RESUMO
Objetivo: Evaluar la prevalencia de fallo en la regulación de la fertilidad posparto y la asociación con otros factores en un municipio colombiano (2017). Método: Estudio observacional de corte transversal con 148 mujeres. Se aplicó un muestreo no aleatorio para incluir mujeres que hubieran tenido un parto en los últimos 5 años. Se calcularon la prevalencia y las razones de prevalencia. Se exploró la asociación con la prueba χ2 o la prueba exacta de Fisher bajo una significancia estadística de 0,05. Resultados: Se encontró una prevalencia de fallo de la regulación de la fertilidad posparto del 40,5%. La prevalencia se asoció con ejercer oficios del hogar, tener uno o dos hijos, no planificar o no acceder a métodos de planificación y haber tenido un embarazo con periodo intergenésico menor de 2 años (p < 0,05). Conclusiones: Es necesario implementar estrategias para identificar barreras de acceso a la planificación, impactando en el espaciamiento entre embarazos y el acceso a los servicios. Lo anterior para generar múltiples beneficios para la madre, su hijo/a, el sistema de salud y la sociedad.
Objective: To evaluate the prevalence of regulated postpartum fertility failure and possible associated factors in a Colombian municipality (2017). Method: Cross-sectional observational study of 148 women. A non-random sampling method was used to include women who had given birth to a child in the last five years. Prevalence and prevalence ratios were calculated. Associations were examined at 0.05 statistical significance using χ2 test or Fishers exact test. Results: The prevalence of postpartum fertility failure was found to be 40.5%. The prevalence was associated with household work, having one or two children, not planning, or not having access to planning methods, and having a pregnancy with an interval between pregnancies of less than 2 years (p < 0.05). Conclusions: It is necessary to implement strategies to identify barriers to access to planning, which have an impact on the spacing between pregnancies and access to services. This will have multiple benefits for mother, child, health system and society.
Assuntos
Humanos , Feminino , Planejamento Familiar , Prevalência , Estudos Transversais , Inquéritos e Questionários , Análise de Variância , Colômbia/epidemiologia , AnticoncepçãoRESUMO
Inadequate access to contraceptives is often considered the primary source of unmet need among women who desire to prevent pregnancy. This study evaluates two potential determinants of contraceptive use among Dominican women: (1) perceived access to family planning and (2) perceived personal reproductive control, a measure based in psychological theories of locus of control. Sexually active women aged 18-45 who did not desire fertility were surveyed to assess influences on contraceptive use. In-depth interviews were conducted among a subset of participants to contextualise survey results. Fewer than half (49%) of the 80 survey respondents had used contraception in the last 3 months. Higher personal reproductive control was significantly related to contraceptive use (aOR 1.18, 95% CI 1.04-1.34), however, higher perceived access to contraceptives was not (aOR 1.09, 95% CI 0.97-1.23). Male partner influence was identified as a barrier to contraceptive use. In this population, high personal reproductive control is a better predictor of contraceptive use than perceived access.
Assuntos
Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Relações Interpessoais , Autonomia Pessoal , Adolescente , Adulto , República Dominicana , Serviços de Planejamento Familiar/provisão & distribuição , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Estado Civil , Adulto JovemRESUMO
Este estudo teve como objetivo avaliar os efeitos da vasectomia bilateral nas características seminais de macacos pregos (Cebus apella) mantidos em cativeiro. Foram utilizados seis animais da Fundação Parque Zoológico de São Paulo. Sêmen foi colhido por eletroejaculação, após anestesia geral dos animais. A primeira colheita foi realizada 15 dias antes da vasectomia e as colheitas posteriores foram realizadas com intervalo de 30 dias até o momento da eliminação completa de espermatozóides do líquido seminal. Imediatamente após a ejaculação, o sêmen foi avaliado quanto suas características físicas, iniciando-se pelo volume (ml) da fração líquida e medição do pH. Posteriormente foram avaliados motilidade (%) e vigor espermático (0-5). Uma fração do sêmen foi diluída em formol salina 10%, para posterior avaliação da