Unfulfilled and method-specific contraceptive preferences among reproductive-aged contraceptive users in Arizona, Iowa, New Jersey, and Wisconsin.

OBJECTIVE: To identify characteristics associated with unfulfilled contraceptive preferences, document reasons for these unfulfilled preferences, and examine how these unfulfilled preferences vary across specific method users. DATA SOURCES AND STUDY SETTING: We draw on secondary baseline data from 4660 reproductive-aged contraceptive users in the Arizona, Iowa, New Jersey, and Wisconsin Surveys of Women (SoWs), state-representative surveys fielded between October 2018 and August 2020 across the four states. STUDY DESIGN: This is an observational cross-sectional study, which examined associations between individuals' reproductive health-related experiences and contraceptive preferences, adjusting for sociodemographic characteristics. Our primary outcome of interest is having an unfulfilled contraceptive preference, and a key independent variable is experience of high-quality contraceptive care. We also examine specific contraceptive method preferences according to current method used, as well as reasons for not using a preferred method. DATA COLLECTION/EXTRACTION METHODS: Survey respondents who indicated use of any contraceptive method within the last 3 months prior to the survey were eligible for inclusion in this analysis. PRINCIPAL FINDINGS: Overall, 23% reported preferring to use a method other than their current method, ranging from 17% in Iowa to 26% in New Jersey. Young age (18-24), using methods not requiring provider involvement, and not receiving quality contraceptive care were key attributes associated with unfulfilled contraceptive preferences. Those using emergency contraception and fertility awareness-based methods had some of the highest levels of unfulfilled contraceptive preferences, while pills, condoms, partner vasectomy, and IUDs were identified as the most preferred methods. Reasons for not using preferred contraceptive methods fell largely into one of two buckets: system-level or interpersonal/individual reasons. CONCLUSIONS: Our findings highlight that avenues for decreasing the gap between contraceptive methods used and those preferred to be used may lie with healthcare providers and funding streams that support the delivery of contraceptive care.

Identification of polymorphic alleles in TERC and TERT gene reprogramming the telomeres of newborn and legacy with parental health.

Telomere and telomerase genes (TERC and TERT) highlighted many novel genetic polymorphisms related to common diseases. This study explored the polymorphic alleles of TERC and TERT gene in parents-newborn (triad) and its association with telomere length (TL) and parental diseases (mother: Gestational Diabetes Mellitus (GDM), Preeclampsia, fathers: Diabetes, Hypertension). In this cross-sectional study, the blood samples (n = 612) were collected from parents-newborn triad (204 each) for TL (T/S ratio) quantification by using qPCR, and gene (TERC and TERT) polymorphism was detected by Sanger sequencing. The correlation analysis was used to find an association between paternal TL (T/S ratio) and newborn TL. The multivariate linear regression was applied to determine the effect of parents genes and diseases on newborn TL. A positive association (r = 0.42,0.39) (p < 0.0001) among parents and newborn TL was observed. In the diseased group, both TERC (rs10936599) and TERT (rs2736100) genes had a high frequency of allele C in newborns (OR = 0.94, P = 0.90, OR = 4.24, P = 0.012). However, among parents, TERT gene [Mother CC (B = 0.575; P = 0.196), Father CC (B = -0.739; P = 0.071)] was found significant contributing factor for Newborn TL. Diseased parents with T/T and A/C genotypes had longer newborn TL (2.82 ± 2.43, p < 0.022; 1.80 ± 1.20, p < 0.00) than the C/C genotype. Therefore, the study, confirmed that major allele C of TERC and TERT genes is associated with smaller TL in diseased parents-newborns of the targeted population.

Association Study of IGF-1 rs35767 and rs6214 Gene Polymorphisms with Cancer Susceptibility and Circulating Levels of IGF-1, IGFBP-2, and IGFBP-3 in Colorectal Cancer Patients.

