Abortion Methods Research Articles

Assessment of peripheral markers and ultrasonographic parameters in pregnant mares receiving intramuscular or intrauterine cloprostenol

Assessment of peripheral markers and ultrasonographic parameters in pregnant mares receiving intramuscular or intrauterine cloprostenol

“Like a mother-daughter relationship”: Community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India

“Like a mother-daughter relationship”: Community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India

Self-managed abortion: A systematic scoping review.

Self-managed abortion: A systematic scoping review.

The Knowledge of Unsafe Abortion among the Youth: The Case of Tamale Metropolis in the Northern Region of Ghana

Background: Unsafe abortion contributes significantly to maternal deaths in Africa despite the availability of safe abortion services. This study assessed the knowledge of unsafe abortion among the youth within the Tamale Metropolis in the Northern region of Ghana.
 Material and methods: This was a cross-sectional descriptive study using structured questionnaires. Data was analysed using SPSS version 23.0 (Chicago).
 Result: The mean age of respondents was 23 ±10.4 years. The great majority (98.8%) (P<0.0001) have heard of unsafe abortion. The act is common among young, and unmarried women (P<0.0001). Unsafe abortion is commonly committed outside health facilities (70.9%; P<0.0001), in the communities (73.2%; P<0.0001), supervised by herbalists (53.9%), because of confidentiality (43.5%) and affordability (42.9%). Majority, (77.4%; P<0.0001) have heard of a method of unsafe abortion. The commonly used method was herbal preparation/medicine (264 (77.6%); P<0.0001). The two major reasons for unsafe abortion were: to allow the victim continue with education (47.4%) and to avoid difficulties in caring for the pregnancy and child (25.9%). Approximately, 99.4% (P<0.0001) were aware of some complications associated with unsafe abortion, particularly death (38.8%) and severe bleeding per vaginam (16.5%). A total of 78 (22.9%) have ever been pregnant, and 68 (87.2%) aborted the pregnancy because their partners did not allow them to keep the pregnancy. The great majority (83.8%) have unsafe abortion at home (59.6%).
 Conclusion: Respondents had significant knowledge of unsafe abortion and the associated complications. Majority of the respondents who have ever been pregnant had unsafe abortion outside a health facility.

Abortion experience and self-efficacy: exploring socioeconomic profiles of GHANAIAN women

BackgroundUnsafe abortions remain a major global public health concern and despite its prevalence, unsafe abortions remain one of the most neglected global health challenges. The proportion of women in Ghana who have experienced unsafe abortions has increased from 45% in 2007 to 62% in 2017. Given the noted consequences of (unsafe) abortions on women health, it is important to explore factors correlated with women’s abortion decisions and why they opt for safe or unsafe methods. The study also examines determinants of over 6,000 Ghanaian women’s self-efficacy in abortion decision-making, given that this is likely to affect the likelihood of future abortions.MethodsUsing cluster-level Geographic Information System data from the 2017 Ghana Maternal Health Survey, the study provides a hot spot analysis of the incidence of abortion in the country. The study also makes use of Probit multivariate analyses also show the correlates of abortion with socio-economic factors.ResultsResults suggest that abortion among women is positively correlated with the absence of partners, low education levels, higher household wealth, lower parity and family size, polygyny and Christian religious background.ConclusionIt is observed that the groups of women with higher abortion self-efficacy are the same groups of women who are more likely to opt for safer abortion methods, indicating some correlation, albeit indirect, between abortion self-efficacy and women’s abortion behaviors in Ghana. Relevant policy applications are adduced from these research findings.

Provision of medical methods of abortion in facilities in India in 2015: A six state comparison

