The potential role of contraception in reducing abortion

This study examines the potential role of further increases in contraceptive prevalence and effectiveness in reducing abortion rates. The model used in this analysis links the abortion rate to its direct determinants, including couples' reproductive preferences, the prevalence and effectiveness of contraceptive practice to implement these preferences, and the probability of undergoing an abortion to avoid an unintended birth when a contraceptive fails or is not used. An assessment of the tradeoff between contraception and abortion yields estimates of the decline in the total abortion rate that would result from an illustrative increase of 10 percentage points in prevalence. This effect varies among societies, primarily because the tendency to obtain an abortion after an unintended pregnancy varies. For example, in a population with an abortion probability of 0.5, a 10 percentage-point increase in prevalence would avert approximately 0.45 abortions per woman, assuming contraception is 95 percent effective. If all unintended pregnancies were aborted, this effect would be three times larger. Eliminating all unintended pregnancies and subsequent abortions would require a rise in contraceptive prevalence to the level at which all fecund women who do not wish to become pregnant practice contraception that is 100 percent effective. A procedure is provided for estimating this "perfect" level of contraceptive prevalence.     

Induced abortion in eight provinces of China.

A survey of 12,000 women in eight provinces of China was carried out in 1988. One urban and one rural area were selected purposely in each province; data on lifetime and recent pregnancies were collected from married women aged 20-44. Data on abortions included reasons, gestational age, and complications. During the five years before the survey, the number of abortions per 100 live births was 102 in urban areas and 62 in rural areas. For those with one or more previous live births in urban areas, nearly all subsequent pregnancies ended in abortion. Also in urban areas, 31% of women with a recent abortion reported the reason was contraceptive failure. Over 80% of women are contraceptive users; the high abortion rates then reflect relatively low use-effectiveness of contraception and that most unplanned pregnancies are aborted.     

Contraceptive failure--results from a study conducted among women with accepted and unaccepted pregnancies in Denmark

Most studies focusing on contraceptive failure in relation to pregnancy have focused on contraceptive failure among women having induced abortions, thereby neglecting those women who, despite contraceptive failure, accept the pregnancy and intend to carry the fetus to term. To get a more complete picture of the problem of contraceptive failure, this study focuses on contraceptive failure among women with diverse pregnancy outcomes.In all, 3520 pregnant women attending Odense University Hospital were included: 373 had induced abortions, 435 had spontaneous abortions, 97 had ectopic pregnancies, and 2614 received antenatal care. The variables studied comprise age, partner relationship, number of births, occupational and economical situation, and contraceptive use.Contraceptive failure, defined as contraceptive use (condom, diaphragm, IUD, oral contraception, or another modern method) at the intercourse where conception most likely occurred, were reported by 315 women, 52% of these women had induced abortions, 10% had spontaneous abortions, 3% had ectopic pregnancies, and 36% received antenatal care. Women aged 15-24 years were more likely to have experienced contraceptive failure in relation to use of condom and oral contraception than women aged 25-34 years. In addition, contraceptive failure was found to be associated with being single, a student, and having given birth twice or more previously. Regarding pregnancy acceptance, being 25-34 years of age was positively associated, whereas being single and a student was negatively associated with pregnancy acceptance.     

Estimation of induced abortions,Japan, 1975

Results of estimation of induced abortions for the year 1975 are presented. The age specific fertility rates assumed in this paper, with or without contraception, are somewhat different from those employed in previous studies as they were taken from more recent data. The estimated total incidence of induced abortions among married women in 1975 was about 2.2 million, as contrasted with the officially reported 671,597. The completeness of reporting of abortions declines with age. The probability of a pregnancy being terminated by abortion seems to be higher than that of its being carried to a live birth among women aged 15-44 as a whole; if broken down by age, it increases sharply after age 25-29. The age specific abortion rates per female population indicate greater resort to abortion among women aged 25 to 39. On the average, a woman is expected to experience 2 or more abortions during her lifetime. The weight of abortion as a factor in fertility control has been lessened during the past years. However, in general it still constitutes a major component of fertility control in Japan.     

Contraception and induced abortion in Armenia: a critical need for family planning programs in eastern Europe.

