Attitudes and Laws About Abortion Are Linked to Extrinsic Mortality Risk: A Life-History Perspective on Variability in Reproductive Rights.

Abortion policy is conventionally viewed as a political matter with religious overtones. This article offers a different view. From the perspective of evolutionary biology, abortion at a young age can represent prioritization of long-term development over immediate reproduction, a pattern established in other animal species as resulting from stable ecologies with low mortality risk. We examine whether laws and moral beliefs about abortions are linked to local mortality rates. Data from 50 U.S. states, 202 world societies, 2,596 adult individuals in 363 U.S. counties, and 147,260 respondents across the globe suggest that lower levels of mortality risk are associated with more permissive laws and attitudes toward abortion. Those associations were observed when we controlled for religiosity, political ideology, wealth, education, and industrialization. Integrating evolutionary and cultural perspectives offers an explanation as to why moral beliefs and legal norms about reproduction may be sensitive to levels of ecological adversity.

How does a ban on sex-selective abortions affect child health?

Bans on sex-selective abortions are typically implemented to make sex ratios more equitable, but they may have adverse effects on surviving children. We examine the impacts of a ban on prenatal sex selection in India on postnatal health outcomes. We first show that the ban increased the share of female children born to mothers, especially among firstborn female families. Strikingly, we also find that the ban led to a worsening of mortality outcomes for both girls and boys in firstborn female families. In terms of mechanisms, we find that fertility increases in firstborn female families after the ban, pointing to the following channel: firstborn female families are disproportionately affected by the ban and are more likely to use the son-biased fertility stopping rule to achieve a desired number of sons. Children in firstborn female families likely face greater competition for parental resources, which may worsen their health.

Women at crossroads: a qualitative study of induced abortion and violence in a Ghanaian region.

Unsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women's experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women's vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women's experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices.

Bibliometric analysis of the global trends in immune-related recurrent pregnancy loss research over the last two decades.

PROBLEM: A comprehensive analysis was conducted to explore the scientific output on immune-related recurrent pregnancy loss (RPL) and its key aspects. Despite the lack of clear explanations for most RPL cases, immune factors were found to play a significant role. METHOD OF STUDY: The study utilized a bibliometric approach, searching the Web of Science Core Collection database for relevant literature published between 2004 and 2023. RESULTS: The collected dataset consisted of 2228 articles and reviews, revealing a consistent increase in publications and citations over the past two decades. The analysis identified the United States and China as the most productive countries in terms of RPL research. Among the institutions, Fudan University in China emerged as the top contributor, followed by Shanghai Jiaotong University. Kwak-kim J was the most prolific author, while Christiansen Ob had the highest number of co-citations. The top 25 co-cited references on diagnosis, treatment, and mechanisms formed the foundation of knowledge in this field. By examining keyword co-occurrence and co-citations, the study found that antiphospholipid syndrome and natural killer cells were the primary areas of focus in immune-related RPL research. Additionally, three emerging hotspots were identified: chronic endometritis, inflammation, and decidual macrophages. These aspects demonstrated increasing interest and research activity within the field of immune-related RPL. CONCLUSIONS: Overall, this comprehensive bibliometric analysis provided valuable insights into the patterns, frontiers, and focal points of global scientific output related to immune-related RPL.

MiR-150-5p contributes to unexplained recurrent spontaneous abortion by targeting VEGFA and downregulating the PI3K/AKT/mTOR signaling pathway.