ABSTRACTMedical methods of abortion, MMA, has been legal in India since 2002. Guidelines stipulate that it should be administered by a provider or acquired via prescription. 1.2 million women having abortions in India use MMA acquired from health facilities [Singh, S., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Pradhan, M. R., … Browne, A. (2018). The incidence of abortion and unintended pregnancy in India, 2015. The Lancet Global Health, 6(1), e111–e120. doi:10.1016/S2214-109X(17)30453-9]. We undertook a study of abortion in Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh in 2015 to better understand under what conditions and how MMA is being administered in facilities. The majority of facilities that provide MMA are in the private sector and located in urban areas. Most facilities offer MMA both at the facility and as a prescription, although some facilities only offer MMA as a prescription. A high proportion of facilities report that women typically take the medication at home. (Re)training providers in MMA protocols and counselling, increasing the number of facilities offering MMA, and stocking of the drugs would help improve women’s access to MMA and the information they need to be able to use this method safely.Key Messages:In the six states in our sample, Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh, 8% of abortions in 2015 were done using medical methods of abortion (MMA) acquired from health facilities.The majority of facilities that provide MMA in the six states are in the private sector and are located in urban areas.Health facilities in Madhya Pradesh and Tamil Nadu are comparatively better in their provision of MMA with Assam, Bihar, Gujarat and Uttar Pradesh demonstrating poorer provision of MMA.There are many opportunities for improvement in the practices of MMA provision through improved training of providers, accessibility to the medications and better support of women using MMA.

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies.

Developing countries register 98% of unsafe abortion annually, 41% of which occur among women aged between 15 and 25 years. Additionally, 70% of hospitalizations due to unsafe abortion are among girls below 20 years of age. This study unveils abortion practices in Africa, its consequences, and control strategies among adolescents. Online databases that provided relevant information on the topic were searched. A Google Scholar search yielded 623 000 results, PubMed yielded 1134 results, African Journals Online yielded 110 results, and PsycINFO yielded eight results. A total of 25 studies published from 2000 to 2018 that met the Critical Appraisal Skills Programme (CASP) standard were thematically reviewed. These studies indicated that abortion is a neglected problem in health care in developing countries, and yet decreasingly safe abortion practices dominate those settings. Adolescents who have unintended pregnancies may resort to unsafe abortion practices due to socio-economic factors and the cultural implications of being pregnant before marriage and the legal status of abortion. Adolescents clandestinely use self-prescribed drugs or beverages, insert sharps in the genitals, and most often consult traditional service providers. Abortion results in morbidities such as sepsis, severe anaemia, disabilities, and, in some instances, infertility and death. Such events can be controlled by the widening availability of and accessibility to contraceptives among adolescents, advocacy, and comprehensive sexuality education and counselling. Adolescents are more likely to use clandestine methods of abortion whose consequences are devastating, lifelong, or even fatal. Awareness and utilization of youth-friendly services would minimize the problem.

Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion.

Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion.

A prospective study of severity of complications associated with use of misoprostol and other abortion methods in South West Nigeria.

To assess the severity of complications following misoprostol used to induce abortion compared with other methods among women admitted for postabortion complications. A cross-sectional study of women who presented with complications of induced abortion at nine secondary and tertiary hospitals in South West Nigeria between April 1, 2013 and May 31, 2014. Face-to-face interviews were conducted and information on the current admission was extracted from patient records. Associations between abortion method used and severity of abortion complications were evaluated using χ2 and Fisher exact tests. Of 522 women included in the study, 177 reported an induced abortion: 41 women (23.2%) had used misoprostol at the first attempt to induce abortion, whereas 79 (44.6%) women had undergone surgical abortion. Occurrence of fever (P=0.06), bleeding (P=0.3), and lower abdominal pain (P=0.32) was not significantly different between the misoprostol and surgical abortion/other methods groups. Severe complications were rare with misoprostol, but more common among women in the surgical abortion/other methods group. Maternal mortality occurred only among women in the surgical abortion/other methods group. Use of misoprostol for induced abortion was associated with fewer complications and no maternal mortality compared with surgical abortion/other methods.

Current and potential methods for second trimester abortion.

Current and potential methods for second trimester abortion.

Induced Abortion, Birth Control Methods, and Breast Cancer Risk: A Case-Control Study in China.

