Abortion Services Research Articles

Patient and health professional attitudes towards the use of telemedicine for abortion care in Britain: Findings from the SACHA study.

Use of telemedicine in abortion care is safe and effective. Patient satisfaction with telemedically supported abortion is high, but as use expands in Britain, little is known about patients' or health professionals' views on how it is best used. We sought the views of both groups on telemedicine's role in abortion provision and how its use might be optimised. We administered a structured survey with an additional free-text response option to a range of health professionals from services identified via clustered random sampling. We conducted semi-structured interviews with patients with recent experience of abortion, purposively sampled from abortion services. Participants were recruited from England, Scotland and Wales. We analysed qualitative data using thematic analysis alongside framework analysis. Support for telemedicine was high among participants, which included 771 health professionals from a range of services and 48 patients. Among health professionals, 23% opposed the use of telemedicine in abortion provision. Opposition was highest among those uninvolved, or who did not feel skilled, in remote provision. Reported benefits included patient convenience and comfort. Patient concerns centred on adequate provision of emotional support. Participants made suggestions for augmenting and extending the use of telemedicine to meet some patients' needs, including combining telemedical consultation with in-person care and providing information and follow-up via digital methods. Acceptability of telemedically supported abortion, which offers logistical and emotional benefits to patients, is high in Britain. Novel ways of providing telemedical support should be explored to enhance remote abortion provision. In-person care should remain an option for patients.

Aya Contigo: evaluation of a digital intervention to support self-managed medication abortion in Venezuela.

Venezuela continues to face a humanitarian crisis, where healthcare is difficult to access and abortion is legally restricted. In response to a growing need for life-saving abortion and sexual and reproductive health (SRH) services, a digital application called Aya Contigo was co-developed with local partners to support self-managed medication abortion. We sought to evaluate this digital health tool among pregnant people seeking abortion in Venezuela. This is a mixed-methods pilot evaluation of Aya Contigo, a digital tool for pregnant people seeking abortion in Venezuela. From April to June of 2021, people in the first trimester of pregnancy were recruited via passive sampling. Once enrolled, participants accessed information and resources on the application and were supported by study team members over an encrypted chat. Following medication abortion, participants completed an online survey and a semi-structured interview. Descriptive statistics were used to evaluate the survey responses. Interviews were coded thematically and analyzed qualitatively with NVivo. Forty participants seeking medication abortion in Venezuela were recruited to the study and given access to Aya Contigo. Seventeen completed the online survey (42.5%), with all participants identifying as women and a mean age of 28 (range 19-38; SD 5.55). Participants expressed confidence in Aya Contigo; 53% (9/17) felt "very supported" and the remaining 47% (8/17) felt "somewhat supported" by the app throughout the self-managed abortion process. The app was rated as highly usable, with an overall System Usability Scale score of 83.4/100. Thirteen respondents participated in a semi-structured phone interview, and qualitative analysis identified key themes relating to the experience of seeking abortion in Venezuela, the user experience with Aya Contigo, and the app's role in the existing ecosystem of abortion and contraceptive care in Venezuela. This mixed-methods pilot study demonstrates that the Aya Contigo mobile application may support pregnant people seeking medication abortion and post-abortion contraceptive services in Venezuela. Participants valued the provision of evidence-based information, virtual accompaniment services, and locally-available sexual and reproductive health resources via the digital tool. Further research and interventions are needed to ensure that all pregnant people in Venezuela can access safe abortion and contraceptive resources.

Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol

IntroductionAccess to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some...

Post-abortion contraceptive utilization and associated factors among women who attended abortion services: A health facility cross-sectional study.

