Acceptance and use of the female condom among women with incomplete abortion in rural Tanzania

BACKGROUND: This study describes the outcome of a postabortion care intervention aimed at introducing the female condom as a means of preventing women from having unwanted pregnancies and sexually transmitted infections (STIs)/HIV. METHODS: Postabortion contraceptive counseling and services were offered to 548 women admitted to the Kagera Regional Hospital for incomplete abortion. The counseling included information about STI/HIV and the use male or female condom. In total, 521 (95%) women accepted contraception. RESULTS: Contraceptive use was assessed 3 months after abortion among 475 (91%) women. The female condom was accepted by 201 of 521 (39%) and was used by 158 of 521 (30%). Women who had experienced an unsafe abortion, had attended secondary school or earned an income were more likely to accept the female condom. The women were generally satisfied with the method, and the majority intended to use it again. CONCLUSION: Postabortion care programs provide an excellent entry point for introducing the female condom as a contraceptive method for the prevention of both repeat unwanted pregnancies and STI/HIV infection.     

Unsafe abortion in Tanzania and the need for involving men in postabortion contraceptive counseling

Targeting male partners involved in unsafe abortions for contraceptive counseling could be an important strategy for decreasing the incidence of unwanted pregnancies, yet few postabortion-care programs have attempted to involve these men. To assess the need for and determine the content of postabortion contraceptive counseling for men, this study examined the contraceptive knowledge, attitudes, and practices of male partners of women who have had an unsafe abortion. A survey was administered to 213 men accompanying female partners receiving hospital care after having undergone an unsafe abortion in Dar es Salaam, Tanzania, and 20 of these men participated in in-depth interviews. Sixteen percent of the men surveyed accompanied an extramarital partner, and of those, only 44 percent reported having practiced contraception in the last six months, compared with 81 percent of the men accompanying their wives and 83 percent accompanying their girlfriends. In general, the men wished to support their partners in practicing contraception, and the majority were willing to participate in contraceptive counseling. These findings suggest that male partners should be included in postabortion contraceptive counseling, which should be sensitive to the nature of the partners' relationship, the risk of HIV transmission, and the importance of promoting gender     

Determinants of Contraceptive Acceptance Among Cambodian Abortion Patients

Although Cambodia's total fertility rate is declining, limited access to and use of contraceptives has meant that some women rely upon induced abortion, legal since 1997, to achieve their fertility intentions. This study identifies factors that facilitate acceptance of postabortion contraception among women using Cambodia's public health facilities. Data were collected in all of Cambodia's hospitals with obstetric and delivery services (n = 71) and a representative sample of 115 of its 887 health-care centers, and from women seeking induced abortion or with abortion complications who presented to selected facilities during a three-week period (n = 933). Weighted data from 316 women who reported not wanting to become pregnant within the next few months and who presented to facilities that provide postabortion contraceptives were analyzed for bivariate and multivariate associations. Approximately 42 percent of women accepted contraceptives at the conclusion of care. After controlling for individual and facility characteristics, women who presented at facilities where a nurse/midwife managed abortion services, where contraceptives and abortions were provided in the same room, and where a larger range of methods were offered had significantly higher odds of contraceptive acceptance following abortion care. Improving contraceptive counseling and training for midwives and physicians, increasing contraceptive choices, and promoting access to contraceptives on site may reduce Cambodian women's risk of unwanted pregnancy and, potentially, unsafe abortion.     

Estimating the incidence of abortion in Pakistan

This study applies an indirect estimation method to develop comprehensive national and provincial estimates of the prevalence of abortion and abortion-related morbidity in Pakistan. Data from a health facilities survey and a health professionals survey from 2002 are analyzed to develop estimates of postabortion hospitalizations and of the abortion rate, abortion ratio, and unwanted pregnancy rate. We estimate that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1,000 women aged 15-49. The abortion rate is found to be higher in provinces where contraceptive use is lower and where unwanted childbearing is higher. The unwanted pregnancy rate is estimated at 77 per 1,000 women, or about 37 percent of all pregnancies. Abortions account for termination of one in seven pregnancies. An estimated 197,000 women are treated annually in public hospitals and private teaching hospitals for induced abortion complications, a number equivalent to an annual rate of 6.4 women hospitalized as a result of unsafe induced abortions per 1,000 women aged 15-49.     