PURPOSE: The purpose of this study is to investigate the function of miR-150-5p in URSA. METHOD: Twenty-six chorionic villous tissues were collected to examine the expression of miR-150-5p and VEGFA by using quantitative polymerase chain reaction (qPCR) and western blot assay, respectively. Transwell assay was conducted to assess the migration and invasion ability of trophoblast cells. The dual-luciferase reporter assay was applied to determine the relationship between miR-150-5p and VEGFA in vitro. Relevant signaling pathway protein expression level was measured via western blot assay. Signaling transduction inhibitor LY294002 was used to block PI3K/AKT/mTOR signaling pathway. Finally, in vivo the effect of miR-150-5p on embryonic absorption rate was evaluated in mice. RESULTS: Clinical samples revealed that miR-150-5p expression was significantly elevated in the villous tissues and serum of URSA patients. Moreover, the overexpressing of miR-150-5p could inhibit both HTR-8/SVneo cell and JAR cell migration, invasion, and restrained PI3K/AKT/mTOR signaling pathway by targeting VEGFA in vitro. This inhibitory effect of miR-150-5p could be reversed by overexpressing the gene of vascular epithelial growth factor A (VEGFA). In contrary, inhibition of miR-150-5p significantly enhanced migration, invasion ability of both HTR-8/SVneo and JAR cells, and also could stimulate PI3K/AKT/mTOR signaling pathway. This promoting effect of miR-150-5p could be ameliorated by LY294002 (PI3K inhibitor). Finally, after miR-150-5p overexpression in vivo, the embryo resorption rate in pregnant mice was increased significantly. CONCLUSIONS: Overall, these findings imply that miR-150-5p is among the key factors that regulate the pathogenesis of URSA.

Effectiveness and acceptability of home use of misoprostol for medical abortion up to 10 weeks of pregnancy.

INTRODUCTION: The administration of mifepristone, followed by misoprostol, is widely used for medical abortion. Many studies have demonstrated home abortion to be safe in pregnancies up to 63 days of gestation, and recent data support its safety when extended to more advanced pregnancies. We studied the efficacy and acceptability of home use of misoprostol up to 70 days of gestation in a Swedish setting and compared the outcomes between pregnancies with a gestational age of up to 63 days and pregnancies with gestational age 64-70 days. MATERIAL AND METHODS: This prospective cohort study was performed between November 2014 and November 2021 at Södersjukhuset and Karolinska University Hospital, Stockholm, and some patients were also recruited from Sahlgrenska University Hospital, Göteborg and Helsingborg Hospital. The primary outcome was the rate of complete abortions and was defined as complete abortion without any need for surgical or medical intervention and assessed by clinical assessment, pregnancy test and/or vaginal ultrasound. Secondary objectives were assessed by daily self-reporting in a diary and included pain, bleeding, side effects and women's satisfaction and perception of home use of misoprostol. A comparison of categorical variables was made with Fisher's exact test. The significance level was set to a p-value ≤0.05. The study was registered at Clinicaltrials.gov on July 14, 2014 (NCT02191774). RESULTS: During the study period we enrolled 273 women opting for medical abortion with home use of misoprostol. In the early group, up to 63 days of gestation, 112 women were included with a mean gestational length of 45 days and in the late group, 64-70 days of gestation, 161 women with a mean gestations length of 66.3 days were included. Complete abortion occurred in 95% (95% CI 89-98) of women in the early group and in 96% (95% CI 92-99) in the late group. No differences were found regarding side effects and acceptability was similarly high in both groups. CONCLUSIONS: Our results show high efficacy and acceptability of medical abortion when misoprostol is administered at home up to 70 days of gestation. This supports previous findings about maintained safety when misoprostol is administered at home even past a very early pregnancy.

Anti-abortionist Action Theory and the Asymmetry between Spontaneous and Induced Abortions.

This essay defends the asymmetry between the badness of spontaneous and induced abortions in order to explain why anti-abortionists prioritize stopping induced abortions over preventing spontaneous abortions. Specifically, it argues (1) the distinction between killing and letting-die is of more limited use in explaining the asymmetry than has sometimes been presumed, and (2) that accounting for intentions in moral agency does not render performances morally inert. Instead, anti-abortionists adopt a pluralist, nonreductive account of moral analysis which is situated against a backdrop that sees the limits of our ability to control the process of fertility as themselves valuable. Although this view is complex, the paper concludes by arguing that it has the advantage of explaining features of the anti-abortion outlook that have sometimes been overlooked. First, it accounts for why the pre-Roe regime of abortion restrictions primarily imposed penalties on doctors who induced abortions rather than the women who seek them. Second, it explains why the advent of ectogestation will not prompt anti-abortionists to compromise on 'disconnect abortions,' which putatively let the embryo die by extracting it from the mother's womb.

Prevention of intrauterine adhesions.

