RESUMO
El acercamiento a las experiencias de mujeres que decidieron abortar en Ecuador, a partir de sus relatos biográficos, nos permitió comprender las trayectorias de cuidado por las que debieron transitar. Se desarrolló una metodología cualitativa, con enfoque biográfico narrativo, con la participación de 19 mujeres mayores de edad, residentes en diferentes provincias del Ecuador, un territorio con medidas restrictivas sancionatorias legales y morales alrededor del aborto. Encontramos que los contextos socio biográficos de las participantes se caracterizaron por la presencia de múltiples formas de violencia; sus decisiones en salud sexual y reproductiva constituyen una carga moral que las responsabiliza y les impone una serie de mandatos sociales en medio de grandes limitaciones y restricciones; sus trayectorias y búsqueda de cuidados se caracterizan por un Estado ausente como garante, lo que las lleva resguardarse en sí mismas o en algunas mujeres que construyen redes de soporte por fuera de la institucionalidad formal de protección, transitando rutas diversas donde el descuido y las violencia vuelven a ser predominantes. Estos hallazgos derivan en una serie de discusiones en torno a la vida de las participantes, como el tránsito por un laberinto donde las violencias que experimentan crean encrucijadas y rodeos difíciles de evadir y superar; por otra parte, la maternidad se presenta como una propuesta que enfrenta a las mujeres a tensiones permanentes, donde la decisión de abortar es una postergación de aquella más que su negación, tensiones como las mutaciones de la religiosidad, que no solo dan soporte del ideal femenino y de su rol básico de la maternidad, sino también un elemento de soporte para la decisión. Se concluye con la propuesta del Cuidado Sororo de la Salud Sexual y Reproductiva (SSR), inspirada en las teorías feministas y en los aportes de las organizaciones sociales que defienden los derechos sexuales y reproductivos de las mujeres. Dicha propuesta se deriva de las narrativas de las mujeres y se centra en su autonomía para reivindicar la importancia del cuidado desde una perspectiva más humanizada, respetuosa, solidaria y empática. (AU)
The approach to the experiences of women who decided to have an abortion in Ecuador allowed us to understand the care trajectories they had to go through, based on their biographical accounts. A qualitative methodology was used with a biographical narrative approach and the participation of 19 women of legal age, residents of different provinces of Ecuador, a territory with restrictive legal and moral sanctioning measures around abortion. We found that the socio-biographical contexts of the participants were characterized by the presence of multiple forms of violence; their sexual and reproductive health decisions constitute a moral burden that makes them responsible and impose a series of social mandates in the midst of great limitations and restrictions; their trajectories and search for care are characterized by an absent State as guarantor, which leads them to take refuge in themselves or in some women who build support networks outside the formal institutionality of protection, going through diverse routes where neglect and violence are once again predominant. These findings lead to a series of discussions about the life of the participants as the transit through a labyrinth, where the violence they experience creates crossroads and detours difficult to avoid and overcome; motherhood as a proposal that confronts women with permanent tensions, where the decision to abort is a postponement of it, rather than its denial and the mutations of religiosity that not only support the feminine ideal and its basic role of motherhood, but also an element of support for the decision. It concludes with the proposal of Sororo Care of Sexual and Reproductive Care (SRH), inspired by feminist theories and the contributions of social organizations that defend women's sexual and reproductive rights. This proposal is derived from women's narratives and focuses on their autonomy, to vindicate the importance of care from a more humanized, respectful, supportive and empathetic perspective. (AU)
Assuntos
Humanos , Feminino , Gravidez , Aborto Induzido/enfermagem , Aspirantes a Aborto , Aborto Induzido/psicologia , Aborto Induzido/reabilitação , Pesquisa Qualitativa , Equador , Aborto , Saúde Reprodutiva/educação , Cuidados de EnfermagemRESUMO
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.
Assuntos
Aborto Induzido , Complicações Pós-Operatórias , Abortivos não Esteroides , Aborto Criminoso , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Misoprostol , Gravidez , Modelos de Riscos Proporcionais , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the behavior of induced abortion as a function of certain demographic variables, for the population of fertile women (15 to 49 years old) residing in the Vila Madalena subdistrict S. Paulo (Brazil). MATERIAL AND METHOD: Two population samples were selected. One sample, with 996 women, investigated the incidence of induced abortions during 1987, using the RRT. In the other, involving 1,004 women, the same information was detected through a conventional approach. In both samples, the induced abortion occurring during the reproductive life was recorded in direct fashion. Though this analysis refers only to information about past abortions, that is by 2,000 women-, it should be noted that it is exactly the RRT that lends credibility to the found or results given results. CONCLUSION: The analysis furnishes evidence showing that single women, young women between the ages of 15 and 19, women who have not had live births, women who have a number of children below the expected ideal, women who use contraceptive methods (especially inefficient ones) and women who do not have any restrictions as to abortion constitute the categories most inclined to resort to induced abortion. This grouping suggests the existence of interrelationships between categories, that is, each of these categories is probably composed primarily of the same women, those who are at the beginning of their reproductive lives.
