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.     

Induced abortion in a rural area of Bangladesh

Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.     

Trends in rates of live births and abortions following state restrictions on public funding of abortion

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.     

Correcting spontaneous abortion rates for the presence of induced abortion.

This paper introduces a method for correcting spontaneous abortion rates by taking into consideration the fact that a number of spontaneous abortions are "prevented" by induced abortions. This correction may be important in settings of high induced abortion incidence. The method is then applied to the data of the Italian region of Lombardy. The results obtained are compared to those obtained with previous correction methods, and it is concluded that the present method is useful and appropriate when data on induced and spontaneous abortions are available by gestational age.     

Subfertility and risk of spontaneous abortion

OBJECTIVES: The purpose of this study was to assess the association between subfertility and spontaneous abortion. METHODS: A total of 1572 women in New York and Vermont reported 3269 pregnancies between 1980 and 1990 and were able to provide an estimate of the waiting time to conception for 2967. Subfertility was defined as a delay of 1 year or more before a recognized conception was achieved. Rates of spontaneous abortion were determined among women with and without subfertility, and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated via multiple logistic regression. RESULTS: Spontaneous abortion rates were 23.0% in pregnancies preceded by subfertility and 14.0% in pregnancies without impaired fertility (adjusted OR = 1.71, 95% CI = 1.26, 2.94). The attributable risk of spontaneous abortion associated with subfertility was 6.2%. CONCLUSIONS: Subfertile women evidence an increased number of spontaneous abortions.     

The effects of short-term variation in abortion funding on pregnancy outcomes.

The appropriations for North Carolina's abortion fund have proven inadequate during five of the years between 1980 and 1994. This on-again, off-again funding pattern provides a natural experiment for estimating the short-run effect of changes in the cost of abortions on the number of abortions to indigent women. Using an unusually detailed dataset, we estimate the effects of funding termination on the monthly abortion and birth rates. Overall, approximately one-third of pregnancies that would have resulted in an abortion, had state funds been available, are instead carried to term.     

Induced abortion and low birthweight in the following pregnancy

BACKGROUND: To examine whether induced abortion increases the risk of low birthweight in subsequent singleton live births. METHODS: Cohort study using the Danish Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the Induced Abortion Registry (IAR). All women who had their first pregnancy during 1980-1982 were identified in the MBR, the HDR, and the IAR. We included all 15,727 women whose pregnancy was terminated by a first trimester induced abortion in the induced abortion cohort and 46,026 women whose pregnancy was not terminated by an induced abortion were selected for the control cohort. All subsequent pregnancies until 1994 were identified by register record linkage. RESULTS: Low birthweight (<2500 g) in singleton term live births occurred more frequently in women with one, two, three or more previous induced abortions, compared with women without any previous induced abortion of similar gravidity, 2.2% versus 1.5%, 2.4% versus 1.7%, and 1.8% versus 1.6%, respectively. Adjusting for maternal age and residence at time of pregnancy, interpregnancy interval, gender of newborn, number of previous spontaneous abortions and number of previous low birthweight infants (control cohort only), the odds ratios (OR) of low birthweight in singleton term live births in women with one, two or more previous first trimester induced abortions were 1.9 (95% CI: 1.6, 2.3), and 1.9 (95% CI: 1.3, 2.7), respectively, compared with the control cohort of similar gravidity. High risks were mainly seen in women with an interpregnancy interval of more than 6 months. CONCLUSIONS: The findings suggest a positive association between one or more first trimester induced abortions and the risk of low birthweight in subsequent singleton term live births when the interpregnancy interval is longer than 6 months. This result was unexpected and confounding cannot be ruled out.     

Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria

This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.     

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.     

Highlights of trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

OBJECTIVES: This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics including age, race, Hispanic origin, and marital status. Summary data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity and contraceptive practices, as well as women's reports of pregnancy intentions. METHODS: Tabular and graphic data on pregnancy rates by demographic characteristics are presented and interpreted. Birth data are from the birth registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. RESULTS: In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.     

