Reproductive health of immigrant women in the Lazio region of Italy

The number of legal immigrant women living in the Lazio region of Italy has increased in recent years; there were 69,320 "permessi di soggiorno" (temporary residence permits) issued in 1992 but 119,778 issued in 2000. This analysis concerns women who left hospital after having a live birth, an induced abortion or a spontaneous abortion. The foreign women were compared with all (Italian and foreign) women living in Lazio. The general fertility rate is slightly higher among all women resident in Lazio than among the foreign women, but the latter have a higher rate at ages 18-24 years. The risk of induced abortion is higher (34.8/1000 women) among the foreigners than among all residents (10.5/1000 women). The spontaneous abortion ratio was also higher among the foreigners (213.8/1000 live births) than the residents (154.6/1000 live births). There is clear evidence of an increase in the demand from foreign women for medical services for reasons associated with reproduction. The provision of these services needs to be modified to take account of their particular needs.     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

Epidemiology of legal abortion in Italy

The paper reports on the trends of induced abortion in Italy since its legalization in 1978. Data collected through the national surveillance system show that the abortion rates and ratios in Italy, after an initial increase, have been stable in the last four years, and are comparable to those of other European countries. Italian women seeking abortion, however, are generally older and more frequently married and parous than in most other western countries. The data on abortion services and procedures show a slow improvement with increasing use of local rather than general anaesthesia, suction rather than surgical curettage, and outpatient rather than inpatient admissions. Post-abortion complications are infrequent and there have been no cases of death from legal abortion. The paper attempts to analyse the effect of legal abortion on fertility and on other maternal and child health indices, reaching tentative conclusions on the contribution of the legalization of abortion to the improvement of reproductive health. Uneven availability of abortion services, however, is currently a major problem; in many of the less developed areas of the country, it is estimated that as many as 50% of abortions are still performed outside the legal abortion service network.     

Induced abortion among low income women: dimensions of the problem

This paper examines the practice of abortion, especially induced abortion among low income women. The discussion is based on survey data collected between 1984 and 1985 in seven slum communities (favelas) situated in the metropolitan area of Rio de Janeiro, Brazil. Despite restrictive law, induced abortion is extremely frequent. Among married women 21.4 per cent reported experience of induced abortion. Most abortions were performed by physicians, however the quality of care of these procedures can be questioned since almost all induced abortions are illegal there is no possible supervision by health authorities. The incidence of post-abortion complication is very high, especially for those performed by traditional midwifes or by the woman herself. More than 60 per cent of the women were not using contraception at the time of pregnancy. About, 21 per cent reported that they were using the pill. Such a high pill failure rate is inacceptable, and probably was related to incorrect use. This points to the need for a better access to family planning care within the health services. The consequences of the restrictive abortion laws in Brazil are also discussed. Restrictions that in practice prove to have little impact on the practice of induced abortion, appear to be very effective in brooding even more the social-economic inequalities.     

Illegal abortion: an attempt to assess its cost to the health services and its incidence in the community

This article describes a study designed to test a method for assessing the cost to the health services of illegally induced abortion and the feasibility of estimating the incidence of induced abortion by a field interviewing approach. The participating centers included three hospitals in Ankara, Turkey; three hospitals in Ibadan, Nigeria; one hospital in Caracas and one in Valencia, Venezuela; and two hospitals in Kuala Lumpur, Malaysia. Hospitalized abortion cases were classified as induced or spontaneous or as "probably induced," "possibly induced," or "unknown" according to a classification scheme comprising certain medical criteria. The sociodemographic characteristics of induced and spontaneous abortion cases were subjected to discriminant function analysis and the discriminating variables best characterizing the induced versus the spontaneous abortion groups were identified for each center. On the basis of this analysis, the "probably" and "possibly" induced and "unknown" categories were further classified as induced or spontaneous abortion, with stated probabilities. Thus an overall estimate is made of the proportion of all hospitalized abortions that can be considered illegally induced outside the hospital. Selected results on costs of induced and spontaneous abortion are shown. The method further tested the feasibility of obtaining valid survey data on abortion from the communities studied by re-interviewing the women hospitalized for induced and spontaneous abortion six months later in their homes. This exercise showed a degree of under-reporting of abortion that varied widely among centers, even among women who had admitted illegal induction at the time of hospitalization. The feasibility of estimating the incidence of illegal abortion by field studies is discussed in the light of these findings.     

