Feasibility of the randomized response technique in rural Ethiopia.

A multiple answer model of Randomized Response Technique (known as Hopkins RRT Model II) was tried in a rural area (Nekempte) in Ethiopia to estimate the incidence of induced abortion among currently married women of childbearing age. In the RRT adopted here, the question on abortion--sensitive as it is--was preceded by two innocuous "practice questions". Despite the very low literacy level of the women, nearly all of them cooperated. The RRT estimates in regard to the two innocuous "practice questions" were fairly reasonable, while the RRT estimate of the rate of induced abortion (35 per cent) was far higher than that derived from direct reporting. The differentials in abortion rates by age and parity were consistent with expectation. A post RRT survey indicated that more than one-half (58 per cent) of the women found RRT "easy" or "moderately easy" to understand, while nearly 80 per cent of them thought that there was no "trick" involved in it.     

Repeat abortions: blaming the victims.

A study of 1,505 women obtaining abortions in a freestanding abortion clinic in Western New York state revealed that women having repeat abortions were more likely to be using contraception at the time of conception than women having first abortions. However, nearly one-half the non-contracepting repeaters were not contracepting at the time of the repeat pregnancy. Repeaters who were not contracepting at the time of the repeat pregnancy listed medical contraindications or lack of supplies as the major reasons for not contracepting at the time of the present conception--indicating that they had tried one or more methods since their first abortion. Repeaters were sexually more active than first timers, thus increasing their statistical risk of unwanted pregnancy even as they contracepted more than first timers. The data indicate that both first timers and repeaters overwhelmingly reject the premise that abortion is a primary or even a back-up birth control method. The essential difficulty for repeaters appears to be that they are victims of technological, organizational, and logistical inadequacies as well as statistical probabilities rather than being motivationally deficient or indifferent to the dangers of unprotected sexual intercourse.     

Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion

BACKGROUND: The rate of repeat induced abortion varies from 30% to 38% in northern Europe. Thus, repeat abortion is an important public health issue. However, risk factors as regards repeat abortion are poorly understood. We characterized risk factors related to sociodemographic characteristics, history of abortion and post-abortal contraception. STUDY DESIGN: A prospective cohort study of 1269 women undergoing medical abortion between August 2000 and December 2002 was conducted. The subjects were followed via the Finnish Registry of Induced Abortions until December 2005, the follow-up time (mean+/-SD) being 49.2+/-8.0 months. RESULTS: Altogether, 179 (14.1%) of the subjects requested repeat abortion within the follow-up time. In univariate analysis, a history of prior abortion, being parous, young age, smoking and failure to attend the follow-up visit were associated with repeat abortion. Immediate--in contrast to postponed--initiation of any contraceptive method was linked to a lower risk of repeat abortion. In comparison with combined oral contraceptives, use of intrauterine contraception was most efficacious in reducing the risk of another pregnancy termination. In multivariate analysis, the effects of young age, being parous, smoking, a history of prior abortion and type of contraception on the risk of another abortion persisted. CONCLUSIONS: An increased focus on young women, parous women and those with a history of abortion may be efficacious in decreasing repeat abortion. Contraceptive choices made at the time of abortion have an important effect on the rate of repeat abortion. Use of intrauterine contraceptives for post-abortal contraception was associated with decreased risk of repeat abortion.     

Repeat abortion: is it a problem?

As the number of Canadian women who have had induced abortions increases with each succeeding year, the number at risk--and the actual incidence--of repeat abortion also increases. Some researchers have argued that women who have more than one induced abortion are less well adjusted, others that they are less willing to use contraceptives, perhaps because of anxiety about sexuality. Still others have suggested that repeat abortion is unrelated to the psychology or attitudes of individual women, but rather is an inevitable result of imperfect contraceptives, imperfect contraceptive practice and the availability of legal abortion for the termination of unwanted pregnancies. A group of 580 women seeking abortions were interviewed at the Montreal General Hospital and given a number of psychological tests. About one in five of these women were having repeat abortions. The women having repeat abortions were older, less likely to be married and more tolerant of legal abortion than were women having their first abortions. They also had intercourse more frequently than the first-abortion patients. Women obtaining a repeat abortion were slightly more likely to have been using contraceptives at the time they became pregnant, but they did not differ from first-abortion patients in the types of methods that they used. On no other social or demographic characteristics, measures of psychological adjustment or attitudes about sexuality were there any important differences between the groups. A more complex statistical analysis reveals that the two most important factors differentiating first-abortion and repeat-abortion patients are age and coital frequency--both of which are variables that reflect added exposure to the risk of unintended pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)     

