Women's Awareness and Knowledge of Abortion Laws: A Systematic Review.

PubMed

Assifi, Anisa R; Berger, Blair; Tunçalp, Özge; Khosla, Rajat; Ganatra, Bela

2016-01-01

Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women's access to safe, legal abortion services. To provide a synthesis of evidence of women's awareness and knowledge of the legal status of abortion in their country, and the accuracy of women's knowledge on specific legal grounds and restrictions outlined in a country's abortion law. A systematic search was carried for articles published between 1980-2015. Quantitative, mixed-method data collection, and objectives related to women's awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis. Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women's correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3%-68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8%-98%, while in the case of incest, ranged from 9.8%-64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7%-94% and 0%-89.5% respectively. This systematic review synthesizes literature on women's awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary.

Psychiatric sequelae to term birth and induced early and late abortion: a longitudinal study.

PubMed

Athanasiou, R; Oppel, W; Michelson, L; Unger, T; Yager, M

1973-01-01

Three obstetric groups matched for parity, age, color, marital and socioeconomic status, were compared for the psychosocial antecedents to abortion or term delivery and sequelae that did exist. One group had induced abortion by suction curettage, the second had induced abortion by saline injection, and the third had term delivery. 373 women were interviewed during pregnancy; 211 were included in follow-up after an average of 16 months for abortion patients and 13 months for the term delivery group. The 373 women received a structured 90-minute interview about family relationships, consort relationships, living arrangements, income, education, religious behavior, sexual behavior, contraceptive knowledge and use, pregnancy history and desired family size. The Srole Anomia scale and the Rosenberg Self-Esteem scale were also used. At the followup interview, similar questions were asked and the two attitude scales were again presented. The MMPI (Minnesota Multiphasic Personality Inventory) and the SCL (Symptom Check List) were also used. 12% of the 211 follow-up scored higher than 70 on the MMPI for mania and psychopathy scales; these women were evenly divided among the three groups. SCL scales showed the three groups of patients to be similar after abortion or birth, with the only statistically significant difference being the suction curettage group, which had fewer complaints after abortion than either of the other two groups. There was no difference on the anomia or self-esteem scale between pre- or post-procedure for any of the groups. The data suggest neither great harm nor great benefit with regard to these variables due to either early or late abortion or term birth. Early abortion by suction curettage was possibly more therapeutic than carrying a pregnancy to term. There were striking improvements with regard to contraceptive use after the procedure. 71% of each group used effective contraception for more than 12 months after abortion or birth: a 20% increase for the term birth group, a 13% increase for the suction curettage group, and a 26% increase for the saline abortion group. Among abortion patients, those found to have low self-esteem, low contraceptive knowledge, high alienation, and who delayed in seeking abortion were related to long recovery times, a high MMPI psychopathology scale, and a number of unpleasant body symptoms post-abortion. These patients could be predicted with accuracy 32% better than chance alone.

Abort Trigger False Positive and False Negative Analysis Methodology for Threshold-Based Abort Detection

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Cruz, Jose A.; Johnson Stephen B.; Lo, Yunnhon

2015-01-01

This paper describes a quantitative methodology for bounding the false positive (FP) and false negative (FN) probabilities associated with a human-rated launch vehicle abort trigger (AT) that includes sensor data qualification (SDQ). In this context, an AT is a hardware and software mechanism designed to detect the existence of a specific abort condition. Also, SDQ is an algorithmic approach used to identify sensor data suspected of being corrupt so that suspect data does not adversely affect an AT's detection capability. The FP and FN methodologies presented here were developed to support estimation of the probabilities of loss of crew and loss of mission for the Space Launch System (SLS) which is being developed by the National Aeronautics and Space Administration (NASA). The paper provides a brief overview of system health management as being an extension of control theory; and describes how ATs and the calculation of FP and FN probabilities relate to this theory. The discussion leads to a detailed presentation of the FP and FN methodology and an example showing how the FP and FN calculations are performed. This detailed presentation includes a methodology for calculating the change in FP and FN probabilities that result from including SDQ in the AT architecture. To avoid proprietary and sensitive data issues, the example incorporates a mixture of open literature and fictitious reliability data. Results presented in the paper demonstrate the effectiveness of the approach in providing quantitative estimates that bound the probability of a FP or FN abort determination.

Women’s Awareness and Knowledge of Abortion Laws: A Systematic Review

PubMed Central

Assifi, Anisa R.; Berger, Blair; Tunçalp, Özge; Khosla, Rajat; Ganatra, Bela

2016-01-01

Background Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women’s access to safe, legal abortion services. Objective To provide a synthesis of evidence of women’s awareness and knowledge of the legal status of abortion in their country, and the accuracy of women’s knowledge on specific legal grounds and restrictions outlined in a country’s abortion law. Methods A systematic search was carried for articles published between 1980–2015. Quantitative, mixed-method data collection, and objectives related to women’s awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis. Results Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women’s correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3% - 68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8% – 98%, while in the case of incest, ranged from 9.8% - 64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7% - 94% and 0% - 89.5% respectively. Conclusion This systematic review synthesizes literature on women’s awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary. PMID:27010629

Measurement of the uterus and gestation sac by ultrasound in early normal and abnormal pregnancy.

PubMed

Chandra, M; Evans, L J; Duff, G B

1981-01-14

Uterine volumes measured by two different ultrasonic methods, and gestation sac volumes in early normal pregnancy are reported. The results obtained for uterine volume measurements are compared. Methods using measurements obtained from only a longitudinal scan were simpler but slightly less accurate. Uterine volumes were also calculated in a series of patients with pregnancy complicated by threatened abortion. The accuracy of the prediction of the outcome of the pregnancy, based solely on uterine volume was 71 percent. Uterine volume measurement is most useful in identifying cases of missed abortion where the period of gestation is known.

Application of Fault Management Theory to the Quantitive Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

SHM/FM theory has been successfully applied to the selection of the baseline set Abort Triggers for the NASA SLS center dot Quantitative assessment played a useful role in the decision process ? M&FM, which is new within NASA MSFC, required the most "new" work, as this quantitative analysis had never been done before center dot Required development of the methodology and tool to mechanize the process center dot Established new relationships to the other groups ? The process is now an accepted part of the SLS design process, and will likely be applied to similar programs in the future at NASA MSFC ? Future improvements center dot Improve technical accuracy ?Differentiate crew survivability due to an abort, vs. survivability even no immediate abort occurs (small explosion with little debris) ?Account for contingent dependence of secondary triggers on primary triggers ?Allocate "? LOC Benefit" of each trigger when added to the previously selected triggers. center dot Reduce future costs through the development of a specialized tool ? Methodology can be applied to any manned/unmanned vehicle, in space or terrestrial

Self-assessment of eligibility for early medical abortion using m-Health to calculate gestational age in Cape Town, South Africa: a feasibility pilot study.

PubMed

Momberg, Mariette; Harries, Jane; Constant, Deborah

2016-04-16

Although abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women's acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Women's acceptability, views and preferences of using mobile technology for gestational age (GA) determination were explored. No previous studies to ascertain the accuracy of online self-administered calculators in a non-clinical setting have been conducted. A convenience sample of abortion seekers were recruited from two health care clinics in Cape Town, South Africa in 2014. Seventy-eight women were enrolled and tasked with completing an online self-assessment by entering the first day of their last menstrual period (LMP) onto a website which calculated their GA. A short survey explored the feasibility and acceptability of employing m-Health technology in abortion services. Self-calculated GA was compared with ultrasound gestational age obtained from clinical records. Participant mean age was 28 (SD 6.8), 41% (32/78) had completed high school and 73% (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24%) women. Most participants found the online GA calculator easy to use (91%; 71/78); thought the calculation was accurate (86%; 67/78) and that it would be helpful when considering an abortion (94%; 73/78). Eighty-three percent (65/78) reported regular periods and recalled their LMP (71%; 55/78). On average women overestimated GA by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation. Timely access to information is an essential component of effective abortion services. Advances in the availability of mobile technology represent an opportunity to provide accurate and safe abortion information and services. Our findings indicate that an online GA calculator would be accurate and helpful. GA could be calculated based on LMP recall within an error of 0.5 days, which is not considered clinically significant. An online GA calculator could potentially act as an enabler for women to access safe abortion services sooner.

[Correlation of the DNA fragmentation index and malformation rate of optimized sperm with embryonic development and early spontaneous abortion in IVF-ET].

PubMed

Jiang, Wei-Jie; Jin, Fan; Zhou, Li-Ming

2016-06-01

To investigate the effects of the DNA fragmentation index (DFI) and malformation rate (SMR) of optimized sperm on embryonic development and early spontaneous abortion in conventional in vitro fertilization and embryo transfer (IVF-ET). We selected 602 cycles of conventional IVF-ET for pure oviductal infertility that had achieved clinical pregnancies, including 505 cycles with ongoing pregnancy and 97 cycles with early spontaneous abortion. On the day of ovum retrieval, we examined the DNA integrity and morphology of the rest of the optimized sperm using the SCD and Diff-Quik methods, established the joint predictor (JP) by logistic equation, and assessed the value of DFI and SMR in predicting early spontaneous abortion using the ROC curve. The DFI, SMR, and high-quality embryo rate were (15.91±3.69)%, (82.85±10.24)%, and 46.53% (342/735) in the early spontaneous abortion group and (9.30±4.22)%, (77.32±9.19)%, and 56.43% (2263/4010) respectively in the ongoing pregnancy group, all with statistically significant differences between the two groups (P<0.05 ). Both the DFI and SMR were the risk factors of early spontaneous abortion (OR = 5.96 and 1.66; both P< 0.01). The areas under the ROC curve for DFI, SMR and JP were 0.893±0.019, 0.685±0.028, and 0.898±0.018, respectively. According to the Youden index, the optimal cut-off values of the DFI and SMR obtained for the prediction of early spontaneous abortion were approximately 15% and 80%. The DFI was correlated positively with SMR (r= 0.31, P<0.01) but the high-quality embryo rate negatively with both the DFI (r= －0.45, P<0.01) and SMR (r= －0.22, P<0.01). The DFI and SMR of optimized sperm are closely associated with embryonic development in IVF. The DFI has a certain value for predicting early spontaneous abortion with a threshold of approximately 15%, but SMR may have a lower predictive value.

Determination of ethanol in breath for legal purposes using a five-filter infrared analyzer: studies on response to volatile interfering substances.

PubMed

Jones, Alan Wayne; Andersson, Lars

2008-06-01

The analysis of ethanol in exhaled breath is widely accepted and used worldwide for legal purposes to gather evidence of alcohol-impaired driving. Most evidential breath-alcohol instruments incorporate infrared (IR) spectroscopy as the analytical principle focusing on C-H or C-O stretching frequencies in ethanol molecules. The instrument approved for legal purposes in Sweden is called Evidenzer and is equipped with five infrared filters of which four are used for identification and quantification of ethanol and the fifth is a reference filter. The response of Evidenzer was tested against 21 volatile organic compounds (VOCs), and the instrument was programmed to deduct any bias caused by these VOCs if present in a sample of breath. If the amount deducted exceeds a certain threshold value, the entire test is aborted. Whenever this happens, the police request a specimen of venous blood for analysis by gas chromatography. Of a total of 24 072 drunken drivers, the evidential breath-alcohol test was aborted on 27 occasions (0.11%) because an interfering substance was present above the critical threshold. The VOCs most commonly identified in blood were acetone, isopropanol and/or methyl ethyl ketone (MEK). Elevated levels of acetone and isopropanol might arise during ketogenesis in people suffering from diabetes, or in those who eat low carbohydrate diets. High concentrations of acetone and MEK are probably caused by people drinking a technical alcohol product (T-Red), which is available in Sweden and is denatured with these agents. This study confirms that relatively few apprehended drivers in Sweden have elevated concentrations of VOCs in breath other than ethanol. Even the aborted breath tests, to a large extent, contained ethanol above the legal limit for driving.

Sensitive Questions in Surveys

ERIC Educational Resources Information Center

Tourangeau, Roger; Yan, Ting

2007-01-01

Psychologists have worried about the distortions introduced into standardized personality measures by social desirability bias. Survey researchers have had similar concerns about the accuracy of survey reports about such topics as illicit drug use, abortion, and sexual behavior. The article reviews the research done by survey methodologists on…

Automatic threshold optimization in nonlinear energy operator based spike detection.

PubMed

Malik, Muhammad H; Saeed, Maryam; Kamboh, Awais M

2016-08-01

In neural spike sorting systems, the performance of the spike detector has to be maximized because it affects the performance of all subsequent blocks. Non-linear energy operator (NEO), is a popular spike detector due to its detection accuracy and its hardware friendly architecture. However, it involves a thresholding stage, whose value is usually approximated and is thus not optimal. This approximation deteriorates the performance in real-time systems where signal to noise ratio (SNR) estimation is a challenge, especially at lower SNRs. In this paper, we propose an automatic and robust threshold calculation method using an empirical gradient technique. The method is tested on two different datasets. The results show that our optimized threshold improves the detection accuracy in both high SNR and low SNR signals. Boxplots are presented that provide a statistical analysis of improvements in accuracy, for instance, the 75th percentile was at 98.7% and 93.5% for the optimized NEO threshold and traditional NEO threshold, respectively.

Security of a semi-quantum protocol where reflections contribute to the secret key

NASA Astrophysics Data System (ADS)

Krawec, Walter O.

2016-05-01

In this paper, we provide a proof of unconditional security for a semi-quantum key distribution protocol introduced in a previous work. This particular protocol demonstrated the possibility of using X basis states to contribute to the raw key of the two users (as opposed to using only direct measurement results) even though a semi-quantum participant cannot directly manipulate such states. In this work, we provide a complete proof of security by deriving a lower bound of the protocol's key rate in the asymptotic scenario. Using this bound, we are able to find an error threshold value such that for all error rates less than this threshold, it is guaranteed that A and B may distill a secure secret key; for error rates larger than this threshold, A and B should abort. We demonstrate that this error threshold compares favorably to several fully quantum protocols. We also comment on some interesting observations about the behavior of this protocol under certain noise scenarios.

Optimization of Second Fault Detection Thresholds to Maximize Mission POS

NASA Technical Reports Server (NTRS)

Anzalone, Evan

2018-01-01

In order to support manned spaceflight safety requirements, the Space Launch System (SLS) has defined program-level requirements for key systems to ensure successful operation under single fault conditions. To accommodate this with regards to Navigation, the SLS utilizes an internally redundant Inertial Navigation System (INS) with built-in capability to detect, isolate, and recover from first failure conditions and still maintain adherence to performance requirements. The unit utilizes multiple hardware- and software-level techniques to enable detection, isolation, and recovery from these events in terms of its built-in Fault Detection, Isolation, and Recovery (FDIR) algorithms. Successful operation is defined in terms of sufficient navigation accuracy at insertion while operating under worst case single sensor outages (gyroscope and accelerometer faults at launch). In addition to first fault detection and recovery, the SLS program has also levied requirements relating to the capability of the INS to detect a second fault, tracking any unacceptable uncertainty in knowledge of the vehicle's state. This detection functionality is required in order to feed abort analysis and ensure crew safety. Increases in navigation state error and sensor faults can drive the vehicle outside of its operational as-designed environments and outside of its performance envelope causing loss of mission, or worse, loss of crew. The criteria for operation under second faults allows for a larger set of achievable missions in terms of potential fault conditions, due to the INS operating at the edge of its capability. As this performance is defined and controlled at the vehicle level, it allows for the use of system level margins to increase probability of mission success on the operational edges of the design space. Due to the implications of the vehicle response to abort conditions (such as a potentially failed INS), it is important to consider a wide range of failure scenarios in terms of both magnitude and time. As such, the Navigation team is taking advantage of the INS's capability to schedule and change fault detection thresholds in flight. These values are optimized along a nominal trajectory in order to maximize probability of mission success, and reducing the probability of false positives (defined as when the INS would report a second fault condition resulting in loss of mission, but the vehicle would still meet insertion requirements within system-level margins). This paper will describe an optimization approach using Genetic Algorithms to tune the threshold parameters to maximize vehicle resilience to second fault events as a function of potential fault magnitude and time of fault over an ascent mission profile. The analysis approach, and performance assessment of the results will be presented to demonstrate the applicability of this process to second fault detection to maximize mission probability of success.

Early-acting inbreeding depression and reproductive success in the highbush blueberry, Vaccinium corymbosum L.

PubMed

Krebs, S L; Hancock, J F

1990-06-01

Tetraploid Vaccinium corymbosum genotypes exhibit wide variability in seed set following self- and cross-pollinations. In this paper, a post-zygotic mechanism (seed abortion) under polygenic control is proposed as the basis for fertility differences in this species. A pollen chase experiment indicated that self-pollen tubes fertilize ovules, but are also 'outcompeted' by foreign male gametes in pollen mixtures. Matings among cultivars derived from a pedigree showed a linear decrease in seed number per fruit, and increase in seed abortion, with increasing relatedness among parents. Selfed (S1) progeny from self-fertile parents were largely self-sterile. At zygotic levels of inbreeding of F>0.3 there was little or no fertility, suggesting that an inbreeding threshold regulates reproductive success in V. corymbosum matings. Individuals below the threshold are facultative selfers, while those above it are obligate outcrossers. Inbreeding also caused a decrease in pollen viability, and reduced female fertility more rapidly than male fertility. These phenomena are discussed in terms of two models of genetic load: (1) mutational load - homozygosity for recessive embryolethal or sub-lethal mutations and (2) segregational load - loss of allelic interactions essential for embryonic vigor. Self-infertility in highbush blueberries is placed in the context of 'late-acting' self-incompatibility versus 'early-acting' inbreeding depression in angiosperms.

The upgraded data acquisition system for beam loss monitoring at the Fermilab Tevatron and Main Injector

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baumbaugh, A.; Briegel, C.; Brown, B.C.

2011-11-01

A VME-based data acquisition system for beam-loss monitors has been developed and is in use in the Tevatron and Main Injector accelerators at the Fermilab complex. The need for enhanced beam-loss protection when the Tevatron is operating in collider-mode was the main driving force for the new design. Prior to the implementation of the present system, the beam-loss monitor system was disabled during collider operation and protection of the Tevatron magnets relied on the quench protection system. The new Beam-Loss Monitor system allows appropriate abort logic and thresholds to be set over the full set of collider operating conditions. Themore » system also records a history of beam-loss data prior to a beam-abort event for post-abort analysis. Installation of the Main Injector system occurred in the fall of 2006 and the Tevatron system in the summer of 2007. Both systems were fully operation by the summer of 2008. In this paper we report on the overall system design, provide a description of its normal operation, and show a number of examples of its use in both the Main Injector and Tevatron.« less

The upgraded data acquisition system for beam loss monitoring at the Fermilab Tevatron and Main Injector

NASA Astrophysics Data System (ADS)

Baumbaugh, A.; Briegel, C.; Brown, B. C.; Capista, D.; Drennan, C.; Fellenz, B.; Knickerbocker, K.; Lewis, J. D.; Marchionni, A.; Needles, C.; Olson, M.; Pordes, S.; Shi, Z.; Still, D.; Thurman-Keup, R.; Utes, M.; Wu, J.

2011-11-01

A VME-based data acquisition system for beam-loss monitors has been developed and is in use in the Tevatron and Main Injector accelerators at the Fermilab complex. The need for enhanced beam-loss protection when the Tevatron is operating in collider-mode was the main driving force for the new design. Prior to the implementation of the present system, the beam-loss monitor system was disabled during collider operation and protection of the Tevatron magnets relied on the quench protection system. The new Beam-Loss Monitor system allows appropriate abort logic and thresholds to be set over the full set of collider operating conditions. The system also records a history of beam-loss data prior to a beam-abort event for post-abort analysis. Installation of the Main Injector system occurred in the fall of 2006 and the Tevatron system in the summer of 2007. Both systems were fully operation by the summer of 2008. In this paper we report on the overall system design, provide a description of its normal operation, and show a number of examples of its use in both the Main Injector and Tevatron.

Research on Quantum Algorithms at the Institute for Quantum Information

DTIC Science & Technology

2009-10-17

accuracy threshold theorem for the one-way quantum computer. Their proof is based on a novel scheme, in which a noisy cluster state in three spatial...detected. The proof applies to independent stochastic noise but (in contrast to proofs of the quantum accuracy threshold theorem based on concatenated...proved quantum threshold theorems for long-range correlated non-Markovian noise, for leakage faults, for the one-way quantum computer, for postselected

Optimum threshold selection method of centroid computation for Gaussian spot

NASA Astrophysics Data System (ADS)

Li, Xuxu; Li, Xinyang; Wang, Caixia

2015-10-01

Centroid computation of Gaussian spot is often conducted to get the exact position of a target or to measure wave-front slopes in the fields of target tracking and wave-front sensing. Center of Gravity (CoG) is the most traditional method of centroid computation, known as its low algorithmic complexity. However both electronic noise from the detector and photonic noise from the environment reduces its accuracy. In order to improve the accuracy, thresholding is unavoidable before centroid computation, and optimum threshold need to be selected. In this paper, the model of Gaussian spot is established to analyze the performance of optimum threshold under different Signal-to-Noise Ratio (SNR) conditions. Besides, two optimum threshold selection methods are introduced: TmCoG (using m % of the maximum intensity of spot as threshold), and TkCoG ( usingμn +κσ n as the threshold), μn and σn are the mean value and deviation of back noise. Firstly, their impact on the detection error under various SNR conditions is simulated respectively to find the way to decide the value of k or m. Then, a comparison between them is made. According to the simulation result, TmCoG is superior over TkCoG for the accuracy of selected threshold, and detection error is also lower.

An integrated use of topography with RSI in gully mapping, Shandong Peninsula, China.

PubMed

He, Fuhong; Wang, Tao; Gu, Lijuan; Li, Tao; Jiang, Weiguo; Shao, Hongbo

2014-01-01

Taking the Quickbird optical satellite imagery of the small watershed of Beiyanzigou valley of Qixia city, Shandong province, as the study data, we proposed a new method by using a fused image of topography with remote sensing imagery (RSI) to achieve a high precision interpretation of gully edge lines. The technique first transformed remote sensing imagery into HSV color space from RGB color space. Then the slope threshold values of gully edge line and gully thalweg were gained through field survey and the slope data were segmented using thresholding, respectively. Based on the fused image in combination with gully thalweg thresholding vectors, the gully thalweg thresholding vectors were amended. Lastly, the gully edge line might be interpreted based on the amended gully thalweg vectors, fused image, gully edge line thresholding vectors, and slope data. A testing region was selected in the study area to assess the accuracy. Then accuracy assessment of the gully information interpreted by both interpreting remote sensing imagery only and the fused image was performed using the deviation, kappa coefficient, and overall accuracy of error matrix. Compared with interpreting remote sensing imagery only, the overall accuracy and kappa coefficient are increased by 24.080% and 264.364%, respectively. The average deviations of gully head and gully edge line are reduced by 60.448% and 67.406%, respectively. The test results show the thematic and the positional accuracy of gully interpreted by new method are significantly higher. Finally, the error sources for interpretation accuracy by the two methods were analyzed.

An Integrated Use of Topography with RSI in Gully Mapping, Shandong Peninsula, China

PubMed Central

He, Fuhong; Wang, Tao; Gu, Lijuan; Li, Tao; Jiang, Weiguo; Shao, Hongbo

2014-01-01

Taking the Quickbird optical satellite imagery of the small watershed of Beiyanzigou valley of Qixia city, Shandong province, as the study data, we proposed a new method by using a fused image of topography with remote sensing imagery (RSI) to achieve a high precision interpretation of gully edge lines. The technique first transformed remote sensing imagery into HSV color space from RGB color space. Then the slope threshold values of gully edge line and gully thalweg were gained through field survey and the slope data were segmented using thresholding, respectively. Based on the fused image in combination with gully thalweg thresholding vectors, the gully thalweg thresholding vectors were amended. Lastly, the gully edge line might be interpreted based on the amended gully thalweg vectors, fused image, gully edge line thresholding vectors, and slope data. A testing region was selected in the study area to assess the accuracy. Then accuracy assessment of the gully information interpreted by both interpreting remote sensing imagery only and the fused image was performed using the deviation, kappa coefficient, and overall accuracy of error matrix. Compared with interpreting remote sensing imagery only, the overall accuracy and kappa coefficient are increased by 24.080% and 264.364%, respectively. The average deviations of gully head and gully edge line are reduced by 60.448% and 67.406%, respectively. The test results show the thematic and the positional accuracy of gully interpreted by new method are significantly higher. Finally, the error sources for interpretation accuracy by the two methods were analyzed. PMID:25302333

Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada.

PubMed

Liu, Ning; Vigod, Simone N; Farrugia, M Michèle; Urquia, Marcelo L; Ray, Joel G

2018-06-08

A woman's risk of venous thromboembolism during pregnancy is estimated to be two-to-six times higher than her risk when she is not pregnant. Such risk estimates are largely based on pregnancies that result in delivery of a newborn baby; no estimates exist for the risk of venous thromboembolism after induced abortion, another common pregnancy outcome. To fill this knowledge gap, we aimed to assess the risk of venous thromboembolism in women whose first pregnancy ended with induced abortion. We did this propensity score-matched cohort study using data from the universal health-care system of Ontario, Canada. We included primigravid women who had an induced abortion between Jan 1, 2003, and Dec 31, 2015, and used a propensity score to match them to primigravid women who had a livebirth (1:1) or nulligravid women who were not pregnant on the procedure date of their matched counterpart and who did not conceive within 1 year afterwards (5:1). We excluded from our analysis women younger than 15 years or older than 49 years and individuals who had missing or invalid information about their sex, area of residence, residential income, or world region of origin. The primary outcome was risk of any venous thromboembolism within 42 days of the index date (defined as the date of an induced abortion, delivery date for livebirth, or for non-pregnant women the induced abortion date of their matched counterpart). We compared the rate of venous thromboembolism in primigravid women who had an induced abortion with the rate of venous thromboembolism in propensity-score-matched non-pregnant women and propensity-score-matched primigravid women whose pregnancy ended with a livebirth. We generated hazard ratios (HRs) of 42-day risk of venous thromboembolism after induced abortion using Cox proportional hazard models. We identified 194 086 eligible women whose first pregnancy ended with induced abortion, of whom 176 001 (90·7%) could be matched with women whose first pregnancy ended in delivery of a newborn. These 176 001 women were also matched to 880 005 non-pregnant women. The rate of venous thromboembolism within 42 days of an induced abortion was 30·1 (95% CI 22·0-38·2) per 100 000 women compared with 13·5 (11·1-16·0) per 100 000 women in the non-pregnant group (HR 2·23, 95% CI 1·61-3·08). The HR was 0·16 (95% CI 0·12-0·22) when compared with the women in the livebirth cohort, whose venous thromboembolism rate within 42 days postpartum was 184·7 (95% CI 164·6-204·7) per 100 000 women. The 42-day risk of venous thromboembolism after an induced abortion is double that of a matched non-pregnant woman, and is significantly lower than after a livebirth. This novel information can inform estimates of peri-procedural risk of venous thromboembolism after induced abortion. Clinicians could consider a lower threshold for ordering a diagnostic test to rule out venous thromboembolism after induced abortion than they would in a non-pregnant woman. Institute for Clinical Evaluative Sciences. Copyright © 2018 Elsevier Ltd. All rights reserved.

A neural mechanism of speed-accuracy tradeoff in macaque area LIP

PubMed Central

Hanks, Timothy; Kiani, Roozbeh; Shadlen, Michael N

2014-01-01

Decision making often involves a tradeoff between speed and accuracy. Previous studies indicate that neural activity in the lateral intraparietal area (LIP) represents the gradual accumulation of evidence toward a threshold level, or evidence bound, which terminates the decision process. The level of this bound is hypothesized to mediate the speed-accuracy tradeoff. To test this, we recorded from LIP while monkeys performed a motion discrimination task in two speed-accuracy regimes. Surprisingly, the terminating threshold levels of neural activity were similar in both regimes. However, neurons recorded in the faster regime exhibited stronger evidence-independent activation from the beginning of decision formation, effectively reducing the evidence-dependent neural modulation needed for choice commitment. Our results suggest that control of speed vs accuracy may be exerted through changes in decision-related neural activity itself rather than through changes in the threshold applied to such neural activity to terminate a decision. DOI: http://dx.doi.org/10.7554/eLife.02260.001 PMID:24867216

Inhibition of Pre-Supplementary Motor Area by Continuous Theta Burst Stimulation Leads to More Cautious Decision-making and More Efficient Sensory Evidence Integration.

PubMed

Tosun, Tuğçe; Berkay, Dilara; Sack, Alexander T; Çakmak, Yusuf Ö; Balcı, Fuat

2017-08-01

Decisions are made based on the integration of available evidence. The noise in evidence accumulation leads to a particular speed-accuracy tradeoff in decision-making, which can be modulated and optimized by adaptive decision threshold setting. Given the effect of pre-SMA activity on striatal excitability, we hypothesized that the inhibition of pre-SMA would lead to higher decision thresholds and an increased accuracy bias. We used offline continuous theta burst stimulation to assess the effect of transient inhibition of the right pre-SMA on the decision processes in a free-response two-alternative forced-choice task within the drift diffusion model framework. Participants became more cautious and set higher decision thresholds following right pre-SMA inhibition compared with inhibition of the control site (vertex). Increased decision thresholds were accompanied by an accuracy bias with no effects on post-error choice behavior. Participants also exhibited higher drift rates as a result of pre-SMA inhibition compared with the vertex inhibition. These results, in line with the striatal theory of speed-accuracy tradeoff, provide evidence for the functional role of pre-SMA activity in decision threshold modulation. Our results also suggest that pre-SMA might be a part of the brain network associated with the sensory evidence integration.

Bayesian methods for estimating GEBVs of threshold traits

PubMed Central

Wang, C-L; Ding, X-D; Wang, J-Y; Liu, J-F; Fu, W-X; Zhang, Z; Yin, Z-J; Zhang, Q

2013-01-01

Estimation of genomic breeding values is the key step in genomic selection (GS). Many methods have been proposed for continuous traits, but methods for threshold traits are still scarce. Here we introduced threshold model to the framework of GS, and specifically, we extended the three Bayesian methods BayesA, BayesB and BayesCπ on the basis of threshold model for estimating genomic breeding values of threshold traits, and the extended methods are correspondingly termed BayesTA, BayesTB and BayesTCπ. Computing procedures of the three BayesT methods using Markov Chain Monte Carlo algorithm were derived. A simulation study was performed to investigate the benefit of the presented methods in accuracy with the genomic estimated breeding values (GEBVs) for threshold traits. Factors affecting the performance of the three BayesT methods were addressed. As expected, the three BayesT methods generally performed better than the corresponding normal Bayesian methods, in particular when the number of phenotypic categories was small. In the standard scenario (number of categories=2, incidence=30%, number of quantitative trait loci=50, h2=0.3), the accuracies were improved by 30.4%, 2.4%, and 5.7% points, respectively. In most scenarios, BayesTB and BayesTCπ generated similar accuracies and both performed better than BayesTA. In conclusion, our work proved that threshold model fits well for predicting GEBVs of threshold traits, and BayesTCπ is supposed to be the method of choice for GS of threshold traits. PMID:23149458

Effects of LiDAR point density, sampling size and height threshold on estimation accuracy of crop biophysical parameters.

PubMed

Luo, Shezhou; Chen, Jing M; Wang, Cheng; Xi, Xiaohuan; Zeng, Hongcheng; Peng, Dailiang; Li, Dong

2016-05-30

Vegetation leaf area index (LAI), height, and aboveground biomass are key biophysical parameters. Corn is an important and globally distributed crop, and reliable estimations of these parameters are essential for corn yield forecasting, health monitoring and ecosystem modeling. Light Detection and Ranging (LiDAR) is considered an effective technology for estimating vegetation biophysical parameters. However, the estimation accuracies of these parameters are affected by multiple factors. In this study, we first estimated corn LAI, height and biomass (R² = 0.80, 0.874 and 0.838, respectively) using the original LiDAR data (7.32 points/m²), and the results showed that LiDAR data could accurately estimate these biophysical parameters. Second, comprehensive research was conducted on the effects of LiDAR point density, sampling size and height threshold on the estimation accuracy of LAI, height and biomass. Our findings indicated that LiDAR point density had an important effect on the estimation accuracy for vegetation biophysical parameters, however, high point density did not always produce highly accurate estimates, and reduced point density could deliver reasonable estimation results. Furthermore, the results showed that sampling size and height threshold were additional key factors that affect the estimation accuracy of biophysical parameters. Therefore, the optimal sampling size and the height threshold should be determined to improve the estimation accuracy of biophysical parameters. Our results also implied that a higher LiDAR point density, larger sampling size and height threshold were required to obtain accurate corn LAI estimation when compared with height and biomass estimations. In general, our results provide valuable guidance for LiDAR data acquisition and estimation of vegetation biophysical parameters using LiDAR data.

Evaluation of the Space Shuttle Transatlantic Abort Landing Atmospheric Sounding System

NASA Technical Reports Server (NTRS)

Leahy, Frank B.

2003-01-01

A study was conducted to determine the quality of thermodynamic and wind data measured by or derived from the Transatlantic Abort Landing (TAL) Atmospheric Sounding System (TASS). The system has Global Positioning System (GPS) tracking capability and includes a helium-filled latex balloon that carries an instrument package (sonde) and various ground equipment that receives and processes the data from the sonde. TASS is used to provide vertical profiles of thermodynamic and low-resolution wind data in support of Shuttle abort landing operations at TAL sites. TASS uses GPS to determine height, wind speed, and wind direction. The TASS sonde has sensors that directly measure air temperature and relative humidity. These are then used to derive air pressure and density. Test flights were conducted where a TASS sonde and a reference sonde were attached to the same balloon and the two profiles were compared. The objective of the testing was to determine if TASS thermodynamic and wind data met Space Shuttle Program (SSP) accuracy requirements outlined in the Space Shuttle Launch and Landing Program Requirements Document (PRD).

Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity.

PubMed

Chen, Sam Li-Sheng; Hsu, Chen-Yang; Yen, Amy Ming-Fang; Young, Graeme P; Chiu, Sherry Yueh-Hsia; Fann, Jean Ching-Yuan; Lee, Yi-Chia; Chiu, Han-Mo; Chiou, Shu-Ti; Chen, Hsiu-Hsi

2018-06-01

Background: Despite age and sex differences in fecal hemoglobin (f-Hb) concentrations, most fecal immunochemical test (FIT) screening programs use population-average cut-points for test positivity. The impact of age/sex-specific threshold on FIT accuracy and colonoscopy demand for colorectal cancer screening are unknown. Methods: Using data from 723,113 participants enrolled in a Taiwanese population-based colorectal cancer screening with single FIT between 2004 and 2009, sensitivity and specificity were estimated for various f-Hb thresholds for test positivity. This included estimates based on a "universal" threshold, receiver-operating-characteristic curve-derived threshold, targeted sensitivity, targeted false-positive rate, and a colonoscopy-capacity-adjusted method integrating colonoscopy workload with and without age/sex adjustments. Results: Optimal age/sex-specific thresholds were found to be equal to or lower than the universal 20 μg Hb/g threshold. For older males, a higher threshold (24 μg Hb/g) was identified using a 5% false-positive rate. Importantly, a nonlinear relationship was observed between sensitivity and colonoscopy workload with workload rising disproportionately to sensitivity at 16 μg Hb/g. At this "colonoscopy-capacity-adjusted" threshold, the test positivity (colonoscopy workload) was 4.67% and sensitivity was 79.5%, compared with a lower 4.0% workload and a lower 78.7% sensitivity using 20 μg Hb/g. When constrained on capacity, age/sex-adjusted estimates were generally lower. However, optimizing age/-sex-adjusted thresholds increased colonoscopy demand across models by 17% or greater compared with a universal threshold. Conclusions: Age/sex-specific thresholds improve FIT accuracy with modest increases in colonoscopy demand. Impact: Colonoscopy-capacity-adjusted and age/sex-specific f-Hb thresholds may be useful in optimizing individual screening programs based on detection accuracy, population characteristics, and clinical capacity. Cancer Epidemiol Biomarkers Prev; 27(6); 704-9. ©2018 AACR . ©2018 American Association for Cancer Research.

CT image segmentation methods for bone used in medical additive manufacturing.

PubMed

van Eijnatten, Maureen; van Dijk, Roelof; Dobbe, Johannes; Streekstra, Geert; Koivisto, Juha; Wolff, Jan

2018-01-01

The accuracy of additive manufactured medical constructs is limited by errors introduced during image segmentation. The aim of this study was to review the existing literature on different image segmentation methods used in medical additive manufacturing. Thirty-two publications that reported on the accuracy of bone segmentation based on computed tomography images were identified using PubMed, ScienceDirect, Scopus, and Google Scholar. The advantages and disadvantages of the different segmentation methods used in these studies were evaluated and reported accuracies were compared. The spread between the reported accuracies was large (0.04 mm - 1.9 mm). Global thresholding was the most commonly used segmentation method with accuracies under 0.6 mm. The disadvantage of this method is the extensive manual post-processing required. Advanced thresholding methods could improve the accuracy to under 0.38 mm. However, such methods are currently not included in commercial software packages. Statistical shape model methods resulted in accuracies from 0.25 mm to 1.9 mm but are only suitable for anatomical structures with moderate anatomical variations. Thresholding remains the most widely used segmentation method in medical additive manufacturing. To improve the accuracy and reduce the costs of patient-specific additive manufactured constructs, more advanced segmentation methods are required. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Accurate aging of juvenile salmonids using fork lengths

USGS Publications Warehouse

Sethi, Suresh; Gerken, Jonathon; Ashline, Joshua

2017-01-01

Juvenile salmon life history strategies, survival, and habitat interactions may vary by age cohort. However, aging individual juvenile fish using scale reading is time consuming and can be error prone. Fork length data are routinely measured while sampling juvenile salmonids. We explore the performance of aging juvenile fish based solely on fork length data, using finite Gaussian mixture models to describe multimodal size distributions and estimate optimal age-discriminating length thresholds. Fork length-based ages are compared against a validation set of juvenile coho salmon, Oncorynchus kisutch, aged by scales. Results for juvenile coho salmon indicate greater than 95% accuracy can be achieved by aging fish using length thresholds estimated from mixture models. Highest accuracy is achieved when aged fish are compared to length thresholds generated from samples from the same drainage, time of year, and habitat type (lentic versus lotic), although relatively high aging accuracy can still be achieved when thresholds are extrapolated to fish from populations in different years or drainages. Fork length-based aging thresholds are applicable for taxa for which multiple age cohorts coexist sympatrically. Where applicable, the method of aging individual fish is relatively quick to implement and can avoid ager interpretation bias common in scale-based aging.

Self-dual random-plaquette gauge model and the quantum toric code

NASA Astrophysics Data System (ADS)

Takeda, Koujin; Nishimori, Hidetoshi

2004-05-01

We study the four-dimensional Z2 random-plaquette lattice gauge theory as a model of topological quantum memory, the toric code in particular. In this model, the procedure of quantum error correction works properly in the ordered (Higgs) phase, and phase boundary between the ordered (Higgs) and disordered (confinement) phases gives the accuracy threshold of error correction. Using self-duality of the model in conjunction with the replica method, we show that this model has exactly the same mathematical structure as that of the two-dimensional random-bond Ising model, which has been studied very extensively. This observation enables us to derive a conjecture on the exact location of the multicritical point (accuracy threshold) of the model, pc=0.889972…, and leads to several nontrivial results including bounds on the accuracy threshold in three dimensions.

Evolutionary stability of mutualism: interspecific population regulation as an evolutionarily stable strategy.

PubMed

Holland, J Nathaniel; DeAngelis, Donald L; Schultz, Stewart T

2004-09-07

Interspecific mutualisms are often vulnerable to instability because low benefit : cost ratios can rapidly lead to extinction or to the conversion of mutualism to parasite-host or predator-prey interactions. We hypothesize that the evolutionary stability of mutualism can depend on how benefits and costs to one mutualist vary with the population density of its partner, and that stability can be maintained if a mutualist can influence demographic rates and regulate the population density of its partner. We test this hypothesis in a model of mutualism with key features of senita cactus (Pachycereus schottii)-senita moth (Upiga virescens) interactions, in which benefits of pollination and costs of larval seed consumption to plant fitness depend on pollinator density. We show that plants can maximize their fitness by allocating resources to the production of excess flowers at the expense of fruit. Fruit abortion resulting from excess flower production reduces pre-adult survival of the pollinating seed-consumer, and maintains its density beneath a threshold that would destabilize the mutualism. Such a strategy of excess flower production and fruit abortion is convergent and evolutionarily stable against invasion by cheater plants that produce few flowers and abort few to no fruit. This novel mechanism of achieving evolutionarily stable mutualism, namely interspecific population regulation, is qualitatively different from other mechanisms invoking partner choice or selective rewards, and may be a general process that helps to preserve mutualistic interactions in nature.

Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation.

PubMed

Andersen, Kathryn; Fjerstad, Mary; Basnett, Indira; Neupane, Shailes; Acre, Valerie; Sharma, Sharad Kumar; Jackson, Emily

2017-01-01

To determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman's eligibility for medical abortion (MA) using a toolkit, compared to comprehensive abortion care (CAC) trained providers. We conducted a prospective diagnostic accuracy study in which women presenting for first trimester abortion, and FCHVs, independently assessed each woman's eligibility for MA using a modified gestational dating wheel to determine gestational age and a nine-point checklist of MA contraindications or cautions. Ability to determine MA eligibility was compared to experienced CAC-providers using Nepali standard of care. Both women (n = 3131) and FCHVs (n = 165) accurately interpreted the wheel 96% of the time, and the eligibility checklist 72% and 95% of the time, respectively. Of the 649 women who reported potential contraindications or cautions on the checklist, 88% misidentified as eligible. Positive predictive value (PPV) of women's assessment of eligibility based on gestational age was 93% (95% CI 92, 94) compared to CAC-providers' (n = 47); PPV of the medical contraindications checklist and overall (90% [95% CI 88, 91] and 93% [95% CI 92, 94] respectively) must be interpreted with caution given women's difficulty using the checklist. PPV of FCHVs' determinations were 93% (95% CI 92, 94), 90% (95% CI 89,91), and 93% (95% CI 91, 94) respectively. Although a promising strategy to assist women and FCHVs to assess MA eligibility, further refinement of the eligibility tools, particularly the checklist, is needed before their widespread use.

Accuracy of Rhenium-188 SPECT/CT activity quantification for applications in radionuclide therapy using clinical reconstruction methods.

PubMed

Esquinas, Pedro L; Uribe, Carlos F; Gonzalez, M; Rodríguez-Rodríguez, Cristina; Häfeli, Urs O; Celler, Anna

2017-07-20

The main applications of 188 Re in radionuclide therapies include trans-arterial liver radioembolization and palliation of painful bone-metastases. In order to optimize 188 Re therapies, the accurate determination of radiation dose delivered to tumors and organs at risk is required. Single photon emission computed tomography (SPECT) can be used to perform such dosimetry calculations. However, the accuracy of dosimetry estimates strongly depends on the accuracy of activity quantification in 188 Re images. In this study, we performed a series of phantom experiments aiming to investigate the accuracy of activity quantification for 188 Re SPECT using high-energy and medium-energy collimators. Objects of different shapes and sizes were scanned in Air, non-radioactive water (Cold-water) and water with activity (Hot-water). The ordered subset expectation maximization algorithm with clinically available corrections (CT-based attenuation, triple-energy window (TEW) scatter and resolution recovery was used). For high activities, the dead-time corrections were applied. The accuracy of activity quantification was evaluated using the ratio of the reconstructed activity in each object to this object's true activity. Each object's activity was determined with three segmentation methods: a 1% fixed threshold (for cold background), a 40% fixed threshold and a CT-based segmentation. Additionally, the activity recovered in the entire phantom, as well as the average activity concentration of the phantom background were compared to their true values. Finally, Monte-Carlo simulations of a commercial [Formula: see text]-camera were performed to investigate the accuracy of the TEW method. Good quantification accuracy (errors  <10%) was achieved for the entire phantom, the hot-background activity concentration and for objects in cold background segmented with a 1% threshold. However, the accuracy of activity quantification for objects segmented with 40% threshold or CT-based methods decreased (errors  >15%), mostly due to partial-volume effects. The Monte-Carlo simulations confirmed that TEW-scatter correction applied to 188 Re, although practical, yields only approximate estimates of the true scatter.