BackgroundThe association between induced abortion and birth control methods (including oral contraceptives and intrauterine devices) and breast cancer may vary among countries, due to the different usage and frequency of birth control methods and induced abortion among countries. A better understanding of this association may help in determining safer birth control methods for Chinese women.MethodsA case-control study was conducted with a total of 794 cases and 805 controls. Standardized questionnaires were used to collect information on demographic characteristics, exposure to induced abortion, birth control methods, and other risk factors for breast cancer. Multivariate logistic regression was conducted to explore the association between birth control methods and breast cancer.ResultsMultivariate logistic regression analyses showed that having a history of medical abortions, ≥3 surgical abortions, or both medical and surgical abortions was associated with an increased risk of breast cancer in post-menopausal women (odds ratio [OR] 2.48; 95% confidence interval [CI], 1.14–5.40). Pre-menopausal women who had used intra-uterine devices (IUDs) for more than 20 years tended to have a lower breast cancer risk than other age-matched pre-menopausal women (OR 0.41; 95% CI, 0.25–0.68). Both pre-menopausal and post-menopausal women who had <20 years exposure to IUDs and those who had used two or more birth control methods (with the exception of women who used IUDs for more than 20 years) tended to have much higher breast cancer risk.ConclusionThe relationship between induced abortion and birth control methods and breast cancer was complex, though being exposed to induced abortion and two or more birth control methods in one’s lifetime appeared to be risk factors for breast cancer in Chinese women.

Experiences of women who travel for abortion: A mixed methods systematic review.

ObjectiveTo systematically review the literature on women’s experiences traveling for abortion and assess how this concept has been explored and operationalized, with a focus on travel distance, cost, delays, and other barriers to receiving services.BackgroundIncreasing limitations on abortion providers and access to care have increased the necessity of travel for abortion services around the world. No systematic examination of women’s experiences traveling for abortion has been conducted; this mixed-methods review provides a summary of the qualitative and quantitative literature on this topic.MethodsA systematic search was conducted using PubMed, Embase, Web of Science, Popline, and Google Scholar in July 2016 and updated in March 2017 (PROSPERO registration # CRD42016046007). We included original research studies that described women’s experiences traveling for abortion. Two reviewers independently performed article screening, data extraction and determination of final inclusion for analysis. Critical appraisal was conducted using CASP, STROBE, and MMAT checklists.ResultsWe included 59 publications: 46 quantitative studies, 12 qualitative studies, and 1 mixed-methods study. Most studies were published in the last five years, relied on data from the US, and discussed travel as a secondary outcome of interest. In quantitative studies, travel was primarily conceptualized and measured as road or straight-line distance to abortion provider, though some studies also incorporated measures of burdens related to travel, such as financial cost, childcare needs, and unwanted disclosure of their abortion status to others. Qualitative studies explored regional disparities in access to abortion care, with a focus on the burdens related to travel, the impact of travel on abortion method choice, and women’s reasons for travel. Studies generally were of high quality, though many studies lacked information on participant recruitment or consideration of potential biases.ConclusionsStandardized measurements of travel, including burdens associated with travel and more nuanced considerations of travel costs, should be implemented in order to facilitate comparison across studies. More research is needed to explore and accurately capture different dimensions of the burden of travel for abortion services on women’s lives.

Abortion, the Disabilities of Pregnancy, and the Dignity of Risk

Abortion, the Disabilities of Pregnancy, and the Dignity of Risk

Is induced abortion becoming a family planning method in Ghana?: A situational analysis of induce abortion and contraception uptake in two urban cities of Ghana

Background: Following amendment of Ghanaian abortion law in 1985, abortion services became more available as permitted by law. Services data however remain scares due to provider and facility stigmatization. Objective: To explore the use of abortion as a family planning option using provider reports, trends of contraception and induced abortion service uptake in facilities within two urban cities in Ghana. Methods: Cross-sectional, descriptive design, using facility data from 50 private (42) and Non-Governmental Organizations (8). Ten in-depth interviews were also held with midwife providers (6) and medical officers (4) between January 2010 and December 2017 in Accra and Kumasi Metropolises. Results: Facility patronage of abortion services in Accra and Kumasi Metropolises increase steadily each year with contraception uptake. Abortion services in NGO facilities were however reported as target driven and providers’ performances/bonuses were tied to meeting set targets thereby encouraging abortion on demand. Whereas NGO facilities provide both abortion and full contraception method mix, majority (38 out of 42) of private facilities provide only abortion services. Those providing contraception focus mainly on short term methods (pills and injections) due to lack of interest and/or trained providers. There are more midwife lead abortion providing facilities in Accra (40) than in Kumasi (10). Where midwives provided abortion services, contraceptives were readily available and clients encouraged to take a method following abortion. This practice was very common in NGO facilities as post abortion contraception was reported to be a mandatory package. Conclusions: The Ghanaian abortion law allows conditional abortion and not on demand. However, increasing numbers of abortions in the study area coupled with reported target setting for abortion services suggest abortion on demand and its being used as a family planning option. A nationwide facility based assessment of abortion and contraception service delivery is recommended to inform policy.

