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1.
Sex Reprod Health Matters ; 29(1): 1985814, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34730066

RESUMO

Medical abortion (MA) is recommended by the WHO as a safe and effective pregnancy termination method in the first trimester. From a feminist perspective, it is a non-medicalised, self-managed, emancipating procedure allowing persons seeking abortion to be more in control of their abortion, as opposed to surgical procedures. In European countries where MA is legal, the proportion of MA (relative to surgical abortions) varies greatly. We hypothesised that this ratio may be partly explained by country-level dimensions of gender equality. We assessed the association between MA ratios and gender equality in Europe in correlation and regression analyses, using several country-level gender equality indices. The relevance of other factors, i.e. date of introduction of MA and pregnancy week until which MA is permitted, was also investigated. MA ratios ranged from 24.4% (Italy) to 97.7% (Finland). MA was more frequent relative to surgical abortion in countries with higher levels of gender equality. All gender equality indices were associated with MA ratios (e.g. Global Gender Gap Index corr. coeff: 0.761, p < 0.0001). Specifically, markers of economic and political gender equality seemed to drive the correlations. The pregnancy week until which MA is permitted was associated with both gender equality and MA ratios. Our study suggests that women's participation in the economic and political sphere may have repercussions on the methods offered and used through abortion services. It highlights the link between feminist perspectives, reproductive health policies and practices, and gender equality, especially in terms of access to economic resources and political representation.


Assuntos
Aborto Induzido , Equidade de Gênero , Correlação de Dados , Europa (Continente) , Feminino , Política de Saúde , Humanos , Gravidez
2.
Cien Saude Colet ; 26(10): 4397-4409, 2021 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34730631

RESUMO

This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.


Assuntos
Aborto Induzido , Aborto Espontâneo , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Mortalidade Materna , Gravidez , Desenvolvimento Sustentável , Adulto Jovem
3.
Cien Saude Colet ; 26(10): 4623-4633, 2021 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34730649

RESUMO

This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.


Assuntos
Aborto Induzido , Racismo , Assistência Integral à Saúde , Atenção à Saúde , Feminino , Pessoal de Saúde , Humanos , Gravidez
4.
Sex Reprod Health Matters ; 29(1): 1982460, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34719353

RESUMO

Pharmacies in low- and middle-income countries play an important role in increasing the availability of medical abortion to individuals for self-use. We aimed to document the costs to users of medical abortion products at outlets across geographies and understand the diversity of available products, primarily in low- and middle-income countries or in places where access to abortion is restricted. A descriptive analysis of price data was completed for identified medical abortion products at retail outlets visited in 44 countries from November 2017 to February 2018. Median prices and ranges are reported in $US for mifepristone 200 mg tablets, misoprostol 200 mcg tablets, and combipacks. Misoprostol, mifepristone, and combipacks were found in 44, 19, and 16 countries, respectively. Nearly two-thirds of products (321/508) required a prescription. The median price of misoprostol was $0.63 per tablet (range $0.09-$27.63) based on 304 price points. Mifepristone and combipacks had fewer price points available (n = 59 and n = 44, respectively). Median prices were $11.78 per mifepristone tablet (range $1.77-$37.83) and $11.18 per combipack (range $3.50-$35.86). Overall, prices were highest in Latin America and lowest in South/Southeast Asia. Only 11.5% (7/61) of the total unique misoprostol brands were quality-assured (i.e. approved by a stringent regulatory authority or pre-qualified by the World Health Organization), compared to 25.0% (4/16) of unique combipack products. There was wide variation in product pricing and availability across settings. The infrequent availability of mifepristone and combipacks, in addition to the limited availability of quality-assured medicines and high cost of abortion medications, are important factors affecting access to high-quality abortion care.


