Abortion Methods Research Articles

Changes in abortion access after implementation of Medicaid coverage in Illinois: a retrospective analysis

IntroductionIn 2018, Illinois implemented House Bill 40 (HB-40), allowing state funds to provide Medicaid coverage for abortion. This study aimed to quantitatively measure changes in access among Illinois residents after...

Abortion methods: the pros and cons of medical and surgical termination of pregnancy

Abortion methods: the pros and cons of medical and surgical termination of pregnancy

Cultural Beliefs and Decision-making in Induced Abortion: Facilitator and Barriers to Safe Abortion Services in Rural Haryana, India – A Qualitative Study

Abstract Background: Abortion remains a sensitive topic in rural India, with cultural, social, and healthcare-related factors influencing access to safe abortion services. We conducted this qualitative study to explore the beliefs, practices, and decision-making pathway surrounding induced abortion and to identify the facilitators and barriers to availing safe abortion services. Materials and Methods: A qualitative study was conducted in a rural village in Haryana between July and September 2022. We conducted focus group discussions with reproductive-age married females, married adult males, and accredited social health activists (ASHAs) workers. In-depth interviews were conducted with key stakeholders of the community, i.e. Sarpanch, multipurpose health worker, medical officer, ASHA, pharmacist (private sector), Gynecologist (subdistrict hospital), and district officer (preconception and prenatal diagnostic techniques department). Data were analyzed using thematic analysis. Results: We generated three themes which were: beliefs surrounding induced abortions, reasons and practices for induced abortion, and facilitators and barriers to safe abortions. Abortions were considered a sin in the community if not medically indicated. Larger family size, unplanned pregnancies, and sex selectivity were the most common reasons to opt for an abortion both traditional and modern methods of abortion were prevalent in the community. The husband and mother-in-law of most women possess the decision-making power in the context of opting for abortions. Conclusions: Abortion was considered a sin in the community, except if done for a congenital anomaly of the fetus. Both traditional and modern methods of abortion were prevalent in the community. The decision-makers for elective abortions were the husband and mother-in-law.

The Silent Crises: Unveiling Young Women’s Perspectives On Unsafe Abortion In The Cape Coast Metropolis, Ghana

Background: Unsafe abortion, as a reproductive health issue, has been widely reported as posing a significant danger to the health of young women worldwide. Objective: Using the theory of planned behaviour as a lens, the study explored the knowledge and attitudes of young women on unsafe abortion practices in the Cape Coast Metropolis of Ghana. Methods: Guided by the interpretivist philosophy, the researchers employed an exploratory design utilising data collected from 21 participants through in-depth interviews. Results: The study revealed that, aborters had little knowledge on safe abortion given that the first point of contact were their sexual partners, friends and guardians who ultimately influenced their decision to engage in unsafe abortion. The study also discovered that education, financial problems, religion and age were the major reasons why young women went for unorthodox abortion method. Conclusions: The desire to further education and to avoid stigmatisation stood out as major reasons why young women opted for unsafe abortion methods. The study recommended the need for stakeholder institutions like the Planned Parenthood Association of Ghana, Ministry of Health, Government of Ghana and related non-governmental organisations to intensify and widen enlightenment on safe abortion practices to the general populace.

A study on abortion care services in different tiers of rural health care in Malda district of West Bengal, India

Objective: To assess comprehensive abortion care (CAC) services uptake and barriers to it in selected representative units of the three tier health care in the district of Malda in West Bengal, India. Methods: We conducted community-based, concurrent, parallel mixed methods study. Quantitative assessment of knowledge of primary health care workers on CAC and appropriate infrastructure assessment was done. Qualitative methods were used to identify themes affecting uptake of quality care among stakeholders. Results: A total of 48 staff nurses and 133 auxiliary nurses and midwives were included in the study. About half of nurses (of total 48) who were second tier health care provider and two thirds (of total 133) of first tier health care provider had incorrect knowledge about legality of abortion. Only 40% mothers seeking abortion were accompanied to subcentre by primary health care worker. At the third tier health care site, physicians insisted on necessity of refresher training. Suboptimal uptake of available CAC services was due to lack of enabling environment. Lack of updated training across health care workers was observed. Conclusions: Health care providers at the community level were unaware of facilities available for mothers seeking abortion. Higher level health care providers were unsure of specific knowledge about legal permissibility and sterilization of apparatus for abortion. At the highest level, more training on medical methods of abortion was required. The problems identified are amenable to correction, and some administrative and service-related provision on appropriate measures may lead to immediate success.