PIP: Statistics on induced abortion incidence in Brazil are considered highly deficient. The randomized response technique (RRT) improves estimates of induced abortion by allowing women to furnish accurate information indirectly, maintaining privacy. Use of the RRT indicates that around 80% of women with induced abortions refuse to admit their experience when questioned directly. The present study explored induced abortion-related behavior among two samples of women 15-49 years from a subdistrict of Sao Paulo (Vila Madalena) as a function of demographic factors. In the first sample (n = 996), the incidence of induced abortion in the year preceding the survey (1987) was estimated through use of the RRT. In the second (n = 1004), the same information was sought through a conventional approach. A total of 275 induced abortions were reported. Analysis of variance indicated single women, women 15-19 years of age, those who have not had live births, those who have a number of children below the expected ideal, users of contraception (especially inefficient methods), and women who do not have any moral resistance to the practice of abortion are most likely to resort to induced abortion. The multivariate model identified a woman's beliefs as to the moral acceptability of abortion--a factor that derives from the broader cultural context--as the variable with the highest predictive value. Overall, these findings indicate a clear need for development of birth control methods that meet the needs of young women at the beginning of their reproductive lives since these women comprise the majority of abortion seekers.
Assuntos
Aborto Induzido/estatística & dados numéricos , População Urbana , Aborto Criminoso , Adolescente , Adulto , Fatores Etários , Comportamento , Brasil , Anticoncepção , Feminino , Humanos , Incidência , Estado Civil , Pessoa de Meia-Idade , GravidezRESUMO
The essay discusses abortion in Puerto Rico from 1937 to 1970, concentrating in its legal status as well as its social practice. The research documents the contradictions between the legality of the procedure and a social practice characterized by secrecy. The essay discusses the role of the Clergy Consultation Service on Abortion in promoting the legal practice of absortion in Puerto Rico. It also discusses the ambivalent role of medical doctors who, despite being legally authorized to perform abortions to protect the life and health of women, refused to perform the procedure arguing abortion was illegal. The essay concludes with a brief discussion on perceptions of illegality regarding abortion, emphasizing the contradictions between the practice of abortion and that of sterilization in Puerto Rico.
PIP: The legal status and occurrence of abortion in Puerto Rico are examined for the years from 1937 (when abortion under some conditions was legalized) through 1970. A series of legislative initiatives in 1937 repealed laws prohibiting interstate transportation of contraceptive materials and information, legalized contraceptive sterilization, and permitted abortion to conserve the health or life of the woman. The effective legalization of abortion in 1937 was not publicly recognized at the time or in later decades, and the legal changes apparently did not lead immediately to a significant increase in the number of abortions, unlike sterilizations, which did increase significantly. The requirement that indications for therapeutic abortion be identified by physicians excluded the nurses and midwives who had traditionally been responsible for most births and abortions. Foreign organizations such as the Clergy Consultation Service promoted the legal practice of abortion in Puerto Rico. Efforts in 1964 to amend the penal code to curtail abortion were less successful than the passage by New York in 1970 of the most liberal abortion law in the US, which greatly reduced the number of abortions in Puerto Rico. Puerto Rican women able to pay obtained abortions from trained professionals, despite the perception of abortion as illegal, but poor women had recourse to poorly trained midwives and nurses at best. A training program for midwives during the 1930s provided instruction and equipment necessary for safe deliveries, but the knowledge gained was reflected in safer abortions and declining maternal mortality.
Assuntos
Aborto Criminoso/história , Aborto Legal/história , Aborto Criminoso/legislação & jurisprudência , Adulto , Atitude do Pessoal de Saúde , Feminino , História do Século XX , Humanos , Gravidez , Porto Rico , Esterilização Reprodutiva/legislação & jurisprudênciaRESUMO
PIP: This article insert describes a program in Cali, Colombia, for training hospital staff in family planning counseling of postabortion patients. Hospital staff at Hospital Universitario del Valle treats about 250 women per month for complications of incomplete abortion. Many are repeat clients. Unwanted pregnancies are attributed to lack of contraception, incorrect use of contraception, and mistaken beliefs about the protective properties of drinking seven glasses of water after intercourse. Postabortion patients range in age from 12 years to over 49 years. 14% are aged under 20 years. The number of women with abortion complications or women with miscarriages puts pressure on inadequate staff and facilities. Therefore, the hospital introduced a new program for postabortion patients. The program includes family planning counseling and provision of contraceptives before release from the hospital. Women are also informed of where to obtain contraceptive supplies in their local communities. The hospital must refer women seeking sterilization to secondary health facilities due to the intensive use of operating rooms. Family planning counseling includes information about the use of traditional and modern methods. Staff members who are trained in family planning include all levels from volunteers to physicians. The hospital is trying to improve client-provider relations by eliminating the fear factor. Emergency room department staff are also trained in family planning. The hospital is reaching out to the special needs of indigenous people who are unfamiliar with hospital settings and family planning information. Hospital staff provide each patient or client with a card that indicates the date of the woman's next menstrual cycle on a calendar. Staff inform the client that family planning must be used before the cycle begins. A variety of methods are explained.^ieng
Assuntos
Aspirantes a Aborto , Assistência ao Convalescente , Educação , Planejamento em Saúde , Hospitais , Recursos Humanos em Hospital , Aborto Induzido , América , Colômbia , Atenção à Saúde , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Instalações de Saúde , Pessoal de Saúde , América Latina , América do SulRESUMO
Using quantitative and qualitative data, the authors present selected characteristics of 626 women who reported complications of induced abortion in five hospitals: one in Nairobi, two in Lima, and two in Manila. Although there are some similarities, the findings show some marked differences in demographic characteristics. In Nairobi nearly all respondents were single, nulliparous, and 25 years or younger; in Lima and Manila most were either married or in union, usually aged 25 years or older and had at least 1 child. There was evidence of repeat abortions, especially in Nairobi where 26% had had at least one previous abortion. Access to safe abortions is severely restricted and is obtained through a secret referral system. A list of potentially hazardous local abortifacients range from the drinking of strong Kenyan tea to dangerous practices such as insertion of sharp objects into the uterus or drinking chemicals and toxic substances.
