Narratives of women presenting with abortion complications in Southwestern Nigeria: A qualitative study.

Unsafe abortion continues to impact negatively on women's health in countries with restrictive abortion laws. It remains one of the leading causes of maternal mortality and morbidity. Paradoxically, modern contraceptive prevalence remains low and the unmet need for contraception continues to mirror unwanted pregnancy rates in many countries within sub-Saharan Africa. This qualitative study assessed women's knowledge; their expectation and experiences of the methods employed for abortion; and their health care-seeking decisions following a complicated abortion. Women who presented with abortion complications were purposively sampled from seven health facilities in south-west Nigeria. In-depth interviews were conducted by social scientists with the aid of a semi-structured interview guide. Coding schemes were developed and content analysis was performed with WEFTQDA software. Thirty-one women were interviewed. Misoprostol was used by 16 women; 15 women used other methods. About one-fifth of respondents were aged ≤ 20 years; almost one-third were students. Common reasons for terminating a pregnancy were: "too young/still in school/training"; "has enough number of children"; "last baby too young" and "still breastfeeding". Women had little knowledge about methods used. Friends, nurses or pharmacists were the commonest sources of information. Awareness about use of misoprostol for abortion among women was high. Women used misoprostol to initiate an abortion and were often disappointed if misoprostol did not complete the abortion process. Given its clandestine manner, women were financially exploited by the abortion providers and only presented to hospitals for post-abortion care as a last resort. Women's narratives of their abortion experience highlight the difficulties and risks women encounter to safeguard and protect their sexual and reproductive health. To reduce unsafe abortion therefore, urgent and synergized efforts are required to promote prompt access to family planning and post-abortion care services.

Prevalence and determinant factors of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital.

INTRODUCTION: Unintended pregnancy is a pregnancy which is not wanted and/or not planed at the time of conception. It has a major consequence on mothers' and newborns' health and its prevalence remains a major health problem in Ethiopia. This study was aimed to assess the prevalence and determinants of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. METHODS: An institutional-based cross-sectional study was employed in Addis Zemen hospital from April 01 to May 30, 2018. The sampled 398 pregnant mothers were selected by systematic random sampling. The data were collected using a-pretested structured questionnaire via face to face interview and the collected data were analyzed by using SPSS Version-20. The data were summarized with frequency and cross-tabulation. Both binary and multiple logistic regressions were used in order to identify predictor variables using odds ratio at 95% confidence interval. RESULTS: All of 398 mothers answered the questionnaire making the response rate 100%. The prevalence of unintended pregnancy was 26.1% (CI;22.1, 30.4). Women who were multigravid (AOR; 4.7: CI; 2.3, 6.8), women who were multipara (AOR; 2.8: CI; 2.6, 9.7), and women who were from rural (AOR; 2.6: CI; 1.5, 4.6) were more likely experienced unintended pregnancy than their counterparts. Women who were Muslim (AOR; 0.79: CI; 0.6, 0.90) and women who attended secondary education (AOR; 0.58: CI; 0.42, 0.78) were less likely experienced unintended pregnancy. CONCLUSION AND RECOMMENDATION: The prevalence of unintended pregnancy is high in the study area. Educational status, parity, gravity, residence, and religion were the most important predictor variables of unintended pregnancy. Reducing the prevalence of unintended pregnancy especially in the rural area is recommended.

Importancia del conocimiento y promoción de la anticoncepción de emergencia / Significance of knowledge and promotion of emergence contraception

El embarazo no deseado cobra cada año un alto precio a la salud de la mujer, el cual es significativamente mayor en las adolescentes. Resulta paradójico que en pleno siglo XXI muchos profesionales de la salud desconozcan o no posean toda la información necesaria relativa a la anticoncepción de emergencia, más aún conociendo que este método utilizado de forma correcta y temprana puede reducir notablemente la incidencia de embarazos no deseados y por tanto del aborto y sus secuelas, por lo que la anticoncepción de emergencia puede ser de gran utilidad en la preservación y promoción de la salud sexual y reproductiva, e incluso en no pocos casos salvar la vida de las mujeres. Motivado por lo antes comentado, fue que se propuso realizar la presente revisión bibliográfica con el objetivo central de brindarle al personal de la salud, ya sean ginecólogos, médicos de familia, pediatras, enfermeras, las herramientas necesarias para educar y promover en la población general, y muy en especial a las y los adolescentes y jóvenes, respecto al uso adecuado de la anticoncepción de emergencia. Es un pequeño aporte a la lucha constante por la elevación de la calidad de vida de la mujer y la familia cubana(AU)

