Induced abortions in Pakistan: an afflicting challenge needing addressal

2021 ◽  
Vol 29 (2) ◽  
pp. 94-98
Author(s):  
Marina Baig ◽  
Sadia Abbas Ali ◽  
Kiran Mubeen ◽  
Arusa Lakhani
Keyword(s):  
Contraceptive Use ◽  
Health System Strengthening ◽  
Contributing Factors ◽  
Financial Barriers ◽  
Abortion Law ◽  
Care Services ◽  
Unintended Pregnancies ◽  
Induced Abortions ◽  
The Individual ◽  
Post Abortion

Unintended pregnancies due to low prevalence of contraceptive use in Pakistan leads to a huge burden of induced abortions. These abortions are a major cause of concern, as a majority of these abortions are performed in an unhygienic environment by untrained providers, leading to maternal morbidities and mortalities. Some of the contributing factors of unsafe abortions are lack of availability of quality services, financial barriers, stigma associated with abortion and lack of awareness about abortion law. Therefore, there is an urgent need to invest on family planning and post-abortion care services through health system strengthening approach. The proposed comprehensive strategy for actions at the individual, facility, community and policy levels can address the issue of unsafe abortion in the country.

INDUCED ABORTIONS IN PAKISTAN: EXPOSITIONS, DESTINATIONS AND REPERCUSSIONS. A QUALITATIVE DESCRIPTIVE STUDY IN RAWALPINDI DISTRICT

2015 ◽  
Vol 48 (5) ◽  
pp. 631-646 ◽  
Author(s):  
Zaeema Naveed ◽  
Babar Tasneem Shaikh ◽  
Muhammad Asif Nawaz
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Service Providers ◽  
Unmet Need ◽  
Care Seeking ◽  
Formal Schooling ◽  
Care Services ◽  
Induced Abortions ◽  
Unwanted Pregnancies ◽  
Post Abortion

SummaryOver 2 million abortions occur annually in Pakistan, mostly in a clandestine and unsafe environment. This is an area of grave concern for the reproductive health of women. A dearth of credible data and incomplete information make the problem more difficult to address. This qualitative study was conducted in semi-urban settings in Pakistan to record perceptions and practices concerning care seeking, experiences and outcomes regarding induced abortions and post-abortion care services. Women who had had induced abortions and abortion service providers were interviewed. Unwanted pregnancies and poverty were found to be the main reasons for seeking an abortion. Moreover, the unwanted pregnancies occurred due to low use of contraceptives, mainly due to a fear or past experience of their side-effects, unfamiliarity with correct usage and perceived inefficacy of the methods, especially condoms. There is an obvious need for practical and innovative interventions to address unmet need for birth spacing through improved access to contraceptives. Contraceptive providers should be provided with up-to-date and detailed training in family planning counselling, and perhaps allowed unrestricted provision of contraceptives. As a long-term measure, improvement in access to education and formal schooling could increase young girls’ and women’s knowledge of the benefits of family planning and the risks of unsafe abortion practices. Males must be involved in all the initiatives so that both partners are in agreement on correct and consistent contraceptive use.

scholarly journals An Assessment of Women’s Experiences and Challenges Faced with Post Abortion Care (PAC) Services in Buea

2021 ◽  
pp. 1-10
Author(s):  
Teng Esther Mbong ◽  
Dickson S. Nsagha ◽  
Niba Clinton Ambe ◽  
Micheal Okunlola ◽  
A. Oladokun Sina
Keyword(s):  
Family Planning ◽  
Health Care Services ◽  
Contraceptive Use ◽  
Unwanted Pregnancy ◽  
Unsafe Abortion ◽  
Women’S Experiences ◽  
Care Services ◽  
Women's Experiences ◽  
Post Abortion

