To examine trends in pregnancy and abortion rates observed in Portugal in the last decade.
We abstracted all delivery and abortionrelated-admissions to Portuguese public hospitals (2000–2010) using a nationwide inpatient database(corresponding to nearly 96% of all deliveries). We
computed age-specific pregnancy and termination of pregnancy rates (all and induced abortion)considering the age groups less than 15, 15–19, 20–34, 35–39 and more than 39 years, using national population estimates as denominator. Joinpoint regression was used to estimate average
annual percent change (AAPC) in rates and to
identify points in time when significant changes in trend occurred.
Youngest teenager pregnancy rates (less than 15 yrs.)decreased significantly from 0.6 to 0.3 per 1000 women (AAPC=-4.9%; p=0.01) with a non-significant decrease
in abortion rates (AAPC=-4.1%; p=0.100). Pregnancy and abortion rates per 1000 15–19 year old girls, showed no significant variation up to 2003 (AAPC=-1.8%;p=0.071 for pregnancy and AAPC=2.5%; p=0.449 for abortion). Then, a significant decrease was
observed either in pregnancy (from 20.1 to 14.6; AAPC=-5.2%; p<0.001) and in abortion rates (from 2.5 to 1.5; AAPC =-8.2%; p<0.001). Pregnancy rates per 1000 women aged 20–34 decreased from 78.1 to
66.5. It corresponded to a significant decline up to 2004 (AAPC=-3.1%; p=0.020) but a stable course onwards (AAPC=-0.6%; p=0.389). Abortion rates in this age
group steadily decreased from 7.7 to 5.5 per 1000 women (AAPC=-3.24%; p<0.001). In contrast...
Kernels at the ear tip of field grown maize (Zea mays L.) often abort during flowering, resulting in significant yield loss. The objective of this study was to determine if abortion is initiated by an inadequate supply of carbohydrates for growth of ear tip kernels, and/or by a hormonal signal. Field grown maize plants were either unshaded or shaded during flowering to increase kernel abortion. Nonstructural carbohydrates, indoleacetic acid (IAA), abscisic acid (ABA), and cytokinins were measured in aborting and nonaborting kernels, before and after abortion occurred. Kernel abortion was initiated 8 days after anthesis (DAA) and was complete by 12 DAA, when kernels ceased dry weight accumulation. Concentrations of reducing sugars, sucrose, and starch in aborting kernels were not significantly different from those in nonaborting kernels up to 12 DAA. Also, total carbohydrate concentrations were higher in the cob of aborting than of nonaborting kernels from 8 to 26 DAA. These data suggest that kernel abortion is not initiated by an inadequate supply of carbohydrates. However, accumulation of reducing sugars in the cob of aborting kernels suggests that transfer of sugars from cob to kernels is impaired early in the abortion process. Differences in IAA...
OBJECTIVE: To assess interregional differences in the utilization of abortion services in Ontario from 1985 to 1992. DESIGN: Retrospective analysis of provincial therapeutic abortion database. SETTING: All hospitals conducting abortions between 1985 and 1992 and all free-standing abortion clinics conducting abortions between 1990 and 1992. POPULATION: All women in Ontario aged 15 to 44 years who underwent a therapeutic abortion in Ontario during the study period. OUTCOME MEASURES: Utilization of abortion services by county and age-specific abortion rates by county of residence. RESULTS: From 1985 to 1989, when only hospital data were gathered, the mean therapeutic abortion rate increased by 11.2%. From 1990 to 1992, when data from hospitals and free-standing clinics were collected, the mean rate increased by 26.5%. Logistic regression analysis showed significant variation in the age-standardized abortion rates between counties in each study year (p < 0.0001). The counties with age-standardized rates below the 25th percentile had the highest proportions of women who sought abortion services outside their county of residence; in some of these counties no abortions were performed in local facilities. CONCLUSION: There are interregional variations in the utilization of abortion services in Ontario. These disparities raise questions about the accessibility of abortion services and need to be further investigated.