Early detection of colorectal cancer (CRC) increases the 5-year survival rate by 90%; therefore, non-invasive biomarkers such as measurable circulating proteins for early detection and prognosis are crucial. Insulin-like growth factor-1 (IGF-1) is involved in the regulation of cell proliferation and apoptosis. IGF binding proteins (IGFBPs) bind and inhibit the activity of IGF-1. It was inconsistently reported that high IGF-1 and IGFBP-2 and low IGFBP-3 circulating levels are associated with high cancer risk, poor prognosis, and tumor metastasis in several cancers. A total of 175 patients with CRC and 429 controls were enrolled in this study. We genotyped for IGF-1 rs35767 and rs6214 gene polymorphisms and assessed their association with circulating levels of IGF-1 and/or the risk for CRC. We also determined plasma levels of IGF-1, IGFBP-2, and IGFBP-3. Neither rs35767 nor rs2614 were associated with cancer risk or IGF-1 levels in our study cohort. IGF-1 and IGFBP-3 levels were higher in controls than in patients, whereas IGFBP-2 was higher in patients than in controls. Only IGFBP-2 was associated with increased tumor grade but not stage. Therefore, IGF-1, IGFBP-2, and IGFBP-3 may be useful as early detection and prognostic biomarkers in CRC.

Comparison of efficacy of intravenous labetalol and intravenous hydralazine for management of pre-eclampsia in pregnant women.

Objectives: To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. Methodology: This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Results: Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). Conclusion: The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia.

Parental Genetics Communicate with Intrauterine Environment to Reprogram Newborn Telomeres and Immunity.

Telomeres, markers for cellular senescence, have been found substantially influenced by parental inheritance. It is well known that genomic stability is preserved by the DNA repair mechanism through telomerase. This study aimed to determine the association between parents−newborn telomere length (TL) and telomerase gene (TERT), highlighting DNA repair combined with TL/TERT polymorphism and immunosenescence of the triad. The mother−father−newborn triad blood samples (n = 312) were collected from Ziauddin Hospitals, Pakistan, between September 2021 and June 2022. The telomere length (T/S ratio) was quantified by qPCR, polymorphism was identified by Sanger sequencing, and immunosenescence by flow cytometry. The linear regression was applied to TL and gene association. The newborns had longest TL (2.51 ± 2.87) and strong positive association (R = 0.25, p ≤ 0.0001) (transgenerational health effects) with mothers' TL (1.6 ± 2.00). Maternal demographics­socioeconomic status, education, and occupation­showed significant effects on TL of newborns (p < 0.015, 0.034, 0.04, respectively). The TERT risk genotype CC (rs2736100) was predominant in the triad (0.6, 0.5, 0.65, respectively) with a strong positive association with newborn TL (ß = 2.91, <0.0011). Further analysis highlighted the expression of KLRG 1+ in T-cells with shorter TL but less frequent among newborns. The study concludes that TERT, parental TL, antenatal maternal health, and immunity have a significantly positive effect on the repair of newborn TL.

Associations between unfulfilled contraceptive preferences due to cost and low-income patients' access to and experiences of contraceptive care in the United States, 2015-2019.

Objective: To identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome. Methods: We drew on data from the 2015-2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (N = 3178) and nonusers (N = 1073). Results: Overall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0-2.5), while having private (aOR = 0.6, CI 0.4-0.9) or public (aOR = 0.7, CI 0.5-1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0-5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4-1.0). Conclusions: Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences. Implications: Factors related to contraceptive access at the systems level-specifically the subsidization and experience of contraceptive care-impact whether cost serves as a barrier to individuals' contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.

Changes in use of emergency contraceptive pills in the United States from 2008 to 2015.