重复人工流产现象的调查研究

[目的]研究重复人工流产跟意外妊娠之间的关系,为流产后服务模式的建立提供相关建议。[方法]采用横断面研究方法,以2008年1月~2010年12月在本院接受人工流产的女性为调查对象,用现场询问的方式收集基本情况、既往人工流产次数等资料。对重复人工流产对象作进一步访谈,填写一份结构式调查问卷。[结果]837名人工流产女性中重复人工流产的比例为55.20%,年龄≥30岁。调查对象希望得到流产后服务的比例为88.1%,而在医疗机构接受到避孕服务的比例为39.9%。[结论]意外妊娠与没有周全的避孕计划、流产后不能持续正确的避孕及对人工流产的危害性认识不足有关。流产后服务未能满足服务对象的需求,应当拓宽流产后服务的覆盖面,丰富服务内容,提供个体化的流产后服务。     

Psychiatric sequelae to term birth and induced early and late abortion: a longitudinal study

Three obstetric groups matched for parity, age, color, marital and socioeconomic status, were compared for the psychosocial antecedents to abortion or term delivery and sequelae that did exist. One group had induced abortion by suction curettage, the second had induced abortion by saline injection, and the third had term delivery. 373 women were interviewed during pregnancy; 211 were included in follow-up after an average of 16 months for abortion patients and 13 months for the term delivery group. The 373 women received a structured 90-minute interview about family relationships, consort relationships, living arrangements, income, education, religious behavior, sexual behavior, contraceptive knowledge and use, pregnancy history and desired family size. The Srole Anomia scale and the Rosenberg Self-Esteem scale were also used. At the followup interview, similar questions were asked and the two attitude scales were again presented. The MMPI (Minnesota Multiphasic Personality Inventory) and the SCL (Symptom Check List) were also used. 12% of the 211 follow-up scored higher than 70 on the MMPI for mania and psychopathy scales; these women were evenly divided among the three groups. SCL scales showed the three groups of patients to be similar after abortion or birth, with the only statistically significant difference being the suction curettage group, which had fewer complaints after abortion than either of the other two groups. There was no difference on the anomia or self-esteem scale between pre- or post-procedure for any of the groups. The data suggest neither great harm nor great benefit with regard to these variables due to either early or late abortion or term birth. Early abortion by suction curettage was possibly more therapeutic than carrying a pregnancy to term. There were striking improvements with regard to contraceptive use after the procedure. 71% of each group used effective contraception for more than 12 months after abortion or birth: a 20% increase for the term birth group, a 13% increase for the suction curettage group, and a 26% increase for the saline abortion group. Among abortion patients, those found to have low self-esteem, low contraceptive knowledge, high alienation, and who delayed in seeking abortion were related to long recovery times, a high MMPI psychopathology scale, and a number of unpleasant body symptoms post-abortion. These patients could be predicted with accuracy 32% better than chance alone.     

Estimating the frequency of induced abortion: a comparison of two methods]

OBJECTIVE: To compare two methods-the "ballot box" method and the "indirect questioning" method-for estimating the frequency of induced abortions in population-based studies. METHODS: A cross-sectional population-based study was conducted with a representative sample of 3 002 women between 15 and 49 years of age living in the city of Pelotas, Rio Grande do Sul, Brazil. The women were selected through multistage sampling and randomly assigned to answer questions concerning induced abortion with one of the two methods, after they had answered a general questionnaire that collected socioeconomic and demographic information. With the "ballot box" method, women received a small piece of paper containing direct questions on abortion. Each woman marked her answers on the paper and then deposited it into a small "ballot box" carried by the interviewer, thus assuring the confidentiality of the responses. With the second method, the interviewer verbally asked the woman a series of questions that indirectly inquired about abortion. RESULTS: Among the women assigned to the ballot box method, 7.2% reported having induced at least one abortion, versus 3.8% of the women assigned to the indirect questioning method. The ratio between the two methods was 1.89 (95% confidence interval: 1.39 to 2.60; P < 0.001). Of the women surveyed who were 45-49 years old (at the end of their reproductive life) and answered using the ballot box method, 12% of them reported having had at least one induced abortion in their lifetime. Among the women who answered using the ballot box method, the main reasons they gave for having had an abortion were economic difficulties, being too young, and being single. Approximately half of the women responding to the ballot box method questions reported they had used unsafe procedures to induce abortion, with 13% of them using misoprostol. CONCLUSIONS: The ballot box method was suitable for studying the frequency of induced abortion and for researching other topics that may lead to underreporting by the persons interviewed, especially in population-based samples. Rephrasing the ballot box method question about abortion (for example, eliminating the word "child") would probably increase the method's sensitivity, that is, its ability to detect induced abortions that had occurred.     