No desired pregnancy every year becomes a high price for women health, which is significantly higher in adolescents. It is paradoxical that in broad XX century many health professionals fails to recognize or not have all the necessary information relative to emergence contraception even though knowing that this method used in appropriate and early way may to reduce significantly the incidence of non-desired pregnancy and therefore the miscarriage and its sequelae, thus, the emergence contraception may be very useful in preservation and promotion of sexual and reproductive behavior, and even in not few cases, to save the women life. Motivated by the above mentioned, we conducted present bibliographic review with the central aim of to offer to health staff, be gynecologists, family physicians, pediatricians, nurses, the tools necessary to educate and to promote in general population and specially in adolescents the appropriate use of mergence contraception. It is our small contribution to constant fight by the rise in life of woman and in the Cuban life(AU)

Importancia del conocimiento y promoción de la anticoncepción de emergencia / Significance of knowledge and promotion of emergence contraception

El embarazo no deseado cobra cada año un alto precio a la salud de la mujer, el cual es significativamente mayor en las adolescentes. Resulta paradójico que en pleno siglo XXI muchos profesionales de la salud desconozcan o no posean toda la información necesaria relativa a la anticoncepción de emergencia, más aún conociendo que este método utilizado de forma correcta y temprana puede reducir notablemente la incidencia de embarazos no deseados y por tanto del aborto y sus secuelas, por lo que la anticoncepción de emergencia puede ser de gran utilidad en la preservación y promoción de la salud sexual y reproductiva, e incluso en no pocos casos salvar la vida de las mujeres. Motivado por lo antes comentado, fue que se propuso realizar la presente revisión bibliográfica con el objetivo central de brindarle al personal de la salud, ya sean ginecólogos, médicos de familia, pediatras, enfermeras, las herramientas necesarias para educar y promover en la población general, y muy en especial a las y los adolescentes y jóvenes, respecto al uso adecuado de la anticoncepción de emergencia. Es un pequeño aporte a la lucha constante por la elevación de la calidad de vida de la mujer y la familia cubana

No desired pregnancy every year becomes a high price for women health, which is significantly higher in adolescents. It is paradoxical that in broad XX century many health professionals fails to recognize or not have all the necessary information relative to emergence contraception even though knowing that this method used in appropriate and early way may to reduce significantly the incidence of non-desired pregnancy and therefore the miscarriage and its sequelae, thus, the emergence contraception may be very useful in preservation and promotion of sexual and reproductive behavior, and even in not few cases, to save the women life. Motivated by the above mentioned, we conducted present bibliographic review with the central aim of to offer to health staff, be gynecologists, family physicians, pediatricians, nurses, the tools necessary to educate and to promote in general population and specially in adolescents the appropriate use of mergence contraception. It is our small contribution to constant fight by the rise in life of woman and in the Cuban life

Attitudes to abortion in the era of reform: evidence from the Abortion Law Reform Association correspondence.

This article examines letters sent by members of the general public to the Abortion Law Reform Association (ALRA) in the decade immediately before the 1967 Abortion Act. It shows how a voluntary organisation, in their aim of supporting a specific cause of unclear legality, called forth correspondence from those in need. In detailing the personal predicaments of those facing an unwanted pregnancy, this body of correspondence was readily deployed by ALRA in their efforts to mobilise support for abortion law reform, thus exercising a political function. A close examination of the content of the letters and the epistolary strategies adopted by their writers reveals that as much as they were a lobbying tool for changes in abortion law, these letters were discursively shaped by debates surrounding that very reform.

