医院服务提供者流产后服务现状

目的:了解郑州市医院服务提供者对流产后服务的知识、态度、行为及服务存在问题,为今后开展流产后服务提供科学依据。方法:采取整群抽样方式,对郑州市10家医院从事流产后服务的234名医护人员进行了调查,调查采用自填与询问相结合方式。结果:避孕方法知识水平较好者为72.2%,最需要的信息是如何生动进行计划生育宣教(70.94%)。仅有1.28%的服务提供者经常向流产妇女提供免费避孕药具。认为有必要向流产妇女提供避孕咨询服务和免费避孕药具的比例分别为89.75%和73.93%。对于今后推广实施流产后服务,认为亟需解决的问题依次是免费避孕药具的获得、妇女在流产手术后疼痛、能否抽出时间及计划生育宣教资料的获得等。结论:郑州市应加强对医院服务提供者的培训,提高医院服务提供者做好流产后服务的意识,计划生育和卫生部门应加强合作、共同推进流产后服务工作使其走向规范化。     

深圳市不同机构流产服务的现状及其评价

目的:了解和评价深圳市不同服务系统和不同等级医疗机构流产服务状况。方法:选择该市计划生育和卫生6家不同等级流产服务机构,采用现场观察和深入访谈等定性研究方法,了解相关设施设备、服务规范、服务记录状况以及流产服务提供过程,进行总结和评价。结果:各家机构设施设备良好,但部分机构手术室和观察室不能满足流产妇女隐私保护和舒适性需要。流产妇女基本能够知情后选择流产方法,但术前血常规和阴道分泌物检查存在一定的医患分歧。多数机构药物流产的有效性偏低(<91.7%),服务记录的内容和完整性尚有一定欠缺,医患交流不足,避孕服务缺乏积极主动。卫生机构流产妇女量经常超出其基础设施承受能力,技术人员相对不足,而计划生育机构流产妇女较少,服务资源利用不充分。结论:要加强机构管理者和技术人员流产优质服务的意识,特别要加强被服务者隐私保护和流产后计划生育服务。有必要积极探讨药物流产有效性偏低的原因,合理分流服务对象,提高计划生育机构流产服务资源利用率。     

深圳和眉山地区人工流产妇女对流产服务的评价及其比较

目的:评价深圳和眉山两地区不同部门和不同等级医疗机构人工流产服务质量,为进一步干预研究提供依据。方法:2005年10月~2006年3月,分别在深圳市和四川省眉山市对计划生育及卫生部门的市、县、乡三级开展人工流产服务机构,对完成流产手术离院前的妇女进行半结构式问卷调查,了解她们获得的相关服务及其对服务的评价。结果:术前医生对服务过程解释的比例为79%,术中对受术者不适进行处理的比例(61%),流产后避孕指导(67%)以及提供相应的宣教材料(52%)的水平均较低。深圳市流产服务在术后随访、性生活和避孕指导以及提供宣教材料方面高于眉山市,计划生育系统的人性化服务和流产后避孕服务好于卫生系统,县级机构术后指导和宣教以及人性化服务好于市级机构。总体上,流产妇女对服务的满意度为83%,其中对计划生育服务机构满意度(89%)高于卫生机构(76%),县级机构(93%)高于市级机构(72%)。结论:我国流产服务质量仍有很大的改善余地,尤其要加强以服务对象为中心的人性化服务和流产后避孕服务。经济欠发达地区和市一级服务机构是改进的重点。     