Expanding a woman's options to include home use of misoprostol for medical abortion up until 76days: an observational study of efficacy and safety.

Home use of misoprostol for medical abortion is increasingly being practiced. With gestational length up to 70days, it is considered effective, safe and acceptable by women. Knowledge of safety and efficacy with longer gestations is limited and studies are required to expand women's options to include this method of abortion. A retrospective cohort study was designed to compare home use of misoprostol for medical abortion at gestational length 64-76days to its use at 57-63days. Primary outcome was success rate. Success was defined as complete uterine evacuation without the need of surgical intervention due to incomplete abortion and no failed abortion with ongoing pregnancy. Secondary outcomes were rates of unscheduled return visits, telephone consultations, admissions to hospital, infections and the need for blood transfusion. We included 397 women, 270 within 57-63days of gestation and 127 within 64-76days of gestation at abortion. Success rate was 95.6% at 57-63days and 93.7% at 64-76days. The difference was not statistically significant (P=.431). The rate of unscheduled return visits was high overall but not significantly different in relation to gestational length at abortion (>63days; 20.5% vs <64days; 16.3%, P=.308). Our study indicates that home use of misoprostol for medical abortion at 64-76days gestation may be as safe and effective as at 57-63days. Further studies with larger sample sizes are needed to confirm our findings and to explore the acceptance of and experiences among women performing abortion at home at greater gestational length, before further implementation in clinical practice.

Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria.

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years’ data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers’ exact and chi-square for trend tests (p<0.05).ResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P <0.001). Patients who used misoprostol were significantly less likely to have infectious morbidity, genital tract injuries or medical complications. There was no difference in incomplete abortion in the groups. Patients were more likely to have in-patient care with surgical abortions (p<0.001), to need prolonged antibiotic regimens (p = 0.003), need further surgeries or additional specialist care (p = 0.009).ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Study of the Efficacy and Success Rate of Single Dose Oral Mifepristone and Vaginal Misoprostol v/s Vaginal Misoprostol alone for Second Trimester Termination of Pregnancy

Background: Second trimester abortions constitute 10-15% of all induced abortions and are considered to be less safe than first trimester abortions. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Aim: To compare the efficacy and the success rate of single dose oral mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second trimester termination of pregnancy. Materials and Methods: A comparative study and was conducted in the Department of Obstetrics and Gynecology in a Tertiary Health Care Hospital. The study was carried out by dividing women into two groups (72 each). Group A received 200mg of oral Tablet Mifepristone and 400 of vaginal misoprostol (48 hours later) which was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Group B received 400 of vaginal misoprostol directly and the dose was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Results: The success rate in Group A was 98.6%, whereas in Group B was 84.7%. The mean induction abortion interval in Group A was lesser (6.2 hours) as compared to Group B (10.8 hours) (p value &lt;0.00001). The mean dose of misoprostol in Group A was 613.88mcg compared to the Group B 1591.66mcg (p value &lt;0.00001). Conclusion: Pretreatment with mifepristone significantly reduces the induction abortion interval (I-A-I) and the misoprostol dose.

Ethics of Managing Unintended Consequences in Global Health Research: A Case Study

In a study of dietary supplementation among women in Ghana, a disproportionately high number of pregnant study participants were found to no longer be pregnant, leading researchers to suspect that the very early identification of pregnancy status made possible by study participation may have contributed to an elevated incidence of elective abortion among study participants. While abortion is legal in Ghana under certain circumstances, misinformation regarding its legality and persistent stigmatization result in many Ghanaian women choosing abortion methods that are unsafe and often illegal. While the study of the potential benefits of dietary supplementation during pregnancy initially appeared to pose very little risk to participants, the unintended and unforeseen consequence of unsafe abortions required researchers to reevaluate study protocol. In the following discussion of this case, we explore the ethical considerations researchers must address when unintended consequences emerge in global health research.

Recent advances in improving the effectiveness and reducing the complications of abortion.

When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman’s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.

Predictors of postabortion contraception use in Cambodia

Predictors of postabortion contraception use in Cambodia