In a previous study in France, we reported that the relative risk of breast cancer associated with a family history of breast cancer was higher in those subjects with a history of abortions. The present study was undertaken to check the existence of this interaction in other studies and to investigate whether the interaction is modified by the time at which abortions occur. Data were obtained from six case-control studies in France, Australia and Russia, with information on family history of breast cancer and abortion for 2693 breast cancer cases and 3493 controls. The interaction effect was estimated in each study separately, then combined using a multivariate weighted average. The relative risk conferred by a family history of breast cancer increased with the number of abortions (1.8 for no abortion, 1.9 for one abortion, 2.8 for two or more). There was a significant interaction between total number of abortions and family history (P = 0.04), but this was no longer significant when adjusted for other risk factors. The familial risk was highest for those who had had an abortion before first childbirth (1.9 for abortion after first childbirth, 2.7 for abortion before first childbirth). The adjusted risk associated with family history was significantly higher in those with an abortion before first childbirth (P = 0.04). Our findings suggest a synergism between familial factors and abortion. The interaction was not substantially modified by the type of abortion (spontaneous or induced) but was modified by the time at which it occurred in relation to first childbirth. This suggests an effect of abortion itself rather than predisposition to abortion. Further studies of breast cancer cases...
In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100...
Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers...
The report consists of three parts:
global trends in fertility, contraceptive use and unintended
pregnancies; studies of two regions (Africa and Eastern
Europe/Central Asia) and two countries (Nigeria and
Kazakhstan) on the costs of fertility regulation behaviors
and provider attitudes towards contraceptive use. Fertility
levels have declined steadily over the last three decades
but the pace of decline varies among regions. Countries that
have achieved a high level of contraceptive use have reached
a lower fertility level. A gap continues to exist between
actual and desired family size, resulting in unintended
pregnancies. More than one-third of the pregnancies that
occur are unintended and one in five pregnancies ends in
induced abortion. Almost half of all induced abortions are
unsafe, and the proportion of all abortions that are unsafe
have increased during the last decade. Sixty-six percent of
unintended pregnancies occur among women who are not using
any method of contraception. Investing in quality family
planning programs is a cost-effective way to address unmet
need for contraception and reduce the risks of unsafe
This study examines fertility regulation
in Kazakhstan, with dual emphases on providers'
attitudes toward abortion and the public financial costs of
abortion provision. Though abortion incidence declined
sharply in the 1990s in Eastern European countries and in
the former Soviet republics, it stagnated at relatively high
levels in the early 2000s, accounting for a substantial
proportion of gynecological morbidity and maternal
mortality. Limited literature is available on the role of
health service providers' attitudes that may encourage
or discourage abortion culture. Additionally, most studies
examine abortion incidence from the perspective of its
impact on women's health, while the issue of the public
financial burden imposed by the provision of services for
"avoidable" abortions remains unexplored. This
study sheds lights on these two areas by conducting a
two-part field survey in Kazakhstan. Three-stage stratified
sampling was used to select 126 providers from 52 health
facilities from four oblasts and two major cities (Almaty
and Astana) at different administrative levels to assess
providers' attitudes and perceptions; and to analyze
the public costs of providing abortion and family planning
services. Findings from the provider survey suggest that
providers' biases towards certain contraceptive
methods-partly attributable to their lack of training in
alternative methods-lead them to limit the choice of
contraceptive methods on offer...
OBJECTIVES: Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive prevalence and unsafe abortion in developing regions with different levels of fertility. These relationships manifest the extent to which the desire to regulate fertility is addressed by contraception or by unsafe abortion, where access to safe abortion is legally restricted. METHODS: Secondary analysis of estimates of unsafe abortion, total fertility rate and contraceptive prevalence, by geographical regions. RESULTS: High levels of unsafe abortion persist even where contraceptive prevalence is increasing and fertility is declining. It appears that a high dependence on sterilization for limiting family size may by be preceded by reliance on unsafe abortion, where abortion is restricted, for birth spacing. CONCLUSIONS: The reliance on unsafe abortion could be reduced during fertility transition by improving women's access to reversible contraceptives for spacing births as well as to sterilization for terminating childbearing. Expanding contraceptive choices and a balanced method mix can serve as an effective strategy to prevent unsafe abortion where reliance on sterilization to limit childbearing is not preceded by the use of reversible modern methods for spacing and where access to safe abortion is restricted by law. The intriguing association between contraceptive method choice and the incidence of unsafe abortion deserves further exploration.
