The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022.

OBJECTIVE: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies.

BACKGROUND: Developing countries register 98% of unsafe abortion annually, 41% of which occur among women aged between 15 and 25 years. Additionally, 70% of hospitalizations due to unsafe abortion are among girls below 20 years of age. PURPOSE: This study unveils abortion practices in Africa, its consequences, and control strategies among adolescents. METHODS: Online databases that provided relevant information on the topic were searched. A Google Scholar search yielded 623 000 results, PubMed yielded 1134 results, African Journals Online yielded 110 results, and PsycINFO yielded eight results. A total of 25 studies published from 2000 to 2018 that met the Critical Appraisal Skills Programme (CASP) standard were thematically reviewed. FINDINGS: These studies indicated that abortion is a neglected problem in health care in developing countries, and yet decreasingly safe abortion practices dominate those settings. Adolescents who have unintended pregnancies may resort to unsafe abortion practices due to socio-economic factors and the cultural implications of being pregnant before marriage and the legal status of abortion. Adolescents clandestinely use self-prescribed drugs or beverages, insert sharps in the genitals, and most often consult traditional service providers. Abortion results in morbidities such as sepsis, severe anaemia, disabilities, and, in some instances, infertility and death. Such events can be controlled by the widening availability of and accessibility to contraceptives among adolescents, advocacy, and comprehensive sexuality education and counselling. CONCLUSION: Adolescents are more likely to use clandestine methods of abortion whose consequences are devastating, lifelong, or even fatal. Awareness and utilization of youth-friendly services would minimize the problem.

Occurrence and predictors of abortion among women of the reproductive age group in a block of Darjeeling District, West Bengal, India.

BACKGROUND: Despite being a sensitive and less explored issue, abortion is a major preventable cause of maternal morbidity and mortality affecting millions of women in developing countries. OBJECTIVES: The study aimed to determine the occurrence, nature, and predictors of abortion among women in the reproductive age group in Naxalbari block of Darjeeling district. METHODS: A community-based cross-sectional study was conducted in Naxalbari block of Darjeeling district, West Bengal, India, from May 2015 to April 2016, among 420 women aged 15-49 years selected from 30 villages by cluster sampling technique. A predesigned, pretested interview schedule validated in the local vernacular was used. Binary logistic regression was used for finding out predictors of abortion among ever-pregnant women. RESULTS: Lifetime occurrence of abortion was 33.6%. Among total 178 events of abortion, 51.7% were spontaneous and 48.3% induced. Majority of spontaneous abortions events were attended by a doctor (73.9%). About 59.3% of induced abortions were illegal, and unwanted pregnancy was major reason (62.4%) for induced abortion. Private facilities and over the counter drugs were preferred. Lower education, nuclear family, number of children <2, not having male child, domestic violence during pregnancy were significant predictors of abortion. CONCLUSIONS: Illegal abortions were highly prevalent in the area. Unwanted pregnancies hint toward unmet needs of family planning. Stigma and poor awareness were the root cause of not visiting a health facility in case of abortions. Building up of better infrastructure, better orientation of frontline workers, non-judgemental and confidential services will attract women to in government facilities.

Negotiating the social and medical dangers of abortion in Addis Ababa: An exploration of young, unmarried women's abortion-seeking journeys.

Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka.

BACKGROUND: When faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women's long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka. METHODS: An unmatched case-control study was conducted in nine hospitals among 171 women admitted for care following an unsafe abortion (Cases) and 600 women admitted to same hospitals for delivery of an unintended term pregnancy (Controls). Interviewer-administered-questionnaires assessed their socio-economic, reproductive and fertility (decisions on family size, family completion) characteristics, contraceptive method last used (traditional, modern), reasons for discontinuation/never-use, and contraceptive practices assessed at different time points. Using several regression models, the risk of abortion was assessed for 'non-use' of contraception against 'ineffective use' at conception; for non-use further categorised as 'never-use', 'early-discontinuation' (discontinued before last birth interval) and 'late-discontinuation' (discontinued during last birth interval); and for any interaction between the contraceptive practice and contraceptive method last used among the ever-users of contraception. RESULTS: At conception, 'non-use' of contraception imparted a two-fold risk for abortion against ineffective use (adjusted-OR = 2.0; 95% CI: 1.2-3.2). The abortion risk on 'non-use' varied further according to 'early' (adjusted-OR = 1.7; 95% CI: 1.1-3.1) and 'late' (adjusted-OR = 2.3; 95% CI: 1.5-3.6) discontinuation of contraception, but not with 'never-use' (crude-OR = 1.1; 95% CI: 0.6-2.3). Among the ever-users, the risk of abortion varied within each contraceptive practice by their last used contraceptive method and reasons for discontinuation. A significant interaction between modern contraceptives and early discontinuation (adjusted-OR = 1.4; 95% CI = 1.1-3.1) demonstrated a seven-fold abortion risk for early discontinuation of modern methods against its ineffective use. In particular, hormonal methods seemed to be responsible for this risk (51.1% cases versus 42.5% controls). CONCLUSIONS: Long-term contraceptive practices showed varying risk for abortion, and was further modified by early discontinuation of modern contraceptives. This knowledge should be applied during postnatal visits by public-health staff.

