RESUMEN
Because of a growing cultural and religious sensitivity and controversy over reproductive health issues, particularly abortion, this area remains relatively unexplored in Egypt. This study was conducted using a participatory approach to determine the morbidity and determinants of abortion in rural Upper Egypt. In all, 1025 women from six villages in Upper Egypt were included in the study. Information regarding the incidence of abortion, patterns of health care utilization and risk factors was obtained using a structured interview format. The local dialect was used in formulating questions and they were revised and amended by a panel of local leaders, interviewers and representatives of the study population. Interviewers were local educated (secondary or university level) female volunteers. Information about exposure to 17 risk factors was also collected and statistical analysis was done by estimating the odds ratio and applying a test of statistical significance. Then, a multivariate logistic regression model was applied to control for possible interactions and confounding effects. The results were that 40.6% (n=416) had aborted at least once; of them 24.6% (n=252) had aborted more than once and were designated as recurrent aborters. The lifetime prevalence of recurrent abortion was estimated to be 25% and nearly 21% of pregnancies were aborted. The incidence of abortion was estimated to be 265 per 1000 live birth. Only 21.9% (n=91) of women received medical care for the last abortion. The vast majority of women (92%, n=299) who did not seek medical help received help from traditional and domestic sources. These sources are midwife (59.9%, n=179), relative or neighbour (29.8%, n=89), and traditional practitioner (10.4%, n=31). The multivariate analysis revealed that the incidence of abortion is significantly associated with gravidity, consanguinity, and mother occupation, while recurrent abortion is associated with gravidity, consanguinity and woman's age at marriage. In conclusion, the morbidity of abortion is a serious public health problem in Egypt. Because the incidence rate is very high and because safe abortion is limited in Egypt, maternal mortality due to abortion is expected to be underestimated. Promotion of family planning is expected to have a significant impact on the incidence of abortion in Upper Egypt.
Asunto(s)
Aborto Inducido/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto , Egipto/epidemiología , Servicios de Planificación Familiar , Femenino , Humanos , Embarazo , Factores de Riesgo , Vigilancia de Guardia , Clase SocialRESUMEN
OBJECTIVE: To analyse the process in making decisions leading to termination of pregnancy in the third trimester and to evaluate the maternal morbidity associated with this procedure. DESIGN: Retrospective study. SETTING: The Maternité Port Royal University Hospital, Paris, France. POPULATION: A consecutive series of 956 terminations of pregnancy performed for fetal anomalies in singleton pregnancies, 305 of which were in the third trimester and 651 in the second. MAIN OUTCOME MEASURES: Indications for termination of pregnancy; process leading to late termination of pregnancy; maternal morbidity. RESULTS: One hundred and thirteen (37%) third trimester terminations of pregnancy were associated with false negative resulted from the results of earlier screening tests. In 15 terminations (5%), the decision was postponed, although the poor fetal prognosis was established earlier. In 55 (18%) the diagnosis was not possible earlier than the third trimester, and in 122 (40%) the diagnosis was possible earlier but the poor prognosis for the fetus was not established until the third trimester. Maternal morbidity due to termination of pregnancy was similar in the second and third trimester. CONCLUSION: One-third of late terminations of pregnancy could have been avoided by more efficient screening in the second trimester. However, because fetal prognosis is not always clear when a malformation is diagnosed, postponing the decision until fetal development allows more thorough evaluation and may avoid unnecessary termination of pregnancy in the second trimester. This could be the main beneficial aspect of not setting a limit to the gestational age for performing termination of pregnancy.
PIP: The processes associated with late terminations of pregnancies with a fetal abnormality were assessed in a retrospective study of 956 consecutive second- and third-trimester abortions performed at the Maternite Port Royal University Hospital in Paris, France, in 1986-94. 651 of these terminations were performed in the second trimester and 305 in the third trimester. The main indications for third-trimester abortion were neurologic anomalies, multiple malformations with a normal karyotype, and chromosomal anomalies diagnosed after an abnormal routine ultrasound scan. In 55 cases (18%) of third-trimester induced abortion, the anomaly could not have been diagnosed before the third-trimester. This group included cases of autoimmune hydrops occurring in the third trimester, Down's syndrome revealed by sonographic anomalies, and structural chromosomal anomalies revealed by intrauterine growth restriction or caused by cytomegalovirus infection. In an additional 122 (40%) of the third-trimester abortions, the prognosis of the anomaly could not have been established firmly until the third trimester, even though prenatal diagnosis was feasible earlier. The majority of these cases involved cerebral ventriculomegalies. In another 15 cases (5%), the poor prognosis of the fetus was established in the second trimester, but the termination was postponed, either by the physician or because the couple required more time to reach a decision. In the final 113 cases (37%), the condition for which pregnancy termination was performed in the third trimester could have been identified earlier in pregnancy, but screenings during the second trimester resulted in false-negative findings. Myelomeningocele, trisomy 18 and 13, and lethal dwarfism accounted for the majority of these potentially avoidable third-trimester terminations.
Asunto(s)
Aborto Inducido , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Aborto Inducido/efectos adversos , Aborto Inducido/métodos , Reacciones Falso Negativas , Femenino , Humanos , Embarazo , Tercer Trimestre del Embarazo , Diagnóstico Prenatal , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: Maternal mortality from complications of unsafe abortion constitutes a serious problem in several developing countries. There is, however, a paucity of well-designed and implemented studies in this area, especially in Latin America. The aim of this paper is to present the findings on the determinants and medical characteristics of abortions among women admitted to hospitals. METHODS: A descriptive cross-sectional hospital-based study was carried out between October 1992 and September 1993 in Fortaleza, Brazil. A Cox's proportional hazard model was used to estimate prevalence rate ratios after adjustment for confounding. RESULTS: Among 2074 (48%) women who admitted to terminating the pregnancy, 66% reported using misoprostol to induce abortion. Women with an induced abortion as compared with those with an unlikely induced abortion are younger, more often not married, have fewer children alive and experienced one or more previous induced abortions. We have not found any important differences with regard to complication or duration of stay in hospital. CONCLUSIONS: This finding, at odds with most previous studies, could reflect the special situation in Brazil where misoprostol is used for illegally-induced abortion. The use of misoprostol by this population may have contributed to the reduction of severe complications related to induced abortion which were most prevalent with more invasive methods. Recommendations are made as to the need for confirmatory studies as well as on information regarding cultural perceptions and concepts of abortion, and reasons why poor women fail to adopt available family planning methods.