Pregnancy outcomes following second-trimester abortions: A comparison between medical and surgical management. A historic cohort study.

Pregnancy outcomes following second-trimester abortions: A comparison between medical and surgical management. A historic cohort study.

The Impact of Lifetime Intimate Partner Violence on Abortion Method Choice

The Impact of Lifetime Intimate Partner Violence on Abortion Method Choice

Attitudes regarding the safety of in-clinic and self-managed abortion methods among the US general public in early 2022

Medication abortion (MAB) is extremely safe—including when accessed outside the formal healthcare system—yet misinformation about its safety often influences policy, and research regarding public perceptions about its safety remains limited. In 2021-2022, we administered a US national probability-based online survey to 7,376 English- and/or Spanish-speaking people assigned female (AFAB, ages 15-49; N = 7,016) or male at birth (AMAB, ages 18-49; N = 360) to assess perceptions of MAB and self-managed abortion method safety. To identify characteristics associated with safety attitudes, we estimated weighted proportions and conducted multivariable multinomial logistic regressions. While approximately half of respondents believed MAB is safe when obtained in-clinic (52% AFAB/43% AMAB), very few believed it is safe when obtained outside the formal healthcare system (7% AFAB/5% AMAB). In multivariable analyses, prior awareness of MAB and the belief that abortion should be legal were associated with the belief that MAB is safe, both when accessed in-clinic and outside the formal healthcare system. Respondents living in US states that were restrictive to abortion rights/access were less likely to agree that in-clinic MAB is safe compared to those in protective abortion policy environments. The general public holds misinformation about the safety of MAB, particularly when obtained outside the formal healthcare system.

Time trends and characteristics associated with abortion method used by young Australian women.

To explore time trends in abortion based on method used and characteristics associated with method type by uniquely linking social and behavioral data reported by a population-based cohort of young Australian women. We analysed self-reported data from 16 993 women in the Australian Longitudinal Study on Women's Health 1989-95 cohort, aged 18-24 years at recruitment in 2013, linked to abortion data from three population-based administrative data sources. The incidence of medication abortion increased over time whereas surgical abortion decreased, with similar trends across the largest states. The adjusted odds ratio (AOR) of having a medication compared with a surgical abortion increased over time [by each 1-year increase in time, 1.33 (95% confidence interval 1.20, 1.48)]. Women who lived in outer regional/remote/very remote areas [AOR 3.51 (2.15, 5.74)] and inner regional areas [1.80 (1.21, 2.69)] had increased odds of a medication abortion compared with women who were living in major cities. Medication abortions were more common than surgical abortions in outer regional/remote/very remote areas from 2017 whereas, in major cities, surgical abortion remained the most common abortion method throughout the study period. Linkage of government-recorded health events with self-reports demonstrated a shift towards increasing use of medication abortion relative to surgical abortion, with greater increases in nonmetropolitan areas. The strong geographical disparities in abortion method suggest that, for those who are living in nonmetropolitan areas, there may be less opportunity to choose surgical abortion due to limited availability of services, with significant implications for women who present later in pregnancy.

Patients' experiences with pain and bleeding in first-trimester abortion care.

Patients' experiences with pain and bleeding in first-trimester abortion care.

Innovationen in der Versorgung von Schwangerschaftsabbrüchen während der COVID-19-Pandemie in Deutschland, Frankreich und Großbritannien

