Previous Abortion Experience Research Articles

Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study.

Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.

Women's experiences of having an early medical abortion at home

ObjectivesThe aim of this study was to assess women's experiences of having an early medical abortion at home and to investigate their perceptions of the information provided before the abortion. The study also aimed to investigate possible differences between groups of women. Study designThe study is cross-sectional with a descriptive and comparative design. Semi-structured telephone interviews were conducted with 119 women who had undergone a medical abortion at home. ResultsAlmost half of the women (43%, n = 51) experienced the bleeding as more than expected and one-fourth (26%, n = 31) bled for more than four weeks. One-third (34%, n = 41) stated a lack of information, especially about the bleeding and pain. The experience of pain differed between groups. Women who had undergone an earlier abortion and women who had previously given birth experienced the abortion as being less painful than that experienced by first-time gravidae (p < 0.05). ConclusionsThe finding that women experience information about the pain and bleeding to be insufficient suggests that information in those areas can be improved. The result that women without previous experience of abortion or childbirth stated the pain as being worse than other groups investigated suggests that special attention should be paid to those women.

Predictors of Health Facility Delivery Service Utilization in Lemo District, South Ethiopia: Unmatched Case Control Study

Background: In Ethiopia, the level of maternal mortality is among the highest in the world [676 per 100,000 live births]. This is attributed to among other factors non use of modern health services, particularly health facility delivery. The risk of maternal death can be reduced if mothers give birth at the health facilities, where skilled birth attendants make close follow up, early detection and take corrective measures against complications. Hence, this study was aimed to assess determinant factors contributing to health facility delivery services utilization in Lemo district, South Ethiopia. Methods: Community based unmatched case control study assessed predictors of health facility delivery in Lemo district using interviewer administered questionnaire. The collected data were analyzed using SPSS version 16.0. Logistic regression analysis was done to identify predictors of health facility delivery among women who has given birth in the last three years prior to the study. Results: Family sizes of 1-4, husbands attended higher education, women occupation being merchant, husbands’ occupation being daily laborer and merchant were socio-demographic predictors of health facility delivery. In the other way, history of at least one abortion, history of still birth and receiving counselling during antenatal care were obstetric predictors of health facility delivery in Lemo district. Conclusions: Health facility delivery service utilization was significantly associated with counselling received on birth preparedness and complication readiness plan during antenatal care visit, previous experience of abortion and stillbirth. Family size of 1-4, husbands attended higher education, women occupation being merchant, husband occupation being merchant and daily laborer were also found to be associated with facility delivery. Ways to improve mothers’ awareness about maternal health services given, the benefits of receiving these services and complications related to pregnancy and delivery should be designed and implemented.

Key determinants of induced abortion in women seeking postabortion care in hospital facilities in Ouagadougou, Burkina Faso.

IntroductionDespite the universal recognition of unsafe abortion as a major public health problem, very little research has been conducted to document its precipitating factors in Burkina Faso. Our aim was to investigate the key determinants of induced abortion in a sample of women who sought postabortion care.Materials and methodsA cross-sectional household survey was carried out from February to September 2012 in Ouagadougou, Burkina Faso. Data of 37 women who had had an induced abortion and 267 women who had had a spontaneous abortion were prospectively collected on sociodemographic characteristics, pregnancy and birth history, abortion experience, including previous abortion experience, and selected clinical information, including the type of abortion. A two-step regression analysis consisting of a univariate and a multivariate logistic regression was run on Stata version 11.2 in order to identify the key determinants of induced abortion.ResultsThe findings indicated that 12% of all abortions were certainly induced. Three key factors were significantly and positively associated with the probability of having an induced abortion: whether the woman reported that her pregnancy was unwanted (odds ratio [OR] 10.45, 95% confidence interval [CI] 3.59–30.41); whether the woman reported was living in a household headed by her parents (OR 6.83, 95% CI 2.42–19.24); and if the woman reported was divorced or widowed (OR 3.47, 95% CI 1.08–11.10). On the contrary, being married was protective against induced abortion, with women who reported being married having an 83% (OR 0.17, CI 0.03–0.89) lower chance of having an induced abortion, even when the pregnancy was unwanted.ConclusionThis study has identified three major determinants of induced abortion in Ouagadougou, Burkina Faso. Improved targeted programs on family planning counseling, methods of contraception, and availability of contraceptives should be widely promoted.