Background: Unsafe abortion is one of the commonest causes of maternal mortality and post-abortion care services have been acclaimed as the best remedy for this situation. Yet, high maternal mortality still prevails pointing to issues with the quality of services. The paper was designed to investigate women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services and identify the challenges women faced in accessing PAC services in Buea. Methods: This study recruited 10 participants in Buea. Using a structured interview, data was collected on women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services, and identify the challenges women faced in accessing PAC services in Buea. Thematic and grounded theory analytical techniques were used to organize and interpret the data. Results: Majority of women in Buea did not use contraceptives for different reasons ranging from personal, spousal consent, ignorance, and the fear of side effects of contraceptive use. The low contraceptive use accounts highly for unwanted pregnancy cases which results in the decisions to induce. Most of these women involuntarily engage in induced abortion, highly driven by second party influence like the request from spouse/partner, disappointment from the spouse, and fear of parents’ reactions; while some occur as a result of missed abortion. The quality of PAC services received by most of these women were merely emergency treatments without proper PAC activities like family planning counseling, provision of modern contraceptive methods, linkages to other reproductive health care services. Women in Buea encounter some challenges in the use of PAC services, pains associated with the procedure, the cost, the absence of some family planning methods, the absence of counselling before PAC and above all, non constant availability of blood in the bood bank for transfusion. Conclusion: This study concluded that most women in Buea engage in induced abortion on account of the pressure to terminate an unwanted pregnancy; resulting from low contraceptives use; desire to avoid problems from their spouses/partners as well as to pursue career ambition. Moreover, the quality of PAC services offered to women in Buea was emergency treatment; void of important aspects like family planning services, linkage to other reproductive health care services, and facilitating their social reinsertion and preventing future induce abortion.

scholarly journals A study on contraceptive use among women attending immunization clinic at McGann teaching hospital, Shimoga

2020 ◽  
Vol 7 (2) ◽  
pp. 729
Author(s):  
Nitin S. Gaonkar ◽  
Raghavendraswamy Koppad ◽  
Sridevi N. H.
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Married Couples ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Number Of Children ◽  
Unintended Pregnancies ◽  
Wide Availability ◽  
Newly Married ◽  
The Individual

Background: India is the first country to implement National family planning programme in 1952. Use of contraceptives can prevent at least 25% of all maternal deaths by allowing women to prevent unintended pregnancies and unsafe abortions, and protect themselves from sexually transmitting diseases. Even though there is wide availability of various types of contraceptives, the rate of population growth and unplanned pregnancies is still high. The acceptance and knowledge of contraceptive methods varies within the societies and factors responsible operate at the individual, family and community level.Methods: A hospital based, cross-sectional study was conducted during August 2018 at McGann Hospital, Shimoga. The study sample included 200 women in the age group of 20 to 40 years attending immunization clinic with their children. Informed consent was taken from the subjects after explaining the purpose of the study to them. A pre-tested, semi-structured questionnaire was used to collect data by face-to-face interview of the study participants.Results: Out of 200 women 51% were aged between 20 to 24 years of age. Majority (72%) were Hindus. 67.5% were currently using contraception. Among acceptors of family planning 42.3% had undergone tubectomy. OCP was the most commonly used temporary method of contraception. Age of the woman, religion, education, husband’s education and number of children were found to be significantly associated with contraceptive usage.Conclusions: Factors influencing fertility and contraceptive practices should be properly assessed and addressed. Newly married couples should be motivated for accepting spacing methods.

scholarly journals Population-based rapid assessment of avoidable blindness survey in Sohag governorate in Egypt

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036337
Author(s):  
Heba AlSawahli ◽  
Ian McCormick ◽  
Caleb D Mpyet ◽  
Gamal Ezzelarab ◽  
Mohammad Shalaby
Keyword(s):  
Cataract Surgery ◽  
Census Data ◽  
Rapid Assessment ◽  
Population Based ◽  
Vision Impairment ◽  
Health System Strengthening ◽  
Secondary Outcome ◽  
Institutional Setting ◽  
Financial Barriers

