Abortion among married young women: findings from a community-based study in Rajasthan and Uttar Pradesh, India

AbstractAbortion service provision has changed noticeably in the recent past and medication abortion currently accounts for four-fifths of all induced abortions taking place in India. How these changes have modified abortion experiences among young women – a group known to be more disadvantaged than adult women – remains unanswered. This paper fills this gap and examines the experiences of married young abortion seekers, including pre-abortion decision-making, abortion seeking and experiences of the procedure, and post-abortion complications. Data were drawn from a community-based survey of 4952 married young women aged 15–24 years conducted in Uttar Pradesh and Rajasthan in 2015. The study focused on 166 young women who had an induced abortion in the two years before the survey, and used descriptive statistics to describe their abortion experiences. Seventy-four per cent of abortion seekers had relied on medication abortion and 47% had obtained it over the counter without a physician’s prescription. Moreover, 90% accessed abortion services from private facilities, including drug sellers. A small proportion (4%) had undergone abortion in the second trimester of pregnancy. At the same time, 13% reported multiple abortion attempts; 17% underwent dilation and curettage; and 52% experienced self-reported complications, including 5% who experienced moderate to severe complications. The findings call for greater attention to providing contraceptive counselling and services to married young women, ensuring abortion services in public health facilities and exploring mechanisms to improve drug sellers’ knowledge and practices in providing medication abortion.

Download Full-text

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico

Women s Health ◽

10.1177/17455065211029763 ◽

2021 ◽

Vol 17 ◽

pp. 174550652110297

Author(s):

Stephanie Andrea Küng ◽

Beatriz Ochoa ◽

Guillermo Antonio Ortiz Avendano ◽

Claudia Martínez López ◽

Mara Zaragoza ◽

...

Keyword(s):

Public Hospitals ◽

World Health ◽

Power Structures ◽

Factors Affecting ◽

Abortion Care ◽

Dilation And Curettage ◽

Induced Abortions ◽

Health Organization ◽

Post Abortion ◽

Depth Interviews

Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

Download Full-text

The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa—study protocol

Trials ◽

10.1186/s13063-021-05402-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Andrew Medina-Marino ◽

Dana Bezuidenhout ◽

Sybil Hosek ◽

Ruanne V. Barnabas ◽

Millicent Atujuna ◽

...

Keyword(s):

South Africa ◽

Adolescent Girls ◽

Young Women ◽

Randomized Control Trial ◽

Community Based ◽

Adherence Support ◽

Randomized Control ◽

Exposure Prophylaxis ◽

Effective Use ◽

Improve Access

Abstract Background HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW’s access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed. Methods We propose a mixed-methods study among AGYW aged 16–25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated. Discussion This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW. Trial registration ClinicalTrials.govNCT03977181. Registered on 6 June 2019—retrospectively registered.

Download Full-text

Constrains for seeking post-abortion care among adolescents and young women in Guangzhou, China: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06263-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yiding Wang ◽

Jinzhi Liu ◽

Ribo Xiong ◽

Yan Liu

Keyword(s):

Young Women ◽

Cross Sectional Study ◽

Public Hospitals ◽

Sectional Study ◽

Cross Sectional ◽

Services Utilization ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion ◽

Youth Friendly

Abstract Background In China, post-abortion care (PAC) services mainly focus on married couples, such that adolescents and unmarried young womenhave limited access to those services for contraception counseling. The provision of youth-friendly PAC services in public hospitals is a new concept in China. This study examined the magnitude of PAC services utilization as well as factors influencing it’s uptake among adolescents and young women in Guangzhou, China. Methods A cross-sectional study was performed from 1st March 2020 to 30th September 2020 using anonymous self-administered questionnaire among 688 women aged 15–24 years in Tianhe district, Guangzhou. The Multivariate logistic regression was used to determine factors that were significantly associated with the uptake of PAC services. Results The magnitude of PAC services utilization was 35.9% among adolescents and young women in Guangzhou, China. Students were 69.0% significantly less likely to use PAC services compared to women who had no job. Immigrants were 59.0% significantly less likely to use PAC services than their native counterparts. Women who had a feeling of stigma were 70.0% significantly less likely to use PAC services compared to those who did not feel stigmatized. Conclusions The study highlights the need to strengthen youth-friendly PAC services provision, and emphasizes the importance of education about both family planning and abortion services among disadvantaged sub-groups of women in the study setting.