Prevalence and Risk Factors of Intimate Partner Violence Among Pregnant Women in Japan

Intimate partner violence (IPV) during pregnancy can result in adverse outcomes for both mothers and their infants. This cross-sectional study examined the prevalence and risk factors of IPV associated with abuse during pregnancy via a self-administered questionnaire completed by 302 healthy pregnant women. Demographic information was also collected from medical records to analyze risk factors for abuse. Of the 302 women, 48 (15.9%) were identified as experiencing IPV. The identified risk factors were age over 30, multipara, previous abortion experience, and male partner aged under 30.

Determinants of late prenatal care initiation by African American women in Washington, DC.

The objective of this study was to identify the determinants of late prenatal care (PNC) initiation among minority women in Washington, DC. DC-resident, African American women (n = 303) were recruited at 14 PNC facilities, representing the various types of PNC facilities located in DC: 4 hospital-based clinics, 5 community-based clinics, and 5 private practices. The women were interviewed at their first prenatal care visits to determine their perceptions of 63 barriers, motivators and facilitators influencing PNC initiation; substance use; and sociodemographic background. PNC initiation was classified as early (prior to the 20th week of gestation) or late (after the 20th week of gestation). The responses of women who initiated PNC early versus late were compared using bivariate and multivariate statistical procedures. Classification and Regression Trees analysis was used to identify groups at risk of late initiation. Variables contributing to late PNC initiation included maternal age not between 20 and 29 years, unemployment, no history of previous abortions, consideration of abortion, lack of money to pay for PNC, and no motivation to learn how to protect ones health. Three risk groups for late PNC initiation included 1) women consideringabortion and not employed outside their homes; 2) women not considering abortion who had no previous abortion experience; and 3) teenagers not considering abortion and with no previous abortions. The results of this study indicate that psychosocial barriers are more important than structural barriers. Of the psychosocial barriers, the major determinants of late PNC initiation were consideration of abortion and previous abortion experience.

Contraceptive risk-taking in women and men facing legal abortion

Objective: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners. Methods: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners. Results: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception. Conclusion: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

Contraceptive risk-taking in women and men facing legal abortion

Objective: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners.Methods: Twohundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women andwomen with a partner relationship, and women whose partner participated in the study and the male partners.Results: The main findings showed that there are more similarities than differencesbetween the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to beolder, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibilityfor preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasonsfor not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception.Conclusion:In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

Beliefs, Attitudes, and Intention in the Context of Abortion1

Women's beliefs, attitudes, and intention, defined according to Fishbein and Ajzen (1975), were studied in relation to procedures for abortion: a commonly used surgical method, vacuum aspiration, and a recent medical alternative. Subjects were 53 women requesting an abortion and 53 nonpregnant women. Effects of having had an abortion prior to the study and of situation were obtained as expected in belief ratings and attitude measures. Choice of the medical alternative was related to having distinctly opposite attitudes to methods. Choice of the surgical treatment related to having slightly negative attitudes to both methods. In the actual situation more positive attitudes had been expected and were obtained. Previous experience of abortion and situation were assumed to be external factors with effects on intention if mediated by the attitudes. A logistic regression model showed a good fit and predicted the intentional choice of treatment from attitude scores.

Postabortion Dysphoria and Religion

This study explores psychosocial factors, especially religion, in women identified as dysphoric 1 to 15 years after abortion. The Millon Clinical Multiaxial Inventory (MCMI) and a demographic questionnaire were mailed to patient-led support groups for women who had poorly assimilated a previous abortion experience. Of the 150 surveys mailed, 71 (47%) were returned. Thirty-three women (46%) stated they had changed to a Fundamentalist or Evangelical church. On the MCMI, members of these conservative denominations scored significantly lower on the subscales for passive-aggressive behavior, ethanol abuse, and avoidance. Religion was strongly perceived by the women as playing a healing role. These findings suggest that conservative personal values may be more critical in understanding attitudes toward abortion than other demographic characteristics. Previous follow-up studies that reported no change in postabortion religiosity may have been too short to detect changes in religion. Implications for treatment of postabortion dysphoria include sensitivity to patients' religious beliefs, with support for the healing aspects of their religion.