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。     

郑州市流产妇女生殖健康知识现状及其影响因素分析

目的：了解流产妇女生殖健康知识和接受相关服务的现状,为进一步完善医院流产后计划生育服务做参考。方法：2005年7～9月,通过流行病学整群抽样调查,对郑州市10家医院选择人工流产且年龄≤25岁共1100名流产妇女进行横断面的问卷调查。结果：调查对象生殖健康知识得分不高,在满分20分情况下,得分为10.75±3.59（1～19）分;避孕方法使用回答正确率较低（8.2%～87.9%）,这与调查对象的年龄、出生地、文化程度和职业有关,而未婚妇女的避孕知识得分除了与其年龄和文化程度有关外,还与其男伴的文化程度有关。流产妇女在医院接受的计划生育服务主要是流产后注意事项（95.4%）,服务方式主要是面对面宣传教育（82.6%）,宣传教育的时间主要在流产后休息时（48.1%）,绝大多数调查对象表示流产后没有接受医生的计划生育咨询、免费避孕药具提供和推荐转诊服务。结论：计划生育宣传教育应多关注未婚有性生活人群,同时让男伴参与进来;医院流产后计划生育服务需要规范,应加强有效计划生育宣传教育,提供免费避孕药具和推荐转诊服务。     

北京市西城区育龄妇女流产后综合服务现状调查

目的:了解城区育龄妇女人工流产术后接受综合服务的现状,为开展规范化流产后服务提供依据。方法:随机抽取在北京市西城区4家计划生育技术服务医疗机构中自愿要求人工流产的育龄妇女400例,进行现场问卷调查。结果:调查对象年龄28.9±6.89(18～48)岁;本次妊娠主要原因,42.6%未使用避孕方法,55.6%避孕失败,其他原因占1.8%;已婚育龄妇女重复流产率(68.05%)高于未婚育龄妇女(37.25%);既往避孕措施使用频率最高的是避孕套(68.1%),其次依次为安全期(38.7%)、体外排精(33.5%)、紧急避孕(19.4%)等;调查对象获得的宣教信息,最多的是流产后注意事项,其次是避孕方法的种类、避孕药具的使用方法等;95%能确定流产后使用哪种避孕方法,并愿意接受计划生育宣教服务;62.0%主动询问了有关避孕方法的问题,在咨询时医生介绍避孕方法占91.2%,咨询时间的中位数和众数均为10min,医生当场提供避孕药具占77.8%。结论:育龄妇女人工流产术后接受计划生育宣教和咨询服务意愿强,开展规范化流产后综合服务,有助于促进妇女生殖健康。     

人工流产后计划生育服务干预效果初探

目的:探讨人工流产后计划生育服务的实施效果。方法:在珠海市6家计划生育服务中心(站、所)选择1500名行人工流产妇女在流产术前进行初始问卷调查;然后将其随机分为流产后计划生育服务组(干预组)和对照组,对干预组进行流产后计划生育服务措施干预,对照组常规处理;1年期满后,对所有的研究对象采用与初始问卷相同的问卷再次进行问卷调查,重点调查避孕节育相关知识知晓情况,避孕措施实施情况,及再次非意愿妊娠情况。结果:随访1年后,收回有效问卷1146份,其中干预组577人,对照组569人。干预组和对照组的避孕相关知识得分分别为9.76和6.07(F=847.87,P0.001)。干预组采取主动避孕措施的比例(83.24%)高于对照组(59.93%),差异有统计学意义(χ2=114.86,P0.001)。干预组的非意愿妊娠率(9.71%)低于对照组(20.74%),差异有统计学意义(χ2=27.08,P0.001)。结论:流产后计划生育服务对育龄女性避孕节育相关知识的掌握,提高避孕措施使用比例,降低非意愿妊娠和人工流产率,提高生殖健康水平有一定的效果。     

How commonly do US abortion clinics offer contraceptive services?

Background

About half of US women having abortions have already had at least one prior abortion. Facilitating access to contraception may help these women avoid subsequent unintended pregnancies. Information is needed to document the availability of contraceptive services in abortion care settings in the United States.

Study Design

Data for this cross-sectional mixed-methods study were collected between December 2008 and September 2009 and come from two sources: 15 semistructured telephone interviews and 173 structured questionnaires administered to a nationally representative sample of eligible facilities. Respondents were administrators at large (400+ abortions per year), nonhospital facilities that provide abortion services in the United States.

Results

Virtually all (96%) abortion clinics incorporate contraceptive education into abortion care, and the three most common methods reported to be distributed are the birth control pill (99%), the vaginal ring (61%) and Depo-Provera (58%). Almost one-third reported being able to offer post-abortion intrauterine device insertion. Most facilities (82%) accept some form of insurance for either contraceptive or abortion services, and those with a broader family planning focus are significantly more likely to do so. Administrators at the majority of facilities (56%) report that patients most commonly do not pay additional fees for contraceptive services because they are included in the cost of abortion services.