经济落后地区农村妇女产次与妊娠结局关系的探讨

为了解经济落后地区农村妇女产次、妊娠结局现状及关系 ,为提高农村地区妇女生殖健康水平提供信息基础 ,统计分析安徽省定远县 2 0个乡镇计划生育部门日常记录的 36 98名妇女的产次及妊娠结局资料。结果 :计划外怀孕占总怀孕数的 9.30 % ,高胎次及计划外怀孕妇女流产、死产比例偏高。建议 :计划生育部门和妇幼保健部门应当通力合作 ,加强对计划外怀孕、人工流产的管理工作 ,为广大妇女提供更为安全有效的保健及计划生育服务     

Availability,practices and acceptance of postabortion contraceptive services in health facilities: A study in six states of India

ObjectiveTo assess the availability of and practices around postabortion contraceptive services in health facilities, and document women’s acceptance of postabortion contraception in six Indian states.Study DesignWe conducted a survey of 4001 public and private health facilities that provide abortion-related care in six Indian states. In this analysis, we assess the availability and range of contraceptive methods offered, the protocols and practices around postabortion contraceptive counseling, the extent to which facilities require women to adopt contraception, and contraceptive uptake among women.ResultsAlthough some contraceptive methods and information were available at a majority of facilities (75–97%), the range of methods was lacking and the information provided to women varied considerably by state. 8–26% of facilities required women seeking induced abortions to accept a modern contraceptive method. Only half to two-thirds of postabortion patients adopted a modern method.ConclusionThe limited number of methods offered in facilities suggests that some women may not obtain the method they desire, or get information about the full range of methods that should be available. While contraceptive uptake should be voluntary, the requirement imposed by some facilities for women to adopt a modern contraceptive method in order to obtain an abortion must be addressed.ImplicationsSome 15.6 million Indian women had an induced abortion in 2015. Understanding the provision of postabortion contraceptive services in health facilities, including counseling, is necessary to inform policies and practices to better enable women and couples to make informed decisions to prevent future unintended pregnancies.     

Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception

In many countries, women treated for complications from spontaneous or unsafely induced abortion lack access to contraceptive services. As a result, many of them soon have a subsequent unplanned pregnancy or a repeat abortion, placing their health at increased risk. This report presents the results of a prospective intervention study on postabortion family planning conducted in the two largest public hospitals in Zimbabwe. Women at Harare Central Hospital, in the capital, received a postabortion family planning intervention, and Mpilo Central Hospital, in Bulawayo, served as the control site. The study cohort was 982 women, 527 of whom were followed for a 12-month period. During the follow-up period, significantly more women used highly effective methods of contraception, significantly fewer unplanned pregnancies occurred, and fewer repeat abortions were performed at the intervention site than at the control site. These results offer compelling evidence that ward-based contraceptive services provided to women treated for incomplete abortion can significantly reduce subsequent unplanned pregnancies. The results also suggest that postabortion family planning services can reduce the incidence of repeat abortion.     

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.     

Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania.

This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es Salaam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life.) A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies--precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics.     

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty‐one percent of the women accepted postabortion contraceptive methods: 53 percent short‐term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first‐trimester services, received induced abortion, attended primary‐level health facilities, and had medical abortions. Doctors receiving post‐training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service‐delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy.     

Levels,Trends, and Determinants of Unintended Pregnancy in Iran: The Role of Contraceptive Failures

The rate of contraceptive use in Iran is high, but because abortion is illegal, many unintended pregnancies among married women are likely to be terminated by clandestine and often unsafe procedures, resulting in adverse health outcomes. Drawing upon data from the 2009 Tehran Survey of Fertility, this study estimates the levels and trends of unintended pregnancy and examines determinants of pregnancy intentions for the most recent birth, using multinomial logistic regression analysis. The level of unintended pregnancy decreased from 32 percent in 2000 to 21 percent in 2009, while contraceptive use increased. Unintended pregnancies in the five years preceding the 2009 survey resulted from failures of withdrawal (48 percent) and of modern contraceptive use (20 percent), together with contraceptive discontinuation (26 percent) and nonuse (6 percent). Multivariate findings show that, compared with women experiencing withdrawal failures, the risk of unintended pregnancy was higher among women reporting modern contraceptive failure and lower among those reporting contraceptive discontinuation and nonuse. The high risk of unwanted pregnancy among women experiencing failures in practicing withdrawal or using modern contraceptive methods points to an unmet need for family planning counseling and education rather than to a shortage of contraceptive methods.     

Assessments of the importance of provider characteristics for abortion care: data from women in Rajasthan, India

While client satisfaction is a widely recognized component of effective reproductive health care services, little is known about women's perspectives toward abortion care and providers. We use data from a large, community-based abortion knowledge, attitudes, and practices survey in Rajasthan, India, to describe women's assessments of the importance of eight attributes of potential abortion providers and to investigate the sociodemographic differentials in these assessments. Women prioritized technical aspects of abortion care, including provider skill and an equipped facility, and they deemphasized distance and postabortion contraceptive requirements. Although assessments were stable across many sociodemographic factors, the priorities of urban and rural women varied significantly. Women's prioritization of provider attributes should be incorporated into abortion services.     