ObjectivesTo determine the prevalence and causes of blindness and vision impairment, and the coverage and quality of cataract surgical services, among population aged 50 years and older in Sohag governorate in Egypt.DesignA population-based cross-sectional survey using two-stage cluster random sampling following the rapid assessment of avoidable blindness methodology.SettingA community-based survey conducted by six teams of ophthalmologists, assistants and local guides. Enrolment and examination were door-to-door in selected clusters.ParticipantsUsing 2016 census data, 68 population units were randomly selected as clusters (of 60 people) with probability proportionate to population size. Anyone aged 50 years and older, residing in a non-institutional setting in a cluster for at least 6 months, was eligible to participate.Primary and secondary outcome measuresThe prevalence and causes of blindness and vision impairment. Secondary outcomes were CSC and effectiveness and participant-reported barriers to cataract surgery.ResultsOf 4078 participants enrolled, 4033 (98.9%) were examined. The age-adjusted and sex-adjusted prevalence of blindness, severe vision impairment and moderate vision impairment were 5.9% (95% CI 4.8% to 6.9%), 4.7% (95% CI 3.8% to 5.7%) and 18.9% (95% CI 16.8% to 21.0%), respectively. Cataract caused most of blindness (41.6%), followed by non-trachomatous corneal opacity (15.7%) and posterior segment diseases (14.5%). Cataract surgical coverage (CSC) for persons for visual acuity <3/60 was 86.8%, the proportion of cataract surgeries with poor visual outcome was 29.5% and effective CSC (eCSC) was 44.9%. eCSC was lower in women than men. The most frequently reported barrier to surgery was cost (51.5%).ConclusionsThe prevalence of blindness in Sohag governorate is higher than districts in other middle-income countries in the region. CSC was high; however, women suffer worse quality-corrected CSC than men. The quality of cataract surgery needs to be addressed, while health system strengthening across government and private settings could alleviate financial barriers.

Predictors of Discontinuation of Modern Spacing Contraceptives in India

2020 ◽  
pp. 101053952098314
Author(s):  
Shahina Begum ◽  
Himanshu Chaurasia ◽  
Kusum V. Moray ◽  
Beena Joshi
Keyword(s):  
Contraceptive Use ◽  
Oral Contraceptive Pill ◽  
Family Health ◽  
Reproductive Age ◽  
Health Priorities ◽  
Unintended Pregnancies ◽  
Reproductive Age Women ◽  
One Year ◽  
Women In India

Data from National Family Health Survey (2015-2016) was analyzed to examine the contraceptive acceptance, discontinuation rates, and associated factors among reproductive age women in India over one year. Findings revealed that 11.7% accepted modern methods of which 68% were for spacing. Only 5% switched to other methods. Discontinuation rate was high among condom (56.8%) and oral contraceptive pill users (34.5%), among women aged less than 25 years, with parity less than 2, belonging to rural area, and having no education. Health concerns/side effects, husband’s disapproval, or method failure were most common reasons cited for discontinuation. The data show high discontinuation rates among some subgroups of women and for certain methods. Hence, women need to be provided options to switch methods to meet changing contraceptive needs and health priorities. Continuum of care with follow-up and counselling can facilitate sustained contraceptive use to avert unintended pregnancies.

scholarly journals Post-abortion family planning use, method preference, and its determinant factors in Eastern Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Asmamaw Demis Bizuneh ◽  
Getnet Gedefaw Azeze
Keyword(s):  
Family Planning ◽  
Marital Status ◽  
Meta Analysis ◽  
Grey Literature ◽  
Eastern Africa ◽  
Determinant Factors ◽  
Unintended Pregnancies ◽  
Pooled Prevalence ◽  
History Of ◽  
Post Abortion

Abstract Background Utilization of post-abortion family planning is very critical to reduce high levels of unintended pregnancy, which is the root cause of induced abortion. In Eastern Africa, it is estimated that as many as 95% of unintended pregnancies occurred among women who do not practice contraception at all. Therefore, this meta-analysis aimed to assess post-abortion family planning utilization and its determinant factors in Eastern Africa. Methods Published papers from Scopus, HINARI, PubMed, Google Scholar, and Web of Science electronic databases and grey literature repository were searched from database inception to January 30, 2020, with no restriction by design and date of publishing. We screened records, extracted data, and assessed risk of bias in duplicate. Cochrane I2 statistics were used to check the heterogeneity of the studies. Publication bias was assessed by Egger and Biggs test with a funnel plot. A random-effects model was calculated to estimate the pooled prevalence of post-abortion family planning utilization. Results A total of twenty-nine cross-sectional studies with 70,037 study participants were included. The overall pooled prevalence of post-abortion family planning utilization was 67.86% (95% CI 63.59–72.12). The most widely utilized post-abortion family methods were injectable 33.23% (95% CI 22.12–44.34), followed by implants 24.71% (95% CI 13.53–35.89) and oral contraceptive pills 23.42% (95% CI 19.95–26.89). Married marital status (AOR=3.20; 95% CI 2.02–5.05), multiparity (AOR=3.84; 95% CI 1.43–10.33), having a history of abortion (AOR=2.33; 95% CI 1.44–3.75), getting counselling on post-abortion family planning (AOR=4.63; 95% CI 3.27–6.56), and ever use of contraceptives (AOR=4.63; 95% CI 2.27–5.21) were factors associated with post-abortion family planning utilization in Eastern Africa. Conclusions This study revealed that the marital status of the women, multiparity, having a history of abortion, getting counselling on post-abortion family planning, and ever used contraceptives were found to be significantly associated with post-abortion family planning utilization.

