Knowledge of Unsafe Abortion among Female Students in Nepal

The term 'abortion' is a deliberate termination of unwanted human pregnancy. To save maternal health and life and control population growth, abortion has been legally permitted in Nepal since 2002. Most of the female youths stay away from home and are vulnerable to risky behavior regarding sex related matters. They have no proper knowledge about unsafe abortion. The objective of this article is to investigate the knowledge about unsafe abortion among the female youths in Pokhara. A descriptive cross-sectional study was conducted among 133 BBS first-year female students by using the simple random sampling. A self-administered questionnaire was prepared to assess the participants’ socio-demographic factors along with their knowledge about unsafe abortion. The association of knowledge was categorized with selected variables. Out of the 133 respondents, 49.6 percent were from the age group 19-20, 46.6 percent from the group of Janjati, 78.2 percent from the group of Hindu followers and 86.5 percent from the single respondents. The majority of the respondents (71.4 percent) were found to have the knowledge that over-bleeding was the consequence of abortion. Among the total respondents, 58 percent respondents had good knowledge about unsafe abortion and 15 percent had poor knowledge about unsafe abortion. No significant connection of age with knowledge of unsafe abortion has been observed during the study as the p value is greater than 0.05 at 95 confidence level, but other variables like caste, religion, place of residence and marital status have been found to have a significant relation with knowledge of unsafe abortion because p value is smaller than 0.05 at 95 confidence level.

Global Epidemiology of Induced Abortion

Induced abortion is a common reproductive experience, with more than 73 million abortions occurring each year globally. Worldwide, the annual abortion incidence decreased in the 1990s and the early decades of the 21st century, but this decline has been driven by high-resource settings, whereas abortion rates in low- and middle-resource countries have remained stable. Induced abortion is a very safe procedure when performed according to World Health Organization guidelines; however, legal restrictions, stigma, cost, lack of resources, and poor health system accountability limit the availability, accessibility, and use of quality abortion care services. Even as women’s use of safer self-managed medication abortion options becomes more common in some parts of the world, 45% of all abortions annually are unsafe, nearly all of which occur in low- and middle-resource settings, where unsafe abortion remains a primary cause of maternal death. Beyond country-level legal and health care system factors, significant disparities exist in women’s reliance on unsafe abortion. Even among women who receive a safe abortion, quality of care is often poor. Yet abortion’s precarious status as a health care service and its clandestine practice have precluded a systematic focus on quality monitoring and evaluation of service inputs. Improving abortion and postabortion care quality is essential to meeting this reproductive health need, as are efforts to prevent abortion-related mortality and morbidity more broadly. This requires a three-tier approach: primary prevention to reduce unintended pregnancy, secondary prevention to make abortion procedures safer, and tertiary prevention to reduce the negative sequelae of unsafe abortion procedures. Strategies include two complementary approaches: vulnerability reduction and harm reduction, the first focusing on the root causes of unsafe abortion by addressing the determinants of unwanted pregnancy and clandestine abortion, while the latter addresses the harmful consequences of clandestine abortion. Political commitments to extend service coverage of abortion and postabortion care need to be implemented through actions that build the public health system’s capacity. Beyond the model of receiving care exclusively in clinical settings, models of guided self-managed abortion are expanding the capacity of individuals to take evidence-based actions to terminate their pregnancies safely and without the threat of judgment. Research has strived to keep up with the changes in the abortion care landscape, but there remains a continuing need to improve methodologies to generate robust evidence to identify and address inequities in abortion care and its health consequences in a diversified landscape. Doing so will provide information for stakeholders to take actions toward a new era of health care reforms that repositions abortion as an integral component of sexual and reproductive health care.