concentração espermática (cel/ml) e das características morfológicas (%). A integridade do acrossoma foi avaliada apenas na primeira colheita e a concentração espermática foi avaliada em apenas quatro animais na colheita antes da vasectomia devido ao fato de não haver quantidade suficiente de sêmen. Na primeira colheita após a vasectomia, todos os animais apresentaram espermatozóides com motilidade e vigor iguais a zero. No entanto, a concentração espermática pode ser avaliada até a segunda colheita pós-vasectomia, apresentando as Médias/EP 2.8±1.3 x 10 elevado a 6ª /ml antes da vasectomia e 4.7±1.6 e 0.8±0.7 x 10 elevado a 6ª /ml, após a vasectomia, respectivamente. Apenas na terceira colheita a média da concentração espermática foi igual a zero. Os resultados sugerem que machos vasectomizados devam voltar ao grupo, sem risco de fecundação acidental, após três meses da realização da vasectomia.(AU)
The effects of bilateral vasectomy on the seminal characteristics were assessed in capuchin monkeys (Cebus apella). Six adult male monkeys were housed separately in outdoor pens at the Fundação Parque Zoológico de São Paulo. Semen samples were collected by electroejaculation, after anesthetized the animals, 15 days before and once a month from 1 to 5 months after vasectomy. Immediately after the ejaculation, semen was analyzed for volume (ml), pH, motility (%), vigour (0-5), concentration (cells / ml), defects (%) and percentage of intact acrosoma (%). The percentage of intact acrossoma was analyzed only in the collection before the vasectomy and the concentration was done in only four males in these collection because have no semen enough for all analyses. One month after the vasectomy ejaculated spermatozoa were non-motilite and non-vigour in all vasectomized males. In addition the Mean/SEM of cells/ml before the vasectomy was 2.8±1.3 x10 involution 6ª /ml and after two months of the vasectomy was 4.7±1.6 x10 involution 6ª/ml, 0.8±0.7 x106/ml,respectively. Only after the thirty month the number of cells/ml was zero. Our results suggest that the vasectomized males may be back to the group, without risks of accidental fecundating, only 3 months after vasectomy.(AU)
Assuntos
Vasectomia/efeitos adversos , Sêmen/fisiologia , Espermatozoides/fisiologia , Ejaculação , Controle da População/métodos , CebusRESUMO
Many biomedical aspects of emergency contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of emergency contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing emergency contraceptive services. The review also offers ideas for designing new emergency contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.
Assuntos
Anticoncepcionais Pós-Coito , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde , Humanos , MEDLINE , Educação de Pacientes como Assunto , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Advances in medical abortion might allow women seeking early abortions to terminate their pregnancies safely and effectively without medical supervision. We investigated whether such women can calculate pregnancy duration accurately, a key step in unsupervised use. METHODS: 422 women seeking first-trimester abortions in two clinics (Pune, India, and Atlanta, USA) used a simple worksheet and calendar to calculate the duration of gestation from the date of last menstrual period (LMP) and/or of unprotected intercourse. Clinicians then used standard clinic practices to estimate pregnancy duration. We compared the two sets of estimates, focusing on women who fell into the "caution zone" (ie, had pregnancy durations >8 weeks according to providers, but < or =8 weeks by their own estimates). FINDINGS: The participants were generally representative of the women seeking abortion at the two clinics. 217 (97.7%) of 222 women in Atlanta and 173 (86.5%) of 200 in Pune could produce an estimate of pregnancy duration. Most (85.4% in Atlanta; 93.6% in Pune) of these estimates were within 2 weeks of those made by providers. For estimates based on LMP, only 10.0% (exact 95% CI 6.2-15.0) of women in Atlanta and 9.8% (5.8-15.3) in Pune fell into the caution zone. For estimates based on a date of intercourse, just 7.7% (4.0-13.1) of women in Atlanta and 3.4% (0-17.8) in Pune fell into the caution zone, although fewer women could use this method. INTERPRETATION: The vast majority of women seeking first-trimester abortion in this study could accurately calculate pregnancy duration within a margin of error clinically inconsequential for safe use of unsupervised medical abortion.