Legal abortion in Italy: 1980-1981

In 1980 and 1981, there were 446,430 legal abortions performed in Italy. There were about 345 legal abortions per 1,000 live births in 1980 and 363 in 1981. About 1.6 percent of women aged 15-49 obtained abortions in both years. An analysis of the characteristics of Italian women who obtained abortions indicates that most were married (about 70 percent), aged 18-36 (74 percent), had had less than a high school education (74 percent) and had had at least one previous live birth (70-75 percent). In 1981, 88 percent of abortions were obtained in public hospitals; 58 percent were carried out at eight or fewer weeks of gestation; and 78 percent were performed under general anesthesia. Only 20 percent were performed without an overnight stay in the hospital; and over 40 percent of women were hospitalized for two days or longer. Infection after the abortion was reported in only 0.03 percent of cases in 1981, and hemorrhage was reported in only 0.27 percent. In 1981, between 43 percent and 84 percent of gynecologists (depending on the region of the country) declined to perform abortions on grounds of conscience.     

The potential role of contraception in reducing abortion

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

A portrait of American women who obtain abortions

In 1981, as in 1980, most abortions in the United States were obtained by young women, unmarried women and white women, and were performed in the first eight weeks following the last menstrual period (approximately six weeks after conception). The proportion of abortions obtained by unmarried women has increased slightly, and the fraction obtained by teenagers has decreased, mainly because of shifts in the distribution of these groups in the population. The percentage of abortions that are repeat procedures has increased, representing more than one-third of all abortions. The increase is due largely to the rise in the number of women who have had a first abortion, and who are, therefore, exposed to the risk of having a second procedure. Eighty-five percent of all abortions are performed by vacuum aspiration. Dilatation and evacuation is the method used in two-thirds of abortions performed more than 12 weeks past the last menstrual period, and in nine out of 10 abortions that are performed between the 13th and the 15th week. About three percent of women aged 15-44 obtained abortions in 1981, and 26 percent of pregnancies were terminated by abortion--the same fractions as in 1980. About six percent of 18-19-year-olds had abortions--the highest rate of any age-group. The abortion rate (the number of abortions per 1,000 women aged 15-44) and ratio (the number of abortions per 100 live births and abortions) are much higher for unmarried than for married women.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of family planning and other factors on fertility,abortion, miscarriage,and stillbirths in the Spectrum model

Background

The Lives Saved Tool (LiST) estimates the effects of maternal and child health interventions on mortality rates and the number of deaths. The family planning module in Spectrum interacts with LiST by providing estimates of the effects of scaling up family planning use on the number of live births, miscarriages, abortions, and stillbirths.

Methods

We use the proximate determinants of fertility framework to estimate the effects of changes in contraceptive use, proportion married, postpartum insusceptibility, abortion and sterility on the total fertility rate. We extend this framework to estimate the number of intended and unintended pregnancies and the resulting live births, abortions, stillbirths, and miscarriages.

Results

We apply the model to four countries (Mali, Kenya, Indonesia, and Ukraine) to demonstrate possible trends with a range of family planning and fertility levels. In high-fertility countries, such as Mali, increases in contraceptive use will partially compensate for the increasing number of women of reproductive age to reduce the annual increases in pregnancies and births. Most unintended pregnancies occur to women defined as having unmet need for contraception. In low-fertility countries, increases in contraceptive use may reduce abortion rates and low levels of unmet need mean that most unintended pregnancies are due to method failure.

Conclusions

The family planning module in Spectrum provides a useful framework to incorporate changes in contraceptive practices and pregnancy outcomes in the LiST calculations of mortality rates and deaths.

     

The impact of U.S. family planning programs on births, abortions and miscarriages, 1970-1979

This paper estimates births (as well as total pregnancies, abortions and miscarriages) averted by program enrollment during the 1970s based not on the common assumption of constant program impact on birth rates, but on assumptions that take into account the changing use of abortion. Estimates of births averted from two national studies are translated into estimates of unintended pregnancies averted and projections of program impact throughout the decade are made assuming constant program impact on pregnancy rates. The number of pregnancies averted is broken into births, abortions and miscarriages averted based on actual distribution of those unintended pregnancies that did occur each year. This methodology is more appropriate to the United States or any other country during a time period when use of abortion has been changing. It also focuses attention on the fact that births averted reflect only part of the program's impact and that much of the program's effect is on averting abortions. During the decade, an estimated 5,434,000 unintended pregnancies were averted by enrollment in the family planning program. In 1979, 4,486,000 women were enrolled in family planning clinics. An estimated 792,000 unintended pregnancies were averted as a direct result, 1 for every 5.7 patients. The 274,000 averted births would have increased the number of births in 1980 in the U.S. from 3,598,000 to 3,872,000, an increase of 8%. The estimated 420,000 abortions averted would have increased abortions in the U.S. about 25% higher, to about 2,000,000.     