Source accuracy data reveal the thresholded nature of human episodic memory.

PubMed

Harlow, Iain M; Donaldson, David I

2013-04-01

Episodic recollection supports conscious retrieval of past events. It is unknown why recollected memories are often vivid, but at other times we struggle to remember. Such experiences might reflect a recollection threshold: Either the threshold is exceeded and information is retrieved, or recollection fails completely. Alternatively, retrieval failure could reflect weak memory: Recollection could behave as a continuous signal, always yielding some variable degree of information. Here we reconcile these views, using a novel source memory task that measures retrieval accuracy directly. We show that recollection is thresholded, such that retrieval sometimes simply fails. Our technique clarifies a fundamental property of memory and allows responses to be accurately measured, without recourse to subjective introspection. These findings raise new questions about how successful retrieval is determined and why it declines with age and disease.

Self-administered multi-level pregnancy tests in simplified follow-up of medical abortion in Tunisia.

PubMed

Dabash, Rasha; Shochet, Tara; Hajri, Selma; Chelli, Héla; Hassairi, Anne-Emmanuele; Haleb, Douha; Labassi, Hayet; Sfar, Ezzedine; Temimi, Fatma; Koenig, Leah; Winikoff, Beverly

2016-07-30

This study was conducted to assess the efficacy and acceptability of using a multi-level pregnancy test (MLPT) combined with telephone follow-up for medical abortion in Tunisia, where the majority of providers are midwives. Four hundred and four women with gestational age ≤ 70 days' LMP seeking medical abortion at six study sites were enrolled in this open-label trial. Participants administered a baseline MLPT at the clinic prior to mifepristone administration and were asked to take a second MLPT at home and to call in its results before returning the day of their scheduled follow-up visit 10-14 days later. Almost all women with follow-up (97.1 %, n = 332/342) had successful abortions without the need for surgical intervention. The MLPT worked extremely well among women ≤63 days' LMP in ruling out ongoing pregnancy (negative predictive value (NPV) =100 % (n = 298/298)) and also detecting women with ongoing pregnancies (sensitivity = 100 %; 2/2) as needing follow-up due to non-declining hCG. Among women 64-70 days' LMP, the test also worked well in ruling out ongoing pregnancy (NPV = 96.9 % (n = 31/32) but not as well in terms of sensitivity (50 %), with only one of two ongoing pregnancies detected by MLPT as needing follow-up. Most women (95.1 %) found the MLPT to be very easy or easy to use and would consider using the MLPT again (97.4 %) if needed. Self-administered pre and post MLPT are very easy for women to use and accurate in assessing medical abortion success up to 63 days' LMP. MLPT use for medical abortion follow-up has the potential to facilitate task sharing services and eliminate the burden of routine in-person follow-up visits for the large majority of women. Additional research is warranted to explore the accuracy of the MLPT in identifying ongoing pregnancy among women with gestational ages > 63 days. This study was registered on May 13, 2010, on clinicaltrials.gov as NCT01150279 .

Refining the Value of Secretory Phospholipase A2 as a Predictor of Acute Chest Syndrome in Sickle Cell Disease: Results of a Feasibility Study (PROACTIVE)

PubMed Central

Styles, Lori; Wager, Carrie G.; Labotka, Richard J.; Smith-Whitley, Kim; Thompson, Alexis A.; Lane, Peter A.; McMahon, Lillian E.C; Miller, Robin; Roseff, Susan; Iyer, Rathi; Hsu, Lewis L.; Castro, Oswaldo; Ataga, Kenneth; Onyekwere, Onyinye; Okam, Maureen; Bellevue, Rita; Miller, Scott T.

2012-01-01

Acute chest syndrome (ACS) is defined as fever, respiratory symptoms and a new pulmonary infiltrate in an individual with sickle cell disease (SCD). Nearly half of ACS episodes occur in SCD patients already hospitalized, potentially permitting pre-emptive therapy in high-risk patients. Simple transfusion of red blood cells may abort ACS if given to patients hospitalized for pain who develop fever and elevated levels of secretory phospholipase A2 (sPLA2). In a feasibility study (PROACTIVE; ClinicalTrials.gov NCT00951808), patients hospitalized for pain who developed fever and elevated sPLA2 were eligible for randomization to transfusion or observation; all others were enrolled in an observational arm. Of 237 enrolled, only 10 were randomized; one of the four to receive transfusion had delayed treatment. Of 233 subjects receiving standard care, 22 developed ACS. A threshold level of sPLA2 ≥ 48 ng/ml gave optimal sensitivity (73%), specificity (71%) and accuracy (71%), but a positive predictive value of only 24%. The predictive value of sPLA2 was improved in adults and patients with chest or back pain, lower haemoglobin concentration and higher white blood cell counts; and those receiving less than two-thirds maintenance fluids. The hurdles identified in PROACTIVE should facilitate design of a larger, definitive, phase 3 randomized controlled trial. PMID:22463614

A generalized methodology for identification of threshold for HRU delineation in SWAT model

NASA Astrophysics Data System (ADS)

M, J.; Sudheer, K.; Chaubey, I.; Raj, C.

2016-12-01

The distributed hydrological model, Soil and Water Assessment Tool (SWAT) is a comprehensive hydrologic model widely used for making various decisions. The simulation accuracy of the distributed hydrological model differs due to the mechanism involved in the subdivision of the watershed. Soil and Water Assessment Tool (SWAT) considers sub-dividing the watershed and the sub-basins into small computing units known as 'hydrologic response units (HRU). The delineation of HRU is done based on unique combinations of land use, soil types, and slope within the sub-watersheds, which are not spatially defined. The computations in SWAT are done at HRU level and are then aggregated up to the sub-basin outlet, which is routed through the stream system. Generally, the HRUs are delineated by considering a threshold percentage of land use, soil and slope are to be given by the modeler to decrease the computation time of the model. The thresholds constrain the minimum area for constructing an HRU. In the current HRU delineation practice in SWAT, the land use, soil and slope of the watershed within a sub-basin, which is less than the predefined threshold, will be surpassed by the dominating land use, soil and slope, and introduce some level of ambiguity in the process simulations in terms of inappropriate representation of the area. But the loss of information due to variation in the threshold values depends highly on the purpose of the study. Therefore this research studies the effects of threshold values of HRU delineation on the hydrological modeling of SWAT on sediment simulations and suggests guidelines for selecting the appropriate threshold values considering the sediment simulation accuracy. The preliminary study was done on Illinois watershed by assigning different thresholds for land use and soil. A general methodology was proposed for identifying an appropriate threshold for HRU delineation in SWAT model that considered computational time and accuracy of the simulation. The methodology can be adopted for identifying an appropriate threshold for SWAT model simulation in any watershed with a single simulation of the model with a zero-zero threshold.

A community detection algorithm based on structural similarity

NASA Astrophysics Data System (ADS)

Guo, Xuchao; Hao, Xia; Liu, Yaqiong; Zhang, Li; Wang, Lu

2017-09-01

In order to further improve the efficiency and accuracy of community detection algorithm, a new algorithm named SSTCA (the community detection algorithm based on structural similarity with threshold) is proposed. In this algorithm, the structural similarities are taken as the weights of edges, and the threshold k is considered to remove multiple edges whose weights are less than the threshold, and improve the computational efficiency. Tests were done on the Zachary’s network, Dolphins’ social network and Football dataset by the proposed algorithm, and compared with GN and SSNCA algorithm. The results show that the new algorithm is superior to other algorithms in accuracy for the dense networks and the operating efficiency is improved obviously.

The evolution of altruism in spatial threshold public goods games via an insurance mechanism

NASA Astrophysics Data System (ADS)

Zhang, Jianlei; Zhang, Chunyan

2015-05-01

The persistence of cooperation in public goods situations has become an important puzzle for researchers. This paper considers the threshold public goods games where the option of insurance is provided for players from the standpoint of diversification of risk, envisaging the possibility of multiple strategies in such scenarios. In this setting, the provision point is defined in terms of the minimum number of contributors in one threshold public goods game, below which the game fails. In the presence of risk and insurance, more contributions are motivated if (1) only cooperators can opt to be insured and thus their contribution loss in the aborted games can be (partly or full) covered by the insurance; (2) insured cooperators obtain larger compensation, at lower values of the threshold point (the required minimum number of contributors). Moreover, results suggest the dominance of insured defectors who get a better promotion by more profitable benefits from insurance. We provide results of extensive computer simulations in the realm of spatial games (random regular networks and scale-free networks here), and support this study with analytical results for well-mixed populations. Our study is expected to establish a causal link between the widespread altruistic behaviors and the existing insurance system.

The afterlife of embryonic persons: what a strange place heaven must be.

PubMed

Murphy, Timothy F

2012-12-01

Some commentators argue that conception constitutes the onset of human personhood in a metaphysical sense. This threshold is usually invoked as the basis both for protecting zygotes and embryos from exposure to risks of death in clinical research and fertility medicine and for objecting to abortion, but it also has consequences for certain religious perspectives, including Catholicism whose doctrines directly engage questions of personhood and its meanings. Since more human zygotes and embryos are lost than survive to birth, conferral of personhood on them would mean - for those believing in personal immortality - that these persons constitute the majority of people living immortally despite having had only the shortest of earthly lives. For those believing in resurrection, zygotes and embryos would also be restored to physical lives. These outcomes do not mean that conception cannot function as a metaphysical threshold of personhood, but this interpretation carries costs that others do not. For example, treating conception as a moral threshold of respect for human life in general, rather than as a metaphysical threshold of personhood, would obviate the prospect of the afterlife being populated in the main by persons who have never lived more than a few hours or days. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

PubMed Central

Fjerstad, Mary; Basnett, Indira; Neupane, Shailes; Acre, Valerie; Sharma, Sharad Kumar; Jackson, Emily

2017-01-01

Objective To determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman’s eligibility for medical abortion (MA) using a toolkit, compared to comprehensive abortion care (CAC) trained providers. Study design We conducted a prospective diagnostic accuracy study in which women presenting for first trimester abortion, and FCHVs, independently assessed each woman’s eligibility for MA using a modified gestational dating wheel to determine gestational age and a nine-point checklist of MA contraindications or cautions. Ability to determine MA eligibility was compared to experienced CAC-providers using Nepali standard of care. Results Both women (n = 3131) and FCHVs (n = 165) accurately interpreted the wheel 96% of the time, and the eligibility checklist 72% and 95% of the time, respectively. Of the 649 women who reported potential contraindications or cautions on the checklist, 88% misidentified as eligible. Positive predictive value (PPV) of women’s assessment of eligibility based on gestational age was 93% (95% CI 92, 94) compared to CAC-providers’ (n = 47); PPV of the medical contraindications checklist and overall (90% [95% CI 88, 91] and 93% [95% CI 92, 94] respectively) must be interpreted with caution given women’s difficulty using the checklist. PPV of FCHVs’ determinations were 93% (95% CI 92, 94), 90% (95% CI 89,91), and 93% (95% CI 91, 94) respectively. Conclusion Although a promising strategy to assist women and FCHVs to assess MA eligibility, further refinement of the eligibility tools, particularly the checklist, is needed before their widespread use. PMID:28880926

Meta‐analysis of test accuracy studies using imputation for partial reporting of multiple thresholds

PubMed Central

Deeks, J.J.; Martin, E.C.; Riley, R.D.

2017-01-01

Introduction For tests reporting continuous results, primary studies usually provide test performance at multiple but often different thresholds. This creates missing data when performing a meta‐analysis at each threshold. A standard meta‐analysis (no imputation [NI]) ignores such missing data. A single imputation (SI) approach was recently proposed to recover missing threshold results. Here, we propose a new method that performs multiple imputation of the missing threshold results using discrete combinations (MIDC). Methods The new MIDC method imputes missing threshold results by randomly selecting from the set of all possible discrete combinations which lie between the results for 2 known bounding thresholds. Imputed and observed results are then synthesised at each threshold. This is repeated multiple times, and the multiple pooled results at each threshold are combined using Rubin's rules to give final estimates. We compared the NI, SI, and MIDC approaches via simulation. Results Both imputation methods outperform the NI method in simulations. There was generally little difference in the SI and MIDC methods, but the latter was noticeably better in terms of estimating the between‐study variances and generally gave better coverage, due to slightly larger standard errors of pooled estimates. Given selective reporting of thresholds, the imputation methods also reduced bias in the summary receiver operating characteristic curve. Simulations demonstrate the imputation methods rely on an equal threshold spacing assumption. A real example is presented. Conclusions The SI and, in particular, MIDC methods can be used to examine the impact of missing threshold results in meta‐analysis of test accuracy studies. PMID:29052347

Evolutionary stability of mutualism: interspecific population regulation as an evolutionarily stable strategy

USGS Publications Warehouse

Holland, J. Nathaniel; DeAngelis, Donald L.; Schultz, Stewart T.

2004-01-01

Interspecific mutualisms are often vulnerable to instability because low benefit : cost ratios can rapidly lead to extinction or to the conversion of mutualism to parasite–host or predator–prey interactions. We hypothesize that the evolutionary stability of mutualism can depend on how benefits and costs to one mutualist vary with the population density of its partner, and that stability can be maintained if a mutualist can influence demographic rates and regulate the population density of its partner. We test this hypothesis in a model of mutualism with key features of senita cactus (Pachycereus schottii) – senita moth (Upiga virescens) interactions, in which benefits of pollination and costs of larval seed consumption to plant fitness depend on pollinator density. We show that plants can maximize their fitness by allocating resources to the production of excess flowers at the expense of fruit. Fruit abortion resulting from excess flower production reduces pre–adult survival of the pollinating seed–consumer, and maintains its density beneath a threshold that would destabilize the mutualism. Such a strategy of excess flower production and fruit abortion is convergent and evolutionarily stable against invasion by cheater plants that produce few flowers and abort few to no fruit. This novel mechanism of achieving evolutionarily stable mutualism, namely interspecific population regulation, is qualitatively different from other mechanisms invoking partner choice or selective rewards, and may be a general process that helps to preserve mutualistic interactions in nature.

Balanced levels of nerve growth factor are required for normal pregnancy progression.

PubMed

Frank, Pierre; Barrientos, Gabriela; Tirado-González, Irene; Cohen, Marie; Moschansky, Petra; Peters, Eva M; Klapp, Burghard F; Rose, Matthias; Tometten, Mareike; Blois, Sandra M

2014-08-01

Nerve growth factor (NGF), the first identified member of the family of neurotrophins, is thought to play a critical role in the initiation of the decidual response in stress-challenged pregnant mice. However, the contribution of this pathway to physiological events during the establishment and maintenance of pregnancy remains largely elusive. Using NGF depletion and supplementation strategies alternatively, in this study, we demonstrated that a successful pregnancy is sensitive to disturbances in NGF levels in mice. Treatment with NGF further boosted fetal loss rates in the high-abortion rate CBA/J x DBA/2J mouse model by amplifying a local inflammatory response through recruitment of NGF-expressing immune cells, increased decidual innervation with substance P(+) nerve fibres and a Th1 cytokine shift. Similarly, treatment with a NGF-neutralising antibody in BALB/c-mated CBA/J mice, a normal-pregnancy model, also induced abortions associated with increased infiltration of tropomyosin kinase receptor A-expressing NK cells to the decidua. Importantly, in neither of the models, pregnancy loss was associated with defective ovarian function, angiogenesis or placental development. We further demonstrated that spontaneous abortion in humans is associated with up-regulated synthesis and an aberrant distribution of NGF in placental tissue. Thus, a local threshold of NGF expression seems to be necessary to ensure maternal tolerance in healthy pregnancies, but when surpassed may result in fetal rejection due to exacerbated inflammation. © 2014 Society for Reproduction and Fertility.

LCAMP: Location Constrained Approximate Message Passing for Compressed Sensing MRI

PubMed Central

Sung, Kyunghyun; Daniel, Bruce L; Hargreaves, Brian A

2016-01-01

Iterative thresholding methods have been extensively studied as faster alternatives to convex optimization methods for solving large-sized problems in compressed sensing. A novel iterative thresholding method called LCAMP (Location Constrained Approximate Message Passing) is presented for reducing computational complexity and improving reconstruction accuracy when a nonzero location (or sparse support) constraint can be obtained from view shared images. LCAMP modifies the existing approximate message passing algorithm by replacing the thresholding stage with a location constraint, which avoids adjusting regularization parameters or thresholding levels. This work is first compared with other conventional reconstruction methods using random 1D signals and then applied to dynamic contrast-enhanced breast MRI to demonstrate the excellent reconstruction accuracy (less than 2% absolute difference) and low computation time (5 - 10 seconds using Matlab) with highly undersampled 3D data (244 × 128 × 48; overall reduction factor = 10). PMID:23042658

Comparison of the diagnostic accuracy, sensitivity and specificity of four odontological methods for age evaluation in Italian children at the age threshold of 14 years using ROC curves.

PubMed

Pinchi, Vilma; Pradella, Francesco; Vitale, Giulia; Rugo, Dario; Nieri, Michele; Norelli, Gian-Aristide

2016-01-01

The age threshold of 14 years is relevant in Italy as the minimum age for criminal responsibility. It is of utmost importance to evaluate the diagnostic accuracy of every odontological method for age evaluation considering the sensitivity, or the ability to estimate the true positive cases, and the specificity, or the ability to estimate the true negative cases. The research aims to compare the specificity and sensitivity of four commonly adopted methods of dental age estimation - Demirjian, Haavikko, Willems and Cameriere - in a sample of Italian children aged between 11 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). In addition, new decision criteria are developed to increase the accuracy of the methods. Among the four odontological methods for age estimation adopted in the research, the Cameriere method showed the highest AUC in both female and male cohorts. The Cameriere method shows a high degree of accuracy at the age threshold of 14 years. To adopt the Cameriere method to estimate the 14-year age threshold more accurately, however, it is suggested - according to the Youden index - that the decision criterion be set at the lower value of 12.928 for females and 13.258 years for males, obtaining a sensitivity of 85% and specificity of 88% in females, and a sensitivity of 77% and specificity of 92% in males. If a specificity level >90% is needed, the cut-off point should be set at 12.959 years (82% sensitivity) for females. © The Author(s) 2015.

Speed accuracy trade-off under response deadlines

PubMed Central

Karşılar, Hakan; Simen, Patrick; Papadakis, Samantha; Balcı, Fuat

2014-01-01

Perceptual decision making has been successfully modeled as a process of evidence accumulation up to a threshold. In order to maximize the rewards earned for correct responses in tasks with response deadlines, participants should collapse decision thresholds dynamically during each trial so that a decision is reached before the deadline. This strategy ensures on-time responding, though at the cost of reduced accuracy, since slower decisions are based on lower thresholds and less net evidence later in a trial (compared to a constant threshold). Frazier and Yu (2008) showed that the normative rate of threshold reduction depends on deadline delays and on participants' uncertainty about these delays. Participants should start collapsing decision thresholds earlier when making decisions under shorter deadlines (for a given level of timing uncertainty) or when timing uncertainty is higher (for a given deadline). We tested these predictions using human participants in a random dot motion discrimination task. Each participant was tested in free-response, short deadline (800 ms), and long deadline conditions (1000 ms). Contrary to optimal-performance predictions, the resulting empirical function relating accuracy to response time (RT) in deadline conditions did not decline to chance level near the deadline; nor did the slight decline we typically observed relate to measures of endogenous timing uncertainty. Further, although this function did decline slightly with increasing RT, the decline was explainable by the best-fitting parameterization of Ratcliff's diffusion model (Ratcliff, 1978), whose parameters are constant within trials. Our findings suggest that at the very least, typical decision durations are too short for participants to adapt decision parameters within trials. PMID:25177265

Meta-analysis of diagnostic accuracy studies in mental health

PubMed Central

Takwoingi, Yemisi; Riley, Richard D; Deeks, Jonathan J

2015-01-01

Objectives To explain methods for data synthesis of evidence from diagnostic test accuracy (DTA) studies, and to illustrate different types of analyses that may be performed in a DTA systematic review. Methods We described properties of meta-analytic methods for quantitative synthesis of evidence. We used a DTA review comparing the accuracy of three screening questionnaires for bipolar disorder to illustrate application of the methods for each type of analysis. Results The discriminatory ability of a test is commonly expressed in terms of sensitivity (proportion of those with the condition who test positive) and specificity (proportion of those without the condition who test negative). There is a trade-off between sensitivity and specificity, as an increasing threshold for defining test positivity will decrease sensitivity and increase specificity. Methods recommended for meta-analysis of DTA studies --such as the bivariate or hierarchical summary receiver operating characteristic (HSROC) model --jointly summarise sensitivity and specificity while taking into account this threshold effect, as well as allowing for between study differences in test performance beyond what would be expected by chance. The bivariate model focuses on estimation of a summary sensitivity and specificity at a common threshold while the HSROC model focuses on the estimation of a summary curve from studies that have used different thresholds. Conclusions Meta-analyses of diagnostic accuracy studies can provide answers to important clinical questions. We hope this article will provide clinicians with sufficient understanding of the terminology and methods to aid interpretation of systematic reviews and facilitate better patient care. PMID:26446042

Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making.

PubMed

Owen, Rhiannon K; Cooper, Nicola J; Quinn, Terence J; Lees, Rosalind; Sutton, Alex J

2018-07-01

Network meta-analyses (NMA) have extensively been used to compare the effectiveness of multiple interventions for health care policy and decision-making. However, methods for evaluating the performance of multiple diagnostic tests are less established. In a decision-making context, we are often interested in comparing and ranking the performance of multiple diagnostic tests, at varying levels of test thresholds, in one simultaneous analysis. Motivated by an example of cognitive impairment diagnosis following stroke, we synthesized data from 13 studies assessing the efficiency of two diagnostic tests: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), at two test thresholds: MMSE <25/30 and <27/30, and MoCA <22/30 and <26/30. Using Markov chain Monte Carlo (MCMC) methods, we fitted a bivariate network meta-analysis model incorporating constraints on increasing test threshold, and accounting for the correlations between multiple test accuracy measures from the same study. We developed and successfully fitted a model comparing multiple tests/threshold combinations while imposing threshold constraints. Using this model, we found that MoCA at threshold <26/30 appeared to have the best true positive rate, whereas MMSE at threshold <25/30 appeared to have the best true negative rate. The combined analysis of multiple tests at multiple thresholds allowed for more rigorous comparisons between competing diagnostics tests for decision making. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Inferring pregnancy episodes and outcomes within a network of observational databases

PubMed Central

Ryan, Patrick; Fife, Daniel; Gifkins, Dina; Knoll, Chris; Friedman, Andrew

2018-01-01

Administrative claims and electronic health records are valuable resources for evaluating pharmaceutical effects during pregnancy. However, direct measures of gestational age are generally not available. Establishing a reliable approach to infer the duration and outcome of a pregnancy could improve pharmacovigilance activities. We developed and applied an algorithm to define pregnancy episodes in four observational databases: three US-based claims databases: Truven MarketScan® Commercial Claims and Encounters (CCAE), Truven MarketScan® Multi-state Medicaid (MDCD), and the Optum ClinFormatics® (Optum) database and one non-US database, the United Kingdom (UK) based Clinical Practice Research Datalink (CPRD). Pregnancy outcomes were classified as live births, stillbirths, abortions and ectopic pregnancies. Start dates were estimated using a derived hierarchy of available pregnancy markers, including records such as last menstrual period and nuchal ultrasound dates. Validation included clinical adjudication of 700 electronic Optum and CPRD pregnancy episode profiles to assess the operating characteristics of the algorithm, and a comparison of the algorithm’s Optum pregnancy start estimates to starts based on dates of assisted conception procedures. Distributions of pregnancy outcome types were similar across all four data sources and pregnancy episode lengths found were as expected for all outcomes, excepting term lengths in episodes that used amenorrhea and urine pregnancy tests for start estimation. Validation survey results found highest agreement between reviewer chosen and algorithm operating characteristics for questions assessing pregnancy status and accuracy of outcome category with 99–100% agreement for Optum and CPRD. Outcome date agreement within seven days in either direction ranged from 95–100%, while start date agreement within seven days in either direction ranged from 90–97%. In Optum validation sensitivity analysis, a total of 73% of algorithm estimated starts for live births were in agreement with fertility procedure estimated starts within two weeks in either direction; ectopic pregnancy 77%, stillbirth 47%, and abortion 36%. An algorithm to infer live birth and ectopic pregnancy episodes and outcomes can be applied to multiple observational databases with acceptable accuracy for further epidemiologic research. Less accuracy was found for start date estimations in stillbirth and abortion outcomes in our sensitivity analysis, which may be expected given the nature of the outcomes. PMID:29389968

20 CFR 404.1670 - General.

Code of Federal Regulations, 2010 CFR

2010-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950... three established threshold levels, one being performance accuracy, for two consecutive quarters, and... period. During this 3-month period we will not require the State agency to meet the threshold levels...

20 CFR 416.1070 - General.

Code of Federal Regulations, 2010 CFR

2010-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED... three established threshold levels, one being performance accuracy, for two consecutive quarters, and... period. During this 3-month period we will not require the State agency to meet the threshold levels...

Education-Adjusted Normality Thresholds for FDG-PET in the Diagnosis of Alzheimer Disease.

PubMed

Mainta, Ismini C; Trombella, Sara; Morbelli, Silvia; Frisoni, Giovanni B; Garibotto, Valentina

2018-06-05

A corollary of the reserve hypothesis is that what is regarded as pathological cortical metabolism in patients might vary according to education. The aim of this study is to assess the incremental diagnostic value of education-adjusted over unadjusted thresholds on the diagnostic accuracy of FDG-PET as a biomarker for Alzheimer disease (AD). We compared cortical metabolism in 90 healthy controls and 181 AD patients from the Alzheimer Disease Neuroimaging Initiative (ADNI) database. The AUC of the ROC curve did not differ significantly between the whole group and the higher-education patients or the lower-education subjects. The threshold of wMetaROI values providing 80% sensitivity was lower in higher-education patients and higher in the lower-education patients, compared to the standard threshold derived over the whole AD collective, without, however, significant changes in sensitivity and specificity. These data show that education, as a proxy of reserve, is not a major confounder in the diagnostic accuracy of FDG-PET in AD and the adoption of education-adjusted thresholds is not required in daily practice. © 2018 S. Karger AG, Basel.

76 FR 67315 - Supplemental Nutrition Assistance Program: Quality Control Error Tolerance Threshold

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

...This direct final rule is amending the Quality Control (QC) review error threshold in our regulations from $25.00 to $50.00. The purpose for raising the QC error threshold is to make permanent the temporary threshold change that was required by the American Recovery and Reinvestment Act of 2008. This change does not have an impact on the public. The QC system measures the accuracy of the eligibility system for the Supplemental Nutrition Assistance Program (SNAP).

Surface Landing Site Weather Analysis for Constellation Program

NASA Technical Reports Server (NTRS)

Altino, Karen M.; Burns, K. Lee

2008-01-01

Weather information is an important asset for NASA's Constellation Program in developing the next generation space transportation system to fly to the International Space Station, the Moon and, eventually, to Mars. Weather conditions can affect vehicle safety and performance during multiple mission phases ranging from pre-launch ground processing to landing and recovery operations, including all potential abort scenarios. Meteorological analysis is an important contributor, not only to the development and verification of system design requirements but also to mission planning and active ground operations. Of particular interest are the surface atmospheric conditions at both nominal and abort landing sites for the manned Orion capsule. Weather parameters such as wind, rain, and fog all play critical roles in the safe landing of the vehicle and subsequent crew and vehicle recovery. The Marshall Space Flight Center Natural Environments Branch has been tasked by the Constellation Program with defining the natural environments at potential landing zones. Climatological time series of operational surface weather observations are used to calculate probabilities of occurrence of various sets of hypothetical vehicle constraint thresholds, Data are available for numerous geographical locations such that statistical analysis can be performed for single sites as well as multiple-site network configurations. Results provide statistical descriptions of how often certain weather conditions are observed at the site(s) and the percentage that specified criteria thresholds are matched or exceeded. Outputs are tabulated by month and hour of day to show both seasonal and diurnal variation. This paper will describe the methodology used for data collection and quality control, detail the types of analyses performed, and provide a sample of the results that can be obtained,

Correcting Velocity Dispersions of Dwarf Spheroidal Galaxies for Binary Orbital Motion

NASA Astrophysics Data System (ADS)

Minor, Quinn E.; Martinez, Greg; Bullock, James; Kaplinghat, Manoj; Trainor, Ryan

2010-10-01

We show that the measured velocity dispersions of dwarf spheroidal galaxies from about 4 to 10 km s-1 are unlikely to be inflated by more than 30% due to the orbital motion of binary stars and demonstrate that the intrinsic velocity dispersions can be determined to within a few percent accuracy using two-epoch observations with 1-2 yr as the optimal time interval. The crucial observable is the threshold fraction—the fraction of stars that show velocity changes larger than a given threshold between measurements. The threshold fraction is tightly correlated with the dispersion introduced by binaries, independent of the underlying binary fraction and distribution of orbital parameters. We outline a simple procedure to correct the velocity dispersion to within a few percent accuracy by using the threshold fraction and provide fitting functions for this method. We also develop a methodology for constraining properties of binary populations from both single- and two-epoch velocity measurements by including the binary velocity distribution in a Bayesian analysis.

Nonlinear time series modeling and forecasting the seismic data of the Hindu Kush region

NASA Astrophysics Data System (ADS)

Khan, Muhammad Yousaf; Mittnik, Stefan

2018-01-01

In this study, we extended the application of linear and nonlinear time models in the field of earthquake seismology and examined the out-of-sample forecast accuracy of linear Autoregressive (AR), Autoregressive Conditional Duration (ACD), Self-Exciting Threshold Autoregressive (SETAR), Threshold Autoregressive (TAR), Logistic Smooth Transition Autoregressive (LSTAR), Additive Autoregressive (AAR), and Artificial Neural Network (ANN) models for seismic data of the Hindu Kush region. We also extended the previous studies by using Vector Autoregressive (VAR) and Threshold Vector Autoregressive (TVAR) models and compared their forecasting accuracy with linear AR model. Unlike previous studies that typically consider the threshold model specifications by using internal threshold variable, we specified these models with external transition variables and compared their out-of-sample forecasting performance with the linear benchmark AR model. The modeling results show that time series models used in the present study are capable of capturing the dynamic structure present in the seismic data. The point forecast results indicate that the AR model generally outperforms the nonlinear models. However, in some cases, threshold models with external threshold variables specification produce more accurate forecasts, indicating that specification of threshold time series models is of crucial importance. For raw seismic data, the ACD model does not show an improved out-of-sample forecasting performance over the linear AR model. The results indicate that the AR model is the best forecasting device to model and forecast the raw seismic data of the Hindu Kush region.

Cluster-based analysis improves predictive validity of spike-triggered receptive field estimates

PubMed Central

Malone, Brian J.

2017-01-01

Spectrotemporal receptive field (STRF) characterization is a central goal of auditory physiology. STRFs are often approximated by the spike-triggered average (STA), which reflects the average stimulus preceding a spike. In many cases, the raw STA is subjected to a threshold defined by gain values expected by chance. However, such correction methods have not been universally adopted, and the consequences of specific gain-thresholding approaches have not been investigated systematically. Here, we evaluate two classes of statistical correction techniques, using the resulting STRF estimates to predict responses to a novel validation stimulus. The first, more traditional technique eliminated STRF pixels (time-frequency bins) with gain values expected by chance. This correction method yielded significant increases in prediction accuracy, including when the threshold setting was optimized for each unit. The second technique was a two-step thresholding procedure wherein clusters of contiguous pixels surviving an initial gain threshold were then subjected to a cluster mass threshold based on summed pixel values. This approach significantly improved upon even the best gain-thresholding techniques. Additional analyses suggested that allowing threshold settings to vary independently for excitatory and inhibitory subfields of the STRF resulted in only marginal additional gains, at best. In summary, augmenting reverse correlation techniques with principled statistical correction choices increased prediction accuracy by over 80% for multi-unit STRFs and by over 40% for single-unit STRFs, furthering the interpretational relevance of the recovered spectrotemporal filters for auditory systems analysis. PMID:28877194

Misperceptions about the risks of abortion in women presenting for abortion.

PubMed

Wiebe, Ellen R; Littman, Lisa; Kaczorowski, Janusz; Moshier, Erin L

2014-03-01

Misinformation about the risks and sequelae of abortion is widespread. The purpose of this study was to examine whether women having an abortion who believe that there should be restrictions to abortion (i.e., that some other women should not be allowed to have an abortion) also believe this misinformation about the health risks associated with abortion. We carried out a cross-sectional survey of women presenting consecutively for an abortion at an urban abortion clinic in Vancouver, British Columbia, between February and September 2012. Of 1008 women presenting for abortion, 978 completed questionnaires (97% response rate), and 333 of these (34%) favoured abortion restrictions. More women who favoured restrictions believed that the health risk of an abortion was the same as or greater than the health risk of childbirth (84.2% vs. 65.6%, P < 0.001), that abortion caused mental health problems (39.1% vs. 28.3%, P < 0.001), and that abortion caused infertility (41.7% vs. 21.9%, P < 0.001). Using multivariate logistic regression analyses, believing that abortion should not be restricted was found to be a significantly correlated with correct answers about health risks, mental health problems, and infertility. Misinformed beliefs about the risks of abortion are common among women having an abortion. Women presenting for abortion who favoured restrictions to abortion have more misperceptions about abortion risks than women who favour no restrictions.

Abortion surveillance - United States, 2007.

PubMed

Pazol, Karen; Zane, Suzanne; Parker, Wilda Y; Hall, Laura R; Gamble, Sonya B; Hamdan, Saeed; Berg, Cynthia; Cook, Douglas A

2011-02-25

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2007. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2007, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during the preceding decade (1998-2007). Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. A total of 827,609 abortions were reported to CDC for 2007. Among the 45 reporting areas that provided data every year during 1998-2007, a total of 810,582 abortions (97.9% of the total) were reported for 2007; the abortion rate was 16.0 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 231 abortions per 1,000 live births. Compared with 2006, the total number and rate of reported abortions decreased 2%, and the abortion ratio decreased 3%. Reported abortion numbers, rates, and ratios were 6%, 7%, and 14% lower, respectively, in 2007 than in 1998. Women aged 20-29 years accounted for 56.9% of all abortions in 2007 and for the majority of abortions during the entire period of analysis (1998-2007). In 2007, women aged 20-29 years also had the highest abortion rates (29.4 abortions per 1,000 women aged 20-24 years and 21.4 abortions per 1,000 women aged 25-29 years). Adolescents aged 15-19 years accounted for 16.5% of all abortions in 2007 and had an abortion rate of 14.5 abortions per 1,000 adolescents aged 15-19 years; women aged ≥35 years accounted for a smaller percentage (12.0%) of abortions and had lower abortion rates (7.7 abortions per 1,000 women aged 35-39 years and 2.6 abortions per 1,000 women aged ≥40 years). During 1998-2007, the abortion rate increased among women aged ≥35 years but decreased among adolescents aged ≤19 years and among women aged 20-29 years. In contrast to the percentage distribution of abortions and abortion rates, abortion ratios were highest at the extremes of reproductive age, both in 2007 and throughout the entire period of analysis. During 1998-2007 abortion ratios decreased among women in all age groups except for those aged <15 years. In 2007, most (62.3%) abortions were performed at ≤8 weeks' gestation, and 91.5% were performed at ≤13 weeks' gestation. Few abortions (7.2%) were performed at 14-20 weeks' gestation, and 1.3% were performed at ≥21 weeks' gestation. During 1998-2007, the percentage of abortions performed at ≤13 weeks' gestation remained stable; however, abortions performed at ≥16 weeks' gestation decreased by 13%-14%, and among the abortions performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 65%. In 2007, 78.1% of abortions were performed by curettage at ≤13 weeks' gestation, and 13.1% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation); 7.9% of abortions were performed by curettage at >13 weeks' gestation. Among the 62.3% of abortions that were performed at ≤8 weeks' gestation, and thus were eligible for early medical abortion, 20.3% were completed by this method. Deaths of women associated with complications from abortions for 2007 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2006, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 1998-2007, the total number, rate, and ratio of reported abortions decreased during 2006-2007. This decrease reversed the increase in reported abortion numbers and rates that occurred during 2005-2006; however, reported abortion numbers and rates for 2007 still were higher than they had been previously in 2005. In 2006, as in previous years, reported deaths related to abortion were rare. Abortion surveillance in the United States continues to provide the data needed to examine trends in the number and characteristics of women obtaining abortions. Policymakers and program planners can use these data to guide and evaluate efforts to prevent unintended pregnancies.

Abortion rights down under.

PubMed

Kirkby, M

1994-08-01

State and federal governments in Australia fear actively trying to ensure access to abortion. No federal abortion law in Australia exists. Abortion is a state matter. The federal government's health care system does reimburse women for abortion services, however. State laws prohibit unlawful abortions but they do not define what they mean by unlawful abortion. Victoria, New South Wales, and Queensland have had common law interpretations of their Crimes Acts, which allow greater access to abortion. Tasmania and Western Australia have not had common law interpretations. Thus, even though abortion is available, women and providers are not secure. Abortion reform in South Australia and the Northern Territory has made access to abortion more difficult. A woman must be a resident in South Australia for 2 months before she can obtain an abortion. Abortions are allowed only in a clinic or a hospital. Women in metropolitan Melbourne and Sydney have good access to abortion services, while those in the country or in an isolated part of NSW or Victoria may have an antiabortion physician serving their area. Women in Queensland, Tasmania, and Western Australia pay a lot for an abortion because they also have to pay for airfare to a large city. Only a gynecologist can perform abortions in the Northern Territory. Social workers often coerce Aboriginal women into an abortion. The few antiabortion physicians have a big impact on whether women receive abortion information or not. Research at Adelaide and Flinders Universities show that abortion-related trauma is linked to obtaining information and access to abortion services. Physicians are nervous about performing abortions because abortion is still in the Crimes Acts and Criminal Codes, making it difficult to recruit high quality and empathetic practitioners. Antiabortion groups are small and tend not to adopt extreme tactics. The Abortion Rights Network of Australia has recently been formed.

Accuracy of cancellous bone volume fraction measured by micro-CT scanning.

PubMed

Ding, M; Odgaard, A; Hvid, I

1999-03-01

Volume fraction, the single most important parameter in describing trabecular microstructure, can easily be calculated from three-dimensional reconstructions of micro-CT images. This study sought to quantify the accuracy of this measurement. One hundred and sixty human cancellous bone specimens which covered a large range of volume fraction (9.8-39.8%) were produced. The specimens were micro-CT scanned, and the volume fraction based on Archimedes' principle was determined as a reference. After scanning, all micro-CT data were segmented using individual thresholds determined by the scanner supplied algorithm (method I). A significant deviation of volume fraction from method I was found: both the y-intercept and the slope of the regression line were significantly different from those of the Archimedes-based volume fraction (p < 0.001). New individual thresholds were determined based on a calibration of volume fraction to the Archimedes-based volume fractions (method II). The mean thresholds of the two methods were applied to segment 20 randomly selected specimens. The results showed that volume fraction using the mean threshold of method I was underestimated by 4% (p = 0.001), whereas the mean threshold of method II yielded accurate values. The precision of the measurement was excellent. Our data show that care must be taken when applying thresholds in generating 3-D data, and that a fixed threshold may be used to obtain reliable volume fraction data. This fixed threshold may be determined from the Archimedes-based volume fraction of a subgroup of specimens. The threshold may vary between different materials, and so it should be determined whenever a study series is performed.

Closed-loop adaptation of neurofeedback based on mental effort facilitates reinforcement learning of brain self-regulation.

PubMed

Bauer, Robert; Fels, Meike; Royter, Vladislav; Raco, Valerio; Gharabaghi, Alireza

2016-09-01

Considering self-rated mental effort during neurofeedback may improve training of brain self-regulation. Twenty-one healthy, right-handed subjects performed kinesthetic motor imagery of opening their left hand, while threshold-based classification of beta-band desynchronization resulted in proprioceptive robotic feedback. The experiment consisted of two blocks in a cross-over design. The participants rated their perceived mental effort nine times per block. In the adaptive block, the threshold was adjusted on the basis of these ratings whereas adjustments were carried out at random in the other block. Electroencephalography was used to examine the cortical activation patterns during the training sessions. The perceived mental effort was correlated with the difficulty threshold of neurofeedback training. Adaptive threshold-setting reduced mental effort and increased the classification accuracy and positive predictive value. This was paralleled by an inter-hemispheric cortical activation pattern in low frequency bands connecting the right frontal and left parietal areas. Optimal balance of mental effort was achieved at thresholds significantly higher than maximum classification accuracy. Rating of mental effort is a feasible approach for effective threshold-adaptation during neurofeedback training. Closed-loop adaptation of the neurofeedback difficulty level facilitates reinforcement learning of brain self-regulation. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

A de-noising method using the improved wavelet threshold function based on noise variance estimation

NASA Astrophysics Data System (ADS)

Liu, Hui; Wang, Weida; Xiang, Changle; Han, Lijin; Nie, Haizhao

2018-01-01

The precise and efficient noise variance estimation is very important for the processing of all kinds of signals while using the wavelet transform to analyze signals and extract signal features. In view of the problem that the accuracy of traditional noise variance estimation is greatly affected by the fluctuation of noise values, this study puts forward the strategy of using the two-state Gaussian mixture model to classify the high-frequency wavelet coefficients in the minimum scale, which takes both the efficiency and accuracy into account. According to the noise variance estimation, a novel improved wavelet threshold function is proposed by combining the advantages of hard and soft threshold functions, and on the basis of the noise variance estimation algorithm and the improved wavelet threshold function, the research puts forth a novel wavelet threshold de-noising method. The method is tested and validated using random signals and bench test data of an electro-mechanical transmission system. The test results indicate that the wavelet threshold de-noising method based on the noise variance estimation shows preferable performance in processing the testing signals of the electro-mechanical transmission system: it can effectively eliminate the interference of transient signals including voltage, current, and oil pressure and maintain the dynamic characteristics of the signals favorably.

Dynamic thresholds and a summary ROC curve: Assessing prognostic accuracy of longitudinal markers.

PubMed

Saha-Chaudhuri, P; Heagerty, P J

2018-04-19

Cancer patients, chronic kidney disease patients, and subjects infected with HIV are routinely monitored over time using biomarkers that represent key health status indicators. Furthermore, biomarkers are frequently used to guide initiation of new treatments or to inform changes in intervention strategies. Since key medical decisions can be made on the basis of a longitudinal biomarker, it is important to evaluate the potential accuracy associated with longitudinal monitoring. To characterize the overall accuracy of a time-dependent marker, we introduce a summary ROC curve that displays the overall sensitivity associated with a time-dependent threshold that controls time-varying specificity. The proposed statistical methods are similar to concepts considered in disease screening, yet our methods are novel in choosing a potentially time-dependent threshold to define a positive test, and our methods allow time-specific control of the false-positive rate. The proposed summary ROC curve is a natural averaging of time-dependent incident/dynamic ROC curves and therefore provides a single summary of net error rates that can be achieved in the longitudinal setting. Copyright © 2018 John Wiley & Sons, Ltd.