Intrauterine adhesions are a serious complication that occurs after intrauterine procedures, most often in connection with pregnancy. Manifestations such as amenorrhea, pelvic pain, and infertility for a woman, especially in reproductive age, are serious and together with intrauterine adhesions we call them Asherman's syndrome. Primary prevention after intrauterine procedures is important. Published studies show that the use of hyaluronic acid gel, especially after abortions, leads to the prevention of moderate and severe intrauterine adhesions and also increases the pregnancy rate.

The role of intervening pregnancy loss in the association between interpregnancy interval and adverse pregnancy outcomes.

OBJECTIVE: To investigate whether intervening miscarriages and induced abortions impact the associations between interpregnancy interval after a live birth and adverse pregnancy outcomes. DESIGN: Population-based cohort study. SETTING: Norway. PARTICIPANTS: A total of 165 617 births to 143 916 women between 2008 and 2016. MAIN OUTCOME MEASURES: We estimated adjusted relative risks for adverse pregnancy outcomes using log-binomial regression, first ignoring miscarriages and induced abortions in the interpregnancy interval estimation (conventional interpregnancy interval estimates) and subsequently accounting for intervening miscarriages or induced abortions (correct interpregnancy interval estimates). We then calculated the ratio of the two relative risks (ratio of ratios, RoR) as a measure of the difference. RESULTS: The proportion of short interpregnancy interval (<6 months) was 4.0% in the conventional interpregnancy interval estimate and slightly increased to 4.6% in the correct interpregnancy interval estimate. For interpregnancy interval <6 months, compared with 18-23 months, the RoR was 0.97 for preterm birth (PTB) (95% confidence interval [CI] 0.83-1.13), 0.97 for spontaneous PTB ( 95% CI 0.80-1.19), 1.00 for small-for-gestational age ( 95% CI 0.86-1.14), 1.00 for large-for-gestational age (95% CI 0.90-1.10) and 0.99 for pre-eclampsia (95% CI 0.71-1.37). Similarly, conventional and correct interpregnancy intervals yielded associations of similar magnitude between long interpregnancy interval (≥60 months) and the pregnancy outcomes evaluated. CONCLUSION: Not considering intervening pregnancy loss due to miscarriages or induced abortions, results in negligible difference in the associations between short and long interpregnancy intervals and adverse pregnancy outcomes. TWEETABLE ABSTRACT: Not considering pregnancy loss in interpregnancy interval estimation resulted no meaningful differences in observed risks of adverse pregnancy outcomes.

Increased incidence of spontaneous abortions on exposure to cadmium and lead: a systematic review and meta-analysis.

BACKGROUND: Spontaneous abortions are the most severe complication of early pregnancy and are a major reproductive health problem. Although this could be caused due to various cytogenetic, immunological, or endocrinological reasons, role of environmental toxicants cannot be ruled out. In order to explore the role of cadmium and lead in causing spontaneous abortions, current systematic review and meta-analysis had been carried out. METHODOLOGY: Literature search was performed using appropriate keywords in PubMed, Science Direct, Cochrane Library, and Google Scholar databases up to December 25 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Metananalysis was carried out with the help of RevMan software (version 5.3). RESULTS: Meta-analysis of nine studies on cadmium concentrations in blood of women with at least one spontaneous abortions and controls revealed standardized mean difference (SMD)=3.39, 95% CI (2.17, 4.61), with p < .05. Similarly, meta-analysis of eight studies on lead concentrations revealed standardized mean difference (SMD)=6.24, 95% CI (4.34, 8.14), with p < .05. CONCLUSION: Populations exposed to heavy metals such as cadmium and lead are at higher risk of pregnancy loss. Therefore, couples experiencing repeated pregnancy losses may be screened for heavy metal load.

Knowledge, attitudes and practices on contraceptive use among young people in selected universities in Zimbabwe.