Abortion incidence and services in the United States in 2000

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996.
METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys.
RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15–44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.     

Second-trimester abortions in the United States

Late abortion remains a complex and difficult issue in the United States, where about 10 percent of all abortions are performed at 13 or more weeks' gestation. The reasons why women delay having abortions appear to be largely personal, and most are not amenable to public health intervention. Dilatation and evacuation (D&E) is the most frequently used method of second-trimester abortion, and the safest. Its greatest safety advantage lies in the 13-16-week-interval; for later abortions, D&E and instillation abortion have similar risks of complications and death. The rare instances in which an abortion procedure ends in a live birth represent the most controversial aspect of second-trimester abortion. However, trends toward abortions at earlier gestational ages, use of D&E and increased reliance on ultrasonography to confirm gestational age should reduce the frequency with which such events occur. Research in the area of midtrimester abortion should seek ways to reduce the need for such procedures, to improve their safety and to minimize the trauma of the experience for women.     

Induced abortion: trends in the tendency to repeat, Norway, 1972-1981

Through the 1970s the number of women who experienced an induced abortion increased in Norway. Thus, the population at risk for a repeat abortion has increased. The frequency of repeat abortions has doubled from 1972 to 1981. However, the annual frequency of observed repeat abortion has been below what could be expected according to contraceptive failure rates. There is no evidence that the liberalized abortion legislation has led to the use of induced abortion as a method of birth control. In order to improve fertility surveillance and to elucidate the epidemiology of induced abortion, there is a need for more detailed and individually based national registration of induced abortions as well as spontaneous abortions.     

Occupational paternal exposure to benzene and risk of spontaneous abortion.

OBJECTIVE--The purpose of this study was to evaluate the risk of spontaneous abortion among the wives of male workers occupationally exposed to benzene. METHODS--The wives of 823 men working in two chemical plants at the time of the study were asked to complete a questionnaire describing their pregnancies. The analysis of the 1739 pregnancies that ended in a spontaneous abortion or a birth is presented. The firms' payroll records provided all workers' employment history, including dates. Benzene exposure, graded at two levels (< 5, > or = 5 ppm), was determined for every job, so that benzene exposure for each worker's entire professional life (at these companies) could be assessed. This information was linked to the dates of the pregnancies reported in the questionnaires to enable the exposure status of each pregnancy to be defined (1270 non-exposed and 274 exposed). The frequency of spontaneous abortion, defined as the number of spontaneous abortions divided by the total of spontaneous abortions and births was evaluated. RESULTS--When adjusted for tobacco consumption, mother's age and pregnancy order, the odds ratio of the association between paternal exposure to approximately 5 ppm of benzene and the risk of spontaneous abortion was close to and statistically not different from unity (OR = 1.1; 95% CI (0.7-1.8). CONCLUSION--In this study paternal exposure to benzene did not increase the risk of spontaneous abortion.     

Spontaneous abortions and birth defects related to tap and bottled water use, San Jose, California, 1980-1985.

We recently studied pregnancies occurring during 1980-1985 in four study areas in Santa Clara County, California. Two of the areas were exposed to solvent-contaminated drinking water during 1980 and 1981, and two were unexposed. There was an overall excess of spontaneous abortions among women who reported any tapwater consumption during the first trimester of pregnancy compared with those who reported no tapwater consumption [odds ratio (OR) = 4.0; 95% confidence interval (CI) = 1.8-9.1)], regardless of exposure to the contaminated water. The odds ratio for spontaneous abortion for women reporting any vs no tapwater was 6.9 (95% CI = 2.7-17.7) after adjustment for numerous potential confounders using multiple logistic regression analyses. The elevated odds ratio of spontaneous abortion was seen among tapwater drinkers who used no filters or softener-type filters but not among women who reported use of active filters. Spontaneous abortion rates were reduced in women who reported any vs no bottled water consumption (OR = 0.26; 95% CI = 0.16-0.43). Among women who reported no tapwater consumption, no birth defects occurred among 263 live births; in comparison, among women who reported tapwater consumption, 4% of 908 live births had defects (P = 0.0001). We observed no relation between birth defects and bottled water use.