Download Full-text

Impact of COVID-19 on household food insecurity and interlinkages with child feeding practices and coping strategies in Uttar Pradesh, India: a longitudinal community-based study

BMJ Open ◽

10.1136/bmjopen-2021-048738 ◽

2021 ◽

Vol 11 (4) ◽

pp. e048738

Author(s):

Phuong Hong Nguyen ◽

Shivani Kachwaha ◽

Anjali Pant ◽

Lan M Tran ◽

Sebanti Ghosh ◽

...

Keyword(s):

Food Insecurity ◽

Coping Strategies ◽

Uttar Pradesh ◽

Feeding Practices ◽

Community Based ◽

Child Feeding ◽

Household Food ◽

Child Feeding Practices ◽

Food Insecure Households ◽

And Coping

ObjectivesThe COVID-19 pandemic has profound negative impacts on people’s lives, but little is known on its effect on household food insecurity (HFI) in poor setting resources. This study assessed changes in HFI during the pandemic and examined the interlinkages between HFI with child feeding practices and coping strategies.DesignA longitudinal survey in December 2019 (in-person) and August 2020 (by phone).SettingCommunity-based individuals from 26 blocks in 2 districts in Uttar Pradesh, India.ParticipantsMothers with children <2 years (n=569).Main outcomes and analysesWe measured HFI by using the HFI Access Scale and examined the changes in HFI during the pandemic using the Wilcoxon matched-pairs signed-rank tests. We then assessed child feeding practices and coping strategies by HFI status using multivariable regression models.ResultsHFI increased sharply from 21% in December 2019 to 80% in August 2020, with 62% households changing the status from food secure to insecure over this period. Children in newly or consistently food-insecure households were less likely to consume a diverse diet (adjusted OR, AOR 0.57, 95% CI 0.34 to 0.95 and AOR 0.51, 95% CI 0.23 to 1.12, respectively) compared with those in food-secure households. Households with consistent food insecurity were more likely to engage in coping strategies such as reducing other essential non-food expenditures (AOR 2.2, 95% CI 1.09 to 4.24), borrowing money to buy food (AOR 4.3, 95% CI 2.31 to 7.95) or selling jewellery (AOR 5.0, 95% CI 1.74 to 14.27) to obtain foods. Similar findings were observed for newly food-insecure households.ConclusionsThe COVID-19 pandemic and its lockdown measures posed a significant risk to HFI which in turn had implications for child feeding practices and coping strategies. Our findings highlight the need for further investment in targeted social protection strategies and safety nets as part of multisectoral solutions to improve HFI during and after COVID-19.

Download Full-text

The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.09.007 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Satu Suhonen ◽

Marja Tikka ◽

Seppo Kivinen ◽

Timo Kauppila

Keyword(s):

Medical Abortion ◽

Nulliparous Women ◽

Home Based ◽

Vaginal Deliveries ◽

Multiparous Women ◽

Induced Abortions ◽

Pain Drawings ◽

Nonopioid Analgesics ◽

Post Abortion ◽

At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

Download Full-text

Sero-immunity to poliovirus in children and young women: England 1972–4

Journal of Hygiene ◽

10.1017/s0022172400024359 ◽

1975 ◽

Vol 74 (2) ◽

pp. 283-287 ◽

Cited By ~ 9

Author(s):

P. P. Mortimer ◽

P. Cunningham

Keyword(s):

Young Adult ◽

Young Women ◽

Neutralizing Antibodies ◽

Oral Poliovirus Vaccine ◽

Lower Proportion ◽

Adult Women ◽

Young Population ◽

Young Adult Women ◽

Acceptance Rates ◽

Different Parts

SUMMARYA total of 292 children's sera and 706 antenatal sera from different parts of England were tested for the presence of poliovirus neutralizing antibodies. Little variation was found between different areas and types of community, but a lower proportion of the 5–14 year old children had antibody than younger children and young adult women. The proportion of the young population with antibody, and the current acceptance rates for oral poliovirus vaccine are barely satisfactory.