ZusammenfassungDie COVID-19-Pandemie hatte drastische Auswirkungen auf die Gesundheitssysteme vieler Länder. Zur Aufrechterhaltung der Versorgung mussten umgehend Lösungen gefunden werden, wobei sich auch das Potenzial ergab, Innovationen zu beschleunigen. So wurde beispielsweise der Zugang zu Schwangerschaftsabbrüchen während der Pandemie durch „Telehealth für frühen medikamentösen Schwangerschaftsabbruch“ (TEMA) verstärkt genutzt.In diesem narrativen Übersichtsartikel werden Deutschland, Frankreich und Großbritannien in Hinblick auf die Entwicklung der Anzahl, Methoden und Settings von Schwangerschaftsabbrüchen in den Jahren 2018–2023 verglichen. Veränderungen im Versorgungsangebot und in der Gesetzgebung während der Pandemie werden dargestellt und die Unterschiede zwischen den Ländern sowie die verschiedenen Innovationsfaktoren diskutiert. Dazu wurden nationale Statistiken analysiert und es fand eine Literatur- und Onlinerecherche (Rapid-Review) statt.In den 3 Ländern zeigen sich unterschiedliche Abbruchraten und Anteile medikamentöser Abbrüche sowie Auswirkungen der Pandemie; ein Anstieg von Telehealth ist aus einigen Quellen ersichtlich. In Frankreich und Großbritannien, wo medikamentöser Schwangerschaftsabbruch die Hauptmethode des Abbruchs ist, waren Dienstleistungen im Zusammenhang mit Schwangerschaftsabbrüchen schon vor der Pandemie leichter zugänglich. Während der Pandemie wurde hier TEMA, inkl. Versenden von Medikamenten, offiziell eingeführt. In Deutschland wurde TEMA erstmals durch Nichtregierungsorganisationen angeboten. Nachhaltigkeit und Verbreitung der Neuerungen bleiben fragil, insbesondere in Deutschland, wo der disruptive Ansatz einiger Organisationen noch keinen Eingang in die allgemeinen Gesundheitsdienste gefunden hat.

Ghana abortion care—a model for others: analysis of the 2017 Ghana Maternal Health Survey

Ghana abortion care—a model for others: analysis of the 2017 Ghana Maternal Health Survey

Comparative study of medical vs surgical abortion in the first trimester- which one is better choice?

Abortion is defined as the spontaneous and induced termination of a pregnancy before foetal viability. Abortions accounted for one-third of all pregnancies, and nearly half of the pregnancies were unintended. An effective way to prevent the burden of unsafe abortion could be access to safe abortion services. Both surgical and medical methods are available for abortion or the termination of a pregnancy. Thus, we compare the two methods of medical and surgical abortions in this study. The study was conducted on women attending obstetrics and gynaecology OPD for seeking treatment for abortion in the first trimester. 100 women were allocated to Group A, who opted for medical treatment, and Group B, for surgical abortion. Two groups were compared in terms of clinical parameters like blood loss, aftereffects, post-procedure visits, and efficacy. In group A, 14% of women had minimal bleeding, 70% had moderate bleeding, and 6% had heavy bleeding. In group B, 72% had minimal bleeding, 28% had moderate bleeding, and no one had heavy bleeding. The combined complication rate in surgical abortion was significantly lower as compared to medical abortion, but the difference in clinical efficacy is not significant. The medical method is a good alternative to surgical abortion. The medical termination was associated with more bleeding and more post-procedural aftereffects, although both procedures were comparable in clinical efficacy.

Socio-demographic, and attitude factors in safety issues of self-administered medical method of abortion: A cross sectional study at Hassan, Karnataka., India

Socio-demographic, and attitude factors in safety issues of self-administered medical method of abortion: A cross sectional study at Hassan, Karnataka., India

Close female friendships and knowledge of recommended abortion methods in Nigeria and the Democratic Republic of the Congo among a representative sample of reproductive-aged women.

There is a high incidence of unsafe abortion among women in Nigeria and the DRC. Low knowledge of recommended abortion methods [i.e., surgical and medication abortion (MA) pills] is a barrier for women accessing safe abortions. Women often rely on friends for information about abortion methods. Understanding characteristics of women with knowledge of recommended abortion methods, and MA specifically, and how it is influenced by close female friendships may help identify women most at risk of relying on unsafe abortion. We used survey data from Performance Monitoring for Action from 11,106 women of reproductive age in Nigeria (April-May 2018) and 3,697 women in Kinshasa and Kongo Central, DRC, (December 2021-April 2022) to produce representative estimates of knowledge of abortion methods at the national and province levels, respectively. We performed bivariate and multivariate logistic regression to determine which characteristics were independently associated with knowing a recommended abortion method, with knowing of MA pills specifically, and to assess our hypothesis that having at least one female confidante would increase one's odds of knowing about these methods. A minority (26.9%) of women in Nigeria and the majority in Kinshasa (76.7%) and Kongo Central (58.1%) reported having knowledge of at least one recommended abortion method, while knowledge of MA pills was low in all sites. Having at least one close female confidante was associated with increased odds of knowing a recommend abortion method in Nigeria (aOR = 1.50, 95% CI 1.25-1.79) and in Kongo Central (aOR = 2.66, 95% CI 1.40-5.40), and with increased odds of knowing about MA specifically in Kinshasa (aOR = 1.44, 95% CI 1.08-1.93) and Kongo Central (aOR = 3.61, 95% CI 1.28-10.22), but not Nigeria. In legally restrictive contexts where knowledge of recommended abortion methods (particularly medication abortion) is low, having close female friends is related to increased knowledge of recommended abortion methods.