Background: Post-abortion contraceptive utilization prevents unintended pregnancies, reduces the number of abortions, and lowers the morbidity and mortality related to obstetric complications. It plays a central role in improving maternal health and reducing child mortality. However, many women are suffering from unintended pregnancy and its complications after abortion care. Hence, the main objective of this study was to determine the magnitude of post-abortion contraceptive utilization and its associated factors in Bahir Dar City. Methods: Health-facility-based cross-sectional study was conducted in Bahir Dar city health facilities from April 1 to May 30, 2018. A systematic random sampling technique was used to select 354 eligible study participants. A pre-tested semi-structured questionnaire was used to collect the data. Data entry was done using Epi Data version 3.7 software and analyzed by SPSS v23 software. Descriptive statistics were done based on the nature of the data. A simple logistic regression model was used to identify the association and strength of exploratory variables and the outcome variables. Associations were announced at a 95% confidence interval and p-value <0.05 with adjusted odds ratio. Model fitness was checked by the Hosmer-Lemeshow goodness of fit test for logistic regression. Results: In this study, 348 aborted participants were involved with a mean age of 24.37 (±5.73) years. About 40% of the participants were not currently married and 12.9% were unable to read and write. The magnitude of post-abortion contraceptive utilization was 65.8%. The number of alive children (adjusted odds ratio: 7.0, 95% confidence interval: 1.54, 31.95), lower income (adjusted odds ratio: 0.14, 95% confidence interval: 0.03, 0.60), and (adjusted odds ratio: 0.11, 95% confidence interval: 0.02, 0.46), primary school education (adjusted odds ratio: 0.18, 95% confidence interval: 0.03, 0.97), and currently unemployed (adjusted odds ratio: 0.23, 95% confidence interval: 0.06, 0.85) were significantly associated with the post-abortion contraceptive utilization. Conclusion: The level of post-abortion contraceptive utilization is low as per the national plan. The number of alive children, lower income, lower education, and currently unemployed were the identified factors affecting post-abortion contraceptive utilization. Therefore, a collaborative effort is needed among stakeholders to increase the utilization and avoid factors that prevent the utilization of post-abortion contraceptive utilization.

How can patient experience of abortion care be improved? Evidence from the SACHA study.

Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. Our study aimed to examine women's satisfaction with abortion care and their suggestions for improvements. Qualitative, in-depth, semi-structured interviews. A purposive sample of 48 women with recent experience of abortion was recruited between July 2021 and August 2022 from independent sector and National Health Service abortion services in Scotland, Wales and England. Interviews were conducted by phone or via video call. Women were asked about their abortion experience and for suggestions for any improvements that could be made along their patient journey - from help-seeking, the initial consultation, referral, treatment, to aftercare. Data were analyzed using the Framework Method. Participants were aged 16-43 years; 39 had had a medical abortion, 8 a surgical abortion, and 1 both. The majority were satisfied with their clinical care. The supportive, kind and non-judgmental attitudes of abortion providers were highly valued, as was the convenience afforded by remotely supported home management of medical abortion. Suggestions for improvement across the patient journey centred around the need for timely care; greater correspondence between expectations and reality; the importance of choice; and the need for greater personal and emotional support. Recent changes in models of care present both opportunities and challenges for quality of care. The perspectives of patients highlight further opportunities for improving care and support. The principles of timely care, choice, management of expectations, and emotional support should inform further service configuration.

A Brief Study on Abortion in Adolescent Girl-Students in Kathmandu Valley

Nepali girl-students of the adolescent age group adopt abortion services in justifiable as well as in unethical ways in the verge of career-making in their study and jobs. There are many responsible factors for abortion deed in Nepali society like the negative impact of social media-internet services, globalization, migration, poverty, legal facility for abortion, and so on. This act has adverse effects on their physical health and performance those who adopt this. This research work objectifies the perception and the attitude of such adolescent girl-students in Kathmandu Valley. To ascertain the study accurate, this research work mentions particular data from Kathmandu Valley as primary sources and also some secondary sources from Nepal Demographic Health Survey (NDHS) and others. It further consults Karl Marx's views as well as the psychoanalytic perspective of Georg Wilhelm Friedrich Hegel and Sigmund Freud as the theoretical tools, and the ideas of David Pavon-Cuellar on Marxist-psychoanalytic theory in the relevant context of the data used in this article suitably in the Nepalese context. It follows sharply the quasi-experimental method of writing from the library's text to the internet and also the field work. Historically, the Nepali adolescent girl-students mostly are aware of abortion than the previous time; they have a legal idea about it, its facilities, and its process now. This research shows that there are majority of such Nepali adolescent girl-students in an urban area, even in Kathmandu city, who use abortion knowingly or unknowingly causing their health poor with poor performance and ruining their career so, it is helpful for the stakeholders to work on the issue raised here.

Abortion Clients’ Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi

ObjectivesWe assessed Mississippi abortion clients’ perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere. MethodsWe conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option. ResultsOf the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy. ConclusionsMississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.