Conclusion

Although almost all large, non-hospital abortion providers in the United States are able to provide some level of contraceptive care to their abortion patients, the degree to which they are able to do so is influenced by a wide range of factors.     

Public or private providers? U.S. women's use of reproductive health services

CONTEXT: U.S. women receive contraceptive and reproductive health services from a wide range of publicly funded and private providers. Information on trends in and on patterns of service use can help policymakers and program planners assess the adequacy of current services and plan for future improvements. METHODS: Women who reported in the 1995 National Survey of Family Growth that they had obtained any contraceptive or other reproductive health service in the past year were classified by their primary source of care, and the services they received, their characteristics and their primary source of care were analyzed. Logistic regression was used to test which factors predict women's use of publicly subsidized family planning clinics and of specific types of services. RESULTS: The percentage of women of reproductive age who obtained family planning services increased slightly between 1988 and 1995, primarily among women aged 30 and older. Nearly one in four women who received any contraceptive care visited a publicly funded family planning clinic, as did one in three who received contraceptive counseling or sexually transmitted disease (STD) testing and treatment. Women whose primary source of reproductive care was a publicly funded family planning clinic received a wider range of services than women who visited private providers; moreover, the former were significantly more likely to report obtaining contraceptive care or STD-related care, even after the effects of their background characteristics were controlled. Young, unmarried, minority, less-educated and poor women were more likely than others to depend on publicly subsidized family planning clinics. Source of health insurance was one of the most important predictors of the use of public family planning clinics: Medicaid recipients and uninsured women were 3-4 times as likely as women with private insurance to obtain clinic care. CONCLUSIONS: Publicly funded family planning clinics are an important source of contraceptive and other reproductive health care, providing millions of U.S. women with a wide range of services. Since women's need for reproductive care and for publicly subsidized care is not likely to diminish, clinics may be financially challenged in their efforts to continue delivering this broad package of services to growing numbers of uninsured or disenfranchised women.     

Contraceptive policies affect post-abortion provision of long-acting reversible contraception

Background

Placement of long-acting reversible contraceptives (LARC) — intrauterine devices (IUDs) and the implant — directly after an abortion provides immediate contraceptive protection and has been proven safe.

Study Design

We conducted a survey of National Abortion Federation member facilities (n=326; response rate 75%) to assess post-abortion contraceptive practices. Using multivariable logistic regression, we measured variations in provision of long-acting contraception by clinic factors and state contraceptive laws and policies.

Results

The majority (69%) of providers surveyed offered long-acting methods, but fewer offered immediate post-abortion placement of intrauterine devices (36%) or implants (17%). Most patients were provided with contraception; 6.6% chose LARC methods offering the highest level of protection. Post-abortion provision of these methods was lower in stand-alone abortion clinics (p≤.001), but higher with recent clinician training (p≤.001) and in the absence of clinic flow barriers (p≤.001). State policies had a significant impact on how women paid for contraception and the likelihood of LARC use. Patient use was higher in states with contraceptive coverage mandates (p≤.01) or Medicaid family planning expansion programs (p≤.05).

Conclusions

Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.     

Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya

This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10–18 years reported having used contraception, as compared to 60% of clients aged 27–46 years. After the abortion and family planning counselling session, only 6% of clients aged 10–18 chose a method, as compared to 96% of clients aged 27–46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.     