Unsafe termination of pregnancy where abortion is illegal: A Botswana context-specific study.

Unsafe pregnancy termination contributes to morbidity and mortality among women globally. Despite Botswana's restrictive abortion laws, women continue to use unsafe abortion methods. This study aimed to explore factors that contributes to unsafe termination of pregnancies in Ngami sub-district, Botswana. A qualitative descriptive and exploratory research approach, using a phenomenological design, was applied. Semi-structured in-depth interviews were conducted with women admitted to the gynecological ward from June to August 2021. Data saturation was reached with the 12th participant. Data was analyzed thematically. The study revealed two major themes: factors contributing to unsafe abortions, and interventions to reduce unsafe abortions. The study underscores the global issue of unsafe abortion that leads to high morbidity and mortality, and long-term complications. An overall recommendation is for Botswana to reconsider its abortion law and aim to prevent unsafe abortions and reduce healthcare cost.

Mifepristone-Misoprostol Regimen vs. Surgical Abortion: Evaluating Pregnancy Termination Options in Bangladesh

Background: Access to safe and effective abortion services plays a vital role in safeguarding women's reproductive health, ultimately contributing to their overall well-being. This is particularly relevant in Bangladesh, where the legality of abortion is contingent upon specific circumstances. Therefore, ensuring women have the autonomy to choose between safe and effective termination methods becomes crucial. Objective: The study aims to see explore the efficacy, safety, and accessibility of mifepristone-misoprostol regimen and surgical abortion methods within the context of Bangladesh. Methods: This investigation employed a cross-sectional observational design, conducted within the Department of Obstetrics and Gynecology at Dhaka National Medical College in Bangladesh. The study spanned one year, commencing in March 2023 and concluding in February 2024. To ensure a representative sample of the patient population seeking abortion services, consecutive sampling was utilized. This approach involved recruiting all patients admitted during the designated timeframe who fulfilled the pre-established inclusion and exclusion criteria. Ultimately, the study enrolled 104 participants, a sample size determined by the number of admissions fitting the criteria within the one year. Results: The study found no significant difference in age distribution between women choosing medical or surgical abortion, with both groups mainly consisting of women aged 18-25. Overall complication rates were similar, but medical abortion had a higher need for additional procedures and longer stays, while surgical abortion required more bleeding observation. Pain experiences differed significantly, with no women in the medical group reporting no pain and a higher prevalence of moderate pain compared to surgical abortion. Women undergoing medical abortion were slightly more likely to experience complications overall, and primigravid women (first pregnancy) were significantly more likely to experience complications than multigravid women. Conclusion: Our findings suggest comparable safety profiles for both surgical and medical abortion procedures within the studied population. This indicates that surgical abortion can be a safe and effective option alongside medical abortion, potentially expanding the range of choices offered to women.

Type, Complications and Treatment of Abortion in a Tertiary Hospital

Background: Abortion remains a critical public health issue, particularly in low-resource settings like Bangladesh, where access to safe abortion services is often restricted. This study aimed to analyze the types of abortions, treatment methods, and post-abortion complications in a tertiary hospital in Bangladesh. Methods: A cross-sectional study was conducted from January to December 2017, including 100 cases of abortion at a 250-bed district hospital in Joypurhat, Bangladesh. Data were collected from patient records, focusing on demographic characteristics, type and nature of abortion, treatment methods, and complications. Descriptive statistics were used for analysis. Results: The majority of patients (42%) were aged 26–30 years, and 58% were primigravida. Most abortions (75%) occurred before 13 weeks of gestation, with incomplete abortions accounting for 86% of cases. Spontaneous abortions constituted 86%, and D&C was the primary treatment method in 83% of cases. Post-abortion complications were infrequent, with incomplete D&C (8%), shock (6%), and septicemia (3%) being the most common. Conclusion: Incomplete abortions and spontaneous abortions are the most common types observed, with D&C being the predominant treatment method. Although complications were low, the findings underscore the need for better access to safe abortion methods, including medical abortion, and the reduction of unsafe practices through improved healthcare education and policy reform.