PIP: The characteristics of induced abortion were investigated among women admitted to two public maternity hospitals in Fortaleza, Brazil, in 1992-93. A total of 4359 women admitted to the hospitals during the 12-month study period with a diagnosis of pregnancy loss were interviewed. 48% of abortions were classified as certainly induced, 40% as possibly induced, and 12% as spontaneous. 1369 (66%) of the 2074 women with certainly induced abortion reported use of misoprostol (mean dose, 400 mcg; range, 200-2400 mcg). Although sales of this abortifacient were suspended in 1991 due to concerns about congenital malformations in unsuccessful procedures, the drug remains widely available on the black market. Compared with women with an unlikely induced abortion, women with a certainly induced abortion were significantly younger, more often unmarried, had fewer living children, and were more likely to have experienced one or more previous induced abortions. The risk of infection was increased by 40% in women with certain induced abortion above that of women with unlikely induced abortion. There were no significant differences between groups in terms of the complication rate or duration of hospital stay. The use of misoprostol in this series may have contributed to the relatively low rate of severe abortion-related complications. Wider availability of emergency contraception could reduce the need for unsafe abortion in Brazil.
Asunto(s)
Aborto Inducido , Complicaciones Posoperatorias , Abortivos no Esteroideos , Aborto Criminal , Adolescente , Adulto , Brasil , Estudios Transversales , Femenino , Hospitalización , Humanos , Masculino , Misoprostol , Embarazo , Modelos de Riesgos Proporcionales , Factores SocioeconómicosRESUMEN
The purpose of the study was to seek knowledge about the reasons for the very high rate of legal abortions in Greenland. In four municipalities in the Disko Bay region of West Greenland all pregnant women were asked to fill in a questionnaire. Due to organisational problems only 39% of the women were asked to participate and a total of 82 women seeking abortion and 175 women who wished to continue the pregnancy were enrolled in the study. A few Danish women (22) were subsequently removed from the study base. The women who wanted an abortion were more often than the other women single, their knowledge of Danish as a second language was poorer, and they less often had a job. Although the age distributions of the two groups were similar the women who wanted an abortion had more often been pregnant before (more births and more abortions). The women who wanted an abortion more often than the other women reported having been drunk, having had a pelvic inflammation or VD, and having been admitted to hospital. Half of the women who wanted an abortion reported that they had forgotten to use their contraception and one fourth were opposed to the use of contraception. There seems not to be a well defined high risk group for legal abortion but a general need for a more realistic view on contraception.
PIP: The purpose of this study was to determine the reasons for the very high rate of legal abortions in Greenland. In four municipalities in the Disko Bay region of West Greenland all pregnant women were asked to fill out a questionnaire. Due to organizational problems, only 39% of the women were asked to participate and a total of 82 women seeking abortion and 175 women who wished to continue their pregnancy were enrolled in the study. A few Danish women (22) were subsequently removed from the study base. The women who wanted an abortion were single more frequently than the other women, their knowledge of Danish as a second language was poorer, and they less frequently were employed. Although the age distributions of the two groups were similar, the women who wanted an abortion had more previous pregnancies (more births and more abortions). The women who wanted an abortion, more frequently than the other women reported having been drunk, having had a pelvic inflammation or venereal disease, and having been admitted to a hospital. Half of the women who wanted an abortion reported that they had forgotten to use their contraception and one-fourth were opposed to the use of contraception. There seems not to be a well defined high-risk group for legal abortion but a general need for a more realistic view on contraception. (author's modified)
Asunto(s)
Solicitantes de Aborto , Aborto Inducido , Aborto Inducido/estadística & datos numéricos , Conducta Anticonceptiva , Servicios de Planificación Familiar , Femenino , Groenlandia/epidemiología , Groenlandia/etnología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Embarazo , Estudios Prospectivos , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Most research on abortion has focused on women's characteristics at the time of the procedure, but individuals' behavior may also be shaped by their experiences from younger ages. This study uses longitudinal data on 351 California white women aged 27-30 in 1990-1991 to identify characteristics in childhood and adolescence that predict who will have a nonmarital first pregnancy and, of those who do, which women will seek an abortion. Bivariate analyses reveal that psychosocial characteristics indicating a strong sense of autonomy, such as feeling it is important not to be tied down and engaging in socially undesirable behavior, are significantly associated with the likelihood of having a nonmarital first pregnancy (odds ratios of 1.7 and 1.5, respectively), but family characteristics are not. However, among women who have a first pregnancy out of wedlock, the odds of having an abortion are mostly influenced by family rather than psychological characteristics, particularly having been a good student and having a well-educated mother (2.0 and 1.7).
