[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.

Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study.

INTRODUCTION: Recent increases in maternal mortality and persistent disparities have led to speculation about why the U.S. has higher rates than most high-income countries. The aim was to examine the impact of changes in state-level factors plausibly linked to maternal mortality on overall rates and by race/ethnicity. METHODS: This quasi-experimental, population-based, difference-in-differences study used 2007-2015 National Vital Statistics System microdata mortality files from 38 states and DC. The primary exposures were 5 state-level sexual and reproductive health indicators and 6 health and economic conditions. Maternal mortality rate was defined as number of deaths of women while pregnant or within 42 days of termination of pregnancy per 100,000 live births. A difference-in-differences zero-inflated negative binomial regression model was estimated using the race/ethnicity-age-state-year population as the denominator and adjusting for race/ethnicity, age, state, and year. Data were analyzed in 2017-2018. RESULTS: There were 4,767 deaths among women up to age 44 years, resulting in a maternal mortality rate of 17.9. Reducing the proportion of Planned Parenthood clinics by 20% from the state-year mean increased the maternal mortality rate by 8% (incidence rate ratio, 1.08; 95% CI=1.04, 1.12). States that enacted legislation to restrict abortions based on gestational age increased the maternal mortality rate by 38% (incidence rate ratio, 1.38; 95% CI=1.03, 1.84). Planned Parenthood clinic closures negatively impacted all women, increasing mortality by 6%-15% across racial/ethnic groups, whereas gestational limits primarily increased mortality among white women. CONCLUSIONS: Recent fiscal and legislative changes reducing women's access to family planning and reproductive health services have contributed to rising maternal mortality rates.

Con la ley y sin la ley/With and without the law: Utilization of abortion services and case fatality in Mexico, 2000-2016.

OBJECTIVE: To describe utilization of health services for, and case fatality from, abortion in Mexico. METHOD: A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. RESULTS: The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. CONCLUSION: Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward.

Violent deaths of pregnant women in Egyptian governorates of Cairo and Giza.

BACKGROUND: Pregnancy-associated deaths are a widely recognized phenomenon, that warrants in-depth investigation. Of the 319 suspicious deaths of adult women (>20 years) autopsied during 2011-2012, in the Cairo and Giza governorates, 37 (11.7%) women were pregnant at the time of the autopsy. This paper analyzes the corresponding demographic data, autopsy findings, and toxicological screening. THE RESULTS: Reveal that the number of deaths of pregnant women were higher in 2012 than in 2011. In addition, the number of cases from Giza exceeded those from Cairo (62.2% and 37.8%, respectively). Most cases involved married women (62.2%) in the third trimester of pregnancy (67.5%). Most deaths were predominantly un-intentional (51.4%) attributed to peri-partum complications. Homicidal deaths contributed to 43% of cases, and the husband was the suspect perpetrator in 37.5% of cases. Only two cases were associated with substance abuse. CONCLUSION: the paper concludes that this analysis may inform future strategies to protect pregnant women from the hazards of violence and labor that threaten their lives.

Muerte de un producto de la concepción. ¿Aborto ilícito o asesinato? / Death of a product of conception. Illegal abortion or murder?

Introducción: Cuando ocurre la muerte del resultado de la concepción, con la realización de la necropsia médico-legal se deben precisar aspectos importantes que definirán las conductas a seguir con los presuntos responsables de un delito. Para ello es necesario precisar si existió vida extrauterina o no, que le dará a este resultado, la definición de persona, según lo establecido en la legislación civil. Objetivo: Establecer el posible tipo de delito y enmarcar la posibilidad de que se trate de un aborto ilícito o un asesinato, además de precisar las causas y circunstancias en que la muerte se produjo. Presentación del caso: Se trata de un cadáver resultado de la concepción que fue hallado en una vivienda, dentro de un envoltorio, junto a la placenta y el cordón umbilical, cuya madre había mantenido su embarazo oculto. Durante el acto de la necropsia se demostró que era un producto viable que había presentado vida extrauterina. Conclusiones: Se presenta un caso poco frecuente en la práctica forense. Se determinó que se trataba de una recién nacida, por haber presentado vida extrauterina, cuyas causas de muerte estuvieron en relación con un traumatismo craneoencefálico(AU)

Introduction: When the death of a product of conception occurs, important aspects resulting from the completion of the medico-legal necropsy that define the behaviors to be followed with those presumed responsible for a crime must be specified. To achieve this, it is necessary to establish whether extrauterine life existed or not, which will give the definition of person to the mentioned product, as it is established in the civil legislation. Objective: To establish the possible type of crime and consider the possibility of an illegal abortion or a murder, as well as to specify the causes and circumstances in which the death occurred. Case Presentation: A corpse that was considered a product of conception was found in a dwelling house, wrapped up next to the placenta and the umbilical cord. The mother had kept a hidden pregnancy. During the act of performing a necropsy, it was demonstrated that it was a viable product that had had extrauterine life. Conclusions: A rare and unusual case is presented in forensic practice. It was determined that she was a newborn baby girl because she had had extrauterine life, whose causes of death were related to a traumatic brain injury(AU)

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)

Induced abortion.

Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.

The politics of unsafe abortion in Burkina Faso: the interface of local norms and global public health practice.

In Burkina Faso, abortion is legally restricted and socially stigmatised, but also frequent. Unsafe abortions represent a significant public health challenge, contributing to the country's very high maternal mortality ratio. Inspired by an internationally disseminated public health framing of unsafe abortion, the country's main policy response has been to provide post-abortion care (PAC) to avert deaths from abortion complications. Drawing on ethnographic research, this article describes how Burkina Faso's PAC policy emerged at the interface of political and moral negotiations between public health professionals, national bureaucrats and international agencies and NGOs. Burkinabè decision-makers and doctors, who are often hostile to induced abortion, have been convinced that PAC is 'life-saving care' which should be delivered for ethical medical reasons. Moreover, by supporting PAC they not only demonstrate compliance with international standards but also, importantly, do not have to contend with any change in abortion legislation, which they oppose. Rights-based international NGOs, in turn, tactically focus on PAC as a 'first step' towards their broader institutional objective to secure safe abortion and abortion rights. Such negotiations between national and international actors result in widespread support for PAC but stifled debate about further legalisation of abortion.

Overview of abortion cases with severe maternal outcomes in the WHO Multicountry Survey on Maternal and Newborn Health: a descriptive analysis.

OBJECTIVE: To summarise individual and institutional characteristics of abortion-related severe maternal outcomes reported at health facilities. DESIGN: Secondary analysis of data from the WHO Multicountry Survey on Maternal and Newborn Health. SETTING: 85 health facilities in 23 countries. SAMPLE: 322 women with abortion-related severe maternal outcomes. METHODS: Frequency distributions and comparisons of differences in characteristics between cases of maternal near miss and death using Fisher's exact tests of association. MAIN OUTCOME MEASURES: Individual and institutional characteristics and frequencies of potentially life-threatening conditions, and interventions provided to women with severe maternal outcomes, maternal near miss, and maternal death. RESULTS: Most women with abortion-related severe maternal outcomes (SMOs) were 20-34 years old (65.2%), married or cohabitating (92.3%), parous (84.2%), and presented with abortions resulting from pregnancies at less than 14 weeks of gestation (67.1%). The women who died were younger, more frequently without a partner, and had abortions at ≥14 weeks of gestation, compared with women with maternal near miss (MNM). Curettage was the most common mode of uterine evacuation. The provision of blood products and therapeutic antibiotics were the most common other interventions recorded for all women with abortion-related SMOs; those who died more frequently had antibiotics, laparotomy, and hysterectomy, compared with women with MNM. Although haemorrhage was the most common cause of abortion-related SMO, infection (alone and in combination with haemorrhage) was the most common cause of death. CONCLUSION: This analysis affirms a number of previously observed characteristics of women with abortion-related severe morbidity and mortality, despite the fact that facility-based data on abortion-related SMO suffers a number of limitations.

Review of population based coroners autopsy findings in Rivers state of Nigeria.

BACKGROUND: Sudden deaths are common findings in Rivers state of Nigeria. The victims of such deaths are subjects, of coroners' autopsies, and the records there from constitute important sources of epidemiological data. AIMS: To determine the pattern, causes and demographic features of all deaths reported to the coroner for medico legal autopsies in Rivers state of Nigeria. MATERIALS AND METHODS: Retrospective descriptive study on reports of coroner autopsies carried out between January 2000 and December 2010 in different mortuaries located across Rivers state was undertaken. The autopsies were unlimited and standardized. Information analyzed were: gender, age, circumstances of death and, autopsy-defined cause of death. RESULTS: Of the 1987 cases reviewed, 83.4% were males. The age range was 2 weeks to 98 years with a mean of, 31.7 years. The peak age range was 21-30 years with 46.5%. The manners of deaths in descending order include: homicides with 50.5%, accidents with 32%, sudden natural deaths with 14.1%, maternal deaths with 2.6% and suicides with 0.8%. Males were most affected in homicidal death with average male:female ratio of 12.4:1. Gunshots constituted the commonest means of homicidal deaths, with 67.9% while decapitation was the least with 0.1%. The commonest cause of accidental death was, road traffic accident with 63.6%. Cardiovascular system pathologies were the commonest causes of natural deaths with 46.1%. Illegal abortions with 41.1% were the commonest causes of maternal, deaths and all suicidal cases were committed by hanging. CONCLUSIONS: Homicides were by far the commonest findings of medico legal autopsies, followed by accidental and natural deaths respectively while suicides were the least in Rivers state of Nigeria. Firearms were the, most frequently used weapons for homicides and road traffic accidents remain the major causes of accidental deaths while cardiovascular system pathologies account for the highest proportion of sudden natural deaths and suicides are committed by hanging. Males within the productive age, brackets of 20-49 years are more affected by sudden deaths of all manners.