Assuntos
Aborto Induzido , Misoprostol , Custos e Análise de Custo , Feminino , Humanos , Mifepristona , Gravidez
5.
Reprod Health ; 18(1): 221, 2021 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-34743705

RESUMO

BACKGROUND: Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales. METHODS: We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes. RESULTS: From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5-23 + 6). We identified 4 major themes that contributed to participant's perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC. CONCLUSIONS: Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Inglaterra , Feminino , Humanos , Lactente , Percepção , Gravidez , Pesquisa Qualitativa , País de Gales
6.
Rev Med Chil ; 149(5): 758-764, 2021 May.
Artigo em Espanhol | MEDLINE | ID: mdl-34751329

RESUMO

Since 2017, women in Chile are allowed to interrupt voluntarily a pregnancy on three grounds: 1) When a woman's life is at risk due to the pregnancy, 2) When there are fetal anomalies incompatible with life, or 3) When pregnancy is result of rape. Women who qualify for any of these three pregnancy interruption requirements are entitled to a psychosocial accompaniment program to promote an integrative approach. In this article we will discuss the role of the psychosocial team in cases of rape resulting pregnancy. Specifically, the clinical and ethical dilemmas posed by the need to certify the rape in a general hospital such as difficulties in assessment of the story's plausibility, clinician's dual role and the limits to confidentiality, are discussed.


Assuntos
Aborto Induzido , Estupro , Chile , Feminino , Humanos , Gravidez
7.
Ceska Gynekol ; 86(5): 304-310, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34736327

RESUMO

OBJECTIVE: The aim of this study was to compare the relation between the quality of life, level of depression and some other psychological characteristics of women and the method (pharmacological or instrumental) they chose to terminate their pregnancy up to 49 days of amenorrhoea. METHODS: From Jan 1st, 2019 to Aug 31st, 2020 we prospectively analyzed data obtained by evaluating questionnaires from 106 women with a choice of pharmacological (faUUT) and 105 women with a choice of surgical (iUUT) termination of pregnancy. The questionnaires focused on their quality of life and other characteristics. RESULTS: Women undergoing faUUT have a statistically significantly higher quality of life (P = 0.001), they are physically (P = 0.003) and mentally (P = 0.027) healthier, they have a higher socioeconomic status, and they are more satisfied with their environment (P = 0.022). CONCLUSION: Women with a differently chosen method of termination of pregnancy had a statistically significantly different quality of life as a whole. This difference is statistically significant in the sub-areas of the quality of life: feeling of physical health and mental well-being, satisfaction with the environment, and subjective perception of the quality of life. The result doesnt confirm a statistically significant difference between both groups on the level of depression and their cohabitation.


Assuntos
Aborto Induzido , Qualidade de Vida , Feminino , Humanos , Gravidez , Inquéritos e Questionários
8.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1374-1380, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792892

RESUMO

The article analyzes the lines of reproductive behavior of the population, which are one of the important indicators of actions to implement reproductive attitudes. The analysis of the lines of reproductive behavior was carried out on the basis of the results of two studies: «Selective observation of reproductive plans of the population¼ conducted by Rosstat in 2012 and the first wave of the All-Russian study «Demographic well-being of Russia¼ conducted by IDR FCTAS RAS in 2019-2020. If the 2012 study showed that almost 2/3 of one-child women did not have contraception and did not have abortions before the birth of their first child, then according to the results of the 2019-2020 study. Equally distributed were those who had and those who had not been protected from pregnancy before the first birth. Depending on the lines of reproductive behavior, on average, the values ​​of the time interval between the registration of marriage and the first birth differ, and the time intervals between the first births and the second are noticeably different. The dependence of the lines of reproductive behavior on the importance of the birth and upbringing of children is manifested not so much with the lines of reproductive behavior in relation to children who have already been born, but with their behavior aimed at childbirth or refusal to give birth.