OBJECTIVES: The purpose of this study was to determine the number of induced abortions per woman and the reasons for selecting induced abortion among parous Armenian women. METHODS: A consecutive series of 200 women attending an abortion clinic in Yerevan, Armenia, were queried by a physician about their reproductive histories. RESULTS: Women younger than 20 years of age reported a median of 1 and women older than 40 years reported a median of 8 induced abortions in their lifetimes (overall median = 3). Lack of contraceptive information was the major reason cited for not using contraception. CONCLUSIONS: Induced abortion is the major form of birth control among parous Armenian women. Concerted public health campaigns are needed to inform women and their physicians in Armenia and other Eastern European countries about alternative contraceptive methods.     

武汉市黄陂地区农村已婚育龄妇女人工流产原因分析

目的:了解黄陂地区已婚育龄妇女流产原因。方法:采用结构式问卷对2006年8月～2007年10月到黄陂区、乡两级计划生育服务站做终止妊娠手术的农村已婚育龄妇女进行问卷调查。结果:被调查者受教育水平以初中为主72.95%,有近50%的妇女认为流产引产对身体没有什么影响(23.41%)或者说不清(21.89%)。流产次数最高可达9次(2人),未采取避孕措施而流产的有1302人次,占46.60%。避孕失败的原因中有30.14%是因使用宫内节育器失败,有25.16%是使用避孕套失败。流产原因中因未计划妊娠有1997人次,占71.81%,政策不允许669人次,占24.06%。结论:应提高妇女的科学文化素质,加强避孕知识的普及和宣传,提高农村妇女的避孕使用率,提高正确选择和使用避孕工具的比率,通过这些措施来降低黄陂地区已婚育龄妇女的流产率。     

中国三城市未婚人工流产女性避孕状况及影响因素调查

目的:研究城市未婚人工流产女性的避孕行为及其影响因素,为促进避孕措施的使用提供科学依据。方法:在上海、成都、太原3城市提供常规人工流产服务的不同等级医院,对自愿要求做人工流产、年龄<25岁的1271例未婚女性进行问卷调查。结果:被调查者首次性行为的平均年龄为19.6～20.3岁。过去半年内,仅有5.0%～7.3%的女性坚持每次性行为时都使用避孕方法,17.6%～21.0%从未使用过避孕措施。最常用的避孕方法为避孕套(77.0%);不避孕或未坚持避孕的主要原因为"抱侥幸心理(49.7%)"。logistic回归分析显示,调查对象的学历、年龄、避孕和人工流产危害知识,以及男友的避孕知识和对避孕的关心程度与避孕措施使用频率及避孕套的使用有关。结论:未婚人工流产女性避孕措施使用率低,应提高这一人群避孕和人工流产相关知识水平,引导男性参与避孕。     

Are partners available for post-abortion contraceptive counseling? A pilot study in a Baltimore City clinic

About half of the 1.2 million abortions each year in the United States are repeat abortions. While most abortion providers counsel women about contraception, one reason for the high repeat rate could be failure to take into account the social context of the women--in particular, the male partner. To assess whether there might be a window of opportunity for a contraceptive intervention that includes the male partner at the time of the abortion, we undertook a pilot study at an urban abortion clinic to examine the role of the male partner among women receiving abortions. Between May 2001 and August 2002, two questionnaires were administered to 109 women receiving abortions in a Baltimore City clinic. On the procedure day, women were more likely to be accompanied by a male partner upon arrival (30%) or when leaving (34%) than by any other individual. The majority of women receiving abortions reported that their partners played positive decision-making and support roles throughout the abortion process. A significant proportion of couples could be available for contraceptive counseling following an abortion, providing rationale for couples' post-abortion contraceptive counseling for women whose partners are already actively and positively involved in the abortion process. Such an intervention may help to reduce repeat abortions.     

Induced abortions and births. Trends in seven counties, Norway, 1972-1983

This paper discusses the changes in the frequencies of induced abortions and births according to changes in the abortion legislation in Norway during the 1970s. The study material consists of women aged 15-44 years having undergone induced abortion or giving birth in seven Norwegian counties during the period 1972-83. Since the liberalization of the abortion legislation in 1976 and later when the law on abortion on women's request came into force in January 1979, the number of induced abortions per 1000 women 15-44 years of age has decreased by 20%, until December 31, 1983. For no age group has the number of induced abortions per 1000 women increased since the liberalization of the abortion legislation. While the number of terminations of pregnancy per 1000 women below the age of 25 has remained unchanged since 1975, the number of abortions per 1000 women aged 25-29 has decreased by nearly 18% and for women aged 30-44, by 34%. The number of terminated pregnancies per 1000 women of fertile age has shown a decrease corresponding to the reduction in births per 1000 women. Thus the liberalization of the abortion law cannot account for the decreased number of births after 1975.     