Complications of unsafe abortion in sub-Saharan Africa: a review

The Commonwealth Regional Health Community Secretariat undertook a study in 1994 to document the magnitude of abortion complications in Commonwealth member countries. The results of the literature review component of that study, and research gaps identified as a result of the review, are presented in this article. The literature review findings indicate a significant public health problem in the region, as measured by a high proportion of incomplete abortion patients among all hospital gynaecology admissions. The most common complications of unsafe abortion seen at health facilities were haemorrhage and sepsis. Studies on the use of manual vacuum aspiration for treating abortion complications found shorter lengths of hospital stay (and thus, lower resource costs) and a reduced need for a repeat evacuation. Very few articles focused exclusively on the cost of treating abortion complications, but authors agreed that it consumes a disproportionate amount of hospital resources. Studies on the role of men in supporting a woman's decision to abort or use contraception were similarly lacking. Articles on contraceptive behaviour and abortion reported that almost all patients suffering from abortion complications had not used an effective, or any, method of contraception prior to becoming pregnant, especially among the adolescent population; studies on post-abortion contraception are virtually nonexistent. Almost all articles on the legal aspect of abortion recommended law reform to reflect a public health, rather than a criminal, orientation. Research needs that were identified include: community-based epidemiological studies; operations research on decentralization of post-abortion care and integration of treatment with post-abortion family planning services; studies on system-wide resource use for treatment of incomplete abortion; qualitative research on the role of males in the decision to terminate pregnancy and use contraception; clinical studies on pain control medications and procedures; and case studies on the provision of safe abortion services where legally allowed.     

Factors Affecting Abortion Decisions among Young Couples in Nepal

PurposeTo explore, using both survey data and case studies, factors that are associated with abortion decisions among young couples in the context of recently legalized abortion in Nepal.MethodsThis article draws primarily on data collected in detailed case histories of 30 participants selected from a sample of the respondents to a survey of 997 married women aged 15 to 24 years and 499 men aged 15 to 27 years collected in 2003. Bivariate analyses of the survey data are presented in summary form to provide some general contextual background, with the key themes that emerged from analysis of the case histories being described.ResultsAlmost half of the young women in the survey reported that they had ever experienced an unintended pregnancy. A considerable proportion of these couples thought about abortion but the majority of them did not take any action. Some of them had attempted abortion but only few had succeeded. Multiple factors, including socio-cultural beliefs, affect the decision-making phase, making the process dynamic and situation-specific. Husbands and health service providers play a major role in the decision-making process.ConclusionsThe study highlights the need to scale up family planning and abortion services to young couples, and emphasizes the importance of involving men and service providers in public education and advocacy campaigns against unsafe abortion. It also points to the need for wider education in the community about family planning and legal abortion services, as well as for the transparent pricing of services and greater efforts to enhance women’s decision-making capacities and control over their reproductive options.     

Exploring the pathways of unsafe abortion in Madhya Pradesh, India

Abstract Nearly 40 years after enactment of the Medical Termination of Pregnancy Act of 1971, unsafe abortion continues to be a neglected women's health issue in India. This prospective study of women presenting for post-abortion care in 10 selected hospitals in Madhya Pradesh, India, aimed to understand the incidence, types and severity of post-abortion complications, probable causes of complications and consequences to women in terms of hospitalisation and incurred costs. Among 1565 women presenting for induced abortion-related services between July and November 2007, 381 women with post-abortion complications consented to participate. Data reveal a high prevalence of post-abortion complications (29%). Approximately half of women originally attempted to induce abortion at home using medication, home-made concoctions or traditional methods. Ninety percent sought care from either qualified (37%) or unqualified providers. More than half of the women were hospitalised as a result of post-abortion complications. This study suggests that supporting access to safely induced abortion services and improving community awareness on legal aspects, safe methods and approved providers are all necessary to reduce morbidity associated with unsafe abortion.     

Abortion laws into action: implementing legal reform

The worldwide trend towards liberalizing abortion laws has resulted in reduced abortion-related mortality in areas where legal abortion is accessible. In countries considering abortion reform, policy-makers and health care providers have a responsibility to ensure that provisions of any new law can be met. Preparations underway to prepare for South Africa's new abortion law can serve as a guideline for such action. A new abortion law calls for policy changes that may include 1) developing new standards, protocols, and guidelines for abortion care services; 2) ensuring provision of adequate trained staff willing to provide abortions; 3) streamlining administrative regulations to avoid delays; 4) establishing regulations and mechanisms for drug and equipment supply and distribution; 5) restructuring the health system to accommodate provision of abortion services; 6) allocating funds for new abortion services; and 7) reviewing and revising security measures. In addition, health professionals will require training in abortion provision, staff will need information updates about aspects of the legislation, and administrators and providers in a position to impede provision of services must be made aware of the affect of unsafe abortion on maternal health. Researchers should document the effect of the new law on women's health, the provision of reproductive health services, and the community. IEC (information, education, communication) activities will be required to inform the public about the new law and services, establish sex education programs in schools and health facilities, and mobilize family planning organizations and programs to help reduce the incidence of repeat abortions.     