Demand for abortion and post abortion care in Ibadan, Nigeria.

PubMed

Awoyemi, Bosede O; Novignon, Jacob

2014-01-01

While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers' education was only statistically significant in determining abortion demand but not post-abortion care demand. The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion care is daunting. There is the need for policymakers to intensify public education against indiscriminate abortion and to reduce unwanted pregnancies. In effect, there is need for effective alternative family planning methods. This is likely to reduce the demand for abortion. Further, with income found as a major constraint, post abortion services should be made accessible to both the rich and poor alike so as to prevent unnecessary maternal deaths as a result of abortion related complications.

A Review of Contraception and Abortion Content in Family Medicine Textbooks.

PubMed

Schubert, Finn D; Akse, Sarp; Bennett, Ariana H; Glassman, Nancy R; Gold, Marji

2015-01-01

Family physicians are critical providers of reproductive health care in the United States, and family physicians and trainees refer to textbooks as a source of clinical information. This study evaluates the coverage of reproductive health topics in current family medicine textbooks. We identified 12 common family medicine textbooks through a computerized literature search and through the recommendations of a local family medicine clerkship and evaluated 24 areas of reproductive health content (comprising contraceptive care, management of early pregnancy loss, and provision of induced abortion) for accuracy and thoroughness using criteria that we created based on the latest guidelines. All contraceptive methods evaluated were addressed in more than half of the textbooks, though discrepancies existed by method, with intrauterine devices (IUDs), external (male) condoms, and diaphragms addressed most frequently (10/12 texts) and male and female sterilization addressed least frequently (8/12 texts). While most contraceptive methods, when addressed, were usually addressed accurately, IUDs were often addressed inaccurately. Coverage of early pregnancy loss management was limited to 7/12 texts, and coverage of early abortion methods was even more limited, with only 4/12 texts addressing the topic. Family medicine textbooks do not uniformly provide correct and thorough information on reproductive health topics relevant to family medicine, and attention is needed to ensure that family physicians are receiving appropriate information and training to meet the reproductive health needs of US women.

The impact of manual threshold selection in medical additive manufacturing.

PubMed

van Eijnatten, Maureen; Koivisto, Juha; Karhu, Kalle; Forouzanfar, Tymour; Wolff, Jan

2017-04-01

Medical additive manufacturing requires standard tessellation language (STL) models. Such models are commonly derived from computed tomography (CT) images using thresholding. Threshold selection can be performed manually or automatically. The aim of this study was to assess the impact of manual and default threshold selection on the reliability and accuracy of skull STL models using different CT technologies. One female and one male human cadaver head were imaged using multi-detector row CT, dual-energy CT, and two cone-beam CT scanners. Four medical engineers manually thresholded the bony structures on all CT images. The lowest and highest selected mean threshold values and the default threshold value were used to generate skull STL models. Geometric variations between all manually thresholded STL models were calculated. Furthermore, in order to calculate the accuracy of the manually and default thresholded STL models, all STL models were superimposed on an optical scan of the dry female and male skulls ("gold standard"). The intra- and inter-observer variability of the manual threshold selection was good (intra-class correlation coefficients >0.9). All engineers selected grey values closer to soft tissue to compensate for bone voids. Geometric variations between the manually thresholded STL models were 0.13 mm (multi-detector row CT), 0.59 mm (dual-energy CT), and 0.55 mm (cone-beam CT). All STL models demonstrated inaccuracies ranging from -0.8 to +1.1 mm (multi-detector row CT), -0.7 to +2.0 mm (dual-energy CT), and -2.3 to +4.8 mm (cone-beam CT). This study demonstrates that manual threshold selection results in better STL models than default thresholding. The use of dual-energy CT and cone-beam CT technology in its present form does not deliver reliable or accurate STL models for medical additive manufacturing. New approaches are required that are based on pattern recognition and machine learning algorithms.

Cost of abortions in Zambia: A comparison of safe abortion and post abortion care.

PubMed

Parmar, Divya; Leone, Tiziana; Coast, Ernestina; Murray, Susan Fairley; Hukin, Eleanor; Vwalika, Bellington

2017-02-01

Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

A COMPACTRIO-BASED BEAM LOSS MONITOR FOR THE SNS RF TEST CAVE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blokland, Willem; Armstrong, Gary A

2009-01-01

An RF Test Cave has been built at the Spallation Neutron Source (SNS) to be able to test RF cavities without interfering the SNS accelerator operations. In addition to using thick concrete wall to minimize radiation exposure, a Beam Loss Monitor (BLM) must abort the operation within 100 usec when the integrated radiation within the cave exceeds a threshold. We choose the CompactRIO platform to implement the BLM based on its performance, cost-effectiveness, and rapid development. Each in/output module is connected through an FPGA to provide point-by-point processing. Every 10 usec the data is acquired analyzed and compared to themore » threshold. Data from the FPGA is transferred using DMA to the real-time controller, which communicates to a gateway PC to talk to the SNS control system. The system includes diagnostics to test the hardware and integrates the losses in real-time. In this paper we describe our design, implementation, and results« less

Abortion Surveillance - United States, 2014.

PubMed

Jatlaoui, Tara C; Shah, Jill; Mandel, Michele G; Krashin, Jamie W; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

2017-11-24

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2014. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births). A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 186 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 7%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 21%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions, respectively, and had abortion rates of 11.9, 7.2, and 2.6 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. From 2005 to 2014, the abortion rate decreased among women aged 20-24, 25-29, 30-34, and 35-39 years by 27%, 16%, 12%, and 5%, respectively, but increased 4% among women aged ≥40 years. In 2014, adolescents aged <15 and 15-19 years accounted for 0.3% and 10.4% of all reported abortions, respectively, and had abortion rates of 0.5 and 7.5 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2005 to 2014, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 38%, and their abortion rate decreased 49%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2014 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2005 to 2014 for women in all age groups. In 2014, the majority (67.0%) of abortions were performed at ≤8 weeks' gestation, and nearly all (91.5%) were performed at ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.2%) or at ≥21 weeks' gestation (1.3%). During 2005-2014, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.4%). Among abortions performed at ≤13 weeks' gestation, there was a shift toward earlier gestational ages, as the percentage performed at ≤6 weeks' gestation increased 21%, and the percentage of all other gestational ages at ≤13 weeks' gestation decreased 7%-20%. In 2014, among reporting areas that included medical (nonsurgical) abortion on their reporting form, 22.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), 67.4% were performed by surgical abortion at ≤13 weeks' gestation, and 8.6% were performed by surgical abortion at >13 weeks' gestation; all other methods were uncommon (<2%). Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.2% were completed by this method. In 2014, women with one or more previous live births accounted for 59.5% of abortions, and women with no previous live births accounted for 40.4%. Women with one or more previous induced abortions accounted for 44.9% of abortions, and women with no previous abortion accounted for 55.1%. Women with three or more previous births accounted for 13.8% of abortions, and women with three or more previous abortions accounted for 8.6% of abortions. Deaths of women associated with complications from abortion for 2014 are being assessed as part of CDC's Pregnancy Mortality Surveillance System. In 2013, the most recent year for which data were available, four women were identified to have died as a result of complications from legal induced abortion. Among the 48 areas that reported data every year during 2005-2014, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2010-2013 continued from 2013 to 2014, resulting in historic lows for all three measures of abortion. The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

Beam Loss Monitoring for LHC Machine Protection

NASA Astrophysics Data System (ADS)

Holzer, Eva Barbara; Dehning, Bernd; Effnger, Ewald; Emery, Jonathan; Grishin, Viatcheslav; Hajdu, Csaba; Jackson, Stephen; Kurfuerst, Christoph; Marsili, Aurelien; Misiowiec, Marek; Nagel, Markus; Busto, Eduardo Nebot Del; Nordt, Annika; Roderick, Chris; Sapinski, Mariusz; Zamantzas, Christos

The energy stored in the nominal LHC beams is two times 362 MJ, 100 times the energy of the Tevatron. As little as 1 mJ/cm3 deposited energy quenches a magnet at 7 TeV and 1 J/cm3 causes magnet damage. The beam dumps are the only places to safely dispose of this beam. One of the key systems for machine protection is the beam loss monitoring (BLM) system. About 3600 ionization chambers are installed at likely or critical loss locations around the LHC ring. The losses are integrated in 12 time intervals ranging from 40 μs to 84 s and compared to threshold values defined in 32 energy ranges. A beam abort is requested when potentially dangerous losses are detected or when any of the numerous internal system validation tests fails. In addition, loss data are used for machine set-up and operational verifications. The collimation system for example uses the loss data for set-up and regular performance verification. Commissioning and operational experience of the BLM are presented: The machine protection functionality of the BLM system has been fully reliable; the LHC availability has not been compromised by false beam aborts.

Measurement and simulation of the RHIC abort kicker longitudinal impedence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abreu,N.P.; Hahn,H.; Choi, E.

2009-09-01

In face of the new upgrades for RHIC the longitudinal impedance of the machine plays an important role in setting the threshold for instabilities and the efficacy of some systems. In this paper we describe the measurement of the longitudinal impedance of the abort kicker for RHIC as well as computer simulations of the structure. The impedance measurement was done by the S{sub 21} wire method covering the frequency range from 9 kHz to 2.5 GHz. We observed a sharp resonance peak around 10 MHz and a broader peak around 20 MHz in both, the real and imaginary part, ofmore » the Z/n. These two peaks account for a maximum imaginary longitudinal impedance of j15 {Omega}, a value an order of magnitude larger than the estimated value of j0.2 {Omega}, which indicates that the kicker is one of the main sources of longitudinal impedance in the machine. A computer model was constructed for simulations in the CST MWS program. Results for the magnet input and the also the beam impedance are compared to the measurements. A more detail study of the system properties and possible changes to reduce the coupling impedance are presented.« less

Improve threshold segmentation using features extraction to automatic lung delimitation.

PubMed

França, Cleunio; Vasconcelos, Germano; Diniz, Paula; Melo, Pedro; Diniz, Jéssica; Novaes, Magdala

2013-01-01

With the consolidation of PACS and RIS systems, the development of algorithms for tissue segmentation and diseases detection have intensely evolved in recent years. These algorithms have advanced to improve its accuracy and specificity, however, there is still some way until these algorithms achieved satisfactory error rates and reduced processing time to be used in daily diagnosis. The objective of this study is to propose a algorithm for lung segmentation in x-ray computed tomography images using features extraction, as Centroid and orientation measures, to improve the basic threshold segmentation. As result we found a accuracy of 85.5%.

Abortion surveillance - United States, 2006.

PubMed

Pazol, Karen; Gamble, Sonya B; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed

2009-11-27

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2006. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, New York City, and the District of Columbia); these data are provided to CDC voluntarily. In 2006, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 46 areas that reported data every year during 1996-2006. For 2006, a total of 846,181 abortions were reported to CDC. Among the 46 areas that provided data consistently during 1996-2006, a total of 835,134 abortions (98.7% of the total) were reported; the abortion rate was 16.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 236 abortions per 1,000 live births. During the previous decade (1997-2006), reported abortion numbers, rates, and ratios decreased 5.7%, 8.8%, and 14.8%, respectively; most of these declines occurred before 2001. During the previous year (2005-2006), the total number of abortions increased 3.1%, and the abortion rate increased 3.2%; the abortion ratio was stable. In 2006, as during the previous decade (1997-2006), women aged 20-29 years accounted for the majority (56.8%) of abortions and had the highest abortion rates (29.9 abortions per 1,000 women aged 20-24 years and 22.2 abortions per 1,000 women aged 25-29 years); by contrast, abortion ratios were highest at the extremes of reproductive age. Adolescents aged 15-19 years accounted for 16.5% of all abortions in 2006 and had an abortion rate of 14.8 abortions per 1,000 adolescents aged 15-19 years; women aged >or=35 years accounted for a smaller percentage (12.1%) of abortions and had lower abortion rates (7.8 abortions per 1,000 women aged 35-39 years and 2.6 abortions per 1,000 women aged >or=40 years). During 1997-2006, the percentage of abortions and the abortion rate increased among women aged >or=35 years but declined among adolescents aged or=21 weeks' gestation (1.3%). During 1997-2006, the percentage of abortions performed at

Demand for abortion and post abortion care in Ibadan, Nigeria

PubMed Central

2014-01-01

Background While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion care is daunting. There is the need for policymakers to intensify public education against indiscriminate abortion and to reduce unwanted pregnancies. In effect, there is need for effective alternative family planning methods. This is likely to reduce the demand for abortion. Further, with income found as a major constraint, post abortion services should be made accessible to both the rich and poor alike so as to prevent unnecessary maternal deaths as a result of abortion related complications. PMID:25024929

Exploring pregnancy termination experiences and needs among Malaysian women: a qualitative study.

PubMed

Tong, Wen Ting; Low, Wah Yun; Wong, Yut Lin; Choong, Sim Poey; Jegasothy, Ravindran

2012-09-05

Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women's experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. Thirty-one women, with ages ranging from 21-43 years (mean 30.16 ± 6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2-8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband's agreement. In terms of the women's needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil.

PubMed

Silva, Dalisbor Marcelo Weber; Borba, Victoria Zeghbi Cochenski; Kanis, John A

2017-12-09

Clinical risk factors for fracture in Southern Brazil are similar to those used in Fracture Risk Assessment Tool (FRAX®). Age-dependent intervention thresholds had higher accuracy than a fixed cut-off point. Access to bone mineral density testing is wanted for a large part of the Brazilian population. The FRAX® has an option to calculate the risk of fracture without this costly evaluation but relies on the clinical risk factors (CRFs) identified in the source cohorts used to generate FRAX. The aims of this study were to determine whether the CRFs used in FRAX are also risk indicators for individuals in Southern Brazil and to evaluate possible intervention thresholds for treatment in Brazil. We determined the CRFs for hip fractures in women and men aged 50 years and more with a hip fracture and controls in Joinville, Southern Brazil (April 1, 2010, and March 31, 2012). For intervention thresholds, we determined the accuracy of using the fixed thresholds of National Osteoporosis Foundation (NOF), USA, compared with the age-dependent thresholds of the National Osteoporosis Guideline Group (NOGG), UK. CRFs that were significant for hip fracture were very similar to FRAX, apart from chronic obstructive pulmonary disease and malabsorptive intestinal disease. FRAX based on the NOGG and NOF models had an accuracy of 64.2 and 58.7%, respectively. CRFs used in FRAX® were similar to those in the Southern Brazil. The NOGG model seems to be more accurate to discriminate patients with increased fracture risk in this population compared to the NOF model, but not significantly.

Induced abortion in villages of Ballabgarh HDSS: rates, trends, causes and determinants.

PubMed

Kant, Shashi; Srivastava, Rahul; Rai, Sanjay Kumar; Misra, Puneet; Charlette, Lena; Pandav, Chandrakant S

2015-05-29

Induced abortion has been legal in India on a broad range of medical and social grounds since 1980s. Often, induced abortion is resorted to as a means for contraception, and has a potential to be misused for sex selective feticide. We assessed the rates, trends, causes and determinants of induced abortions from 2008-12 in a rural community of northern India. Present study is a secondary data analysis of pregnancy outcomes at Ballabgarh Health and Demographic Surveillance System from 2008-12. The data was retrieved from the Health and Management Information System maintained at Ballabgarh. Cause of abortion was self-reported by the women who underwent abortion. Of the 11,102 pregnancies, 1,226 (11%) culminated as abortions of which 425 (3.8%) were induced abortions. Spontaneous abortion rate (7.2%) was twice that of induced abortion rate (3.8%). Both abortion rates had an increasing trend during the course of the study period. Self-reported reasons for opting for induced abortions were bleeding per vaginum (23%), unwanted pregnancy (16%), and unviable fetus diagnosed by ultrasonography (11%). Eight percent of the induced abortions were due to the female sex of the fetus. About 11% of the abortions were performed beyond 20 weeks of gestation which was the upper legal permissible gestational age for performing induced abortions in India. About 10% of the abortions were performed by unqualified practitioners. Caste, wealth index, birth order and size of the village population were the factors that were significantly associated with induced abortion. Though the abortion rate was low, the proportionate contribution of induced abortion was more than what could be expected. Unsafe and sex selective abortion, though illegal, was prevalent. Upper caste and higher socio-economic status families were more likely to opt for induced abortion.

Why Abortion is Illegal? Comparison of Legal and Illegal Abortion: A Critical Review.

PubMed

Huq, M E; Raihan, M J; Shirin, H; Chowdhury, S; Jahan, Y; Chowdhury, A S; Rahman, M M

2017-10-01

Abortion is the termination of pregnancy that occurs spontaneously or purposely. In the most developed world, abortion is legally allowed for women seeking safe termination of pregnancies. Particularly, when access to legal abortion is restricted, abortion is the resort to unsafe methods. The aim of this review is to necessitate safe abortion and to accentuate the consequences of illegal abortion in case of legal prohibition. We used Pubmed, MedLine and Scopus databases to review previous literatures of safe, unsafe, legal and illegal abortions. Research work and reports from organizations such as World Health Organization (WHO), World Bank (WB) and United Nations (UN) were included. Snowball sampling was used to obtain relevant journals. Abortion is conventional whether it is safe, unsafe, legal or illegal. The intention of the antiabortion policy was to reduce the number of abortions globally. However, instead of decreasing rates, evidences show significant increase in abortions. When abortion is legal, the preconditions to be ensured are availability, accessibility, affordability and acceptability for the safe abortion facilities. When abortion is illegal, risk reduction strategies are needed to decrease maternal morbidity and mortality. We can reduce abortion related morbidity and mortality, whether it is legal or illegal if we can ensure the appropriate access to health care, including abortion services, education on sexuality, access to contraceptives, post abortion care, and suitable interventions and liberalization of laws. The paper reviewed the Mexico City Policy and the US foreign aid strategies and highlighted the evidence based analysis for policy reform. The liberalized abortion law can save pregnant women from abortion related complications and death.

The incidence of abortion worldwide.

PubMed

Henshaw, S K; Singh, S; Haas, T

1999-01-01

Accurate measurement of induced abortion levels has proven difficult in many parts of the world. Health care workers and policymakers need information on the incidence of both legal and illegal induced abortion to provide the needed services and to reduce the negative impact of unsafe abortion on women's health. Numbers and rates of induced abortions were estimated from four sources: official statistics or other national data on legal abortions in 57 countries; estimates based on population surveys for two countries without official statistics; special studies for 10 countries where abortion is highly restricted; and worldwide and regional estimates of unsafe abortion from the World Health Organization. Approximately 26 million legal and 20 million illegal abortions were performed worldwide in 1995, resulting in a worldwide abortion rate of 35 per 1,000 women aged 15-44. Among the subregions of the world, Eastern Europe had the highest abortion rate (90 per 1,000) and Western Europe to the lowest rate (11 per 1,000). Among countries where abortion is legal without restriction as to reason, the highest abortion rate, 83 per 1,000, was reported for Vietnam and the lowest, seven per 1,000, for Belgium and the Netherlands. Abortion rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe conditions) than in areas where abortion is legally permitted. Both developed and developing countries can have low abortion rates. Most countries, however, have moderate to high abortion rates, reflecting lower prevalence and effectiveness of contraceptive use. Stringent legal restrictions do not guarantee a low abortion rate.

Abortion surveillance--United States, 2009.

PubMed

Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B; Burley, Kim D; Jamieson, Denise J

2012-11-23

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2009. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000-2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000-2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000-2009. In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20-24 and 25-29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20-24 years and 20.4 abortions per 1,000 women aged 25-29 years. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 14.7%, 8.8%, and 3.3% of all abortions, respectively, and had an abortion rate of 13.3 abortions per 1,000 women aged 30-34 years, 7.6 abortions per 1,000 women aged 35-39 years, and 2.7 abortions per 1,000 women aged ≥40 years. Throughout the period of analysis, abortion rates decreased among women aged 20-24 and 25-29 years, whereas they increased among women aged ≥40 years. In 2009, adolescents aged 15-19 years accounted for 15.5% of all abortions and had an abortion rate of 13.0 abortions per 1,000 adolescents aged 15-19 years. Throughout the period of analysis, the percentage of all abortions accounted for by adolescents and the adolescent abortion rate decreased. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2009 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2000 to 2009 for women in all age groups except for those aged <15 years, for whom they increased. In 2009, most (64.0%) abortions were performed at ≤8 weeks' gestation, and 91.7% were performed at ≤13 weeks' gestation. Few abortions (7.0%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. From 2000 to 2009, the percentage of all abortions performed at ≤8 weeks' gestation increased 12%, whereas the percentage performed at >13 weeks' decreased 12%. Moreover, among abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of these abortions performed at ≤6 weeks' gestation increasing 47%. In 2009, 74.2% of abortions were performed by curettage at ≤13 weeks' gestation, 16.5% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.1% were performed by curettage at >13 weeks' gestation. Among abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 25.2% were completed by this method. The use of early medical abortion increased 10% from 2008 to 2009. Deaths of women associated with complications from abortions for 2009 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2008, the most recent year for which data were available, 12 women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 2000-2009, the gradual decrease that had occurred during previous decades in the total number and rate of reported abortions continued through 2005, whereas year-to-year variation from 2006 to 2008 resulted in no net change during this later period. However, the change from 2008 to 2009 for both the total number of abortions and the abortion rate was the largest single year decrease during 2000-2009, and all three measures of abortion (total numbers, rates, and ratios) decreased to the lowest level observed during this period. Unintended pregnancy is the major contributor to abortion. Because unintended pregnancies are rare among women who use the most effective methods of reversible contraception, increasing access to and use of these methods can help further reduce the number of abortions performed in the United States. The data in this report can help program planners and policy makers identify groups of women at greatest risk for unintended pregnancy and help guide and evaluate prevention efforts.

Abortion Surveillance - United States, 2013.

PubMed

Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

2016-11-25

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2013. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2.5 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. During 2004-2013, the decrease in abortion rates among adult women aged 20-39 years ranged from 8% to 27% across these age groups, whereas the abortion rate was stable for women aged ≥40 years. In 2013, adolescents aged <15 and 15-19 years accounted for 0.3% and 11.4% of all abortions, respectively, and had abortion rates of 0.6 and 8.2 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2004 to 2013, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 31% and their abortion rate decreased 46%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2013 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2004 to 2013 for women in all age groups, except for adolescents aged <15 years. In 2013, the majority (66.0%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.6%) were performed by ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.1%) or at ≥21 weeks' gestation (1.3%). From 2004 to 2013, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.5%) and among those performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 16%. In 2013, among the 43 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 67.9% of abortions were performed by curettage at ≤13 weeks' gestation, 22.2% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.6% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.8% were completed by this method. From 2012 to 2013, the percentage of abortions reported as early medical abortions increased 5%. Deaths of women associated with complications from abortion for 2013 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2012, the most recent year for which data were available, four women were identified to have died as a result of complications from known legal induced abortion. No reported deaths were associated with known illegal induced abortion. Among the 47 areas that reported data every year during 2004-2013, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2009-2012 continued from 2012 to 2013, resulting in historic lows for all three measures of abortion. The data in this report can help program planners and policymakers identify groups of women with highest rates of abortion. Unintended pregnancy is the major contributor to abortion. Increasing access to and use of contraception, including the most effective methods, can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

Abortion Surveillance - United States, 2012.

PubMed

Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J

2015-11-27

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2012. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003-2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003-2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003-2012). In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20-24 and 25-29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of 12.4, 7.3, and 2.8 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20-24, 25-29, and 30-34 years by 24%, 18%, and 10%, respectively, whereas they increased among women aged ≥40 years by 8%. In 2012, adolescents aged <15 and 15-19 years accounted for 0.4% and 12.2% of all abortions, respectively, and had abortion rates of 0.8 and 9.2 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2003 to 2012, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 27% and their abortion rate decreased 40%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2012 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30-39 years. Abortion ratios decreased from 2003 to 2012 for women in all age groups. In 2012, the majority (65.8%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.2%) were performed between 14-20 weeks' gestation or at ≥21 weeks' gestation (1.3%). From 2003 to 2012, the percentage of all abortions performed at ≤8 weeks' gestation increased 7%; the percentage performed at >13 weeks remained consistently low (≤9.0%). In 2012, among the 40 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 69.4% of abortions were performed by curettage at ≤13 weeks' gestation, 20.8% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.7% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible on the basis of gestational age for early medical abortion, 30.8% were completed by this method. The percentage of abortions reported as early medical abortions increased 10% from 2011 to 2012. Deaths of women associated with complications from abortions for 2012 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2011, the most recent year for which data were available, two women were identified to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 47 areas that reported data every year during 2003-2012, the notable decreases that occurred during 2008-2011 in the total number, rate, and ratio of reported abortions continued from 2011 to 2012 and resulted in historic lows for all three measures of abortion. The data in this report can help to identify groups of women at greatest risk for abortion and can be used to guide and evaluate prevention efforts. Because unintended pregnancy is the major contributor to abortion, and unintended pregnancies are rare among women who use the most effective methods of contraception, increasing access to and use of these methods can help further reduce the number of unintended pregnancies, and therefore abortions, performed in the United States.

Perspectives of Chinese healthcare providers on medical abortion.

PubMed

Gan, Kang; Zhang, Yuhan; Jiang, Xiaomei; Meng, Yucui; Hou, Liyan; Cheng, Yimin

2011-07-01

To evaluate Chinese healthcare providers' knowledge regarding medical abortion, to understand provider preferences for abortion methods, and to investigate the role of remuneration on providers' decision making. Between November 2009 and May 2010, 658 abortion service providers from family-planning service centers and hospitals in Shenzhen and Henan, China, were surveyed via self-administered questionnaires. The knowledge score (out of a maximum of 32) regarding medical abortion was 16-20 for 60.9% of the providers; 20.4% of the providers preferred medical abortion to surgical abortion, whereas 35.0% preferred surgical abortion. Overall, 72.2% of providers stated that they did not receive any commission for providing medical abortion or surgical abortion. Most healthcare providers believed that surgical abortion was preferable to medical abortion. Efforts should be made to overcome the perceived disadvantages of medical abortion. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Abortion surveillance--United States, 2008.

PubMed

Pazol, Karen; Zane, Suzanne B; Parker, Wilda Y; Hall, Laura R; Berg, Cynthia; Cook, Douglas A

2011-11-25

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 1999-2008. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2008, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during 1999-2008. Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. A total of 825,564 abortions were reported to CDC for 2008. Of these, 808,528 abortions (97.9% of the total) were from the 45 reporting areas that provided data every year during 1999-2008. Among these same 45 reporting areas, the abortion rate for 2008 was 16.0 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 234 abortions per 1,000 live births. Compared with 2007, the total number and rate of reported abortions for these 45 reporting areas essentially were unchanged, although the abortion ratio was 1% higher. Reported abortion numbers, rates, and ratios remained 3%, 4%, and 10% lower, respectively, in 2008 than they had been in 1999. Women aged 20-29 years accounted for 57.1% of all abortions reported in 2008 and for the majority of abortions during the entire period of analysis (1999-2008). In 2008, women aged 20-29 years also had the highest abortion rates (29.6 abortions per 1,000 women aged 20-24 years and 21.6 abortions per 1,000 women aged 25-29 years). Adolescents aged 15-19 years accounted for 16.2% of all abortions in 2008 and had an abortion rate of 14.3 abortions per 1,000 adolescents aged 15-19 years; women aged ≥35 years accounted for a smaller percentage (11.9%) of abortions and had lower abortion rates (7.8 abortions per 1,000 women aged 35-39 years and 2.7 abortions per 1,000 women aged ≥40 years). Throughout the period of analysis, abortion rates decreased among adolescents aged ≤19 years, whereas they increased among women aged ≥35 years. Among women aged 20-24 years abortion rates decreased during 1999-2003 and then leveled off during 2004-2008. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2008 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30-39 years. Abortion ratios decreased during 1999-2008 for women in all age groups except for those aged <15 years; however, the steady decrease was interrupted from 2007 to 2008 when abortion ratios increased among women in all age groups except for those aged ≥40 years. In 2008, most (62.8%) abortions were performed at ≤8 weeks' gestation, and 91.4% were performed at ≤13 weeks' gestation. Few abortions (7.3%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. During 1999-2008, the percentage of abortions performed at ≤13 weeks' gestation remained stable, whereas abortions performed at ≥16 weeks' gestation decreased 13%-17%. Moreover, among the abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of abortions performed at ≤6 weeks' gestation increasing 53%. In 2008, 75.9% of abortions were performed by curettage at ≤13 weeks' gestation, and 14.6% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation); 8.5% of abortions were performed by curettage at >13 weeks' gestation. Among the 62.8% of abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 22.5% were completed by this method. The use of medical abortion increased 17% from 2007 to 2008. Deaths of women associated with complications from abortions for 2008 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2007, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 1999-2008, the total number and rate of reported abortions essentially did not change from 2007 to 2008. This finding is consistent with the recent leveling off from steady decreases that had been observed in the past. In contrast, the abortion ratio increased from 2007 to 2008 after having decreased steadily. In 2007, as in previous years, reported deaths related to abortion were rare. This report provides the data for examining trends in the number and characteristics of women obtaining abortions. This information is needed to better understand the reasons why efforts to reduced unintended pregnancy have stalled and can be used by policymakers and program planners to guide and evaluate efforts to prevent unintended pregnancy.

Abortion surveillance - United States, 2011.

PubMed

Pazol, Karen; Creanga, Andreea A; Burley, Kim D; Jamieson, Denise J

2014-11-28

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2011. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2011, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 46 areas that reported data every year during 2002-2011. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 730,322 abortions were reported to CDC for 2011. Of these abortions, 98.3% were from the 46 reporting areas that provided data every year during 2002-2011. Among these same 46 reporting areas, the abortion rate for 2011 was 13.9 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 219 abortions per 1,000 live births. From 2010 to 2011, the total number and rate of reported abortions decreased 5% and the abortion ratio decreased 4%, and from 2002 to 2011, the total number, rate, and ratio of reported abortions decreased 13%, 14%, and 12%, respectively. In 2011, all three measures reached their lowest level for the entire period of analysis (2002-2011). In 2011 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, and women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2011, women aged 20-24 and 25-29 years accounted for 32.9% and 24.9% of all abortions, respectively, and had abortion rates of 24.9 and 19.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 15.8%, 8.9%, and 3.6% of all abortions, respectively, and had abortion rates of 12.7, 7.5, and 2.8 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20-24 and 25-29 years by 21% and 16%, respectively, whereas they increased among women aged ≥40 years by 8%. In 2011, adolescents aged <15 and 15-19 years accounted for 0.4% and 13.5% of all abortions, respectively, and had abortion rates of 0.9 and 10.5 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2002 to 2011, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 21% and their abortion rate decreased 34%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2011 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2002 to 2011 for women in all age groups except for those aged <15 years, for whom they increased. In 2011, most (64.5%) abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.3%) were performed between 14-20 weeks' gestation or at ≥21 weeks' gestation (1.4%). From 2002 to 2011, the percentage of all abortions performed at ≤8 weeks' gestation increased 6%. In 2011, among reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 71.0% of abortions were performed by curettage at ≤13 weeks' gestation, 19.1% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.6% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 28.5% were completed by this method. The percentage of abortions reported as early medical abortions increased 3% from 2010 to 2011. Deaths of women associated with complications from abortions for 2011 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2010, the most recent year for which data were available, 10 women were identified to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 46 areas that reported data every year during 2002-2011, large decreases in the total number, rate, and ratio of reported abortions from 2010 to 2011, in combination with decreases that occurred during 2008-2010, resulted in historic lows for all three measures of abortion. Unintended pregnancy is the major contributor to abortion. Because unintended pregnancies are rare among women who use the most effective methods of contraception, increasing access to and use of these methods can help further reduce the number of abortions performed in the United States. The data in this report can help program planners and policy makers identify groups of women at greatest risk for unintended pregnancy and help guide and evaluate prevention efforts.

Austerity and Abortion in the European Union

PubMed Central

Reeves, Aaron; Billari, Francesco; McKee, Martin; Stuckler, David

2016-01-01

Economic hardship accompanying large recessions can lead families to terminate unplanned pregnancies. To assess whether abortions have risen during the recession, we collected crude abortion data from 2000 to 2012 from Eurostat for countries that had legal abortions and complete data. Declining trends in abortion ratios between 2000 and 2009 have been reversing. Excess abortions between 2010 and 2012 totaled 10.6 abortions per 1000 pregnancies ending in abortion or birth or 6701 additional abortions (95% CI 1190–9240) with stronger effects in younger ages. Economic shocks may increase recourse to abortion. Further research should explore causal pathways and protective factors. PMID:27009038

Abortion legalized: challenges ahead.

PubMed

Singh, M; Jha, R

2007-01-01

To see whether advocacy for abortion law and comprehensive abortion care (CAC) sites after legalization of abortion in Nepal is adequate among educated people (above school leaving certificate). 150 participants were assigned randomly who agreed to be in the survey and were given structured questionnaires to find out their perception of abortion and CAC sites. Majority know abortion is legalized and majority have positive attitude about legalization of abortion, however majority are not aware of abortion service in CAC sites and none knew the cost of abortion service. Proper and adequate advocacy of the new abortion law and CAC service is essential.

Antibiotics for treating septic abortion.

PubMed

Udoh, Atim; Effa, Emmanuel E; Oduwole, Olabisi; Okusanya, Babasola O; Okafo, Obiamaka

2016-07-01

A septic abortion refers to any abortion (spontaneous or induced) complicated by upper genital tract infection including endometritis or parametritis. The mainstay of treatment of septic abortion is antibiotic therapy alone or in combination with evacuation of retained products of conception. Regimens including broad-spectrum antibiotics are routinely recommended for treatment. However, there is no consensus on the most effective antibiotics alone or in combination to treat septic abortion. This review aimed to bridge this gap in knowledge to inform policy and practice. To review the effectiveness of various individual antibiotics or antibiotic regimens in the treatment of septic abortion. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and POPLINE using the following keywords: 'Abortion', 'septic abortion', 'Antibiotics', 'Infected abortion', 'postabortion infection'. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials on 19 April, 2016. We considered for inclusion randomised controlled trials (RCTs) and non-RCTs that compared antibiotic(s) to another antibiotic(s), irrespective of route of administration, dosage, and duration as well as studies comparing antibiotics alone with antibiotics in combination with other interventions such as dilation and curettage (D&C). Two review authors independently extracted data from included trials. We resolved disagreements through consultation with a third author. One review author entered extracted data into Review Manager 5.3, and a second review author cross-checked the entry for accuracy. We included 3 small RCTs involving 233 women that were conducted over 3 decades ago.Clindamycin did not differ significantly from penicillin plus chloramphenicol in reducing fever in all women (mean difference (MD) -12.30, 95% confidence interval (CI) -25.12 to 0.52; women = 77; studies = 1). The evidence for this was of moderate quality. "Response to treatment was evaluated by the patient's 'fever index' expressed in degree-hour and defined as the total quantity of fever under the daily temperature curve with 99°F (37.2°C) as the baseline".There was no difference in duration of hospitalisation between clindamycin and penicillin plus chloramphenicol. The mean duration of hospital stay for women in each group was 5 days (MD 0.00, 95% CI -0.54 to 0.54; women = 77; studies = 1).One study evaluated the effect of penicillin plus chloramphenicol versus cephalothin plus kanamycin before and after D&C. Response to therapy was evaluated by "the time from start of antibiotics until fever lysis and time from D&C until patients become afebrile". Low-quality evidence suggested that the effect of penicillin plus chloramphenicol on fever did not differ from that of cephalothin plus kanamycin (MD -2.30, 95% CI -17.31 to 12.71; women = 56; studies = 1). There was no significant difference between penicillin plus chloramphenicol versus cephalothin plus kanamycin when D&C was performed during antibiotic therapy (MD -1.00, 95% CI -13.84 to 11.84; women = 56; studies = 1). The quality of evidence was low.A study with unclear risk of bias showed that the time for fever resolution (MD -5.03, 95% CI -5.77 to -4.29; women = 100; studies = 1) as well as time for resolution of leukocytosis (MD -4.88, 95% CI -5.98 to -3.78; women = 100; studies = 1) was significantly lower with tetracycline plus enzymes compared with intravenous penicillin G.Treatment failure and adverse events occurred infrequently, and the difference between groups was not statistically significant. We found no strong evidence that intravenous clindamycin alone was better than penicillin plus chloramphenicol for treating women with septic abortion. Similarly, available evidence did not suggest that penicillin plus chloramphenicol was better than cephalothin plus kanamycin for the treatment of women with septic abortion. Tetracyline enzyme antibiotic appeared to be more effective than intravenous penicillin G in reducing the time to fever defervescence, but this evidence was provided by only one study at low risk of bias.There is a need for high-quality RCTs providing reliable evidence for treatments of septic abortion with antibiotics that are currently in use. The three included studies were carried out over 30 years ago. There is also a need to include institutions in low-resource settings, such as sub-Saharan Africa, Latin America and the Caribbean, and South Asia, with a high burden of abortion and health systems challenges.

The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion.

PubMed

Leone, Tiziana; Coast, Ernestina; Parmar, Divya; Vwalika, Bellington

2016-09-01

Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women.This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider payments. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016.

PubMed

Chae, Sophia; Kayembe, Patrick K; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15-49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15-49. Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India.

PubMed

Sjöström, Susanne; Essén, Birgitta; Sydén, Filip; Gemzell-Danielsson, Kristina; Klingberg-Allvin, Marie

2014-07-01

Although abortion care has been an established routine since decades in India, 8% of maternal mortality is attributed to unsafe abortion. Increased knowledge and improved attitudes among health care providers have a potential to reduce barriers to safe abortion care by reducing stigma and reluctance to provide abortion. Previous research has shown that medical students' attitudes can predict whether they will perform abortions. The objective of our study was to explore attitudes toward abortion among medical interns in Maharastra, India. A cross-sectional survey was carried out among 1996 medical interns in Maharastra, India. Descriptive and analytical statistics were used to interpret the study instrument. Almost one quarter of the respondents considered abortion to be morally wrong, one fifth did not find abortions for unmarried women acceptable and one quarter falsely believed that a woman needs her partner or spouse's approval to have an abortion. Most participants agreed that unsafe abortion is a serious health problem in India. A majority of the respondents rated their knowledge of sexual and reproductive health as good, but only 13% had any clinical practice in abortion care services. Disallowing attitudes toward abortion and misconceptions about the legal regulations were common among the surveyed medical students. Knowledge and attitudes toward abortion among future physicians could be improved by amendments to the medical education, potentially increasing the number of future providers delivering safe and legal abortion services. Abortion is legal in India since decades, but maternal mortality due to unsafe abortions remains high. This survey of attitudes toward abortion among medical interns in Maharastra indicates that disallowing views prevail. Improved knowledge and clinical training can increase numbers of potential abortion providers, thus limit unsafe abortion. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementing medical abortion with mifepristone and misoprostol in Norway 1998–2013

PubMed Central

Løkeland, Mette; Bjørge, Tone; Iversen, Ole-Erik; Akerkar, Rupali; Bjørge, Line

2017-01-01

Abstract Background: Medical abortion with mifepristone and misoprostol was introduced in Norway in 1998, and since then there has been an almost complete change from predominantly surgical to medical abortions. We aimed to describe the medical abortion implementation process, and to compare characteristics of women obtaining medical and surgical abortion. Methods: Information from all departments of obstetrics and gynaecology in Norway on the time of implementation of medical abortion and abortion procedures in use up to 12 weeks of gestation was assessed by surveys in 2008 and 2012. We also analysed data from the National Abortion Registry comprising 223 692 women requesting abortion up to 12 weeks of gestation during 1998–2013. Results: In 2012, all hospitals offered medical abortion, 84.4% offered medical abortion at 9–12 weeks of gestation and 92.1% offered home administration of misoprostol. The use of medical abortion increased from 5.9% of all abortions in 1998 to 82.1% in 2013. Compared with women having a surgical abortion, women obtaining medical abortion had higher odds for undergoing an abortion at 4–6 weeks (adjusted OR 2.33; 95% confidence interval 2.28-2.38). Waiting time between registered request for an abortion until termination was reduced from 11.3 days in 1998 to 7.3 days in 2013. Conclusions: Norwegian women have gained access to more treatment modalities and simplified protocols for medical abortion. At the same time they obtained abortions at an earlier gestational age and the waiting time has been reduced. PMID:28031316

Denial of abortion in legal settings.

PubMed

Gerdts, Caitlin; DePiñeres, Teresa; Hajri, Selma; Harries, Jane; Hossain, Altaf; Puri, Mahesh; Vohra, Divya; Foster, Diana Greene

2015-07-01

Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Abortion Incidence and Service Availability In the United States, 2014

PubMed Central

Jones, Rachel K.; Jerman, Jenna

2017-01-01

CONTEXT National and state-level information about abortion incidence can help inform policies and programs intended to reduce levels of unintended pregnancy. METHODS In 2015–2016, all U.S. facilities known or expected to have provided abortion services in 2013 or 2014 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. The number of abortion-providing facilities and changes since a similar 2011 survey were also assessed. The number and type of new abortion restrictions were examined in the states that had experienced the largest proportionate changes in clinics providing abortion services. RESULTS In 2014, an estimated 926,200 abortions were performed in the United States, 12% fewer than in 2011; the 2014 abortion rate was 14.6 abortions per 1,000 women aged 15–44, representing a 14% decline over this period. The number of clinics providing abortions declined 6% between 2011 and 2014, and declines were steepest in the Midwest (22%) and the South (13%). Early medication abortions accounted for 31% of nonhospital abortions, up from 24% in 2011. Most states that experienced the largest proportionate declines in the number of clinics providing abortions had enacted one or more new restrictions during the study period, but reductions were not always associated with declines in abortion incidence. CONCLUSIONS The relationship between abortion access, as measured by the number of clinics, and abortion rates is not straightforward. Further research is needed to understand the decline in abortion incidence. PMID:28094905

Estimating the probability of spontaneous abortion in the presence of induced abortion and vice versa.

PubMed Central

Hammerslough, C R

1992-01-01

An integrated approach to estimate the total number of pregnancies that begin in a population during one calendar year and the probability of spontaneous abortion is described. This includes an indirect estimate of the number of pregnancies that result in spontaneous abortions. The method simultaneously takes into account the proportion of induced abortions that are censored by spontaneous abortions and vice versa in order to estimate the true annual number of spontaneous and induced abortions for a population. It also estimates the proportion of pregnancies that women intended to allow to continue to a live birth. The proposed indirect approach derives adjustment factors to make indirect estimates by combining vital statistics information on gestational age at induced abortion (from the 12 States that report to the National Center for Health Statistics) with a life table of spontaneous abortion probabilities. The adjustment factors are applied to data on induced abortions from the Alan Guttmacher Institute Abortion Provider Survey and data on births from U.S. vital statistics. For the United States in 1980 the probability of a spontaneous abortion is 19 percent, given the presence of induced abortion. Once the effects of spontaneous abortion are discounted, women in 1980 intended to allow 73 percent of their pregnancies to proceed to a live birth. One medical benefit to a population practicing induced abortion is that induced abortions avert some spontaneous abortions, leading to a lower mean gestational duration at the time of spontaneous abortion. PMID:1594736

Diagnostic accuracy of FEV1/forced vital capacity ratio z scores in asthmatic patients.