PIP: Interviews with 626 women treated in 1993 for complications of unsafe abortion at five hospitals in Nairobi (Kenya), Lima (Peru), and Manila (Philippines) revealed marked differences in their demographic characteristics. The percentage under 25 years of age was 26% in Manila, 45% in Lima, and 91% in Nairobi. 84% of abortion patients in Nairobi were single compared with 77% in Manila and 21% in Lima; 77% of women in Nairobi had no children compared with 29% in Lima and 11% in Manila. In general, Nairobi abortion seekers tended to be young women who migrated to the city and were concerned pregnancy would impede their social mobility. In Lima and Manila, abortion was sought to limit births within union, generally for financial reasons. Never-use of contraception was reported by 80% of Kenyan women, 65% of Manila women, and 48% of those in Lima. When presented with 11 scenarios that might justify an abortion, the only indication the majority in all three cities supported was pregnancy resulting from rape. Women reported use of abortifacient agents such as livestock droppings, drinking chemicals and detergents, herbal medicines, and overdoses of over-the-counter medications, as well as insertion of sharp objects into the uterus. 98% of Kenyan respondents compared with 36% in Peru and 24% in the Philippines claimed illegal abortion was common; 92%, 75%, and 35%, respectively, were aware of at least one woman who died after an unsafe abortion. All of the women in Kenya and 89% in the Philippines reported it was difficult or very difficult to obtain an abortion; most were obtained through a secret referral system and involved unsanitary conditions. These findings indicate a need for postabortion family planning counseling as well as scrutiny of existing abortion laws and policies.
Assuntos
Aborto Criminoso/etnologia , Aborto Criminoso/estatística & dados numéricos , Adulto , Comparação Transcultural , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Pesquisa Metodológica em Enfermagem , Peru , Filipinas , Saúde da População UrbanaRESUMO
PIP: Third World women with complications from an illegally induced abortion tend to postpone seeking medical treatment, because of both a lack of knowledge about the signs of infection or hemorrhage and a fear of moral and legal sanctions. At admission, hospital policies require that women be questioned repeatedly until they acknowledge whether their symptoms are a result of induced or spontaneous abortion. In Bolivia, women hospitalized for abortion-related complications also face financial sanctions. They are charged 450 Bs (US$105) for dilatation and curettage); social security coverage is denied as is eligibility for sliding scale fees based on ability to pay. Interviews with 12 patients and 14 staff members at 4 Bolivian hospitals revealed substantial variation in the postabortion care women receive. Care seemed to be more dependent on the personal ethics of staff members than definite policies. In general, however, these women did not receive the moral support needed to help them overcome their feelings of ambivalence, guilt, and depression. Rather, a double standard prevails, where women alone bear responsibility for the pregnancy and then are blamed for seeking termination under illegal conditions.^ieng
Assuntos
Aspirantes a Aborto , Aborto Criminoso , Assistência ao Convalescente , Hospitais , Aborto Induzido , América , Bolívia , Atenção à Saúde , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Instalações de Saúde , América Latina , Reprodução , América do SulRESUMO
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
Assuntos
Aspirantes a Aborto , Aborto Induzido , Adolescente , Coito , Menarca , Gravidez na Adolescência , Comportamento Sexual , Estatística como Assunto , Fatores Etários , América , Comportamento , Brasil , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , Fertilidade , América Latina , Menstruação , População , Características da População , Dinâmica Populacional , Reprodução , Pesquisa , América do SulRESUMO
This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.