Abortion services for sex workers in Uganda: successful strategies in an urban clinic

Sex workers' need for safe abortion services in Uganda is greater than that of the population of women of reproductive age because of their number of sexual contacts, the inconsistent use of contraception and their increased risk of forced sex, rape or other forms of physical and sexual violence. We sought to understand sex workers' experiences with induced abortion services or post-abortion care (PAC) at an urban clinic in Uganda. We conducted nine in-depth interviews with sex workers. All in-depth interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. We identified several important programmatic considerations for safe abortion services for sex workers. Most important is creating community-level interventions in which women can speak openly about abortion, creating a support network among sex workers, training peer educators, and making available a community outreach educator and community outreach workshops on abortion. At the health facility, it is important for service providers to treat sex workers with care and respect, allow sex workers to be accompanied to the health facility and guarantee confidentiality. These programmatic elements help sex workers to access safe abortion services and should be tried with all women of reproductive age to improve women's access to safe abortion in Uganda.     

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.     

854名已婚妇女生殖健康状况及影响因素研究

目的 :从生殖健康服务了解妇女的生殖健康状况 ,探索妇女生殖健康状况的影响因素 ,为制定保护妇女生殖健康的政策及改善生殖健康服务条件 ,制定优质服务措施提供理论依据。方法 :采用多阶段随机抽样方法 ,抽取武汉市 2个区 2 0～ 4 9岁的已婚妇女 85 4例 ,对其生殖健康状况分别进行问卷调查和结果分析。结果 :77.70 %妇女在孕期接受过 1次以上产前检查 ;80 .4 1%妇女住院分娩 ,剖宫产占住院分娩者 2 0 .78% ;4 6 .0 3%妇女接受过 1次以上产后访视 ;妇科病患病率 37.90 % ;4 9.30 %的妇女有过 1次以上人工流产。妇女年龄、职业、文化程度及其丈夫和家人的关心是其影响因素。结论 :已婚妇女生殖健康状况较差 ,生殖健康服务与全国甲类城市保健服务标准存在一定差距。因此 ,改善妇女生殖健康状况 ,降低剖宫产率和人工流产率 ,关键在于倡导妇幼保健和计划生育优质服务     

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

STUDY OBJECTIVES: To describe the utilisation of reproductive health services (family planning, antenatal care, and delivery services) and the socioeconomic determinants for utilisation of health services. DESIGN: This was a cross sectional survey, using a multistage sampling technique. SETTING: Tien Hai district, Thai Binh Province, Vietnam. Altogether 1132 mothers with children under 5 years of age were interviewed about antenatal, delivery, and family planning services utilisation during a five year period (1987-92). MAIN RESULTS: Seventy per cent of the women used contraceptive methods, with the intrauterine device being the most common. The use of the intrauterine device was positively associated with the number of children alive but not with other sociodemographic factors in the mothers. Thirty per cent of the women had attended an antenatal clinic for check ups during their last pregnancy. It was found that mothers with fewer deliveries, higher education, and who were Buddhist or of no religion had utilised antenatal services more frequently than the others. Seventy five per cent of the mothers in this study had been assisted by health professionals at their last delivery. Those mothers with fewer deliveries, higher education, who were Buddhist or had no religion, and had sufficient to eat were more likely to have their births attended by health professionals. CONCLUSIONS: In spite of a relatively high education level in the population and services which are generally available, there was an under utilisation of antenatal and delivery care and there was no equal opportunity for different groups of mothers to use these services. Family planning services were, however, frequently used and were used to the same extent by different groups of mothers. Except for abortion, alternatives to the intrauterine device method were rarely available. If pregnancies are to be protected in an efficient way in rural Vietnam, reproductive health care must be strengthened and efforts should be made to reach the women who are not using these services at present.     

Induced abortion and spontaneous abortion: no connection?

The hypothesis that spontaneous abortion is associated with prior induced abortion is tested in an epidemiologic study. The reproductive histories of a consecutive series of women admitted to hospital with spontaneous abortions were compared with those of a control series of women who delivered after 28 weeks gestation. There is no association between spontaneous abortion and prior induced abortion. The power of the analysis to detect a 30% excess in the frequency of induced abortion in cases as compared to controls is 82% at alpha = .05. The design and analysis effectually controlled for all potentially confounding factors.     