Unintended pregnancy and unsafe abortion in the Philippines: context and consequences.

Despite advances in reproductive health law, many Filipino women experience unintended pregnancies, and because abortion is highly stigmatized in the country, many who seek abortion undergo unsafe procedures. This report provides a summary of reproductive health indicators in the Philippines­in particular, levels of contraceptive use, unplanned pregnancy and unsafe abortion­and describes the sociopolitical context in which services are provided, the consequences of unintended pregnancy and unsafe abortion,and recommendations for improving access to reproductive health services.

Postabortion care in Pakistan.

The current law in Pakistan permits abortion only under narrow circumstances. As a result, women resort to clandestine and unsafe abortion procedures, which often lead to complications. This report summarizes findings from a study that examined the conditions under which women obtain abortion in Pakistan; the incidence, coverage and quality of facility-based postabortion care (PAC); and the extent to which recommended standards for PAC have been implemented in health facilities.

Ray of hope: opportunities for reducing unsafe abortions!

Unsafe abortion is one of the leading causes of maternal mortality and morbidity which impede the nation in achieving the targets of MDG 5. In the developing world, it is estimated that 13% of all maternal deaths are due to unsafe abortions. Despite having certain liberty in the law and religion, Pakistan has a relatively high prevalence of unsafe abortion. Poverty, unintended pregnancies, ineffective use of contraceptive methods and unawareness about the law are the root causes for the rise in the number of women seeking abortions. Nonetheless, with all these opening points of having permission in the law and religion could direct us that if we just follow them we can reduce the number of unsafe and illegal abortions.Therefore, there is a strong interventions would be required in health and legal aspects, which would decrease maternal mortality and morbidity.

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.

Menstrual regulation, unsafe abortion, and maternal health in Bangladesh.

Maternal mortality has declined considerably in Bangladesh over the past few decades. Some of that decline--though precisely how much cannot be quantified--is likely attributable to the country's menstrual regulation program,which allows women to establish nonpregnancy safely after a missed period and thus avoid recourse to unsafe abortion. Key Points. (1) Unsafe clandestine abortion persists in Bangladesh. In 2010, some 231,000 led to complications that were treated at health facilities, but another 341,000 cases were not. In all, 572,000 unsafe procedures led to complications that year. (2) Recourse to unsafe abortion can be avoided by use of the safe, government sanctioned service of menstrual regulation (MR)--establishing nonpregnancy after a missed period, most often using manual vacuum aspiration. In 2010, an estimated 653,000 women obtained MRs, a rate of 18 per 1,000 women of reproductive age. (3) The rate at which MRs result in complications that are treated in facilities is one-third that of the complications of induced abortions--120 per 1,000 MRs vs. 357 per 1,000 induced abortions. (4) There is room for improvement in MR service provision, however. In 2010, 43% of the facilities that could potentially offer it did not. Moreover, one-third of rural primary health care facilities did not provide the service. These are staffed by Family Welfare Visitors, recognized to be the backbone of the MR program. In addition, one-quarter of all MR clients were denied the procedure. (5) To assure that trends toward lower abortion-related morbidity and mortality continue, women need expanded access to the means of averting unsafe abortion. To that end, the government needs to address barriers to widespread, safe MR services, including women's limited knowledge of their availability, the reasons why facilities do not provide MRs or reject women who seek one, and the often poor quality of care.

Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review.

BACKGROUND: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70 000 women die globally as a result, with the majority occurring in the developing world. This study aims to determine the sociodemographic factors involved in complicated unsafe abortions. SUBJECTS AND METHODS: The study is a four-year retrospective evaluation of all cases of complicated unsafe abortions managed at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria between January 1, 2007 and December 31, 2010. RESULTS: The incidence of unsafe complicated abortions over the study period was 4.10% of total deliveries and contributed 14.0% of gynaecological admissions: 34.92% occurred in adolescents less than 20 years of age, of which the majority (55.55%) were secondary school students. There were 55.45% of patients who were nulliparae, 60.32% were unemployed and 69.80% were unmarried. A total of 87.30% had never used any form of contraceptive. Abortion mortality rate was 256/100 000 deliveries and the case fatality was 4.76%. It constituted 30.0% of all gynaecological deaths and 17.64% of maternal deaths during the study period. The commonest cause of death was septicaemia (66.66%). CONCLUSION: Unfavourable sociodemographic factors are major determinants of the high incidence of unsafe abortion in the Niger Delta despite strict abortion laws. Concrete measures must be put in place to address these, as unsafe abortion and its complications are a major cause of maternal morbidity and mortality in the environment.