PIP: This study identifies key predictors of a nonmarital first pregnancy and of abortion resolution. Potential predictors include family characteristics and eight psychosocial traits during childhood and adolescence. Data were obtained from 351 eligible women who were members of the Kaiser Health Plans in the San Francisco Bay Area during 1990-91. The sample included White women presenting for prenatal care and White women born between March 1960 and March 1963. Findings show that 217 had ever been pregnant. 38% had a first pregnancy within marriage. 62% had a pregnancy out of wedlock. 6% used abortion to terminate the nonmarital pregnancy. Family characteristics had no effect on the likelihood of having a nonmarital first pregnancy. The best predictors were psychosocial characteristics. Women with a nonmarital first pregnancy were more likely to be more unconventional: negative feelings about being tied down, boyish or socially undesirable behavior, feeling free to disagree with their father, temperamental behavior, and experience with nightmares. These women began intercourse earlier than other women and during adolescence. In the multivariate model, the important predictors of age at first nonmarital pregnancy were the feeling that it was important not to be tied down, boyishness, and believing it was less important to obey the law. A comparison between women with a nonmarital first pregnancy and women with a first pregnancy within marriage revealed that women with an out of wedlock pregnancy were 2 times more likely to feel it was important not to be tied down and to have had nightmares as a child. Family characteristics were a good predictor of abortion outcomes. Women who chose abortion were much more likely to have been good students at ages 9-11 years and to have well-educated mothers. Other good predictors included fewer siblings at home during their youth, higher scores on standardized tests, and better educated fathers. The logistic model reveals that only number of siblings and maternal education were significant. Significant psychosocial characteristics of abortion included willingness to disobey the law and the belief that it was not important to be dependable.
Asunto(s)
Aborto Inducido/psicología , Ilegitimidad/psicología , Adulto , California , Bases de Datos Factuales , Composición Familiar , Femenino , Estudios de Seguimiento , Libertad , Humanos , Ilegitimidad/estadística & datos numéricos , Oportunidad Relativa , Relaciones Padres-Hijo , Padres/educación , Paridad , Embarazo , Embarazo no Deseado/psicología , Embarazo no Deseado/estadística & datos numéricos , Análisis de Regresión , Factores de Riesgo , Muestreo , Persona Soltera/psicología , Responsabilidad Social , VocabularioRESUMEN
This study analyses an economic model of pregnancy resolution; that is, a model of the choice by a pregnant woman to abort her fetus or carry it to term. This analysis, using an analytical model derived from the household utility framework, adds to previous research by presenting race- and residence-specific estimates of how individual characteristics, history of abortion, and the community-based factors determine women's choices of giving birth vs. aborting. The main data for estimating the model were drawn from the 1984 vital statistics of all induced abortions and live births in the Commonwealth of Virginia. The major findings indicate that low parental education, high maternal age, previous early abortions, and the availability of abortion providers all significantly reduce the probability of choosing the live birth option. Married status and the availability of family planning clinics significantly increase the probability of the live birth option. The findings also suggest that women's choices between abortion and live birth vary substantially with race (White vs. Black) and residential (urban vs. rural) location.
Asunto(s)
Aborto Inducido , Negro o Afroamericano , Toma de Decisiones , Escolaridad , Servicios de Planificación Familiar , Planificación en Salud , Accesibilidad a los Servicios de Salud , Estado Civil , Edad Materna , Modelos Teóricos , Población Rural , Población Urbana , Población Blanca , Factores de Edad , Américas , Conducta , Tasa de Natalidad , Cultura , Demografía , Países Desarrollados , Economía , Etnicidad , Fertilidad , Matrimonio , América del Norte , Organización y Administración , Padres , Población , Características de la Población , Dinámica Poblacional , Evaluación de Programas y Proyectos de Salud , Investigación , Clase Social , Factores Socioeconómicos , Estados Unidos , VirginiaRESUMEN
This study investigated the factors associated with the obtaining of a second-trimester induced abortion in women consulting the Family Planning Clinic of Le Centre Hospitalier de l'Université Laval in Quebec City, between September 6, 1988 and May 11, 1990. During the study period, 2,771 women obtained abortions at between six and 16 weeks of gestation in a multidisciplinary setting. Of 18 independent variables entered in a stepwise multiple regression analysis, ten made independent contributions to explain the variance at least at the p < 0.05 level of statistical significance. Taken together, these ten variables explained 9.4% of the total variance in gestational age: being young; having a low level of education; living far from the clinic; having other children; having a sexually transmitted disease before the abortion; not using contraception or using oral contraceptives at the time of conception, or being sterilized or having a sexual partner who has had a vasectomy; having had few sexual partners in the year preceding the abortion; not having a significant relationship with a regular sexual partner; being ambivalent about the decision to abort; and having a delay between the first consultation with the clinic and the abortion.
PIP: Researchers analyzed data on 2771 women who underwent an induced abortion at the family planning clinic of Le Centre Hospitalier de l'Universite Laval in Quebec City in Canada between September 6, 1988, and May 11, 1990, to identify factors related to second trimester abortion. 281 (10.1%) women had undergone a second trimester abortion (gestational age, 13-16 weeks). 10 of the 18 independent variables in the stepwise multiple regression analysis made significant contributions to explain variance. Overall, these 10 variables explained 9.4% of the total variance. Factors associated with induced abortion at later gestational age were: being young (age 20 years) (odds ratio [OR] = 4.06; p 0.001); having less than 16 years of schooling (p = 0.013 for 13-15 years and p = 0.002 for 0-12 years); living far from the clinic (200 km) (OR = 2.04; p 0.001); having other children (p = 0.004); having had few sexual partners during the year before the abortion (OR = 1.53; p = 0.001); diagnosis of a sexually transmitted disease at the time of the abortion (p = 0.038); using oral contraceptives (OR = 2.14; p 0.001); benefiting from sterilization (OR = 1.81; p = 0.008); no contraceptive use at time of conception (OR = 1.94; p 0.001); lacking significant relationship with sexual partner (OR = 1.55; p 0.001); ambivalence about decision to undergo abortion (OR = 1.8; p 0.001); and delay between first consultation and abortion (p = 0.003). The major determinant of second trimester abortion was age (regression coefficient [RC] = 1.400; 95% confidence interval [CI] = 2.59-6.34), followed by place of residence (RC = 0.711; CI = 1.52-2.73). These results point out the importance of personal characteristics, psychological factors, and environmental influences as determinants of gestational age at the time of abortion.