从未婚人工流产女性视角看人工流产

目的：从未婚人工流产女性视角分析未婚妊娠原因,了解她们对未婚人工流产的认识。方法：对成都市不同等级妇幼保健机构/医院接受过人工流产术的19名未婚女性进行个人深入访谈。结果：避孕知识缺乏、发生性行为时心存侥幸心理、未采取避孕措施和避孕措施不当为未婚妊娠的主要原因;对未婚人工流产对健康影响有一定的认识,最为担心的是怕影响以后的再生育。结论：对未婚人群加强生殖健康知识教育、尤其是避孕措施的咨询和服务非常重要,需要政府牵头、家庭-学校-社会多部门协同合作,并不断探索适宜、有效的教育方式方法以及服务模式,以促进未婚人群的生殖健康。     

社区规范开展流产后服务的必要性

目的通过对笔者所在医院325例人工流产后接受随访的育龄妇女进行问卷调查，论证社区规范开展流产后服务的必要性。方法择2008年10月～2009年2月自愿到笔者所在医院接受人工流产并在社区进行术后随访的325名妇女，由专业医生对其进行面对面询问调查，填写自行设计的调查表，并对调查结果进行分析。结果在单因素分析中，与人工流产有关的因素有文化程度、避孕方法等；多因素分析显示，控制文化程度因素后，以前有人丁二流产和引产史（重复流产）、未采用宫内节育器、使用短效避孕药具等因素仍然增加意外妊娠和流产的危险性。结论社区医院妇科医师在社区工作中，要重视计划生育工作的重要性，加强流产后咨询、访视及科普宣传工作，做好规范化流产后服务，从而有效减少重复性流产的发生率，降低人工流产术后的并发症，更好地保障广大育龄妇女的生殖健康，提高妇女的生存质量。     

Reproductive Tract Infections in Northern Vietnam: Health Providers' Diagnostic Dilemmas

Research was conducted on reproductive tract infections among women obtaining induced abortions at Ph?-S?n hospital in Haiphong City, a major maternity hospital in northern Vietnam. The research aimed to explore how clinicians and lab-technicians diagnose reproductive tract infections and the difficulties they experience in establishing exact diagnoses. A combination of both quantitative and qualitative research methodologies was employed. The quantitative research involved 748 abortion-seeking women; the qualitative research was conducted with 10 doctors and 10 lab-technicians providing reproductive health services. A marked tendency was observed among both clinicians and lab-technicians to overdiagnose reproductive tract infections and to prescribe antibiotics routinely. Social, cultural, and clinical factors associated with the tendency to overdiagnose reproductive tract infections included: inadequate training of health staff, lack of equipment, and cultural assumptions regarding the overwhelming prevalence of reproductive tract infections in Vietnamese women, especially among those who receive abortion services. Misconceptions of reproductive tract infections led to substantial over-diagnosis and unnecessary treatment of reproductive tract infections in this hospital. To enhance reproductive tract infection care, providers need to be sensitized to the social and medical consequences of their own cultural perceptions and to increase their awareness of the risks associated with overuse of antibiotics.     

Reproductive health in Romania: reversing the Ceausescu legacy

As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.     

常熟市流动人口人流现状分析及生殖保健建议

目的对流动人口实施人工流产情况进行调查分析,以便更好地向流动人口提供生殖健康服务。方法对1227例人工流产妇女的病历资料进行回顾性分析。结果人工流产妇女年龄分布呈橄榄型,年龄≤20岁组及年龄≥41岁组妇女分布在橄榄的两端,21—40岁的妇女分布在橄榄的中间;2l～30岁性活跃期妇女占人工流产妇女总数的55．91％,〉30岁的妇女人工流产率下降至32．11％。未婚先孕组妇女流动人口构成比显著高于常熟户籍人口（χ2=8．93,P〈0．05）;常熟户籍人口避孕率显著高于流动人口,经比较差异有统计学意义（χ2=14．33,P〈0．05）。流动人口和常熟户籍人口病理因素流产率及多次重复流产率均无显著性差异（均P〉0．01）。结论常熟当地政府应为流动人口提供必要的生殖健康服务,加强对流动人口性知识、性健康、计划生育、优生优育知识的宣传教育,提高流动人口避孕知识知晓率和避孕率,减少非意愿妊娠的发生,降低人工流产尤其是重复人工流产率,保护流动人口的生殖健康。     

未婚流产女青年对医疗保健服务满意度与需求现况分析

目的:了解未婚人工流产女青年对医疗机构服务的满意度和服务需求,为探索青少年友好服务相关措施提供依据。方法:采用匿名问卷调查形式对在医院计划生育门诊接受人工流产手术的未婚女青年1 225例进行调查。结果:①服务满意度:对服务人员的满意度比对候诊时间和就诊环境高,达60%;20岁以下者对就诊环境满意度(45.60%)比20～24岁满意度(50.00%)低,20～24岁组对候诊时间的满意度(37.40%)比20岁以下的(45.60%)低;9.0%未婚人工流产女青年认为医务人员对其存在歧视或者态度冷淡。②需求:对性生殖健康知识最希望了解的前三位为:怀孕与避孕、性生理保健及人工流产后保健;③服务:对于流产希望获得的相关服务主要为人工流产后保健指导、避孕指导、心理咨询指导等;对服务的希望是获得保护隐私(65.96%),性保健知识宣教(36.49%),工作人员友好(35.27%)等。结论:未婚女青年对目前人工流产服务的环境、候诊时间的满意度相对较低,对接受人工流产的相关服务内涵及要求相对较高,提示需要建立满足青春期性生殖保健的友好服务模式。     