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

2011 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
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.

Packaging the Promise: Money, Messaging, and Misalignment

2021 ◽  
Vol 123 (6) ◽  
pp. 1-38
Author(s):  
Debbie H. Kim ◽  
Kelly Krupa Rifelj
Keyword(s):  
Public Schools ◽  
Theory Of Change ◽  
Organizational Level ◽  
School Staff ◽  
Full Potential ◽  
Financial Barriers ◽  
Structural Support ◽  
Exit Survey ◽  
Policy Tool ◽  
The Individual

Background Promise programs are a quickly spreading policy tool in the free college movement. Despite their rapid spread, promise programs remain generally untested and there is even less information about how they are implemented. Research Questions (1) In what ways were The Degree Project's (TDP) theory of change and intents represented in messaging materials to students and to school staff? 1(a) In what ways did these messages shape conditions (or not) for sensemaking? (2) In what ways did these messages support (or not) students and school staff in changing their practice? (2a) What changes in practice did we see (or not) for students and school staff? Intervention TDP, which was implemented in Milwaukee Public Schools between 2011–15, is the nation's first randomized control trial of a promise program. Freshmen in the treatment group were offered $12,000 for college if they met particular requirements (e.g., average 2.5 GPA, 90% attendance). TDP leaned heavily on marketing materials and personalized letters to students, families, and school staff to communicate its requirements and to provide college access tips. Research Design We analyze messaging materials, climate and exit survey data, and student and school staff interviews to understand how TDP's theory of change and intents were packaged into messaging materials and ultimately enacted among target students and staff. Findings TDP implementation was successful to a point. School staff handed out messaging materials; students understood the requirements and demonstrated an increase in motivation and desire to go to college. However, TDP failed to meet its goal of sending more students to college. Expectations for school staff (hand out flyers and speak to students) versus students were misaligned, contributing to a lack of substantive conversation and structures for students to convert their increased motivation to go to college into actionable practices over time. School staff were already stretched thin and, with no added structural support, were unable to interact more meaningfully with students. Conclusion TDP failed to send more students to college because it targeted change at the individual rather than organizational level. Students exhibited change in their motivation to attend college, but this was not met with the support needed to convert this motivation to meaningful action. To achieve their full potential, such programs will have to not only address financial barriers, but also leverage broader structural supports in schools to help channel increased student motivation in more productive directions.

High Performance Coaches’ Mental Health and Wellbeing: Applying the Areas of Work Life Model

2018 ◽  
Vol 5 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Fraser Carson ◽  
Julia Walsh ◽  
Luana C. Main ◽  
Peter Kremer
Keyword(s):  
Mental Health ◽  
High Performance ◽  
Group Analysis ◽  
Work Life ◽  
Contributing Factors ◽  
Health And Wellbeing ◽  
Life Model ◽  
Workload Control ◽  
Sport Athlete ◽  
The Individual

In the last five years, mental health and wellbeing has attracted greater public, government, and research interest. In sport, athlete mental health and wellbeing has been a focus across all competition levels. The high performance coach responsible for athlete performance, health and wellbeing has not attracted the same attention despite working in an intense high-pressure work environment. Using the Areas of Work Life Model as a theoretical framework, this Insights paper discusses the existing coaching literature to ascertain both contributing factors for promoting positive mental health and wellbeing, and negative influences that increase stress and potential burnout. The six dimensions (workload; control; reward; fairness; community; and values) resonate throughout the coaching literature, but to-date, no study has applied the model to this group. Analysis of the extracted articles indicated that high performance coaches should become more self-aware around how to cope with stress and stressful situations, while sports organisations should invest in both the individual coach and the organisational culture to enhance work engagement. Coaches are performers and should prepare themselves to ensure they can perform at their peak; and managing their own mental health and wellbeing is an important component to this.

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