PIP: The hypothesis that a restriction of family planning services will be associated with an increased incidence of abortion was investigated in a survey carried out in Asuncion, Paraguay, in 1985. In 1979, the Government of Paraguay abruptly eliminated all support for family planning services at Ministry of Health clinics--a measure that affected at least half of all contraceptive acceptors and forced them to turn to pharmacies for contraceptive supplies. The survey, which samples 10% of the registered private pharmacies in Asuncion, used the sale of pseudo- abortifacients as a measure of induced abortion. Also interviewed were 56 contraceptive purchasers and 51 purchasers of injectables contraceptives intended for use as abortifacients who were recruited at the participating pharmacies. The results indicated that low-income women were 5 times more likely than their higher income counterparts to purchase pseudo-abortifacients. In addition, unmarried women were 3 times more likely to purchase progestogen injections to induce a missed menstrual period than married women. Almost 70% of abortifacient purchasers reported that they had attempted to self-abort on previous occasions. The pharmacists stated that up to 50 women a week requested medication for pregnancy termination and were in agreement that this practice had increased substantially following the government's withdrawal of support for contraception. The pharmacists expressed concern about the nonavailability of counseling from trained family planning personnel and indicated that some pharmacy staff knowingly exploit women by injecting them with unsafe preparations or drugs that cannot induce abortion. The administration of ineffective pseudo-abortifacients can delay the decision to seek an illegal abortion or result in life-threatening incomplete abortion.
Assuntos
Abortivos , Aborto Induzido , Farmácias/economia , Abortivos/efeitos adversos , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Serviços de Planejamento Familiar/legislação & jurisprudência , Feminino , Política de Saúde , Humanos , Paraguai , Gravidez , Saúde da População UrbanaRESUMO
PIP: This work discusses various views of abortion and presents data on the legal aspects and incidence of abortion in Mexico as a contribution to a more productive dialogue on the problems of abortion. It is very difficult to deter women who have decided to seek an abortion, regardless of whether the procedure is legal or even safe. In the state of Sinaloa, Mexico, an abortion has not been punishable since 1939 if it caused by "imprudence", if the woman is a victim of rape, or if the woman's life is endangered by pregnancy. The penal codes of most Mexican states and the Federal District contain similar provisions. In October 1990, the state of Chiapas decriminalized abortion for most indications in the 1st 90 days of pregnancy on the basis that the fertility and growth rates were too high, many children were in situations of extreme poverty, and the widespread practice of illegal abortion led to high rates of maternal morbidity and mortality. The decree legalizing abortion in Chiapas was suspended in early 1991 by the Congress of Chiapas and is currently under further study by the National Commission on Human Rights. UNICEF estimates that in 1990, some 100,000 illegal abortions occurred daily in the world. 150,000-200,000 women may die each year as a result of illegal abortions. Today some 300 million couples throughout the world do not want more children but lack access to family planning. UNICEF estimates that the world rate of population growth would decline by 30% if all couples not desiring children practiced effective contraception. A large number of illegal abortions are believed to occur annually in Mexico. Abortions in Mexico are most common among married women of lower or lower middle class who already have children and who wish to avoid the economic hardships of a new baby. Perhaps because of their illegality, abortions represent a significant expense for a household. Unsafe abortions may cause serious health and fertility problems for women. The Mexican Institute of Social Security estimates that the rate of abortion has declined by about 25% between 1982-1990. Currently 1 of every 10 pregnancies is believed to end in induced abortion. Family planning programs have led to declines in the rates of both pregnancy and abortion in Mexico. The number of fertile-aged women attended in Social Security facilities for abortion complications declined from 11.5/1000 in 1982 to 8.8 in 1990. The extremes of opinion about whether abortion should be made safe and legal appear irreconcilably opposed. From a national perspective, abortion is a public health problem that needs to be addressed by the health sector. Existing laws permitting abortion under some circumstances should be made more explicit. The point of view of society should be respected, but women should also be protected.^ieng
Assuntos
Aspirantes a Aborto , Aborto Criminoso , Aborto Induzido , Serviços de Planejamento Familiar , Legislação como Assunto , América , Países em Desenvolvimento , América Latina , México , América do NorteRESUMO
PIP: This retrospective study analyzes the sociodemographic and fertility characteristics of a sample of 5368 women undergoing abortion at a private clinic in San Juan, Puerto Rico, in 1985. Although induced abortion is a controversial phenomenon in Puerto Rico, there is as yet little knowledge of the characteristics of women who seek abortions. The 5358 study women ranged in age from 12-48 years and averaged 26. 63% were aged 20-29 years. 40% were single, 43% were currently married, 16% were divorced, and 1% were widows. Women who has never married were 23.7 years old on average and ever-married women were 27.8 years old on average. 46.7% were economically active, 28.1% were housewives, 22.7% were students, and 2.5% were unemployed. The women had had an average of 2.9 pregnancies each. 6 women had been pregnant 12-15 times including the current pregnancy. 50.7% of the women were in the 3rd or higher order pregnancy, 20.8% were in their 2nd pregnancy, and 28.5% were in their 1st pregnancy. Ever-married subjects had an average of 3.5 pregnancies vs. 2.0 for single subjects. The average numbers of pregnancies were 2.9 for both economically active and inactive women. 40.9% had abortions without ever having children, 45.1% had had 1 or 2 children, and 13.9% had had 3 children or more. 74.2% of the single women and 19.2% of the ever-married women had abortions before ever having children. The average numbers of living children were .46 for single women, 1.64 for ever-married women, 1.1 for economically active women, 1.24 for inactive women, and 1.17 for the entire sample. The average numbers of prior induced abortions were .45 for single women, .72 for ever-married women, .71 for economically active women, .53 for inactive women, and .61 for the entire sample. 63.1% were undergoing their 1st abortion, 22.6% had had 1 previous abortion, and 14.2% had had more than 1. 17 women had had 6 ore more previous abortions. 65.5% of the women had used contraception. 78.1% of the abortions were performed at 8 weeks gestation or earlier, and 90.7% were done in the 1st trimester. Complications occurred in 35 of the 5368 procedures (.7%). These findings, which are not necessarily representative of induced abortion in Puerto Rico, suggest that both single and ever-married women resort to abortion. Single women tend to terminate their 1st pregnancies while ever-married women terminate pregnancies exceeding their desired number of children.^ieng