广州市未婚流动人口人工流产状况及影响因素分析

目的:了解广州市未婚流动人口人工流产状况及其影响因素。方法:采用随机整群抽样方法进行抽样,应用统一的“外来务工未婚女性生殖健康需求与服务调查问卷”,对调查对象进行现场问卷调查。结果:共调查1872名未婚女性流动人口,有过婚前性行为者233名,发生率为12.4%。69人至少有过1次人工流产,人工流产率为29·9%。在实施过人工流产的人群中,32人(46.3%)的妊娠月份超过2个月,21人(30.4%)选择在家中或私人诊所实施手术。人工流产的发生与调查对象的文化程度、收入情况,对人工流产危害的认识,避孕情况及其了解避孕方法的种类有关。结论:未婚流动人口人工流产的发生率较高,与其认知水平和避孕行为密切相关,为流动人口提供及时有效的生殖健康教育和服务将有助于提高其生殖健康认知水平和行为能力,降低人工流产率及其危害。     

Spontaneous abortions in an industrialized community in Finland

Spontaneous abortions were analyzed in an industrialized Finnish community according to the occupation and workplace of both the women and their husbands. Information about spontaneous abortions and births was obtained from the hospital discharge register, and data about the women and their families were collected from census files. When compared with all women employed outside the home, women who worked at a textile plant (factory A, a clothing manufacturer) had an increased rate of spontaneous abortion (16.7 per cent vs 11.4 per cent). The rate of spontaneous abortions among women employed at factory A differed according to the husband's workplace. The odds ratio for women employed at factor A whose husbands worked at a large metallurgical factory was 3.8, whereas the odds ratio for women whose husbands worked elsewhere was 1.2. Between 1973 and 1976, the rate of spontaneous abortions in this town was consistently lower for the summer period. (May-August) than for the other periods of the year.     

A survey of health agencies' responses to non-English-speaking women's health needs in South Australia

Abstract: Evidence from the literature points to the disadvantages encountered by migrant women from non-English-speaking backgrounds in obtaining access to health services. In May 1994, a survey of 31 health units in the metropolitan area and two country areas was conducted in South Australia. The study investigated the services available to women of non-English-speaking background, their level of usage, the factors that affected the use of health services by the women, and the strategies developed by the service providers to overcome the barriers. The study found sexual and reproductive health to be the most important, and occupational health and safety the least important issue for women of non-English-speaking background attending the state's health units. The main problems were English language deficiencies, lack of culturally appropriate services and inadequate knowledge and awareness of the existing services. From the service providers' point of view, language (79 per cent), culture (87 per cent), and information or awareness about health units (78 per cent) were the most important factors affecting title use of health services by women of non-English-speaking background. Women of non-English-speaking background have different linguistic and cultural needs from English-speaking women, and as a result, require specifically designed services.     

Spontaneous abortion in Italy: social differences and temporal trends

Spontaneous abortion in Italy between 1980 and 1993 has been analysed with particular reference to temporal trends and to indicators of social status (level of education and occupation of the women). Each year about 50,000 spontaneous abortions are notified in Italy and the trend is slightly increasing. The national rate passed from 8 to 9 spontaneous abortions per 100 conceptions during the period 1983-93. Geographically, the rate decreases from North to South (respectively from 11-12 to 6-8 spontaneous abortions per 100 known conception in 1993). The national rate of spontaneous abortion is slightly higher for women with little or no education: 9.0 per 100 known conceptions for women with no or primary school certificate (schooling from 6 to 10 years), 8.8 for those with lower school certificate (ages: 11 to 13 years) 7.8 for high school certificate (ages: 14 to 18 years) and 8.3 for university degree, in 1991. There were no significant differences between occupations, excepting agricultural workers who had the lowest rate: 4.1 per 100 known conceptions compared with 8.2 for women employed in industry, 9.3 for other occupations and 8.9 for housewives, students or the unemployed, in 1991. However, maternal age is confirmed to be a more important risk factor: the risk of spontaneous abortion increased from 6-7 per 100 known conception among women aged less than 30 to 20 per 100 among women aged 40 or more. The same effects are found in a logistic regression model.