Assuntos
Aspirantes a Aborto/psicologia , Atitude Frente a Saúde , Idade Gestacional , Adolescente , Adulto , Comparação Transcultural , Feminino , Georgia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Pessoa de Meia-Idade , GravidezRESUMO
PIP: This article relates the case of two young girls who became pregnant as a result of rape and their efforts to exercise their rights to terminate the pregnancy. The first victim was a 12-year-old girl from Bolivia and the second was Paulina, a 13-year-old resident of Baja California, Mexico. Though abortion is illegal in both countries, in the case of rape the procedure is "unpunishable" in Bolivia and legal in Mexico. Despite these laws, the girls, their families and their advocates contend repeatedly with local government and Catholic Church officials on the issue. Only the first victim successfully exercised her right to terminate her pregnancy through the efforts of her family and the decision of Penal Judge Luis Ledezma. This paper also highlights the need for reforms in the abortion law in both countries.^ieng
Assuntos
Aborto Induzido , Legislação como Assunto , Estupro , Mulheres , América , Bolívia , Crime , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , México , América do Norte , Problemas Sociais , América do SulRESUMO
PIP: This paper characterizes the Mexican abortion laws using the case of a girl aged 14 years, Paulina Ramirez Jacinta, who was raped, became pregnant, and chose to terminate the unwanted pregnancy, yet was denied an abortion. This case clearly showed that Mexican abortion law, despite its legality, is highly restrictive in nature and, in a way, violated the human rights of Paulina. Even though it permits first-trimester abortion procedures for rape victims or women whose lives are endangered by the pregnancy, many pregnant women still resort to illegal abortion. To further aggravate the restrictive nature of the law, Baja California state Rep. Martin Dominguez Rocha made a proposal to eliminate the rape exception in the state's penal code. The case of Paulina will be handled by the lawyers at the Center for Reproductive Law and Policy in order to arrive at a settlement favorable to Paulina.^ieng
Assuntos
Aborto Legal , Adolescente , Direitos Humanos , Legislação como Assunto , Gravidez na Adolescência , Estupro , Mulheres , Aborto Induzido , Fatores Etários , América , Crime , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , Fertilidade , América Latina , México , América do Norte , População , Características da População , Dinâmica Populacional , Pesquisa , Comportamento Sexual , Problemas SociaisRESUMO
Increased access to medical methods of abortion could significantly reduce maternal mortality, especially in developing countries. In light of the political and commercial difficulties in distributing the abortifacient mifepristone, the widely studied mifepristone-misoprostol regimen may not be sufficiently available in the near future. Thus, researchers have begun to look for alternative regimens, including regimens using misoprostol alone. This article reviews the current available evidence on the potential of a misoprostol-alone regimen for medical abortion. Although the data are varied and difficult to compare, recent studies indicate that a misoprostol-alone regimen could be safe and effective as a method of medical abortion. Misoprostol is widely marketed around the world for its other indications and is inexpensive, stable in tropical climates, easy to transport, and simple to administer. A misoprostol-alone regimen of medical abortion could thus greatly improve the access to safe medical abortion services by women in developing countries.
PIP: Studies have been conducted to examine the potential of misoprostol alone for early termination of pregnancy. These studies were done by Norman et al. (1991), Creinin and Vittinghoff (1994), Bugalho et al. (1996), Koopersmith and Mishell (1996), Carbonell et al. (two studies: 1997, 1998), and Jain et al. (1998). The designs, population sampling methods and regimens varied from study to study. Thus, comparison of results has been difficult. Overall, though, findings indicate that a misoprostol-alone regimen could be safe and effective as a method of medical abortion. This regimen could greatly improve access to safe medical abortion services for women in developing countries, which in turn would lead to a significant reduction in maternal mortality.
Assuntos
Abortivos não Esteroides , Aborto Induzido , Misoprostol , Cuba , Feminino , Humanos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Gravidez , Escócia , Estados UnidosRESUMO
PIP: This article discusses the effects of the alliance between the Church and the Argentine state on women's reproductive rights. Several commentators have criticized how President Carlos Menem used the campaign against abortion for his own political interest. He issued a presidential decree on antiabortion campaign--the Day of the Unborn Child. This decree was announced on December 8, 1998, and the day of observance is March 25 of every coming year. Although the Argentine government does not have a law that explicitly regulates family planning method for the last two decades, many Argentines find the action of the president selfish. The initiation of this presidential decree was the culmination of Menem's manipulation of church and state to secure clerical support for his political regime. Even if statistics is providing him with data concerning the effects of unclear reproductive health laws, he and the church still has chosen not to focus on reproductive rights exclusively, but have concerned themselves primarily with other social and economic issues. While Menem uses the Vatican's pro-life rhetoric and his presidential power to protect fetal life, Argentines will have to contend with the existing Menem policies, which compromise the health of women and children.^ieng
Assuntos
