Attitudes of Students of Medicine, University of Mostar According to Induced Abortion.

BACKGROUND: Aim of this study was to establish attitudes of medical students on induced abortion and connection of those attitudes with religiousness, length of their studies, sex and various circumstances of pregnancy. SUBJECTS AND METHODS: In total, 148 students of the first, second, fifth and sixth year of medical faculty participated in the research. The study was conducted at the Medical Faculty of the University in Mostar. While collecting the data, we used a survey taken over from literature. The data were tested with adequate statistical methods afterwards. RESULTS: 81.1% of students would perform an abortion under certain circumstances (χ2=57.189; P<0.001). Most students answered that they would perform an abortion in case that a fetus had malformations (χ2=3.892; P=0.49) or if the mother's life were endangered (χ2=47.676; P<0.001). By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on length of medical education, statistically significant difference was proved in the following circumstances: rape (χ2=6.097; P=0.014) and if the pregnancy would endanger mother's mental health (χ2=4.488; P=0.034). Students with shorter medical education expressed more liberal attitudes in the above stated circumstances. By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on religiousness statistically significant difference was proved in the following circumstances: in case of 'abortion on demand', no matter the reason (χ2=11.908; P=0.012), teenage pregnancy (χ2=33.308; P<0.001) and if the pregnancy would interfere with mother's career χ2=35.897; P<0.001). Unreligious students expressed more liberal attitudes. CONCLUSION: Influence of length of medical education and sex on attitudes on abortion was not proved statistically. Impact of religiousness on that attitude cannot be commented due to very small share of unreligious students in the sample.

[Legal health services of abortion in Uruguay. Strategies of the primary health care public services]. / Servicios legales de interrupción voluntaria del embarazo en Uruguay. Estrategias de los servicios públicos del primer nivel de atención.

OBJECTIVE: To analyze the strategies developed by the health centers to implement the law of legal abortion (LA) in public services of the primary care in Montevideo, Uruguay. MATERIALS AND METHODS: A qualitative research was conducted combining techniques of document analysis, self-administered questionnaires to key informants, and in-depth interviews with directors of health centers. A simple summative index of accessibility to abortion services was built. RESULTS: The law approved in Uruguay in 2012 demanded the development of a strategy to promote women's accessibility to LA in the public primary care system. The services failed to fully implement the strategy, due to institutional barriers. CONCLUSION: Despite the wide availability of LA services in primary care and that they are an integral part of sexual and reproductive health benefits, there is an important barrier to their use in the number of gynecologists that appeal to conscientious objection.

OBJETIVO: Analizar las estrategias desarrolladas por los centros de salud para implementar la ley de interrupción voluntaria del embarazo (IVE) en los servicios públicos del primer nivel de atención en Montevideo, Uruguay. MATERIAL Y MÉTODOS: Investigación cualitativa, que combinó técnicas de análisis documental y cuestionarios autoadministrados a informantes clave y entrevistas semidirigidas a directores de centros de salud. Se construyó un índice sumatorio simple de accesibilidad a las prestaciones de IVE en el centro de salud. RESULTADOS: La ley aprobada en Uruguay en 2012 exigió el desarrollo de una estrategia para favorecer la accesibilidad de las mujeres a la IVE en el primer nivel de atención público. Los servicios no lograron implementar cabalmente la estrategia por dificultades institucionales. CONCLUSIÓN: Pese a la amplia disponibilidad de servicios públicos de IVE en el primer nivel de atención y a que forman parte de las prestaciones en salud sexual y reproductiva, lo que favorece integralidad en la atención, persiste una barrera importante en el alto porcentaje de ginecólogos objetores de conciencia.

"I Am Ready and Willing to Provide the Service Though My Religion Frowns on Abortion"-Ghanaian Midwives' Mixed Attitudes to Abortion Services: A Qualitative Study.

BACKGROUND: Unsafe abortion is a major preventable public health problem and contributes to high mortality among women. Ghana has ratified international conventions to prevent unwanted pregnancies and provide safe abortion services, legally authorizing midwives to provide induced abortion services in certain circumstances. OBJECTIVE: The aim of the study was to understand midwives' readiness to be involved in legal induced abortions, should the law become less restricted in Ghana. METHODS: A qualitative study design, with a topic guide for individual in-depth interviews of selected midwives, was adopted. The interviews were tape-recorded and analyzed using content analysis. RESULTS: Participants emphasized their willingness to reduce maternal mortalities, their experiences of maternal deaths, and their passion for the health of pregnant women. Knowledge of Ghana's abortion law was generally low. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women. CONCLUSION: The midwives made it clear that unsafe abortions are common, stigmatizing and contributing to maternal mortality, issues that must be addressed. They made various suggestions to reduce this preventable tragedy.