Embarazo no deseado en adolescente en un área de salud / Unwanted pregnancy in teenagers in a health area

Introducción. Detección de los casos atendidos, debidamente codificados en atención primaria de interrupción voluntaria del embarazo (IVE), embarazo no deseado (END) y anticoncepción de emergencia (AE) en adolescentes entre 13 y 18 años, atendidas en consulta a demanda en el Área de Salud de Cartagena. Material y método. Estudio cuantitativo, longitudinal retrospectivo realizado con las codificaciones en OMI-AP de los Centros de Salud del Área II de la Gerencia de Atención Primaria de Cartagena (2003-2008, ambos inclusive) participando las adolescentes atendidas en consulta entre 13 y 18 años ambos inclusive, desde enero de 2003 a diciembre de 2008. Se estudiaron las variables por edad y origen de procedencia. Resultados. El estudio incluye 227 casos de IVE, 235 de END, y 151 casos de AE, suponiendo más del 50% de los casos atendidas, adolescentes murcianas en todos los rangos de edad, con respecto al IVE y END entre 17 y 18 años y 15 y 16 años. Aunque en AE la muestra presenta el mayor porcentaje procedente de la comunidad de la Región de Murcia entre 15 y 16 años con significación estadística. Conclusiones. La IVE sería atendida en igualdad de condiciones en todas las comunidades al ser ofertado desde el sistema público de salud. En los casos de END mejorar las condiciones actuales de la maternidad, así como las medidas de prevención del embarazo (AU)

Introduction. Detection of the cases duly coded as abortion, unwanted pregnancy and emergency contraception in teenagers, between 13 and 18 years of age in Primary Health Care, who were treated on demand in a primary health care clinic in Cartagena (Murcia). Material and method. A retrospective, longitudinal, quantitative study carried out on the cases coded in OMI-AP software of the health centres, in Area II Primary Care Management of Cartagena (2003-2008 inclusive) conducted on teenagers between 13 and 18 years old, inclusive, seen in clinics from January 2003 to December 2008. Variables studied were: age and birth origin. Results. The study included 227 cases of abortion; 235 unwanted pregnancies and 151 cases of emergency contraception, accounting for over 50% of all cases of teenagers treated, and teenagers from Murcia in all range ages as regards abortion, and UP between 17 and 18 years, and 15 and 16 years. It is worth noting that emergency contraception has the highest rate sample in the community of Murcia between 15 and 16 year-olds, with statistical significance. Conclusions. Abortion is treated equally in all communities, as it is offered by the public health system. In unwanted pregnancy cases, improving conditions for maternity is highly recommended and the prevention of pregnancy (AU)

Modifiable risk factors for low birth weight and their effect on cerebral palsy and mental retardation.

OBJECTIVE: to estimate the effect of modifiable risk factors on low birth weight and two of its sequelae-cerebral palsy and mental retardation. METHODS: The population attributable risk percent (PARP) was used as a measure of effect. A literature search was conducted to determine estimates of the percent of CP and MR attributable to low birth weight. Data from the 1996-1997 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS), a population based surveillance system, were used to estimate the percent of low birth weight attributable to modifiable risk factors. The PARP was calculated for smoking and unwanted conception. RESULTS: Unwanted pregnancy and smoking were statistically significant risk factors for LBW. Four percent of all LBW births were attributable to unwanted pregnancy. If all unwanted pregnancies were prevented, 13% of cases of CP (27 cases per year in GA) and 14% of cases of MR (151 cases per year in GA) would be prevented. In wanted or mistimed pregnancies, 6% of LBW births were attributable to smoking. If all smoking during wanted or mistimed pregnancy was prevented, an additional 2.5% (5 cases) of CP and an additional 0.8% (8 cases) of MR would be prevented in Georgia each year. If all unwanted pregnancies and all smoking during wanted or mistimed pregnancies were prevented, 1692 LBW births could be prevented per year and the rate of LBW in Georgia would fall from 7.6% to 6.8%. Additionally, 32 cases of cerebral palsy and 159 cases of mental retardation could be prevented each year in Georgia. CONCLUSIONS: The PARP approach is useful in estimating the benefit of evidence-based prevention services. Preventing unwanted pregnancy and smoking during pregnancy would substantially reduce the burden of cerebral palsy and mental retardation in Georgia.