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

Over 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.

A Study on Unsafe Abortion Presented for Medicolegal Examination: Medicolegal Evidence and Limitations in Opinion.

INTRODUCTION: Unsafe abortion is a major health problem causing women's health at risk. It is the third leading cause of maternal mortality in Sri Lanka during the last decade. Strong evidence for administration of justice and thereby to improve the health care and policies regarding such victims is the expected aim of medicolegal examination. OBJECTIVE: The aims of the study were to determine the pattern of unsafe abortions in medicolegally referred cases and to assess the strengths and the limitations of medicolegal opinion in such cases. STUDY DESIGN: Retrospective descriptive study was done based on the notes of the medicolegal examinations performed by the authors, on women who underwent illegal abortions during past 5 years. RESULTS: Of 51 cases reviewed, mechanical interference was the method used in 45% of cases. Sixty-eight percent of the women were admitted to hospital with heavy bleeding. The condition on admission was critical requiring medical interventions to save the life in 53% of cases. Referral for medicolegal examination had been performed after 3 days of admission in the majority (59%) of cases, whereas in 47% of cases, there was a therapeutic interference within 3 days of medicolegal examination. At the time of medicolegal examination, evidence of initial interference could not be identified in majority (84%). CONCLUSION: Provision of strong evidence to give expected legal outcome in cases of illegal abortion is limited. Judiciary and law enforcement authorities should be aware of these limitations and look for strong corroborative evidence to implement the penalty.

Induced abortion: incidence and trends worldwide from 1995 to 2008.

BACKGROUND: Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003. METHODS: We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based largely on official statistics and nationally representative surveys. Unsafe abortion estimates were based primarily on information from published studies, hospital records, and surveys of women. We used additional sources and systematic approaches to make corrections and projections as needed where data were misreported, incomplete, or from earlier years. We assessed trends in abortion incidence using rates developed for 1995, 2003, and 2008 with the same methodology. We used linear regression models to explore the association of the legal status of abortion with the abortion rate across subregions of the world in 2008. FINDINGS: The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15-44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05). INTERPRETATION: The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals. FUNDING: UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation.

Abortion in a progressive legal environment: the need for vigilance in protecting and promoting access to safe abortion services in South Africa.

The importance of South Africa as a model for reproductive self-determination in Africa cannot be underestimated. Abortion has been legal since 1996, and the country has some of the most developed government systems for the provision of abortion care on the continent. Yet in the same way opponents of abortion in the United States have whittled away at access with increased bureaucracy, South Africa faces similar assaults that leave women without safe care and threaten to turn back achievements made during the past 16 years. I explore the history of the law, subsequent legal challenges, and new threats to women's access to abortion services, including service delivery issues that may influence the future of public health in the country.

Abortion in Sri Lanka: the double standard.

In Sri Lanka, women do not have access to legal abortion except under life-saving circumstances. Clandestine abortion services are, however, available and quite accessible. Although safe specialist services are available to women who can afford them, others access services under unsafe and exploitative conditions. At the time of this writing, a draft bill that will legalize abortion in instances of rape, incest, and fetal abnormalities awaits approval, amid opposition. In this article, I explore the current push for legal reform as a solution to unsafe abortion. Although a welcome effort, this amendment alone will be insufficient to address the public health consequences of unsafe abortion in Sri Lanka because most women seek abortions for other reasons. Much broader legal and policy reform will be required.

