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。     

Post-diagnostic abortion in Germany: reproduction gone awry,again?

Routine use of prenatal diagnostic technologies (PDTs) such as ultrasound and amniocentesis result in the detection of a small percentage of fetal anomalies. For those women faced with the diagnosis of fetal disability, a decision must be made to continue or terminate the pregnancy. When the diagnosis is merely hypothetical, the discursive specter of post-diagnostic abortion is shaped by social and historical contexts in which interested discourses (regional, political, ethical, and religious) weigh in with varying degrees of authority and influence. However, when the diagnosis is actual, in this sample population of women, an estimated minimum of 90% opt to terminate their pregnancies. Data collected at two German hospitals-one in former East Germany, one in former West Germany-illuminate rates of PDT use and provide data with which to discuss the specter of post-diagnostic abortion in relation to mainstream medical discourses, Germany's divided history, abortion politics, feminism, disability activism, and religion. These data demonstrate how reproductive discourses are shaped by ideological and historical contingencies, even when women's ultimate reproductive decisions are not.     

The influence of significant others on Australian teenagers' decisions about pregnancy resolution

CONTEXT: Teenagers' decisions about how to resolve a pregnancy are made in the context of a society, a family and a relationship with a partner. Little is known about how such decisions are made, however, particularly in Australia. METHODS: The association between the influence--both direct and indirect--of significant others and adolescent women's decisions to terminate or continue a pregnancy is examined here using data from a case-control study on 1,324 pregnant teenagers in Australia. Bivariate analyses were used to explore the association between pregnancy resolution and direct or indirect influence toward abortion or birth. Multivariate logistic regression analyses were used to model the association between significant others' influence and teenagers'pregnancy resolution decisions while controlling for adolescent women's background characteristics. RESULTS: Teenagers who reported that their partner influenced them toward abortion had significantly increased odds of choosing abortion (10.4), and those whose partner influenced them toward motherhood had significantly reduced odds of choosing abortion (0.5). Direct influence from parents toward either abortion or motherhood was not significantly associated with teenagers' decisions. Mothers are an important source of indirect influence, however: Teenagers whose mother had become a mother as a teenager had reduced odds of choosing abortion (0.4), and those whose mother had ever had an abortion had increased odds of choosing abortion (2. 1). Teenagers who had a sister who had ever had an abortion had significantly increased odds of choosing abortion (2.4). CONCLUSION: While most young women report they were not directly influenced by a significant other in their decision to continue or terminate a pregnancy, pregnancy resolution decisions are affected by families and partners, often indirectly. These findings have important implications for the manner in which services are delivered to these young women.     

Conditions for choosing between drug-induced and surgical abortions

In France, pregnant women with amenorrhoea of no more than 49 days intending to terminate pregnancy can choose between a surgical abortion via vacuum aspiration under local or general anesthesia and a drug method combining Mifepristone orally administered (RU 486^o), with a prostaglandin analogue. This prospective survey was conducted to study the conditions under which women choose their abortion method, and to evaluate the acceptability of each method after the abortion. The data gathered from 488 women were analyzed according to their initial decision, and then according to the method actually used. The majority (62%) chose RU 486.

The women's choice was found to be linked to sociodemographic characteristics such as age, education, occupation, geographic origin, and certain attitudes towards pregnancy, as well as to the individual criteria of each method. The women who chose the drug protocol had most often already made their decision before going to the family planning center (68%), having been advised by their doctor (20%). They were slightly less satisfied with the abortion experience than they had expected: 12.4% were unsatisfied in the RU group and 3.6% in the aspiration group. They needed more rest and quiet afterwards (50%) than the other women. They were distinguished by their desire to verify the expulsion (63%).

The length of pregnancy is therefore not the only criterion to be considered when recommending one or other of these methods: the women concerned have different requirements and should have several possibilities to choose from.     