Lack of family planning leading to induced abortion in rural Greece

29 (31%) of the 94 mothers interviewed in a domiciliary study of the use of mother and child health services in rural northwest Greece reported they had undergone an induced abortion. Most of these women, between 30-40 years of age, had at least 2 children. There was no correlation with the mother's literacy, father's occupation, and family's socioeconomic situation. The rate of abortion reported in this study is consistent with the findings of other Greek studies in urban settings. In the current study it was difficult to identify the exact time when women had undergone the abortion as the topic was delicate. Yet, all women were prompt and sincere in their answers and willing to share their anxieties and their fears about possible effects on subsequent pregnancies. The women had gone to considerable efforts to obtain an induced abortion. These included the inconvenience of going to a doctor in the main town (40 miles away) and incurring travel costs as well as the cost of the operation, which is currently about 10,000 drachmas. Few women (36%) were using any contraceptive method. The 36% included 27% who used condoms and coitus interruptus, 7% the rhythm method, and 2% all 3 methods. Only a few of the more educated women had heard or read about other methods. All of the women were concerned about the risk of becoming pregnant when they used no method or a risky method. In Greece induced abortion is clearly a response to unwanted pregnancies, which follow the lack of family planning or birth spacing services. The government introduced legislation concerning the provision of family planning services in 1980, but the provision of these services has been very slow. Currently, only a few family planning clinics are operational and mainly in the large cities. 1 way to make some progress may be to develop interest in the provision of more appropriate primary health care and more appropriate training of doctors and other health workers. There are few experienced doctors practicing in rural Greece at this time. The key person for providing family planning care could be the rural midwife who is already a respected provider of family advice in the community. Needed is an active program to expand the provision of family planning services to the rural areas of Greece. Contraceptive services must be provided to enable people to limit the size of their family to the size they want without having to resort to abortion. It is time for health care providers to stop saying that what is needed is family planning education and to start providing the actual services.     

Explanations of unmet need for contraception in Chitwan, Nepal

This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use; poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey.     

Exploring the pathways of unsafe abortion in Madhya Pradesh,India

Abstract

Nearly 40 years after enactment of the Medical Termination of Pregnancy Act of 1971, unsafe abortion continues to be a neglected women's health issue in India. This prospective study of women presenting for post-abortion care in 10 selected hospitals in Madhya Pradesh, India, aimed to understand the incidence, types and severity of post-abortion complications, probable causes of complications and consequences to women in terms of hospitalisation and incurred costs. Among 1565 women presenting for induced abortion-related services between July and November 2007, 381 women with post-abortion complications consented to participate. Data reveal a high prevalence of post-abortion complications (29%). Approximately half of women originally attempted to induce abortion at home using medication, home-made concoctions or traditional methods. Ninety percent sought care from either qualified (37%) or unqualified providers. More than half of the women were hospitalised as a result of post-abortion complications. This study suggests that supporting access to safely induced abortion services and improving community awareness on legal aspects, safe methods and approved providers are all necessary to reduce morbidity associated with unsafe abortion.     

Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya

This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10-18 years reported having used contraception, as compared to 60% of clients aged 27-46 years. After the abortion and family planning counselling session, only 6% of clients aged 10-18 chose a method, as compared to 96% of clients aged 27-46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.     

Exploring pregnancy termination experiences and needs among Malaysian women: A qualitative study

ABSTRACT: BACKGROUND: Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. METHODS: Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women's experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. RESULTS: Thirty-one women, with ages ranging from 21--43 years (mean 30.16 +/-6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2--8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband's agreement. In terms of the women's needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. CONCLUSIONS: The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.