A study of unnatural female death profile in Lucknow, India.

Epidemiological and medicolegal, including forensic pathological, aspects of 456 cases of unnatural deaths of females aged 16 to 30 years were studied in Lucknow during the period of 1 year (May 2, 2011 to May 1, 2012). These constituted 62.5% of the total unnatural deaths autopsied from all ages in females. Most of the victims were young Hindu housewives killed or who died within 7 years of marriage. The most common cause was vehicular accidents followed by poisons and burns. The homicidal, suicidal, and accidental deaths were 87, 129, and 240, respectively. The common motives and circumstances were mental stress due to various reasons, family quarrel, maladjustment in married life, and cruelty by the in-laws. Level of education, joint family structure, unemployment, dependence of the woman on the in-laws, infidelity, large families, and failure in love in unmarried girls were other contributing factors affecting the incidence. The study suggests different measures to check unnatural female deaths to improve the situation.

Estimates of induced abortion in South Korea: health facilities survey.

AIM: The aim of this study was to estimate the national rates of induced abortion in South Korea, where no quantitative national studies of abortion exist because the procedure is illegal. MATERIALS AND METHODS: A survey of 25 hospitals and 176 private clinics that provide induced abortions was conducted in 2005. The data were analyzed to estimate the nationwide rate of induced abortion. Indirect estimation methodology was used to calculate the number of annual induced abortions. RESULTS: In 2005, an estimated 342 433 induced abortions were performed in South Korea at a rate of 29.8 per 1000 women aged 15-44years. We observed that the abortion rate was higher in single women (31.6 per 1000 women) than in married women (28.6 per 1000 women). CONCLUSIONS: A significant number of induced abortions occur in both cohorts of married and unmarried women. To prevent serious physical harm to patients, the government should reconsider the practicality of the current statutes that prohibit women from seeking abortions from a qualified provider.

[Sexual violence in Congo-Kinshasa: necessity of decriminalizing abortion]. / Violence sexuelle au Congo-Kinshasa: nécessité de la dépénalisation de l'avortement.

The sexual violence's committed in the Democratic Republic of Congo (DRC) are from their scales and consequences on women, real public health, politico-legal, and socio-economical challenges. More than a million of women have been victims of sexual violence on a period of less than fifteen years. Systematic rapes of women were used as war weapon by different groups involved in the Congolese war. Sexual violence against women has impacted public health by spreading sexually transmissible diseases including HIV/AIDS, causing unwanted pregnancies, leading to the gynaecological complications of rape-related injuries, and inflicting psychological trauma on the victims. Despite high level of unwanted pregnancies observed, the Congolese law is very restrictive and interdict induced abortion. This paper presents three arguments which plead in favour of legalizing abortion in DRC: 1) a restrictive law on abortion forces women to use unsafe abortion and increase incidence of injuries and maternal mortality ; 2) DRC has ratified the universal Declaration of human rights, the African union charter, and has than to promote equality between sexes, in this is included women reproductive rights; 3) an unwanted birth is an additional financial charge for a woman, a factor increasing poverty and psychologically unacceptable in case of rape. From the politico-legal point of view, ending rape impunity and decriminalizing abortion are recommended. Decriminalizing abortion give women choice and save victims and pregnant women from risks related to the pregnancy, a childbirth, or an eventual unsafe abortion. These risks increase the maternal mortality already high in DRC (between 950 and 3000 for 100000 live births).

Postnatal depression in women after unsuccessful attempted abortion.

A population-based cohort study investigated postnatal depression in Brazilian women who attempted an abortion. Participants' views and actions on abortion were assessed during pregnancy and postnatal depression was evaluated with the Edinburgh Postnatal Depression Scale. An unsuccessful abortion attempt was associated with postnatal depression (adjusted OR = 1.6, 95% CI 1.0-2.5). In Brazil abortion is illegal under most circumstances.

Abortion and contraceptive use in sub-Saharan Africa: how women plan their families.