Accuracy, Quality, and Misinformation of YouTube Abortion Procedural Videos: Cross-Sectional Study.

The internet is often the first source patients turn to for medical information. YouTube is a commonly used internet-based resource for patients seeking to learn about medical procedures, including their risks, benefits, and safety profile. Abortion is a common yet polarizing medical procedure. People interested in obtaining an abortion are likely to use the internet to learn more about abortion procedures and may encounter misinformed and biased information. This is troubling as information found on the internet can significantly alter perceptions and understanding of these procedures. There is no current research that evaluates the accuracy, quality, and misinformation of instructional abortion videos available to patients. The purpose of this study was to assess if any given video can deliver accurate and quality information about this topic in an unbiased manner and to assess the level of factually incorrect, distorted, or medically irrelevant information in any given video. Procedural methods of abortion were queried on YouTube on August 22, 2022. The videos were screened with strict exclusion criteria. Videos were categorized into "video slants" based on the language and attitudes expressed in each video. Video accuracy was calculated using the Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist for each corresponding procedure. Video quality was calculated using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) criteria. The level of misinformation was assessed with the evidence-based Anti-Choice Rubric, which scores the amount of factually incorrect, distorted, or medically irrelevant information in each video. A total of 32 videos were analyzed and categorized into 3 "video slant" groups: neutral (n=23, 72%), antichoice (n=4, 12%), and prochoice (n=5, 16%). Using the SCOG checklist, neutral videos had the highest median accuracy (45.9%), followed by antichoice videos (24.6%) and prochoice videos (18.5%). None of the videos met the LAP-VEGaS quality control criteria, (score>11, indicating adequate quality). Neutral videos had a median score of 8.8 out of 18, with antichoice videos scoring 10.75 and prochoice videos scoring 6.2. Using the Anti-Choice Rubric, neutral videos mentioned only 1 factually incorrect piece of information. Antichoice videos mentioned 12 factually incorrect pieces of information, 8 distortions, and 3 medically irrelevant pieces of information. Prochoice videos did not mention any of the 3 themes. Using the SCOG checklist, the accuracy of instructional videos were inconsistent across the 3 identified "video slants." Using LAP-VEGaS criteria, the quality of educational videos were also inconsistent across the 3 "video slants." Prochoice videos had the lowest level of misinformation, with no mentions of any of the 3 themes. Antichoice videos had the highest levels of misinformation, with mentions in all 3 themes. Health care professionals should consider this when counseling patients who may watch YouTube videos for information regarding abortion procedures.

Women's satisfaction with comprehensive abortion care services and associated factors in central Gondar zone public primary hospitals, northwest Ethiopia, 2023.

Abortion complications are the leading causes of maternal death in low and middle-income countries, including Ethiopia. Providing quality and comprehensive abortion care services is crucial for improving the health of women and increased their satisfaction. Evaluating a client's satisfaction with abortion care is clinically relevant since women's satisfaction with health services is one of the key indicators of high-quality healthcare services. Therefore, this study aimed to assess women's satisfaction with comprehensive abortion care services and associated factors. An institution-based cross-sectional study was implemented among 333 women in Central Gondar Zone public primary hospitals from October 1, 2022, to April 30, 2023. Eligible participants were selected using a systematic random sampling technique. The data was collected using an interviewer-administered semi-structured, and pretested questionnaire. STATA version 17 and SPSS version 25 software were used for data entry and analysis respectively. Bivariable and multivariable logistic regression models were used to identify factors associated with clients' satisfaction with comprehensive abortion care services. A P-value of ≤0.05 with a 95% confidence interval was the cutoff point for determining statistical significance. This study revealed that the level of client satisfaction with comprehensive abortion care services was 60.4% (95% CI: 55.0%, 66.0%). The use of abortion medication (AOR = 4.41, 95% CI: 2.59, 7.48), women's age 20-24 years (AOR = 2.94, 95% CI: 1.02, 8.48), and being a student (AOR = 2.88, 95% CI: 1.10, 7.51) were significantly associated with women's satisfaction with comprehensive abortion care services. Women's satisfaction with comprehensive abortion care services was relatively low, and it was strongly correlated with the method of abortion, age, and occupation. To improve women's satisfaction requires a comprehensive understanding of women's values and perspectives, providing sexual and reproductive health education, and quality abortion care services are recommended.