Assuntos
Aborto Induzido , Comportamento Reprodutivo , Anticoncepção , Feminino , Humanos , Casamento , Gravidez , Reprodução
9.
J Pak Med Assoc ; 71(Suppl 7)(11): S45-S49, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34793428

RESUMO

OBJECTIVE: The study aimed to document the impact of interpersonal communication (IPC) activities on increasing volume of family planning clients, new users, long term contraceptive uptake, post-partum, and post abortion family planning uptake at the associated health facilities of the Sabz Sitara Network. Methodology: A comparative secondary analysis of retrospective programme service delivery data from two groups of providers was performed. The exposure variable is defined as receipt of IPC. The six outcome variables are volume of: family planning (FP) clients, FP clients less < 25 years, intra-uterine device (IUD) insertions, post-partum FP clients (PPFP), users, and post-abortion FP (PAFP) clients. RESULTS: The increase in client volume in IPC supported providers is significant for all the FP outcomes when adjusted for provider qualification and location. The adjusted model shows a significant increase of 10 more FP clients, 2 more youth clients and IUD insertions each, 3 more new users, and 1 more client for post abortion services. CONCLUSIONS: The IPC intervention has a positive and significant impact on increasing client volume for all related FP outcomes at the associated provider facilities. Location and qualification of providers seem to moderate the impact. Considering qualification, and geo-social demographics of the area to tweak intervention intensity and design will help amplify the associated beneficial outcomes and minimize underperformance. To maximize return on investment, subsequent evaluations should help determine the ideal time frame required to achieve and sustain the positive results.


Assuntos
Aborto Induzido , Serviços de Planejamento Familiar , Adolescente , Comunicação , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Educação Sexual
10.
Pan Afr Med J ; 40: 34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795815

RESUMO

Introduction: adolescent pregnancy in Ghana, like in most low and middle income countries, is an issue of immense public health importance. Pregnant adolescents are faced with the stronger dilemma of either terminating the unwanted pregnancy or keeping it. This discourse which is based on findings from empirical research in Accra Ghana aims at contributing to the usefulness of understanding the meaning and scope of autonomy when it comes to providing ethically grounded, and adolescent friendly, reproductive health care services to pregnant adolescents. The aim of this work was to document the meaning and determinants of autonomous decision making among pregnant adolescents in the James Town area of Accra, Ghana. Methods: thirty (30) semi-structured in depth interviews were conducted among adolescents who had been pregnant at least once, 23 in depth interviews among purposively selected stakeholders (parents, teachers, NGO staff working in reproductive health, community volunteers), and 8 focus group discussions among parents, teachers, adolescent students who had not been pregnant before, and adolescents who had at least one pregnancy in the past. Data were transcribed verbatim and analyzed thematically. Results: most adolescents reported that the final decision to continue a pregnancy to term or go in for an abortion was taken by them. The partner´s willingness to take responsibility of the pregnant adolescent and baby, as well as financial considerations, were main players in deciding upon the pregnancy outcomes. Cultural desirability for children and health care provider/father paternalism (power dynamics) in the decision-making process were central considerations in the decision-making process. Unaffordable and unfriendly safe abortion services pushed adolescents to either continue pregnancies to term against their will, or opt to visit unsafe abortion care providers. Conclusion: adolescents stand to make truly autonomous decisions if they are provided with the right information, at the right time, at the right place, by the right persons, and in the right way. Health system, economic, and cultural factors play significant roles in rendering pregnant adolescent autonomy meaningful when deciding upon their pregnancy outcomes. Continuing pregnancies to term against one´s will or being forced to go in for an abortion are ethically unjustified. Further research is required to examine the long-term consequences of forced pregnancy terminations or births.