Assuntos
Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Gravidez , Porto Rico , Fatores SocioeconômicosRESUMO
PIP: This article discusses the value of family planning programs (FPP) in improvements in maternal and child health and contribution in raising people's standard of living. Access to FFP increases the contraceptive prevalence rate (CPR) with fertility rates dropping. This happened in Matlab, Bangladesh where the CPR rose to 45% as opposed to only 16% in the rest of the country. FPP helps prevent high numbers of abortions and keeps maternal mortality rates. For example when Chile began its program in 1963, 3% of couples used contraception. By 1978 the CPR rose to 23% and the death rates due to abortion fell from 118 to 24/1,000,000. The World Bank states that 85 developing countries, representing 95% of the population in The Third World, now offer FPP, and this has been achieved by offering couples information and access to contraception. However, most of these FPP are still not reaching the rural populations, the retention rates are low, and the administration of services is poor. A major social problem still remains-the high incidence of adolescent pregnancies. Worldwide it has been estimated that between 25-50% of maternal deaths could be prevented by the use of contraception to avoid high-risk or unwanted pregnancies. Worldwide between 20-30% of all unwanted pregnancies end up in abortions, legal or illegal. 80% of these abortions are illegal, with an estimated 100,000- 200,000 women dying annually. FP has many additional benefits including: 1) helping to make paternity a responsibility; 2) increasing people options and alternatives; and 3) helping mothers to space their pregnancies assuring better health for themselves and their children. Their success also depends on medical, political and financial support nationally and internationally.^ieng
Assuntos
Aspirantes a Aborto , Aborto Criminoso , Aborto Induzido , Logro , Comportamento Contraceptivo , Serviços de Planejamento Familiar , Planejamento em Saúde , Mortalidade Materna , Filosofia , Prevalência , América , Comportamento , Colômbia , Anticoncepção , Demografia , Países em Desenvolvimento , América Latina , Mortalidade , População , Dinâmica Populacional , Pesquisa , Projetos de Pesquisa , América do SulRESUMO
PIP: Sociocultural and psychological investigations were conducted to determine why lower class Chilean women undergo abortions despite strong social, religious, and legal sanctions. According to various estimates, there are 2 undetected illegal abortions in Chile for each abortion leading to hospitalization of the woman. Some 120,000-150,000 abortions are estimated to occur each year, compared to perhaps 300,000 live births. Illegal abortion is the principal cause of maternal mortality in Chile, carrying 4 times greater risk of death than term pregnancy. Because of the extreme difficulty of obtaining systematic information on abortion in the society at large, the studies were conducted in hospital wards treating women for septic abortions. Qualitative studies were 1st conducted using intensive methods such as life histories and a test of body image to assess knowledge of reproductive anatomy and physiology. A more extensive study was then done 2 of the 6 health services in metropolitan Santiago and a health service in Valparaiso. The sample of 357 women represented almost all of the women treated for abortion in the services during the time of the study. The women were lower class, primarily of urban origin, and 16-34 years old for the most part. 60% were single and 10% were separated or widowed. 75% had some secondary education but only 20% had finished secondary school. 1/2 of the sample had no gainful employment and 60% of the rest lacked any type of social insurance. 1/2 of the abortions were in single women abandoned by their partners or who lived with their parents and feared their reactions. 15% were single women who feared loss of employment. 30% were married with children and gave economic reasons for seeking abortion. The women were found to have erroneous ideas about the reproductive cycle, believing pregnancy to be possible only around the time of menstruation. Their beliefs were part of a coherent system passed down by oral tradition and not challenged by any scientific teaching imparted in the educational process. Very few used modern contraception. They relied instead on periodic abstinence during the days they erroneously believed to be fertile. They were not strongly motivated to seek modern contraception and many believed they lacked access or did not meet qualifications for family planning programs. The products of conception were not viewed as a truly living thing until after the 1st months of gestation. They believed that once the lesser abortifacient actions such as drinking concoctions were undertaken the child would inevitably be deformed. They were thus motivated for the 2nd stage, traumatic introduction of foreign objects into the uterus to provoke abortion usually at the hands of unskilled person under septic conditions. Most of the women knew of safer means of abortion but were unable to pay for them.^ieng
Assuntos
Aspirantes a Aborto , Aborto Criminoso , Aborto Séptico , Comunicação , Cultura , Inquéritos Epidemiológicos , Pobreza , Psicologia , Aborto Induzido , América , Comportamento , Chile , Países em Desenvolvimento , Doença , Economia , Serviços de Planejamento Familiar , América Latina , Complicações na Gravidez , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
The Court granted the petition sought by the Juvenile Defender of the Argentina Ministry of Minors to prevent a mentally retarded minor who had been the victim of rape and who was four months into her pregnancy from having an abortion. The Defender sought to prevent the abortion because he believed 1) that the fetus had a right to life and 2) that the performance of the abortion would pose a significant health risk to the mother. Although the mother of the minor had consented under provisions of the Penal Code allowing a pregnancy occurring under such circumstances to be terminated if the legal representative of the mentally retarded woman consents, the Court ruled that there was no consent. It concluded that the mother was not the legal representative of the minor because the minor did not live with her parents and had not been legally declared mentally incompetent. The Court also stated that, in cases where a pregnant woman with parental authority petitions to have an abortion, the law mandates that the fetus be represented legally and that the court must consult the Ministry of Minors before it authorizes an abortion. It based its decision on the legal right of a fetus to life.