Status of abortion in Japan

Recent information on induced abortion in Jan appears in a general review of Japanese family planning. The Eugenic Protection Law of 1948 greatly broadened the indications for legal abortion. There were two reasons for this. One was concern over the rising birth rate and the other was an attempt to protect women from the harmful effects of illegal abortion. Since 1952 abortion has been performed at the sole discretion of the doctor in charge of the patient, and most Japanese women now believe that an abortion can be procured from a doctor without any difficulty. Where contraception is practised, abortion is looked on as a safeguard against contraceptive failure. Even so, total reported abortions in Japan have been falling, from a peak of about 1.2 million in 1955 to about 900,000 in 1964. Many abortions go unreported, so these totals are probably very much higher. Abortions among primigravidae seem to be on the increase. Up to 1955 at least 70% of the decrease in the birth rate was due to abortion, and 30% to contraception and sterilization. At present abortion accounts for only 40-50% of total fertility control. Induces abortion was an important factor in the postwar economic recovery of Japan, which was helped by the large reduction in the birth rate. 2n the past few years many leaders of the community, including religious authorities, Government officials and civic leaders, have been concerned about the widespread use of abortion and its easy accessibility. Many women, although experiencing some remorse after an abortion, would rather undergo the operation than have an unwanted child. Other reasons given for the relatively high rate of abortion are "the inexpensiveness of the operation and the ready availability of designated physicans". Surveys have shown that few harmful effects follow legal induced abortions. It is suggested that conditions favouring the use of induced abortion will be eliminated if young couples age given better homes and if highly effective, free-from-failure contraceptive methods are introduced.     

Korean experience of abortion

Dr Sung-bong-Hong, of the department of obstetrics and gynaecology, Woo Sok University, Seoul, has studied the effect of induced abortion (which is illegal) in Korea. It has markedly reduced the birth rate, and in the women he studied is used mainly by those in the higher scio-economic strata. In Seoul Cith, 33% of pregnancies in married women end in induced abortion. Nearly 80% of all induced abortions in Korea are of fourth or later pregnancies--family limitation being the main motive. Although both Buddhism and Catholicism prohibit destruction of life, about a quarter of the women belonging to both these religious groups have induced abortions. Dr Sung-bong-Hong concludes that until contraceptive practice becomes established women will resort to induced abortion, especially those with large families. The women pay moderate fees for this operation and most receive good medical care. Many husbands are just as interested in family limitation as their wives once there are several living children. This motivation towards limitation of families may help to popularize contraceptive methods once the women have been educated towards them.     

Contraception,unintended pregnancy,and induced abortion within 24 months of delivery in China: a retrospective cohort study

ObjectiveTo explore the prevalence of contraceptive use, unintended pregnancy, and induced abortions within 24 months postpartum in eastern, central, and western regions of China and in China overall.Study DesignWe conducted a retrospective cohort study and selected women who delivered a live birth between 12 and 24 months before the survey at 60 hospitals in eastern, central, and western regions of China. We used structured questionnaires for data collection and applied life-table analyses to estimate the prevalence of contraception, unintended pregnancy, and abortions. We used clustered log-rank tests to compare trends and rate differences at each time interval between/among regions.ResultsA total of 19,939 postpartum women were contacted, and 18,045 (90.5%) of them agreed to be interviewed. The 6-, 12-, and 24-month rates for modern contraceptive methods were 62.7% (95% confidence interval [CI] 58.9–66.4), 72.4% (95% CI 68.8–75.7), and 73.2% (95% CI 69.6–76.6), respectively. Condoms accounted for 79% of contraceptive initiators. The 6-, 12-, and 24-month rates were 1.4% (95% CI 1.2–1.7), 5.3% (95% CI 4.5-–6.1), and 13.1% (95% CI 11.3–14.8) for unintended pregnancy; and 1.1% (95% CI 0.8–1.3), 4.0% (95% CI 3.4–4.6), and 10.4% (95% CI 8.9–11.8) for induced abortion, respectively. By 24 months postpartum, 3-quarters of unintended pregnancies ended in abortion. The 24-month rates of modern contraceptive methods (75.2% vs73.4%, 71.1%), unintended pregnancy (15.3% vs 11.1%, 12.6%), and induced abortion (11.8% vs 9.9%, 9.4%) were higher in the western region relative to the eastern or central regions.ConclusionPostpartum contraception use was relatively high in China but dominated by less-effective methods, and these may contribute to higher risks of unintended pregnancy and induced abortion during the postpartum period. Use of long-acting reversible contraceptives and effective and reliable short-acting methods should thus be fostered in postpartum family planning services in China.ImplicationsA national postpartum family planning program is needed in China. Service providers should work on counselling postpartum women and their partners with respect to long-acting reversible contraceptive methods, and to effectively and reliably use short-acting methods during the postpartum period.     

