Improving abortion underreporting in the United States: a cognitive interview study

Background: Abortion is a difficult-to-measure behavior with extensive survey underreporting, which compromises the ability to study and monitor abortion. The purpose of this study was to improve our understanding of how women interpret and respond to survey items asking if they have ever had an abortion. Methods: We developed multiple new questions hypothesized to improve abortion reporting, using approaches that aim to clarify which experiences to report as an induced abortion; reduce the stigma and sensitivity of induced abortion; reduce the sense of intrusiveness of asking about abortion; and increase the motivation to report. We conducted cognitive interviews with cisgender women aged 18-49 in two US states (N=64) to iteratively assess these new approaches and questions for improving abortion reporting. Results: Our findings suggest that including abortion as part of a list of other sexual and reproductive health services, asking a yes/no question about lifetime experience of abortion instead of asking about number of abortions, and developing an improved introduction to abortion questions may help to elicit more accurate survey reports. Conclusions: Opportunities exist to improve survey measurement of abortion. Reducing underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.

Reducing the harms of unsafe abortion: a systematic review of the safety, effectiveness and acceptability of harm reduction counselling for pregnant persons seeking induced abortion

BackgroundGlobally, access to safe abortion is limited. We aimed to assess the safety, effectiveness and acceptability of harm reduction counselling for abortion, which we define as the provision of information about safe abortion methods to pregnant persons seeking abortion.MethodsWe searched PubMed, EMBASE, ClinicalTrials.gov, Cochrane, Global Index Medicus and the grey literature up to October 2021. We included studies in which healthcare providers gave pregnant persons information on safe use of abortifacient medications without providing the actual medications. We conducted a descriptive summary of results and a risk of bias assessment using the ROBINS-I tool. Our primary outcome was the proportion of pregnant persons who used misoprostol to induce abortion rather than other methods among those who received harm reduction counselling.ResultsWe included four observational studies with a total of 4002 participants. Most pregnant persons who received harm reduction counselling induced abortion using misoprostol (79%–100%). Serious complication rates were low (0%–1%). Uterine aspiration rates were not always reported but were in the range of 6%–22%. Patient satisfaction with the harm reduction intervention was high (85%–98%) where reported. We rated the risk of bias for all studies as high due to a lack of comparison groups and high lost to follow-up rates.DiscussionBased on a synthesis of four studies with serious methodological limitations, most recipients of harm reduction counselling use misoprostol for abortion, have low complication rates, and are satisfied with the intervention. More research is needed to determine abortion success outcomes from the harm reduction approach.FundingThis work did not receive any funding.PROSPERO registration numberWe registered the review in the PROSPERO database of systematic reviews (ID number: CRD42020200849).

Wearable Devices and Intelligent Application in Women’s Postpartum Repair for Smart Healthcare

Wearable devices are more and more widely used in the field of smart healthcare. The purpose of this study was to explore the effect of contraceptive counseling and education on contraceptive behavior of women after induced abortion. The investigators will explain the situation of this topic to the respondents and select the respondents in strict accordance with the framework requirements of sampling design. All the data are from the induced abortion women in the first-, second-, and third-level hospitals, which reduces the selection bias of the respondents. It is found that the proportion of induced abortion among college students is the highest, reaching 66.03%. This study is helpful to reduce the incidence of unwanted pregnancy, induced abortion, and repeated abortion and improve the reproductive health of women.

The Hippocratic Oath and deontology in modern medicine

The article deals with the history of the origin of Hippocratic Oath, the main issues of professional medical (medical) ethics (bioethics) from the standpoint of modern trends in the development of medicine: euthanasia, induced abortion, gender relations and transgender transition.

Community acceptability of contraception after induced versus spontaneous miscarriage.

Objective: To study the relationship between history of miscarriage (induced or spontaneous) and current use of modern contraceptive method among women in Pakistan. Study Design: Cross Sectional study. Setting: OPD of MCH, PIMS. Period: July 2019 to December 2019. Material & Methods: A total of 80 married women were enrolled, 40 women who had induced miscarriage (group A) and 40 from spontaneous miscarriage (group B). Data is obtained on predesigned questionnaire. Primary outcome was acceptance of contraception (LARC) after induced versus spontaneous miscarriage. Results: About 51% of women were in the age group of 30–35 years and out of total 80 women, 67 (83%) women had parity of three or above (27 % had parity of three). Out of 66 women who used contraception, 35 (53%) had induced miscarriage (group A) and 31 (46%) had spontaneous miscarriage (group B). Women who belonged to induced miscarriage (group A) faced menstrual irregularity, as the reason of leaving contraception, followed by chronic PID and husband opposition. While in the group B, fertility desire was main reason of discontinuation of contraception. In Group A, 20 (50%) women were willing to use LARC (long acting reversible contraception) after induced abortion to reduce the chances of unwanted pregnancy while in other group B, 15 (37.5%) women were wanted to use LARC and 18 (45%) women were not ready to use contraception due to fertility. Conclusion: High rate of induced abortion due to failed contraception and dis-continuation of contraceptives needs to be addressed by encouraging women to manage the side effects to ensure continuity of contraceptives.