ELICITING QUALITATIVE INFORMATION ABOUT INDUCED ABORTION: LESSONS FROM NORTHEAST THAILAND

Obtaining reliable information about induced abortion is notoriously difficult, especially where abortion is illegal. This article describes methods used in a study of illegal induced abortion among village women in Northeast Thailand. A variety of methods were used to gather in-depth qualitative data on abortion experiences including a randomized interview survey on reproductive health, in-depth interviews with women who had experienced an induced abortion in the last two years, and the use of vignettes in focus group discussions with men and women. The survey provided a broad overview of the extent of the experience of abortion. In-depth interviews through social networks proved more successful for obtaining reliable accounts of abortions and suggest that survey results were underestimates. Focus groups discussed the situational ethics involved in abortion decisions. Within an appropriate context and study design, it is possible to obtain highly sensitive information while respecting the privacy of informants.     

Eliciting qualitative information about induced abortion: lessons from Northeast Thailand

Obtaining reliable information about induced abortion is notoriously difficult, especially where abortion is illegal. This article describes methods used in a study of illegal induced abortion among village women in Northeast Thailand. A variety of methods were used to gather in-depth qualitative data on abortion experiences including a randomized interview survey on reproductive health, in-depth interviews with women who had experienced an induced abortion in the last two years, and the use of vignettes in focus group discussions with men and women. The survey provided a broad overview of the extent of the experience of abortion. In-depth interviews through social networks proved more successful for obtaining reliable accounts of abortions and suggest that survey results were underestimates. Focus groups discussed the situational ethics involved in abortion decisions. Within an appropriate context and study design, it is possible to obtain highly sensitive information while respecting the privacy of informants.     

长沙市女性人工流产及避孕现状调查

目的了解女性人工流产状况、避孕现状及其影响因素,为合理采用避孕措施、提高女性生殖健康水平提供参考依据。方法对在长沙市妇幼保健院行人工流产术的3 260例妇女进行问卷调查,其中合格问卷3 056份。收集调查对象的婚育史、流产史、获得避孕节育知识的途径、避孕方法的使用、避孕知识掌握情况、意外妊娠原因等情况,进行统计分析,并提出应对措施。结果未婚人工流产1 449例(47.41%),已婚人工流产1 607例(52.59%);避孕失败2 177例(71.24%),其中采用避孕套失败的653例(21.37%),未采取避孕措施879例(28.76%);两次以上的重复人工流产2 067例(67.64%)。多因素分析结果显示:受教育程度、经济水平和避孕知识掌握情况为重复人工流产的危险因素(P0.05)。结论避孕失败是人工流产的主要因素,未婚女性所占比例与已婚女性相近;应对未婚女性施以正确、专业的生殖健康和避孕知识教育;受教育程度、经济水平和避孕知识掌握情况对重复人工流产具有影响。     

Observation: contraceptive method use following an abortion

Researchers comparing 1st and repeat abortion patients directly, have found that the latter were using methods that are only slightly or no more effective than those used by 1st-abortion patients at the time they became pregnant. It is here argued that such direct comparisons are not appropriate because repeat patients are not typical of all women who have ever had an abortion. Most women who use effective methods consistently after a 1st abortion, will never appear in the repeat abortion statistics. Therefore, in terms of contraceptive use, repeat abortion patients overrepresent women who use no method or the least effective method. This point is illustrated using 1981-82 data collected by the Minnesota Department of Health on virtually all the state's residents obtaining abortions in the state during a 2-year period. A total of 22,070 women obtained 1st abortions and 8734 women repeat abortions. The data is collected by method used and shows the monthly contraceptive failure rate per woman, the number of users per failure, the estimated % distribution of women at risk of a 1st abortion, the acutal distribution of those obtaining a 1st abortion, and the estimated distribution of women at risk of a repeat abortion. Comparisons of these statistics show that of the women exposed to the risk of abortion, those acutally obtaining one are disproportionately using no cotraceptives (70%) or the least effective method. The pill and sterilization were the methods used most commonly by the group exposed to the risk of a repeat abortion. By contrast, at the time of the 1st abortion, only 5% of women had been using the pill and less than 1% had depended on sterilization. Only 9% of women at risk of a repeat abortion used no method, compared with 70% before the 1st abortion. Thus although women who have an abortion tend to be relatively poor contraceptive users, after the abortion, they use methods at least as effective as those used by women at risk of a 1st abortion. The data suggest a marked improvement in contraceptive practice subsequent to a 1st abortion. While a number of factors may contribute to this improvement, it is probable that the abortion experience and the contraceptive services offered at the time of the abortion play an important role in improving contraceptive practice.     

Social context and the experience of a sample of U.S. women taking RU-486 (mifepristone) for early abortion

Of 50 women seeking an abortion in Rochester, New York, between November 1999 and January 2001, 35 went on to complete an in-depth interview from 1 to 6 weeks after their follow-up clinical visit. A higher proportion of women who defined their pregnancy as a baby indicated emotional distress during their in-depth interview compared to those who saw their pregnancy as only having the potential to become a baby. The authors conclude that abortion might be made less difficult through public education about the different views of pregnancy and abortion throughout U.S. history. It might be important for abortion counselors to first ask a woman how she defines her pregnancy. A larger study is warranted.     