OBJECTIVES: To describe changes in use and receipt of emergency contraceptive (EC) pills among women in the United States during a period of key EC policy changes, from 2008 to 2015. STUDY DESIGN: Using data from the 2006 to 2010 and 2013 to 2017 National Surveys of Family Growth, we present changes in the percent of women who ever used EC between 2008 and 2015 by select sociodemographic and sexual and reproductive health characteristics, and we examine multivariable relationships of these characteristics with EC ever use in 2015. We also examine changes in repeat EC use, receipt of EC counseling, reasons for EC use and source of EC between the time periods. RESULTS: Among sexually experienced women ages 15 to 44, EC ever use increased from 11% in 2008 to 23% in 2015 overall and among nearly all groups of women. In 2015, age 20 to 29, non-Hispanic other or Hispanic race, at least a high school education, working part-time, income at least 100% of the federal poverty level, ever having been married, and having received EC counseling in the prior year all represent characteristics associated with higher odds of having ever used EC. In 2015, a smaller share of women last obtained EC with a prescription or at a health facility than in 2008. CONCLUSIONS: Increases in EC use occurred as access to EC was broadened through regulatory changes that moved some forms of EC from behind-the-counter to fully over-the-counter between 2008 and 2015. IMPLICATIONS: Over-the-counter provision of many forms of EC pills may have increased access and introduced more flexibility in how EC is obtained, but these changes may have come with tradeoffs, both in the form of cost barriers and decreased opportunities for clinicians to discuss EC with their patients. Despite improved access to contraception more broadly through the Affordable Care Act, EC remains a necessary component of the overall contraceptive method mix, and clinicians can play a key role in discussing EC as one option among many during contraceptive counseling sessions.

Recurrent formation of haematocolpos in a young girl with multiple congenital anomalies of the urogenital tract.

An 11-year-old girl, a known case of left crossed fused renal ectopia and sacral hypoplasia presented to the gynaecological OPD in Karachi, Pakistan, in February 2019 with complaints of abdominal pain. On examination, she was found to have a septum covering her vaginal orifice. She was subsequently diagnosed with haematocolpos secondary to imperforate hymen. Incision and drainage was done. However, despite surgical management, she continued to have recurrent formation of haematocolpos for the next two months secondary to multiple complete and partial transverse vaginal septa and post-operative formation of adhesions. Definitive management was done with ultrasound guided needle puncture and drainage, followed by post-operative tampon use to maintain patency.

Incidence of treatment for postabortion complications in India, 2015.

Abortion has been legal under broad criteria in India since 1971. However, access to legal abortion services remains poor. In the past decade, medication abortion (MA) has become widely available in India and use of this method outside of health facilities accounts for over 70% of all abortions. Morbidity from unsafe abortion remains an important health issue. The informal providers who are the primary source of MA may have poor knowledge of the method and may offer inadequate or inaccurate advice on use of the method. Misuse of the method can result in women seeking treatment for true complications as well as during the normal processes of MA. An estimated 5% of all abortions are done using highly unsafe methods and performed by unskilled providers, also contributing to abortion morbidity. This paper provides new representative abortion-related morbidity measures at the national and subnational levels from a large-scale 2015 study of six Indian states-Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh. The outcomes include the number and treatment rates of women with complications resulting from induced abortion and the type of complications. The total number of women treated for abortion complications at the national level is 5.2 million, and the rate is 15.7 per 1000 women of reproductive age per year. In all six study states, a high proportion of all women receiving postabortion care were admitted with incomplete abortion from use of MA-ranging from 33% in Tamil Nadu to 65% in Assam. The paper fills an important gap by providing new evidence that can inform policy-makers and health planners at all levels and lead to improvements in the provision of postabortion care and legal abortion services-improvements that would greatly reduce abortion-related morbidity and its costs to Indian women, their families and the healthcare system.

Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017.

Introduction: Induced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approach: the Abortion Incidence Complications Methodology (AICM), to understand the incidence of abortion in Ghana in 2017. Methods: We drew a nationally representative, two-stage, stratified sample of health facilities. We used information from 539 responding facilities to estimate treated complications stemming from illegal induced abortions, and to estimate the number of legal abortions provided. We used information from 146 knowledgeable informants to generate zonal multipliers representing the inverse of the proportion of illegal induced abortions treated for complications in facilities in Ghana's three ecological zones. We applied multipliers to estimates of treated complications from illegal abortions, and added legal abortions to obtain an annual estimate of all induced abortions. Results: The AICM approach suggests that approximately 200 000 abortions occurred in Ghana in 2017, corresponding to a national abortion rate of 26.8 (95% CI 21.7 to 31.9) per 1000 women 15-49. Abortion rates were lowest in the Northern zone (18.6) and highest in the Middle zone (30.4). Of all abortions, 71% were illegal. Conclusion: Despite Ghana's relatively liberal abortion law and efforts to expand access to safe abortion services, illegal induced abortion appears common. A concurrently published paper compares the AICM-derived estimates presented in this paper to those from other methodological approaches.