PubMed

Lambert, Allison; Drummond, M Bradley; Wei, Christine; Irvin, Charles; Kaminsky, David; McCormack, Meredith; Wise, Robert

2015-09-01

The FEV1/forced vital capacity (FVC) ratio is used as a criterion for airflow obstruction; however, the test characteristics of spirometry in the diagnosis of asthma are not well established. The accuracy of a test depends on the pretest probability of disease. We wanted to estimate the FEV1/FVC ratio z score threshold with optimal accuracy for the diagnosis of asthma for different pretest probabilities. Asthmatic patients enrolled in 4 trials from the Asthma Clinical Research Centers were included in this analysis. Measured and predicted FEV1/FVC ratios were obtained, with calculation of z scores for each participant. Across a range of asthma prevalences and z score thresholds, the overall diagnostic accuracy was calculated. One thousand six hundred eight participants were included (mean age, 39 years; 71% female; 61% white). The mean FEV1 percent predicted value was 83% (SD, 15%). In a symptomatic population with 50% pretest probability of asthma, optimal accuracy (68%) is achieved with a z score threshold of -1.0 (16th percentile), corresponding to a 6 percentage point reduction from the predicted ratio. However, in a screening population with a 5% pretest probability of asthma, the optimum z score is -2.0 (second percentile), corresponding to a 12 percentage point reduction from the predicted ratio. These findings were not altered by markers of disease control. Reduction of the FEV1/FVC ratio can support the diagnosis of asthma; however, the ratio is neither sensitive nor specific enough for diagnostic accuracy. When interpreting spirometric results, consideration of the pretest probability is an important consideration in the diagnosis of asthma based on airflow limitation. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Acceptance of family planning methods by induced abortion seekers: An observational study over five years.

PubMed

Kathpalia, S K

2016-01-01

Prior to legalization of abortion, induced abortions were performed in an illegal manner and that resulted in many complications hence abortion was legalized in India in 1971 and the number of induced abortions has been gradually increasing since then. One way of preventing abortions is to provide family planning services to these abortion seekers so that same is not repeated. The study was performed to find out the acceptance of contraception after abortion. A prospective study was performed over a period of five years from 2010 to 2014. The study group included all the cases reporting for abortion. A proforma was filled in detail to find out the type of contraception being used before pregnancy and acceptance of contraception after abortion. The existing facilities were also evaluated. 1228 abortions were performed over a period of five years. 94.5% of abortions were during the first trimester. 39.9% had not used any contraceptive before, contraceptives used were natural and barrier which had high failure. The main indication for seeking abortion was failure of contraception and completion of family. 39.6% of patients accepted sterilization as a method of contraception. The existing post abortion family planning services are inadequate. Post abortion period is one which is important to prevent subsequent abortions and family planning services after abortion need to be strengthened.

Abortion Incidence and Unintended Pregnancy in Nepal.

PubMed

Puri, Mahesh; Singh, Susheela; Sundaram, Aparna; Hussain, Rubina; Tamang, Anand; Crowell, Marjorie

2016-12-01

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. 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. 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. 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.

Acceptance of family planning methods by induced abortion seekers: An observational study over five years

PubMed Central

Kathpalia, S.K.

2016-01-01

Background Prior to legalization of abortion, induced abortions were performed in an illegal manner and that resulted in many complications hence abortion was legalized in India in 1971 and the number of induced abortions has been gradually increasing since then. One way of preventing abortions is to provide family planning services to these abortion seekers so that same is not repeated. The study was performed to find out the acceptance of contraception after abortion. Methods A prospective study was performed over a period of five years from 2010 to 2014. The study group included all the cases reporting for abortion. A proforma was filled in detail to find out the type of contraception being used before pregnancy and acceptance of contraception after abortion. The existing facilities were also evaluated. Results 1228 abortions were performed over a period of five years. 94.5% of abortions were during the first trimester. 39.9% had not used any contraceptive before, contraceptives used were natural and barrier which had high failure. The main indication for seeking abortion was failure of contraception and completion of family. 39.6% of patients accepted sterilization as a method of contraception. The existing post abortion family planning services are inadequate. Conclusion Post abortion period is one which is important to prevent subsequent abortions and family planning services after abortion need to be strengthened. PMID:26900216

Abortion Incidence and Unintended Pregnancy in Nepal

PubMed Central

Puri, Mahesh; Singh, Susheela; Sundaram, Aparna; Hussain, Rubina; Tamang, Anand; Crowell, Marjorie

2017-01-01

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. PMID:28825899

Acquisition of decision making criteria: reward rate ultimately beats accuracy.

PubMed

Balci, Fuat; Simen, Patrick; Niyogi, Ritwik; Saxe, Andrew; Hughes, Jessica A; Holmes, Philip; Cohen, Jonathan D

2011-02-01

Speed-accuracy trade-offs strongly influence the rate of reward that can be earned in many decision-making tasks. Previous reports suggest that human participants often adopt suboptimal speed-accuracy trade-offs in single session, two-alternative forced-choice tasks. We investigated whether humans acquired optimal speed-accuracy trade-offs when extensively trained with multiple signal qualities. When performance was characterized in terms of decision time and accuracy, our participants eventually performed nearly optimally in the case of higher signal qualities. Rather than adopting decision criteria that were individually optimal for each signal quality, participants adopted a single threshold that was nearly optimal for most signal qualities. However, setting a single threshold for different coherence conditions resulted in only negligible decrements in the maximum possible reward rate. Finally, we tested two hypotheses regarding the possible sources of suboptimal performance: (1) favoring accuracy over reward rate and (2) misestimating the reward rate due to timing uncertainty. Our findings provide support for both hypotheses, but also for the hypothesis that participants can learn to approach optimality. We find specifically that an accuracy bias dominates early performance, but diminishes greatly with practice. The residual discrepancy between optimal and observed performance can be explained by an adaptive response to uncertainty in time estimation.

Exploring pregnancy termination experiences and needs among Malaysian women: A qualitative study

PubMed Central

2012-01-01

Background Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. Methods Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women’s experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. Results Thirty-one women, with ages ranging from 21–43 years (mean 30.16 ±6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2–8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband’s agreement. In terms of the women’s needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. Conclusions The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs. PMID:22950371

Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014.

PubMed

Jones, Rachel K; Jerman, Jenna

2017-12-01

To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014. We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion. Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years. The decline in abortion was not uniform across all population groups.

Threshold-based segmentation of fluorescent and chromogenic images of microglia, astrocytes and oligodendrocytes in FIJI.

PubMed

Healy, Sinead; McMahon, Jill; Owens, Peter; Dockery, Peter; FitzGerald, Una

2018-02-01

Image segmentation is often imperfect, particularly in complex image sets such z-stack micrographs of slice cultures and there is a need for sufficient details of parameters used in quantitative image analysis to allow independent repeatability and appraisal. For the first time, we have critically evaluated, quantified and validated the performance of different segmentation methodologies using z-stack images of ex vivo glial cells. The BioVoxxel toolbox plugin, available in FIJI, was used to measure the relative quality, accuracy, specificity and sensitivity of 16 global and 9 local threshold automatic thresholding algorithms. Automatic thresholding yields improved binary representation of glial cells compared with the conventional user-chosen single threshold approach for confocal z-stacks acquired from ex vivo slice cultures. The performance of threshold algorithms varies considerably in quality, specificity, accuracy and sensitivity with entropy-based thresholds scoring highest for fluorescent staining. We have used the BioVoxxel toolbox to correctly and consistently select the best automated threshold algorithm to segment z-projected images of ex vivo glial cells for downstream digital image analysis and to define segmentation quality. The automated OLIG2 cell count was validated using stereology. As image segmentation and feature extraction can quite critically affect the performance of successive steps in the image analysis workflow, it is becoming increasingly necessary to consider the quality of digital segmenting methodologies. Here, we have applied, validated and extended an existing performance-check methodology in the BioVoxxel toolbox to z-projected images of ex vivo glia cells. Copyright © 2017 Elsevier B.V. All rights reserved.

Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients.

PubMed

Giraldo-Cadavid, Luis F; Burguete, Javier; Rueda, Felipe; Galvis, Ana M; Castaneda, Natalia; Arbulu, Mario; Balaguera, Jorge I; Paez, Nelson; Fernandez, Secundino

2018-02-01

Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for associations with major alterations in swallowing safety (pharyngeal residues, penetration, and aspiration). We evaluated the discriminative capacity of the LPMS test using ROC curves and the area under the curve (AUC-ROC) and its relationship with the eight-point penetration-aspiration scale (PAS) using the Spearman's ρ correlation coefficient (SCC). We found a positive correlation between the PAS and LART (SCC 0.47; P < 0.001), CRT (SCC 0.46; P < 0.001) and GRT (SCC 0.34; P = 0.002). The AUC-ROC values for detecting a PAS ≥7 were as follows: LART, 0.83 (P < 0.0001); CRT, 0.79 (P < 0.0001); GRT, 0.72 (P < 0.0001). In this study, the LPEER showed good accuracy for evaluating LPMS. These results justify further validation studies in independent populations.

"Sometimes they used to whisper in our ears": health care workers' perceptions of the effects of abortion legalization in Nepal.

PubMed

Puri, Mahesh; Lamichhane, Prabhat; Harken, Tabetha; Blum, Maya; Harper, Cynthia C; Darney, Philip D; Henderson, Jillian T

2012-04-20

Unsafe abortion has been a significant cause of maternal morbidity and mortality in Nepal. Since legalization in 2002, more than 1,200 providers have been trained and 487 sites have been certified for the provision of safe abortion services. Little is known about health care workers' views on abortion legalization, such as their perceptions of women seeking abortion and the implications of legalization for abortion-related health care. To complement a quantitative study of the health effects of abortion legalization in Nepal, we conducted 35 in-depth interviews with physicians, nurses, counsellors and hospital administrators involved in abortion care and post-abortion complication treatment services at four major government hospitals. Thematic analysis techniques were used to analyze the data. Overall, participants had positive views of abortion legalization - many believed the severity of abortion complications had declined, contributing to lower maternal mortality and morbidity in the country. A number of participants indicated that the proportion of women obtaining abortion services from approved health facilities was increasing; however, others noted an increase in the number of women using unregulated medicines for abortion, contributing to rising complications. Some providers held negative judgments about abortion patients, including their reasons for abortion. Unmarried women were subject to especially strong negative perceptions. A few of the health workers felt that the law change was encouraging unmarried sexual activity and carelessness around pregnancy prevention and abortion, and that repeat abortion was becoming a problem. Many providers believed that although patients were less fearful than before legalization, they remained hesitant to disclose a history of induced abortion for fear of judgment or mistreatment. Providers were generally positive about the implications of abortion legalization for the country and for women. A focus on family planning and post-abortion counselling may be welcomed by providers concerned about multiple abortions. Some of the negative judgments of women held by providers could be tempered through values-clarification training, so that women are supported and comfortable sharing their abortion history, improving the quality of post-abortion treatment of complications.

“Sometimes they used to whisper in our ears”: health care workers’ perceptions of the effects of abortion legalization in Nepal

PubMed Central

2012-01-01

Background Unsafe abortion has been a significant cause of maternal morbidity and mortality in Nepal. Since legalization in 2002, more than 1,200 providers have been trained and 487 sites have been certified for the provision of safe abortion services. Little is known about health care workers’ views on abortion legalization, such as their perceptions of women seeking abortion and the implications of legalization for abortion-related health care. Methods To complement a quantitative study of the health effects of abortion legalization in Nepal, we conducted 35 in-depth interviews with physicians, nurses, counsellors and hospital administrators involved in abortion care and post-abortion complication treatment services at four major government hospitals. Thematic analysis techniques were used to analyze the data. Results Overall, participants had positive views of abortion legalization – many believed the severity of abortion complications had declined, contributing to lower maternal mortality and morbidity in the country. A number of participants indicated that the proportion of women obtaining abortion services from approved health facilities was increasing; however, others noted an increase in the number of women using unregulated medicines for abortion, contributing to rising complications. Some providers held negative judgments about abortion patients, including their reasons for abortion. Unmarried women were subject to especially strong negative perceptions. A few of the health workers felt that the law change was encouraging unmarried sexual activity and carelessness around pregnancy prevention and abortion, and that repeat abortion was becoming a problem. Many providers believed that although patients were less fearful than before legalization, they remained hesitant to disclose a history of induced abortion for fear of judgment or mistreatment. Conclusions Providers were generally positive about the implications of abortion legalization for the country and for women. A focus on family planning and post-abortion counselling may be welcomed by providers concerned about multiple abortions. Some of the negative judgments of women held by providers could be tempered through values-clarification training, so that women are supported and comfortable sharing their abortion history, improving the quality of post-abortion treatment of complications. PMID:22520231

STS-1 operational flight profile. Volume 6: Abort analysis

NASA Technical Reports Server (NTRS)

1980-01-01

The abort analysis for the cycle 3 Operational Flight Profile (OFP) for the Space Transportation System 1 Flight (STS-1) is defined, superseding the abort analysis previously presented. Included are the flight description, abort analysis summary, flight design groundrules and constraints, initialization information, general abort description and results, abort solid rocket booster and external tank separation and disposal results, abort monitoring displays and discussion on both ground and onboard trajectory monitoring, abort initialization load summary for the onboard computer, list of the key abort powered flight dispersion analysis.

Legalized abortion: a public health success story.

PubMed

Kelly, M

1999-06-01

60% of more than 2000 women surveyed by the Picker Institute who underwent induced abortion procedures rated the quality of their care as excellent. Another third reported their care as being either very good or good. The survey also found that the quality of abortion care is comparable to other outpatient surgery. However, the high quality of care women receive from abortion providers is lost in the hostile anti-abortion climate created by threatening protesters outside of clinics and the murder of 7 clinic workers and physicians who performed abortions. Abortion opponents fail to acknowledge that legal abortion is a medical procedure which protects women's health and saves their lives. Before abortion was legalized in the US, countless women were either rendered unable to reproduce or died from abortion-related complications. Efforts to outlaw abortion persist despite it being widely recognized by medical experts as one of the most safe medical procedures currently performed in the US. When state legislatures target abortion providers with unduly strict regulations, abortion becomes prohibitively expensive and difficult to obtain.

Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy.

PubMed

Korjamo, Riina; Heikinheimo, Oskari; Mentula, Maarit

2018-04-01

To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion. retrospective cohort study of 666 women who underwent medical abortion between January-May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014. During the 21 months ([median], IQR 20-22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68-2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06-0.48). When adjusted for LARC initiation status, age <25 years was a risk factor for subsequent abortion (27 abortions/283 women, 9.5%) compared to women ≥25 years (27/383, 7.0%, HR1.95, 95% CI 1.04-3.67). Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.

Abortion trends from 1996 to 2011 in Estonia: special emphasis on repeat abortion

PubMed Central

2014-01-01

Background The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia. Methods Data were retrieved from the Estonian Medical Birth and Abortion Registry and Statistics Estonia. Total induced abortion numbers, rates, ratios and age-specific rates are presented for 1996–2011. The percentage change in the number of repeat abortions within selected socio-demographic subgroups, contraception use and distribution of induced abortions among Estonians and non-Estonians for the first, second, third, fourth and subsequent abortions were calculated for the periods 1996–2003 and 2004–2011. Results Observed trends over the 16-year study period indicated a considerable decline in induced abortions with a reduction in abortion rate of 57.1%, which was mainly attributed to younger cohorts. The percentage of women undergoing repeat abortions fell steadily from 63.8% during 1996–2003 to 58.0% during 2004–2011. The percentage of women undergoing repeat abortions significantly decreased over the 16 years within all selected socio-demographic subgroups except among women with low educational attainment and students. Within each time period, a greater percentage of non-Estonians than Estonians underwent repeat abortions and obtained third and subsequent abortions. Most women did not use any contraceptive method prior to their first or subsequent abortion. Conclusion A high percentage of women obtaining repeat abortions reflects a high historical abortion rate. If current trends continue, a rapid decline in repeat abortions may be predicted. To decrease the burden of sexual ill health, routine contraceptive counselling, as standard care in the abortion process, should be seriously addressed with an emphasis on those groups - non-Estonians, women with lower educational attainment, students and women with children - vulnerable with respect to repeat abortion. PMID:25005363

Characteristics of women obtaining induced abortions in selected low- and middle-income countries

PubMed Central

Desai, Sheila; Crowell, Marjorie; Sedgh, Gilda; Singh, Susheela

2017-01-01

Background In 2010–2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions. Objectives To examine the characteristics of women obtaining induced abortions in LMICs. Methods We use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC). Results Women across all sociodemographic subgroups obtain abortions. In most countries, women aged 20–29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions. Conclusions These findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this information to improve access to safe abortion services, postabortion care, and contraceptive services. PMID:28355285

An overview of medical abortion for clinical practice.

PubMed

Bryant, Amy G; Regan, Elizabeth; Stuart, Gretchen

2014-01-01

Medical abortion is a safe, convenient, and effective method for terminating an early unintended pregnancy. Medical abortion can be performed up to 63 days from the last menstrual period and may even be used up to 70 days for women who prefer medical abortion over surgical abortion. Counseling on the adverse effects and expectations for medical abortion is critical to success. Medical abortion can be performed in a clinic without special equipment, and it is perceived as more "natural" than a surgical abortion by many women. Follow-up for medical abortion can be simplified to include only serum human chorionic gonadotropin measurements when necessary, although obtaining an ultrasound remains the criterion standard. Pain associated with medical abortion is best treated with nonsteroidal anti-inflammatory medications, possibly in combination with opioid analgesics. Medical abortion can contribute to continuity of care for women who wish to remain with their primary care providers for management of their abortion.

Bayesian estimation of sensitivity and specificity of a milk pregnancy-associated glycoprotein-based ELISA and of transrectal ultrasonographic exam for diagnosis of pregnancy at 28-45 days following breeding in dairy cows.

PubMed

Dufour, Simon; Durocher, Jean; Dubuc, Jocelyn; Dendukuri, Nandini; Hassan, Shereen; Buczinski, Sébastien

2017-05-01

Using a milk sample for pregnancy diagnosis in dairy cattle is extremely convenient due to the low technical inputs required for collection of biological materials. Determining accuracy of a novel pregnancy diagnostic test that relies on a milk sample is, however, difficult since no gold standard test is available for comparison. The objective of the current study was to estimate diagnostic accuracy of the milk PAG-based ELISA and of transrectal ultrasonographic (TUS) exam for determining pregnancy status of individual dairy cows using a methodology suited for test validation in the absence of gold standard. Secondary objectives were to evaluate whether test accuracy varies with cow's characteristics and to identify the optimal ELISA optical density threshold for PAG test interpretation. Cows (n=519) from 18 commercial dairies tested with both TUS and PAG between 28 and 45days following breeding were included in the study. Other covariates (number of days since breeding, parity, and daily milk production) hypothesized to affect TUS or PAG test accuracy were measured. A Bayesian hierarchical latent class model (LCM) methodology assuming conditional independence between tests was used to obtain estimates of tests' sensitivities (Se) and specificities (Sp), to evaluate impact of covariates on these, and to compute misclassification costs across a range of ELISA thresholds. Very little disagreement was observed between tests with only 23 cows yielding discordant results. Using the LCM model with non-informative priors for tests accuracy parameters, median (95% credibility intervals [CI]) TUS Se and Sp estimates of 0.96 (0.91, 1.00) and 0.99 (0.97, 1.0) were obtained. For the PAG test, median (95% CI) Se of 0.99 (0.98, 1.00) and Sp of 0.95 (0.89, 1.0) were observed. The impact of adjusting for conditional dependence between tests was negligible. Test accuracy of the PAG test varied slightly by parity number. When assuming false negative to false positive costs ratio≥3:1, the optimal ELISA optical density threshold allowing minimization of misclassification costs was 0.25. In conclusion, both TUS and PAG showed excellent accuracy for pregnancy diagnosis in dairy cows. When using the PAG test, a threshold of 0.25 could be used for test interpretation. Copyright © 2017 Elsevier B.V. All rights reserved.

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia.

PubMed

Sully, Elizabeth; Dibaba, Yohannes; Fetters, Tamara; Blades, Nakeisha; Bankole, Akinrinola

2018-06-01

The 2005 expansion of the Ethiopian abortion law provided minors access to legal abortions, yet little is known about abortion among adolescents. This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014. This paper uses data from three surveys: a Health Facility Survey (n = 822) to collect data on legal abortions and postabortion complications, a Health Professionals Survey (n = 82) to estimate the share of clandestine abortions that resulted in treated complications, and a Prospective Data Survey (n = 5,604) to collect data on abortion care clients. An age-specific variant of the Abortion Incidence Complications Method was used to estimate abortions by age-group. Adolescents have the lowest abortion rate among all women below age 35 (19.6 per 1,000 women). After adjusting for lower levels of sexual activity among adolescents however, we find that adolescents have the highest abortion rate among all age-groups. Adolescents also have the highest proportion (64%) of legal abortions compared with other age-groups. We find no differences in the severity of abortion-related complications between adolescent and nonadolescent women. We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available. Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Abortion surveillance--United States, 1992.

PubMed

Koonin, L M; Smith, J C; Ramick, M; Green, C A

1996-05-03

From 1980 through 1992, the number of legal induced abortions reported to the CDC remained stable, varying each year by < or = 5%. This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1992. This report also includes recently reported abortion-related deaths for 1988-1991 and an update on abortion-related deaths for 1985-1987. For each year since 1969, CDC has compiled abortion data received from 52 reporting areas (i.e., the 50 states, the District of Columbia, and New York City). In 1992, 1,359,145 abortions were reported--a 2.1% decrease from 1991. The abortion ratio was 335 legal induced abortions per 1,000 live births, and the abortion rate was 23 per 1,000 women 15-44 years of age. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most had had no previous live births and were obtaining an abortion for the first time. More than half (51%) of all abortions were performed at or before the 8th week of gestation, and 87% were before the 13th week. Approximately 14% of abortions were performed at < or = 6 weeks of gestation, 15% were performed at 7 weeks of gestation, and 22% at 8 weeks of gestation. Younger women (i.e., women < or = 19 years of age) were more likely to obtain abortions later in pregnancy than were older women. Sixteen deaths in 1988, 12 deaths in 1989, and five deaths in 1990 were associated with legal induced abortion. The case-fatality rates for 1988, 1989, and 1990, respectively, were 1.2, 0.9, and 0.3 abortion-related deaths per 100,000 legal induced abortions. Since 1980, the number and rate of abortions have remained relatively stable, with only small year-to-year fluctuations of < or = 5%. However, since 1987, the abortion-to-live-birth ratio has declined; in 1992, the abortion ratio was the lowest recorded since 1977. More pregnant women have been opting to carry their pregnancies to term rather than choosing to have an abortion. As in previous years, deaths associated with legal induced abortions occurred rarely (i.e., one or fewer deaths per 100,000 legal induced abortions). The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that efforts to prevent unintended pregnancy can be assessed and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.

Destigmatising abortion: expanding community awareness of abortion as a reproductive health issue in Ghana.

PubMed

Lithur, Nana Oye

2004-04-01

Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performance of abortion in three circumstances, the Ghana reproductive health service policy did not have any induced legal abortion services component to cover the three exceptions until it was revised in 2003. The policy only had 'unsafe and post-abortion' care components, and abortions performed in health facilities operated by the Ghana Health Service were performed under this component. Though the policy has been revised, women and girls who need abortion services in Ghana more often resort to the backstreet dangerous methods and procedures. Criminalisation of abortion and those who perform abortions has contributed to unsafe abortion, the second leading cause of maternal deaths in Ghana. Most of these are performed outside the formal health service structures. Traditionally, abortion is perceived as a shameful act and the community may shun and give a woman who has caused anabortion derogatory names. Would provision of legal abortion services be culturally acceptable within a Ghanaian community? Yes, if they are made aware of the reproductive health benefits of providing safe abortion services. Three major strategies that would help to destigmatise abortion in the community are (1) the liberal interpretation of the three exceptions to the law on abortion; (2) expanding community awareness of its reproductive health benefits; and (3) improving and increasing access to legal abortion services within the formal health facilities.

Psychosocial factors and pre-abortion psychological health: The significance of stigma

PubMed Central

Steinberg, Julia R.; Tschann, Jeanne M.; Furgerson, Dorothy; Harper, Cynthia C.

2016-01-01

Rationale Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. Objective This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted. Methods The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma. Results Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6 %, 20.7 %, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2 %, 9.7 %, and 10.7 % of the variance in depressive, anxiety, and stress symptoms pre-abortion. Conclusion This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological distress. PMID:26735332

Psychosocial factors and pre-abortion psychological health: The significance of stigma.

PubMed

Steinberg, Julia R; Tschann, Jeanne M; Furgerson, Dorothy; Harper, Cynthia C

2016-02-01

Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted. The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma. Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion. This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological distress. Copyright © 2015 Elsevier Ltd. All rights reserved.

Incidence of Induced Abortion and Post-Abortion Care in Tanzania.

PubMed

Keogh, Sarah C; Kimaro, Godfather; Muganyizi, Projestine; Philbin, Jesse; Kahwa, Amos; Ngadaya, Esther; Bankole, Akinrinola

2015-01-01

Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence. To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar). A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology. In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15-49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone. The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies.

Contraception and induced abortion in the West Indies: a review.

PubMed

Boersma, A A; de Bruijn, J G M

2011-10-01

Most islands in the West Indies do not have liberal laws on abortion, nor laws on pregnancy prevention programmes (contraception). We present results of a literature review about the attitude of healthcare providers and women toward (emergency) contraception and induced abortion, prevalence, methods and juridical aspects of induced abortion and prevention policies. Articles were obtained from PubMed, EMBASE, MEDLINE, PsychlNFO and Soclndex (1999 to 2010) using as keywords contraception, induced abortion, termination of pregnancy, medical abortion and West Indies. Thirty-seven articles met the inclusion criteria: 18 on contraception, 17 on induced abortion and two on both subjects. Main results indicated that healthcare providers' knowledge of emergency contraception was low. Studies showed a poor knowledge of contraception, but counselling increased its effective use. Exact numbers about prevalence of abortion were not found. The total annual number of abortions in the West Indies is estimated at 300 000; one in four pregnancies ends in an abortion. The use of misoprostol diminished the complications of unsafe abortions. Legislation of abortion varies widely in the different islands in the West Indies: Cuba, Puerto Rico, Martinique, Guadeloupe and St Martin have legal abortions. Barbados was the first English-speaking island with liberal legislation on abortion. All other islands have restrictive laws. Despite high estimated numbers of abortion, research on prevalence of abortion is missing. Studies showed a poor knowledge of contraception and low use among adolescents. Most West Indian islands have restrictive laws on abortion.

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia.

PubMed

Fetters, Tamara; Samandari, Ghazaleh; Djemo, Patrick; Vwallika, Bellington; Mupeta, Stephen

2017-02-16

Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation. An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country's abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships. After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47% after the intervention. Despite progress in attitudes towards abortion clients, such as empathy, and improved community engagement, the evaluation revealed continuing stigma on both provider and client sides. These findings provide a case study of the medical abortion introduction in Zambia and offer important lessons for expanding safe and legal abortion access in similar settings across Africa.

Induced abortion: incidence and trends worldwide from 1995 to 2008.

PubMed

Sedgh, Gilda; Singh, Susheela; Shah, Iqbal H; Ahman, Elisabeth; Henshaw, Stanley K; Bankole, Akinrinola

2012-02-18

Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003. We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based largely on official statistics and nationally representative surveys. Unsafe abortion estimates were based primarily on information from published studies, hospital records, and surveys of women. We used additional sources and systematic approaches to make corrections and projections as needed where data were misreported, incomplete, or from earlier years. We assessed trends in abortion incidence using rates developed for 1995, 2003, and 2008 with the same methodology. We used linear regression models to explore the association of the legal status of abortion with the abortion rate across subregions of the world in 2008. The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15-44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05). The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals. UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Automated tumour boundary delineation on 18F-FDG PET images using active contour coupled with shifted-optimal thresholding method

NASA Astrophysics Data System (ADS)

Khamwan, Kitiwat; Krisanachinda, Anchali; Pluempitiwiriyawej, Charnchai

2012-10-01

This study presents an automatic method to trace the boundary of the tumour in positron emission tomography (PET) images. It has been discovered that Otsu's threshold value is biased when the within-class variances between the object and the background are significantly different. To solve the problem, a double-stage threshold search that minimizes the energy between the first Otsu's threshold and the maximum intensity value is introduced. Such shifted-optimal thresholding is embedded into a region-based active contour so that both algorithms are performed consecutively. The efficiency of the method is validated using six sphere inserts (0.52-26.53 cc volume) of the IEC/2001 torso phantom. Both spheres and phantom were filled with 18F solution with four source-to-background ratio (SBR) measurements of PET images. The results illustrate that the tumour volumes segmented by combined algorithm are of higher accuracy than the traditional active contour. The method had been clinically implemented in ten oesophageal cancer patients. The results are evaluated and compared with the manual tracing by an experienced radiation oncologist. The advantage of the algorithm is the reduced erroneous delineation that improves the precision and accuracy of PET tumour contouring. Moreover, the combined method is robust, independent of the SBR threshold-volume curves, and it does not require prior lesion size measurement.

Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal.

PubMed

Suh, Siri

2018-06-01

Reproductive governance operates through calculating demographic statistics that offer selective truths about reproductive practices, bodies, and subjectivities. Post-abortion care, a global reproductive health intervention, represents a transnational reproductive regime that establishes motherhood as women's primary legitimate reproductive status. Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I illustrate how post-abortion care accomplishes reproductive governance in a context where abortion is prohibited altogether and the US is the primary bilateral donor of population aid. Reproductive governance unfolds in hospital gynecological wards and the national health information system through the mobilization and interpretation of post-abortion care data. Although health workers search women's bodies and behavior for signs of illegal abortion, they minimize police intervention in the hospital by classifying most post-abortion care cases as miscarriage. Health authorities deploy this account of post-abortion care to align the intervention with national and global maternal health policies that valorize motherhood. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma by scrutinizing women's bodies and masking induced abortion within and beyond the hospital. Post-abortion care reinforces reproductive inequities by withholding safe, affordable obstetric care from women until after they have resorted to unsafe abortion.

Characteristics of private abortion services in Mexico City after legalization.

PubMed

Schiavon, Raffaela; Collado, Maria Elena; Troncoso, Erika; Soto Sánchez, José Ezequiel; Zorrilla, Gabriela Otero; Palermo, Tia

2010-11-01

In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157-505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Abortion surveillance--United States, 1997.

PubMed

Koonin, L M; Strauss, L T; Chrisman, C E; Parker, W Y

2000-12-08

In 1969, CDC began abortion surveillance to document the number and characteristics of women obtaining legal induced abortions, to monitor unintended pregnancy, and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions. This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States in 1997. For each year since 1969, CDC has compiled abortion data by state where the abortion occurred. The data are received from 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1997, a total of 1,186,039 legal abortions were reported to CDC, representing a 3% decrease from the number reported for 1996. The abortion ratio was 306 legal induced abortions per 1,000 live births, and since 1995, the abortion rate has remained at 20 per 1,000 women aged 15-44 years. The availability of information about characteristics of women who obtained an abortion in 1997 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions by state is reported by state of residence and state of occurrence; characteristics of women obtaining abortions in 1997 are reported by state of occurrence. Women who were undergoing an abortion were more likely to be young (i.e., aged < 25 years), white, and unmarried; approximately one half were obtaining an abortion for the first time. More than one half of all abortions for which gestational age was reported (55%) were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. Overall, 18% of abortions were performed at the earliest weeks of gestation (< or = 6 weeks), 18% at 7 weeks of gestation, and 20% at 8 weeks of gestation. From 1992 through 1997, increases have occurred in the percentage of abortions performed at the very early weeks of gestation. Few abortions were provided after 15 weeks of gestation--4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained at > or = 21 weeks. A total of 19 reporting areas submitted information regarding abortions performed by medical (nonsurgical) procedures, comprising < 1% of procedures reported by all states. Younger women (i.e., aged < or = 24 years) were more likely to obtain abortions later in pregnancy than were older women. From 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, and in 1997, the number of abortions in the United States declined to it lowest level since 1978. The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed and efforts to prevent unintended pregnancy can be evaluated.

Abortion surveillance - United States, 2010.

PubMed

Pazol, Karen; Creanga, Andreea A; Burley, Kim D; Hayes, Brenda; Jamieson, Denise J

2013-11-29

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2010. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2010, data were received from 49 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 46 areas that reported data every year during 2001-2010. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 765,651 abortions were reported to CDC for 2010. Of these abortions, 753,065 (98.4%) were from the 46 reporting areas that provided data every year during 2001-2010. Among these same 46 reporting areas, the abortion rate for 2010 was 14.6 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 228 abortions per 1,000 live births. Compared with 2009, the total number and rate of reported abortions for 2010 decreased 3% and reached the lowest levels for the entire period of analysis (2001-2010); the abortion ratio was stable, changing only 0.4%. From 2001 to 2010, the total number, rate, and ratio of reported abortions decreased 9%, 10%, and 8%, respectively. Given the 3% decrease from 2009 to 2010 in the total number and rate of reported abortions, in combination with the 5% decrease that had occurred in the previous year from 2008 to 2009, the overall decrease for both measures was greater during 2006-2010 than during 2001-2005, despite the annual variations that resulted in no net decrease during 2006-2008. In 2010 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2010, women aged 20-24 and 25-29 years accounted for 32.9% and 24.5% of all abortions, respectively, and had abortion rates of 26.7 and 20.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 15.3%, 8.9%, and 3.4% of all abortions, respectively, and had abortion rates of 13.2, 7.6, and 2.8 abortions per 1,000 women aged 30-34 years, 35-39 years, ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20-24 and 25-29 years, whereas they increased among women aged ≥40 years. In 2010, adolescents aged 15-19 years accounted for 14.6% of all abortions and had an abortion rate of 11.7 abortions per 1,000 adolescents aged 15-19 years. Throughout the period of analysis, the percentage of all abortions accounted for by adolescents and the adolescent abortion rate decreased. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2010 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2001 to 2010 for women in all age groups except for those aged <15 years, for whom they increased. In 2010, most (65.9%) abortions were performed at ≤8 weeks' gestation, and 91.9% were performed at ≤13 weeks' gestation. Few abortions (6.9%) were performed at 14-20 weeks' gestation, and even fewer (1.2%) were performed at ≥21 weeks' gestation. From 2001 to 2010, the percentage of all abortions performed at ≤8 weeks' gestation increased 10%, whereas the percentage performed at >13 weeks' decreased 10%. Moreover, among abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of these abortions performed at ≤6 weeks' gestation increasing 36%. In 2010, a total of 72.4% of abortions were performed by curettage at ≤13 weeks' gestation, 17.7% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.3% were performed by curettage at >13 weeks' gestation. Among abortions that were performed at ≤8 weeks' gestation, and thus were eligible for early medical abortion on the basis of gestational age, 26.5% were completed by this method. From 2009 to 2010, the use of early medical abortion increased 13%. Deaths of women associated with complications from abortions for 2010 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2009, the most recent year for which data were available, eight women were identified to have died as a result of complications from known legal induced abortions. No reported deaths were associated with illegal induced abortions. Among the 46 areas that reported data every year during 2001-2010, the gradual decrease that had occurred during previous decades in the total number and rate of reported abortions continued through 2005, whereas year-to-year variation from 2006 to 2008 resulted in no net change during this later period. However, the large decreases that occurred both from 2008 to 2009 and from 2009 to 2010 resulted in a greater overall decrease during 2006-2010 as compared with 2001-2005 and the lowest number and rate of reported abortions for the entire period of analysis. Unintended pregnancy is the major contributor to abortion. Because unintended pregnancies are rare among women who use the most effective methods of reversible contraception, increasing access to and use of these methods can help further reduce the number of abortions performed in the United States. The data in this report can help program planners and policy makers identify groups of women at greatest risk for unintended pregnancy and help guide and evaluate prevention efforts.

Abortion surveillance--United States, 1998.

PubMed

Herndon, Joy; Strauss, Lilo T; Whitehead, Sara; Parker, Wilda Y; Bartlett, Linda; Zane, Suzanne

2002-06-07

In 1969, CDC began abortion surveillance to document the number and characteristics of women obtaining legal induced abortions, to monitor unintended pregnancy, and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions. This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States in 1998. For each year since 1969, CDC has compiled abortion data by occurrence. From 1973 to 1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998, CDC compiled abortion data from only 48 reporting areas; Alaska, California, New Hampshire, and Oklahoma did not report. In 1998, 884,273 legal induced abortions were reported to CDC, representing a 2% decrease from the 900,171 legal induced abortions reported by the same 48 reporting areas for 1997. The abortion ratio, defined as the number of abortions per 1,000 live births, was 264, compared with 274 in 1997 (for the same 48 areas); the abortion rate for these 48 areas was 17 per 1,000 women aged 15-44 years for both 1997 and 1998. The availability of information about characteristics of women who obtained an abortion in 1998 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions by state is reported by state of residence and state of occurrence; characteristics of women obtaining abortions in 1998 are reported by state of occurrence. Women undergoing an abortion were likely to be young (i.e., age < 25 years), white, and unmarried; slightly more than one half were obtaining an abortion for the first time. Of all abortions for which gestational age was reported, 56% were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. Overall, 19% of abortions were performed at the earliest weeks of gestation (< or = 6 weeks), 18% at 7 weeks, and 19% at 8 weeks. From 1992 (when this information was first collected) through 1998, an increasing percentage of abortions were performed at the very early weeks of gestation. Few abortions were provided after 15 weeks of gestation; 4% were obtained at 16-20 weeks, and 1.4% were obtained at > or = 21 weeks. A total of 24 reporting areas submitted information stating that they performed medical (nonsurgical) procedures (two of these areas categorized medical abortions with "other" procedures), making up < 1% of all procedures reported from all states. From 1993 through 1997 (years for which data have not been published previously and the most recent years for which such data are available), 36 women died as a result of complications from known legal induced abortion, and three deaths were associated with known illegal abortion. The annual case-fatality rate of legal induced abortion ranged from 0.3 to 0.8 abortion-related deaths per 100,000 reported legal induced abortions. From 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, but in 1997, it declined to its lowest level since 1978. In 1998, the number of abortions continued to decrease when comparing the 48 reporting areas. In 1997, as in previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTIONS TAKEN: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed and efforts to prevent unintended pregnancy can be evaluated.

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016

PubMed Central

Kayembe, Patrick K.; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

Background In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Objectives Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. Methods We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. Results In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49. Conclusions Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality. PMID:28968414

Telling stories about abortion: abortion-related plots in American film and television, 1916-2013.

PubMed

Sisson, Gretchen; Kimport, Katrina

2014-05-01

Popular discourse on abortion in film and television assumes that abortions are under- and misrepresented. Research indicates that such representations influence public perception of abortion care and may play a role in the production of social myths around abortion, with consequences for women's experience of abortion. To date, abortion plotlines in American film and television have not been systematically tracked and analyzed. A comprehensive online search was conducted to identify all representations of pregnancy decision making and abortion in American film and television through January 2013. Search results were coded for year, pregnancy decision and mortality outcome. A total of 310 plotlines were identified, with an overall upward trend over time in the number of representations of abortion decision making. Of these plotlines, 173 (55.8%) resulted in abortion, 80 (25.8%) in parenting, 13 (4.2%) in adoption and 21 (6.7%) in pregnancy loss, and 16 (5.1%) were unresolved. A total of 13.5% (n=42) of stories ended with the death of the woman who considered an abortion, whether or not she obtained one. Abortion-related plotlines occur more frequently than popular discourse assumes. Year-to-year variation in frequency suggests an interactive relationship between media representations, cultural attitudes and policies around abortion regulation, consistent with cultural theory of the relationship between media products and social beliefs. Patterns of outcomes and rates of mortality are not representative of real experience and may contribute to social myths around abortion. The narrative linking of pregnancy termination with mortality is of particular note, supporting the social myth associating abortion with death. This analysis empirically describes the number of abortion-related plotlines in American film and television. It contributes to the systematic evaluation of the portrayal of abortion in popular culture and provides abortion care professionals and advocates with an initial accurate window into cultural stories being told about abortion. Copyright © 2014 Elsevier Inc. All rights reserved.

A Study of Incomplete Abortion Following Medical Method of Abortion (MMA).

PubMed

Pawde, Anuya A; Ambadkar, Arun; Chauhan, Anahita R

2016-08-01

Medical method of abortion (MMA) is a safe, efficient, and affordable method of abortion. However, incomplete abortion is a known side effect. To study incomplete abortion due to medication abortion and compare to spontaneous incomplete abortion and to study referral practices and prescriptions in cases of incomplete abortion following MMA. Prospective observational study of 100 women with first trimester incomplete abortion, divided into two groups (spontaneous or following MMA), was administered a questionnaire which included information regarding onset of bleeding, treatment received, use of medications for abortion, its prescription, and administration. Comparison of two groups was done using Fisher exact test (SPSS 21.0 software). Thirty percent of incomplete abortions were seen following MMA; possible reasons being self-administration or prescription by unregistered practitioners, lack of examination, incorrect dosage and drugs, and lack of follow-up. Complications such as collapse, blood requirement, and fever were significantly higher in these patients compared to spontaneous abortion group. The side effects of incomplete abortions following MMA can be avoided by the following standard guidelines. Self medication, over- the-counter use, and prescription by unregistered doctors should be discouraged and reported, and need of follow-up should be emphasized.

Optimal Binarization of Gray-Scaled Digital Images via Fuzzy Reasoning

NASA Technical Reports Server (NTRS)

Dominguez, Jesus A. (Inventor); Klinko, Steven J. (Inventor)

2007-01-01

A technique for finding an optimal threshold for binarization of a gray scale image employs fuzzy reasoning. A triangular membership function is employed which is dependent on the degree to which the pixels in the image belong to either the foreground class or the background class. Use of a simplified linear fuzzy entropy factor function facilitates short execution times and use of membership values between 0.0 and 1.0 for improved accuracy. To improve accuracy further, the membership function employs lower and upper bound gray level limits that can vary from image to image and are selected to be equal to the minimum and the maximum gray levels, respectively, that are present in the image to be converted. To identify the optimal binarization threshold, an iterative process is employed in which different possible thresholds are tested and the one providing the minimum fuzzy entropy measure is selected.

The incidence of abortion and unintended pregnancy in India, 2015

PubMed Central

Singh, Susheela; Shekhar, Chander; Acharya, Rajib; Moore, Ann M; Stillman, Melissa; Pradhan, Manas R; Frost, Jennifer J; Sahoo, Harihar; Alagarajan, Manoj; Hussain, Rubina; Sundaram, Aparna; Vlassoff, Michael; Kalyanwala, Shveta; Browne, Alyssa

2018-01-01

Summary 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. PMID:29241602

Abortion - surgical

MedlinePlus

Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

Framing a 'social problem': Emotion in anti-abortion activists' depiction of the abortion debate.

PubMed

Ntontis, Evangelos; Hopkins, Nick

2018-02-27

Social psychological research on activism typically focuses on individuals' social identifications. We complement such research through exploring how activists frame an issue as a social problem. Specifically, we explore anti-abortion activists' representation of abortion and the abortion debate's protagonists so as to recruit support for the anti-abortion cause. Using interview data obtained with UK-based anti-abortion activists (N = 15), we consider how activists characterized women having abortions, pro-abortion campaigners, and anti-abortion campaigners. In particular, we consider the varied ways in which emotion featured in the representation of these social actors. Emotion featured in different ways. Sometimes, it was depicted as constituting embodied testament to the nature of reality. Sometimes, it was depicted as blocking the rational appraisal of reality. Our analysis considers how such varied meanings of emotion shaped the characterization of abortion and the abortion debate's protagonists such that anti-abortion activists were construed as speaking for women and their interests. We discuss how our analysis of the framing of issues as social problems complements and extends social psychological analyses of activism. © 2018 The British Psychological Society.