Introdução: O aborto inseguro corresponde a uma das principais causas de mortalidade materna no mundo. Na última década, o acesso a métodos seguros para o aborto, principalmente o misoprostol, tem contribuído para um declínio nos relatos de morbidade relacionada ao aborto. Na cidade de Campinas, a mortalidade materna por aborto, que era uma das primeiras causas de morte na década passada, parece ter-se reduzido consideravelmente. Esses dados podem refletir o maior uso de misoprostol pelas mulheres que optam por induzir o aborto. Objetivos: Verificar a proporção de abortos induzidos com misoprostol e outros métodos, e comparar as complicações observadas. Sujeitos e Métodos: De julho de 2008 a abril de 2009 as mulheres internadas com diagnóstico de aborto em dois hospitais de Campinas foram entrevistadas e submetidas a uma lista de verificação que continha os critérios da OMS para a classificação de abortos induzidos. De acordo com estes critérios, as mulheres foram classificadas como abortos possivelmente, provavelmente e certamente induzidos; as mulheres que não apresentaram qualquer um dos critérios foram classificadas como abortos espontâneos. As pacientes classificadas como aborto possível, provável ou certamente provocado...
Tese (doutorado)—Universidade de Brasília, Instituto de Ciência Política, Programa de Pós-Graduação em Ciência Política, 2014.; A questão central dessa tese tem origem no questionamento sobre como e por que o aborto tornou-se central na disputa entre os candidatos à Presidência no segundo turno das eleições de 2010. O estudo pretende demonstrar como se deu a competição entre os atores do campo político, religioso e jornalístico que determinaram a definição da temática sobre o aborto como a agenda central da cobertura eleitoral no segundo turno de 2010. A partir da análise dos textos noticiosos e de opinião publicados nos jornais O Globo, Folha de S.Paulo e O Estado de S. Paulo no período entre 11 de julho e 31 de outubro de 2010, pretende-se observar o mecanismo de agenda-setting e a complexidade da produção da agenda numa perspectiva que avance na compreensão de como se dá a construção do noticiário, sobretudo político, entendendo seu resultado como parte de tensões e interações, disputas e arranjos entre diferentes forças que competem entre si e com o campo jornalístico. A metodologia utilizada foi a análise qualitativa e quantitativa dos dados a partir da seleção de todos os textos em que a palavra “aborto” foi citada no período analisado...
STUDY OBJECTIVE: To ascertain, from the published reports to date, whether or not a significantly increased risk of breast cancer is specifically attributable to a history of induced abortion, independent of spontaneous abortion and age at first full term pregnancy (or first live birth); to establish the relative magnitude of such risk increase as may be found, and to ascertain and quantify such risk increases as may pertain to particular subpopulations of women exposed to induced abortion; in particular, nulliparous women and parous women exposed before compared with after the first full term pregnancy. INCLUDED STUDIES: The meta-analysis includes all 28 published reports which include specific data on induced abortion and breast cancer incidence. Since some study data are presented in more than one report, the 28 reports were determined to constitute 23 independent studies. Overall induced abortion odds ratios and odds ratios for the different subpopulations were calculated using an average weighted according to the inverse of the variance. An overall unweighted average was also computed for comparison. No quality criteria were imposed, but a narrative review of all included studies is presented for the reader's use in assessing the quality of individual studies. EXCLUDED STUDIES: All 33 published reports including data on abortion and breast cancer incidence but either pertaining only to spontaneous abortion or to abortion without specification as to whether it was induced or spontaneous. These studies are listed for the reader's information. RESULTS: The overall odds ratio (for any induced abortion exposure; n = 21 studies) was 1.3 (95% confidence interval of 1.2...
Spontaneous abortion is rarely addressed in moral evaluations of abortion. Indeed, 'abortion' is virtually always taken to mean only induced abortion. After a brief review of medical aspects of spontaneous abortion, I attempt to articulate the moral implications of spontaneous abortion for the two poles of the abortion debate, the strong pro-abortion and the strong anti-abortion positions. I claim that spontaneous abortion has no moral relevance for strict pro-abortion positions but that the high incidence of spontaneous abortion is not (as some claim) eo ipso any sort of justification for voluntarily induced abortion. Secondly, I show that if the strict anti-abortionist position is to be taken seriously in its insistence that prenatal life has a right to be protected by virtue of its being conceived, then it seems necessary to take measures to prevent spontaneous abortion and its presumptive causes, and this as a matter of moral obligation.