Availability, practices and acceptance of postabortion contraceptive services in health facilities: A study in six states of India.

OBJECTIVE: To assess the availability of and practices around postabortion contraceptive services in health facilities, and document women's acceptance of postabortion contraception in six Indian states. STUDY DESIGN: We conducted a survey of 4001 public and private health facilities that provide abortion-related care in six Indian states. In this analysis, we assess the availability and range of contraceptive methods offered, the protocols and practices around postabortion contraceptive counseling, the extent to which facilities require women to adopt contraception, and contraceptive uptake among women. RESULTS: Although some contraceptive methods and information were available at a majority of facilities (75-97%), the range of methods was lacking and the information provided to women varied considerably by state. 8-26% of facilities required women seeking induced abortions to accept a modern contraceptive method. Only half to two-thirds of postabortion patients adopted a modern method. CONCLUSION: The limited number of methods offered in facilities suggests that some women may not obtain the method they desire, or get information about the full range of methods that should be available. While contraceptive uptake should be voluntary, the requirement imposed by some facilities for women to adopt a modern contraceptive method in order to obtain an abortion must be addressed. IMPLICATIONS: Some 15.6 million Indian women had an induced abortion in 2015. Understanding the provision of postabortion contraceptive services in health facilities, including counseling, is necessary to inform policies and practices to better enable women and couples to make informed decisions to prevent future unintended pregnancies.

Clinical Spectrum of Near-miss Cases in Obstetrics.

Introduction Near-miss obstetric cases are the ones which have survived childbirth after a life-threatening and complicated pregnancy. The aim of this study is to evaluate important characteristics and causes of near-miss cases, compare them with maternal deaths, and assess urgent interventions managing these patients. Materials and methods This prospective, cross-sectional study was conducted in the intensive care unit of the Obstetrics and Gynecology department. Clinical spectrum of near-miss patients was compared with that of maternal deaths. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY). Results The incidence of near-miss events was 31.4/1,000 live births. The incidence of maternal mortality was 8.2/1,000 live births. The ratio of near-miss to maternal mortality was 3.8:1. Hemorrhage, hypertensive disorders, and puerperal sepsis were the leading causes of near-miss cases. Conclusion Evaluation of characteristics of near-miss cases helps in establishing severe maternal morbidity. These high-risk patients must be provided urgent interventions to prevent maternal mortality.

There might be blood: a scoping review on women's responses to contraceptive-induced menstrual bleeding changes.

INTRODUCTION: Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. METHODS: We conducted a systematic scoping review of data on women's responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. RESULTS: We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women's responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women's responses to menstrual suppression; and other emergent themes. Women's preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of "dirty" or "blocked" blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. CONCLUSIONS: Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women's lives. Women's responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely - and potentially substantial - impacts on contraceptive discontinuation and unmet need for modern contraception.

The incidence of abortion and unintended pregnancy in India, 2015.

BACKGROUND: Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015. METHODS: National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015-16 National Family Health Survey-4. FINDINGS: We estimate that 15·6 million abortions (14·1 million-17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2-52·1) per 1000 women aged 15-49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15-49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15-49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended. INTERPRETATION: Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous supplies of medication abortion drugs, and by increasing the number of trained providers. In view of how many women rely on self-administration of medication abortion drugs, interventions are needed to provide women with accurate information on these drugs and follow-up care when needed. Research is needed to test interventions that improve knowledge and practice in providing medication abortion, and the Indian Government at the national and state level needs to prioritise improving policies and practice to increase access to comprehensive abortion care and quality contraceptive services that prevent unintended pregnancy. FUNDING: Government of UK Department for International Development (until 2015), the David and Lucile Packard Foundation, the John D. and Catherine T. MacArthur Foundation, and the Ford Foundation.