Induced abortion in Italy: levels, trends and characteristics.

PubMed

Bettarini, S S; D'Andrea, S S

1996-01-01

Subsequent to the legalization of abortion in Italy in 1978, abortion; rates among Italian women first rose and then declined steadily, from a peak of 16.9 abortions per 1,000 women of reproductive age in 1983 to 9.8 per 1,000 in 1993. Abortion rates vary considerably by geographic region, with rates typically highest in the more secular and modernized regions and lowest in regions where traditional values predominate. Data from 1981 and 1991 indicate that age-specific abortion rates decreased during the 1980s for all age-groups, with the largest declines occurring in regions with the highest levels of abortion. Moreover, a shift in the age distribution of abortion rates occurred during the 1980s, with women aged 30-34 registering the highest abortion rate in 1991, whereas in 1981 the highest level of abortion occurred among those aged 25-29. The abortion rate among adolescent women was low at both times (7.6 per 1,000 in 1981 and 4.6 per 1,000 in 1991). These data are based only on reported legal abortions; the number of clandestine abortions remains unknown.

Higgs boson gluon-fusion production beyond threshold in N 3LO QCD

DOE PAGES

Anastasiou, Charalampos; Duhr, Claude; Dulat, Falko; ...

2015-03-18

In this study, we compute the gluon fusion Higgs boson cross-section at N 3LO through the second term in the threshold expansion. This calculation constitutes a major milestone towards the full N 3LO cross section. Our result has the best formal accuracy in the threshold expansion currently available, and includes contributions from collinear regions besides subleading corrections from soft and hard regions, as well as certain logarithmically enhanced contributions for general kinematics. We use our results to perform a critical appraisal of the validity of the threshold approximation at N 3LO in perturbative QCD.

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

PubMed Central

Norman, Wendy V.; Soon, Judith A.; Maughn, Nanamma; Dressler, Jennifer

2013-01-01

Background Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC). Methods We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. Results Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. Conclusions Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians. PMID:23840578

Incidence of emergency department visits and complications after abortion.

PubMed

Upadhyay, Ushma D; Desai, Sheila; Zlidar, Vera; Weitz, Tracy A; Grossman, Daniel; Anderson, Patricia; Taylor, Diana

2015-01-01

To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures. Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. II.

Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

PubMed

Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

2015-02-01

The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Decriminalization of abortion in Mexico City: the effects on women's reproductive rights.

PubMed

Becker, Davida; Díaz Olavarrieta, Claudia

2013-04-01

In April 2007, the Mexico City, Mexico, legislature passed landmark legislation decriminalizing elective abortion in the first 12 weeks of pregnancy. In Mexico City, safe abortion services are now available to women through the Mexico City Ministry of Health's free public sector legal abortion program and in the private sector, and more than 89 000 legal abortions have been performed. By contrast, abortion has continued to be restricted across the Mexican states (each state makes its own abortion laws), and there has been an antichoice backlash against the legislation in 16 states. Mexico City's abortion legislation is an important first step in improving reproductive rights, but unsafe abortions will only be eliminated if similar abortion legislation is adopted across the entire country.

Contrast discrimination: Second responses reveal the relationship between the mean and variance of visual signals

PubMed Central

Solomon, Joshua A.

2007-01-01

To explain the relationship between first- and second-response accuracies in a detection experiment, Swets, Tanner, and Birdsall [Swets, J., Tanner, W. P., Jr., & Birdsall, T. G. (1961). Decision processes in perception. Psychological Review, 68, 301–340] proposed that the variance of visual signals increased with their means. However, both a low threshold and intrinsic uncertainty produce similar relationships. I measured the relationship between first- and second-response accuracies for suprathreshold contrast discrimination, which is thought to be unaffected by sensory thresholds and intrinsic uncertainty. The results are consistent with a slowly increasing variance. PMID:17961625

Effect of mifepristone on abortion access in the United States.

PubMed

Finer, Lawrence B; Wei, Junhow

2009-09-01

To examine the pattern of mifepristone uptake in the United States and whether the introduction of this drug has facilitated access to abortion services. Using data from a national census of abortion providers and from the U.S. distributor of mifepristone, we assessed the number and proportion of abortions performed using mifepristone, the distribution of mifepristone providers by provider type and medical specialty, and the geographic distribution of mifepristone and surgical providers. The number of mifepristone providers increased from 208 in the last 2 months of 2000 to 700 in 2001, the first full year of availability, and to 902 in 2007. Some 158,000 mifepristone abortions were performed in 2007, representing an estimated 14% of all abortions and 21% of eligible early abortions. Physicians represented 51% of mifepristone providers but accounted for just 11% of abortions; most were obstetrician-gynecologists. The proportion of abortions in each state performed using mifepristone ranged from 0% to 80%. Most mifepristone abortions were performed at or near facilities that also provided surgical abortion. Only five mifepristone-only providers of 10 or more abortions were located farther than 50 miles from any surgical provider of 400 or more abortions. Mifepristone has become an integral part of abortion provision in the United States and likely has contributed to a trend toward very early abortions. However, expectations that approval of mifepristone would result in a wider range of providers offering abortion have not yet been met, and mifepristone has not brought a major improvement in the geographic availability of abortion. III.

The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal.

PubMed

Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak

2015-02-01

Medical abortion was introduced in Nepal in 2009, but rural women's access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers' knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011-12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Anti-legal attitude toward abortion among abortion patients in the United States.

PubMed

Thomas, Rachel G; Norris, Alison H; Gallo, Maria F

2017-11-01

To measure the prevalence of believing that abortion should be illegal in all or most cases among women obtaining an abortion in the United States and to identify correlates of holding this belief. Study population was drawn from the nationally-representative 2008 Abortion Patient Survey. The primary outcome was having an anti-legal abortion attitude, defined as agreeing that abortion should be illegal in all or most cases. We assessed potential correlates in bivariable and multivariable analyses using weights to account for the complex sampling. A total of 4769 abortion patients completed the survey module containing the question on abortion legality, of which 4492 (94.2%) had non-missing data for the outcome. Overall, 4.1% of patients (N=183) reported an anti-legal abortion attitude. Correlates of having anti-legal attitude included being married, at <200% federal poverty level, fundamentalist, contraception non-use, no abortion history, perceiving the pregnancy with ambivalence or as unintended, and using misoprostol or another product on their own to bring back their period or end the pregnancy. Abortion patients who do not believe abortion should be legal appear to differ substantially from women who are more supportive of legality. Findings raise important questions about this subset of patients, including whether possible discordance between patient beliefs and behavior could influence their use of medical abortion or other products. Some abortion patients do not agree with abortion legality, and this subset could experience a degree of cognitive dissonance, which could influence the method by which they seek to abort. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with repeat induced abortion in Kenya.

PubMed

Maina, Beatrice W; Mutua, Michael M; Sidze, Estelle M

2015-10-12

Over six million induced abortions were reported in Africa in 2008 with over two million induced abortions occurring in Eastern Africa. Although a significant proportion of women in the region procure more than one abortion during their reproductive period, there is a dearth of research on factors associated with repeat abortion. Data for this study come from the Magnitude and Incidence of Unsafe Abortion Study conducted by the African Population and Health Research Center in Kenya in 2012. The study used a nationally-representative sample of 350 facilities (level II to level VI) that offer post-abortion services for complications following induced and spontaneous abortions. A prospective morbidity survey tool was used by health providers in 328 facilities to collect information on socio-demographic charateristics, reproductive health history and contraceptive use at conception for all patients presenting for post-abortion services. Our analysis is based on data recorded on 769 women who were classified as having had an induced abortion. About 16 % of women seeking post abortion services for an induced abortion reported to have had a previous induced abortion. Being separated or divorced or widowed, having no education, having unwanted pregnancy, having 1-2 prior births and using traditional methods of contraception were associated with a higher likelihood of a repeat induced abortion. The findings point to the need to address the reasons why women with first time induced abortion do not have the necessary information to prevent unintended pregnancies and further induced abortions. Possible explanations linked to the quality of post-abortion family planning and coverage of long-acting methods should be explored.

Incidence of Induced Abortion and Post-Abortion Care in Tanzania

PubMed Central

Keogh, Sarah C.; Kimaro, Godfather; Muganyizi, Projestine; Philbin, Jesse; Kahwa, Amos; Ngadaya, Esther; Bankole, Akinrinola

2015-01-01

Background Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence. Objectives To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar). Methods A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology. Results In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15–49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone. Conclusions The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies. PMID:26361246

Orion Crew Exploration Vehicle Launch Abort System Guidance and Control Analysis Overview

NASA Technical Reports Server (NTRS)

Davidson, John B.; Kim, Sungwan; Raney, David L.; Aubuchon, Vanessa V.; Sparks, Dean W.; Busan, Ronald C.; Proud, Ryan W.; Merritt, Deborah S.

2008-01-01

Aborts during the critical ascent flight phase require the design and operation of Orion Crew Exploration Vehicle (CEV) systems to escape from the Crew Launch Vehicle (CLV) and return the crew safely to the Earth. To accomplish this requirement of continuous abort coverage, CEV ascent abort modes are being designed and analyzed to accommodate the velocity, altitude, atmospheric, and vehicle configuration changes that occur during ascent. Aborts from the launch pad to early in the flight of the CLV second stage are performed using the Launch Abort System (LAS). During this type of abort, the LAS Abort Motor is used to pull the Crew Module (CM) safely away from the CLV and Service Module (SM). LAS abort guidance and control studies and design trades are being conducted so that more informed decisions can be made regarding the vehicle abort requirements, design, and operation. This paper presents an overview of the Orion CEV, an overview of the LAS ascent abort mode, and a summary of key LAS abort analysis methods and results.

Abortion in Europe, 1920-91: a public health perspective.

PubMed

David, H P

1992-01-01

This article grew out of a keynote address prepared for the conference, "From Abortion to Contraception: Public Health Approaches to Reducing Unwanted Pregnancy and Abortion Through Improved Family Planning Services," held in Tbilisi, Georgia, USSR in October 1990. The article reviews the legal, religious, and medical situation of induced abortion in Europe in historical perspective, and considers access to abortion services, attitudes of health professionals, abortion incidence, morbidity and mortality, the new antiprogestins, the characteristics of abortion seekers, late abortions, postabortion psychological reactions, effects of denied abortion, and repeat abortion. Special attention is focused on the changes occurring in Romania, Albania, and the former Soviet Union, plus the effects of the new conservatism elsewhere in the formerly socialist countries of central and eastern Europe, particularly Poland. Abortion is a social reality that can no more be legislated out of existence than the controversy surrounding it can be stilled. No matter how effective family planning services and practices become, there will always be a need for access to safe abortion services.

Effects of Legislation Regulating Abortion in Arizona.

PubMed

Williams, Sigrid G; Roberts, Sarah; Kerns, Jennifer L

2018-04-06

Abortion is a common and safe procedure in the United States, the regulation of which varies by state. Since 2011, hundreds of state-level abortion restrictions have been enacted by legislatures across the country. This study describes the effects of two such regulations enacted in 2011 in Arizona, (A.R.S.) 36-2153 and 36-2155, that imposed a 24-hour waiting period requiring two separate in-person clinic visits before obtaining an abortion and banned advanced practice clinicians such as physician assistants, nurse practitioners, and nurse midwives from inducing medication abortions by prescribing mifepristone. We conducted a pre-post study to describe the effect of Arizona's scope of practice law on abortion provision by county. Using publicly available data, we compared patterns of abortion provision in 2009 and 2010 (before the laws) with 2012 and 2013. Our primary objective was to compare the proportion of abortions performed with medication by prescription of mifepristone (versus abortions performed surgically, known as aspiration abortions) before and after the laws were enacted. Our secondary objectives were to report the number of counties that lost an abortion provider and the change in the proportion of abortions performed before 14 weeks' gestation of pregnancy after the enactment of the laws. After enactment of the laws, the proportion of Arizona's 15 counties with abortion clinics decreased from 33% to 13%. Over this time, the proportion of abortions performed with medication in Arizona decreased by 17.4% (95% CI, 16.6%-18.3%; p = .0002), from 47.6% to 30.2%. Similarly, the proportion of abortions performed before 14 weeks' gestation in Arizona decreased by 3.3% (95% CI, 2.8%-3.8%; p = .0002) after the enactment of these laws. The proportion of abortions performed with medication and the proportion of abortion performed before 14 weeks' gestation in Arizona were negatively affected by the enactment of these laws. These findings are not explained by national temporal trends in abortion, because the proportion of abortions performed with medication increased and early abortions remained stable over the same time period in the United States as a whole. Proponents of laws restricting the provision of abortion such as these claim to improve the safety of abortion, but they actually seem to decrease access to abortion, as defined by the number of counties with abortion providers, and subsequently lead to delays in abortion. These data should inform future policies by providing an example of how such laws affect women seeking abortion. Copyright © 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis.

PubMed

Kabiru, Caroline W; Ushie, Boniface A; Mutua, Michael M; Izugbara, Chimaraoke O

2016-05-14

Unsafe abortion is a leading cause of death among young women aged 10-24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12-24 years seeking abortion-related care in Kenya. We used data on 1,378 young women aged 12-24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %). Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.

Accuracy of Mobile-Based Audiometry in the Evaluation of Hearing Loss in Quiet and Noisy Environments.

PubMed

Saliba, Joe; Al-Reefi, Mahmoud; Carriere, Junie S; Verma, Neil; Provencal, Christiane; Rappaport, Jamie M

2017-04-01

Objectives (1) To compare the accuracy of 2 previously validated mobile-based hearing tests in determining pure tone thresholds and screening for hearing loss. (2) To determine the accuracy of mobile audiometry in noisy environments through noise reduction strategies. Study Design Prospective clinical study. Setting Tertiary hospital. Subjects and Methods Thirty-three adults with or without hearing loss were tested (mean age, 49.7 years; women, 42.4%). Air conduction thresholds measured as pure tone average and at individual frequencies were assessed by conventional audiogram and by 2 audiometric applications (consumer and professional) on a tablet device. Mobile audiometry was performed in a quiet sound booth and in a noisy sound booth (50 dB of background noise) through active and passive noise reduction strategies. Results On average, 91.1% (95% confidence interval [95% CI], 89.1%-93.2%) and 95.8% (95% CI, 93.5%-97.1%) of the threshold values obtained in a quiet sound booth with the consumer and professional applications, respectively, were within 10 dB of the corresponding audiogram thresholds, as compared with 86.5% (95% CI, 82.6%-88.5%) and 91.3% (95% CI, 88.5%-92.8%) in a noisy sound booth through noise cancellation. When screening for at least moderate hearing loss (pure tone average >40 dB HL), the consumer application showed a sensitivity and specificity of 87.5% and 95.9%, respectively, and the professional application, 100% and 95.9%. Overall, patients preferred mobile audiometry over conventional audiograms. Conclusion Mobile audiometry can correctly estimate pure tone thresholds and screen for moderate hearing loss. Noise reduction strategies in mobile audiometry provide a portable effective solution for hearing assessments outside clinical settings.

A comparison of bivariate, multivariate random-effects, and Poisson correlated gamma-frailty models to meta-analyze individual patient data of ordinal scale diagnostic tests.

PubMed

Simoneau, Gabrielle; Levis, Brooke; Cuijpers, Pim; Ioannidis, John P A; Patten, Scott B; Shrier, Ian; Bombardier, Charles H; de Lima Osório, Flavia; Fann, Jesse R; Gjerdingen, Dwenda; Lamers, Femke; Lotrakul, Manote; Löwe, Bernd; Shaaban, Juwita; Stafford, Lesley; van Weert, Henk C P M; Whooley, Mary A; Wittkampf, Karin A; Yeung, Albert S; Thombs, Brett D; Benedetti, Andrea

2017-11-01

Individual patient data (IPD) meta-analyses are increasingly common in the literature. In the context of estimating the diagnostic accuracy of ordinal or semi-continuous scale tests, sensitivity and specificity are often reported for a given threshold or a small set of thresholds, and a meta-analysis is conducted via a bivariate approach to account for their correlation. When IPD are available, sensitivity and specificity can be pooled for every possible threshold. Our objective was to compare the bivariate approach, which can be applied separately at every threshold, to two multivariate methods: the ordinal multivariate random-effects model and the Poisson correlated gamma-frailty model. Our comparison was empirical, using IPD from 13 studies that evaluated the diagnostic accuracy of the 9-item Patient Health Questionnaire depression screening tool, and included simulations. The empirical comparison showed that the implementation of the two multivariate methods is more laborious in terms of computational time and sensitivity to user-supplied values compared to the bivariate approach. Simulations showed that ignoring the within-study correlation of sensitivity and specificity across thresholds did not worsen inferences with the bivariate approach compared to the Poisson model. The ordinal approach was not suitable for simulations because the model was highly sensitive to user-supplied starting values. We tentatively recommend the bivariate approach rather than more complex multivariate methods for IPD diagnostic accuracy meta-analyses of ordinal scale tests, although the limited type of diagnostic data considered in the simulation study restricts the generalization of our findings. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Changes in abortion service provision in Bihar and Jharkhand states, India between 2004 and 2013

PubMed Central

Singh, Kaushalendra K.; Li, Qingfeng; Fruhauf, Timothee; Tsui, Amy O.

2018-01-01

Background The Medical Termination of Pregnancy (MTP) Act of 1971 liberalized abortion laws in India. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013. Methods We used state-representative data from cross-sectional surveys of reproductive health service providers we conducted in 2004 (N = 1,323) and 2012/2013 (N = 1,020). We employed chi-squared tests to examine and compare abortion providers’ characteristics, and fitted separate multivariate logistic regression models for provision of surgical, medical, and any abortion services, respectively, adjusting for potential confounders to identify factors associated with abortion service provision at the two survey time points. Results Of providers interviewed in 2004 and 2012/2013, 63.7% and 84.5%, respectively, offered abortion services. Among abortion providers, 21.1% offered surgical and 10.7% offered medical abortions in 2004; 15.8% and 94.1% did so, respectively, in 2012/2013. Private providers were more likely than public providers to offer abortion services at both time points. Compared to female providers, male providers were significantly less likely to provide both surgical and medical abortions in 2004, and significantly less likely to provide surgical abortions in 2012/2013. Pharmacists and community health workers played increasingly important roles in abortion service provision, especially medical abortion, during the period. Conclusion This study documents important changes in abortion provision in the two Indian states during 2004–2013. PMID:29879132

[Repeat induced abortion: A multicenter study on medical abortions in France in 2014].

PubMed

Opatowski, M; Bardy, F; David, P; Dunbavand, A; Saurel-Cubizolles, M-J

2017-01-01

To describe the social characteristics of women seeking a medical abortion, and the conditions of that abortion, according to whether they had one or more previous induced abortions. An observational study was carried out in 11 French units in 2013-2014, among women 18 years or older. A self-administered questionnaire on the abortion context and social situation was given to them, as well as a diary to record the pain level for each of five days following the mifepristone intake. The sample included 453 women. Among the respondents, 22% had had one previous abortion and 8% had had two or more. Women having had a previous voluntary abortion were more often isolated and in a poorer social situation than women having their first abortion. Better support for contraception after abortion could reduce the number of repeated abortions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Medical abortion reversal: science and politics meet.

PubMed

Bhatti, Khadijah Z; Nguyen, Antoinette T; Stuart, Gretchen S

2018-03-01

Medical abortion is a safe, effective, and acceptable option for patients seeking an early nonsurgical abortion. In 2014, medical abortion accounted for nearly one third (31%) of all abortions performed in the United States. State-level attempts to restrict reproductive and sexual health have recently included bills that require physicians to inform women that a medical abortion is reversible. In this commentary, we will review the history, current evidence-based regimen, and regulation of medical abortion. We will then examine current proposed and existing abortion reversal legislation. The objective of this commentary is to ensure physicians are armed with rigorous evidence to inform patients, communities, and policy makers about the safety of medical abortion. Furthermore, given the current paucity of evidence for medical abortion reversal, physicians and policy makers can dispel bad science and misinformation and advocate against medical abortion reversal legislation. Copyright © 2017 Elsevier Inc. All rights reserved.

Myths and misconceptions about abortion among marginalized underserved community.

PubMed

Thapa, K; Karki, Y; Bista, K P

2009-01-01

Unsafe abortion remains a huge problem in Nepal even after legalization of abortion. Various myths and misconceptions persist which prompt women towards unsafe abortive practices. A qualitative study was conducted among different groups of women using focus group discussions and in depth interviews. Perception and understanding of the participants on abortion, methods and place of abortion were evaluated. A number of misconceptions were prevalent like drinking vegetable and herbal juices, and applying hot pot over the abdomen could abort pregnancy. However, many participants also believed that health care providers should be consulted for abortion. Although majority of the women knew that they should seek medical aid for abortion, they were still possessed with various misconceptions. Merely legalizing abortion services is not enough to reduce the burden of unsafe abortion. Focus has to be given on creating awareness and proper advocacy in this issue.

Situating stigma in stratified reproduction: Abortion stigma and miscarriage stigma as barriers to reproductive healthcare.

PubMed

Bommaraju, Aalap; Kavanaugh, Megan L; Hou, Melody Y; Bessett, Danielle

2016-12-01

To examine whether race and reported history of abortion are associated with abortion stigma and miscarriage stigma, both independently and comparatively. Self-administered surveys with 306 new mothers in Boston and Cincinnati, United States. Abortion stigma perception (ASP); miscarriage stigma perception (MSP); and comparative stigma perception (CSP: abortion stigma perception net of miscarriage stigma perception). Regardless of whether or not they reported having an abortion, white women perceived abortion (ASP) to be more stigmatizing than Black and Latina women. Perceptions of miscarriage stigma (MSP), on the other hand, were dependent on reporting an abortion. Among those who reported an abortion, Black women perceived more stigma from miscarriage than white women, but these responses were flipped for women who did not report abortion. Reporting abortion also influenced our comparative measure (CSP). Among those who did report an abortion, white women perceived more stigma from abortion than miscarriage, while Black and Latina women perceived more stigma from miscarriage than abortion. By measuring abortion stigma in comparison to miscarriage stigma, we can reach a more nuanced understanding of how perceptions of reproductive stigmas are stratified by race and reported reproductive history. Clinicians should be aware that reproductive stigmas do not similarly affect all groups. Stigma from specific reproductive outcomes is more or less salient dependent upon a woman's social position and lived experience. Copyright © 2016 Elsevier B.V. All rights reserved.

Legal abortion in Peru: knowledge, attitudes and practices among a group of physician leaders.

PubMed

Pace, Lydia; Grossman, Daniel; Chávez, Susana; Távara, Luis; Lara, Diana; Guerrero-Vásquez, Rossina

2006-01-01

We sought to examine knowledge, attitudes and practices regarding legal abortion among a group of Peruvian physicians. A pre-conference survey was mailed to Peruvian physicians invited to a workshop on legal abortion. A post-conference survey was distributed following the event. Eighty-six percent of 35 respondents correctly indicated that abortion is legal in Peru when a pregnancy endangers a woman's life while less than 50% knew it is also legal when necessary to protect a woman's health. Knowledge about abortion techniques was lower for induced abortion than for management of incomplete abortions. Dilation and curettage was used more frequently than manual vacuum aspiration and medications. Half of physicians reported having performed a legal abortion. The vast majority of physicians surveyed thought legal indications for abortion should be expanded to include cases of rape or fetal malformations. Most considered their abortion training to be inadequate. They identified lack of training and administrative and professional support as barriers to legal abortion provision. Physicians surveyed were willing to provide legal abortions but lacked the knowledge, skills, and support to do so. Improved training of health professionals, increasing institutional support, and developing administrative and legal procedures to guide management of women seeking abortions could increase women's access to legal abortion services and diminish the occurrence of unsafe abortion in Peru.

The political economy of abortion in India: cost and expenditure patterns.

PubMed

Duggal, Ravi

2004-11-01

Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman's marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount--first trimester abortion averages Rs.500- 1000 and second trimester abortion Rs.2000-3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe abortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.

Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

PubMed Central

Tey, Nai-peng; Yew, Siew-yong; Low, Wah-yun; Su’ut, Lela; Renjhen, Prachi; Huang, M. S. L.; Tong, Wen-ting; Lai, Siow-li

2012-01-01

Background Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools. Methods and Results A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity. Conclusions Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights. PMID:23300600

Decriminalization of Abortion in Mexico City: The Effects on Women’s Reproductive Rights

PubMed Central

Díaz Olavarrieta, Claudia

2013-01-01

In April 2007, the Mexico City, Mexico, legislature passed landmark legislation decriminalizing elective abortion in the first 12 weeks of pregnancy. In Mexico City, safe abortion services are now available to women through the Mexico City Ministry of Health’s free public sector legal abortion program and in the private sector, and more than 89 000 legal abortions have been performed. By contrast, abortion has continued to be restricted across the Mexican states (each state makes its own abortion laws), and there has been an antichoice backlash against the legislation in 16 states. Mexico City’s abortion legislation is an important first step in improving reproductive rights, but unsafe abortions will only be eliminated if similar abortion legislation is adopted across the entire country. PMID:23409907

Late-Term Elective Abortion and Susceptibility to Posttraumatic Stress Symptoms

PubMed Central

Coleman, Priscilla K.; Coyle, Catherine T.; Rue, Vincent M.

2010-01-01

The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic Stress Disorder (PTSD) symptoms after controlling for socio-demographic and personal history variables. Online surveys were completed by 374 women who experienced either a 1st trimester abortion (up to 12 weeks gestation) or a 2nd or 3rd trimester abortion (13 weeks gestation or beyond). Most respondents (81%) were U.S. citizens. Later abortions were associated with higher Intrusion subscale scores and with a greater likelihood of reporting disturbing dreams, reliving of the abortion, and trouble falling asleep. Reporting the pregnancy was desired by one's partner, experiencing pressure to abort, having left the partner prior to the abortion, not disclosing the abortion to the partner, and physical health concerns were more common among women who received later abortions. Social reasons for the abortion were linked with significantly higher PTSD total and subscale scores for the full sample. Women who postpone their abortions may need more active professional intervention before securing an abortion based on the increased risks identified herein. More research with diverse samples employing additional measures of mental illness is needed. PMID:21490737

Making abortions safe: a matter of good public health policy and practice.

PubMed Central

Berer, M.

2000-01-01

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. PMID:10859852

Abortion and maternal mortality in the developing world.

PubMed

Okonofua, Friday

2006-11-01

Unsafe abortion is an important public health problem, accounting for 13% of maternal mortality in developing countries. Of an estimated annual 70,000 deaths from unsafe abortion worldwide, over 99% occur in the developing countries of sub-Saharan Africa, Central and Southeast Asia, and Latin America and the Caribbean. Factors associated with increased maternal mortality from unsafe abortion in developing countries include inadequate delivery systems for contraception needed to prevent unwanted pregnancies, restrictive abortion laws, pervading negative cultural and religious attitudes towards induced abortion, and poor health infrastructures for the management of abortion complications. The application of a public health approach based on primary, secondary, and tertiary prevention can reduce morbidity and mortality associated with unsafe abortion in developing countries. Primary prevention includes the promotion of increased use of contraception by women (and by men) at risk for unwanted pregnancy; secondary prevention involves the liberalization of abortion laws and the development of programs to increase access to safe abortion care in developing countries. In contrast, tertiary prevention includes the integration and institutionalization of post-abortion care for incomplete abortion and the early and appropriate treatment of more severe complications of abortion. Efforts to address these problems will contribute both to reducing maternal mortality associated with induced abortion and to achieving the Millennium Development Goals in developing countries.

Abortion clinic patients' opinions about obtaining abortions from general women's health care providers.

PubMed

Weitz, Tracy Ann; Cockrill, Kate

2010-12-01

Most U.S. women obtain abortions at specialty clinics. This qualitative study explores abortion clinic patients' opinions about receiving abortions from general women's health care providers. We conducted 20 h-long, semi-structured interviews with diverse women who had abortions in the U.S. Heartland. Each described her usual health care provider and how she accessed abortion care. We used qualitative analytic methods to organize and interpret the data. Despite having a general provider, most women sought clinic abortions. Some women offered reasons for preferring specialty care and others for preferring abortion from their general provider. Most women assumed their general provider did not "do abortion" and many believed those providers were opposed to abortion. Women who had delivered a baby were concerned with their image in their general provider's eyes. Two women were denied care by their general providers. Women's preferences for abortion care centered on privacy, cost, empathy, ability to control their image, and desire for safe quality care. Two women who sought abortions through their general providers experienced negative repercussions. General providers should proactively make patients aware of their positions on abortion and if supportive indicate that they can provide that care and/or a referral. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Can stories reduce abortion stigma? Findings from a longitudinal cohort study.

PubMed

Cockrill, Kate; Biggs, Antonia

2018-03-01

Women often hide or selectively disclose abortion experiences due to stigma. Secrecy can help women avoid stigma but may also result in isolation and a lack of social support and contribute to broader social silence. This study assesses whether a book-club intervention can support abortion disclosure among book club participants and improve participants' affective responses towards women who have abortions and abortion providers. A total of 109 women from 13 all-female book clubs located in 9 US states read and discussed a non-fiction book that included stories about pregnancy and abortion, participated in a book club discussion and completed baseline, immediate post-intervention and endline surveys. In 10 out of the 13 book club discussions, at least one member disclosed having had a previous abortion. Overall, 15 of the 19 women who privately reported having a previous abortion self-disclosed one or more abortions during the book club discussion. Following the book club intervention, women reported having more positive feelings toward women who have abortions and abortion providers. Greater improvement and longer lasting effects were seen in groups where there was also an in-person disclosure of abortion experience. Findings suggest that exposure to the stories of women who have had abortions can reduce abortion stigma.

Influence of clinician referral on Nebraska women's decision-to-abortion time.

PubMed

French, Valerie; Anthony, Renaisa; Souder, Chelsea; Geistkemper, Christine; Drey, Eleanor; Steinauer, Jody

2016-03-01

To assess the association of clinician referral with decision-to-abortion time. We conducted a cross-sectional survey of women seeking abortion at all three Nebraska abortion clinics. We defined referral as direct (information for an abortion clinic), inappropriate (information for a clinic that does not provide abortions) or no referral. Women reported when they recognized their pregnancy, decided to seek abortion and contacted a clinician. The primary outcome - decision-to-abortion time - was time from certain decision to abortion. We used multivariate linear regression analysis, controlling for potential confounders. Participants (n=356) were a mean of 26.8±5.3years old, primarily white (62%), unmarried (88%) and urban (87%), with a mean gestational duration of 8(2/7)weeks (S.D.±20days). Forty-six percent (164) had contacted a clinician and 30% (104) had discussed abortion with one before their abortion. Of those, 30% received a direct referral, 6% received an inappropriate referral and 64% received no referral. Decision-to-abortion time did not vary by referral type [mean difference compared with direct referral: inappropriate referral, 1.1days, 95% confidence interval (CI) -13.4 to 15.6, p=.88; no referral, -0.4days, 95% CI -7.0 to 6.3]. The most common reasons cited for delay in obtaining an abortion were an inability to get an earlier appointment (105/263, 40%) and time needed to raise money to pay for the abortion (73/263, 28%). While neither occurrence of referral nor type was associated with decision-to-abortion times, women in Nebraska continue to face barriers to timely abortion care. Additional research is needed to explore whether quality clinician referral improves abortion access and whether increased resources should be dedicated to improving referral patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research.

PubMed

Steinberg, Julia R

2011-01-01

Some abortion policies in the U.S. are based on the notion that abortion harms women's mental health. The American Psychological Association (APA) Task Force on Abortion and Mental Health concluded that first-trimester abortions do not harm women's mental health. However, the APA task force does not make conclusions regarding later abortions (second trimester or beyond) and mental health. This paper critically evaluates studies on later abortion and mental health in order to inform both policy and practice. Using guidelines outlined by Steinberg and Russo (2009), post 1989 quantitative studies on later abortion and mental health were evaluated on the following qualities: 1) composition of comparison groups, 2) how prior mental health was assessed, and 3) whether common risk factors were controlled for in analyses if a significant relationship between abortion and mental health was found. Studies were evaluated with respect to the claim that later abortions harm women's mental health. Eleven quantitative studies that compared the mental health of women having later abortions (for reasons of fetal anomaly) with other groups were evaluated. Findings differed depending on the comparison group. No studies considered the role of prepregnancy mental health, and one study considered whether factors common among women having later abortions and mental health problems drove the association between later abortion and mental health. Policies based on the notion that later abortions (because of fetal anomaly) harm women's mental health are unwarranted. Because research suggests that most women who have later abortions do so for reasons other than fetal anomaly, future investigations should examine women's psychological experiences around later abortions. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Abortion surveillance--United States, 1991.

PubMed

Koonin, L M; Smith, J C; Ramick, M

1995-05-05

From 1980 through 1991, the number of legal induced abortions reported to CDC remained stable, varying each year by < or = 5%. This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1991. For each year since 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City. In 1991, 1,388,937 abortions were reported--a 2.8% decrease from 1990. The abortion ratio was 339 legal induced abortions per 1,000 live births, and the abortion rate was 24 per 1,000 women 15-44 years of age. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most had had no previous live births and had been obtaining an abortion for the first time. More than half (52%) of all abortions were performed at or before the 8th week of gestation, and 88% were before the 13th week. Younger women (i.e., women < 19 years of age) were more likely to obtain abortions later in pregnancy than were older women. Since 1980, the number and rate of abortions have remained relatively stable, with only small year-to-year fluctuations of < or = 5%. However, since 1987, the abortion-to-live-birth ratio has declined; in 1991, the abortion ratio was the lowest recorded since 1977. An increasing rate of childbearing may partially account for this decline. An accurate assessment of the number and characteristics of women who obtain abortions in the United States is necessary both to monitor efforts to prevent unintended pregnancy and to identify and reduce preventable causes of morbidity and mortality associated with abortions.

Profiles of women presenting for abortions in Singapore: focus on teenage abortions and late abortions.

PubMed

Lim, Limin; Wong, Hungchew; Yong, Euleong; Singh, Kuldip

2012-02-01

Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions. In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged <20 years were compared with those ≥ 20 years old using Chi-square test if the assumptions for Chi-square test were met; otherwise, Fisher's exact test was carried out. Logistic regression was used to investigate the risk factors for second trimester termination of pregnancy. 2109 women presented for induced abortions, of which 1998 had single abortion throughout the course of the study. The mean age of women with single abortion was 29.1 years (sd 7). In the group of women with single abortion, 182 (9.1%) were teenage abortions. In contrast to women ≥ 20 years of age, pregnant teenagers were more likely not to have used any contraception (51.1% vs. 25.2%) and more likely to present late for abortions (39.6% vs. 15.9%). Other risk factors for late presentation for abortions include Malay ethnicity, singlehood, nulliparity and lack of prior usage of contraception. Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Why resort to illegal abortion in Zambia? Findings of a community-based study in Western Province.

PubMed

Koster-Oyekan, W

1998-05-01

This article presents part of the findings of a community-based study on the causes and effects of unplanned pregnancies in four districts of Western Province, Zambia. The study broke the silence around abortion in Western Province and revealed that induced abortion poses a public health problem. Using innovative methodology of recording and analyzing histories of deaths from induced abortion, the abortion mortality ratio was calculated for the study districts. Findings reveal all extremely high induced abortion mortality ratio of 120 induced abortion-related deaths per 100,000 live births. More than half the deaths were of schoolgirls. Although abortion in Zambia is legal on medical and social grounds, most women in Western Province resort to illegal abortions because legal abortion services are inaccessible and unacceptable. The main reasons women resort to abortion is for fear of being expelled from school, their unwillingness to reveal a secret relationship, to protect the health of their previous baby and common knowledge that postpartum sexual taboos have been transgressed. An inventory was made of abortion methods, taboos and abortion-providers. The article describes how health staff were involved throughout the study, and shows how recommendations were made by involving all parties concerned.

Abortion-related maternal mortality in the Russian Federation.

PubMed

Zhirova, Irina Alekseevna; Frolova, Olga Grigorievna; Astakhova, Tatiana Mikhailovna; Ketting, Evert

2004-09-01

This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.

A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010.

PubMed

Levels, Mark; Sluiter, Roderick; Need, Ariana

2014-10-01

The extent to which women have had access to legal abortions has changed dramatically in Western-Europe between 1960 and 2010. In most countries, abortion laws developed from completely banning abortion to allowing its availability on request. Both the timing and the substance of the various legal developments differed dramatically between countries. Existing comparative studies on abortion laws in Western-European countries lack detail, usually focus either on first-trimester abortions or second trimester abortions, cover a limited time-span and are sometimes inconsistent with one another. Combining information from various primary and secondary sources, we show how and when the conditions for legally obtaining abortion during the entire gestation period in 20 major Western-European countries have changed between 1960 and 2010. We also construct a cross-nationally comparable classification of procedural barriers that limit abortion access. Our cross-national comparison shows that Western-Europe witnessed a general trend towards decreased restrictiveness of abortion laws. However, legal approaches to regulating abortion are highly different in detail. Abortion access remains limited, sometimes even in countries where abortion is legally available without restrictions relating to reasons. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Update on abortion policy.

PubMed

Conti, Jennifer A; Brant, Ashley R; Shumaker, Heather D; Reeves, Matthew F

2016-12-01

To review the status of antiabortion restrictions enacted over the last 5 years in the United States and their impact on abortion services. In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently. Liberalization of abortion laws saves women's lives. The rising number of antiabortion restrictions will ultimately harm women and their families.

Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.

PubMed

Blanchard, Kelly; Lince-Deroche, Naomi; Fetters, Tamara; Devjee, Jaymala; de Menezes, Ilundi Durão; Trueman, Karen; Sudhinaraset, May; Nkonko, Errol; Moodley, Jack

2015-10-01

Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001). Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings. Copyright © 2015 Elsevier Inc. All rights reserved.

The effect of a simple educational intervention on interest in early abortion training among family medicine residents.

PubMed

Wu, Justine P; Bennett, Ian; Levine, Jeffrey P; Aguirre, Abigail Calkins; Bellamy, Scarlett; Fleischman, Joan

2006-06-01

We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents. We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs. Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01). Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.

A new edge detection algorithm based on Canny idea

NASA Astrophysics Data System (ADS)

Feng, Yingke; Zhang, Jinmin; Wang, Siming

2017-10-01

The traditional Canny algorithm has poor self-adaptability threshold, and it is more sensitive to noise. In order to overcome these drawbacks, this paper proposed a new edge detection method based on Canny algorithm. Firstly, the media filtering and filtering based on the method of Euclidean distance are adopted to process it; secondly using the Frei-chen algorithm to calculate gradient amplitude; finally, using the Otsu algorithm to calculate partial gradient amplitude operation to get images of thresholds value, then find the average of all thresholds that had been calculated, half of the average is high threshold value, and the half of the high threshold value is low threshold value. Experiment results show that this new method can effectively suppress noise disturbance, keep the edge information, and also improve the edge detection accuracy.

Estimates of the incidence of induced abortion and consequences of unsafe abortion in Senegal.

PubMed

Sedgh, Gilda; Sylla, Amadou Hassane; Philbin, Jesse; Keogh, Sarah; Ndiaye, Salif

2015-03-01

Abortion is highly restricted by law in Senegal. Although women seek care for abortion complications, no national estimate of abortion incidence exists. Data on postabortion care and abortion in Senegal were collected in 2013 using surveys of a nationally representative sample of 168 health facilities that provide postabortion care and of 110 professionals knowledgeable about abortion service provision. Indirect estimation techniques were applied to the data to estimate the incidence of induced abortion in the country. Abortion rates and ratios were calculated for the nation and separately for the Dakar region and the rest of the country. The distribution of pregnancies by planning status and by outcome was estimated. In 2012, an estimated 51,500 induced abortions were performed in Senegal, and 16,700 (32%) resulted in complications that were treated at health facilities. The estimated abortion rate was 17 per 1,000 women aged 15-44 and the abortion ratio was 10 per 100 live births. The rate was higher in Dakar (21 per 1,000) than in the rest of the country (16 per 1,000). Poor women were far more likely to experience abortion complications, and less likely to receive treatment for complications, than nonpoor women. About 31% of pregnancies were unintended, and 24% of unintended pregnancies (8% of all pregnancies) ended in abortion. Unsafe abortion exacts a heavy toll on women in Senegal. Reducing the barriers to effective contraceptive use and ensuring access to postabortion care without the risk of legal consequences may reduce the incidence of and complications from unsafe abortion.

The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008.

PubMed

Moore, Ann M; Gebrehiwot, Yirgu; Fetters, Tamara; Wado, Yohannes Dibaba; Bankole, Akinrinola; Singh, Susheela; Gebreselassie, Hailemichael; Getachew, Yonas

2016-09-01

In 2005, Ethiopia's parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008. Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008. An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15-49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008. Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women's access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed.

Estimates of the Incidence of Induced Abortion And Consequences of Unsafe Abortion in Senegal

PubMed Central

Sedgh, Gilda; Sylla, Amadou Hassane; Philbin, Jesse; Keogh, Sarah; Ndiaye, Salif

2015-01-01

CONTEXT Abortion is highly restricted by law in Senegal. Although women seek care for abortion complications, no national estimate of abortion incidence exists. METHODS Data on postabortion care and abortion in Senegal were collected in 2013 using surveys of a nationally representative sample of 168 health facilities that provide postabortion care and of 110 professionals knowledgeable about abortion service provision. Indirect estimation techniques were applied to the data to estimate the incidence of induced abortion in the country. Abortion rates and ratios were calculated for the nation and separately for the Dakar region and the rest of the country. The distribution of pregnancies by planning status and by outcome was estimated. RESULTS In 2012, an estimated 51,500 induced abortions were performed in Senegal, and 16,700 (32%) resulted in complications that were treated at health facilities. The estimated abortion rate was 17 per 1,000 women aged 15–44 and the abortion ratio was 10 per 100 live births. The rate was higher in Dakar (21 per 1,000) than in the rest of the country (16 per 1,000). Poor women were far more likely to experience abortion complications, and less likely to receive treatment for complications, than nonpoor women. About 31% of pregnancies were unintended, and 24% of unintended pregnancies (8% of all pregnancies) ended in abortion. CONCLUSIONS Unsafe abortion exacts a heavy toll on women in Senegal. Reducing the barriers to effective contraceptive use and ensuring access to postabortion care without the risk of legal consequences may reduce the incidence of and complications from unsafe abortion. PMID:25856233

Access to safe abortion: progress and challenges since the 1994 International Conference on Population and Development (ICPD).

PubMed

Shah, Iqbal H; Åhman, Elisabeth; Ortayli, Nuriye

2014-12-01

The 1994 International Conference on Population and Development (ICPD) viewed access to safe abortion as imperative for public health. Globally, the number of induced abortions (safe and unsafe) per 1000 women aged 15-44 years declined from 35 in 1995 to 28 in 2008. The number of deaths due to unsafe abortion declined from 69,000 in 1990 to 47,000 in 2008, as safe and effective methods of abortion, including manual vacuum aspiration and medical abortion, became more widely available. During the same period, there was a slight increase in the number of countries where abortion is permitted on request, and 70 countries made grounds for abortion more liberal. Since ICPD, the decline in unsafe abortion was slower than that in safe abortion, and unsafe-abortion-related mortality continued to be a problem. Nearly all unsafe abortions and mortality occur in developing countries. While more must be done to ensure universal access to safe, acceptable and affordable contraception to reduce the need for abortion, this need will always exist. Information on grounds for safe abortion should be made widely available for women to access services to which they are legally entitled to. As recommended by ICPD, quality postabortion care including contraception counseling and provision should be available to all women, regardless of the legal grounds for abortion. The paper provides the evidence on unsafe abortion, a reproductive health issue that is entirely preventable but has been largely neglected or tarnished by emotional and contentious debates. Copyright © 2014 Elsevier Inc. All rights reserved.