Abortion in Europe: Recent legislative changes and risk of inequality

BACKGROUND: Induced abortion is a medical practice that has always been much discussed all over the world. Abortion is allowed in most European countries at the request of the woman with limitations that are imposed mainly by the gestational age. However, there are legislative differences between European countries which impose stringent limits on the use of induced abortion. OBJECTIVE: This article analyzes the European legislation on abortion, with a particular focus on countries in which there have been recent legislative changes in recent years, and the possible consequent risk of inequality among European women. METHODS: Government and ministerial websites of the countries analyzed have been consulted to investigate abortion laws in Europe. In addition, the Global Abortion Policies Database of the World Health Organization was also consulted for a regulatory comparison. RESULTS: The differences between the various European countries are considerable. Although guaranteed by most legislation, abortion remains a fragile right in some European countries. CONCLUSION: Different legislation in the various countries of Europe causes difficulties for women who want to have an abortion but who reside in states where there are strict limits to abortion. In addressing the issue of induced abortion, we must not forget that the center of this practice is the woman. For this reason, it is essential to apply a reasoning based on respect for women’s rights: freedom, health, and self-determination.

Study of Underlying Factors among Women Presenting with Septic/Unsafe Termination of Pregnancy

Background: In our nation, induced abortions are common. Unexpected and unintentional births are serious public health issues in both developed and underdeveloped nations. According to the WHO, abortion complications account for 2–12% of maternal fatalities in Pakistan. The circumstances surrounding these abortions have major ramifications for both females and communities. However, insufficient information about factors leading to septic induced abortions at the country level was the reason to determine the contributing factors among women with abortion. Objective: The objective of our current research is to regulate occurrence of underlying factors contributing in patients presenting with septic induced abortion in a tertiary care setup. Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynecology, Jinnah hospital, Lahore for six months after approval of synopsis. Sample size of 130 cases was included through non-Probability consecutive sampling technique after the approval from hospital ethical committee. Informed consent was taken from each patient before including them in the study. Results: The mean age of the women was noted 26.24±4.93 years of which the minimum age was 18 year and maximum of 40 years. Out of these 130 women 26(20%) had no child, at least one abortion was most common as it was noted in 197(82%) of women. The underlying factors contributing to septic induced abortion it was noted that unwanted pregnancy in 41(31.5%) of cases, failed contraception in 37(28.5%) of cases, divorce in 6(4.6%) of cases, displeased family relation in 27(20.8%) of women and out of wedlock was noted in 19(14.6%) of cases. When data were stratified for effect modifiers statistically significant difference was found between parity and contributing factors for abortions (P-value = 0.000) and insignificant difference was observed with respect to age, educational status and economic status i.e., P-value > 0.05. Conclusion: The most common reason for abortion was unwanted pregnancy among the pregnant women. Keyword: Pregnancy, Abortion, Septic, maternal fatalities in Pakistan, WHO

Prevalence and determinants of induced abortion among reproductive-aged women in Aykel town North West, Ethiopia: A community-based cross-sectional study

Objective: This study aimed to assess the prevalence and determinants of induced abortion among women of the reproductive age group in Aykel town North West, Ethiopia. Method: Community based cross-sectional study was employed in Aykel town North West Ethiopia, from August to September 2018. A systematic random sampling technique was used to recruit a total of 422 reproductive-aged women during the study period. Binary logistic regression model fitted to identify factors associated with induced abortion. Adjusted odds ratio with 95%CI used to explore the strength of association between outcome and independent variables. Result: The prevalence of induced abortion was 14.5% with 95% CI (11.2 to 18.17). Age group of 15-24 years [AOR=3.10, 95%CI (1.116-8.543)], pregnancy status unwanted [AOR=3.1; 95%CI (1.292-7.322], not ever used contraceptive [AOR = 3.96; 95%CI (1.612-9.709)], parity [AOR= 0.37, 95%CI (0.164-0.823)], knowing induce abortion complication [AOR=2.24, 95%CI (1.104-4.551],partner primary educational level [AOR = 3.68, 95%CI (1.082-12.528)] were determinants of induced abortion among reproductive age women. Conclusions: This study revealed that the magnitude of induced abortion was high. Younger age, pregnancy status unwanted, had not ever used contraceptive, knowing induced abortion complication, and partner education level was positively associated with induced abortion. In contrast, parity negatively associated with induced abortion. Therefore, induce abortion intervention like contraception provisions need to focus young age group.