Contracepción poscoital de urgencia / No disponible

La contracepción de emergencia puede definirse como la administración de fármacos o el uso de un dispositivo para prevenir un posible embarazo después de una relación sexual sin protección y dentro de las 72 horas tras el contacto. El mecanismo de acción es impedir la ovulación o la fertilización o la implantación. Si el óvulo fecundado está implantado, ya no actuaría. Existe evidencia de que actúa en distintos momentos del ciclo reproductivo. Si sólo actuase sobre la ovulación y la fertilización, sólo podría prevenir muchos, pero no todos, los embarazos. El efecto sobre el endometrio y sus consecuencias sobre la implantación hacen necesario que los médicos conozcan todos los posibles mecanismos de estos medicamentos cuando se informa al paciente y la familia. La eficacia depende del régimen usado y del tiempo transcurrido entre la relación y la toma de la medicación. Tiene escasos efectos secundarios. La Asociación Americana de Pediatría propone, entre varias medidas, esta opción terapéutica para disminuir los embarazos no deseados en adolescentes. No obstante, con el uso de estos medicamentos deberían evaluarse algunas variables (AU)

Emergency postcoital contraception may be defined as the administration of a drug or use of a device to prevent a possible pregnancy after a sexual unprotected and within 72 hours after intercourse. Mode of action could work by inhibiting ovulation, interfering with fertilization or inhibiting implantation in the endometrium. If a fertilized egg is implanted prior to taking pills, it will not work. There is evidence of effects at several stages of the reproductive cycle. The method that affected ovulation or fertilization would prevent most but no all pregnancies. The effects on the endometrium and impact on implantation requires the physicians be knowledgeable about all potential mechanism when offering treatment to patients and families. The effectiveness depends on the regimen used and on the time between intercourse and treatment. It has low rate of side effects. The American Academics of Pediatrics proposes this measurement, besides others, to disminish the pregnancies nowished in adolescent. However, some variables, would have to be evaluated with the use of theses preparations (AU)

Sexualidad y calidad de vida en la mujer menopáusica / Sexuality and quality of life in the menopausal woman

La sexualidad es la forma de expresión de la intimidad, y en ella se manifiestan las dimensiones física, emocional, social y espiritual de la persona. Un primer paso para conseguir una sexualidad satisfactoria es disponer de una anticoncepción efectiva que libere el temor frente a un embarazo no deseado en una época donde las complicaciones maternas y perinatales están aumentadas. La sexualidad tiene una repercusión importante en la calidad de vida y aunque éste es un concepto subjetivo para cada individuo, resulta necesaria en la práctica clínica disponer de herramientas que permitan obtener una evaluación objetiva. Con esta idea se diseñó la escala Cervantes que permite la valoración de calidad de vida de la mujer posmenopáusiéa en nuestro medio y constatar los posibles cambios producidos tras una intervención terapéutica

The sexuality is the expression of the privacy, and relationship whit physical, emotional, social, and spiritual dimensions of the persono A first step to obtain a satisfactory sexuality is to have an effective contraception that it releases the fear a non wished pregnancy at a time where maternal and perinatal complications are increased. The sexuality has a important repercussion in the quality of life and although this it is a subjective concept for each individual, is necessary actually clinical to have tools that aIlow to obtain an objective evaluation. With this idea the Cervantes scale was designed that allows the valuation of quality of life of the menopausal woman in our country and to state the possible changes produced after a therapeutic intervention

The biopsychosocial aspects of unwanted teenage pregnancy.

Unwanted teenage pregnancy is a major health problem in Wales and perioperative nurses are frequently involved in caring for teenagers undergoing surgical termination of pregnancy. By providing such adolescents with holistic care--by taking into account both biological and psychological aspects of health--nurses can help reduce an adolescent's anxiety and pain.

Correlates of unintended pregnancy in Beheira governorate, Egypt.

This study looked at the frequency and determinants of unplanned births among women in Beheira governorate, Egypt, and the effects on antenatal and postnatal care sought by the mother for herself and her child. Unintended births comprised 23.6%; 13.8% were unwanted and 9.8% were mistimed. Contraceptive failure accounted for 28.8% of unintended pregnancies; 47.1% of women who reported unintended pregnancy were not using [corrected] contraception. Age, education and parity were predictors of unwanted pregnancy. Contraceptive use and maternal employment status predicted mistimed pregnancy. Unintended pregnancy was a barrier to antenatal care, but not to child care. Our findings suggest that family planning programmes should help women of reproductive age achieve spacing and fertility limits.