Roles of pharmacists in expanding access to safe and effective medical abortion in developing countries: a review of the literature

Unsafe abortion continues to be a major contributor to maternal mortality and morbidity around the world. This article examines the role of pharmacists in expanding women's access to safe medical abortion in Latin America, Africa, and Asia. Available research shows that although pharmacists and pharmacy workers often sell abortion medications to women, accurate information about how to use the medications safely and effectively is rarely offered. No publication covered effective interventions by pharmacists to expand access to medical abortion, but lessons can be learned from successful interventions with other reproductive health services. To better serve women, increasing awareness and improving training for pharmacists and pharmacy workers about unsafe abortion - and medications that can safely induce abortion - are needed.     

"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities

CONTEXT: Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased. A better understanding of the interaction between HIV and family planning is needed, especially as antiretroviral medications allow HIV-positive women to live longer, healthier lives. METHODS: Qualitative methods were used to examine pregnancy decision-making among 56 HIV-positive women in four U.S. cities. Biomedical, individual and sociocultural themes were analyzed in groups of women, categorized by their pregnancy experiences and intentions. RESULTS: Regardless of women's pregnancy experiences or intentions, reproductive decision-making themes included the perceived risk of vertical transmission, which was often overestimated; beliefs about vertical transmission risk reduction strategies; desire for motherhood; stigma; religious values; attitudes of partners and health care providers; and the impact of the mother's health and longevity on the child. Most women who did not want children after their diagnosis cited vertical transmission risk as the reason, and most of these women already had children. Those who became pregnant or desired children after their diagnosis seemed more confident in the efficacy of risk reduction strategies and often did not already have children. CONCLUSIONS: Future studies may help clarify the relationship between factors that influence pregnancy decision-making among HIV-positive women. HIV-positive and at-risk women of childbearing age may benefit from counseling interventions sensitive to factors that influence infected women's pregnancy decisions.     

God-sent ordeals and their discontents: ultra-orthodox Jewish women negotiate prenatal testing

Through narrative interviews with 20 pregnant ultra-orthodox [Haredi] Jewish women in Israel conducted between 2007 and 2009, we examine the implications for such women of prenatal testing, and of pregnancy as a gendered route of piety. We found that pregnancy signified both a divine mission and possible reproductive misfortunes. Bearing a child with a disability was taken as a test of faith and God's decree was to be accepted. Fetal anomaly created anxiety about the women's ability to fulfill their God-given task and about their position in an unwritten hierarchy of gendered righteousness. Challenging reproductive decisions were often assigned to rabbis, but this did not exempt women from viewing themselves as inadequate in their religious devotion. We conclude that prenatal testing becomes a spiritual ordeal that aggravates pregnancy tensions.     

Women's life cycle and abortion decision in unintended pregnancies

OBJECTIVE: To study the impact of sociodemographic, financial, and reproductive factors and of characteristics related to intimate relationships on the decisions of women in different age groups about whether or not to continue an unintended pregnancy. DESIGN: Cross sectional population based survey. SETTING: Telephone interview survey between September 2000 and January 2001 in France. From a representative sample (n=14704) of 18 to 44 year old women, those who in the past five years had an abortion or whose last pregnancy was unintended were oversampled (sampling fraction=100%, n=1034) while the other women were randomly selected (sampling fraction =19%, n=1829). Altogether, 2863 women answered the questionnaire. PARTICIPANTS: All women whose last pregnancy was unintended and ended in induced abortion or birth (n=645). Main results: Factors associated with the abortion decision varied strongly according to age. Younger women's abortion decisions were mainly related to being a student and being single. Wanting to stop childbearing when the desired number of children was achieved best explained the decision to have an abortion among 25 to 34 year old women. Older women chose abortion especially when childbearing did not fit their work situation or when the relationship with the partner was unstable. A high level of education of a woman and her partner increased the likelihood of abortion, especially among young women. CONCLUSIONS: The impact of socioeconomic and relationship factors on the decision to have an abortion is not the same at different stages in life, and refers to the social representations and perceptions of what good conditions are for being a mother.     

Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa

BACKGROUND AND METHODOLOGY: South Africa's Choice on Termination of Pregnancy Act of 1996 provides for safe termination of pregnancy (TOP) in designated facilities in the public and private health sectors. In 2001, mifepristone-misoprostol medical abortion was approved for TOP up to 56 days, but this method is not yet available in the public sector. Information on the operational requirements for integrating mifepristone-misoprostol medical abortion into South Africa's public sector safe abortion services is required to guide policy decisions. This study trained health workers to provide medical abortion to 290 women attending three TOP sites. Prospective data were collected to ascertain women's experience of the method, pregnancy outcome, women's and provider's acceptability of the method, and the operational requirements for providing medical abortion. RESULTS: Twenty-nine (10%) women were lost to follow-up; 261 (90%) women had a confirmed abortion outcome, of whom 93% had a complete abortion. Given the option, the vast majority of women opted to use misoprostol at home. No serious side effects were reported; pain (66%), and heavy bleeding (67%) were the most common side effects. Most (96%) women were very satisfied with the experience. Health providers were satisfied with providing medical abortion and recommended its introduction to complement existing surgical TOP services. DISCUSSION AND CONCLUSION: This study demonstrates that integration of medical abortion into public sector services is feasible. The results of this study will guide policy decisions about integrating medical abortion into South Africa's public sector safe abortion services, within the context of the existing enabling legislative framework.     

The delivery of medical abortion services: the views of experienced providers.

This study examined beliefs about the delivery of medical abortion services and current roles of 76 providers of methotrexate-induced abortion. The sample included physicians, midlevel professionals, administrators, and counselors/other medical staff. Over 75% of participants believed that, given proper training and emergency backup, physicians and midlevel clinicians alike could provide medical abortions. Over 85% agreed that methotrexate-induced abortions could be provided in any physician's office or medical facility. There were no differences in perceptions by participant group. Involvement of midlevel providers in provision of medical abortion could potentially increase access and options for women seeking to terminate an early pregnancy.     

Medical abortion in family practice: a case series

BACKGROUND: We wanted to determine the outcomes of medical abortions in four family practice centers. METHODS: This study was a retrospective case series of consecutive medical abortions in four community health centers between November 2000 and April 2002. We defined a successful medical abortion as one that required no further intervention after the administration of the medications mifepristone and misoprostol. The subset of abortions in patients who had suction procedures were called failures. RESULTS: In this series of 236 abortions, only 1 woman had a viable pregnancy after taking the medication as directed, and she had an elective suction procedure to terminate the pregnancy. None of the patients under the complete care of family physicians received suction procedures for other indications. Two patients underwent suction procedures at other institutions for unknown indications. Eight were lost to follow-up. One did not adhere to the protocol and so was excluded from the data analysis. The failure rate of the protocol for patients cared for by the family physicians at follow-up was 0.4%. CONCLUSIONS: Medical abortion in a family practice setting is a safe and effective procedure. If practiced widely, it could make abortion care much more accessible to women.     

"There is such a thing as too many daughters, but not too many sons": A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States

In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women's narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women's early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive "choice." We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion.     

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.     

Assertiveness with physicians is related to women's perceived roles in the medical encounter

Women's self-reported assertiveness with their healthcare providers is associated with their use of cancer screening. Women who report repeating information when they feel their doctors did not hear them, asking their doctors to explain information they do not understand, or reminding their doctors about screening tests, are more likely to receive mammograms than those who report using these assertive behaviors less often. In this study, we examined women's beliefs about their role in medical encounters with their physicians and their use of assertive behaviors, in a convenience sample of 136 women receiving care at an ultrasound clinic for reasons other than pregnancy. We found that women who behaved assertively were more likely to view physicians as advisors to them in their health care and less likely to view their physicians as experts. Data are also presented on the development of a scale designed to assess assertiveness with physicians for use in studies of medical care.     