Induced abortion in Canada 1974-2005: trends over the first generation with legal access

BackgroundCanadian women currently entering menopause are the first generation with access to legal induced abortion throughout their reproductive years.Study DesignStatistics Canada data from 1974 to 2005 on age-specific abortion and first-abortion rates were analyzed to determine the proportion of the cohort hypothetically and actually undergoing at least one induced abortion, as well as the age-specific trends.ResultsAmong Canadian women who turned 45 years old in 2005, 31% had at least one abortion, with a median age at first abortion of 24 years. Since 1997, age-specific induced abortion rates overall and among teenagers have declined significantly, while rates among older women show less decline as age increases. Annually from 1974 to 2005, women aged 20–29 years account for 52% (SD 1.8%) of all abortions in Canada.ConclusionsInduced abortion is a common procedure experienced by nearly a third of Canadian women during their reproductive years. Consistently, half of all women accessing abortion are in their twenties. These findings suggest that Canadian women, particularly those in their twenties, experience a significant unmet need for effective contraception.     

健康教育提高育龄妇女避孕效率降低人工流产率的研究

对1800例已婚育龄妇女的避孕和人工流产情况进行流行病学调查,94.7％妇女正在避孕,58.4％妇女有过人工流产。对IUD、避孕药和阴茎套的续用率进行生命表分析,IUD15年累积续用率0.51。用Tietze法分析了原因和Cox模型检测与人工流产发生有关因素,提示妇女避孕知识缺乏与操作人不认真是最主要的,通过健康教育人工流产率明显下降。     

广东省城市流动人口年轻女性避孕现况调查

目的 :调查广东省城市流动人口年轻女性避孕现况及需求 ,探讨加强该人群避孕意识、降低人工流产率的有效措施。方法 :采用个人问卷调查和小组访谈方式调查了 2 0 0 6名 15～ 35岁流动人口女性。结果 :有婚前性行为者占 2 3 4 % ,其中有人工流产史者占 6 6 8% ,75 7%是由于未采用避孕措施造成的。未婚人工流产者性行为中无避孕措施的高达 93.9%。 2 0 0 6人中避孕知识答卷得分≥6 0分占 35 9% ,<6 0分占 6 4 1% ,其中 0分占 7 6 % ;有人工流产史者避孕知识得分≥ 6 0分占18 7% ,<6 0分占 81 3%。能说出 3种以上避孕药具及正确使用方法的仅占 8 0 %。能正确描述紧急避孕方法者占 12 % ;听说过紧急避孕但不能正确描述者占 34 0 % ;不知道紧急避孕者占 5 3 9%。结论 :流动人口年轻女性避孕生殖健康知识贫乏 ,婚前性行为普遍 ,无防护性行为率高。     

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.     

农村已婚妇女避孕方式与人工流产相关性分析

目的 了解安徽省农村已婚妇女避孕现状,探讨避孕方式和人工流产关系,为生殖保健提供依据。方法 在保证市级代表性基础上,分层整群抽取15~49岁52 481名农村育龄妇女,采用先集中后入户调查方式进行问卷调查。结果 在过去6个月内,调查对象的避孕率为95.2%(49 970人);选择长效避孕模式和短效避孕模式分别占46.7%(24 481人)和48.5%(25 489人),其中女性结扎比率最高,占43.7%(22 916人),其次为避孕环,占41.1%(21 563人);选择长效避孕工具、短效避孕工具及未避孕的妇女中,有人工流产史者分别占25.2%(6 165人),38.0%(9 684人),37.9%(951人),3组差异有统计学意义(χ²=983.16,P<0.001)。结论 避孕的有效性与人工流产密切相关,有关部门应提高农村妇女对各种避孕工具的认识及避孕的有效性,从而降低人工流产率。     