Characteristics and Outcomes of Abortion Cases at a Tertiary Care Hospital in Bangladesh

Introduction: Abortion is a critical public health issue, particularly in developing countries like Bangladesh, where access to safe abortion services is often limited. This study aimed to analyze the characteristics and outcomes of abortion cases in a tertiary-level hospital setting, providing insights into the demographic profile of patients, nature and type of abortions, treatment methods, and post-abortion complications. Methods: This cross-sectional observational study was conducted at the department of Obstetrics and Gynecology, Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh, from June 2022 to July 2023. A total of 100 patients were consecutively sampled based on specific inclusion and exclusion criteria. Data were collected through patient medical records and interviews, focusing on demographic information, details of the abortion, and subsequent outcomes. Result: The majority of patients were in the 26-30 age group (42%), with 58% being primigravida. Most abortions occurred in the early stages of pregnancy (&lt;13 weeks, 75%). Incomplete abortions were the most common type (83%), and the majority of cases were spontaneous (84%). Surgical intervention (D&amp;C) was the predominant treatment method (83%). While most patients (84%) did not experience complications, a minority faced significant health challenges, including shock (5%) and septicemia (3%). Conclusion: The study highlights a high incidence of incomplete abortions and a preference for surgical treatment in abortion cases at the tertiary hospital level in Bangladesh. These findings underscore the need for improved abortion care, enhanced patient education, and better access to comprehensive abortion services. The study's insights are crucial for informing policy and practice to improve reproductive health services and address the challenges of unsafe abortion practices in Bangladesh.

The impact of COVID-19-related restrictions on pregnancy and abortion rates in the Republic of Georgia

BackgroundThe Republic of Georgia implemented COVID-19-related restrictions starting on 31 March 2020, when it imposed a 1-month strict lockdown, after which the country continued with some form of restrictions for 1 year. These restrictions created barriers to healthcare access, affected healthcare services, caused severe economic degradation, and changed reproductive behavior. The aim of this study was to explore the impact of COVID-19-related restrictions on pregnancy and abortion rates in Georgia.MethodsInformation on pregnancy, abortion, and related variables was extracted from the Georgian Birth Registry from January 2018 through April 2022. The final study sample included 232,594 pregnancies and 86,729 abortions. We used interrupted time series analysis to study the impact of COVID-19-related restrictions.ResultsThere were slightly decreasing trends in pregnancy and abortion rates in the pre-pandemic period (1 January 2018-31 March 2020). During the 1-month strict lockdown (1 April-30 April 2020), pregnancy and abortion rates decreased in all investigated age groups. There were no substantial differences in pregnancy or abortion rates in the pandemic period (for pregnancies: 1 April 2020-30 June 2021; for abortions: 1 April 2020-30 April 2022) compared to the pre-pandemic period. The precision of all estimates suggested that both small increases and decreases in pregnancy and abortion rates are reasonably compatible with our data.ConclusionsDespite the 1-year-long COVID-19-related restrictions, our results did not indicate substantial long-term changes in pregnancy or abortion rates during the study period for any age group. This may indicate that the restrictions did not substantially influence access to contraception, abortion services, or reproductive behavior.

Clinical readiness for essential maternal and child health services in Kenya: A cross-sectional survey

High rates of maternal and neonatal morbidity and mortality in Kenya may be influenced by provider training and knowledge in emergency obstetric and neonatal care in addition to availability of supplies necessary for this care. While post-abortion care is a key aspect of life-saving maternal health care, no validated questionnaires have been published on provider clinical knowledge in this arena. Our aim was to determine provider knowledge of maternal-child health (MCH) emergencies (post-abortion care, pre-eclampsia, postpartum hemorrhage, neonatal resuscitation) and determine factors associated with clinical knowledge. Our secondary aim was to pilot a case-based questionnaire on post-abortion care. We conducted a cross-sectional survey of providers at health facilities in western Kenya providing maternity services. Providers estimated facility capacity through perceived availability of both general and specialized supplies. Providers reported training on the MCH topics and completed case-based questions to assess clinical knowledge. Knowledge was compared between topics using a linear mixed model. Multivariable models identified variables associated with scores by topic. 132 providers at 37 facilities were interviewed. All facilities had access to general supplies at least sometime while specialized supplies were available less frequently. While only 56.8% of providers reported training on post-abortion care, more than 80% reported training on pre-eclampsia, postpartum hemorrhage, and neonatal resuscitation. Providers’ clinical knowledge across all topics was low (mean score of 63.3%), with significant differences in scores by topic area. Despite less formal training in the subject area, providers answered 71.6% (SD 16.7%) questions correctly on post-abortion care. Gaps in supply availability, training, and clinical knowledge on MCH emergencies exist. Increasing training on MCH topics may decrease pregnancy and postpartum complications. Further, validated tools to assess knowledge in post-abortion care should be created, particularly in sub-Saharan Africa where legal restrictions on abortion services exist and many abortions are performed in unsafe settings.