Rare primary fallopian tube carcinoma; a gynaecologist's dilemma.

Primary fallopian tube carcinoma is rare and accounts for 0.14-1.8% of all malignancies of the female genital tract. It has been found to be associated with nulliparity and subfertility, as well as with pelvic inflammatory disease. High parity has been reported to be protective but not in our 3 cases. History of pregnancy and the use of oral contraceptives decrease the PFTC risk significantly in literature. PFTC has been described in high-risk breast-ovarian cancer families with germ-line BRCA-1 and BRCA-2 mutations. Symptoms are nonspecific and include abdominal pelvic pain, vaginal bleeding and watery discharge. However, diagnosis is rarely achieved pre-operative because of misleading imaging. In many cases, the diagnosis is made incidentally on histopathology after surgery for an un-related condition commonly being an ovarian carcinoma.

Abortion Incidence and Unintended Pregnancy in Nepal.

CONTEXT: Although abortion has been legal under broad criteria in Nepal since 2002, a significant proportion of women continue to obtain illegal, unsafe abortions, and no national estimates exist of the incidence of safe and unsafe abortions. METHODS: Data were collected in 2014 from a nationally representative sample of 386 facilities that provide legal abortions or postabortion care and a survey of 134 health professionals knowledgeable about abortion service provision. Facility caseloads and indirect estimation techniques were used to calculate the national and regional incidence of legal and illegal abortion. National and regional levels of abortion complications and unintended pregnancy were also estimated. RESULTS: In 2014, women in Nepal had 323,100 abortions, of which 137,000 were legal, and 63,200 women were treated for abortion complications. The abortion rate was 42 per 1,000 women aged 15-49, and the abortion ratio was 56 per 100 live births. The abortion rate in the Central region (59 per 1,000) was substantially higher than the national average. Overall, 50% of pregnancies were unintended, and the unintended pregnancy rate was 68 per 1,000 women of reproductive age. CONCLUSIONS: Despite legalization of abortion and expansion of services in Nepal, unsafe abortion is still common and exacts a heavy toll on women. Programs and policies to reduce rates of unintended pregnancy and unsafe abortion, increase access to high-quality contraceptive care and expand safe abortion services are warranted.

The Incidence of Abortion in Nigeria.

CONTEXT: Because of Nigeria's low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country's restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS: A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS: An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15-49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION: Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.

Intended and unintended pregnancies worldwide in 2012 and recent trends.

Periodic estimation of the incidence of global unintended pregnancy can help demonstrate the need for and impact of family planning programs. We draw upon multiple sources of data to estimate pregnancy incidence by intention status and outcome at worldwide, regional, and subregional levels in 2012 and to assess recent trends using previously published estimates for 2008 and 1995. We find that 213 million pregnancies occurred in 2012, up slightly from 211 million in 2008. The global pregnancy rate decreased only slightly from 2008 to 2012, after declining substantially between 1995 and 2008. Eighty-five million pregnancies, representing 40 percent of all pregnancies, were unintended in 2012. Of these, 50 percent ended in abortion, 13 percent ended in miscarriage, and 38 percent resulted in an unplanned birth. The unintended pregnancy rate continued to decline in Africa and in the Latin America and Caribbean region. If the aims of the London Summit on Family Planning are carried out, the incidence of unwanted and mistimed pregnancies should decline in the coming years.

Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries.

The level of unmet need for contraception-an important motivator of international family planning programs and policies-has declined only slightly in recent decades. This study draws upon data from 51 surveys conducted between 2006 and 2013 in Africa, Asia, and Latin America and the Caribbean to provide an updated review of the reasons why many married women having unmet need are not practicing contraception. We examine the reasons for contraceptive nonuse and how these reasons vary across countries and according to national levels of unmet need and contraceptive use. We present specific findings regarding the most widespread reasons for nonuse, particularly infrequent sex and concerns regarding side effects or health risks. Our findings suggest that access to services that provide a range of methods from which to choose, and information and counseling to help women select and effectively use an appropriate method, can be critical in helping women having unmet need overcome obstacles to contraceptive use.

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.