女青年人工流产情况及避孕知识调查

目的:了解郑州市女青年人工流产和避孕知识知晓情况,探讨人工流产影响因素。方法:采用自填式调查问卷,对郑州市年龄≤25岁1100名人工流产女青年进行横断面调查。结果:调查对象年龄为(22.50±1.68)岁,平均月收入为800元,职业以公司职员为主(29.4%),大部分未婚,流动人口占75.1%,初中以下文化程度和常住人口相比有统计学意义;34.9%的女青年经历过流产,首次流产未婚者占72.6%,且随着年龄增加,重复流产率逐渐增高;本次妊娠原因67.9%的女青年未采用避孕措施,32.1%为避孕失败,避孕失败的主要原因是避孕套(44.5%)、安全期(25.2%)和体外排精(15.9%);过去3个月中,最常用的避孕方法是避孕套(82.3%),其次为紧急避孕(28.5%)、安全期(27.7%)、体外排精(22.7%);谈及避孕知识,深入到避孕措施具体使用方法回答正确率较低。结论:非意愿妊娠的主要原因是未采用避孕措施,而使用避孕措施的女青年中,坚持使用和正确使用有效避孕措施率低,且流产女青年掌握的避孕知识有限,应加强未婚人群和流动人口的避孕知识宣教和咨询,内容侧重坚持、正确使用高效避孕措施的宣传,提供优质的计划生育服务,从而避免非意愿妊娠和人工流产。     

Emergency contraception and prevention of induced abortion in India

OBJECTIVE: Induced abortion is associated with high morbidity and mortality in India. Use of regular contraception with emergency contraception (EC) as backup can reduce the incidence of induced abortion. The study aimed to assess women's knowledge, practice, preference and acceptance of different contraceptive methods with special reference to the causes of induced abortion, and their willingness to use hormonal EC. METHODS: The study comprised a structured questionnaire survey conducted in the family planning clinic of a tertiary teaching hospital in New Delhi, India. A total of 623 women and three men seeking contraceptive advice and/or termination of pregnancy were interviewed. The main outcome measures were knowledge of different contraceptive methods including EC and the reasons for unintended pregnancy. RESULTS: More than 99% of the respondents knew about most of the modern methods of contraception whereas only 37 (5.9%; 95% CI 4.0-7.8) of the respondents knew about EC and none of them had ever used it. Contraceptive method failure led to unintended pregnancy in 39.1% (95% CI 33.7-44.5) of abortion seekers. Correct use of EC could have prevented nearly 65.5% (95% CI 57.0-74.0) of induced abortions due to contraceptive method failure and 25.6% (95% CI 20.7-30.5) of all induced abortions. CONCLUSIONS: More efforts are required to generate awareness about the safety, efficacy and availability of EC, regular use of effective contraception and the health hazards of induced abortion.     

Characteristics of women having abortion in China

A pre-coded, closed response questionnaire was administered to women at abortion clinic sites in August 1985. The convenience sample was comprised of 1200 women, 200 samples in both Chengdu and the Lianshan Yi Autonomous Region in Sichuan Province, 400 in Nanjing and Jiangsu Province, and 400 in the municipality of Shanghai. The women were interviewed by physicians as part of the women's intake medical history. The sample yielded 574 respondents who were urban and 624 who were rural. The number of previous abortions reported ranged from 0 to 5. Nearly half of the abortion recipients had had at least one prior abortion and 18% had had two or more prior abortions. Education, age, marriage duration and residence have apparent effect on abortion order. The urban respondents reported an average of 1.08 children vs 1.60 children for the rural respondents. Approximately 72% of the respondents claimed to have been using a contraceptive method at the time they became pregnant. The most commonly used method was the IUD (41.6%), followed by the pill (21.3%) and the condom only (16.5%). Residence appeared to be the greatest factor determining the type of contraceptive methods. The data presented here are limited and cannot be generalized to the larger population. However, they do shed some light on the contraception characteristics of a group of women who undergo abortion procedures in China. Their response to questions to contracepting behavior prior to abortion suggests that the problem, in part, is behavioral. For example after the expulsion of the IUD, no other method was substituted to avert pregnancy. In order to alleviate the problem of contraceptive failure, and subsequent abortion, there are policy as well as training and education implications for the state.