年轻妇女重复人工流产状况及影响因素

目的:了解北京市年轻妇女(≤25岁)重复流产的基本状况、有关避孕态度行为,并探讨相关影响因素。方法:本研究采用以医院为基础的描述性流行病学研究,分析多次重复流产妇女的基本状况及相关影响因素。随机选取北京市8家医院,对6个月内到这8家医院进行早期人工流产的妇女(1980年8月1日以后出生)进行问卷调查并应用SPSS10.0统计软件进行分析。结果:在所有被调查的1008例流产妇女中,2次以上(包括2次)为330例,占所有流产妇女的比例为32.7%;在重复流产的妇女中,56.9%的人未使用任何避孕措施,43.1%的妇女怀孕原因是因为避孕失败。在所有因避孕失败怀孕者中,有36.9%为安全期避孕失败,29.8%是避孕套避孕失败所引起,26.2%是体外排精,19.1%是紧急避孕药。多元Logistic回归分析,最后进入模型的因素有职业、文化程度、避孕知识、本次流产避孕状况。结论:由于年轻妇女对避孕知识相对缺乏,未采取避孕措施的比例较高,安全期避孕的使用率仍然较高。职业、文化程度、对避孕知识的掌握程度以及本次流产是否避孕是妇女重复流产的影响因素。应加强对流产后避孕知识的宣教,特别是安全期避孕与体外排精的相关知识。     

Effect of shared contraceptive experiences on IUD use at an urban abortion clinic

BackgroundWe studied the effect of contraceptive social networking on postabortion intrauterine device (IUD) uptake. This study explores whether women who have heard personal stories of IUD use are more likely to use an IUD for postabortion contraception.Study DesignWe surveyed 299 women undergoing induced abortion at San Francisco General Hospital's Women's Options Center before and after contraceptive counseling. Both English- and Spanish-speaking women, aged 15 years and older, were surveyed.ResultsFifty percent of women surveyed chose to use an IUD for postabortion contraception. Women choosing IUDs were more likely than women choosing other contraceptives or no contraceptives to be multiparous, Latina and interested in IUDs prior to contraceptive counseling. Disclosure of personal IUD use by a clinic staff member was independently associated with the decision to use an IUD (odds ratio 8.1, 95% confidence interval 3.8–17.2).ConclusionsWomen undergoing abortion in an urban clinic have knowledge and high acceptance of IUDs, and sharing of contraceptive experiences is common among women of all demographics. Controlling for demographics and prior knowledge of IUDs, sharing of personal IUD experiences by providers is significantly associated with IUD use.     

The social constructions of unwanted pregnancy and abortion in Lima, Peru

Although modern contraceptive use in Peru has increased, many women still face unwanted or unplanned pregnancies and abortions remain high despite the illegality of elective pregnancy termination. To improve understanding of how men and women make reproductive decisions, we conducted this study in Lima. Fifty-two 18-37 year old low- and middle-income women and men participated in in-depth interviews and focus groups. Reproductive planning constitutes a worry among participants. The paradigm of contraception, pregnancy, childbearing and pregnancy termination is complex and contained within a context of contradictory pressures toward women: while women feel the need to be autonomous in all realms of their lives, they also need to meet the traditional roles associated with sexuality and childbearing and rearing. The woman, her partner and family members take part in reproductive decisions. However, participants expressed difficulties preventing unwanted pregnancies and social stigma if they resorted to abortion or, interestingly, if they continued a pregnancy when involved in a socially undesirable personal situation. Abortion-related stigma generated fear and guilt in addition to safety concerns given the unsafe, clandestine contexts in which pregnancy termination takes place. Despite these concerns, interviewees often opted for abortion for personal reasons, which were primarily economic.     

Assessments of the Importance of Provider Characteristics for Abortion Care: Data From Women in Rajasthan,India

While client satisfaction is a widely recognized component of effective reproductive health care services, little is known about women's perspectives toward abortion care and providers. We use data from a large, community-based abortion knowledge, attitudes, and practices survey in Rajasthan, India, to describe women's assessments of the importance of eight attributes of potential abortion providers and to investigate the sociodemographic differentials in these assessments. Women prioritized technical aspects of abortion care, including provider skill and an equipped facility, and they deemphasized distance and postabortion contraceptive requirements. Although assessments were stable across many sociodemographic factors, the priorities of urban and rural women varied significantly. Women's prioritization of provider attributes should be incorporated into abortion services.     