Asunto(s)
Aborto Inducido , Aborto Inducido/psicología , Adulto , Factores de Edad , Femenino , Humanos , Modelos Logísticos , Oportunidad Relativa , Embarazo , Segundo Trimestre del Embarazo , Quebec/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVE: To study the impact of marital status, age and parity on the decision regarding pregnancy termination over time among pregnant Norwegian women. DESIGN: National surveillance data of induced abortions and births. MATERIAL: All women terminating their pregnancies (n = 174,590) as registered in the Abortion File in the Central Bureau of Statistics and all women giving birth (n = 639,551) as registered in the Medical Birth Registry of Norway between January 1, 1979 and December 31, 1990 were eligible for the study. Included in the analysis of pregnancy outcome were records with complete information on marital status, age and parity, which comprise 93.8% (n = 163,826) of all women having had an induced abortion and 99.0% (n = 633,542) of all women giving birth during the time period. OUTCOME MEASURE: The proportion of pregnancies terminated as induced abortions and the relative risk of pregnant women choosing abortion in strata of marital status, age and parity. STATISTICAL METHODS: Trend analysis of the proportion of pregnancies terminated as induced abortions in different time periods in categories of marital status, age and parity. RESULTS AND CONCLUSION: From the first three-year period 1979-81 to the last three-year period 1988-90 there was a decreasing tendency to choose abortion among unmarried pregnant women above 20 years of age and married women with two or more children. In the other strata of marital status, age and parity there were no changes over the time period, except for married women 20-24 years of age which was the only group that showed an increasing abortion tendency over the time period. The prospect of single parenthood was the strongest determinant for choosing abortion independent of age and parity. Within all age groups of married women the abortion tendency increased more with parity than age. Cohabiting women chose abortion significantly more often than married women did. However, the true estimate of choosing abortion among cohabiting women was closer to married women than to single women. In order to find out the importance of other social factors and attitudes in the decision making process regarding pregnancy outcome, adjustments must be made for marital status, age and parity.
PIP: Data from the Abortion File of the Central Bureau of Statistics in Norway for 1979-90 were used to examine the relative risks of induced abortion among groups varying by marital status, age, and parity for four 3-year time periods. Between January 1979 and December 1990, 639,551 births were registered and 174,590 pregnancies were terminated by abortion. The mean number of induced abortions in three-year periods increased from 12,800 to 14,600 (14%), and births increased from 50,700 to 58,800 (16%). The two prominent groups having abortions were unmarried women without children aged less than 30 years (40%) and married women with 2 or more children. Declines in abortion occurred among married women with two or more children, from 24% of all abortions in 1979-81 to 15% in 1988-90. Unmarried, pregnant women aged more than 20 years of age experienced a decline in abortion terminations. Unmarried teenage abortions remained stable. Pregnancy terminations increased primarily for married women aged 10-24 years without children. The lowest group with abortions comprised married childless women aged 25-29 years: the reference group. Unmarried women, regardless of age and parity, ended their pregnancies 40-50 times more often than the reference group. Registration of data affected the data by overestimation of abortions among single teenagers by 4% for all time periods. Although abortions increased among unmarried women aged over 20 years, there was still a decline in the proportion of pregnancies terminated by abortion among unmarried women aged over 20 years. Births among cohabiting or unmarried women increased more than the relative number of abortions among unmarried women. Cohabitation increased from 12% in 1977 to 30% in 1988. The suggestion was that the decreasing trend in abortion among pregnant unmarried women might be related to the changes in consensual unions. Data from the 1988 Norway Fertility Survey found that 40% of births were to childless married couples not using contraception, and 5% of abortions occurred among this same group. This means that prevention of unplanned pregnancies would reduce births more than abortions.
Asunto(s)
Aborto Inducido , Estado Civil , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Edad Materna , Noruega , Paridad , Embarazo , Resultado del Embarazo , Factores de RiesgoRESUMEN
PIP: Induced abortion remains a relatively uncharted research topic in medical demography, social science, and to a lesser extent, in epidemiology. Up to 20% of the 500,000 maternal deaths which occur annually throughout the world, however, may be a consequence of complications of unsafe abortion procedures. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction started a number of studies in 1989 in developing countries on the determinants and consequences of induced abortion. The program's research has produced a wealth of data, with many countries taking important steps to change abortion policy in the interest of improving reproductive health. For example, a study in Mauritius of women hospitalized for abortion revealed that 20% of them had not been using a method of contraception when they became pregnant; a motion was subsequently tabled in the National Assembly to decriminalize abortion. Another study in Chile showed the incidence of induced abortions to be generally under-reported by women and that interventions based upon sound policy can reduce their incidence and improve reproductive health.^ieng
Asunto(s)
Aborto Inducido , Legislación como Asunto , Política Pública , Investigación , África , África del Sur del Sahara , África Oriental , África del Norte , Américas , Chile , Países en Desarrollo , Servicios de Planificación Familiar , América Latina , Mauricio , América del SurRESUMEN
In general, it can be concluded that the initiative on the determinants and consequences of induced abortion has shown some important patterns. For example, induced abortion is not restricted to adolescents but occurs also within marriage to limit family size. Induced abortion is prevalent both where family planning services are available and contraceptive prevalence is high as well as where family planning is not common, but for different reasons. In the former, motivation to limit family size is high and women would use any option if contraception fails or an unwanted pregnancy occurs. In the latter case, induced abortion forms part of a mix of incipient fertility regulation alternatives, most of which are traditional and of little effectiveness but including some use or improper use of modern methods. Few abortion seekers, and among them even fewer adolescents, were using a modern contraceptive at the time the pregnancy started. High use of traditional methods in some countries leads to abortion as women/couples fail to follow proper instructions with regards to the safe period. Unsafe clandestine abortions are more likely to be sought by poorer women and by adolescents. The findings of this research are increasingly being used to question the legal status of abortion in countries where the law is restrictive, or to strengthen family planning efforts in order to reduce abortion incidence.