OBJECTIVE: To identify factors associated with increased risk of immediate complications from induced abortion. DESIGN: Retrospective analysis of a provincial database. SETTING: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. POPULATION: Women in Ontario aged 15 to 44 years who underwent an induced abortion in the province (without concurrent sterilization) between Jan. 1, 1992, and Dec. 31, 1993. OUTCOME MEASURES: Recording of complications at the time of the procedure, gestational age, type of procedure, place of abortion (hospital or clinic), and patient's age, parity and history of previous abortion (spontaneous or induced). RESULTS: During the study period 83 469 abortions were performed that met our inclusion criteria. Immediate complications were reported in 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient's age, parity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications; however, gestational age, method of abortion and place of abortion were significant risk factors (p < 0.001). The odds ratio (OR) for having a complication from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks...
OBJECTIVE: To describe women's attitudes and predicted behaviour regarding the potential for fetal tissue transplantation (FTT) to influence abortion decisions. DESIGNS: Self-administered questionnaire survey by mail. SETTING: Academic family practice in Toronto. PARTICIPANTS: Random sample of 475 women 18 to 40 years of age selected from the family practice registry of an urban teaching hospital. Family physicians were blind to their patients' participation, and investigators were blind to the subjects' identity. Forty questionnaires were undeliverable. Of the remaining 435, 272 (62.5%) were completed. Six of the women were over 40 years of age or did not indicate their age and were excluded, which left 266 (61.1%) questionnaires for analysis. OUTCOME MEASURES: Number of women who would (a) be more likely to have an abortion if they could donate tissue for FTT and (b) feel better or worse about choosing abortion if FTT were an option, and open-ended comments about the potential for FTT to influence abortion decisions. RESULTS: Of the 266 respondents 32 (12.0%) reported that they would be more likely to have an abortion if they could donate tissue for FTT, 178 (66.9%) stated that they would not be more likely to do so, and 56 (21.1%) were uncertain. Of the 122 who indicated that they would consider an abortion if they were pregnant...
Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.
Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g.: hospital fees). This paper estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n=112) with women who had an abortion. Three treatment routes are identified: i) safe abortion at the hospital ii) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and iii) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample.
Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions...
Fonte: SAMJ: South African Medical JournalPublicador: SAMJ: South African Medical Journal
Tipo: Artigo de Revista CientíficaFormato: text/html
Publicado em 01/04/2014EN
Relevância na Pesquisa
BACKGROUND: Despite South Africa's liberal abortion law permitting abortion on request in the first trimester and under restricted conditions for second-trimester pregnancies, the practice of unsafe self-induced abortion persists. However, the prevalence of this practice, the methods used and the reasons behind it are relatively under-researched. As part of a larger study seeking to improve abortion services in the Western Cape Province, we explored reports of prior attempts to self-induce abortion among women undergoing legal second-trimester abortion. OBJECTIVE: To describe the prevalence and methods of and factors related to unsuccessful attempts at self-induction of abortion by women presenting without complications and seeking second-trimester abortion at public health facilities in the Western Cape. METHODS: In a cross-sectional study from April to August 2010, 194 consenting women undergoing second-trimester abortion were interviewed by trained fieldworkers using structured questionnaires at four public sector facilities near Cape Town. RESULTS: Thirty-four women (17.5%; 95% confidence interval 12.7 - 23.4) reported an unsuccessful attempt to self-induce abortion during the current pregnancy before going to a facility for second-trimester abortion. No factors were significantly associated with self-induction...
Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition...
Fonte: World Health OrganizationPublicador: World Health Organization
Tipo: Artigo de Revista CientíficaFormato: text/html
Publicado em 01/05/2011EN
Relevância na Pesquisa
OBJECTIVE: To compare medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. METHODS: A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Popline were searched. Failure to abort completely, side-effects and acceptability were the main outcomes of interest. Odds ratios and their 95% confidence intervals (CIs) were calculated. Estimates were pooled using a random-effects model. FINDINGS: Nine studies met the inclusion criteria (n = 4522 participants). All were prospective cohort studies that used mifepristone and misoprostol to induce abortion. Complete abortion was achieved by 86-97% of the women who underwent home-based abortion (n = 3478) and by 80-99% of those who underwent clinic-based abortion (n = 1044). Pooled analyses from all studies revealed no difference in complete abortion rates between groups (odds ratio = 0.8; 95% CI: 0.5-1.5). Serious complications from abortion were rare. Pain and vomiting lasted 0.3 days longer among women who took misoprostol at home rather than in clinic. Women who chose home-based medical abortion were more likely to be satisfied...