Why Abortion is Illegal? Comparison of Legal and Illegal Abortion: A Critical Review.

Abortion is the termination of pregnancy that occurs spontaneously or purposely. In the most developed world, abortion is legally allowed for women seeking safe termination of pregnancies. Particularly, when access to legal abortion is restricted, abortion is the resort to unsafe methods. The aim of this review is to necessitate safe abortion and to accentuate the consequences of illegal abortion in case of legal prohibition. We used Pubmed, MedLine and Scopus databases to review previous literatures of safe, unsafe, legal and illegal abortions. Research work and reports from organizations such as World Health Organization (WHO), World Bank (WB) and United Nations (UN) were included. Snowball sampling was used to obtain relevant journals. Abortion is conventional whether it is safe, unsafe, legal or illegal. The intention of the antiabortion policy was to reduce the number of abortions globally. However, instead of decreasing rates, evidences show significant increase in abortions. When abortion is legal, the preconditions to be ensured are availability, accessibility, affordability and acceptability for the safe abortion facilities. When abortion is illegal, risk reduction strategies are needed to decrease maternal morbidity and mortality. We can reduce abortion related morbidity and mortality, whether it is legal or illegal if we can ensure the appropriate access to health care, including abortion services, education on sexuality, access to contraceptives, post abortion care, and suitable interventions and liberalization of laws. The paper reviewed the Mexico City Policy and the US foreign aid strategies and highlighted the evidence based analysis for policy reform. The liberalized abortion law can save pregnant women from abortion related complications and death.

Effects of gestational age and the mode of surgical abortion on postabortion hemorrhage and fever: evidence from population-based reproductive health survey in Georgia.

BACKGROUND: Every year around 50 million unintended pregnancies worldwide are terminated by induced abortion. Even in countries, where it is legalized and performed in a safe environment, abortion carries some risk of complications for women. Findings of researchers on the factors that influence the sequelae of abortion are controversial and inconsistent. This study evaluates the effects of gestational age and the method of surgical abortion (i.e., dilatation and curettage and vacuum aspiration) on the most common abortion complications: postabortion hemorrhage and fever. METHODS: We performed a secondary analysis of the data from the population-based Georgian Reproductive Health Survey 2010. Information on 1974 surgical abortions performed >30 days prior to the survey interview were analyzed during the study. Logistic regression statistical analysis was applied to compare the abortion sequelae that followed vacuum aspiration and dilatation and curettage at different gestational ages (<10 weeks and ≥10 weeks). We examined two major early abortion-related complications: postabortion hemorrhage and febrile morbidity (fever ≥38 °C). RESULTS: Postabortion hemorrhage was reported in 43 cases (1.9%), and febrile morbidity occurred in 44 cases (2%) among all of the surgical abortions. The abortions performed by dilatation and curettage were associated with an estimated fourfold increased risk of developing hemorrhage (OR 4.4, 95% CI 2.2-8.6) and a twofold increased risk of developing fever (OR 2.37, 95% CI 1.17-4.79) compared with the abortions that were performed via vacuum aspiration. The risk of postabortion hemorrhage (OR 1.9, 95% CI 0.8-4.4) or fever (OR 0.9, 95% CI 0.4-2.1) did not significantly differ at gestational age < 10 weeks and ≥10 weeks. CONCLUSION: Vacuum aspiration was associated with reduced risks of postabortion hemorrhage and fever compared to dilatation and curettage. Gestational age ≥ 10 weeks was not found to be a predictive factor of immediate postabortion complications: hemorrhage and fever.

Abortion as empowerment: reproductive rights activism in a legally restricted context.

BACKGROUND: This paper analyzes the strategies used by activist health professionals in Argentina who justify providing abortion despite legal restrictions on the procedure. These "insider activists" make a case for abortion rights by linking pregnancy termination to a woman's ability to exert agency at a key point in her reproductive life, and argue that refusing women access to the procedure constitutes a grievous health risk. This argument frames pregnancy termination as an issue of empowerment and also as a medical necessity. METHODS: This article is based on ethnographic research conducted in Argentina in 2013 and 2015, which includes in-depth interviews with abortion activists and health professionals and ethnographic observation at activist events and in clinics. RESULTS: During the period of my field research, the medical staff in one clinic shifted from abortion counseling, based on a harm reduction model, to legal pregnancy termination, a new mode of abortion provision where they directly provided abortions based on the legal health exception. These insider activists formalized the latter approach by creating a diagnostic instrument that frames women's "bio-psycho-social" reasons for wishing to terminate a pregnancy as medically justified. CONCLUSIONS: The clinical practice analyzed in this article raises important questions about the potential for health professionals to take on an activist role by making safe abortion accessible, even in a context where the procedure is highly restricted.