Asunto(s)
Aborto Inducido , Demografía , Estudios de Evaluación como Asunto , Prevalencia , Servicios de Planificación Familiar , Población , Proyectos de InvestigaciónRESUMEN
PIP: Study results suggested that Korea's family planning program must shift to the promotion of a balanced sex ratio and prevention of induced abortion. The abortion rate increased markedly until the mid-1980s and then stabilized. The number of abortions almost equalled the number of live births. Retrospective data from the 1991 National Fertility and Family Health Survey of Korea were used to examine the determinants of pregnancy outcomes. The sample included 8475 pregnancies at parity 0, 7947 at parity 1, 5358 at parity 2, and 3437 at parity 3 or higher. An interesting finding was that families with 2 girls reported a very high number of spontaneous abortions since 1985: over 10% (41/389). The number of spontaneous abortions among families with 1-2 male children was only 3% (22/718). Among childless parents only 27% of pregnancies were aborted, while among one-child families 46% were aborted and among two-child families 81% were aborted. From before 1975 until after 1985, abortions among childless parents increased from 10% to 30%. This increase was accounted for by the increased number of premarital pregnancies, which were greater among middle and high school graduates. The abortion rate was high for pregnancies occurring at least 8 months before marriage and for pregnancies of more highly educated recent cohorts occurring earlier than 7 months before marriage. The probability of abortion was 3% for cohorts prior to 1974 with one son and 9% for the recent cohort (1985 and later). This shift may reflect a changed preference for smaller families and son preference. About 40% of pregnancies resulted in a live birth among families with 2 daughters in the most recent cohort. The probability of abortion was 33% higher among families with 2 boys in the earliest cohort than families without a son. The effect of education on pregnancy outcome varied with parity and time period. The abortion rate was higher among educated women, which meant less effective contraceptive methods. Urban families had higher abortion rates. 80% of pregnancies occurring while using contraception and 90% of pregnancies occurring while using none were terminated. The sex ratio at birth in 1990 was 117 males per 100 females and exceeded 2.0 males per 1.0 females for parities of 3 and higher. Recommendations were for services for the unmarried, wider choice of reversible, effective methods, and for weakening son preference through institutional and social support policies.^ieng
Asunto(s)
Aborto Inducido , Tasa de Natalidad , Estudios de Cohortes , Anticoncepción , Encuestas Epidemiológicas , Ilegitimidad , Resultado del Embarazo , Razón de Masculinidad , Sexo , Factores Socioeconómicos , Asia , Conducta , Conducta Anticonceptiva , Demografía , Países en Desarrollo , Economía , Servicios de Planificación Familiar , Asia Oriental , Fertilidad , Salud , Corea (Geográfico) , Población , Características de la Población , Dinámica Poblacional , Embarazo , Psicología , Reproducción , Investigación , Distribución por Sexo , Factores Sexuales , Conducta Sexual , Valores SocialesRESUMEN
PIP: The finding that adolescents comprised 16.4% of 2588 cases of women with post-abortion complications treated at a Sao Paulo, Brazil, hospital during 1978-92 led to an analysis of the biological and demographic factors associated with induced abortion among women under 20 years of age. Compared to abortion patients 20 years of age and above, adolescents in this study were more likely to be single, work in domestic service, to opt for abortion rather than pregnancy continuation, and to delay abortion to 14-20 weeks of gestation. The average age at menarche in the study population as a whole was 13.4 years, with a range of 9-19 years. 81.4% initiated sexual intercourse before the age of 14 years (range, 10-39 years). The average difference between age at menarche and age at first intercourse was 2.8 years for adolescent abortion seekers compared to 5.9 years for older women, while the difference between age at first intercourse and age at onset of first pregnancy was 1.3 years among adolescents compared to 4.8 years for older women. The finding that young women are at risk of an unwanted pregnancy soon after menarche should be considered in the design of adolescent health care services.^ieng
Asunto(s)
Solicitantes de Aborto , Aborto Inducido , Adolescente , Coito , Menarquia , Embarazo en Adolescencia , Conducta Sexual , Estadística como Asunto , Factores de Edad , Américas , Conducta , Brasil , Demografía , Países en Desarrollo , Servicios de Planificación Familiar , Fertilidad , América Latina , Menstruación , Población , Características de la Población , Dinámica Poblacional , Reproducción , Investigación , América del SurRESUMEN
PIP: A longitudinal study of young women's pregnancy resolution decision making provided evidence of the important role of significant others; also observed was a positive association between prior adoption socialization experiences and the choice of adoption. Conceptual approaches to decision making considered in the analysis included opportunity structures, socialization, social networks, and expectancy value theory. Subjects included 527 unmarried women 21 years of age or younger who were recruited from US maternity residences and prenatal clinics. Mean age was 17 years; 73% of subjects were White. On a descriptive level, the adoption choice was more frequent among White women (55%), and those with above-average educational aspirations (51%). When the subject's mother was in favor of placement, 75% chose adoption and only 18% kept the child; when the boyfriend wanted adoption, these statistics were 82% and 34%, respectively. If the subject or a close relative had been adopted, 59% chose adoption and 39% kept the child. Next, logistic regression was used to develop a multivariate analysis of pregnancy resolution decisions. The most significant (p 0.001) determinants of pregnancy choice were mother wants placement of child, close relative wants placement, and the expectancy that the quality of the mother and child's life would be adversely influenced by keeping the child. Significant at the 0.01 level were not having a boyfriend or having a boyfriend who wants placement. Only 1 demographic variable--women in an age-appropriate grade--was significantly associated with adoption. Since adoption is selected by less than 3% of US women, this outcome was overrepresented in this sample by the inclusion of maternity homes as a recruitment site.^ieng