Aborto Induzido , Catolicismo , Anticoncepção , Estudos de Avaliação como Assunto , Política Pública , Mulheres , América , Argentina , Cristianismo , Países em Desenvolvimento , Serviços de Planejamento Familiar , Direitos Humanos , América Latina , Religião , América do SulRESUMO
PIP: This article reports the nonapplication of Article 266 in the case of an 11-year-old pregnant girl in Bolivia. Article 266, is a policy on unpunishable abortion. It explicitly states that in extreme cases of pregnancy, such as the consequence of rape, abduction for sexual purposes not followed by marriage, statutory rape, or incest, abortions are not punishable by law. In the case of a developmentally disabled girl in Santa Cruz, who was raped by her stepfather and became pregnant, she was denied the choice of aborting the baby despite the order of the juvenile court judge. This was because the doctors of certain hospitals in the city refused to perform the act and leaders of the Catholic Church and conservative groups opposed the abortion. However, abortion could have been pushed through if the justice system upheld Article 266. In addition, problems in the said article are cited. The article is not sufficient for enforcement as it lacks legislation, which subsequently leaves the rights of women at the mercy of police, doctors, and judges. Although women's rights groups have presented a revised version of Article 266, it still needs the approval of the Chamber of Deputies, the Senate, and finally the president of the Bolivian Congress.^ieng
Assuntos
Aborto Induzido , Legislação como Assunto , Gravidez , Estupro , Pesquisa , Mulheres , Adolescente , Fatores Etários , América , Bolívia , Criança , Crime , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , População , Características da População , Reprodução , Problemas Sociais , América do SulRESUMO
PIP: At February's Cairo+5 proceedings at the Hague, the Center for Reproductive Law and Policy (CRLP) called a press conference to discuss changes in abortion laws around the world since the International Conference on Population and Development in Cairo in 1994. According to the director of CRLP's International Program, 9 countries have modified their abortion laws since Cairo. Of those, 7 liberalized their laws, while Poland and El Salvador further restricted legislation. The CRLP supports the liberalization of abortion laws for all women in all countries. Abortion law has been liberalized in South Africa since Cairo, with the enactment in 1997 of the Termination of Pregnancy Act. In contrast, however, anti-choice groups in Poland successfully challenged the legality of abortion in 1996 by declaring it against the Polish Constitution. Abortion is prohibited in Chile in all circumstances, even to save the life of the woman. However, despite the illegality of abortion in that country, half of all pregnancies in Chile end in abortion. Unsafe abortion contributes to the 50% maternal mortality rate in Nepal. Abortion in the country is punishable by a 20-year prison sentence, regardless of the age of the woman.^ieng
Assuntos
Aborto Induzido , Legislação como Assunto , África , África Subsaariana , África Austral , América , Ásia , América Central , Chile , Países Desenvolvidos , Países em Desenvolvimento , El Salvador , Europa (Continente) , Europa Oriental , Serviços de Planejamento Familiar , América Latina , Nepal , América do Norte , Polônia , África do Sul , América do SulRESUMO
PIP: Emergency contraception (EC) refers to methods usually based on standard contraceptives for use within a few days of unprotected intercourse to prevent pregnancy. The most common, used in many countries for over 2 decades, is based on high doses of combined oral contraceptives (OCs) taken within 72 hours of unprotected coitus, followed by a second dose 12 hours later. Copper IUDs inserted within 5 days also provide protection. The "morning-after pills" have no effect on a pregnancy that is already established, do not cause abortion, and have not been shown to cause congenital malformations in case of failure. Emergency OCs entail no risk for most women, and occasional use is not believed to carry the same risks as regular OC use for women at cardiovascular risk, although progestin-only EC may be indicated. Only about 2% of women who use EC become pregnant. EC is useful in case of method failure, unexpected sexual relations, or rape. EC may reduce recourse to abortion by preventing unwanted pregnancy. There is no evidence that availability of EC increases sexual activity among young people. Women are not likely to replace their regular methods with emergency OCs because of the side effects, greater expense, and lower efficacy. Adding EC to existing reproductive health services is not costly in itself and offers savings in care for unwanted pregnancy and abortion.^ieng
Assuntos
Anticoncepcionais Pós-Coito , Anticoncepção , Anticoncepcionais , Anticoncepcionais Femininos , Serviços de Planejamento FamiliarRESUMO
PIP: The Center for Reproductive Law and Policy reports on the recent amendment of the Constitution to recognize life from the moment of conception. Researcher Soledad Varela discovered that the Catholic Church in El Salvador had been actively engaged in manipulative tactics to sway an already conservative legislature into passing the extreme laws. Although some legislators were in favor of this amendment, some believe that the reform was wrong and that therapeutic abortions and terminations of pregnancies resulting from rape should not be penalized. Restrictive abortion laws did not stop abortions from occurring; in fact, the UN estimated that 35% of all pregnancies in Chile end in illegal abortions. With the new restrictions, mothers are abandoning unwanted newborns. Illegal practitioners have become harder to trace. Nevertheless, others seem to be successful at evading the law. The wealthy have the right to choose and still avail themselves of legal, more liberal abortion laws from other countries.^ieng