Inadequate weight gain among pregnant adolescents: risk factors and relationship to infant birth weight.

OBJECTIVE: Our purpose was to identify behavioral markers for inadequate weight gain (< 20 pounds) during pregnancy among adolescents < 18 years old. STUDY DESIGN: A total of 337 adolescents who were delivered of a term infant at our institution between March 10, 1992, and November 28, 1994 participated in this study. A comprehensive structured interview conducted at the first prenatal visit elicited demographic information and behavioral risk factors. Maternal weights, reproductive history, evidence of sexually transmitted disease, and infant birth weight were extracted from medical records. Logistic regression and chi 2 analyses compared characteristics and infant birth weights between those who gained < 20 pounds with those who gained > or = 20 pounds. RESULTS: A total of 11.6% (39/337) of the total sample gained < 20 pounds during the pregnancy. Adolescents who gained < 20 pounds compared with > or = 20 pounds were delivered of significantly lighter (2942 gm vs 3392 gm) infants and were more likely to be delivered of infants weighing < 2500 gm (13% vs < 1%). Stepwise logistic regression revealed that adolescents who were battered (odds ratio 5.3) or had a sexually transmitted disease (odds ratio 2.3) or an unplanned pregnancy (odds ratio 8.1) were at increased risk for insufficient weight gain during pregnancy. CONCLUSION: Our data suggest that behavioral risk factors are important in the identification of adolescents at greatest risk for inadequate weight gain. Early identification during pregnancy is essential to modify nutritional practices and thus minimize poor obstetric outcomes.

PIP: Among adolescents, maternal weight gain is considered the most important determinant of infant birth weight. To assist obstetricians in identifying adolescents at highest risk of inadequate weight gain early in the pregnancy, a study was conducted of 337 US adolescents under 18 years of age who delivered a full-term infant at the University of Texas Medical Branch (Galveston) in 1992-94. 39 (11.6%) of these adolescents gained under 20 pounds during pregnancy. Infants of these adolescents weighed significantly less at birth (average, 2942 g) than those of adolescents who gained 20 or more pounds (average, 3392 g). Moreover, the low-birth-weight (2500 g) rate was 13% in the former group compared with less than 1% in the adequate weight gain group. Gravidity, parity, school enrollment, marital status, employment status, or poverty level were not associated with maternal weight gain. Stepwise logistic regression identified the following risk factors for insufficient weight gain during pregnancy: physical assault/battering during pregnancy (odds ratio (OR), 5.3), a sexually transmitted disease during pregnancy (OR, 2.3), and an unplanned pregnancy (OR, 8.1). History taking during adolescent pregnancy should be expanded to include assessment of these factors.

The unanticipated pregnancy: a preliminary study.

To guide clinical judgements regarding possible pregnancy in women seen for nonpregnancy concerns, 75 pregnant women tested for pregnancy confirmation were compared to 31 women with pregnancies diagnosed when tested to clarify undifferentiated symptoms. Symptom clarification patients were more often unmarried (74.2% vs 37.3%, P less than 0.001), unemployed (54.8% vs 14.7%, P less than 0.0001), uninsured (54.8% vs 25.3%, P less than 0.004), black (67.8% vs 45.3%, P less than 0.04), using contraception (45.2% vs 22.7%, P less than 0.02), and carrying unwanted gestations (77.4% vs 34.7%, P less than 0.0001). Symptom clarification patients had a median 2 pregnancy symptoms versus 3 for pregnancy confirmation patients (P less than 0.001), less often reported amenorrhea (25.8% vs 6.7%, P less than 0.01) or breast tenderness (38.7% vs 66.7%, P less than 0.01), but more often experienced abdominal pain (45.2% vs 17.3%, P less than 0.003). Thus, symptom clarification patients are often earlier in gestation with fewer pregnancy symptoms, or may differ in how they perceive and interpret such symptoms when present, findings consistent with a tentative hypothesis that symptom clarification patients may not have anticipated being pregnant.