Asunto(s)
Aborto Inducido , Adopción , Toma de Decisiones , Madres , Embarazo , Parejas Sexuales , Persona Soltera , Estadística como Asunto , Américas , Conducta , Crianza del Niño , Demografía , Países Desarrollados , Composición Familiar , Servicios de Planificación Familiar , Relaciones Familiares , Fertilidad , Estado Civil , Matrimonio , América del Norte , Padres , Población , Dinámica Poblacional , Investigación , Conducta Sexual , Estados UnidosRESUMEN
PIP: In Uganda, university students interviewed 1180 abortion cases admitted to the gynecological emergency ward at New Mulago Hospital in Kampala during 1983-1987 to examine the magnitude of induced abortion at this referral/teaching hospital. Obvious induced abortions, probable induced abortions, and spontaneous abortions comprised 25.4% (300), 40.7% (480), and 33.9% (400), respectively. Further analysis was only conducted on the 300 induced abortion cases. All but 4% (12) of induced abortion cases were younger than 25. Adolescents comprised 67.7% of all induced abortion cases. No one over 34 had an induced abortion. Most induced abortion cases (79%) had never been married. Induced abortion was most common among students (49.7%) and single working women (30.3%) and least common among full-time housewives (5.7%). Induced abortion had a positive association with education (no schooling = 1.3%, primary = 2%, secondary = 53.7%, and university = 23.7%). Christians were more likely to undergo induced abortion than Moslems (43.3% for Protestants and 46.3% for Catholics vs. 10.3% for Moslems). Most of the induced abortion cases had been pregnant with their first pregnancy (57.3%). The main method of pregnancy termination was dilatation and curettage (53.3%). Physicians (91%) performed most of the induced, albeit illegal, abortions. 56.6% of induced abortion patients stayed in the hospital for no more than 13 days. Patients who stayed for more than two days had serious complications, including hemorrhage (39.7%), sepsis (21%), and genital perforation (15.3%). The main reasons the women sought an induced abortion were desire for more education (48.7%) and fear of parents (25.7%). The induced abortion related mortality rate was 3.3%. These induced abortion cases were probably faced with an unwanted pregnancy. Most knew about family planning, but had not used any of family planning methods. Liberalization of contraception and reform of the abortion law should occur to provide women family planning and legal, inexpensive, and safe abortion services.^ieng
Asunto(s)
Aborto Criminal , Aborto Inducido , Aborto Séptico , Anticoncepción , Consejo , Necesidades y Demandas de Servicios de Salud , Encuestas Epidemiológicas , Hospitales , Legislación como Asunto , África , África del Sur del Sahara , África Oriental , Instituciones de Atención Ambulatoria , Atención a la Salud , Países en Desarrollo , Enfermedad , Economía , Servicios de Planificación Familiar , Salud , Instituciones de Salud , Planificación en Salud , Complicaciones del Embarazo , UgandaRESUMEN
Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.
PIP: The effects of Chernobyl on pregnancy outcome were investigated in Norway in terms of legal abortions, early spontaneous abortions, total pregnancies, and perinatal health problems (cataracts, microcephaly, low birth weight, and perinatal mortality). The epidemiological results showed that there were no serious gross changes in pregnancy outcome in Norway after Chernobyl in 1986. Anxiety may have led to the temporary decrease in pregnancies. The statistically significant difference in spontaneous abortions between 19867 and 1987, particularly in the months following Chernobyl, may be related but causation cannot be determined based on the present data; i.e., dietary changes due to anxiety may also be related. Further analyses will be conducted with data spanning 5 years after Chernobyl. The Central Bureau of Statistics provided data on legal abortions as reported by hospitals to county medical officers. Spontaneous abortions (16 weeks) are based on ad hoc notifications from hospitals in 5 counties: Aust-Agder, Hordaland, Oppland, Troms, and Trondelag. Compulsory notification of births is recorded in the Medial birth Registry and includes congenital malformations and other perinatal health problems. The National Institute of Radiation Hygiene recorded data after the accident on indoor gamma rates, radiocesium (Cs 134) soil samples, and municipality specific average food-based dose equivalents of Cs 134 and 137 in meat and meat supplies. The total external and internal dose is provided for May 1986-April 1989. Food-based doses remained at an elevated level for an extended period of time. Infant exposure was considered form the 2nd month of gestation. Legal abortions, induced or spontaneous, were not impacted by Chernobyl, but the effect may have been delayed to the 3rd or 4th quarter with a 1.0% increase. However, at Haukeland Hospital in Bergen, the highest abortion rates were 19.1% in 1985-86 and 19.2% in 1986-87. Pregnancies temporarily decreased in the 3rd and 4th quarters following the accident in a period usually reflecting annual increases. Cataract occurrences increased the year after the accident with 8 observed and 3.8 expected, but the P value was insignificant (P=.74). Microcephaly followed a similar pattern. Birth 2500 gms had observed values of 2726 vs. 2639.2 expected, an insignificant P value of .99. Observed perinatal deaths of 634 were less than the 718.8 expected.