Based on available evidence, this review article posits that contemporary use of abortion in sub-Saharan Africa often substitutes for and sometimes surpasses modern contraceptive practice. Some studies and some data sets indicate that this occurs not only among adolescents but also within older age groups. In several sub-Saharan cities, particularly where contraceptive use is low and access to clinical abortion is high (though largely illegal), abortion appears to be the method of choice for limiting or spacing births. Even in rural areas, women may regularly resort to abortion, often using extremely unsafe procedures, instead of contraception. Available data seem to indicate that relatively high levels of abortion correlate with low access to modern contraception, low status of women, strong sanctions against out-of-wedlock pregnancy, traditional tolerance of abortion, and availability of modern abortion practices. Abortion has been and will likely continue to be used to plan families within much of sub-Saharan Africa.

Factors associated with severe complications in unsafe abortion.

OBJECTIVE: To assess factors associated with severe complications in unsafe abortion and to compare the complications in unsafe abortions with spontaneous or therapeutic induced abortion at Khon Kaen Hospital. MATERIAL AND METHOD: Four hundred sixty two medical records with the diagnosis of abortion at Khon Kaen Hospital between January and December 2008 were reviewed. Patient characteristics, complications and treatment outcomes were collected. The complications from abortion were classified into mild and severe group. Qualitative data were presented as frequencies and percentage. Comparison data was analyzed by using Pearson Chi-square test. RESULTS: Out of 462 cases of abortion observed over the study period, 170 (36.8%) women had undergone an unsafe abortion. Twenty-seven (16%) women had severe complications and included 18 cases with hemorrhage requiring blood transfusions (66.6%), 17 cases with shock (63%), six cases with acute renal failure (22.2%), two cases with sepsis with DIC (7.4%) and two death cases. Ninety-five women (56%) in the unsafe abortion did not use any contraception. When compared between the mild and severe complication in the unsafe abortion group, there were statistical differences in the marital status, level of education and the method used (p = 0.003, p = 0.019, p < 0.001, respectively). Severe complications from unsafe abortion more frequently occurred in married, low educated women where intrauterine chemical injection was the most often used. CONCLUSION: The unsafe abortion had more severe complications than the spontaneous or therapeutic abortion, which had affected the women's health. Level of education, marital status, and method used were factors associated with severe complications in unsafe abortion.

[Reproductive health and abortion in Antananarivo (Madagascar): results of an original research]. / Sante de la reproduction et avortement a Antananarivo (Madagascar) resultats d'une recherche originale.

In Madagascar, voluntary termination of pregnancy is totally forbidden. However, many women resort to it, most especially in the capital, Antananarivo. These secret abortions are carried out not only by traditional birth attendants but also by private medical practitioners. This article presents the results of a research conducted on 193 women interviewed in 2005 when they came to consult a doctor and seek abortion. This first survey was complemented by qualitative data collected from students who had already had an abortion, but most especially the young ones, spinsters and those still in school. The latter try to delay the time of first childbirth in order to complete their studies, to find a first job and to get married. The young girls have a very limited access to contraception and their contraceptive choice yet depends on the willingness of their sexual partners

[Clandestine abortion complications and street drugs in Brazzaville]. / Avortements clandestins compliqués et médicaments de la rue à Brazzaville.

INTRODUCTION: clandestine abortions increase maternal morbi-mortality in sub-Saharan Africa and are closely linked to restrictive legislation and low contraceptive prevalence. In Brazzaville street drugs are commonly used to induce abortion. The purpose of this study is to determine street drug prevalence and socio-demographic characteristics of these patients. METHODS: we conducted a longitudinal study of 67 patients with induced abortion complications admitted to the Talangaï Hospital from July to December 2018. (i) Socio-demographic (ii) and obstetrical (iii) characteristics as well as abortion features (procedure, Manganguiste involvement, abortion rank and cost) were collected and analyzed using EPI info 7 software. We compared the means using student's test, proportions with CHI-2, p value was set to < 0.05. RESULTS: the average age of patients was 25 years ± 6.6; 59.7% of them were attending college, 53.8% had no income-generating activity, 38.8% lived alone and in 15% of cases biological father had denied paternity. Street drugs had been used in 74.5% of cases, mean abortion cost was 3500 CFA (US$7) and 29500CFA (US$59) when it had been performed by health-care professionals. High school respondents were more likely (73.69%) to know at least contraceptive methods (p<0.05). Greater numbers of singles (p=0.000) and of those who knew a contraceptive method (p=0.003) expressed the intention to use contraception. Conclusion: combatting the use of street drugs and securing the right to safe voluntary abortion are necessary to limit complications due to clandestine abortions.