Assuntos
Tomada de Decisões , Autonomia Pessoal , Gravidez na Adolescência/psicologia , Gestantes/psicologia , Aborto Induzido/psicologia , Adolescente , Feminino , Grupos Focais , Gana , Humanos , Entrevistas como Assunto , Paternalismo , Gravidez , Gravidez não Desejada/psicologia , Serviços de Saúde Reprodutiva/organização & administração
11.
Reprod Health ; 18(1): 240, 2021 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-34838089

RESUMO

BACKGROUND: Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women's decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted. METHODS: This analysis uses data from a 2019-2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women's preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women's decisions about where to terminate their pregnancy and identify factors hindering women's ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location. RESULTS: Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). "Privacy/confidentiality" was the most common main reason driving women's abortion provider/location choice (20.7%), followed by "convenience" (16.9%) and "recommended" by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence. CONCLUSIONS: These findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women's choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women's abortion care preferences in a legally restrictive environment.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Nigéria , Gravidez
12.
BMC Health Serv Res ; 21(1): 1104, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654428

RESUMO

BACKGROUND: Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. METHODS: We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. RESULTS: Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. DISCUSSION: Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. CONCLUSIONS: SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.


Assuntos
Aborto Induzido , Assistência ao Convalescente , Estudos Transversais , Feminino , Gana , Instalações de Saúde , Humanos , Gravidez
13.
Artigo em Inglês | MEDLINE | ID: mdl-34639806

RESUMO

It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence-itself from 15 to 20 years ago-suggests that 6-7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70-150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Induzido/efeitos adversos , Aborto Espontâneo/epidemiologia , Feminino , Humanos , Malaui/epidemiologia , Mortalidade Materna , Gravidez
15.
J Nepal Health Res Counc ; 19(2): 327-330, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601525

RESUMO

BACKGROUND: An ectopic or extra uterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity. The objective of the study was to find incidence, risk factors, clinical presentation and mode of management of ectopic pregnancy. METHODS: Observational study was conducted at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu. All the relevant data were recorded in performa. The collected data were entered in MS Excel and exported into SPSS 26 version for statistical analysis. RESULTS: About one third of the patients 10 (33.3%) was of 25-29 age group.The most common risk factor was pelvic infection in 23 (76.6%) cases, abortion in 11 (36.7%), and abdominal surgery in 8 (26.7%) of cases. The of classic triad of amenorrhea (100%), pain abdomen (99.7%) and per vaginal bleeding (66.7%). Ruptured ectopic seen in 26 (86.7%) cases, unruptured status in 1 (3.3%) case, tubal abortion in 1(3.3%) case and organized ectopic in 2(6.7%) cases. The most common site was found to be ampulla in 23 (76.7%) cases, fmbria 3(10%) cases, corneal in 3(10%) cases and ithmus in 1 (3.3%) case. All the cases managed surgically, of them unilateral salphingectomy, unilateral salphingo-opherectomy and wedge resection for corneal pregnancy were done in 25(83.3%), 2(6.7%) and 3(10%) cases respectively. CONCLUSIONS: Ectopic pregnancy mostly present as ruptured form in young females in our context. Pelvic infection is the commonest risk factor with ampulla being the commonest site. All cases required surgical intervention in form of unilateral salphingo-opherectomy and wedge resection.


Assuntos
Aborto Induzido , Gravidez Ectópica , Feminino , Humanos , Nepal/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/cirurgia , Fatores de Risco , Centros de Atenção Terciária
16.
Reprod Health ; 18(1): 211, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702283

RESUMO

BACKGROUND: South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women's experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers' and policy makers' ideas for public sector strategies to facilitate prompt confirmation of pregnancy. METHODS: We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis. RESULTS: Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible. CONCLUSION: Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.


Assuntos
Aborto Induzido , Gravidez não Planejada , Feminino , Pessoal de Saúde , Acesso aos Serviços de Saúde , Humanos , Gravidez , África do Sul
17.
Sex Reprod Health Matters ; 29(2): 1966983, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34620041