Contraception is vital, not only because of the statistical evidence on utilisation of the services by women, but for economic and societal reasons. Uptake and use of contraceptives among youth in Zimbabwe is low at 12% for the 15-19 years and 49% for the 20-24 years compared to 67% of all married women in the country. Unmet need for family planning remains high at 13% (15-19 years) and 10.4% (20-24 years) compared to 10% among all women in Zimbabwe. Students in tertiary institutions are within these age groups and use of contraception among them is vital. The study was conducted to explore the knowledge level, attitudes and practices among young people towards the use of contraceptives in purposively selected universities. A mixed method approach using both qualitative and quantitative research design was used. Data was collected from 537 female students aged 18-24 years using structured questionnaires. Twenty Key informant interviews and 12 focus group discussions with bouth young males and females were conducted. Quantitative data was cleaned and analysed using STATA while content analysis was used for qualitative data. Ninety five percent (95%) of the young women in tertiary institutions had ever heard of contraception and 27% had ever used contraceptives. Students had myths and misconceptions regarding use of contraceptives including causing cancers, infertility in future and unbearable side effects. The pill was the most common contraceptive method known (85%). Religion and the involvement of family members, peers as well as other relatives were among the factors contributing to barriers of FP services uptake. The study has provided evidence that awareness on contraceptives among young people in tertiary institutions, does not necessarily lead to increased uptake. Educational campaigns with emphasis on the benefits of contraception will help reduce misconceptions and increase access and utilization of family planning services among the tertiary institution students.

Molecular detection of Brucella spp. in ruminant herds in Greece.

Brucellosis is a worldwide distributed infectious disease. Ruminants and other animal species (swine, dogs, equids, etc.), as well as wild mammals, can be affected. The disease can be transmitted to humans through the food chain or by direct contact with infected animals. Because of the relatively high economic burden due to abortions within a herd, significant efforts have been employed and hence the disease in most European countries has been eradicated. Accordingly, Greece applies both control and eradication programs concerning small ruminants (sheep and goats) and bovines depending on the geographical area. Current challenges in the standard antibody-based laboratory methods used for Brucella detection are the failure to differentiate antibodies against the wild strain from the ones against the vaccine strain Rev1 and antibodies against B. melitensis from those against B. abortus. The aim of the study was to reexamine and combine previously published protocols based on PCR analysis and to generate a rapid, not expensive, and easy to perform diagnostic tool able to confirm the doubtful results delivered from serology. For this reason, 264 samples derived from 191 ruminants of the farm and divided in 2 groups (male/female) were examined with a modified DNA extraction and PCR protocol. Molecular examination revealed the presence of Brucella spp. in 39 out of 264 samples (derived from 30 animals). In addition, Brucella spp. was detected in infected tissues such as testicles, inguinal lymph nodes, fetal liver, and fetal stomach content.

Investigation of the outbreaks of abortions and orchitis in livestock in Namibia during 2016-2018.

This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to 2018, affecting cattle, sheep and goats. Fifty-nine questionnaires were administered, and 48 were completed giving an 81.4% return. The outbreaks were limited to Namibia's east and central regions, mainly on farms rearing cattle, sheep and goats and on farms with a mixture of these species. There was no significant difference between Khomas and other regions on abortion reporting at the farm level [X2 (1, N = 48) = 0.0002, p = 0.987851]. However, there was a significant difference in the abortions at the animal level among the three regions [X2 (2, N = 6246) = 239.8339, p = .00001]. In addition, the proportions of abortions calculated at the animal level at each farm were significantly different when the Khomas region was compared to the other regions. Seventeen cattle sera, 35 sheep sera, 52 caprine sera, 18 bovine liver samples, one caprine liver, five aborted cattle foetuses, two cattle placentas, 18 testes (one bull, eight bucks and nine rams) and ten bull sheath scrapings were collected and tested. Histopathology, microbiology, serology, immunohistochemistry, real-time PCR and mineral analytical techniques were used to establish the aetiology of the abortion and orchitis outbreaks. The gross and histopathological findings on the 18 testicles were characteristic of chronic orchitis. In aborted foetuses, significant histopathological findings included meconium aspiration, funisitis and cardiomyopathy. Placentitis and endometritis were the primary pathologies observed in cows. The bacteria isolated from microbiological samples included Enterococcus spp. (65.5% [19/29]), Enterobacter spp. (6.9% [2/29]) and Streptococcus spp. (10.3% [3/29]), Trueperella pyogenes (3.4% [1/29]), Stenotrophomonas maltophilia (3.4% [1/29]), Staphylococcus epidermidis (3.4% [1/29]), Providencia rettgeri (3.4% [1/29]) and Acinetobacter lwoffii (3.4% [1/29]), mostly opportunistic bacteria. On mineral analysis, 28%, 33%, 83%, 33% and 17% (n = 18) of cattle livers were low in copper, zinc, manganese, selenium and iron, respectively. Twenty-three percent (12/52) of the caprine sera were positive for Brucella melitensis on the Rose Bengal and complement fixation tests. Thirty-five ovine sera were tested for B. melitensis, B. ovis and Coxiella burnetii, and the prevalence for each was 2.9% (1/35). PCR tests on foetuses were all negative for Brucella spp., Coxiella burnetii, Chlamydia spp., Listeria monocytogenes, Salmonella spp., Campylobacter fetus spp., Leptospira pathogenic strains, bovine viral diarrhoea virus, Rift Valley fever virus, Anaplasma phagocytophilum and bovine herpes virus 4 Campylobacter fetus spp. and Trichomonas foetus spp. The authors concluded that Brucella spp., Enterococcus spp., Escherichia coli, Streptococcus spp., Trueperella pyogenes and Coxiella burnetii could have contributed to this outbreak. Micronutrient imbalances and pathogenic abiotic nanoparticles were also identified as possible contributors to the abortion outbreaks.