New resources to help pharmacists provide services for contraception and medication abortion

New resources to help pharmacists provide services for contraception and medication abortion

Resilience Amid Chaos: Abortion Provision Across the United States During COVID-19.

Background: Pregnant people face many challenges to obtaining abortion services, including cost, stigma, administrative requirements, and legislative barriers. In 2020, the COVID-19 pandemic added additional barriers for clients and abortion service providers to overcome. Methods: The current study uses the Family Planning Visits During COVID-19 longitudinal dataset to explore abortion service provision from April 2020 through November 2020 from a sample of clinics (N = 63) providing abortion services across the United States. Results: Clinics in the sample were 49.2% academic/hospital-based, based in urban counties (96.8%), with a majority (82.5%) utilizing in-house providers for abortion care. Results show that the majority of clinics (59%) experienced staffing changes in response to COVID-19, including staff and clinicians who took extended leave, quit, were furloughed, or hired. Although the volume of overall abortion service provision decreased March through July 2020, the volume returned to pre-COVID numbers by August and surpassed pre-COVID volume in September and October 2020. Conclusion: Findings from this study demonstrate the adaptability and resilience shown by providers to ensure the continued availability of abortion services. Strategies adopted during COVID-19, such as telehealth and mail-delivery of abortion medication, may prove useful in a post-Roe legislative landscape.

“I wasn’t sure it would work. I was just trying”: an ethnographic study on the choice of abortion methods among young women in Kilifi County, Kenya, and Atlantique Department, Benin

BackgroundDespite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin.MethodsWe draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process.ResultsOur findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality).ConclusionOur findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.

Developing and validating an abortion care quality metric for facility and out-of-facility settings: an observational cohort study in Bangladesh, Ethiopia, and Nigeria

Despite progress in assuring provision of safe abortion, substantial disparities remain in quality of abortion care around the world. However, no consistent, valid, reliable method exists to routinely measure quality in abortion care across facility and out-of-facility settings, impeding learning and improvement. To address this need, the Abortion Service Quality Initiative developed the first global standard for measuring quality of abortion care in low-income and middle-income countries. This prospective cohort study was conducted in Bangladesh, Ethiopia, and Nigeria in 2020-2022. Participants included sites and providers offering abortion care, including health facilities, pharmacies, proprietary and patent medicine vendors (PPMVs), and hotlines, and clients aged 15-49 receiving abortion care from a selected site. 111 structure and process indicators were tested, which originated from a review of existing abortion quality indicators and from qualitative research to develop additional client-centred quality indicators. The indicators were tested against 12 clinical and client experience outcomes at the site-level (such as abortion-related deaths) and client-level (such as whether the client would recommend the service to a friend) that were expected to result from the abortion quality indicators. Indicators were selected for the final metric based on predictive validity assessed using Bayesian models to test associations between indicators and outcomes, content validity, and performance. We included 1915 abortion clients recruited from 131 sites offering abortion care across the three countries. Among the 111 indicators tested, 44 were associated with outcomes in Bayesian analyses and an additional 8 were recommended for inclusion by the study's Resource Group for face validity. These 52 indicators were evaluated on content validity, predictive validity, and performance, and 29 validated indicators were included in the final abortion care quality metric. The 29 validated indicators were feasibility tested among 53 clients and 24 providers from 9 facility sites in Ethiopia and 57 clients and 6 PPMVs from 9 PPMV sites in Nigeria. The median time required to complete each survey instrument indicated feasibility: 10min to complete the client exit survey, 16min to complete the provider survey, and 11min to complete the site checklist. Overall, the indicators performed well. However, all providers in the feasibility test failed two indicators of provider knowledge to competently complete the abortion procedure, and these indicators were subsequently revised to improve performance. This study provides 29 validated abortion care quality indicators to assess quality in facility, pharmacy, and hotline settings in low-income and middle-income countries. Future research should validate the Abortion Care Quality (ACQ) Tool in additional abortion care settings, such as telemedicine, online medication abortion (MA) sellers, and traditional abortion providers, and in other geographical and legal settings. The David and Lucile Packard Foundation and the Children's Investment Fund Foundation.