RESUMO

The unmet need for contraception is documented as a significant determinant of unintended pregnancies and high number of induced abortions. The period immediately after an abortion is recognised as a unique opportunity to offer contraceptive services. This paper explores the association between place of abortion and women's post-abortion contraceptive behaviour. The reproductive calendar data from the National Family Health Survey (NFHS-4) (2015-16) was used for this study. Multinomial logistic regression models were used to understand factors associated with post-abortion method choices. Single decrement life-tables were built to examine rates of contraceptive discontinuation and proportional hazard models were employed to examine probability and correlates of method discontinuation. About 20% of women who underwent an abortion adopted a contraceptive method by the end of one month following an abortion. The decision to choose methods like sterilisation or intrauterine contraceptive devices (IUCDs) was associated with the place of abortion, past contraceptive behaviour, number and sex of surviving children at the time of abortion, mass media exposure, and time of the abortion. Compared to women who underwent an abortion at private health facilities, women who sought abortion at public health facilities were more likely to choose permanent methods or IUCDs. Furthermore, women who opted for an IUCD were less likely to discontinue the method compared to those using short-acting modern methods. The lack of post-abortion contraceptive choices for women is evident in the low uptake of post-abortion contraceptives in private facilities and the predominant promotion of permanent methods and IUCDs in public health facilities.


Assuntos
Aborto Induzido , Anticoncepcionais , Criança , Anticoncepção , Comportamento Contraceptivo , Feminino , Humanos , Gravidez , Gravidez não Planejada
18.
Sex Reprod Health Matters ; 29(2): e1966218, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34651568

RESUMO

Irrespective of the legal status of abortion, access to abortion services for women is fraught with numerous challenges across the world. A recent study in India found that most women who had an abortion sought care outside an authorised facility or from a less qualified provider. An analysis of women's experiences in seeking abortion services would provide a better understanding of the underlying reasons. This paper is based on a qualitative study of the experiences of 16 married women from rural Tamil Nadu, India. The in-depth interviews focused on their pregnancy and childbirth experiences and access to abortion services. The study highlights the obstacle course that women seeking to terminate an unwanted pregnancy have to traverse. Many women were not aware of the legal status of abortion, and frontline workers discouraged them and gave misleading information. The pathways to seeking an abortion were more complex for women from marginalised communities. Providers were judgemental and used delaying tactics or denied abortion services. For the less privileged women, abortion services from government health facilities were conditional on the acceptance of female sterilisation. The providers' attitudes in government and private health facilities were disrespectful of the women seeking abortion services. To uphold the reproductive and human rights of women who seek abortion services, we need accessible and publicly funded health care services that respect the dignity of all women, are empathetic and uphold women's right to safe abortion services.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Feminino , Humanos , Índia , Gravidez , Gravidez não Desejada , Pesquisa Qualitativa
19.
J Law Med Ethics ; 49(3): 500-502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665093

RESUMO

On January 3, 2019, U.S. District Judge Theodore D. Chuang of the U.S. District Court of the District of Maryland took a crucial first step in redressing one of the worst human subjects research ethics violations in U.S. history.


Assuntos
Aborto Induzido , Preparações Farmacêuticas , Direitos Civis , Feminino , Direitos Humanos , Humanos , Jurisprudência , Responsabilidade Legal , Maryland , Gravidez , Governo Estadual
20.
Int J Gynaecol Obstet ; 155(3): 556-560, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34628655

RESUMO

Medical associations and leading courts reinforce the duty of physicians who conscientiously object to participating in treatment indicated for their patients to refer them to non-objecting practitioners. Ethical and legal duties require continuity of care when physicians withdraw from patients' treatment on grounds of conscience. The duty to refer might affect gynecologists when their patients request for example, contraceptive means, sterilization, abortion, medically assisted reproductive procedures, or gender reassignment. Legislation and leading law courts, notably the UK Supreme Court and Constitutional Court of Colombia, and professional associations such as the College of Physicians and Surgeons of Ontario, have clarified the duty to refer. Physicians are expected to cater their individual conscience to their professional ethical and legal duties, favoring their patients' choices over their personal objections. Physicians can object to "hands-on" conduct of procedures they find objectionable, but cannot deny referral on grounds of complicity in what other care providers do.


Assuntos
Aborto Induzido , Ginecologia , Médicos , Consciência , Feminino , Humanos , Gravidez , Recusa do Médico a Tratar
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