Assuntos
Aborto Induzido , Catolicismo , Constituição e Estatutos , Legislação como Assunto , Pesquisa , América , América Central , Cristianismo , Países em Desenvolvimento , El Salvador , Serviços de Planejamento Familiar , América Latina , América do Norte , ReligiãoRESUMO
Mifepristone-misoprostol medical abortion promises to revolutionize reproductive health-care. Several simplifications of the standard three clinic visit regimen may be possible, however. Particularly in developing countries, access to the method can be greatly increased by eliminating the longest clinic visit. Indeed, shortly after mifepristone's introduction in Guadeloupe, a semi-developed Caribbean territory administered by France, in 1991, two of the authors conducted a small prospective study of a one treatment-visit regimen. The study regimen was subsequently adopted as the standard of care for medical abortion on the island. Women (n = 92) with amenorrhea of < or = 49 days received 600 mg mifepristone under clinical supervision and were given 400 micrograms oral misoprostol for home administration 2 days later, returning 2 weeks later for follow-up. The success rate (95.4%) is comparable to rates found when both drugs are administered in the clinic and to rates from a similar study conducted recently in the United States. Adverse events were also comparable to protocols requiring in-clinic administration of misoprostol. Protocol adherence appeared to be excellent and loss to follow-up was rare. We suggest that home administration of misoprostol can be safe and effective in most nonindustrialized settings.
PIP: This paper presents a prospective study of home administration and a one-treatment-visit regimen of mifepristone-misoprostol for medical abortion in Guadeloupe. The administration of this contraceptive method usually requires a standard 3-clinic visit regimen, which would sometimes lead to discontinuation of the abortion process. The study consisted of 92 medical abortion cases conducted over a 13-month period. The intervention involved a 1-day treatment visit with patients receiving 600 mg of mifepristone and instructions on ingesting 2 tablets (400 mcg) of misoprostol orally after 2 days and another 200 mcg misoprostol if bleeding had not occurred within 6-12 hours. A follow-up was conducted among these women after 10-15 days of initial clinic visit and contraceptive administration. The total success rate was 95.4% in comparison with those who received a 3-clinic visit regimen and the statistical result of a study conducted in the US. Several adverse effects have been associated with the administration of abortive methods, which include bleeding (19.6% in mifepristone users and 68.2% in misoprostol users) and vomiting. Strict monitoring of mifepristone and misoprostol distribution and patient follow-up was ensured by French legislators. The authors conclude that home administration of misoprostol must be made available to women in developing countries.
Assuntos
Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Autoadministração , Abortivos não Esteroides/efeitos adversos , Abortivos Esteroides/efeitos adversos , Aborto Induzido , Adulto , Feminino , Idade Gestacional , Guadalupe , Humanos , Mifepristona/efeitos adversos , Misoprostol/efeitos adversos , Cooperação do Paciente , Gravidez , Estudos ProspectivosRESUMO
Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.
PIP: An interview was conducted to ascertain knowledge, attitudes, and practices concerning emergency contraception (EC) among health care providers and potential EC users in metropolitan Mexico. Findings showed that there was a limited knowledge about EC per se and its method, but nevertheless, most of the participants were cautious to support EC in Mexico. Health care providers and clients greatly overestimated the negative health effects of EC, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believe EC should be more widely available, including in schools and vending machines, with information prevalent in the mass media and elsewhere.
Assuntos
Anticoncepcionais Pós-Coito , Adolescente , Adulto , Anticoncepcionais Pós-Coito/efeitos adversos , Serviços de Planejamento Familiar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Masculino , México , Gravidez , Comportamento Sexual , UniversidadesRESUMO
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
BACKGROUND: Misoprostol is commonly used to induce abortion in Brazil, and in other countries in South and Central America where abortions are illegal. However, misoprostol is not very effective in inducing abortions, and exposure to the drug in utero can cause abnormalities in the fetus. We aimed to define the common phenotypical effects of exposure to the drug. METHODS: We studied 42 infants from São Paulo, Brazil, who were exposed to misoprostol during the first 3 months of gestation, and then born with congenital abnormalities. We interviewed each of the infants' mothers to find out about misoprostol exposure and dosage. Each infant was physically examined by a geneticist or a neuropaediatrician. FINDINGS: 17 of the infants had equinovarus with cranial-nerve defects. Ten children had equinovarus as part of more extensive arthrogryposis. The most distinctive phenotypes were arthrogryposis confined to the legs (five cases) and terminal transverse-limb defects (nine cases) with or without Mobius sequence. The most common dose of misoprostol taken was 800 microg (range 200-16000 microg). INTERPRETATION: Deformities attributed to vascular disruption were found in these children. We suggest that the uterine contractions induced by misoprostol cause vascular disruption in the fetus, including brain-stem ischaemia. Information on the effects of taking misoprostol during pregnancy should be made more widely available, to dissuade women from misusing the drug.
