from legal abortion was only 0.1/million. When it is performed illegally in pregnant women who cannot pay a competent professional, the case fatality rate in Chile, considering only women who died in hospital, is 100 times greater and represents 38% of total maternal deaths. The treatment of complicated cases also represents a high cost for the hospitals. In the hospitals, the proportion of complicated abortions in women under age 20 is usually low; it varies from 11-20%. Chilean statistics show that in 1980 a total of 26.8% of births were illegitimate, and among those born to mothers under age 20 this was 44.1%. Needed are epidemiological studies on an international basis that would allow comparability and show ways to prevent the adverse consequences of illegal abortion.     

The incidence of induced abortion in a prospective cohort study of 16- to 25-year-old Australian women

In Australia, data for induced abortions (IA) is unreliable, although accurate information is essential for the development of policy and funding for services relating to IA. The rate of induced abortion was an incidental finding from questionnaire data collected for a longitudinal study of chlamydia in young women in Australia. We found a pregnancy rate of 7.2/100 woman years (95% confidence interval (CI): 5.7-9.0) (n=76) and IA rate of 2.1/100 women years (95% CI: 1.4-3.2) (n=22). Differences were found between States and Territories, information which might influence the development of services in regions of Australia.     

Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling

PURPOSE: Low birth weight (LBW), preterm births, abnormal placentation, and miscarriages have been associated with prior induced abortions. An incidence-related effect has been suggested. The objective of this study is to assess the effects of prior induced abortions on obstetric risk factors and pregnancy outcome in conditions of free high-standard maternity care used by almost the entire pregnant population in Finland. METHODS: We analyzed a population-based database including 26,976 singleton pregnancies from 1989 to 2001, of which 2364 were among women with one prior induced abortion and 355 women had had at least two prior induced abortions. Data included maternal risk factors, pregnancy characteristics, and obstetric outcome measures and were based on results of a self-administered questionnaire at 20 weeks of pregnancy and clinical records. Odds ratios (ORs) concerning pregnancy outcomes were calculated in multiple logistic regression analysis. RESULTS: Induced abortions were associated with several known pregnancy risk factors; specifically, maternal age older than 35 years, unemployment, unmarried status, low educational level, smoking, alcohol consumption, overweight condition, and chronic illnesses. Preterm birth (OR, 1.19; 95% confidence interval, 1.01-1.41) in women with one prior abortion (7.3% versus 6.2%) and LBW (OR, 1.54; 95% confidence interval, 1.02-2.32) in women with two or more prior abortions (7.0% versus 4.7%) appeared to be more common, but after logistic regression analysis, we found no evidence of adverse pregnancy outcomes. CONCLUSIONS: Induced abortion is not an independent risk factor for adverse obstetric outcome. Marked health behavioral pregnancy risks are associated with prior induced abortions. Health counseling of these women is a challenge, but this objective has not yet been achieved.     

The accessibility of abortion services in the United States.

Abortion services are provided in hospitals, doctors' offices and various types of clinics, but about two-thirds of procedures are performed in specialized abortion clinics. While this system appears to work well for most women, some women seeking abortion face obstacles related to distance, cost, harassment and special medical conditions. Nine percent of nonhospital abortion patients must travel more than 100 miles and 18 percent travel 50 to 100 miles for services. The average woman having a first-trimester nonhospital abortion paid $251 in 1989. Fees were higher in facilities with small abortion caseloads. An abortion at 10 weeks' gestation in a hospital cost an average of $1,757. Charges for abortions at 16 weeks averaged $509 in abortion clinics, compared with $1,539 in hospitals for curettage and $2,246 for instillation procedures. Some women face other barriers: Only 43 percent of all abortion facilities offer services past 12 weeks, and 27-37 percent of nonhospital facilities say they do not treat patients who test positive for the human immunodeficiency virus (HIV), the virus that causes AIDS. Women who need special services such as an administration of Rh immunoglobulin, general anesthesia or HIV testing usually pay extra for these services. In addition, 85 percent of nonhospital facilities that serve 400 or more abortion patients a year reported some form of antiabortion harassment in 1988, most commonly picketing; there was virtually no change in this proportion between 1985 and 1988.     

An epidemiological analysis of abortion in Georgia.

Examination of abortion experience in Georgia following the passage of an abortion law based on the American Law Institute's Model Penal Code, intended to increase the availability of abortion, suggests that nonhospital abortions are still a black health problem, especially for unmarried blacks. Abortion mortality has declined for unmarried whites, married whites, and married black women. The abortion rate is highest for women under the age of 15 (falling into the rape catagory of the abortion law) and over 34 years (due to maternal physical health conditions). Maternal mental health indications are more restrictively defined in the medical community in Georgia. A comparison with several states liberalizing abortion laws demonstrates that in proportion to live births, markedly fewer hospital abortions have been performed in Georgia than in other states. Only 20 abortions were performed in Georgia each month until 1970 when the number increased to 47 due to publicity over a proposed abortion law. To reduce nonhospital abortion mortality, hospital abortions must be provided equitably to all women in need.     

Induced abortion: a world review, 1990

The worldwide trend toward liberalization of abortion laws has continued in the last four years with changes in Canada, Czechoslovakia, Greece, Hungary, Romania, the Soviet Union and Vietnam. Forty percent of the world's population now lives in countries where induced abortion is permitted on request, and 25 percent lives where it is allowed only if the woman's life is in danger. In 1987, an estimated 26 to 31 million legal abortions and 10 to 22 million clandestine abortions were performed worldwide. Legal abortion rates ranged from a high of at least 112 abortions per 1,000 women of reproductive age in the Soviet Union to a low of five per 1,000 in the Netherlands. In recent years, abortion rates have been increasing in Czechoslovakia, England and Wales, New Zealand and Sweden and declining in China, France, Iceland, Italy, Japan and the Netherlands. In most Western European and English-speaking countries, about half of abortions are obtained by young, unmarried women seeking to delay a first birth, while in Eastern Europe and the developing countries, abortion is most common among married women with two or more children. Mortality from legal abortion averages 0.6 deaths per 100,000 procedures in developed countries with data. Abortion services are increasingly being provided outside of hospitals, and for those performed in hospitals, overnight stays are becoming less common. National health insurance covers abortions needed to preserve the health of a pregnant woman in all developed countries except the United States, where Medicaid and federal insurance programs do not cover abortion unless the woman's life is in danger.     

Legal abortion in Finland

The 1950 abortion law in Finland allowed the operation in cases where pregnancy threatened maternal health, where women were criminally raped, or were under 16, or where hereditary disease was present. From 1951 to 1969, the number of abortions per 1000 births increased from 32.2 to 121.2. The new abortion law of 1970 expanded the old law by permitting the operation if delivery and care of child would strain family resources, if the mother was under 17, or if she was over 40 and had 4 children. The number of abortions has doubled from 1969 to 1970. The consent for abortion has increased from 54.5 percent to 83.8 percent of the applications.     

Characteristics of U.S. women having abortions, 1987

In 1987, as in earlier years, women having abortions were predominantly white (65 percent), younger than 25 (59 percent), and unmarried (82 percent). A majority had no previous live births (53 percent), and most had no previous abortions (58 percent). About half the abortions were performed before nine weeks of gestation, and 97 percent were curettage procedures, usually suction curettage. Comparisons with 1980 data reveal a six percent decline in the U.S. abortion rate after changes in age, race and marital status within the population are controlled for; however, the decline occurred only among the white population and not among minority races. Among teenagers aged 15-19, the abortion rate declined slightly for whites and increased for minorities. The rate also increased among women younger than age 15.