Download Full-text

Community Based Study of Rural, Tribal Women Seeking Induced Abortions in a Extremely Low Resource Region

Journal of Woman s Reproductive Health ◽

10.14302/issn.2381-862x.jwrh-20-3504 ◽

2020 ◽

Vol 2 (2) ◽

pp. 22-29

Author(s):

S. CHHABRA ◽

Jain S ◽

Thool K

Keyword(s):

Contraceptive Use ◽

Group Discussions ◽

Community Based ◽

Private Hospitals ◽

Economic Class ◽

Medical College ◽

Tribal Women ◽

Primary Health Centres ◽

Induced Abortions ◽

Unskilled Workers

Background Induced abortions are globally sought, whether permitted, or not permitted. Community based information about abortion seeking by rural tribal women is scarce. Objectives Community based study was carried out to know the magnitude, profile, reasons, places, persons performing IA for rural tribal women. Material Methods Study was conducted in 118 villages to get the study subjects . Women from every fourth house were interviewed for desired information. Results and Conclusion Of all abortions, 2.17% in Melghat and 24.38 %in Sewagram were IA. Most women who had IA were young and 19% in Melghat region, 2.6% in Sewagram region were illiterate. Majority of Sewagram region, were housewives of low middle class, in Melghat unskilled workers of low economic class. In Melghat region all women reported seeking IA at health facilities,63% Private hospitals (PH), 18.5% Sub centres (SC), 7.4% Medical College (MC), 7.4% District hospital(DH), 3.7% Primary Health Centres (PHCs) and In Sewagram region 58% PH, 23% MC, 6.7% PHCs, 3.9% DH, 3.9% SCs and 3.9% at home. Most women said they had IA for spacing with no contraceptive use or contraceptive failure, poor health, poverty, IA were done medically in 76.2%, surgically 23%. No sex–selective IA were reported and there was no evidence Many women lacked awareness and had misconceptions, more so in Melghat region. In focus group discussions, common reasons for disfavoring IA were personal beliefs (34%), practice restrictions (19%). There was extreme poverty, still PH were used. Lot of awareness is required.

Download Full-text

Reinventing the Squeal: Young New Zealand Women Negotiating Space in the Current Sexual Culture

10.26686/wgtn.16999864.v1 ◽

2021 ◽

Author(s):

◽

Lesley Wright

Keyword(s):

New Zealand ◽

Young Women ◽

Public Discourse ◽

Instant Messaging ◽

Sexual Experience ◽

Casual Sex ◽

Adult Women ◽

Sexual Culture ◽

Wide Range ◽

The Impact

<p>The sexual behaviour of young emergent adult women in New Zealand has become a target of media attention and commentary. Moralising language is prevalent in the public discourse, describing young women negatively with respect to character and psychology. Research investigating the increase of cultural artefacts such as hooking up or casual sex is often risk-focused, concentrating predominantly on detrimental impacts such as STIs, rape-risks, and depression. Some feminist analyses describe behaviour as postfeminist or as examples of false consciousness. Despite these positions, young New Zealand women are engaging in these and other non-relationship sexual activities in growing numbers, suggesting that current approaches are failing to capture salient explanatory information. Due to the negative impacts of social constraints such as the sexual double standard, traditional femininity and moralising social commentary on young women it is important to present a more holistic image of their behaviour so as to provide a deeper explanatory view which better accounts for young women’s experiences and motivations. In this study I utilise a mixed method research design to access a wide range of participants on a sensitive research topic. A self-selecting sample of 163 young women aged between 18 and 30, recruited from various university campuses around New Zealand, completed an online survey. From this group 18 heterosexually-identifying young women were selected to participate in instant messaging, email and face to face interviews, and an online discussion group. To analyse the material they provided I use a Third Wave feminist theoretical lens in order to give primacy not only to their voices but also their claims to agency and the importance of subjective positionality. I use Sexual Script Theory as a framework to illuminate the impact of cultural dialogues on individuals, and space was conceptualised as a way to illustrate performances and agency. Results suggest that young New Zealand women are strongly affected by risk-focused and moralising dialogues to the effect that they have internalised a risk-focused cultural script that guides their sexual interactions and behaviours within socio-sexual culture in constrained and avoidant ways. Other performed scripts such as ‘good girl’ femininity, traditional masculinity, and the normative performance of heterosex also presented as barriers to subjective sexual experience/development. However, many young women in this study were resistant to some of these scripts, as evidenced in their attempts to occupy traditionally masculine and/or social spaces where non-normative behaviours are (partially) permitted. Their behaviour suggests critical engagement with their socio-sexual environment and some awareness of script elements that dictate acceptable feminine behaviour, and how these constraints can be (at least temporarily) resisted as a means to not only developing sexual subjectivity but also to refashioning modern femininity.</p>

Download Full-text