Induced abortion: an overview for internists.

PubMed

Grimes, David A; Creinin, Mitchell D

2004-04-20

Internists care for many women who have had abortions and many who will seek abortions in the future. Each year, about 2% of all women of reproductive age have an abortion. Women having abortions tend to be young, white, unmarried, and early in pregnancy. Most abortions are done by suction curettage under local anesthesia in a freestanding clinic. However, medical abortion is growing in popularity as a nonsurgical alternative. The regimen approved by the U.S. Food and Drug Administration specifies mifepristone, 600 mg orally, followed 2 days later by misoprostol, 400 microg orally (within 49 days from last menses). Recent studies have recommended alternative approaches, such as mifepristone, 200 mg orally, followed in 1 to 3 days by misoprostol, 800 microg vaginally (up to 63 days). Medical abortion can be provided by a broader variety of physicians than can surgical abortion. The overall case-fatality rate for abortion is less than 1 death per 100,000 procedures. Infection, hemorrhage, acute hematometra, and retained tissue are among the more common complications. Referral back to the original abortion provider for management is advisable. Overall, induced abortion does not lead to late sequelae, either medical or psychiatric. Of importance, no link exists between induced abortion and later breast cancer. For physicians who are asked to help with a referral, the National Abortion Federation and Planned Parenthood Federation of America have helpful Web sites and networks of high-quality clinics. The cost of abortion (currently about 372 dollars at 10 weeks) has decreased in recent decades. Provision of ongoing contraception and encouragement of emergency contraception can reduce unintended pregnancies and the need for abortion.

Algorithm for Determination of Orion Ascent Abort Mode Achievability

NASA Technical Reports Server (NTRS)

Tedesco, Mark B.

2011-01-01

For human spaceflight missions, a launch vehicle failure poses the challenge of returning the crew safely to earth through environments that are often much more stressful than the nominal mission. Manned spaceflight vehicles require continuous abort capability throughout the ascent trajectory to protect the crew in the event of a failure of the launch vehicle. To provide continuous abort coverage during the ascent trajectory, different types of Orion abort modes have been developed. If a launch vehicle failure occurs, the crew must be able to quickly and accurately determine the appropriate abort mode to execute. Early in the ascent, while the Launch Abort System (LAS) is attached, abort mode selection is trivial, and any failures will result in a LAS abort. For failures after LAS jettison, the Service Module (SM) effectors are employed to perform abort maneuvers. Several different SM abort mode options are available depending on the current vehicle location and energy state. During this region of flight the selection of the abort mode that maximizes the survivability of the crew becomes non-trivial. To provide the most accurate and timely information to the crew and the onboard abort decision logic, on-board algorithms have been developed to propagate the abort trajectories based on the current launch vehicle performance and to predict the current abort capability of the Orion vehicle. This paper will provide an overview of the algorithm architecture for determining abort achievability as well as the scalar integration scheme that makes the onboard computation possible. Extension of the algorithm to assessing abort coverage impacts from Orion design modifications and launch vehicle trajectory modifications is also presented.

Differential Impact of Abortion on Adolescents and Adults.

ERIC Educational Resources Information Center

Franz, Wanda; Reardon, David

1992-01-01

Compared adolescent and adult reactions to abortion among 252 women. Compared to adults, adolescents were significantly more likely to be dissatisfied with choice of abortion and with services received, to have abortions later in gestational period, to feel forced by circumstances to have abortion, to report being misinformed at time of abortion,…

Patterns of online abortion among teenagers

NASA Astrophysics Data System (ADS)

Wahyudi, A.; Jacky, M.; Mudzakkir, M.; Deprita, R.

2018-01-01

An on-going debate of whether or not to legalize abortion has not stopped the number of abortion cases decreases. New practices of abortion such as online abortion has been a growing trend among teenagers. This study aims to determine how teenagers use social media such as Facebook, YouTube and Wikipedia for the practice of abortion. This study adopted online research methods (ORMs), a qualitative approach 2.0 by hacking analytical perspective developed. This study establishes online teen abortion as a research subject. This study finds patterns of online abortions among teenagers covering characteristics of teenagers as perpetrators, styles of communication, and their implication toward policy, particularly Electronic Transaction Information (ETI) regulation. Implications for online abortion behavior among teenagers through social media. The potential abortion client especially girls find practical, fast, effective, and efficient solutions that keep their secret. One of prevention patterns that has been done by some people who care about humanity and anti-abortion in the online world is posting a anti-abortion text, video or picture, anti-sex-free (anti -free intercourse before marriage) in an interesting, educative, and friendly ways.

Trying to prevent abortion.

PubMed

Bromham, D R; Oloto, E J

1997-06-01

It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.

Access to Medication Abortion Among California's Public University Students.

PubMed

Upadhyay, Ushma D; Cartwright, Alice F; Johns, Nicole E

2018-06-09

A proposed California law will require student health centers at public universities to provide medication abortion. To understand its potential impact, we sought to describe current travel time, costs, and wait times to access care at the nearest abortion facilities. We projected total medication abortion use based on campus enrollment figures and age- and state-adjusted abortion rates. We calculated distance and public transit time from campuses to the nearest abortion facility. We contacted existing abortion-providing facilities to determine costs, insurance acceptance, and wait times. We estimate 322 to 519 California public university students seek medication abortions each month. As many as 62% of students at these universities were more than 30 minutes from the closest abortion facility via public transportation. Average cost of medication abortion was $604, and average wait time to the first available appointment was one week. College students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus could reduce these barriers. Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Trends of abortion complications in a transition of abortion law revisions in Ethiopia.

PubMed

Gebrehiwot, Yirgu; Liabsuetrakul, Tippawan

2009-03-01

Evidence from developed countries has shown that abortion-related mortality and morbidity has decreased with the liberalization of the abortion law. This study aimed to assess the trend of hospital-based abortion complications during the transition of legalization in Ethiopia in May 2005. Medical records of women with abortion complications from 2003 to 2007 were reviewed (n = 773). Abortion and its complications with regard to legalization were described by rates and ratios, and predictors of fatal outcomes were analyzed by logistic regression. The overall and abortion-related maternal mortality ratios (AMMRs) showed a non-statistically significant downward trend over the 5-year period. However, the case fatality rate of abortion increased from 1.1% in 2003 to 3.6% in 2007. Late gestational age, history of interference and presenting after new abortion legislation passed have been found to be significant predictors of mortality. Decreased trends of abortion ratio and the AMMR were identified, but the severity of abortion complications and the case fatality rate increased during the transition of legal revision.

Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa.

PubMed

Grossman, Daniel A; Grindlay, Kate; Buchacker, Todd; Potter, Joseph E; Schmertmann, Carl P

2013-01-01

We assessed the effect of a telemedicine model providing medical abortion on service delivery in a clinic system in Iowa. We reviewed Iowa vital statistic data and billing data from the clinic system for all abortion encounters during the 2 years prior to and after the introduction of telemedicine in June 2008 (n = 17,956 encounters). We calculated the distance from the patient's residential zip code to the clinic and to the closest clinic providing surgical abortion. The abortion rate decreased in Iowa after telemedicine introduction, and the proportion of abortions in the clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction. Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion.

28 CFR 551.23 - Abortion.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide... the pregnancy to full term or to have an elective abortion. If an inmate chooses to have an abortion...

28 CFR 551.23 - Abortion.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide... the pregnancy to full term or to have an elective abortion. If an inmate chooses to have an abortion...

28 CFR 551.23 - Abortion.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide... the pregnancy to full term or to have an elective abortion. If an inmate chooses to have an abortion...

28 CFR 551.23 - Abortion.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide... the pregnancy to full term or to have an elective abortion. If an inmate chooses to have an abortion...

28 CFR 551.23 - Abortion.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide... the pregnancy to full term or to have an elective abortion. If an inmate chooses to have an abortion...

Queering abortion rights: notes from Argentina.

PubMed

Sutton, Barbara; Borland, Elizabeth

2018-03-06

In recent years, there have been calls in activist spaces to 'queer' abortion rights advocacy and to incorporate non-normative notions of gender identity and sexuality into abortion struggles and services. Argentina provides an interesting site in which to examine these developments, since there is a longstanding movement for abortion rights in a context of illegal abortion and a recent ground-breaking Gender Identity Law that recognises key trans rights. In this paper, we analyse public documents from the abortion rights movement's main coalition - the National Campaign for the Right to Legal, Safe and Free Abortion - alongside interviews with 19 Campaign activists to examine shifts and tensions in contemporary abortion rights activism. We trace the incorporation of trans-inclusive language into the newly proposed abortion rights bill and conclude by pointing to contextual factors that may limit or enhance the further queering of abortion rights.

A review of evidence for safe abortion care.

PubMed

Kapp, Nathalie; Whyte, Patti; Tang, Jennifer; Jackson, Emily; Brahmi, Dalia

2013-09-01

The provision of safe abortion services to women who need them has the potential to drastically reduce or eliminate maternal deaths due to unsafe abortion. The World Health Organization recently updated its evidence-based guidance for safe and effective clinical practices using data from systematic reviews of the literature. Systematic reviews pertaining to the evidence for safe abortion services, from pre-abortion care, medical and surgical methods of abortion and post-abortion care were evaluated for relevant outcomes, primarily those relating to safety, effectiveness and women's preference. Sixteen systematic reviews were identified and evaluated. The available evidence does not support the use of pre-abortion ultrasound to increase safety. Routine use of cervical preparation with osmotic dilators, mifepristone or misoprostol after 14 weeks gestation reduces complications; at early gestational ages, surgical abortions have very few complications. Prophylactic antibiotics result in lower rates of post-surgical abortion infection. Pain medication such as non-steroidal anti-inflammatories should be offered to women undergoing abortion procedures; acetaminophen, however, is not effective in reducing pain. Women who are eligible should be offered a choice between surgical (vacuum aspiration or dilation and evacuation) and medical methods (mifepristone and misoprostol) of abortion when possible. Modern methods of contraception can be safely initiated immediately following abortion procedures. Evidence-based guidelines assist health care providers and policymakers to utilize the best data available to provide safe abortion care and prevent the millions of deaths and disabilities that result from unsafe abortion. Copyright © 2013 Elsevier Inc. All rights reserved.

Incidence of induced abortion in Malawi, 2015.

PubMed

Polis, Chelsea B; Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert

2017-01-01

In Malawi, abortion is legal only if performed to save a woman's life; other attempts to procure an abortion are punishable by 7-14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi's high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15-44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. We estimate that approximately 141,044 (95% CI: 121,161-160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15-49 (95% CI: 32 to 43); which varied by geographical zone (range: 28-61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34-35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

Incidence of induced abortion in Malawi, 2015

PubMed Central

Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert

2017-01-01

Background In Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. Methods We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. Results We estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. Conclusions The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi. PMID:28369114

Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework.

PubMed

Taylor, Diana; Upadhyay, Ushma D; Fjerstad, Mary; Battistelli, Molly F; Weitz, Tracy A; Paul, Maureen E

2017-07-01

To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first-trimester aspiration abortion procedures. Standardization will assist healthcare providers, researchers and policymakers to anticipate morbidity and prevent abortion adverse events, improve care metrics and enhance abortion quality. Copyright © 2017 Elsevier Inc. All rights reserved.

Optical Associative Memory Model With Threshold Modification Using Complementary Vector

NASA Astrophysics Data System (ADS)

Bian, Shaoping; Xu, Kebin; Hong, Jing

1989-02-01

A new criterion to evaluate the similarity between two vectors in associative memory is presented. According to it, an experimental research about optical associative memory model with threshold modification using complementary vector is carried out. This model is capable of eliminating the posibility to recall erroneously. Therefore the accuracy of reading out is improved.

The Impact of Clinical History on the Threshold Estimation of Auditory Brainstem Response Results for Infants

ERIC Educational Resources Information Center

Zaitoun, Maha; Cumming, Steven; Purcell, Alison; O'Brien, Katie

2017-01-01

Purpose: This study assesses the impact of patient clinical history on audiologists' performance when interpreting auditory brainstem response (ABR) results. Method: Fourteen audiologists' accuracy in estimating hearing threshold for 16 infants through interpretation of ABR traces was compared on 2 occasions at least 5 months apart. On the 1st…

The impact of a liberalisation law on legally induced abortion hospitalisations.

PubMed

Gonçalves-Pinho, Manuel; Santos, João V; Costa, Antónia; Costa-Pereira, Altamiro; Freitas, Alberto

2016-08-01

Legal abortion based purely in maternal option without fetal/maternal pathology was liberalised in Portugal in 2007 and since then abortion rates have increased substantially. The aim of this paper was to study the impact of the liberalisation of abortion by maternal request on total legal abortion related hospitalisation trends. We considered hospitalisations of legal abortion (ICD-9-CM codes 635.x) with discharges from 2000 to 2014. Data was obtained from a Portuguese administrative database, which contains all registered public hospitalisations in mainland Portugal. Performed legal abortions during the same period were obtained from INE (National Statistics Institute). Hospitalisations per abortion were calculated by dividing the number of legal abortions hospitalisations per the number of legal abortions, mean ages, number of hospitalisations per age group, complications, admission type and length of stay were also analysed, throughout the study period. Hospitalisations rose during the study period, (from 618 episodes in 2000 to 1,259 in 2014, with a peak of 1,603 in 2010). Since the liberalisation law was passed there was a significant decrease in the number of hospitalisations per abortion: from 1.07 in 2000 to 0.11 in 2014 (p<0.001). Furthermore, the mean age maintained stable since liberalisation (30.8 years before 2007 and 31.0 after). Abortion related hospitalisations are more frequent in women aged 25-39. A significant decrease from the emergent to the scheduled type of admission occurred from 2000 to 2014 (from 83.5% to 56.7% of emergent admissions) (p<0.001). Complications remained stable between 2000 and 2014 and delayed or excessive haemorrhage was the most frequent (4.6%). Since the liberalisation, hospitalisations per abortion have decreased, reflecting the major impact that the liberalisation of legal abortion by maternal request had on abortion trends nationwide. Before the liberalisation, each abortion led to approximately one hospitalisation while after the liberalisation this trend shifted to approximately 10% of the number of abortions. Legal abortion related hospitalisations are more frequent in women aged between 25 and 39 years old, an older age group when compared to the one registered in all cases of legal abortions, reflecting the differences between those hospitalised and those who are not. Our study shows the impact that legal abortion by maternal request liberalisation law can bring to abortion and to hospitalisation trends. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Abortion surveillance--United States, 2001.

PubMed

Strauss, Lilo T; Herndon, Joy; Chang, Jeani; Parker, Wilda Y; Levy, Deborah A; Bowens, Sonya B; Zane, Suzanne B; Berg, Cynthia J

2004-11-26

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2001. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. In 2000 and 2001, Oklahoma again reported these data, increasing the number of reporting areas to 49. A total of 853,485 legal induced abortions were reported to CDC for 2001 from 49 reporting areas, representing a 0.5% decrease from the 857,475 legal induced abortions reported by the same 49 reporting areas for 2000. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2001, compared with 245 reported for 2000. This represents a 0.4% increase in the abortion ratio. The abortion rate was 16 per 1,000 women aged 15-44 years for 2001, the same as for 2000. For both the 48 and 49 reporting areas, the abortion rate remained relatively constant during 1997-2001. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%) and aged <25 years (52%). Of all abortions for which gestational age was reported, 59% were performed at < or =8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2001, steady increases have occurred in the percentage of abortions performed at < or =6 weeks' gestation. A limited number of abortions were obtained at >15 weeks' gestation, including 4.3% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed medical (nonsurgical) procedures, making up 2.9% of all reported procedures from the 45 areas with adequate reporting on type of procedure. In 2000 (the most recent year for which data are available), 11 women died as a result of complications from known legal induced abortion. No deaths were associated with known illegal abortion. During 1990-1997, the number of legal induced abortions gradually declined. When the same 48 reporting areas are compared, the number of abortions decreased during 1996-2001. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly. In 2000, as in previous years, deaths related to legal induced abortions occurred rarely (less than one death per 100,000 abortions). Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.

Abortion surveillance--United States, 1999.

PubMed

Elam-Evans, Laurie D; Strauss, Lilo T; Herndon, Joy; Parker, Wilda Y; Whitehead, Sara; Berg, Cynthia J

2002-11-29

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions and to monitor unintended pregnancy. This report summarizes and describes data reported to CDC regarding legal induced abortions obtained in the United States in 1999. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. From 1973 through 1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. Beginning in 1998, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these areas were not estimated. The availability of data regarding the characteristics of women who obtained an abortion in 1999 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions is reported by state of residence and also by state of occurrence for most areas; characteristics of women obtaining abortions in 1999 are reported by state of occurrence. A total of 861,789 legal induced abortions were reported to CDC for 1999, representing a 2.5% decrease from the 884,273 legal induced abortions reported by the same 48 reporting areas for 1998. The abortion ratio, defined as the number of abortions per 1,000 live births, was 256 in 1999, compared with 264 reported for 1998; the abortion rate for these 48 reporting areas was 17 per 1,000 women aged 15-44 years for 1999, the same as in 1997 and 1998. The highest percentages of abortions were reported for women aged < 25 years, women who were white, and unmarried women; slightly more than half were obtaining an abortion for the first time. Fifty-eight percent of all abortions for which gestational age was reported were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. From 1992 (when these data were first collected) through 1999, increases have occurred in the percentage of abortions performed at < or = 6 weeks of gestation. Few abortions were provided after 15 weeks of gestation; 4.3% were obtained at 16-20 weeks and 1.5% were obtained at > or = 21 weeks. A total of 27 reporting areas submitted data stating that they performed medical (nonsurgical) procedures (two of these areas categorized medical abortions with "other" procedures), making up < 1.0% of all procedures reported from all reporting areas. In 1998 (for which data have not been published previously and the most recent year for which such data are available), nine women died as a result of complications from known legal induced abortion; no deaths were associated with known illegal abortion. From 1990 through 1997, the number of legal induced abortions gradually declined. In 1998 and in 1999, the number of abortions continued to decrease when comparing the same 48 reporting areas. In 1998, as in previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States should continue so that trends and characteristics of women who obtain legal induced abortions can be examined and efforts to prevent unintended pregnancy can be enhanced.

Is Induced Abortion Really Declining in Armenia?

PubMed

Jilozian, Ann; Agadjanian, Victor

2016-06-01

As in other post-Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in-depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex-selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self-administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices. © 2016 The Population Council, Inc.

[Abortion in Brazil: a household survey using the ballot box technique].

PubMed

Diniz, Debora; Medeiros, Marcelo

2010-06-01

This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.

Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment.

PubMed

Gelman, Amanda; Rosenfeld, Elian A; Nikolajski, Cara; Freedman, Lori R; Steinberg, Julia R; Borrero, Sonya

2017-03-01

Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services. A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women's responses to them. Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions. Women's reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women's abortion experiences. Copyright © 2016 by the Guttmacher Institute.

Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States

PubMed Central

Biggs, M. Antonia; Ralph, Lauren; Gerdts, Caitlin; Roberts, Sarah; Glymour, M. Maria

2018-01-01

Objectives. To determine the socioeconomic consequences of receipt versus denial of abortion. Methods. Women who presented for abortion just before or after the gestational age limit of 30 abortion facilities across the United States between 2008 and 2010 were recruited and followed for 5 years via semiannual telephone interviews. Using mixed effects models, we evaluated socioeconomic outcomes for 813 women by receipt or denial of abortion care. Results. In analyses that adjusted for the few baseline differences, women denied abortions who gave birth had higher odds of poverty 6 months after denial (adjusted odds ratio [AOR] = 3.77; P < .001) than did women who received abortions; women denied abortions were also more likely to be in poverty for 4 years after denial of abortion. Six months after denial of abortion, women were less likely to be employed full time (AOR = 0.37; P = .001) and were more likely to receive public assistance (AOR = 6.26; P < .001) than were women who obtained abortions, differences that remained significant for 4 years. Conclusions. Women denied an abortion were more likely than were women who received an abortion to experience economic hardship and insecurity lasting years. Laws that restrict access to abortion may result in worsened economic outcomes for women. PMID:29345993

A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one

PubMed Central

Foster, Diana G.; Steinberg, Julia R.; Roberts, Sarah C.M.; Neuhaus, John; Biggs, M. Antonia

2016-01-01

Background This study prospectively assesses the mental health outcomes among women seeking abortions, by comparing women having later abortions to women denied abortions, up to two years post-abortion seeking. Methods We present the first two years of a 5-year telephone interview study that is following 956 women who sought an abortion from 30 facilities throughout the U.S. We use adjusted linear mixed effects regression analyses to assess whether symptoms of depression and anxiety, as measured by the BSI-short form and Prime-MD, differ over time among women denied an abortion due to advanced gestational age, compared to women who received abortions. Results Baseline predicted mean depressive symptom scores for women denied abortion (3.07) were similar to women receiving an abortion just below the gestational limit (2.86). Depressive symptoms declined over time with no difference between groups. Initial predicted mean anxiety symptoms were higher among women denied care (2.59) than among women who had an abortion just below the gestational limit (1.91). Anxiety levels in the two groups declined and converged after one year. Conclusions Women who received an abortion had similar or lower levels of depression and anxiety than women denied an abortion. Our findings do not support the notion that abortion is a cause of mental health problems. PMID:25628123

A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one.

PubMed

Foster, D G; Steinberg, J R; Roberts, S C M; Neuhaus, J; Biggs, M A

2015-07-01

This study prospectively assesses the mental health outcomes among women seeking abortions, by comparing women having later abortions with women denied abortions, up to 2 years post-abortion seeking. We present the first 2 years of a 5-year telephone interview study that is following 956 women who sought an abortion from 30 facilities throughout the USA. We use adjusted linear mixed-effects regression analyses to assess whether symptoms of depression and anxiety, as measured by the Brief Symptom Inventory-short form and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, differ over time among women denied an abortion due to advanced gestational age, compared with women who received abortions. Baseline predicted mean depressive symptom scores for women denied abortion (3.07) were similar to women receiving an abortion just below the gestational limit (2.86). Depressive symptoms declined over time, with no difference between groups. Initial predicted mean anxiety symptoms were higher among women denied care (2.59) than among women who had an abortion just below the gestational limit (1.91). Anxiety levels in the two groups declined and converged after 1 year. Women who received an abortion had similar or lower levels of depression and anxiety than women denied an abortion. Our findings do not support the notion that abortion is a cause of mental health problems.

Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment

PubMed Central

Gelman, Amanda; Rosenfeld, Elian A.; Nikolajski, Cara; Freedman, Lori R.; Steinberg, Julia R.; Borrero, Sonya

2017-01-01

CONTEXT Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services. METHODS A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women’s responses to them. RESULTS Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions. CONCLUSIONS Women’s reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women’s abortion experiences. PMID:27984674

An analysis of 1150 cases of abortions from the Government R.S.R.M. Lying-in Hospital, Madras.

PubMed

Francis, O

1959-09-01

The Government R.S.R.M. Lying-in Hospital is located in one of the poorest sections of Madras, India, where the abortion rate is very high. The total number of complete abortions during the period, October 1957-November 1958, is 1150; the total number of deliveries including abortions is 10,367, an incidence rate of 11.09%. Of the 1150 cases, 789 (68.61%) were early abortions, up to 12 weeks; 361 (31.39%) were late, from the 13th to 28th week. An analysis of 1000 spontaneous abortions by Simons found that about 75% occurred before the 12th week. 758 abortions were performed on women aged 21-30; 204 occurred among those 31-40. 253 (22%) were primary abortions, i.e. the first pregnancy ended in an abortion and 897 (78%) were secondary abortions, i.e. there were 1 or more viable pregnancies before the abortion. Fetal death may be caused by abnormalities of the ovum, genital tract, or general maternal causes, or rare paternal causes. No cause could be found in 549 (47.74%) cases, but an associated abnormality was found in 601 (52.25%) cases. In 518 cases a single factor caused the abortion; in 83 cases more than a single etiological factor was found. There were 89 habitual aborters (7.74%). 19 of these were primary and 70 were secondary abortions.

Rapid immunoassays for diagnosis of heparin-induced thrombocytopenia: Comparison of diagnostic accuracy, reproducibility, and costs in clinical practice

PubMed Central

Bankova, Andriyana; Andres, Yvonne; Horn, Michael P.; Alberio, Lorenzo

2017-01-01

Background Immunoassays are crucial in the work-up of patients with suspected heparin-induced thrombocytopenia (HIT) and rapid tests have been recently developed. However, comparative data on diagnostic accuracy, reproducibility, and analytical costs of different immunoassays in clinical practice are limited. Methods Samples of 179 consecutive patients evaluated for suspected HIT in clinical practice using a polyspecific enzyme-linked immunoabsorbent assay (GTI diagnostics; ELISA) and a rapid particle gel immunoassay (PaGIA), were additionally analysed with a IgG-specific chemiluminescent immunoassay (AcuStar HIT-IgG). Presence of HIT was defined as a positive functional heparin-induced platelet aggregation test. Diagnostic accuracy was determined for low, intermediate and high thresholds as previously established (ELISA: optical density 0.4, 1.3, and 2.0 respectively; PaGIA: positive/negative, titre of 4, titre of 32; AcuStar HIT-IgG: 1.0 U/ml, 2.8, 9.4) and reproducibility was assessed by repeated measurements. Costs of test determination were calculated taking reagents, controls, and working time of technicians according to Swiss health care system into account. Results Data on PaGIA results were available for 171 patients (95.5%), ELISA for 144 patients (80.4%), and AcuStar HIT-IgG for 179 patients (100%). Sensitivity was above 95% for all assays at low and intermediate thresholds. Specificity increased with higher thresholds and was above 90% for all assays with intermediate and high thresholds. Specificity of AcuStar HIT-IgG (92.8%; 95% CI 87.7, 96.2) was significantly higher than PaGIA (83.0%; 95% CI 76.3, 88.5) and higher than ELISA (81.8%, 95% CI 74.2, 88.0) at low threshold (p<0.05). Reproducibility was adequate for all assays. Total costs per test were CHF 51.02 for ELISA, 117.70 for AcuStar HIT-IgG, and 83.13 for PaGIA. Conclusions We observed favourable diagnostic accuracy measures and a high reproducibility for PaGIA and AcuStar HIT-IgG. Implementation into 24-hours-service might improve patient care but the results must be confirmed in other settings and larger populations as well. PMID:28594835

Timing of abortion among adolescent and young women presenting for post-abortion care in Kenya: a cross-sectional analysis of nationally-representative data.

PubMed

Ushie, Boniface A; Izugbara, Chimaraoke O; Mutua, Michael M; Kabiru, Caroline W

2018-02-17

Complications of unsafe abortion are a leading cause of maternal mortality in sub-Saharan Africa. Adolescents and young women are disproportionately represented among those at risk of these complications. Currently, we know little about the factors associated with young women's timing of abortion. This study examined the timing of abortion as well as factors influencing it among adolescents and young women aged 12-24 years who sought post-abortion care (PAC) in health facilities in Kenya. We draw on data from a cross-sectional study on the magnitude and incidence of induced abortion in Kenya conducted in 2012. The study surveyed women presenting with a diagnosis of incomplete, inevitable, missed, complete, or septic abortion over a one-month data collection period in 328 health facilities (levels 2-6). Survey data, specifically, from adolescents and young women were analyzed to examine their characteristics, the timing of abortion, and the factors associated with the timing of abortion. One thousand one hundred forty-five adolescents and young women presented for PAC during the data collection period. Eight percent of the women reported a previous induced abortion and 78% were not using a modern method of contraception about the time of conception. Thirty-nine percent of the index abortions occurred after 12 weeks of gestation. A greater proportion of women presenting with late abortions (more than 12 weeks gestational age) (46%) than those presenting with early abortions (33%) presented with severe complications. Controlling for socio-demographic and reproductive history, timing of abortion was significantly associated with place of residence (marginal), education, parity, clinical stage of abortion and level of severity. Late-term abortions were substantial, and may have contributed substantially to the high proportion of women with post-abortion complications. Efforts to reduce the severity of abortion-related morbidities and mortality must target young women, particularly those living in rural and other remote areas. Interventions to reduce unintended pregnancies in this population are also urgently needed to improve early pregnancy detection and timely care seeking.

Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals.

PubMed

Rocca, C H; Puri, M; Dulal, B; Bajracharya, L; Harper, C C; Blum, M; Henderson, J T

2013-08-01

To investigate abortion practices of Nepali women requiring postabortion care. Cross-sectional study. Four tertiary-care hospitals in urban and rural Nepal. A total of 527 women presenting with complications from induced abortion in 2010. Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors. Induction method; uncertified abortion source. In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1-16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1-26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2-0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5-4.3), compared with women accessing certified sources. Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

Abortion in Indonesia.

PubMed

Sedgh, Gilda; Ball, Haley

2008-09-01

Each year in Indonesia, millions of women become pregnant unintentionally, and many choose to end their pregnancies, despite the fact that abortion is generally illegal. Like their counterparts in many developing countries where abortion is stigmatized and highly restricted, Indonesian women often seek clandestine procedures performed by untrained providers, and resort to methods that include ingesting unsafe substances and undergoing harmful abortive massage. Though reliable evidence does not exist, researchers estimate that about two million induced abortions occur each year in the country and that deaths from unsafe abortion represent 14-16% of all maternal deaths in Southeast Asia. Preventing unsafe abortion is imperative if Indonesia is to achieve the fifth Millennium Development Goal of improving maternal health and reducing maternal mortality. Current Indonesian abortion law is based on a national health bill passed in 1992. Though the language on abortion was vague, it is generally accepted that the law allows abortion only if the woman provides confirmation from a doctor that her pregnancy is life-threatening, a letter of consent from her husband or a family member, a positive pregnancy test result and a statement guaranteeing that she will practice contraception afterwards. This report presents what is currently known about abortion in Indonesia. The findings are derived primarily from small-scale, urban, clinic-based studies of women's experiences with abortion. Some studies included women in rural areas and those who sought abortions outside of clinics, but none were nationally representative. Although these studies do not give a full picture of who is obtaining abortions in Indonesia or what their experiences are, the evidence suggests that abortion is a common occurrence in the country and that the conditions under which abortion takes place are often unsafe.

Determinants of first and second trimester induced abortion - results from a cross-sectional study taken place 7 years after abortion law revisions in Ethiopia.

PubMed

Bonnen, Kristine Ivalu; Tuijje, Dereje Negussie; Rasch, Vibeke

2014-12-19

In 2005 Ethiopia took the important step to protect women's reproductive health by liberalizing the abortion law. As a result women were given access to safe pregnancy termination in first and second trimester. This study aims to describe socio-economic characteristics and contraceptive experience among women seeking abortion in Jimma, Ethiopia and to describe determinants of second trimester abortion. A cross-sectional study conducted October 2011 - April 2012 in Jimma Town, Ethiopia among women having safely induced abortion and women having unsafely induced abortion. In all 808 safe abortion cases and 21 unsafe abortion cases were included in the study. Of the 829 abortions, 729 were first trimester and 100 were second trimester abortions. Bivariate and multivariate logistic regressions were used to determine risk factors associated with second trimester abortion. The associations are presented as odds ratios (OR) with 95% confidential intervals. Age stratified analyses of contraceptive experience among women with first and second trimester abortions are also presented. Socio-economic characteristics associated with increased ORs of second trimester abortion were: age < 19 years, being single, widowed or divorced, attending school, being unemployment, being nullipara or para 3+, and having low education. The contraceptive prevalence rate varied across age groups and was particularly low among young girls and young women experiencing second trimester abortion where only 15% and 19% stated they had ever used contraception. Young age, poor education and the prospect of single parenthood were associated with second trimester abortion. Young girls and young women were using contraception comparatively less often than older women. To ensure women full right to control their fertility in the setting studied, modern contraception should be made available, accessible and affordable for all women, regardless of age.

Induced abortion.

PubMed

2017-06-01

Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008

PubMed Central

Moore, Ann M.; Gebrehiwot, Yirgu; Fetters, Tamara; Wado, Yohannes Dibaba; Bankole, Akinrinola; Singh, Susheela; Gebreselassie, Hailemichael; Getachew, Yonas

2017-01-01

CONTEXT In 2005, Ethiopia’s parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008. METHODS Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008. RESULTS An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15–49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008. CONCLUSIONS Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women’s access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed. PMID:28825902

Distance traveled for Medicaid-covered abortion care in California.

PubMed

Johns, Nicole E; Foster, Diana Greene; Upadhyay, Ushma D

2017-04-19

Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

Eliminating the high abortion related complications and deaths in Cameroon: the restrictive legal atmosphere on abortions is no acceptable excuse.

PubMed

Bain, Luchuo Engelbert; Kongnyuy, Eugene Justine

2018-05-24

The abortion law in Cameroon is highly restrictive. The law permits induced abortions only when the woman's life is at risk, to preserve her physical and mental health, and on grounds of rape or incest. Unsafe abortions remain rampant with however rare reported cases of persecution, even when these abortions are proven to have been carried out illegally. Available public health interventions are cheap and feasible (Misoprostol and Manual Vacuum Aspiration in post abortion care, modern contraception, post-abortion counseling), and must be implemented to reduce unacceptably high maternal mortality rates in the country which still stand at as high as 596/100.000. Changes in the legal status of abortions might take a long time to come by. Albeit, advocacy efforts must be reinforced to render the law more liberal to permit women to seek safe abortion services. The frequency of abortions, generally clandestine, in this restrictive legal atmosphere has adverse economic, health and social justice implications. We argue that a non-optimal or restrictive legal atmosphere is not an acceptable excuse to justify these high maternal deaths resulting from unsafe abortions, especially in Cameroon where unsafe abortions remain rampant. Implementing currently available, cheap and effective evidence based practice guidelines are possible in the country. Expansion and use of Manual Vacuum Aspiration kits in health care facilities, post-abortion misoprostol and carefully considering the content of post abortion counseling packages deserve keen attention. More large scale qualitative and quantitative studies nationwide to identify and act on context specific barriers to contraception use and abortion related stigma are urgently needed.

Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014

PubMed Central

Gebrehiwot, Yirgu; Fetters, Tamara; Gebreselassie, Hailemichael; Moore, Ann; Hailemariam, Mengistu; Dibaba, Yohannes; Bankole, Akinrinola; Getachew, Yonas

2017-01-01

CONTEXT In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care—i.e., legal abortion and treatment of abortion complications—changed over time. METHODS Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities—some of which provide abortion care—to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014. RESULTS The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception. CONCLUSIONS Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved. PMID:28825903

Socio-clinical profile of married women with history of induced abortion: A community-based cross-sectional study in a rural area.

PubMed

Pattanaik, Sumitra; Patnaik, Lipilekha; Subhadarshini, Arpita; Sahu, Trilochan

2017-01-01

Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of the availability of contraceptive services. (1) To study the sociodemographic profile of abortion seekers. (2) To study the reasons for procuring abortions by married women of reproductive age group. It was a cross-sectional community-based study. All the married women of reproductive age group (15-49 years) with a history of induced abortion were selected as the subjects. The most common reason for seeking an abortion was poverty (39.4%), followed by girl child and husband's insistence, which accounted for 17.2% each. More complications were noted in women undergoing an abortion in places other than government hospitals and also who did it in the second trimester. To reduce maternal deaths from unsafe abortion, several broad activities require strengthening such as decreasing unwanted pregnancies, increasing geographic accessibility and affordability, upgrading facilities that offers medical termination of pregnancy (MTP) services, increasing awareness among the reproductive age about the legal and safe abortion facilities, the consequences of unsafe abortion, ensuring appropriate referral facilities, increasing access to safe abortion services and increasing the quality of abortion care, including postabortion care.

A qualitative investigation of low-income abortion clients' attitudes toward public funding for abortion.

PubMed

Nickerson, Adrianne; Manski, Ruth; Dennis, Amanda

2014-01-01

We explored how low-income abortion clients in states where public funding was and was not available perceived the role of public funding for abortion. From October 2010 through February 2011, we conducted 71 semi-structured in-depth telephone interviews with low-income abortion clients in Arizona, Florida, New York, and Oregon. Women reported weighing numerous factors when determining which circumstances warranted public funding. Though most women generally supported coverage, they deviated from their initial support when asked about particular circumstances. Respondents felt most strongly that abortion should not be covered when a woman could not afford another child or was pregnant outside of a romantic relationship. Participants used disparaging language to describe the presumed behavior of women faced with unintended pregnancies. In seeking to discredit "other" women's abortions, women revealed the complex nature of abortion stigma. We propose that women's abortion experiences and subsequent opinions on coverage indicated three distinct manifestations of abortion stigma: women (1) resisted the prominent discourse that marks women who have had abortions as selfish and irresponsible; (2) internalized societal norms that stereotype women based on the circumstances surrounding the abortion; and (3) reproduced stigma by distancing themselves from the negative stereotypes associated with women who have had abortions.

Second trimester abortion in Viet Nam: changing to recommended methods and improving service delivery.

PubMed

Tuyet, Hoang T D; Thuy, Phan; Trang, Huynh N K

2008-05-01

In Viet Nam, abortion has been legal up to 22 weeks of pregnancy since the 1960s. There are about one million induced abortions every year. First trimester abortion is provided at central, provincial, district and commune level, while second trimester abortion is provided only at central and provincial level. For second trimester abortion, dilatation and evacuation (D&E) has been introduced at some central and provincial hospitals, and medical abortion protocols have been included in the draft National Standards and Guidelines currently being updated. However, Kovac's, an unsafe method, is still often used at many provincial hospitals. While access to first trimester abortion services is not difficult, there are still many barriers to second trimester abortion, especially for young, unmarried women. In order to prevent unwanted pregnancies, increase access to safe abortion and improve quality of care, the Vietnamese Ministry of Health is working with others to establish national policies and developing effective models for women-friendly comprehensive abortion care, including post-abortion family planning. This paper, based on published information, interviews and observations by the second author of service delivery in 2006-2008, provides an overview of second trimester abortion services in Viet Nam and ongoing plans for improving them.

Socio-clinical profile of married women with history of induced abortion: A community-based cross-sectional study in a rural area

PubMed Central

Pattanaik, Sumitra; Patnaik, Lipilekha; Subhadarshini, Arpita; Sahu, Trilochan

2017-01-01

Background: Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of the availability of contraceptive services. Objectives: (1) To study the sociodemographic profile of abortion seekers. (2) To study the reasons for procuring abortions by married women of reproductive age group. Materials and Methods: It was a cross-sectional community-based study. All the married women of reproductive age group (15–49 years) with a history of induced abortion were selected as the subjects. Results: The most common reason for seeking an abortion was poverty (39.4%), followed by girl child and husband's insistence, which accounted for 17.2% each. More complications were noted in women undergoing an abortion in places other than government hospitals and also who did it in the second trimester. Conclusions: To reduce maternal deaths from unsafe abortion, several broad activities require strengthening such as decreasing unwanted pregnancies, increasing geographic accessibility and affordability, upgrading facilities that offers medical termination of pregnancy (MTP) services, increasing awareness among the reproductive age about the legal and safe abortion facilities, the consequences of unsafe abortion, ensuring appropriate referral facilities, increasing access to safe abortion services and increasing the quality of abortion care, including postabortion care. PMID:29026757

Women’s embodied experiences of second trimester medical abortion

PubMed Central

Brown, Audrey; Melville, Catriona; McDaid, Lisa M

2017-01-01

Abortions in general, and second trimester abortions in particular, are experiences which in many contexts have limited sociocultural visibility. Research on second trimester abortion worldwide has focused on a range of associated factors including risks and acceptability of abortion methods, and characteristics and decision-making of women seeking the procedure. Scholarship to date has not adequately addressed the embodied physicality of second trimester abortion, from the perspective of women’s lived experiences, nor how these experiences might inform future framings of abortion. To progress understandings of women’s embodied experiences of second trimester abortion, we draw on the accounts of 18 women who had recently sought second trimester abortion in Scotland. We address four aspects of their experiences: later recognition of pregnancy; experiences of a second trimester pregnancy which ended in abortion; the “labour” of second trimester abortion; and the subsequent bodily transition. The paper has two key aims: Firstly, to make visible these experiences, and to consider how they relate to dominant sociocultural narratives of pregnancy; and secondly, to explore the concept of “liminality” as one means for interpreting them. Our findings contribute to informing future research, policy and practice around second trimester abortion. They highlight the need to maintain efforts to reduce silences around abortion and improve equity of access. PMID:28546655

Death after legally induced abortion. A comprehensive approach for determination of abortion-related deaths based on record linkage.

PubMed Central

Shelton, J D; Schoenbucher, A K

1978-01-01

The sources for determination of abortion-related deaths in Georgia are the cause of death listed on the death certificate and reports from informal reporting channels. Although Georgia residents 10-44 years of age obtained 19,877 induced abortions in 1975, no deaths related to abortion were found through these two usual sources. To determine the sensitivity of this system, all abortion certificates for 1975 were compared with all death certificates of Georgia females aged 10-44 who died in 1975 and the first 2 months of 1976. Based on the age and racial distribution of the women who received abortions, approximately 13 deaths (from all causes) would be expected to have subsequently occurred during the period of time studied. The authors found only 10. From national death-to-case rates for legal abortion, the expected number actually atrributable to abortion was 0.78 death. Of the 10 deaths, 2 were potentially related to the previous abortion, but a causal relationship to the preceding abortion was not clearly evident for any of the 10 deaths. The data, therefore, tend to support the assertion that no large numbers of deaths related to abortion are undiscovered and that current measurements of abortion mortality are accurate. Images p376-a PMID:684149

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments.

PubMed

Shinkins, Bethany; Yang, Yaling; Abel, Lucy; Fanshawe, Thomas R

2017-04-14

Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests.

The Development of Instruments to Measure Attitudes toward Abortion and Knowledge of Abortion

ERIC Educational Resources Information Center

Snegroff, Stanley

1976-01-01

This study developed an abortion attitude scale and abortion knowledge inventory that may be utilized by health educators, counselors, and researchers for assessing attitudes toward abortion and knowledge about it. (SK)

Introducing early medical abortion in Australia: there is a need to update abortion laws.

PubMed

de Costa, Caroline M; Russell, Darren B; de Costa, Naomi R; Carrette, Michael; McNamee, Heather M

2007-12-01

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

The Affordable Care Act and Abortion Comparing the U.S. and Western Europe.

PubMed

McFarlane, Deborah R

2015-01-01

The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACA's abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACA's restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.

Social stigma and disclosure about induced abortion: results from an exploratory study.

PubMed

Shellenberg, Kristen M; Moore, Ann M; Bankole, Akinrinola; Juarez, Fatima; Omideyi, Adekunbi Kehinde; Palomino, Nancy; Sathar, Zeba; Singh, Susheela; Tsui, Amy O

2011-01-01

It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.

[The gynecologist and the problem of therapeutic abortion].

PubMed

Pundel, J P

1972-01-01

Most of this essay on the abortion problem in French-speaking western Europe concerns the Sermon of Hippocrates forbidding abortion; the discussion ends with an ethical discussion on abortion codes in a pluralist society. 1st, scholars question whether Hippocrates himself actually wrote the text of the Sermon, or whether his Pythagorean followers did. 2nd, probably abortion in Hippocrates' time was relegated to midwives and lithotomists. The meaning of the quotation "I do not give any abortive remedy" is obscure since in other contexts Hippocrates distinguished between abortive and contraceptive drugs and also abortive instruments. Finally, Hipoocrates specifically recommended abortion, e.g., to avoid pregnancy for prostitutes. Persons in authority, then, should not invoke Hippocrates or any other moral code to deprive a woman of medical abortion, especially in cases of rape, age, and failure of contraception. Divorce, for example, has been legalized in most countries, without forcing anyone to take advantage of it.