The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis.

Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.

The Provision of Abortion Care via Telehealth in the United States: A Rapid Review.

The recent Supreme Court decision Dobbs v. Jackson Women's Health that has overruled Roe v. Wade has resulted in severe limitations of abortion access throughout the United States. Telehealth has been put forth as one solution for improving access for reproductive health care, including abortion services. Telehealth has demonstrated safety and efficacy in several health care disciplines; however, its use for abortion care and services has not been explored and synthesized. As part of a larger review on telehealth and general reproductive health, our team identified a moderate amount of literature on telehealth and abortion care. We conducted a rapid review searching for eligible studies in MEDLINE, Embase, and CINAHL. Information was extracted from each included study to explore 4 key areas of inquiry: (1) clinical effectiveness, (2) patient and provider experiences, (3) barriers and facilitators, and (4) the impact of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-five studies on the use of telehealth for providing abortion services published between 2011 and 2022 were included. Telehealth for medical abortion increased during the COVID-19 pandemic and was found to be safe and clinically effective, with high patient satisfaction. Overall, telehealth improved access and removed barriers for patients including lack of transportation. Legal restrictions in certain states were cited as the primary barriers. Studies contained limited information on the perspectives and experiences of health care providers and diverse patient populations. Abortion care via telehealth is safe and effective with high satisfaction and may also remove barriers to care including transportation and fear. Removing restrictions on telehealth for the provision of abortion services may further improve access to care and promote greater health equity.

Hostilities faced by people on the frontlines of sexual and reproductive health and rights: a scoping review

Frontline workers for sexual and reproductive health and rights (SRHR) provide life-changing and life-saving services to millions of people every year. From accompanying the pregnant, delivering babies and caring for...

Reassessing the relationship between women's empowerment and fertility: Evidence from India

AbstractAn overwhelming body of evidence supports a negative relationship between women's empowerment and fertility. In this paper, we evaluate whether this relationship holds in a setting with a high degree of son preference and limited access to abortion services by focusing on rural India. We exploit the reforms to the Hindu Succession Act that improved female empowerment by mandating equal inheritance rights for women to assess the reform's impact on women's fertility. Using NFHS‐3 data and a difference‐in‐differences estimation, our results show that women who benefitted from the reform had more children than their counterparts. We attribute this increase in fertility to women's ability to use the stopping rule to achieve son preference. Finally, women impacted by the reform had a higher proportion of sons for a given family size, indicating stronger inherent son preference among treated women.

To Asses Maternal Morbidity and Mortality of Induced Abortion among Admitted Cases in Rajshahi Medical College Hospital, Rajshahi

Background: Abortion is pregnancy termination before the 24th week. Unsafe induced abortions, lacking proper skills or medical standards, cause 67,000 annual deaths in developing countries, according to WHO. Ensuring access to safe and legal abortion services is critical to reducing maternal mortality and safeguarding women's health globally. Objectives: The aim of this study was to find out maternal mortality as well as morbidity related to induce abortion for termination of unwanted pregnancy in our set up. Methods: A cross-sectional study was conducted on 92 patients who admitted as cases of induced abortion in Rajshahi Medical College Hospital from March' 2014 to September 2014Those who had given informed written consent was finally enrolled in this study. Patients' details history, clinical examination investigation, and operation note was collected in a preformed data sheet. Data was presented in the form of tables and graphs. Data was presented with descriptive statistics the level of significance of 0.05 was used for this study. Results: Among 92 patients were 15(16.3%) hemorrhage, 9(9.8%) hypovolemic shock, 10(10.9%) generalized peritonitis, 34(36.9%) pelvic peritonitis5 (5.4%) perforation of uterus, 4(4.3%) cervical injury, 1(1.1%) perforation of gut, 2(2.2%) septic shock, 2(2.2%) acute renal failure, 10(10.9%) no major complication. Among 92 patient 86 (93.5%) patients were improved and discharged and 6(6.5%) patients were expired. Conclusion: Induced abortion is a common gynecological problem requiring hospital admission and treatment. It has serious short term and long-term complications affecting women's health and life.

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners.

People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.