Assessment of Knowledge, Attitude and Utilization of Emergency Contraception Among Women of Reproductive Age in Arsi Zone, Ethiopia

Background: Unintended pregnancies, pregnancies that occur within short intervals as well as unsafe abortion could be avoided by using contraceptives. Therefore: assessment of emergency contraceptives among unmarried women is importance because of high rates of unintended sexual intercourse leading to unwanted pregnancies as well as unsafe abortion. Methods: A cross-sectional community based household survey was conducted among 965 women chosen by systematic random sampling at Arsi zone. Descriptive statistics was presented with text and frequency tables. Both bivariable and multivariable logistic regression analysis was carried out by Epi Info version 5.3.1 and exported to SPSS version 21. The association was also presented using odds ratios and 95% confidence levels. P-value of < 0.05 is used to declare the significance of association between variables. Results: From the total respondent participated in the study, 373 (38.7 %), 61.8%, and 11.2% of the total unmarried women had awareness, attitude and used emergency contraception respectively. Age, educational status, occupation, having experience of sexual intercourse and having discussion on reproductive health are significantly associated with awareness of emergency contraception. Conclusions: There is high level of knowledge, but low utilization of emergency contraceptives among unmarried women. Therefore, there is a need to emphasize on increasing awareness and accessibly as an option with other contraceptive method to all unmarried women in the study area.

Maternal mortality: structure and solutions to the problem

Maternal mortality is the most important indicator of womens health, but its level is still high. In 2018, 146 cases of maternal death were registered in the Russian Federation. Its main causes were extragenital diseases, bleeding, preeclampsia and eclampsia, amniotic fluid embolism, clinical narrow pelvis, and unsafe abortion. The aim of this study was to assess the structure of maternal mortality in recent years and to evaluate possible ways to reduce it. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on the maternal mortality issue. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. The measures adopted so far do not allow for counting on a further decrease in maternal mortality rate, therefore the coming decade requires the introduction of artificial intelligence technologies.

Women Leaders Perceived Barriers and Consequences of Safe Abortion in Rwanda: A Qualitative Study

Background: Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often do not have the power to make informed decisions on the subject. The purpose of this study is to explore the barriers and consequences of safe abortion as perceived by women leaders in Rwanda. Method: In this qualitative study, seven focus group discussions and seven key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. Results: The emerging theme “strong barriers and numerous consequences of safe abortion” illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: 1) “Perceived barriers of safe abortion” and 2) “Consequences of providing safe abortion”. The sub-categories for the first category are “Reluctance to fully support safe abortion due to perceived unjustified abortions”, “Abortion-related stigma, “Abortion is against cultural and religious beliefs”, and “Emotional attachment to the unborn”. The sub-categories for the second category are “Perceived physiological trauma”, “cause for barrenness/infertility”, “increase in services abuse by adolescents/women”, “increase of workload for healthcare providers”, “increase in sexual activities and STIs”, and “Abortion-related physiological trauma”. Conclusion: The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word ‘abortion’ disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word ‘abortion’ outweighs the word ‘safe’. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.

Maternal Mortality from Induced Abortion in Malawi: What Does the Latest Evidence Suggest?

It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence—itself from 15 to 20 years ago—suggests that 6–7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70–150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion.

Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010–2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.

A research note on the mortality consequence of denying all wanted induced abortions

In this research note, I estimate one component of the mortality impact of denying all wanted induced abortions in the U.S. This estimate quantifies the magnitude of an increase in pregnancy-related death which would occur solely due to the greater mortality risk of continuing pregnancy to term compared to having a legal induced abortion. Using published statistics on pregnancy-related mortality ratios, births, and abortions, I estimate U.S. pregnancy-related deaths by race/ethnicity before and in first and subsequent years of a total abortion ban. I estimate deaths after a total abortion ban by assuming all induced abortions are denied, assuming each abortion denied averts 0.8 births, and increasing exposure to pregnancy-related mortality accordingly. I find that in the first year of ban, estimated pregnancy-related deaths would increase from 675 to 724 (49 additional deaths, 7% increase), and in subsequent years to 815 (140 additional deaths, 21% increase). Non-Hispanic Black women would experience the greatest increase in deaths (33% increase in subsequent years). Estimated pregnancy-related deaths would increase for all race/ethnicities examined. Denying all wanted induced abortions in US would increase pregnancy-related mortality substantially, even if unsafe abortion does not increase.