Unsafe abortion: the silent scourge.

PubMed

Grimes, David A

2003-01-01

An estimated 19 million unsafe abortions occur worldwide each year, resulting in the deaths of about 70,000 women. Legalization of abortion is a necessary but insufficient step toward improving women's health. Without skilled providers, adequate facilities and easy access, the promise of safe, legal abortion will remain unfulfilled, as in India and Zambia. Both suction curettage and pharmacological abortion are safe methods in early pregnancy; sharp curettage is inferior and should be abandoned. For later abortions, either dilation and evacuation or labour induction are appropriate. Hysterotomy should not be used. Timely and appropriate management of complications can reduce morbidity and prevent mortality. Treatment delays are dangerous, regardless of their origin. Misoprostol may reduce the risks of unsafe abortion by providing a safer alternative to traditional clandestine abortion methods. While the debate over abortion will continue, the public health record is settled: safe, legal, accessible abortion improves health.

Abortion Before & After Roe

PubMed Central

Joyce, Ted; Tan, Ruoding; Zhang, Yuxiu

2013-01-01

We use unique data on abortions performed in New York State from 1971–1975 to demonstrate that women travelled hundreds of miles for a legal abortion before Roe. A100- mile increase in distance for women who live approximately 183 miles from New York was associated with a decline in abortion rates of 12.2 percent whereas the same change for women who lived 830 miles from New York lowered abortion rates by 3.3 percent. The abortion rates of nonwhites were more sensitive to distance than those of whites. We found a positive and robust association between distance to the nearest abortion provider and teen birth rates but less consistent estimates for other ages. Our results suggest that even if some states lost all abortion providers due to legislative policies, the impact on population measures of birth and abortion rates would be small as most women would travel to states with abortion services. PMID:23811233

Crew Exploration Vehicle Ascent Abort Overview

NASA Technical Reports Server (NTRS)

Davidson, John B., Jr.; Madsen, Jennifer M.; Proud, Ryan W.; Merritt, Deborah S.; Sparks, Dean W., Jr.; Kenyon, Paul R.; Burt, Richard; McFarland, Mike

2007-01-01

One of the primary design drivers for NASA's Crew Exploration Vehicle (CEV) is to ensure crew safety. Aborts during the critical ascent flight phase require the design and operation of CEV systems to escape from the Crew Launch Vehicle and return the crew safely to the Earth. To accomplish this requirement of continuous abort coverage, CEV ascent abort modes are being designed and analyzed to accommodate the velocity, altitude, atmospheric, and vehicle configuration changes that occur during ascent. The analysis involves an evaluation of the feasibility and survivability of each abort mode and an assessment of the abort mode coverage. These studies and design trades are being conducted so that more informed decisions can be made regarding the vehicle abort requirements, design, and operation. This paper presents an overview of the CEV, driving requirements for abort scenarios, and an overview of current ascent abort modes. Example analysis results are then discussed. Finally, future areas for abort analysis are addressed.

The level of unpleasantness of pain influences the choice of home treatment during medical abortion.

PubMed

Suhonen, Satu; Tikka, Marja; Kivinen, Seppo; Kauppila, Timo

2017-12-29

Background and aims Medical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure. Methods We studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3-6 weeks after abortion. Results Especially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck's Depression Index (BDI), Beck's Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion. Conclusions The unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions. Implications These patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

The estimated incidence of induced abortion in Kenya: a cross-sectional study.

PubMed

Mohamed, Shukri F; Izugbara, Chimaraoke; Moore, Ann M; Mutua, Michael; Kimani-Murage, Elizabeth W; Ziraba, Abdhalah K; Bankole, Akinrinola; Singh, Susheela D; Egesa, Caroline

2015-08-21

The recently promulgated 2010 constitution of Kenya permits abortion when the life or health of the woman is in danger. Yet broad uncertainty remains about the interpretation of the law. Unsafe abortion remains a leading cause of maternal morbidity and mortality in Kenya. The current study aimed to determine the incidence of induced abortion in Kenya in 2012. The incidence of induced abortion in Kenya in 2012 was estimated using the Abortion Incidence Complications Methodology (AICM) along with the Prospective Morbidity Survey (PMS). Data were collected through three surveys, (i) Health Facilities Survey (HFS), (ii) Prospective Morbidity Survey (PMS), and (iii) Health Professionals Survey (HPS). A total of 328 facilities participated in the HFS, 326 participated in the PMS, and 124 key informants participated in the HPS. Abortion numbers, rates, ratios and unintended pregnancy rates were calculated for Kenya as a whole and for five geographical regions. In 2012, an estimated 464,000 induced abortions occurred in Kenya. This translates into an abortion rate of 48 per 1,000 women aged 15-49, and an abortion ratio of 30 per 100 live births. About 120,000 women received care for complications of induced abortion in health facilities. About half (49%) of all pregnancies in Kenya were unintended and 41% of unintended pregnancies ended in an abortion. This study provides the first nationally-representative estimates of the incidence of induced abortion in Kenya. An urgent need exists for improving facilities' capacity to provide safe abortion care to the fullest extent of the law. All efforts should be made to address underlying factors to reduce risk of unsafe abortion.

Contraceptive use among clients of the Atlanta Feminist Women's Health Center at three to five weeks post-abortion.

PubMed

Moslin, Trisha A; Rochat, Roger W

2011-08-01

Little is known about women's contraceptive use and sexual activity in the immediate post-abortion period although effective contraceptive use is paramount during this time because fertility returns almost immediately. This study sought to learn more about women's contraceptive use and sexual behaviors to inform abortion providers and help them serve their clients better, potentially leading to a decline in the rates of unintended pregnancy and repeat abortion. Abortion clients of an Atlanta, GA clinic were surveyed over the telephone 3-5 weeks post-abortion. Background information was collected from clinic medical charts. Simple and stratified frequencies and logistic regression were used to describe women's sexual activity and contraceptive use in the immediate post-abortion period and to determine if variables known at the time of the abortion could predict contraceptive use 3-5 weeks post-abortion. 54.2% (n = 39) of women had engaged in sexual intercourse in the immediate post-abortion period. Of these, 30.8% (n = 12) were not using a contraceptive method or were not using it effectively. Women who said they did not want or need information about birth control on their medical history form were less likely to be using contraception 3-5 weeks post abortion. Emphasizing the rapid return of fertility and risk of conception in pre-abortion counseling sessions could prevent future unintended pregnancies among abortion clients. Further research could explore the interaction between a willingness to talk about contraceptive methods at the time of abortion and method use post-abortion.

Induced abortion amongst undergradute students of University of Port Harcourt.

PubMed

Oriji, Vaduneme K; Jeremiah, Israel; Kasso, Terhemen

2009-01-01

Induced abortion is the termination of pregnancy through a deliberate intervention intended to end the pregnancy. This practice is widespread in Nigeria despite the restrictive abortion laws in Nigeria. Many women still undergo induced abortion every year and endanger their health and lives as induced abortion can only be procured illegally in Nigeria. We hope to determine the proportion of undergraduate students who had induced abortion in the past and the contributing factors. To determine the proportion of the undergraduate students who support the restrictive abortion laws in Nigeria. A cross sectional questionnaire survey of undergraduate students of the University of Port Harcourt was done through a cluster sampling method along with focus group discussion with some of the respondents. 451 out of 500 administered questionnaires were retrieved and analyzed. The incidence of induced abortion amongst the respondents was 47.2%. About 40% had never used an effective form of contraception in the past and 13% were unaware of contraception. 77.9% of the induced abortion was by dilation and curettage and 1% by manual vacuum aspiration. Up to two third of the respondents were against legalization of abortion. Up to 47% of these undergraduates had performed abortion in the past. Protecting educational career was the single most important reason for this. Although most of these undergraduates are against legalizing abortion, they highly patronize unsafe abortion. Improving contraceptive awareness and usage will reduce unwanted pregnancy and induced abortion. This option appears next to total abstinence in reducing the morbidity and mortality from induced abortion in this country.

Sex-selective abortion in Nepal: a qualitative study of health workers' perspectives.

PubMed

Lamichhane, Prabhat; Harken, Tabetha; Puri, Mahesh; Darney, Philip D; Blum, Maya; Harper, Cynthia C; Henderson, Jillian T

2011-01-01

Sex-selective abortion is expressly prohibited in Nepal, but limited evidence suggests that it occurs nevertheless. Providers' perspectives on sex-selective abortion were examined as part of a larger study on legal abortion in the public sector in Nepal. In-depth interviews were conducted with health care providers and administrators providing abortion services at four major hospitals (n = 35), two in the Kathmandu Valley and two in outlying rural areas. A grounded theory approach was used to code interview transcripts and to identify themes in the data. Most providers were aware of the ban on sex-selective abortion and, despite overall positive views of abortion legalization, saw sex selection as an increasing problem. Greater availability of abortion and ultrasonography, along with the high value placed on sons, were seen as contributing factors. Providers wanted to perform abortions for legal indications, but described challenges identifying sex-selection cases. Providers also believed that illegal sex-selective procedures contribute to serious abortion complications. Sex-selective abortion complicates the provision of legal abortion services. In addition to the difficulty of determining which patients are seeking abortion for sex selection, health workers are aware of the pressures women face to bear sons and know they may seek unsafe services elsewhere when unable to obtain abortions in public hospitals. Legislative, advocacy, and social efforts aimed at promoting gender equality and women's human rights are needed to reduce the cultural and economic pressures for sex-selective abortion, because providers alone cannot prevent the practice. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

"The stakes are so high": interviews with progressive journalists reporting on abortion.

PubMed

Sisson, Gretchen; Herold, Stephanie; Woodruff, Katie

2017-12-01

Because news frames can influence public and policy agendas, proponents of abortion access should be concerned with how this issue is covered in the news. While previous research has examined the content of news on abortion, this analysis explores the process of newsmaking on abortion, examining how journalists understand their role in and experience of covering abortion. We recruited journalists with experience reporting on abortion through listservs for progressive and feminist reporters. Thirty-one participants, with experiences at 75 diverse media outlets, completed in-depth, open-ended interviews. We used grounded theory to code interview transcripts in Dedoose to identity emergent themes. Journalists described many challenges that applied to reporting generally, but that they perceived to be more difficult around abortion: grappling with the meaning of "neutrality" on this issue, finding new angles for articles, and handling editors with varying knowledge of abortion. Over one-third (n=13) of participants mentioned feeling that the stakes were higher around abortion: this urgency and polarization left journalists frustrated by efforts to find new sources or angles on abortion stories. Finally, over 80% (n=28) of participants reported experiencing anti-abortion harassment as a result of their abortion work. The difficulties journalists described when reporting on abortion were often rooted in abortion stigma and the political polarization around the issue. This pattern was true even for reporters who worked to counter abortion stigma through their reporting. Advocates interested in accurate, destigmatizing news frames might work pro-actively to educate editors and increase reporters' access to providers, patients, and advocates. Copyright © 2017 Elsevier Inc. All rights reserved.

House committees refuse to limit health plan abortion coverage.

PubMed

1994-06-24

Anti-choice efforts to eliminate and/or restrict abortion coverage in US health care reform proposals were overwhelmingly rejected by Congressional committees on June 22 and 23, 1994. The committees rejected Kentucky Republican Representative Jim Bunning's amendment to remove abortion services except in cases of life endangerment, rape, or incest; Wisconsin Democrat Gerald Kleczka's attempt to let health plans opt out of providing abortion coverage; Pennsylvania Republican Rick Santorum's attempt to prevent the health plan from preempting state constitutional laws and regulations on abortion; amendments by Pennsylvania Democrat Ron Klink to drop abortion coverage except in cases of life endangerment, rape, or incest, and to guarantee against the plan overturning state regulations on abortion; and an amendment by Wisconsin Republican Steve Gunderson to allow plans to single out abortion from the guaranteed benefits package and offer plans without that coverage as well as to allow self-insured businesses to opt out of abortion coverage. Moreover, a final proposal to move abortion services into an optional benefit category was withdrawn and the House Education and Labor Committee refused to endorse abortion restrictions in its version of Clinton's HR 3600 health care proposal. The Senate Labor and Human Resources Committee previously defeated restrictions on abortion coverage.

TRAP laws and the invisible labor of US abortion providers

PubMed Central

Mercier, Rebecca J; Buchbinder, Mara; Bryant, Amy

2016-01-01

Targeted Regulations of Abortion Providers (TRAP laws) are proliferating in the United States and have increased barriers to abortion access. In order to comply with these laws, abortion providers make significant changes to facilities and clinical practices. In this article, we draw attention to an often unacknowledged area of public health threat: how providers adapt to increasing regulation, and the resultant strains on the abortion provider workforce. Current US legal standards for abortion regulations have led to an increase in laws that target abortion providers. We describe recent research with abortion providers in North Carolina to illustrate how providers adapt to new regulations, and how compliance with regulation leads to increased workload and increased financial and emotional burdens on providers. We use the concept of invisible labor to highlight the critical work undertaken by abortion providers not only to comply with regulations, but also to minimize the burden that new laws impose on patients. This labor provides a crucial bridge in the preservation of abortion access. The impact of TRAP laws on abortion providers should be included in the consideration of the public health impact of abortion laws. PMID:27570376

Theorizing Time in Abortion Law and Human Rights.

PubMed

Erdman, Joanna N

2017-06-01

The legal regulation of abortion by gestational age, or length of pregnancy, is a relatively undertheorized dimension of abortion and human rights. Yet struggles over time in abortion law, and its competing representations and meanings, are ultimately struggles over ethical and political values, authority and power, the very stakes that human rights on abortion engage. This article focuses on three struggles over time in abortion and human rights law: those related to morality, health, and justice. With respect to morality, the article concludes that collective faith and trust should be placed in the moral judgment of those most affected by the passage of time in pregnancy and by later abortion-pregnant women. With respect to health, abortion law as health regulation should be evidence-based to counter the stigma of later abortion, which leads to overregulation and access barriers. With respect to justice, in recognizing that there will always be a need for abortion services later in pregnancy, such services should be safe, legal, and accessible without hardship or risk. At the same time, justice must address the structural conditions of women's capacity to make timely decisions about abortion, and to access abortion services early in pregnancy.

Pharmacy workers’ knowledge and provision of medication for termination of pregnancy in Kenya

PubMed Central

Reiss, Kate; Footman, Katharine; Akora, Vitalis; Liambila, Wilson; Ngo, Thoai D

2016-01-01

Objective To assess pharmacy workers’ knowledge and provision of abortion information and methods in Kenya. Methods In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion services they provide. We also used mystery clients, who made 401 visits to pharmacies to collect first-hand information on abortion practices. Results The majority (87.5%) of pharmacy workers had heard of misoprostol but only 39.2% had heard of mifepristone. We found that pharmacy workers had limited knowledge of correct medical abortion regimens, side effects and complications and the legal status of abortion drugs. 49.8% of pharmacy workers reported providing abortion information to clients and 4.3% reported providing abortion methods. 75.2% of pharmacies referred mystery clients to another provider, though 64.2% of pharmacies advised mystery clients to continue with their pregnancy. Pharmacy workers reported that they were experiencing demand for abortion services from clients. Conclusions Pharmacy workers are important providers of information and referrals for women seeking abortion, however their medical abortion knowledge is limited. Training pharmacy workers on medical abortion may improve the quality of information provided and access to safe abortion. PMID:26869694

Needs for laws dealing with abortion in Africa.

PubMed

Ojo, S L

1976-09-01

This paper reviews from the point of view of a lawyer, the need for abortion, the state of the laws in Africa and hazards of illegal abortion encouraged by restrictive laws. The author then examines the trends in the liberalization of laws in Africa and poses the problem of intention towards liberalization and the tendency of the governments to continue retaining some aspects of the restrictive laws. It is concluded that restrictive abortion laws in many African countries have proved ineffective and should therefore be liberalized. Miller's 8 stages in a woman's reproductive career when she is especially vulnerable psychologically to unwanted pregnancy and the 5 aspects of ego psychology to explain these stages are delineated. Hazards of illegal abortions include use of unqualified personnel, unsanitary conditions, high mortality rate and a sense of punishment conveyed especially to the poor and uneducated which may deter them from seeking medical assistance and contraceptive advice after the operation. 7% of the world's population live in countries where abortion is prohibited; for 12% abortion is permitted only to save the life of the mother; 15% must have broad medical grounds for abortion; for 22% social factors are taken into consideration; 36% can have abortions at their own request, 8% are subject to restrictive abortion laws. Only Tunisia and Zambia in Africa have so far liberalized their abortion laws. Liberalization will substantially reduce frequency of illegal and/or self induced abortions and the incidence of illegitimate births. Women who practice contraception are more likely to accept abortion and those who have an abortion are more likely to accept contraceptive methods when available. Since Potts predicts that 1/3 of all married couples will have at least 1 unplanned pregnancy, liberalization of abortion laws cannot be denied on the argument that instead emphasis should be placed on prevention through family planning education and services. The specific intentions of Nigeria, Ghana, Zaire, Mali, Dahomey, Senegal and Kenya are given. It is concluded that various African governments believe incorrectly that providing contraception can avoid abortion. The author recommends educating these governments on the links between abortion and contraception and a push from appropriate associations in Africa for liberalization. Appendices list grounds for abortion in all countries of the world, the effect of the English Abortion Act (1967) on illegitimate births, and abortion deaths, and the text of the French law of 1920.

Access to abortion: what women want from abortion services.

PubMed

Wiebe, Ellen R; Sandhu, Supna

2008-04-01

Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services. Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses. Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic. Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa.

PubMed

Lince-Deroche, Naomi; Fetters, Tamara; Sinanovic, Edina; Devjee, Jaymala; Moodley, Jack; Blanchard, Kelly

2017-01-01

Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32-75.51). The total average cost per MVA was higher at $69.60 (52.62-86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

PubMed Central

Martins-Melo, Francisco Rogerlândio; Lima, Mauricélia da Silveira; Alencar, Carlos Henrique; Ramos, Alberto Novaes; Carvalho, Francisco Herlânio Costa; Machado, Márcia Maria Tavares; Heukelbach, Jorg

2014-01-01

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country. PMID:25119946

"It was as if society didn't want a woman to get an abortion": a qualitative study in Istanbul, Turkey.

PubMed

MacFarlane, Katrina A; O'Neil, Mary Lou; Tekdemir, Deniz; Foster, Angel M

2017-02-01

In 1983, abortion without restriction as to reason was legalized in Turkey. However, at an international conference in 2012, the Prime Minister condemned abortion and announced his intent to draft restrictive abortion legislation. As a result of public outcry and protests, the law was not enacted, but media reports suggest that barriers to abortion access have since worsened. We aimed to conduct a qualitative study exploring women's recent abortion experiences in Istanbul, Turkey. In 2015, we conducted 14 semi-structured in-depth interviews with women aged 18 or older who had obtained abortion care in Istanbul on/after January 1, 2009. We employed a multimodal recruitment strategy and analyzed these interviews for content and themes using deductive and inductive techniques. Women reported on a total of 19 abortions. Although abortion care is available in private facilities, only one public hospital provides abortion services without restriction as to reason. Women who had multiple abortions in different facility types described quality of care more positively in the private sector. Unmarried women considered their marital status when making the decision to seek an abortion and reported challenges obtaining comprehensive sexual and reproductive health services. All participants were familiar with the Turkish government's antiabortion discourse and believed that this was reflective of an overarching desire to restrict women's rights. Public abortion services in Istanbul are currently limited, and private abortion services are accessible but relatively expensive to obtain. Recent antiabortion political rhetoric appears to have negatively impacted access and service quality. This is the first qualitative study exploring women's experiences obtaining abortion services in Turkey since the proposed abortion restriction in 2012. Further research exploring the experiences of unmarried women and abortion accessibility in other regions of the country is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

The demographic argument in Soviet debates over the legalization of abortion in the 1920s.

PubMed

Solomon, S G

1993-01-01

Russia legalized abortion in 1920. State policy was pronatalist. Regional abortion commissions were established in order to monitor costs and maintain records. The physicians before the legal change were mainly against legalization. In 1923 the abortion rate was 2.91 abortions per live birth. A 1923 study by M. Karlin, M.D., found among 1362 women that the health risk to women of zero parity with an induced abortion was higher than giving birth. Public discussion of abortion was limited between 1921 and 1924. Russian physicians between 1925 and 1927 both publicly and privately discussed the problems; greater attention to demographic concerns occurred during the 1930s. The connection between abortion and the declining birth rate was established in a limited way in a May 1927 obstetricians' society meeting in Kiev, Ukraine. The albeit unreliable statistics appeared to confirm the decline in the birth rate due to increased numbers of abortions. The literature in the 1920s was devoted to the well-being of women as workers; abortion policy favored the interests of working women and was set up for prevention of unsafe illegal abortions. Russian demographers were more concerned with population movements. Surveys found that the profiled abortion client was indeed not destitute, but better off and married. Roesle, a German demographer, considered legal abortion beneficial in reducing maternal mortality, but he was criticized for obscuring abortions' impact on the birth rate. The debate in Russia was tangled in ideology. A comparison of abortion rates in Vienna and Moscow by a Viennese demographer Peller found similar rates regardless of legality. Peller further suggested that contraception had more to do with birth rates. Even though rural populations were hard hit by famine in 1931 and forced collectivization in 1929, increased rural abortions were blamed for the declining rural birth rates. The demographic argument against abortion became prominent again in 1931/32 after a hiatus between 1927 and the late 1930s.

[Complications of induced abortion].

PubMed

Kretowicz, J

1984-03-26

The abortion problem has been a major topic of debate for many years. Polish legislation permitting abortion has both supporters and opponents. It appears that both groups fail to fully recognize the risks of the various medical complications of induced abortion. A literature review of the complications of abortion shows that these complications are often underestimated by the public and the medical community. The review clearly demonstrates that abortion adversely affects women's health. Inflammation of the genital system is the most frequent complication. The ocurrence of complications increases as the term of the pregnancy advances. It is concluded that the public is not fully aware of the immediate danger and aftereffects of induced abortion. Wider popularization of the extensive body of scientific information regarding the risks of induced abortion might change current perceptions about the "safety" of abortion.

The Incidence of Abortion in Nigeria

PubMed Central

Bankole, Akinrinola; Adewole, Isaac F.; Hussain, Rubina; Awolude, Olutosin; Singh, Susheela; Akinyemi, Joshua O.

2016-01-01

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. PMID:26871725

Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

PubMed Central

Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

2016-01-01

Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

Social sources of women's emotional difficulty after abortion: lessons from women's abortion narratives.

PubMed

Kimport, Katrina; Foster, Kira; Weitz, Tracy A

2011-06-01

The experiences of women who have negative emotional outcomes, including regret, following an abortion have received little research attention. Qualitative research can elucidate these women's experiences and ways their needs can be met and emotional distress reduced. Twenty-one women who had emotional difficulties related to an abortion participated in semi-structured, in-depth telephone interviews in 2009. Of these, 14 women were recruited from abortion support talklines; seven were recruited from a separate research project on women's experience of abortion. Transcripts were analyzed using the principles of grounded theory to identify key themes. Two social aspects of the abortion experience produced, exacerbated or mitigated respondents' negative emotional experience. Negative outcomes were experienced when the woman did not feel that the abortion was primarily her decision (e.g., because her partner abdicated responsibility for the pregnancy, leaving her feeling as though she had no other choice) or did not feel that she had clear emotional support after the abortion. Evidence also points to a division of labor between women and men regarding pregnancy prevention, abortion and childrearing; as a result, the majority of abortion-related emotional burdens fall on women. Experiencing decisional autonomy or social support reduced respondents' emotional distress. Supporting a woman's abortion decision-making process, addressing the division of labor between women and men regarding pregnancy prevention, abortion and childrearing, and offering nonjudgmental support may guide interventions designed to reduce emotional distress after abortion. Copyright © 2011 by the Guttmacher Institute.

The impact of recent changes in therapeutic abortion laws.

PubMed

Kahn, J B; Bourne, J P; Tyler, C W

1971-12-01

This report summarizes the current status of abortion legislation as of January 1, 1971. Data are presented from several sources to characterize the population receiving abortion services in terms of age, race, marital status, and indications for pregnancy termination. A special section details the abortion scene in New York City, especially insofar as it pertains to the availability of abortion services to out-of state women. Certain conclusions are drawn. The practice of legal abortion is increasing dramatically. From January to June 1970, there were 34,143 abortions in 9 selected states. It was estimated that no more than 8000 legal abortions per year were done as recently as 1965. It is apparent that the status of a given law regulating the performance of abortions does not necessarily dictate the actual number performed. While it is true that the complexity or liberalism of the worded law may be instrumental in guiding physicians to the greater performance of legal abortions, it is just as clear that the intention of the practicing physician or hospital to comply with the spirit of the law may, in fact, be more critical. A disproportionate number of abortions reported as a given statewide experience are still being done by a limited number of institutions in that state. States like California and Oregon are defined as "liberal performance states". They do more abortions for mental health indications and more abortions on women who are young and unmarried. Based on the abortion data in this report, it is obvious that race-specific abortion ratios do not correspond to race-specific live birth rates. In Jefferson County, Alabama, and in the State of California, black women have obtained hospital abortions at a rate nearly equal to that of white women, but in Georgia and South Carolina, there is a lower abortion ratio among black women than among white women. It has yet to be determined if this variability is the result of a negative patient attitude or a policy of willful or accidental physical and hospital discrimination. New York City is now providing abortion services for the entire country. The highly significant rise in the citywide abortion ratio between prelaw 1968 and the first postlaw reporting period of 1970 was almost 4 times greater for private than for ward patients. A large influx of out-of-state women was documented and may help to account for this disparity in current abortion ratios. It is concluded that there is an unmet need for more accessible abortion services in these women's home states.

Rape as a legal indication for abortion: implications and consequences of the medical examination requirement.

PubMed

Teklehaimanot, K I; Smith, C Hord

2004-01-01

A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.

Knowledge and attitudes of Swedish politicians concerning induced abortion.

PubMed

Sydsjö, Adam; Josefsson, Ann; Bladh, Marie; Muhrbeck, Måns; Sydsjö, Gunilla

2012-12-01

Induced abortion is more frequent in Sweden than in many other Western countries. We wanted to investigate attitudes and knowledge about induced abortion among politicians responsible for healthcare in three Swedish counties. A study-specific questionnaire was sent to all 375 elected politicians in three counties; 192 (51%) responded. The politicians stated that they were knowledgeable about the Swedish abortion law. More than half did not consider themselves, in their capacity as politicians, sufficiently informed about abortion-related matters. Most politicians (72%) considered induced abortion to be primarily a 'women's rights issue' rather than an ethical one, and 54% considered 12 weeks' gestational age an adequate upper limit for induced abortion. Only about a third of the respondents were correctly informed about the number of induced abortions annually carried out in Sweden. Information and knowledge on induced abortion among Swedish county politicians seem not to be optimal. Changes aimed at reducing the current high abortion rates will probably not be easy to achieve as politicians seem to be reluctant to commit themselves on ethical issues and consider induced abortion mainly a women's rights issue.

Mortality and morbidity associated with legal abortions in Hungary, 1960-1973.

PubMed Central

Bognar, Z; Czeizel, A

1976-01-01

In Hungary, with 10 million inhabitants, the number of induced abortions in the 1960's first approached and then reached 200,000 cases annually. These data mean that the number of induced abortions has increased substantially compared with earlier decades. A qualitative change has also occurred, from criminal abortions to, in most cases, legally induced abortions performed in hospitals. On the basis of 32 deaths directly resulting from legal induced abortion in the first trimester during 1960-1972, maternal mortality is about 1.5 per 100,000 abortions in Hungary, the lowest rat observed until the present anywhere in the world. According to a special survey conducted in Budapest in 1966, the overall morbidity rate was 41.6 per 1,000 abortions of which 0.9 was due to perforations, 22.7 to post-abortal hemorrhages, and 18.0 to inflammatory complications, i.e., early post-abortal complications had to be reckoned with in every 25th case. Data in the present study suggest a correlation between induced abortions and the incidence of placenta previa, premature separation of the placenta, and premature births. PMID:937603

Surgical abortion in second trimester: initial experiences in Nepal.

PubMed

Shrivastava, V; Bajracharya, L; Thapa, S

2010-01-01

In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal. The objective of the study is to fi nd the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix. A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed. Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%). Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people.

Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States.

PubMed

Biggs, M Antonia; Neuhaus, John M; Foster, Diana G

2015-12-01

We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility's gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.

Reactions to abortion and subsequent mental health.

PubMed

Fergusson, David M; Horwood, L John; Boden, Joseph M

2009-11-01

There has been continued interest in the extent to which women have positive and negative reactions to abortion. To document emotional reactions to abortion, and to examine the links between reactions to abortion and subsequent mental health outcomes. Data were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30. Abortion was associated with high rates of both positive and negative emotional reactions; however, nearly 90% of respondents believed that the abortion was the right decision. Analyses showed that the number of negative responses to the abortion was associated with increased levels of subsequent mental health disorders (P<0.05). Further analyses suggested that, after adjustment for confounding, those having an abortion and reporting negative reactions had rates of mental health disorders that were approximately 1.4-1.8 times higher than those not having an abortion. Abortion was associated with both positive and negative emotional reactions. The extent of negative emotional reactions appeared to modify the links between abortion and subsequent mental health problems.

More on Koop's study of abortion.

PubMed

1990-01-01

In the report presented by Surgeon General Everett Koop to former president Ronald Reagan on the medical and physiological impact of abortion in women, after extensive research, it was concluded that the risk of death due to abortion had declined by 5 fold since the legalization of abortion, and pregnancy or childbirth is 25 times more likely to result in death of the mother than an abortion. Also, abortion was seen as having no medical contraindications, given that infertility, miscarriages, low birth weight, and other reproductive problems were equally evident in women who had not received an abortion. In addition, 90% of all abortions occurred in the safer 1st trimester of pregnancy. Evidence of psychological complications following an abortion is thus far lacking, and therefore not a public health concern. However, in spite of the overwhelming evidence in support of the need for abortion services, Dr Koop's bias against abortion remains. Instead, Dr Koop emphasized the need for greater emphasis in prevention of unwanted pregnancies, and encouraged more funding and political support on the development of new, safer, and more effective contraceptives.

Brazilian abortion law: the opinion of judges and prosecutors.

PubMed

Duarte, Graciana Alves; Osis, Maria José Duarte; Faúndes, Anibal; Sousa, Maria Helena de

2010-06-01

To analyze the opinion of judges and prosecutors concerning Brazilian abortion law and situations in which the abortion should be allowed. A cross-sectional study was performed with 1,493 judges and 2,614 prosecutors in Brazil between 2005 and 2006. Participants completed a structured questionnaire approaching sociodemographic characteristics, opinions about abortion law, and circumstances in which abortion is considered lawful. Bivariate and multivariate analyses of data were carried out through Poisson regression. The majority of participants (78%) found that the circumstances in which abortion is considered lawful should be broadened, or even that abortion should not be criminalized. The highest rates of pro-abortion opinions resulted from: risk to the life of the mother (84%), anencephaly (83%), severe congenital malformation of fetus (82%), and pregnancy resulting from rape (82%). Variables related to religion were strongly associated to the opinion of participants. There is a trend in considering the need of changing the current abortion law, in the sense of widening the circumstances in which abortion is considered lawful, or even toward decriminalizing abortion, regardless of the circumstances in which it takes place.

National crisis, supranational opportunity: the Irish construction of abortion as a European service.

PubMed

Fletcher, R

2000-11-01

In the late 1980s, the anti-abortion movement successfully sought injunctions against pregnancy counselling centres and students' unions in Ireland, preventing them from distributing information on how to obtain an abortion abroad. One of the defensive arguments that the students' unions employed was to claim that the distribution of abortion information was protected as an aspect of the free movement of services under European Community law. This paper addresses the implications of categorising abortion as a supranational economic service for feminist legal strategy. The advantages of categorising abortion as a service to which women have access as consumers are that it legitimates abortion and it provides a new strategy for making abortion claims. The disadvantages are that a woman's legal interest in abortion is based on her capacity to buy the service, fetal life is rendered devoid of value, and the service supplier has as much say about the abortion transaction as the woman consumer. If feminist legal strategy is to successfully use the legal construction of abortion as an economic service, it must work to minimise such negative implications.

‘This Is Real Misery’: Experiences of Women Denied Legal Abortion in Tunisia

PubMed Central

Hajri, Selma; Raifman, Sarah; Gerdts, Caitlin; Baum, Sarah; Foster, Diana Greene

2015-01-01

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff. PMID:26684189

Abort Options for Potential Mars Missions

NASA Technical Reports Server (NTRS)

Tartabini, P. V.; Striepe, S. A.; Powell, R. W.

1994-01-01

Mars trajectory design options were examined that would accommodate a premature termination of a nominal manned opposition class mission for opportunities between 2010 and 2025. A successful abort must provide a safe return to Earth in the shortest possible time consistent with mission constraints. In this study, aborts that provided a minimum increase in the initial vehicle mass in low Earth orbit (IMLEO) were identified by locating direct transfer nominal missions and nominal missions including an outbound or inbound Venus swing-by that minimized IMLEO. The ease with which these missions could be aborted while meeting propulsion and time constraints was investigated by examining free return (unpowered) and powered aborts. Further reductions in trip time were made to some aborts by the addition or removal of an inbound Venus swing-by. The results show that, although few free return aborts met the specified constraints, 85% of each nominal mission could be aborted as a powered abort without an increase in propellant. Also, in many cases, the addition or removal of a Venus swing-by increased the number of abort opportunities or decreased the total trip time during an abort.

Unconscious Reward Cues Increase Invested Effort, but Do Not Change Speed-Accuracy Tradeoffs

ERIC Educational Resources Information Center

Bijleveld, Erik; Custers, Ruud; Aarts, Henk

2010-01-01

While both conscious and unconscious reward cues enhance effort to work on a task, previous research also suggests that conscious rewards may additionally affect speed-accuracy tradeoffs. Based on this idea, two experiments explored whether reward cues that are presented above (supraliminal) or below (subliminal) the threshold of conscious…

Abortion rights judgment: a ray of hope!

PubMed

Johari, Veena; Jadhav, Uma

2017-01-01

While granting a prisoner the right to abort her foetus, a recent Bombay High Court judgment recognised a woman's absolute right to abortion. This article discusses the judgment in detail and the bioethical debates over abortion rights. It deals with the restrictions imposed by the law not only on when the foetus can be aborted, but also who can get the abortion done and in what circumstances.

Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study

PubMed Central

Liu, Ning; Farrugia, M. Michèle; Vigod, Simone N.; Urquia, Marcelo L.; Ray, Joel G.

2018-01-01

BACKGROUND: A teenage woman’s sexual health practices may be influenced by her mother’s experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters. METHODS: We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters’ data for induced abortions between age 12 years and their 20th birthday. We assessed each mother’s history of induced abortion for the period from 4 years before her daughter’s birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter’s risk of having an induced abortion in relation to the mother’s history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother– daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile. RESULTS: A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%–10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%–4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86–2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69–1.85) with 1 maternal abortion, 2.04 (95% CI 1.91–2.18) with 2 maternal abortions, 2.39 (95% CI 2.19–2.62) with 3 maternal abortions and 2.54 (95% CI 2.33–2.77) with 4 or more maternal abortions, relative to none. INTERPRETATION: We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion. PMID:29378869

Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study.

PubMed

Liu, Ning; Farrugia, M Michèle; Vigod, Simone N; Urquia, Marcelo L; Ray, Joel G

2018-01-29

A teenage woman's sexual health practices may be influenced by her mother's experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters. We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters' data for induced abortions between age 12 years and their 20th birthday. We assessed each mother's history of induced abortion for the period from 4 years before her daughter's birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter's risk of having an induced abortion in relation to the mother's history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother- daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile. A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%-10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%-4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86-2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69-1.85) with 1 maternal abortion, 2.04 (95% CI 1.91-2.18) with 2 maternal abortions, 2.39 (95% CI 2.19-2.62) with 3 maternal abortions and 2.54 (95% CI 2.33-2.77) with 4 or more maternal abortions, relative to none. We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion. © 2018 Joule Inc. or its licensors.

[Sex and pregnancy termination].

PubMed

D'isle, B

1985-11-01

Sex is of the utmost importance in voluntary abortions, because it is the cause of the procedure and because it is always a subject at the time of the abortion. Abortion practitioners are conscious of the woman's sexuality and of sexual techniques. The sexual dimension in abortion is more acute than in other medical acts. Abortion announces the existence of sexual desire, the complexity of sex, and the uncontrollable aspect of sex. The public procedure of abortion removes the intimacy from sex. It is an oversimplification to believe that proper use of contraception could obviate all abortions, that good sex is sex with contraception and bad sex is sex with abortion. Such an attitude neglects the role of desire and the subconscious in sex. "Resistance" to contraception should be understood to mean subconscious defense against contraception which deprives one of one's sex or reduces it to impotence. Abortion exists because sex is not rational. The 1st request for an abortion usually does not cause any problems among practitioners, but requests for subsequent abortions tend to cause resentment and recourse to the domain of psychiatry for explanations. Multiple abortions may however not be a symptom but a sign that desire exists and is not codifiable. Abortion exists outside of the usual medical sequence of illness-treatment-cure and is not comprehensible in the usual medical terms. Abortion raises questions of life, death, and the very nature of men and women that are largely unanswerable. Women undergoing abortion admit to ambivalence and to suffering during the experience. The 1 thing to understand is that all persons should decide individually what course they would follow; there are no ideal responses, only personal solutions. The ideology that dictates that all pregnancies must be warmly welcomed just reduces women once again to their fertility. Contraception and abortion can increase freedom, and especially the right to sexual pleasure. Society should not fall into the insidious and pernicious trap of observing pleasure through the lens of contraception and regarding all abortion as pathology. Contraception is not a duty, and abortion is a right; they are 2 different ways in which women experience their sex.

Psychiatric symptoms and pregnancy distress in subsequent pregnancy after spontaneous abortion history.

PubMed

Haghparast, Elahe; Faramarzi, Mahbobeh; Hassanzadeh, Ramezan

2016-01-01

Spontaneous abortion is one of the most important complications of pregnancy with short and long adverse psychological effects on women. This study assesses the implications of a spontaneous abortion history has on women's psychiatric symptoms and pregnancy distress in subsequent pregnancy less than one years after spontaneous abortion. A case-control study was conducted on pregnant women of Babol city from September 2014 to May 2015. In this study, 100 pregnant women with spontaneous abortion history during a year ago and 100 pregnant women without spontaneous abortion history were enrolled. All the participants in two groups completed the Symptom Checklist-90-Revised (SCL-90-R), and pregnancy Distress Questionnaire (PDQ). Women with spontaneous abortion history had significantly higher mean of many subscales of SCL-90 (depression, anxiety, somatization, obsessive-compulsiveness, interpersonal sensitivity, psychoticism, hostility, paranoid, and Global Severity Index) more than women without spontaneous abortion history. Also, women with spontaneous abortion history had significantly higher mean of two subscales of PDQ concerns about birth and the baby, concerns about emotions and relationships) and total PDQ more than women without spontaneous abortion history. Pregnant women with less than a year after spontaneous abortion history are at risk of psychiatric symptoms and pregnancy distress more than controls. This study supports those implications for planning the post spontaneous abortion psychological care for women, especially women who wanted to be pregnant during 12 month after spontaneous abortion.

Abortion surveillance--United States, 2005.

PubMed

Gamble, Sonya B; Strauss, Lilo T; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed

2008-11-28

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2005. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. Information is requested each year from all 50 states, New York City, and the District of Columbia. For 2005, data were received from 49 reporting areas: New York City, District of Columbia, and all states except California, Louisiana, and New Hampshire. For the purpose of trends analysis, data were evaluated from the 46 reporting areas that have been consistently reported since 1995. A total of 820,151 legal induced abortions were reported to CDC for 2005 from 49 reporting areas, the abortion ratio (number of abortions per 1,000 live births) was 233, and the abortion rate was 15 per 1,000 women aged 15--44 years. For the 46 reporting areas that have consistently reported since 1995, the abortion rate declined during 1995--2000 but has remained unchanged since 2000. For 2005, the highest percentages of reported abortions were for women who were known to be unmarried (81%), white (53%), and aged <25 years (50%). Of all abortions for which gestational age was reported, 62% were performed at 15 weeks' gestation (3.7% at 16--20 weeks and 1.3% at >/=21 weeks). A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.9% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. In 2004 (the most recent years for which data are available), seven women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. For the 46 reporting areas that have consistently reported since 1995, the number of abortions has steadily declined over the previous 10 years. The abortion rate declined from 1995 to 2000, but remained unchanged since 2000. In 2004, as in the previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and evaluate efforts to prevent unintended pregnancies.

Abortion surveillance--United States, 2002.

PubMed

Strauss, Lilo T; Herndon, Joy; Chang, Jeani; Parker, Wilda Y; Bowens, Sonya V; Berg, Cynthia J

2005-11-25

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2002. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. For 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49. A total of 854,122 legal induced abortions were reported to CDC for 2002 from 49 reporting areas, representing a 0.1% increase from the 853,485 legal induced abortions reported by the same 49 reporting areas for 2001. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2002, the same as reported for 2001. The abortion rate was 16 per 1,000 women aged 15-44 years for 2002, the same as for 2001. For the same 48 reporting areas, the abortion rate remained relatively constant during 1997-2002. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged <25 years (51%). Of all abortions for which gestational age was reported, 60% were performed at < or =8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2002, steady increases have occurred in the percentage of abortions performed at < or =6 weeks' gestation. A limited number of abortions was obtained at >15 weeks' gestation, including 4.1% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, accounting for 5.2% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. During 1990-1997, the number of legal induced abortions gradually declined. When the same 48 reporting areas were compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002. Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design.

PubMed

El Mhamdi, Sana; Ben Salah, Arwa; Bouanene, Ines; Hlaiem, Imen; Hadhri, Saloua; Maatouk, Wahiba; Soltani, Mohamed

2015-05-10

Repeat abortion is a public health concern favored by many obstetric and social factors. The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion. We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC). Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women's demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3-4 weeks following pregnancy termination. Of the 500 interviewed women, 211 (42.2 %; CI95% [37.88 - 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion. CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %). Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

[Abortion practices in high school students in Yamoussoukro, Côte d'Ivoire].

PubMed

Aké-Tano, Sassor Odile Purifine; Kpebo, Denise Olga; Konan, Yao Eugène; Tetchi, Ekissi Orsot; Sable, Stéphane Parfait; Ekou, Franck Kokora; Attoh, Touré Harvey; Aka, Lepri Nicaise; Diarassouba, Barakissa; Dagnan, N Cho Simplice

2017-12-05

Induced abortion is illegal in Cote d'Ivoire, except when the mother's life is in danger. The primary objective of this study was to describe abortion practices among Yamoussoukro high school students. More specifically, this study estimated the prevalence of induced abortion, described the pathway and the methods used for abortion and determined any abortion-related complications. This cross-sectional study was conducted in July 2011 on 312 randomly selected girls attending the Lycée Jeunes Filles in Yamoussoukro. These girls had a mean age (SD) of 16.1 (4.7) years; 258 (82.7%) of them had already had sexual intercourse and 81 (31.4%) had already been pregnant. Fifty (61.7% [56.3-67.1%]) of these 81 girls had already had an abortion. The abortion pathway was as follows: the main method was self-prescribed medication (70%) as first attempt, followed, in case of failure, by traditional healers (56.4%). Healthcare practitioners were usually consulted at the third attempt (85.7%). The most commonly used methods of abortion were drugs (91.9%), ingestion of plants/beverages (68.5%) and introduction of devices into the uterine cavity (62.3%). Twenty-two (44%) out of 50 induced abortions resulted in complications, mostly infectious complications (81.8%), and bleeding (68.2%). Complications were significantly associated with self-induced abortions or abortions performed by traditional healers (p < 0.001). More intensive sexual education, access to modern methods of contraception, awareness campaigns concerning the risks related to unwanted pregnancies and abortions performed by non-medical personnel need to be implemented to prevent school abortions. The quality and accessibility of post-abortion services also need to be reinforced.