Assuntos
Aspirantes a Aborto , Aborto Induzido , Adolescente , Pessoas com Deficiência , Jurisprudência , Estupro , Consentimento do Representante Legal , Fatores Etários , América , Argentina , Crime , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , População , Características da População , Problemas Sociais , América do SulRESUMO
PIP: Over the July 1, 1983 through June 30, 1984 period, data were collected on all women admitted to a sample of Bolivian hospitals for treatment of complications associated with abortion to determine the sociodemographic characteristics of these women along with the proportion of abortions that were illegally induced. Data was collected on the patients' symptoms, the complications involved, the medical treatment provided and hospital resources used, the patients' patterns of contraceptive use and their subsequent contraceptive plans for 4371 women hospitalized for complications associated with pregnancy loss. 992 (23%) of the abortions were classified as illegally induced; 3379 (77%) were classified as spontaneous. Women with induced abortions were more likely to have a fever exceeding 38 degrees Centigrade, infection, traumatic lesions, and excessive blood loss and also were more likely to receive antibiotics and blood transfusions. Due to abortion-related complications, 20 women, 16 of whom had reported induced abortions, received a total hysterectomy. 15 of these 20 women were less than 30 years of age and 5 had no living children. 7 women died during their hospitalization. The case-fatality rate among the 992 patients classified as having induced abortions was 6/1000 compared to 0.3/000 among women classified as having spontaneous abortions. Only 7% of the study population reported using modern clinical contraceptive methods in the month prior to conception. In sum, the physical and psychological costs of abortion to some women were high as was the cost to hospitals of treating these women. The study results indicate an obvious need to improve the delivery of family planning services in Bolivia.^ieng
Assuntos
Aborto Criminoso , Aborto Induzido , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Bolívia , Comportamento Contraceptivo , Demografia , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , Condições SociaisRESUMO
Why do some pregnant teenagers decide to carry to term while others terminate their pregnancy? This study examined the influence of family relationships and support, religion, and education on the decision to carry or to abort. A nonrandom sample of 43 pregnant Puerto Rican teenagers (21 who carried and 22 who aborted) were interviewed in 1982 using a 34-item interview schedule. It was found that girls in the carry group were more significantly influenced and supported by family and friends than were those in the abort group. Fathers were the least influential persons in both carry and abort groups, while mothers were the most influential in the carry group, and sisters in the abort group. Brothers, boyfriends, and best friends were more influential for carry girls than for abort girls. Contrary to expectations, girls in the abort group reported a greater degree of religiosity than did those in the carry group. Further, girls who received strong support from family and friends reported a higher degree of satisfaction with their decision than did those who received less support. Finally, girls in the abort group were more likely to continue their education than were those in the carry group. Overall, the findings of this study have immediate implications for research and counseling services. Practitioners should focus on the girls in conjunction with their families in order to achieve better results in both treatment and preventive services.
PIP: Why do some pregnant teenagers decide to carry to term while others terminate their pregnancy? This study examined the influence of family relationships and support, religion, and education on the decision to carry or to abort. A nonrandom sample of 43 pregnant Puerto Rican teenagers living in a large eastern US city (21 who carried and 22 who aborted) were interviewed in 1982 using a 34-item interview schedule. It was found that girls in the carry group were more significantly influenced and supported by family and friends than were those in the abort group. Fathers were the least influential persons in both carry and abort groups, while mothers were the most influential in the carry group, and sisters in the abort group. Brothers, boyfriends, and best friends were more influential for carry girls than for abort girls. Contrary to expectations, girls in the abort group reported a greater degree of religiosity than did those in the carry group. Further, girls who received strong support from family and friends reported a higher degree of satisfaction with their decision than did those who received less support. Finally, girls in the abort group were more likely to continue their education than were those in the carry group. Overall, the findings of this study have immediate implications for research and counseling services. Practitioners should focus on the girls in conjunction with their families in order to achieve better results in both treatment and preventive services.