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。     

Differential characteristics of adolescent pregnancy test patients: Abortion,childbearing test groups

Studies of the consequences of adolescent childbearing report many negative sequelae, but the effects of induced abortion are less studied, and most studies lack appropriate controls for preexisting characteristics. This paper uses baseline data from the intake interview into a longitudinal study of 360 innercity black women (≤17 years old) presenting for a pregnancy test at two sites in Baltimore to examine baseline differences between three groups: young women who terminated the index pregnancy and, as controls, those who carried to term and those whose tests were negative. They were interviewed before being told the test result. Education aspirations/ achievement, economic well-being, sexual/contraceptive history, psychologic characteristics, and desire for a child were compared. Negative test patients often reveal characteristics suggesting a particularly high risk of pregnancy, e.g., more prior pregnancy tests and a greater desire to conceive. Implications are discussed, emphasizing the need to intervene after a negative pregnancy test with counseling to help avert a future undesired conception.     

城市妇女非意愿妊娠的原因及避孕知识态度和行为调查

目的:了解非意愿妊娠的主要原因,以及有关避孕方法知情选择的知识、态度和行为。方法:采用整群抽样的方法对191例非意愿妊娠妇女进行有关避孕知识、态度和行为问卷调查并应用SPSS/PC10·0分析软件进行统计。结果:2次以上重复流产率占34·6%;本次意外妊娠的原因,有54·4%的人是因为避孕失败。失败的原因依次为安全套57·8%、体外排精14·7%、安全期12·1%、口服避孕药10·3%和紧急避孕药4·3%。仅有11·5%的人能正确回答相关的知识试题。最喜爱的避孕方法前3位为安全套55·0%、安全期20·6%和体外排精10·1%。希望获得避孕信息的途径与现有来源存在一定差距。结论:重复流产率较高,亟待开展流产后服务项目,特别是避孕方法的正确使用。     

Estimating clandestine abortion with the confidants method--results from Ouagadougou, Burkina Faso

Data on abortion in sub-Saharan Africa are rare and non-representative. This study presents a new method to collect quantitative data on clandestine abortion, the confidants method, applied in 2001 in Ouagadougou, Burkina Faso. Preliminary qualitative work showed that individuals are aware of their close friends' induced abortions: women usually talk to their peers about the unintended pregnancy and ask them for help in locating illegal abortion providers. In a survey of 963 women of reproductive age representative of the city of Ouagadougou, we asked respondents to list their close relations, and, for each of them, and for each of the 5 years preceding the survey, whether they had an induced abortion. According to these data, there are 40 induced abortions per 1000 women aged 15-49 in Ouagadougou annually, and 60 per 1000 women aged 15-19. Adverse health consequences followed 60% of the reported induced abortions, and 14% of them received treatment in a hospital. Extrapolating these results to the entire city, we estimate that its hospitals treat about 1000 cases of abortion complications a year. Hospital data indicate that these centers admitted 984 induced abortions (adding all "certainly", "probably" and "possibly" induced abortions in the WHO protocol) in 2001; the age distribution of patients admitted for induced abortion also corresponds to the confidants method's projections ("certainly" induced abortions only). At least two biases could affect the abortion rates estimated by the confidants method, pertaining to the selection of the sample of relations and to the varying number of third parties involved in the abortion process. The confidants method, which is similar in its principle to the sisterhood method used to estimate maternal mortality levels, might generate accurate estimates of illegal abortion in certain contexts if these two biases are controlled for. Further testing is necessary.     

重复人工流产相关危险因素的横向研究

目的:探讨首次人工流产女性与重复人工流产女性之间不同的个体行为和社会经济差异,确定重复流产的相关危险因素。方法:调查2009年8月～2010年7月接受人工流产治疗服务女性1 132名,年龄20～49岁,采用回归分析方法研究重复流产的相关危险因素。结果:接受问卷调查女性的重复流产率为48.45%,调查一年间重复流产率为15.85%;重复流产的危险因素,包括生育史(OR=2.45),未婚或缺乏感情基础(OR=2.14),无业或失业(OR=1.66),吸烟或成瘾性药物使用(OR=1.43),低学历教育水平(OR=1.5)。其中部分女性(n=135)认为在经济条件允许或者建立婚姻关系后愿意继续妊娠。还有部分女性认为流产后未能获得相关避孕咨询,或采取不恰当的避孕方法,是重复流产的重要原因。结论:较高的女性重复流产比例,使开展流产后计划生育服务成为提高女性健康和生育质量的重要手段。虽然可以确定一些重复流产的相关危险因素,但是女性受到身心侵害的几率较高,所以预防非意愿妊娠需要全社会关心和努力。     

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。     

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。