Abortion Surveillance - United States, 2014.

PROBLEM/CONDITION: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. PERIOD COVERED: 2014. DESCRIPTION OF SYSTEM: Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births). RESULTS: A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 186 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 7%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 21%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions, respectively, and had abortion rates of 11.9, 7.2, and 2.6 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. From 2005 to 2014, the abortion rate decreased among women aged 20-24, 25-29, 30-34, and 35-39 years by 27%, 16%, 12%, and 5%, respectively, but increased 4% among women aged ≥40 years. In 2014, adolescents aged <15 and 15-19 years accounted for 0.3% and 10.4% of all reported abortions, respectively, and had abortion rates of 0.5 and 7.5 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2005 to 2014, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 38%, and their abortion rate decreased 49%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2014 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2005 to 2014 for women in all age groups. In 2014, the majority (67.0%) of abortions were performed at ≤8 weeks' gestation, and nearly all (91.5%) were performed at ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.2%) or at ≥21 weeks' gestation (1.3%). During 2005-2014, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.4%). Among abortions performed at ≤13 weeks' gestation, there was a shift toward earlier gestational ages, as the percentage performed at ≤6 weeks' gestation increased 21%, and the percentage of all other gestational ages at ≤13 weeks' gestation decreased 7%-20%. In 2014, among reporting areas that included medical (nonsurgical) abortion on their reporting form, 22.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), 67.4% were performed by surgical abortion at ≤13 weeks' gestation, and 8.6% were performed by surgical abortion at >13 weeks' gestation; all other methods were uncommon (<2%). Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.2% were completed by this method. In 2014, women with one or more previous live births accounted for 59.5% of abortions, and women with no previous live births accounted for 40.4%. Women with one or more previous induced abortions accounted for 44.9% of abortions, and women with no previous abortion accounted for 55.1%. Women with three or more previous births accounted for 13.8% of abortions, and women with three or more previous abortions accounted for 8.6% of abortions. Deaths of women associated with complications from abortion for 2014 are being assessed as part of CDC's Pregnancy Mortality Surveillance System. In 2013, the most recent year for which data were available, four women were identified to have died as a result of complications from legal induced abortion. INTERPRETATION: Among the 48 areas that reported data every year during 2005-2014, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2010-2013 continued from 2013 to 2014, resulting in historic lows for all three measures of abortion. PUBLIC HEALTH ACTION: The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

'I felt the world crash down on me': Women's experiences being denied legal abortion in Colombia.

BACKGROUND: In 2006, Colombia's constitutional court overturned a complete ban on abortion, liberalizing the procedure. Despite a relatively liberal new law, women still struggle to access safe and legal abortion services. We aimed to understand why women are denied services in Colombia, and what factors determine if and how they ultimately terminate pregnancies. METHODS: We recruited women denied abortion at a private facility in Bogota. Twenty-one participants completed an initial interview and eight completed a second longer interview. Two researchers documented themes and developed and applied a codebook to transcripts using ATLAS.ti. RESULTS: Participants faced barriers, such as lack of knowledge of service availability and delayed pregnancy recognition, leading to denial. Five out of eight participants ultimately received abortions in public hospitals, due to support from partners and a robust referral system; nevertheless, they received poor care. Those who continued pregnancies endured stigmatizing events and inaccurate medical counselling at referral facilities. Several women contemplated illegal abortion though were afraid to attempt it. CONCLUSION: We propose the following recommendations: 1) increase awareness about availability and legality of abortion services to prevent delay and consequent denial; 2) provide counseling and referral upon denial; and 3) train providers in interpersonal quality abortion care.

A 21st-Century Public Health Approach to Abortion.

In the United States, groups advocating for and against abortion rights often deploy public health arguments to advance their positions. Recently, these arguments have evolved into state laws that use the government health department infrastructure to increase law enforcement and regulatory activities around abortion. Many major medical and public health associations oppose these new laws because they are not evidence-based and do not protect women's health. Yet state health departments have been defending these laws in court. We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically, we apply the Centers for Disease Control and Prevention's 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women's ability to obtain an abortion in the state and county where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services.

Ectogenesis, abortion and a right to the death of the fetus.

Many people believe that the abortion debate will end when at some point in the future it will be possible for fetuses to develop outside the womb. Ectogenesis, as this technology is called, would make possible to reconcile pro-life and pro-choice positions. That is because it is commonly believed that there is no right to the death of the fetus if it can be detached alive and gestated in an artificial womb. Recently Eric Mathison and Jeremy Davis defended this position, by arguing against three common arguments for a right to the death of the fetus. I claim that their arguments are mistaken. I argue that there is a right to the death of the fetus because gestating a fetus in an artificial womb when genetic parents refuse it violates their rights not to become a biological parent, their rights to genetic privacy and their property rights. The right to the death of the fetus, however, is not a woman's right but genetic parents' collective right which only can be used together.

Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model.

BACKGROUND: Global estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. METHODS: We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. FINDINGS: Of the 55·â€ˆ7 million abortions that occurred worldwide each year between 2010-14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9-59·4) were safe, 17·1 million (30·7%, 25·5-35·6) were less safe, and 8·0 million (14·4%, 11·5-18·1) were least safe. Thus, 25·1 million (45·1%, 40·6-50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. INTERPRETATION: Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. FUNDING: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.

Servicios legales de interrupción voluntaria del embarazo en Uruguay. Estrategias de los servicios públicos del primer nivel de atención / Legal health services of abortion in Uruguay. Strategies of the primary health care public services

Resumen: Objetivo: Analizar las estrategias desarrolladas por los centros de salud para implementar la ley de interrupción voluntaria del embarazo (IVE) en los servicios públicos del primer nivel de atención en Montevideo, Uruguay. Material y métodos: Investigación cualitativa, que combinó técnicas de análisis documental y cuestionarios autoadministrados a informantes clave y entrevistas semidirigidas a directores de centros de salud. Se construyó un índice sumatorio simple de accesibilidad a las prestaciones de IVE en el centro de salud. Resultados: La ley aprobada en Uruguay en 2012 exigió el desarrollo de una estrategia para favorecer la accesibilidad de las mujeres a la IVE en el primer nivel de atención público. Los servicios no lograron implementar cabalmente la estrategia por dificultades institucionales. Conclusión: Pese a la amplia disponibilidad de servicios públicos de IVE en el primer nivel de atención y a que forman parte de las prestaciones en salud sexual y reproductiva, lo que favorece integralidad en la atención, persiste una barrera importante en el alto porcentaje de ginecólogos objetores de conciencia.

Abstract: Objective: To analyze the strategies developed by the health centers to implement the law of legal abortion (LA) in public services of the primary care in Montevideo, Uruguay. Materials and methods: A qualitative research was conducted combining techniques of document analysis, self-administered questionnaires to key informants, and in-depth interviews with directors of health centers. A simple summative index of accessibility to abortion services was built. Results: The law approved in Uruguay in 2012 demanded the development of a strategy to promote women's accessibility to LA in the public primary care system. The services failed to fully implement the strategy, due to institutional barriers. Conclusion: Despite the wide availability of LA services in primary care and that they are an integral part of sexual and reproductive health benefits, there is an important barrier to their use in the number of gynecologists that appeal to conscientious objection.

Tweeting PP: an analysis of the 2015-2016 Planned Parenthood controversy on Twitter.

OBJECTIVES: We analyzed Twitter tweets and Twitter-provided user data to give geographical, temporal and content insight into the use of social media in the Planned Parenthood video controversy. METHODOLOGY: We randomly sampled the full Twitter repository (also known as the Firehose) (n=30,000) for tweets containing the phrase "planned parenthood" as well as group-defining hashtags "#defundpp" and "#standwithpp." We used demographic content provided by the user and word analysis to generate charts, maps and timeline visualizations. Chi-square and t tests were used to compare differences in content, statistical references and dissemination strategies. RESULTS: From July 14, 2015, to January 30, 2016, 1,364,131 and 795,791 tweets contained "#defundpp" and "#standwithpp," respectively. Geographically, #defundpp and #standwithpp were disproportionally distributed to the US South and West, respectively. Word analysis found that early tweets predominantly used "sensational" words and that the proportion of "political" and "call to action" words increased over time. Scatterplots revealed that #standwithpp tweets were clustered and episodic compared to #defundpp. #standwithpp users were more likely to be female [odds ratio (OR) 2.2, confidence interval (CI) 2.0-2.4] and have fewer followers (median 544 vs. 1578, p<.0001). #standwithpp and #defundpp did not differ significantly in their usage of data in tweets. #defundpp users were more likely to link to websites (OR 1.8, CI 1.7-1.9) and to other online dialogs (mean 3.3 vs. 2.0 p<.0001). CONCLUSION: Social media analysis can be used to characterize and understand the content, tempo and location of abortion-related messages in today's public spheres. Further research may inform proabortion efforts in terms of how information can be more effectively conveyed to the public. IMPLICATIONS: This study has implications for how the medical community interfaces with the public with regards to abortion. It highlights how social media are actively exploited instruments for information and message dissemination. Researchers, providers and advocates should be monitoring social media and addressing the public through these modern channels.