Assuntos
Aborto Induzido/psicologia , Família , Hispânico ou Latino/psicologia , Gravidez na Adolescência , Religião e Psicologia , Meio Social , Apoio Social , Adolescente , Tomada de Decisões , Escolaridade , Feminino , Humanos , Gravidez , Porto Rico/etnologia , Estados UnidosRESUMO
PIP: This article presents current estimates of the number, rate, and proportion of abortions for all countries which make such data available. 76% of the world's population lives in countries where induced abortion is legal at least for health reasons. Abortion is legal in almost all developed countries. Most developing countries have some laws against abortion, but it is permitted at least for health reasons in the countries of 67% of the developing world's population. The other 33%--over 1 billion persons--reside mainly in subSaharan Africa, Latin America, and the most orthodox Muslim countries. By the beginning of the 20th century, abortion had been made illegal in most of the world, with rules in Africa, Asia, and Latin America similar to those in Europe and North America. Abortion legislation began to change first in a few industrialized countries prior to World War II and in Japan in 1948. Socialist European countries made abortion legal in the first trimester in the 1950s, and most of the industrialized world followed suit in the 1960s and 1970s. The worldwide trend toward relaxed abortion restrictions continues today, with governments giving varying reasons for the changes. Nearly 33 million legal abortions are estimated to be performed annually in the world, with 14 million of them in China and 11 million in the USSR. The estimated total rises to 40-60 million when illegal abortions added. On a worldwide basis some 37-55 abortions are estimated to occur for each 1000 women aged 15-44 years. There are probably 24-32 abortions per 100 pregnancies. The USSR has the highest abortion rate among developed countries, 181/1000 women aged 15-44, followed by Rumania with 91/1000, many of them illegal. The large number of abortions in some countries is due to scarcity of modern contraception. Among developing countries, China apparently has the highest rate, 62/1000 women aged 15-44. Cuba's rate is 59/1000. It is very difficult to calculate abortion rates in countries where the procedure is illegal. On the basis of hospital reports and other fragmentary information, the true rate appears to be relatively high in Latin America and the Far East. The abortion rate for Latin America in the mid-1970s was estimated at 65/1000 fertile aged women, and rates were believed to be higher in urban areas. Sub-Saharan Africa, where women desire very large families, apparently had the lowest rates. Up to 68% of pregnancies in the USSR, 57% in Rumania, and 55% in Japan may end in abortion. The proportion in developing countries ranged from 8% in Vietnam to 43% in China. Women undergoing abortion in developed countries tend to be young, childless, and single, while those in developing countries tend to be older, high parity, and married. Abortion mortality is still high in countries where large numbers of illegal abortions are performed by unqualified personnel, as in many parts of Latin America.^ieng
Assuntos
Aspirantes a Aborto , Aborto Criminoso , Aborto Induzido , Aborto Legal , Países Desenvolvidos , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , Legislação como Assunto , Política , Projetos de Pesquisa , Pesquisa , África , África Subsaariana , América , Ásia , Sudeste Asiático , Região do Caribe , América Central , Anticoncepção , Cuba , Europa (Continente) , Europa Oriental , Ásia Oriental , Japão , América Latina , América do Norte , Romênia , América do Sul , U.R.S.S. , VietnãRESUMO
PIP: In 1940, Chile had a population of slightly over 5 million, a crude birth rate of 36.4/1000, a death rate of 21.3/1000, and a natural increase of 1.5%. Between 1940-65, birth rates remained stable and high while the death rate declined steadily, so that the rate of natural increase gradually rose to 2.6%. After 1965, the birth rate declined faster than the death rate, and the natural increase rate slowly returned to its 1940 level--this due to lower fertility rather than high mortality. A slight increase in fertility rates followed a pronatalist campaign launched in 1978, but another slight decline began in 1982. The natural increase rate in 1985 was 1.6%. A private family planning organization was started in chile in the early 1960s to respond to the problem of illegal abortion. Studies had shown that 80% of Chilean women seeking abortion were married or in stable unions with 3 or more living children. In 1965, Chile's new family planning organization reached an agreement with the Ministry of Health whereby free family planning information and services would be offered in Ministry of Health facilities facilities to all women seeking them. The association also became a member of the International Planned Parenthood Federation, enabling it to receive external aid in the form of modern contraceptives and gynecological equipment. In its 21 years of existence, the family planning associated has maintained its agreement with the Ministry of Health and initiated others. Between 1960-84, with availability of family planning services, age specific fertility rates declined slightly for women aged 15-19 and very greatly for older women. In 1960 and 1984 respectively, age specific rates were 72.6 and 64.0 for women aged 15-19, 211.1 and 141.1 for women 20-24, 240.9 and 127.6 for those 25-05.5 and 90.8 for those 30-34, 141.4 and 45.0 