Modeling the process leading to abortion: an application to French survey data

In this study, we model women's recourse to induced abortion as resulting from a process that starts with sexual intercourse and contraceptive use (or nonuse), continues with the occurrence of an unintended pregnancy, and ends with the woman's decision to terminate the pregnancy and her access to abortion services. Our model includes two often-neglected proximate determinants of abortion: sexual practices and access to abortion services. We relate three sociodemographic characteristics--women's educational level, their relationship status, and their age--step by step to the stages of the abortion process. We apply our framework using data from the COCON survey, a national survey on reproductive health conducted in France in 2000. Our model shows that sociodemographic variables may have opposite impacts as the abortion process unfolds. For example, women's educational level can be positively linked to the probability of practicing contraception but negatively linked to the propensity to carry the unintended pregnancy to term. This conceptual framework brings together knowledge that is currently dispersed in the literature and helps to identify the source of abortion-rate differentials.     

Abortion among young women and subsequent life outcomes

CONTEXT: Young women frequently cite concerns about the effects of unplanned pregnancies on future life course outcomes, including education, employment and relationships, as reasons for seeking abortion. There is relatively little evidence as to whether abortion leads to improved life course outcomes for young women who choose this option. METHODS: Data from 492 women participating in a 25-year longitudinal study of a New Zealand birth cohort were used in regression models that examined the relationship between pregnancy and abortion history prior to age 21 and selected social and economic outcomes at ages 21-25. RESULTS: Compared with young women who became pregnant before age 21 but did not seek an abortion, young women who had an abortion had significantly better outcomes on six out of 10 measures spanning education, income, welfare dependence and domestic violence. Adjustment for confounding factors indicated that most of these differences were explained by family, social and educational characteristics that were present prior to pregnancy. Nonetheless, even after adjustment for confounding factors, young women who had abortions had higher levels of subsequent educational achievement than those who became pregnant but did not have abortions. CONCLUSIONS: Abortion may mitigate some effects of early unplanned pregnancy. However, further study of its potential risks and benefits is needed so that women can make fully informed decisions as to whether to terminate unintended pregnancies.     

The ideological and technological shaping of motherhood.

Women's medical care, especially the care of birthing women, is increasingly based on technological innovations. While the use of electronic fetal monitoring, in vitro fertilization and cesarean section have benefited some women, the expanding use of medical technology distances women and their physicians. The problem is compounded because the application of medical technology is often clouded by a gender based ideology that defines women as mere reproductive beings. Forgotten is the recognition that the "facts" and interpretations generated by medical advance are subject to the same ideological bias as traditional beliefs and understandings about women. Forgotten is the women, the person, in the body. By seeing, hearing, touching and talking with women, physicians, not technological feats, provide a foundation for women's health based on the mutual interaction, understanding and respect between women and their physicians.     

Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk

Despite high infant and maternal mortality rates, many Mozambican women with access to prenatal services delay prenatal clinic consultations, limiting opportunity for prevention and treatment of preventable pregnancy complications. Ethnographic research, interviews with health providers and longitudinal pregnancy case studies with 83 women were conducted in Central Mozambique to examine pregnant women's underutilization of clinic-based prenatal services. The study found that pregnancy beliefs and prenatal practices reflect women's attempts to influence reproduction under conditions of vulnerability at multiple levels. Women reported high maternal reproductive morbidity, frequent pregnancy wastage, and immense pressure to bear children throughout their reproductive years. Reproductive vulnerability is intensified by poverty and an intense burden placed on poor, peri-urban women farmers for family subsistence and continuous fertility in a period of economic austerity, land shortages, and increasing social conflict and inequality. In this environment of economic insecurity exacerbated by congested living conditions, women report competing for scarce resources, including male support and income. This vulnerability heightens women's perceptions that they and their unborn infants will be targets of witchcraft or sorcery by jealous neighbors and kin. They respond by hiding pregnancy and delaying prenatal care. Within the context of women's perceived reproductive risks, delayed prenatal care can be seen as a strategy to protect pregnancy from purposeful human and spirit harm. Women mobilized limited resources to acquire prenatal care outside the formal clinic setting. It is concluded that provision of clinical prenatal services is insufficient to reduce reproductive risks for the most socially and economically marginal since it is their vulnerability that prevents women from using available services. Confidential maternity services and social safety nets for greater economic security are recommended.     

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.