Prioritizing reproductive health for refugees

It has been recognized that the extreme disruption and isolation that refugees experience can also have serious consequences for their reproductive health. Among these are poor access to safe delivery services and contraceptive methods, as well as sexual violence, with consequences ranging from physical and psychological trauma to HIV/AIDS and sexually transmitted diseases (STDs) and unwanted pregnancy. Reproductive health care can, therefore, save refugee women's lives and should be given priority in emergency refugee assistance efforts. Critical reproductive health services during emergency phase include clean and safe delivery, prevention and treatment of STDs and HIV/AIDS, emergency contraception, and life-saving treatment for complications of miscarriage and contraception. Within this context, the Inter-Agency Working Group has made considerable progress in strengthening reproductive health services in terms of equipment supply, technical materials, policy and advocacy, as well as research and monitoring and programmatic action. Finally, as access to safe abortion care is increased for refugee women, efforts are being made to prevent unsafe abortion by improving supplies of contraceptives to prevent unwanted pregnancy, emergency contraception, and postabortion care.     

Induced Abortions and Unintended Pregnancies in Pakistan

During the past decade, unmet need for family planning has remained high in Pakistan and gains in contraceptive prevalence have been small. Drawing upon data from a 2012 national study on postabortion‐care complications and a methodology developed by the Guttmacher Institute for estimating abortion incidence, we estimate that there were 2.2 million abortions in Pakistan in 2012, an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 per 1,000 women in 2002. After taking into consideration the earlier study's underestimation of abortion incidence, we conclude that the abortion rate has likely increased substantially between 2002 and 2012. Varying contraceptive‐use patterns and abortion rates are found among the provinces, with higher abortion rates in Baluchistan and Sindh than in Khyber Pakhtunkhwa and Punjab. This suggests that strategies for coping with the other wise uniformly high unintended pregnancy rates will differ among provinces. The need for an accelerated and fortified family planning program is greater than ever, as is the need to implement strategies to improve the quality and coverage of postabortion services.     

郑州市医院流产后计划生育服务现况的定性研究

目的:了解郑州市医院流产妇女流产原因及影响因素,医院开展流产后计划生育服务的需求以及服务现况。方法:采用个人访谈、关键信息人访谈和小组集中讨论的研究方法。结果:主要流产原因未婚妇女是不了解避孕方法而未采用避孕措施,已婚妇女多为避孕失败,少数是对优生考虑而流产。大多数流产妇女认为,医生的服务态度不好,只是简单介绍流产后注意事项,没有主动提供避孕知识的宣教和咨询,更没有提供免费的避孕药具。绝大多数流产妇女建议医院的流产后服务应该改善,医生应该主动向妇女介绍一些避孕方法,提供一些免费避孕药具等。大多数服务提供者认为流产前后对流产妇女进行避孕知识的宣传教育有必要,但存在一定的困难,主要是需要增加人员、加大经费投入等;一部分人认为若在流产后对妇女进行避孕知识的宣传和教育,可以增加避孕方法的使用,减少非意愿妊娠和重复流产。结论:流产原因多为未避孕和避孕失败,医院尚未开展流产后计划生育服务,应提供规范的流产后计划生育服务,以提高流产妇女的避孕知识和避孕方法的正确使用。     

Expanded Access to Postabortion Contraception under Oregon's Reproductive Health Equity Act

ObjectiveWe describe the first 24 months of expanded family planning services for low-income immigrants under Oregon's Reproductive Health Equity Act. We examined postabortion contraceptive use in rural versus urban locations.Study DesignWe conducted a historical cohort study of abortion services reimbursed under the Reproductive Health Equity Act in the first 2 years after its implementation (2018 and 2019). Our primary outcome was shift in contraceptive tier from a less effective method before an abortion to a more effective contraceptive method after an abortion. Our key independent variable was residence in a metropolitan or nonmetropolitan area. We tested the association of nonmetropolitan residence and shift to a tier 1 or tier 2 method after the abortion, controlling for other factors, using logistic regression.ResultsOur analysis included 625 abortions from across the state. After an abortion, 68% of women transitioned to a more effective form of contraception. Nonmetropolitan residence was not significantly associated with a shift from no method or a tier 3 method to tier 1 or tier 2 method (adjusted odds ratio, 1.28; 95% confidence interval, 0.81–2.02) compared with metropolitan residence.ConclusionsThe program was successful in helping women not wishing pregnancy to transition to a more effective contraceptive method postabortion, regardless of metropolitan location of residence.