for those 35-39, and 62.2 and 14.4 for those 40-44. The total fertility rate was 4.7 in 1960 and 2.4 in 1984. The family planning program has greatly reduced health risks from multiparity, but adolescent pregnancy continues to pose a threat for mothers and children, especially since over half of births to women under 20 are illegitimate. Chile's infant mortality rates were 192.8 1940, 120.3 in 1960, and 19.7 in 1985. Between 1960-85, the neonatal rate declined from 35.2 to 10.4. It is possible that decline in late infant mortality was relative to the declining proportion of unwanted births made possible by availability of family planning services. It has been estimated that 30% of the decline in infant mortality between 1972-82 was due to the decline in high order births made possible by family planning. Maternal mortality has declined due to better care during pregnancy and delivery, decline in illegal abortions, and decreased fertility among women over 35.^ieng
Assuntos
Aspirantes a Aborto , Coeficiente de Natalidade , Causas de Morte , Atenção à Saúde , Demografia , Fertilidade , Programas Governamentais , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Mortalidade Infantil , Idade Materna , Mortalidade Materna , Medicina , Mortalidade , Dinâmica Populacional , Crescimento Demográfico , População , Projetos de Pesquisa , Aborto Criminoso , Aborto Induzido , América , Chile , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , América Latina , Organização e Administração , Gravidez , Gravidez na Adolescência , Reprodução , Pesquisa , América do SulRESUMO
Individuals of Spanish and Mexican descent in New Mexico have used a number of plants as emmenagogues and abortifacients. Of the plants used, cotton root bark (Gossypium sp.), inmortal ((Asclepias capricornu Woodson), poleo chino (Hedeoma oblongifolia (Gray) Heller), rue Ruta graveolens L.), wormseed (Chenopodium ambrosioides L.), and three species of Artemesia seem to be used most widely. Of these, the cotton root bark, when used as an abortifacient, seems to exhibit the lowest toxicity. Rue is notable because of its use independently within different cultures, but may exhibit toxic side effects when used as an abortifacient. Seven other plants are outlined on the basis of anecdotal and folkloric reports. Investigations are underway to look at use effectiveness, side effects, impact on fertility, and acceptance among cultures of the Southwestern United States.
PIP: Spanish and Mexican descendents in New Mexico have used plants as emmenagogues and abortifacients to bring on their periods if pregnancy is suspected. The absence of menses in a woman must be treated as a disease because menses is believed to be the removal of bad blood. The most widely used plants are cotton root bark (Gossypium sp.), inmortal (Asclepias capricornu Woodson), wormseed (Chenopodium ambrosioides L.), poleo chino (Hedeoma oblongifolia), rue (Ruta graveolens L.), and 3 species of Aremesia. The cotton root bark, when used as an abortifacient, exhibits the lowest toxicity. Rue is used independently within different cultures but may exhibit toxic side effects when used as an abortifacient. The plants are used by 3 principal practitioners: 1) curanderos (healers), who tend to specialize in the care of certain diseases; 2) herbalists, who use many of the materials used in traditional medicine; and 3) brujos, who are sorcerers and witches. Other plants used are osha, chuchupate-lovage; ponso or tanse-tansy; poleo-spearmint or pennyroyal mint; amolillo-wild licorice; dormilon-tall cone flower; malva; and, lanten-plantain. The least toxic abortifacients are species of Gossypium, Ruta, Ligusticum, Asclepias, and Rudbeckia.
Assuntos
Abortivos não Esteroides , Abortivos , Hispânico ou Latino , Medicina Tradicional , Indutores da Menstruação , Plantas Medicinais , Feminino , Gossypium , Humanos , México/etnologia , New Mexico , Fitoterapia , Extratos Vegetais/farmacologia , GravidezRESUMO
PIP: 10 socialworkers were recruited to identify and interview nonmedical abortion providers and clients in the northern Mexico states of Sonora, Tamaulipas, Chihuahua, Nuevo Leon, Coahuila, and Baja California for a 1979 study. Problems were encountered with wording of the questionnaire and the quality of the work of some of the social workers. 49 single clients aged 24.5 years on average and 29 married clients aged 29 years on average were interviewed. The married women appeared to be of slightly lower educational and social status than the single. Single women paid on average U. S. $91, $37 more than married women, but otained better service and had lower rates of complication. 65% of married women attempted to induced menstruation themselves before seeking abortions. Only 2 women, both married, waited more than 3 months to seek abortions, both because of lack of funds. Little relation was found between the cost, method, and quality of the abortions. Married women sought abortions typically for economic reasons, while single women did so for social reasons. The 11 female and 1 male nonmedical abortion providers were aged 32 to 53 years, 2 were nurses, and the rest had 6 or fewer years of education. 1 nurse performed D and Cs with local anesthesia, 7 used probes, 3 used herbal injections and 1 used an infusion of herbs. 5 had learned their techniques from medical personnel. Income from abortions was the major source of livelihood for 10 of the 12 but charges, volume of patients, and total income varied. The average provider had been performing abortions for over 10 years.^ieng