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study.

BACKGROUND: Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. METHODS: We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. RESULTS: Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. CONCLUSIONS: The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women's needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions.

Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, who they discuss and seek help from, and the factors that influence their decision to seek an abortion outside of the formal health care sector. We interviewed 15 women who had obtained an abortion outside of the health care sector in Cape Town, South Africa. Women were aware that abortions were legal and available in public clinics, but they were concerned about negative and judgmental attitudes from health care providers even though some women were aware of the possible health safety issues related to seeking an abortion outside of the clinic setting. Abortion services should adapt to women's needs and offer them options of facility-based care but also self-managed medical abortions under the guidance of health care providers.

Incidence of self-induced abortion with misoprostol, admitted to a provincial hospital in Papua New Guinea: A prospective observational study.

BACKGROUND: Misoprostol is a life-savingmedication in obstetric practice but the prevalence of misoprostol-related self-induced abortion is increasing in many communities. AIMS: To investigate the hospital incidence, clinical management, and legal framework of self-induced abortions with misoprostol. MATERIALS AND METHODS: This was a prospective observational study conducted over 18 months. All patients <20 weeks pregnant who were admitted with a diagnosis of misoprostol-induced abortion were included in the study. RESULTS: Of 186 women with abortion-related admissions during the study period, 51 (27.4%) women reported using misoprostol to induce abortion. The majority were young (27.8 ± 5.5) married women (32/51: 62.7%), particularly educated (27/51: 52.9%) employed women (27/51: 52.9%), who were not on any contraception (46/51: 90.1%). Most abortions were induced in the first trimester (39/51: 76.5%) and patients were admitted because of prolonged bleeding (23/51: 45.1%). A significant proportion of participants who did not receive the correct dose of misoprostol developed sepsis compared to those who received a correct dose (6/18 (33.3%) vs 1/30 (3.3%); P = 0.008). CONCLUSION: The use of misoprostol as an abortifacient is increasing in Papua New Guinea, particularly among educated and employed women. A review of the laws to meet the demand for abortion services and to limit complications of unsafe abortion practices is required.

Recurrent Medical Termination of Pregnancy, Not Always the Same Pathology.

OBJECTIVE: Recurrence of termination of pregnancy (TOP) due to fetal or maternal pathology is an uncommon event, and not always related to the same pathology. We aimed to evaluate the indications leading to recurrent TOP and associated risk factors. MATERIALS AND METHODS: Retrospective study of the recurrent cases of TOP conducted between January 2002 and December 2018. RESULTS: A recurrence rate of 2.5% was found in a cohort of 693 women submitted to TOP (17/693). Among the paired cases of recurrent TOP, 65% (11/17) were consequent to a different indication, whereas 35% (6/17) were due to the same cause, mainly related to monogenic diseases. TOP related to chromosomopathy was significantly associated with higher maternal and gestational age. CONCLUSIONS: Most of recurrent cases of TOP do not seem related to the same cause. The occurrence of a monogenic disease or polymalformative syndrome should raise the suspicion of recurrence due to the same pathology.