Asunto(s)
Accidentes/estadística & datos numéricos , Reactores Nucleares/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Aborto Legal/estadística & datos numéricos , Aborto Espontáneo/epidemiología , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Noruega/epidemiología , Embarazo , UcraniaRESUMEN
The annual and monthly distributions of congenital abnormalities and pregnancy outcomes as confounding factors were evaluated in Hungary in reflection of the accident at the Chernobyl reactor. The different congenital abnormality entities and the components of fetal radiation syndrome did not show a higher rate after the Chernobyl accident in the data-set of the Hungarian Congenital Abnormality Registry. Among confounding factors, the rate of induced abortions did not increase after the Chernobyl accident in Hungary. In the 9th month after the peak of public concern (May and June, 1986) the rate of livebirths decreased. Three indicator conditions: 15 sentinel anomalies as indicators of germinal dominant gene mutations, Down syndrome as an indicator of germinal numerical and structural chromosomal mutations, and unidentified multiple congenital abnormalities as indicators of germinal dominant gene and chromosomal mutations were selected from the material of the Hungarian Congenital Abnormality Registry. Diagnoses were checked, familial and sporadic cases were separated and only the sporadic cases were evaluated. The analysis of indicator conditions did not reveal any measurable germinal mutagenic effect of the Chernobyl accident in Hungary.
PIP: The Hungarian Investigation of the effects of radiation from the Chernobyl accident involved evaluation of isolated and multiple congenital anomalies (CAs), unidentified CAs, fetal radiation syndrome, induced abortions, sentinel anomalies, and Down syndrome prevalence. There were no measurable teratogenic and germinal mutagenic effects after the April 28-May 15, 1986 impact. The highest beta activity occurred through late June. The highest external gamma ray level was .4 uSv. Hungary had the 13th highest radiocesium (Cs 137) deposition (7.9 x 10 to the 14th power Bg) and the 10th-11th highest national collective 50-year total body dose (1.3 x 10 to the 4th power person Gy). The level of external dose and individual total body ingestion dose gave Hungary a rank of 70th. The maximum extra dose was around .4 mSv in some regions. Mortality is obligatorily recorded and all births take place in hospitals with obstetrically trained birth attendants where CAs are also recorded. Registration of CAs is considered nearly complete and is available from the Hungarian Congenital Abnormality Registry (HCAR). Data on induced abortion, fetal deaths, and live births is provided by the Central Statistical Office to HCAR. The Hungarian Surveillance of Germinal Mutations (HSGM) provides data on sentinel anomalies, Down syndrome, and unidentified multiple CAs. The results indicate that isolated and multiple CA entities in 1986 and 1987, annually or monthly, did not exceed the rates of previous years. Microencephaly, cataracts, microphthalmos, and CAs of the eyes, and other fetal radiation syndrome showed no monthly increase and did not exceed the expected numbers based on baseline figures of 1973-82, regardless of region. The monthly distribution of induced abortions did not change after Chernobyl. February and March 1987 births decreased in the 9=month period after Chernobyl. An average of 3.7 new mutations/10,000 live births was found annually between 1980-89 which was not a significant change. Down syndrome cases averaged 104.year due to numerical or structural chromosomal changes and was not considered significant. Unidentified MCAs did not show an increased rate.
Asunto(s)
Anomalías Inducidas por Radiación/etiología , Aborto Legal/estadística & datos numéricos , Accidentes/estadística & datos numéricos , Reactores Nucleares/estadística & datos numéricos , Anomalías Inducidas por Radiación/epidemiología , Femenino , Humanos , Hungría/epidemiología , Recién Nacido , Embarazo , Resultado del Embarazo/epidemiología , UcraniaRESUMEN
The explosion at the Chernobyl nuclear power plant caused radioactive fallout in Finland in April-May 1986. The fallout was unevenly distributed geographically, and, accordingly, the country was divided into 3 fallout zones. Whole-body radioactivity measurements of randomly chosen persons showed that the regional differences prevailed throughout the following 2 years. Data for legal abortions, registered congenital malformations as well as preterm births and stillbirths of malformed children were collected. The corresponding expected figures were obtained from statistics from 1984 and 1985. No differences in the expected/observed rates of the above parameters were detected.
PIP: The effects of the 1986 Chernobyl accident on Finland are reported. Legal abortions, registered congenital malformations, preterm births, and stillbirths showed no differences in observed vs. expected rates after the accident. The limitations are that the population base is small, the detection system is incomplete, no reliable data are available on early abortions, and germinal mutations were not presently analyzed. Measurement of radiocesium (Cs 134 and 137) was accomplished by the Research Institute for Social Security with a stratified random sample of 380 people. 5 fallout zones differentiated groups, which were then collapsed into 3 groups. Regional differences in levels persisted into 1988. The Finnish Register of Congenital Malformations provided the compulsory data on congenital malformations. The 3 groups (children born before the accident in 1984-85, in the latter half of 1986, and in 1987) were analyzed in the 3 zones during 2 study periods (August-December 1986 and January-December 1987). Monthly analysis of induced abortions showed no increase following the accident. There was a slight decrease in births between January and March 1987, which is believed to be related to anxiety reinforced by public advice. There were no differences between expected and observed congenital defects in the 2 study periods. Preterm and stillbirths followed a similar pattern. The analysis showed no association between the temporal and spatial variations in radioactivity and variable incidence of congenital malformations.