PIP: In Brazil and other South and Central American countries where abortion is illegal, misoprostol is widely available and commonly used to induce abortion. However, misoprostol is not very effective as an abortifacient agent and can cause fetal abnormalities. The present study reviewed the cases of 42 infants from Sao Paulo, Brazil, who were exposed to misoprostol during the first trimester of pregnancy and then born with a congenital abnormality. 17 children had equinovarus with cranial nerve deficiencies and 10 had equinovarus as part of a more extensive arthrogryposis. The most distinctive phenotypes were arthrogryposis confined to the legs (5 cases) and terminal transverse limb defects (9 cases). Congenital hydrocephalus was present in 8 children. The most commonly taken dose of misoprostol was 800 mcg (range, 200-16,000 mcg). Greater awareness of the widespread use of misoprostol to induce abortion should lead to public health interventions to prevent teratogenic effects.
Assuntos
Anormalidades Induzidas por Medicamentos/epidemiologia , Abortivos não Esteroides/efeitos adversos , Aborto Criminoso , Artrogripose/induzido quimicamente , Pé Torto Equinovaro/induzido quimicamente , Nervos Cranianos/anormalidades , Misoprostol/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Abortivos não Esteroides/administração & dosagem , Aborto Criminoso/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Misoprostol/administração & dosagem , Gravidez , AutoadministraçãoRESUMO
A prospective trial including 300 pregnant women seeking elective abortion was conducted to evaluate the safety and efficacy of methotrexate and misoprostol for abortion at < or = 63 days' gestation. Subjects received methotrexate 50 mg orally and were randomly allocated to receive 800 micrograms of misoprostol vaginally 3, 4, or 5 days after administration of the methotrexate. The misoprostol dose was repeated 48 and 96 h later if abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure) and side effects. Complete abortion occurred in 273 of 300 patients (91%, 95%, CI 87, 94%) patients. No significant statistical differences were found in the success rates when misoprostol was given days 3, 4, or 5 after the administration of methotrexate (p = 0.69). Vaginal bleeding lasted 7.1 +/- 3.8 days, spotting 4.1 +/- 2.5 days, and total bleeding 11.2 +/- 4.1 days. Side effects for methotrexate were minimal, whereas, for misoprostol they were mild and transient except for pain. The use of methotrexate and misoprostol together could be an alternative to the intramuscular use of methotrexate or the use of antiprogestins and prostaglandin for medical abortion.
PIP: The safety and effectiveness of oral methotrexate and vaginal misoprostol for early abortion were evaluated in a prospective study of 300 women who presented to the Cuidad de la Habana (Havana, Cuba) for termination of a pregnancy of a gestational age of 63 days or less. All women were given 50 mg of methotrexate at study entry and then were randomly allocated to receive 800 mcg of misoprostol either 3, 4, or 5 days later. If abortion did not occur, misoprostol was readministered 48 and 96 hours later. Complete abortion occurred in 273 women (91%); the success rate was 72% (216 cases) after just one dose of misoprostol. There were no significant differences in abortion rates based on the day on which misoprostol was administered. Vaginal bleeding lasted an average of 7.1 +or- 3.8 days, spotting continued for 4.1 +or- 2.5 days, and total bleeding persisted for 11.2 +or- 4.1 days. Side effects for methotrexate included nausea (9.7%), vomiting (6.7%), dizziness (10.3%), fatigue (6.3%), headache (5.3%), and chills (5.3%). For misoprostol, side effects included nausea (23.0%), vomiting (25.3%), diarrhea (51.7%), dizziness (18.3%), headache (18.0%), chills (60.0%), and pelvic pain (97.3%). All signs and symptoms were of low intensity and short duration, however. These results suggest that combined use of methotrexate and misoprostol represents a feasible alternative to the intramuscular use of methotrexate or of antiprogestins and prostaglandin for medical abortion. The efficacy and safety of this new regimen are very close to those of RU-486, but the cost is considerably less.