Development and validation of a psychometric scale to assess attitude towards safe abortions in Pakistan.

Despite severe health and economic consequences that women face because of the negative attitude of healthcare providers towards safe abortion and post-abortion care (SA/PAC), no psychometric tool has yet been validated for assessing the attitude towards SA/PAC. Only a handful of studies have attempted to assess healthcare providers' attitude towards safe abortions in Pakistan. Therefore, this study aimed to develop and validate a psychometric scale to assess attitude towards safe abortions in Pakistan. The study collected data from 106 workers of an NGO that provides SA/PAC through an online and anonymous survey using the organisation's network. The study used factor analytic techniques and structural equation modelling to validate the factor structure and a final hierarchical model. A final scale of seven items relating to attitude towards elective abortions and moral attitude towards safe abortions was validated. The scales were highly reliable with both factors having reliability indicators greater than 0.7. The scale can be easily implemented to assess providers' attitude towards safe abortions. This will allow programmers to screen healthcare providers with a negative attitude, and evaluate the efficacy of their Value Clarification and Attitude Transformation (VCAT) programmes that are aimed at transforming providers' attitude towards safe abortions.

Application of Copy Number Variation Sequencing in Genetic Analysis of Miscarriages in Early and Middle Pregnancy.

High-throughput sequencing based on copy number variation (CNV-seq) is commonly used to detect chromosomal abnormalities. This study identifies chromosomal abnormalities in aborted embryos/fetuses in early and middle pregnancy and explores the application value of CNV-seq in determining the causes of pregnancy termination. High-throughput sequencing was used to detect chromosome copy number variations (CNVs) in 116 aborted embryos in early and middle pregnancy. The detection data were compared with the Database of Genomic Variants (DGV), the Database of Chromosomal Imbalance and Phenotype in Humans using Ensemble Resources (DECIPHER), and the Online Mendelian Inheritance in Man (OMIM) database to determine the CNV type and the clinical significance. High-throughput sequencing results were successfully obtained in 109 out of 116 specimens, with a detection success rate of 93.97%. In brief, there were 64 cases with abnormal chromosome numbers and 23 cases with CNVs, in which 10 were pathogenic mutations and 13 were variants of uncertain significance. An abnormal chromosome number is the most important reason for embryo termination in early and middle pregnancy, followed by pathogenic chromosome CNVs. CNV-seq can quickly and accurately detect chromosome abnormalities and identify microdeletion and microduplication CNVs that cannot be detected by conventional chromosome analysis, which is convenient and efficient for genetic etiology diagnosis in miscarriage.

Universal access to contraception: women, families, and communities benefit.

Universal access to contraception benefits society: unintended pregnancies, maternal mortality, preterm birth, abortions, and obesity would be reduced by increasing access to affordable contraception. Women should be able to choose when and whether to use contraception, choose which method to use, and have ready access to their chosen method. State and national government should support unrestricted access to all contraceptives. As obstetrician-gynecologists, we have a critical mandate, based on principle and mission, to step up with leadership on this vital medical and public health issue, to improve the lives of women, their families, and society. The field of Obstetrics and Gynecology must provide the leadership for moving forward. The American Gynecological and Obstetrical Society (AGOS), representing academic and public policy leaders from across all disciplines of Obstetrics and Gynecology, is well positioned to serve as a unifying organization, focused on developing a strong unified advocacy voice to fight for accessible contraception for all in the United States.

Factors associated with the timing of abortions.

The timing of an abortion (often measured as gestational age) can have important effects on the woman's physical health and on the cost of the procedure. To the authors' knowledge, there has been only one national analysis of the factors associated with the gestational age at abortion, but it employed data from over 20 years ago. The state-specific studies that have explored abortion timing have typically examined the effects of a specific change in abortion regulations. In this study, we employ annual, state-level data covering the 1991-2014 period that measure the frequency of abortions by gestational age. We regress these measures of abortion utilization on policy, economic, demographic, and health care infrastructure characteristics. The estimates indicate that the introduction of state restrictions on Medicaid funding of abortions is associated with a 13% increase in the rate of abortions after the first trimester. We do not find a statistically significant association between parental involvement laws and the rate or percentage of post-first-trimester abortions.