Asunto(s)
Anomalías Inducidas por Radiación/epidemiología , Accidentes/estadística & datos numéricos , Reactores Nucleares/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Anomalías Inducidas por Radiación/mortalidad , Aborto Legal/estadística & datos numéricos , Femenino , Finlandia/epidemiología , Humanos , Recién Nacido , Embarazo , UcraniaRESUMEN
PIP: A demographer analyzed data on 44,862 15-57 year old married women living in 29 provinces, autonomous regions, and cities in China to determine the abortion rate and determinants of abortion. 24.51% of the women had experienced at least 1 abortion (mean number of abortions in this group, 1.41/woman). Overall, for every 100 live births 12.7 induced abortions occurred. The ratio for urban areas was more than 2 times that of rural areas (24.9% vs. 9.7%). Further, the abortion rate among urban women who had no live births stood at 8.2%, which was 3 times greater than that among rural women (2.4%). The highest urban ratios were in Shanghai (41.1%), Beijing (34.6%), Sichuan (28%), and Tianjin (27.3%). The highest ratios according to age group were among the 40-44 year olds in 1982 (66%) and 1985 (75%) and among 35-39 year olds in 1987 (81.5%). The lowest ratios were in the provinces of Gansu (5.1%) and Guizhou (5.6%). Induced abortion occurred in 26.1% of women using condoms (effectiveness 0.63%), 25.4% of those using natural family planning methods (safe period), 17.15% of those using oral contraceptives (effectiveness 0.67), and 8.5% of those using the IUD (effectiveness 0.71). Therefore, there was an inverse relationship between contraceptive effectiveness and abortion occurrence rate. Further, this rate increased with greater frequency of usage. For example, the rate for a single usage of IUD was 3.9%, but climbed to 29.9% for 2 usages, and 53.7% for 3 usages. Thus, family planning providers should not have a woman continue the same contraceptive with which she experienced failure and abortion. Increased contraceptive effectiveness can prevent more live births than no contraceptive (0.88 births at 95% effectiveness vs. 0.36). In conclusion, the leading cause of induced abortion in China was low contraceptive effectiveness.^ieng
Asunto(s)
Aborto Inducido , Tasa de Natalidad , Condones , Anticoncepción , Anticonceptivos Orales , Servicios de Planificación Familiar , Fertilidad , Dispositivos Intrauterinos , Matrimonio , Población Rural , Población Urbana , Asia , China , Conducta Anticonceptiva , Demografía , Países en Desarrollo , Asia Oriental , Estado Civil , Población , Características de la Población , Dinámica PoblacionalRESUMEN
PIP: During October-December 1988 in Mali, the Union for the Study of the African Population conducted an abortion survey among 335 women at nine maternity wards of hospital centers (Djikoroni, Gabriel Tore, Garnison, Hamdalaye, Korofina, Missira, Point G, Quartier Mali, and Sognoninko) throughout Bamako District to measure the extent of abortion in hospital centers in the district and to identify the principal causes for abortion. More than 90% of the women were Moslem. More than 50% were illiterate. 111 women (about 33%) had an induced abortion. They included students and women with no profession. 64% claimed that their poor state of health was responsible for the abortion. Fear of parents was the reason for undergoing an abortion among 10.7% of women while the reason was the pursuit of studies among 3.3%. 47 women were less than 18 years old. 23 of them said that poor health status was responsible for their abortion. Other reasons among adolescents were fear of parents (10), pursuit of studies (5), difficult financial situation (3), not knowing the man responsible for their pregnancy (3), and other causes (3). Among the 111 women who had undergone induced abortion, poor state of health was the reason for the abortion in 22% of the students and among their lack-of-profession counterparts. Fear of parents, pursuit of studies, and difficult financial situation were reasons for abortion among 55.6% of women without a profession compared to 66.6% among students. It is difficult to get an exact count of the extent of induced abortion in Bamako District since this survey only covered hospitals. It is known that many abortions are performed clandestinely. It would be interesting to conduct a more expanded survey which would cover abortions practiced outside of official health facilities. This would allow a comparative analysis between adolescent pregnancy and induced abortions and elucidation of their causes.^ieng
Asunto(s)
Aborto Criminal , Aborto Inducido , Encuestas Epidemiológicas , Hospitales , Embarazo en Adolescencia , África , África del Sur del Sahara , África del Norte , África Occidental , Atención a la Salud , Demografía , Países en Desarrollo , Servicios de Planificación Familiar , Fertilidad , Salud , Instituciones de Salud , Malí , Población , Dinámica Poblacional , Conducta SexualRESUMEN
The paper provides the results of sample socio-hygienic survey of 418 women after operation of mini-abortion. The women are classified according to age and family status. The contraceptive behaviour of women is analysed, methods and types of contraception are examined. With respect to this new type of activity, main causes of visits to the women's consultation clinic and certain medical and organisational aspects of its work are analysed.
PIP: To evaluate the short-term and long-term results of mini-abortions (vacuum-aspiration during early gestation periods), a special survey was conducted in 418 women (aged 17 to 40 years old; median age group 25- 29 years old). The survey was carried out in 3 stages. Stage I included sociological-medical interview immediately prior to abortion. Stage II was conducted immediately after the abortion and 10-12 days later. Stage III was conducted among the gynecologists who performed abortions. Of 418 women seeking abortion, 80.6% were married (86.4% of them had a 1st marriage). Among single women, 39.5% were divorced or widowed. Various contraceptive methods were used by 216 women (189/337 married women and 27/81 single women). Traditional questioning indicated that 29.7% of the women used various mechanical methods of contraception, 21.1% used chemical agents, and 7.3% used oral contraceptives; when more specific questions were asked, 40% of women were found to use contraceptives incorrectly. The reasons for abortion included mutual decision of both husband and wife (43.3%), inadequate financial situation (26.0%), common low marriage (10.8%), and medical contraindications (7.2%). Lacking the information about optimum timing of mini-abortion, women sought abortion after up to a 4-day delay of menstruation in 23% of the cases, after 4-7 days in 44.2%, after 7-10 days in 21.3%, after 10-14 days in 7.4%, and after 14 days in 4.9%. Following the mini-abortion, only 8.8% of women returned to work during the same day. Questioning on day 10-12 after mini-abortion indicated that 45.9% could resume work 2-3 hours after the procedure, 19.7% within 4-6 hours, 17.2% within 2-3 days, and 6.1% within 4 days. On average, mini-abortion required 3.4 visits to a clinic. Within the 1st 10-15 days after mini-abortion, only 34% of women went to a clinic for a follow-up examination.