Unsafe abortion: a neglected tragedy. Review from a tertiary care hospital in India.

PubMed

Jain, Vanita; Saha, Subhas C; Bagga, Rashmi; Gopalan, Sarala

2004-06-01

With 16% of the world's population, India accounts for over 20% of the world's maternal deaths. The maternal mortality ratio, defined as the number of maternal deaths per 100 000 live births is incredibly high at 408 per 100 000 live births for the country. Abortion has been legalized in India for the past three decades. However, the share of unsafe abortion as a cause of maternal mortality continues to be alarming. The objective of the present study is to identify the magnitude of problem of unsafe abortion in India. Emergency gynecologic admissions to a tertiary care center in North India over a 15-year period (1988-2002) were reviewed to evaluate the demographic and clinical profile of patients admitted as a result of unsafe abortion. The records were analyzed with regard to the age group, parity and marital status of the abortion seekers, the indication of abortion, the methods used, qualification of abortion providers, complications and fatality rate. The majority of women who were admitted with diagnosis of unsafe abortion were in the third decade of their lives. They were married, multiparous women living with their spouses. Sixty percent of the women had approached unqualified abortion providers who used primitive methods of pregnancy termination. All the women were admitted with serious complications of unsafe abortions and one-fourth of them succumbed to the complications. Unsafe abortion constitutes a major threat to the health and lives of women. This study highlights the need to focus more directly on the needs and preferences of women who seek abortion as well as on the accessibility of contraceptives and skills of the providers of abortion services, in order to improve the quality of abortion care.

Who makes the abortion decision?: law, practice, and the limits of the liberal solution.

PubMed

Lamanna, M A

1991-01-01

Since abortion is an important aspect of women's control over reproduction, barriers to abortion threaten women's efforts to attain equality. The ensuing discussion rests upon 2 assumptions: 1) That women want and need control over their reproductive capacity, and 2) that women want personal access to abortion and desire the availability of abortion to women generally. Under Roe v. Wade, abortions can only be performed if physicians choose to do them; this has left 4/5ths of US counties without an abortion provider. Roe neither compelled the availability of abortion services to all interested women, nor did it establish a "women's entitlement to an abortion based on her decision... "While the liberal solution in the Law may provide formal new rights, these rights are often ineffective because they fail to address attitudes firmly rooted in the social structure. Feminists' radical, self-help approach of becoming their own abortion providers offers a limited solution because of 1) geography and regional culture: the "paucity of abortion providers is likely to be replicated for feminist health collectives"; 2) the legal risk in underground institutions; and 3) the woman's choice, i.e., will the tradition-minded women use an alternative medical facility? Finally, "the woman's own decision-making process may be the ultimate barrier to abortion." The high visibility and intense emotions brought to contemporary abortion discussions in the post-Roe era may be far more chilling to individual decision than the relative silence of the 1950s. Psychological, as well as physical, availability of abortion must be kept in mind. For the future, social scientists can provide awareness of the social context in which the legal definition of abortion rights confronts the lives of women.

[History of induced abortion in Denmark from 1200 to 1979].

PubMed

Manniche, E

1982-10-01

History of induced abortion in Denmark from 1200 to 1979 is reviewed. The 1st Danish law of 1200 did not touch upon the question of induced abortion. From the beginning of the 13th century to Religious Reformation in 1536, Roman Catholic law influenced every aspect of Danish life including induced abortion. In 1683 in King Christian V's constitution called Dansk Lov induced abortion was discussed. Immoral women who aborted fetuses or killed newborn babies were decapitated. In Copenhagen in the years 1624-1632 and 1638-1663 17 women were executed because of induced abortion or murder of newborn babies. Although Dansk Lov was effective till 1866, Danish kings came to treat female criminals less severely since about 1780-1800. For example, between 1855 and 1866 42 women convicted of murder of newborn babies or abortion were given pardon (12 years of imprisonment instead of life sentence). In 1866, abortion and murder of babies were treated separately in the Danish criminal law. Induced abortion meant up to 8 years of imprisonment and labor. In 1930 life sentence was abolished; induced abortion called for only up to 2 years of imprisonment, while those who assisted for money were punished more severely (up to 8 years in prison). In 1937 the Danes legalized induced abortion for medical, ethical, (e.g. rape case) and eugenic reasons. By 1973 legalized abortion was available, free of charge, to every Danish female resident within 12 weeks of pregnancy. In 1980 abortion rate was about 41% of total births. It is estimated 2/3 of Danish women experience abortion. Lastly, illegitimate births and miscarriages are on the rise due to changes in women's social status and role.

Induced abortion and contraception in Italy.

PubMed

Spinelli, A; Grandolfo, M E

1991-09-01

This article discusses the legal and epidemiologic status of abortion in Italy, and its relationship to fertility and contraception. Enacted in May 1978, Italy's abortion law allows the operation to be performed during the 1st 90 days of gestation for a broad range of health, social, and psychological reasons. Women under 18 must receive written permission from a parent, guardian, or judge in order to undergo an abortion. The operation is free of charge. Health workers who object to abortion because of religious or moral reasons are exempt from participating. Regional differences exist concerning the availability of abortion, easy to procure in some places and difficult to obtain in others. After an initial increase following legalization, the abortion rate was 13.5/1000 women aged 15-44 and the abortion ratio was 309/1000 live births -- an intermediate rate and ratio compared to other countries. By the time the Abortion Act of 1978 was adopted, Italy already had one of the lowest fertility levels in Europe. Thus, the legalization of abortion has had no impact on fertility trends. Contrary to initial fears that the legalization of abortion would make abortion a method of family planning, 80% of the women who sought an abortion in 1983-88 were using birth control at the time (withdrawal being the most common method used by this group). In fact, most women who undergo abortions are married, between the ages of 25-34, and with at least one child. Evidence indicates widespread ignorance concerning reproduction. In a 1989 survey, only 65% of women could identify the fertile period of the menstrual cycle. Italy has no sex education in schools or national family planning programs. Compared to most of Europe, Italy still has low levels of reliable contraceptive usage. This points to the need to guarantee the availability of abortion.

Abortion: a reader's guide.

PubMed

Hisel, L M

1996-01-01

This review traces the discussion of abortion in the US through 10 of the best books published on the subject in the past 25 years. The first book considered is Daniel Callahan's "Abortion: Law, Choice and Morality," which was published in 1970. Next is book of essays also published in 1970: "The Morality of Abortion: Legal and Historical Perspectives," which was edited by John T. Noonan, Jr., who became a prominent opponent to the Roe decision. It is noted that Roman Catholics would find the essay by Bernard Haring especially interesting since Haring supported the Church's position on abortion but called for acceptance of contraception. Third on the list is historian James C. Mohr's review of "Abortion in America: The Origins and Evolution of National Policy," which was printed five years after the Roe decision. Selection four is "Enemies of Choice: The Right-to-Life Movement and Its Threat to Abortion" by Andrew Merton. This 1981 publication singled out a concern about sexuality as the overriding motivator for anti-abortion groups. Two years later, Beverly Wildung Harrison published a ground-breaking, feminist, moral analysis of abortion entitled "Our Right to Choose: Toward a New Ethic of Abortion. This was followed by a more empirical and sociopolitical feminist analysis in Kristin Luker's 1984 "Abortion and the Politics of Motherhood." The seventh book is by another feminist, Rosalind Pollack Petchesky, whose work "Abortion and Women's Choice: The State, Sexuality, and Reproductive Freedom" was first published in 1984 and reprinted in 1990. The eighth important book was "Abortion and Catholicism: The American Debate," edited by Thomas A. Shannon and Patricia Beattie Jung. Rounding out the list are the 1992 work "Life Itself: Abortion in the American Mind" by Roger Rosenblatt and Ronald Dworkin's 1993 "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom."

Reproductive Disorders and Leptospirosis: A Case Study in a Mixed-Species Farm (Cattle and Swine).

PubMed

Mori, Marcella; Bakinahe, Raïssa; Vannoorenberghe, Philippe; Maris, Jo; de Jong, Ellen; Tignon, Marylène; Marin, Martine; Desqueper, Damien; Fretin, David; Behaeghel, Isabelle

2017-12-01

Animal leptospirosis, exempt in rodents, manifests as peculiar biology where the animal can function, simultaneously or not, as a susceptible host or reservoir. In the first case, clinical symptoms are likely. In the second case, infection is subclinical and manifestations are mild or absent. Mild clinical symptoms encompass reproductive failure in production animals for host-adapted Leptospira sp. serovars. This work presents a study on Leptospira sp. infection in a mixed-species (bovine and swine) farm with documented reproductive disorders in the cattle unit. A long calving interval (above 450 days) was the hallmark observed in cows. Some cows (2/26 tested) presented a high titre of antibodies against Leptospira sp. serogroup Sejroe, but the overall within-herd prevalence was low (11.5% and 7.7% for cut-off titres of 1:30 and 1:100, respectively). The in-herd prevalence of leptospirosis in the sow unit (determined for 113/140 animals) was high when using a lowered cut-off threshold (32.7% vs. 1.8% for cut-off titre of 1:30 and 1:100, respectively). In this unit, the most prevalent serogroup was Autumnalis. The final diagnostic confirmation of Leptospira sp. maintenance within the farm was obtained through detection by PCR of Leptospira sp. DNA in an aborted swine litter. Despite the fact that a common causative infective agent was diagnosed in both species, the direct link between the two animal units was not found. Factors such as drinking from the same water source and the use of manure prepared with the swine slurry might raise suspicion of a possible cross-contamination between the two units. In conclusion, this work suggests that leptospirosis be included in the differential diagnosis of reproductive disorders and spontaneous abortions in production animals and provides data that justify the use of a lowered threshold cut-off for herd diagnosis.

Sensitivity, specificity and predictive probability values of serum agglutination test titres for the diagnosis of Salmonella Dublin culture-positive bovine abortion and stillbirth.

PubMed

Sánchez-Miguel, C; Crilly, J; Grant, J; Mee, J F

2018-06-01

The objective of this study was to determine the diagnostic value of maternal serology for the diagnosis of Salmonella Dublin bovine abortion and stillbirth. A retrospective, unmatched, case-control study was carried out using twenty year's data (1989-2009) from bovine foetal submissions to an Irish government veterinary laboratory. Cases (n = 214) were defined as submissions with a S. Dublin culture-positive foetus from a S. Dublin unvaccinated dam where results of maternal S. Dublin serology were available. Controls (n = 415) were defined as submissions where an alternative diagnosis other than S. Dublin was made in a foetus from an S. Dublin unvaccinated dam where the results of maternal S. Dublin serology were available. A logistic regression model was fitted to the data: the dichotomous dependent variable was the S. Dublin foetal culture result, and the independent variables were the maternal serum agglutination test (SAT) titre results. Salmonella serology correctly classified 87% of S. Dublin culture-positive foetuses at a predicted probability threshold of 0.44 (cut-off at which sensitivity and specificity are at a maximum, J = 0.67). The sensitivity of the SAT at the same threshold was 73.8% (95% CI: 67.4%-79.5%), and the specificity was 93.2% (95% CI: 90.3%-95.4%). The positive and negative predictive values were 84.9% (95% CI: 79.3%-88.6%) and 87.3% (95% CI: 83.5%-91.3%), respectively. This study illustrates that the use of predicted probability values, rather than the traditional arbitrary breakpoints of negative, inconclusive and positive, increases the diagnostic value of the maternal SAT. Veterinary laboratory diagnosticians and veterinary practitioners can recover from the test results, information previously categorized, particularly from those results declared to be inconclusive. © 2017 Blackwell Verlag GmbH.

INDUCED ABORTION FROM AN ISLAMIC PERSPECTIVE: IS IT CRIMINAL OR JUST ELECTIVE?

PubMed Central

Albar, Mohammed A.

2001-01-01

Background: Induced Abortion for social reasons is spreading all over the world. It is estimated that globally 50 million unborn babies are killed annually, resulting in the deaths of 200,000 pregnant women and the suffering of millions. The complications of illegal abortion are very serious. Abortion is still used in many countries as a means of family planning. The medical reasons for abortion are limited and con-sti-tute a small proportion of all abortion cases. This paper discusses the different views on abortion, its history, its evolution over time, and the present legal circumstances. The emphasis is on the situation in Islamic countries and the effect of Islamic Fatwas on abortion. PMID:23008648

[[Abortion: An Unforgivable Sin?].

PubMed

Lalli, Chiara

Abortion has become something to hide, something you can't tell other people, something you have to expiate forever. Besides, abortion is more and more difficult to achieve because of the raising average of consciencious objection (from 70 to 90% of health care providers are conscientious objectors, 2014 data, Ministero della Salute) and illegal abortion is "coming back"from the 70s, when abortion was a crime (Italian law n. 194/1978). Abortion is often blamed as a murder, an unforgivenable sin, even as genocide. Silence against shouting "killers!" to women who are going to have an abortion: this is a common actual scenario. Why is it so difficult to discuss and even to mention abortion?

Restricted access to abortion in the Republic of Ireland and Northern Ireland: exploring abortion tourism and barriers to legal reform.

PubMed

Bloomer, Fiona; O'Dowd, Kellie

2014-01-01

Access to abortion remains a controversial issue worldwide. In Ireland, both north and south, legal restrictions have resulted in thousands of women travelling to England and Wales and further afield to obtain abortions in the last decade alone, while others purchase the 'abortion pill' from Internet sources. This paper considers the socio-legal context in both jurisdictions, the data on those travelling to access abortion and the barriers to legal reform. It argues that moral conservatism in Ireland, north and south, has contributed to the restricted access to abortion, impacting on the experience of thousands of women, resulting in these individuals becoming 'abortion tourists'.

Virologic versus cytologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia.

PubMed

Arbyn, Marc; Buntinx, Frank; Van Ranst, Marc; Paraskevaidis, Evangelos; Martin-Hirsch, Pierre; Dillner, Joakim

2004-02-18

The appropriate management of women with minor cytologic lesions in their cervix is unclear. We performed a meta-analysis to assess the accuracy of human papillomavirus (HPV) DNA testing as an alternative to repeat cytology in women who had equivocal results on a previous Pap smear. Data were extracted from articles published between 1992 and 2002 that contained results of virologic and cytologic testing followed by colposcopically directed biopsy in women with an index smear showing atypical cells of undetermined significance (ASCUS). Fifteen studies were identified in which HPV triage and the histologic outcome (presence or absence of a cervical intraepithelial neoplasia of grade II or worse [CIN2+]) was documented. Nine, seven, and two studies also documented the accuracy of repeat cytology when the cutoff for abnormal cytology was set at a threshold of ASCUS or worse, low-grade squamous intraepithelial lesion (LSIL) or worse, or high-grade squamous intraepithelial lesion (HSIL) or worse, respectively. Random-effects models were used for pooling of accuracy parameters in case of interstudy heterogeneity. Differences in accuracy were assessed by pooling the ratio of the sensitivity (or specificity) of HPV testing to that of repeat cytology. The sensitivity and specificity were 84.4% (95% confidence interval [CI] = 77.6% to 91.1%) and 72.9% (95% CI = 62.5% to 83.3%), respectively, for HPV testing overall and 94.8% (95% CI = 92.7% to 96.9%) and 67.3% (95% CI = 58.2% to 76.4%), respectively, for HPV testing in the eight studies that used the Hybrid Capture II assay. Sensitivity and specificity of repeat cytology at a threshold for abnormal cytology of ASCUS or worse was 81.8% (95% CI = 73.5% to 84.3%) and 57.6% (95% CI = 49.5% to 65.7%), respectively. Repeat cytology that used higher cytologic thresholds yielded substantially lower sensitivity but higher specificity than triage with the Hybrid Capture II assay. The ratio of the sensitivity of the Hybrid Capture II assay to that of repeat cytology at a threshold of ASCUS or worse pooled from the four studies that used both triage tests was 1.16 (95% CI = 1.04 to 1.29). The specificity ratio was not statistically different from unity. The published literature indicates that the Hybrid Capture II assay has improved accuracy (higher sensitivity, similar specificity) than the repeat Pap smear using the threshold of ASCUS for an outcome of CIN2+ among women with equivocal cytologic results. The sensitivity of triage at higher cytologic cutoffs is poor.

Abortion surveillance--United States, 2000.

PubMed

Elam-Evans, Laurie D; Strauss, Lilo T; Herndon, Joy; Parker, Wilda Y; Bowens, Sonya V; Zane, Suzanne; Berg, Cynthia J

2003-11-28

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data reported to CDC regarding legal induced abortions obtained in the United States in 2000. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these areas were not estimated. In 2000, Oklahoma again reported these data, increasing the number of reporting areas to 49. A total of 857,475 legal induced abortions were reported to CDC for 2000 from 49 reporting areas, representing a 0.5% decrease from the 861,789 legal induced abortions reported by 48 reporting areas for 1999 and a 1.3% decrease for the same 48 reporting areas that reported in 1999. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2000 (for the same 48 reporting areas as 1999), compared with 256 reported for 1999. This represents a 3.8% decline in the abortion ratio. The abortion rate (for the same 48 reporting areas as 1999) was 16 per 1,000 women aged 15-44 years for 2000. This was also a 3.8% decrease from the rate reported for procedures performed during 1997-1999 for the same 48 reporting areas. The highest percentages of reported abortions were for women aged <25 years (52%), women who were white (57%), and unmarried women (81%). Fifty-eight percent of all abortions for which gestational age was reported were performed at < or =8 weeks of gestation, and 88% were performed before 13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2000, steady increases have occurred in the percentage of abortions performed at < or =6 weeks of gestation. Few abortions were performed after 15 weeks of gestation; 4.3% were obtained at 16-20 weeks and 1.4% were obtained at > or =21 weeks. A total of 31 reporting areas submitted data stating that they performed medical (nonsurgical) procedures, making up 1.0% of all reported procedures from the 42 areas with adequate reporting on type of procedure. In 1998 and 1999 (the most recent years for which data are available), 14 women died as a result of complications from known legal induced abortion. Ten of these deaths occurred in 1998 and four occurred in 1999; no deaths were associated with known illegal abortion. From 1990 through 1997, the number of legal induced abortions gradually declined. In 1998 and 1999, the number of abortions continued to decrease when comparing the same 48 reporting areas. In 2000, even with one additional reporting state, the number of abortions declined slightly. In 1998 and 1999, as in previous years, deaths related to legal induced abortions occurred rarely (<1 death per 100,000 abortions). Abortion surveillance in the United States continues to provide data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and for increasing understanding of one additional aspect of the spectrum of pregnancy outcomes. Policy makers and program planners need these data to improve the health and well-being of women and infants.

The relationship of global form and motion detection to reading fluency.

PubMed

Englund, Julia A; Palomares, Melanie

2012-08-15

Visual motion processing in typical and atypical readers has suggested aspects of reading and motion processing share a common cortical network rooted in dorsal visual areas. Few studies have examined the relationship between reading performance and visual form processing, which is mediated by ventral cortical areas. We investigated whether reading fluency correlates with coherent motion detection thresholds in typically developing children using random dot kinematograms. As a comparison, we also evaluated the correlation between reading fluency and static form detection thresholds. Results show that both dorsal and ventral visual functions correlated with components of reading fluency, but that they have different developmental characteristics. Motion coherence thresholds correlated with reading rate and accuracy, which both improved with chronological age. Interestingly, when controlling for non-verbal abilities and age, reading accuracy significantly correlated with thresholds for coherent form detection but not coherent motion detection in typically developing children. Dorsal visual functions that mediate motion coherence seem to be related maturation of broad cognitive functions including non-verbal abilities and reading fluency. However, ventral visual functions that mediate form coherence seem to be specifically related to accurate reading in typically developing children. Copyright © 2012 Elsevier Ltd. All rights reserved.

Maternal Near-Miss Due to Unsafe Abortion and Associated Short-Term Health and Socio-Economic Consequences in Nigeria

PubMed Central

Prada, Elena; Bankole, Akinrinola; Oladapo, Olufemi T.; Awolude, Olutosin A.; Adewole, Isaac F.; Onda, Tsuyoshi

2016-01-01

Little is known about maternal near-miss (MNM) due to unsafe abortion in Nigeria. We used the WHO criteria to identify near-miss events and the proportion due to unsafe abortion among women of childbearing age in eight large secondary and tertiary hospitals across the six geo-political zones. We also explored the characteristics of women with these events, delays in seeking care and the short-term socioeconomic and health impacts on women and their families. Between July 2011 and January 2012, 137 MNM cases were identified of which 13 or 9.5% were due to unsafe abortions. Severe bleeding, pain and fever were the most common immediate abortion complications. On average, treatment of MNM due to abortion costs six times more than induced abortion procedures. Unsafe abortion and delays in care seeking are important contributors to MNM. Programs to prevent unsafe abortion and delays in seeking postabortion care are urgently needed to reduce abortion related MNM in Nigeria. PMID:26506658

Husbands' involvement in abortion in Vietnam.

PubMed

Johansson, A; Nga, N T; Huy, T Q; Dat, D D; Holmgren, K

1998-12-01

This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion.

Second trimester abortions in India.

PubMed

Dalvie, Suchitra S

2008-05-01

This article gives an overview of what is known about second trimester abortions in India, including the reasons why women seek abortions in the second trimester, the influence of abortion law and policy, surgical and medical methods used, both safe and unsafe, availability of services, requirements for second trimester service delivery, and barriers women experience in accessing second trimester services. Based on personal experiences and personal communications from other doctors since 1993, when I began working as an abortion provider, the practical realities of second trimester abortion and case histories of women seeking second trimester abortion are also described. Recommendations include expanding the cadre of service providers to non-allopathic clinicians and trained nurses, introducing second trimester medical abortion into the public health system, replacing ethacridine lactate with mifepristone-misoprostol, values clarification among providers to challenge stigma and poor treatment of women seeking second trimester abortion, and raising awareness that abortion is legal in the second trimester and is mostly not requested for reasons of sex selection.

Maternal Near-Miss Due to Unsafe Abortion and Associated Short-Term Health and Socio-Economic Consequences in Nigeria.

PubMed

Prada, Elena; Bankole, Akinrinola; Oladapo, Olufemi T; Awolude, Olutosin A; Adewole, Isaac F; Onda, Tsuyoshi

2015-06-01

Little is known about maternal near-miss (MNM) due to unsafe abortion in Nigeria. We used the WHO criteria to identify near-miss events and the proportion due to unsafe abortion among women of childbearing age in eight large secondary and tertiary hospitals across the six geo-political zones. We also explored the characteristics of women with these events, delays in seeking care and the short-term socioeconomic and health impacts on women and their families. Between July 2011 and January 2012, 137 MNM cases were identified of which 13 or 9.5% were due to unsafe abortions. Severe bleeding, pain and fever were the most common immediate abortion complications. On average, treatment of MNM due to abortion costs six times more than induced abortion procedures. Unsafe abortion and delays in care seeking are important contributors to MNM. Programs to prevent unsafe abortion and delays in seeking postabortion care are urgently needed to reduce abortion related MNM in Nigeria.

From unwanted pregnancy to safe abortion: Sharing information about abortion in Asia through animation.

PubMed

Krishnan, Shweta; Dalvie, Suchitra

2015-05-01

Although unsafe abortion continues to be a leading cause of maternal mortality in many countries in Asia, the right to safe abortion remains highly stigmatized across the region. The Asia Safe Abortion Partnership, a regional network advocating for safe abortion, produced an animated short film entitled From Unwanted Pregnancy to Safe Abortion to show in conferences, schools and meetings in order to share knowledge about the barriers to safe abortion in Asia and to facilitate conversations on the right to safe abortion. This paper describes the making of this film, its objectives, content, dissemination and how it has been used. Our experience highlights the advantages of using animated films in addressing highly politicized and sensitive issues like abortion. Animation helped to create powerful advocacy material that does not homogenize the experiences of women across a diverse region, and at the same time emphasize the need for joint activities that express solidarity. Copyright © 2015. Published by Elsevier Ltd.

Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

PubMed Central

2011-01-01

Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform. PMID:22192901

Impact of reproductive laws on maternal mortality: the chilean natural experiment.

PubMed

Koch, Elard

2013-05-01

Improving maternal health and decreasing morbidity and mortality due to induced abortion are key endeavors in developing countries. One of the most controversial subjects surrounding interventions to improve maternal health is the effect of abortion laws. Chile offers a natural laboratory to perform an investigation on the determinants influencing maternal health in a large parallel time-series of maternal deaths, analyzing health and socioeconomic indicators, and legislative policies including abortion banning in 1989. Interestingly, abortion restriction in Chile was not associated with an increase in overall maternal mortality or with abortion deaths and total number of abortions. Contrary to the notion proposing a negative impact of restrictive abortion laws on maternal health, the abortion mortality ratio did not increase after the abortion ban in Chile. Rather, it decreased over 96 percent, from 10.8 to 0.39 per 100,000 live births. Thus, the Chilean natural experiment provides for the first time, strong evidence supporting the hypothesis that legalization of abortion is unnecessary to improve maternal health in Latin America.

Prevalence of Abortion and Contraceptive Practice among Women Seeking Repeat Induced Abortion in Western Nigeria.

PubMed

Lamina, Mustafa Adelaja

2015-01-01

Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high.

Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea--a descriptive study of women's and health care workers' experiences.

PubMed

Vallely, Lisa M; Homiehombo, Primrose; Kelly-Hanku, Angela; Whittaker, Andrea

2015-03-21

In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality. We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women's reflections post abortion. 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help. In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion.

Pharmacy workers' knowledge and provision of medication for termination of pregnancy in Kenya.

PubMed

Reiss, Kate; Footman, Katharine; Akora, Vitalis; Liambila, Wilson; Ngo, Thoai D

2016-07-01

To assess pharmacy workers' knowledge and provision of abortion information and methods in Kenya. In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion services they provide. We also used mystery clients, who made 401 visits to pharmacies to collect first-hand information on abortion practices. The majority (87.5%) of pharmacy workers had heard of misoprostol but only 39.2% had heard of mifepristone. We found that pharmacy workers had limited knowledge of correct medical abortion regimens, side effects and complications and the legal status of abortion drugs. 49.8% of pharmacy workers reported providing abortion information to clients and 4.3% reported providing abortion methods. 75.2% of pharmacies referred mystery clients to another provider, though 64.2% of pharmacies advised mystery clients to continue with their pregnancy. Pharmacy workers reported that they were experiencing demand for abortion services from clients. Pharmacy workers are important providers of information and referrals for women seeking abortion, however their medical abortion knowledge is limited. Training pharmacy workers on medical abortion may improve the quality of information provided and access to safe abortion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Transcriptomic and proteomic analysis reveals mechanisms of embryo abortion during chrysanthemum cross breeding.

PubMed

Zhang, Fengjiao; Wang, Zhiquan; Dong, Wen; Sun, Chunqing; Wang, Haibin; Song, Aiping; He, Lizhong; Fang, Weimin; Chen, Fadi; Teng, Nianjun

2014-10-07

Embryo abortion is the main cause of failure in chrysanthemum cross breeding, and the genes and proteins associated with embryo abortion are poorly understood. Here, we applied RNA sequencing and isobaric tags for relative and absolute quantitation (iTRAQ) to analyse transcriptomic and proteomic profiles of normal and abortive embryos. More than 68,000 annotated unigenes and 700 proteins were obtained from normal and abortive embryos. Functional analysis showed that 140 differentially expressed genes (DEGs) and 41 differentially expressed proteins (DEPs) were involved in embryo abortion. Most DEGs and DEPs associated with cell death, protein degradation, reactive oxygen species scavenging, and stress-response transcriptional factors were significantly up-regulated in abortive embryos relative to normal embryos. In contrast, most genes and proteins related to cell division and expansion, the cytoskeleton, protein synthesis and energy metabolism were significantly down-regulated in abortive embryos. Furthermore, abortive embryos had the highest activity of three executioner caspase-like enzymes. These results indicate that embryo abortion may be related to programmed cell death and the senescence- or death-associated genes or proteins contribute to embryo abortion. This adds to our understanding of embryo abortion and will aid in the cross breeding of chrysanthemum and other crops in the future.

Enablers of and barriers to abortion training.

PubMed

Guiahi, Maryam; Lim, Sahnah; Westover, Corey; Gold, Marji; Westhoff, Carolyn L

2013-06-01

Since the legalization of abortion services in the United States, provision of abortions has remained a controversial issue of high political interest. Routine abortion training is not offered at all obstetrics and gynecology (Ob-Gyn) training programs, despite a specific training requirement by the Accreditation Council for Graduate Medical Education. Previous studies that described Ob-Gyn programs with routine abortion training either examined associations by using national surveys of program directors or described the experience of a single program. We set out to identify enablers of and barriers to Ob-Gyn abortion training in the context of a New York City political initiative, in order to better understand how to improve abortion training at other sites. We conducted in-depth qualitative interviews with 22 stakeholders from 7 New York City public hospitals and focus group interviews with 62 current residents at 6 sites. Enablers of abortion training included program location, high-capacity services, faculty commitment to abortion training, external programmatic support, and resident interest. Barriers to abortion training included lack of leadership continuity, leadership conflict, lack of second-trimester abortion services, difficulty obtaining mifepristone, optional rather than routine training, and antiabortion values of hospital personnel. Supportive leadership, faculty commitment, and external programmatic support appear to be key elements for establishing routine abortion training at Ob-Gyn residency training programs.

Design of Launch Abort System Thrust Profile and Concept of Operations

NASA Technical Reports Server (NTRS)

Litton, Daniel; O'Keefe, Stephen A.; Winski, Richard G.; Davidson, John B.

2008-01-01

This paper describes how the Abort Motor thrust profile has been tailored and how optimizing the Concept of Operations on the Launch Abort System (LAS) of the Orion Crew Exploration Vehicle (CEV) aides in getting the crew safely away from a failed Crew Launch Vehicle (CLV). Unlike the passive nature of the Apollo system, the Orion Launch Abort Vehicle will be actively controlled, giving the program a more robust abort system with a higher probability of crew survival for an abort at all points throughout the CLV trajectory. By optimizing the concept of operations and thrust profile the Orion program will be able to take full advantage of the active Orion LAS. Discussion will involve an overview of the development of the abort motor thrust profile and the current abort concept of operations as well as their effects on the performance of LAS aborts. Pad Abort (for performance) and Maximum Drag (for separation from the Launch Vehicle) are the two points that dictate the required thrust and shape of the thrust profile. The results in this paper show that 95% success of all performance requirements is not currently met for Pad Abort. Future improvements to the current parachute sequence and other potential changes will mitigate the current problems, and meet abort performance requirements.

Adaptive thresholding and dynamic windowing method for automatic centroid detection of digital Shack-Hartmann wavefront sensor.

PubMed

Yin, Xiaoming; Li, Xiang; Zhao, Liping; Fang, Zhongping

2009-11-10

A Shack-Hartmann wavefront sensor (SWHS) splits the incident wavefront into many subsections and transfers the distorted wavefront detection into the centroid measurement. The accuracy of the centroid measurement determines the accuracy of the SWHS. Many methods have been presented to improve the accuracy of the wavefront centroid measurement. However, most of these methods are discussed from the point of view of optics, based on the assumption that the spot intensity of the SHWS has a Gaussian distribution, which is not applicable to the digital SHWS. In this paper, we present a centroid measurement algorithm based on the adaptive thresholding and dynamic windowing method by utilizing image processing techniques for practical application of the digital SHWS in surface profile measurement. The method can detect the centroid of each focal spot precisely and robustly by eliminating the influence of various noises, such as diffraction of the digital SHWS, unevenness and instability of the light source, as well as deviation between the centroid of the focal spot and the center of the detection area. The experimental results demonstrate that the algorithm has better precision, repeatability, and stability compared with other commonly used centroid methods, such as the statistical averaging, thresholding, and windowing algorithms.

Threshold models for genome-enabled prediction of ordinal categorical traits in plant breeding.

PubMed

Montesinos-López, Osval A; Montesinos-López, Abelardo; Pérez-Rodríguez, Paulino; de Los Campos, Gustavo; Eskridge, Kent; Crossa, José

2014-12-23

Categorical scores for disease susceptibility or resistance often are recorded in plant breeding. The aim of this study was to introduce genomic models for analyzing ordinal characters and to assess the predictive ability of genomic predictions for ordered categorical phenotypes using a threshold model counterpart of the Genomic Best Linear Unbiased Predictor (i.e., TGBLUP). The threshold model was used to relate a hypothetical underlying scale to the outward categorical response. We present an empirical application where a total of nine models, five without interaction and four with genomic × environment interaction (G×E) and genomic additive × additive × environment interaction (G×G×E), were used. We assessed the proposed models using data consisting of 278 maize lines genotyped with 46,347 single-nucleotide polymorphisms and evaluated for disease resistance [with ordinal scores from 1 (no disease) to 5 (complete infection)] in three environments (Colombia, Zimbabwe, and Mexico). Models with G×E captured a sizeable proportion of the total variability, which indicates the importance of introducing interaction to improve prediction accuracy. Relative to models based on main effects only, the models that included G×E achieved 9-14% gains in prediction accuracy; adding additive × additive interactions did not increase prediction accuracy consistently across locations. Copyright © 2015 Montesinos-López et al.

Gas ultrasonic flow rate measurement through genetic-ant colony optimization based on the ultrasonic pulse received signal model

NASA Astrophysics Data System (ADS)

Hou, Huirang; Zheng, Dandan; Nie, Laixiao

2015-04-01

For gas ultrasonic flowmeters, the signals received by ultrasonic sensors are susceptible to noise interference. If signals are mingled with noise, a large error in flow measurement can be caused by triggering mistakenly using the traditional double-threshold method. To solve this problem, genetic-ant colony optimization (GACO) based on the ultrasonic pulse received signal model is proposed. Furthermore, in consideration of the real-time performance of the flow measurement system, the improvement of processing only the first three cycles of the received signals rather than the whole signal is proposed. Simulation results show that the GACO algorithm has the best estimation accuracy and ant-noise ability compared with the genetic algorithm, ant colony optimization, double-threshold and enveloped zero-crossing. Local convergence doesn’t appear with the GACO algorithm until -10 dB. For the GACO algorithm, the converging accuracy and converging speed and the amount of computation are further improved when using the first three cycles (called GACO-3cycles). Experimental results involving actual received signals show that the accuracy of single-gas ultrasonic flow rate measurement can reach 0.5% with GACO-3 cycles, which is better than with the double-threshold method.

Transcranial Direct Current Stimulation Does Not Influence the Speed-Accuracy Tradeoff in Perceptual Decision-making: Evidence from Three Independent Studies.

PubMed

de Hollander, Gilles; Labruna, Ludovica; Sellaro, Roberta; Trutti, Anne; Colzato, Lorenza S; Ratcliff, Roger; Ivry, Richard B; Forstmann, Birte U

2016-09-01

In perceptual decision-making tasks, people balance the speed and accuracy with which they make their decisions by modulating a response threshold. Neuroimaging studies suggest that this speed-accuracy tradeoff is implemented in a corticobasal ganglia network that includes an important contribution from the pre-SMA. To test this hypothesis, we used anodal transcranial direct current stimulation (tDCS) to modulate neural activity in pre-SMA while participants performed a simple perceptual decision-making task. Participants viewed a pattern of moving dots and judged the direction of the global motion. In separate trials, they were cued to either respond quickly or accurately. We used the diffusion decision model to estimate the response threshold parameter, comparing conditions in which participants received sham or anodal tDCS. In three independent experiments, we failed to observe an influence of tDCS on the response threshold. Additional, exploratory analyses showed no influence of tDCS on the duration of nondecision processes or on the efficiency of information processing. Taken together, these findings provide a cautionary note, either concerning the causal role of pre-SMA in decision-making or on the utility of tDCS for modifying response caution in decision-making tasks.

Induced Abortion Practices in an Urban Indian Slum: Exploring Reasons, Pathways and Experiences.

PubMed

Behera, Deepanjali; Bharat, Shalini; Chandrakant Gawde, Nilesh

2015-09-01

To explore the context, experiences and pathways of seeking abortion care among married women in a minority dominated urban slum community in Mumbai city of India. A mixed-method study was conducted using a systematic random sampling method to select 282 respondents from the slum community. One fifth of these womenreported undergoing at least one induced abortion over past five years. A quantitative survey was conducted among these women (n = 57) using structured face-to-face interviews. Additionally, in-depths interviews involving 11 respondents, 2 community health workers and 2 key informants from the community were conducted for further exploration of qualitative data. The rate of induced abortion was 115.6 per 1000 pregnancies in the study area with an abortion ratio of 162.79 per 1000 live births. Frequent pregnancies with low birth spacing and abortions were reported among the women due to restricted contraception use based on religious beliefs. Limited supportfrom husband and family compelled the women to seek abortion services, mostly secretly, from private, unskilled providers and unregistered health facilities. Friends and neighbors were main sources of advice and link to abortion services. Lack of safe abortion facilities within accessible distance furtherintensifies the risk of unsafe abortions. Low contraception usage based on rigid cultural beliefs and scarcely accessible abortion services were the root causes of extensive unsafe abortions.Contraception awareness and counseling with involvement of influential community leaders as well as safe abortion services need to be strengthened to protect these deprived women from risks of unwanted pregnancies and unsafe abortions.

Association between perceived social support and induced abortion: A study in maternal health centers in Lima, Peru.

PubMed

Sánchez-Siancas, Luis E; Rodríguez-Medina, Angélica; Piscoya, Alejandro; Bernabe-Ortiz, Antonio

2018-01-01

This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. A cross-sectional study enrolling women aged 18-25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%-49.3%), and 17.4% (95%CI: 13.1%- 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81-3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14-3.30) after controlling for confounders. There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.

Abortion training in Canadian obstetrics and gynecology residency programs.

PubMed

Liauw, J; Dineley, B; Gerster, K; Hill, N; Costescu, D

2016-11-01

To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty. Copyright © 2016 Elsevier Inc. All rights reserved.

Abortion and public health: Time for another look

PubMed Central

McCurdy, Stephen A.

2016-01-01

Four decades after Roe v. Wade, abortion remains highly contentious, pitting a woman's right to choose against a fetal claim to life. Public health implications are staggering: the US annual total of more than one million induced abortions equals nearly half the number of registered deaths from all causes. Sentiment regarding abortion is roughly evenly split among the general public, yet fundamental debate about abortion is largely absent in the public health community, which is predominantly supportive of its wide availability. Absence of substantive debate on abortion separates the public health community from the public we serve, jeopardizing the trust placed in us. Traditional public health values—support for vulnerable groups and opposition to the politicization of science—together with the principle of reciprocity weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. Lay Summary: Four decades after Roe v. Wade, abortion remains highly divisive. Public sentiment regarding abortion is roughly evenly split, yet fundamental debate is largely absent in the public health community, which supports abortion’s wide availability. Absence of substantive debate separates the public health community from the public it serves. Traditional public health values—support for vulnerable populations and opposition to politicization of science—and the principle of reciprocity (“the Golden Rule”) weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. PMID:27833179

Induced Abortion: a Systematic Review and Meta-analysis.

PubMed

Dastgiri, Saeed; Yoosefian, Maryam; Garjani, Mehraveh; Kalankesh, Leila R

2017-03-01

Induced abortion accounts for 1 in 8 of approximately 600000 maternal deaths that occur annually worldwide. Induced abortion rate can be considered as one of the indicators for assessing availability of the appropriate reproductive health plans for women and identifying needs for appropriate related health policies and programs. Researchers searched Pubmed, Google Scholar, CINAHL, Embase, PsycINFO, Cochrane, Iranian Scientific Information Database (SID), Iranian biomedical journals (Iranmedex), and Iranian Research Institute of Information and Documentation (Irandoc) between January 2000 and June 2013, which reported induced abortion. Search terms from two categories including abortion and termination of pregnancy were compiled. The search terms were "induced abortion", "illegal abortion", "illegal abortion", "unsafe abortion", and "criminal abortion". The search was also conducted with "induced termination of pregnancy", "illegal termination of pregnancy", "illegal termination of pregnancy", "unsafe termination of pregnancy" and "criminal termination of pregnancy". Meta-analysis was carried out by using OpenMeta software. Induced abortion rates were calculated based on the random effect model. Overall induced abortion rate was obtained 58.1 per 1000 women (95%CI: 55.16-61.04). In continental level, rate of induced abortion was 14 per 1000 women (95%CI: 11-16). Nation-wide and local rates were obtained 67.27 per 1000 women (95% CI: 60.02-74.23) and 148.92 (95% CI: 140.06-157.79) respectively. Induced abortion is a major public health problem that occurs worldwide whether under the legal restriction or freedom, and it remains as reproductive health concern globally. To eliminate the need for induced abortion is at the core of any effort for preventing this issue. Option with the highest priority is to prevent unwanted pregnancies through promoting reproductive health plans for women of reproductive age. In case the prevention strategies fail, universal provision of safe abortion services should be put in place.

"These things are dangerous": Understanding induced abortion trajectories in urban Zambia.

PubMed

Coast, Ernestina; Murray, Susan F

2016-03-01

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Fundamental discrepancies in abortion estimates and abortion-related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases

PubMed Central

Koch, Elard; Aracena, Paula; Gatica, Sebastián; Bravo, Miguel; Huerta-Zepeda, Alejandra; Calhoun, Byron C

2012-01-01

In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100,000 live births). Currently, approximately 98% of maternal deaths in Mexico are related to causes other than induced abortion, such as hemorrhage, hypertension and eclampsia, indirect causes, and other pathological conditions. Therefore, only marginal or null effects would be expected from changes in the legal status of abortion on overall maternal mortality rates. Rather, maternal health in Mexico would greatly benefit from increasing access to emergency and specialized obstetric care. Finally, more reliable methodologies to assess abortion-related deaths are clearly required. PMID:23271925

[Is a sociology of abortion possible?].

PubMed

Isambert, F A

1982-01-01

Abortion is a thorny problem whose study is problematic because it is a source of social and juridical discord, of moral incertitude, of medical and psychiatric confusion, and of personal anguish. The question arises of whether a single perspective can be found which allows comprehension of the entire phenomenon. This work uses published sources to examine the abortion debate, beginning with the varying views of abortion expressed in the struggles to liberalize abortion legislation in France, Europe, and the US. 4 particular views of abortion were identified in the Paris press; the traditional religious view, which condemns abortion because the fetus is regarded as fully human from conception; the view of abortion as a means of fertility regulation; the view of abortion as a cause of public health problems that could be alleviated through legalization and medical control; and the view that abortion allows women to control their own bodies. The law is obliged to reconcile these diverse positions. Abortion legislation in different countries ranges along a continuum from severe to lenient, but regional variations are also evident. Abortion trials in the US and France shortly before liberalization of the laws of either country showed striking similarities but also notable differences due largely to dissimilarities in the social structures of the 2 countries. The relations between the individual and the state, morality, and the law, as reflected in the abortion debate, rested on inverse bases in the 2 countries. The typically American doctrine of privacy occupied a prominent place in the American legislation, while the French was more concerned with the humanitarian goal of reducing health damage from illegal abortions. Tension and ambiguity nevertheless unavoidably characterize the abortion regulations in the 2 countries. Abortion as an institution is a controlled and practical compromise between 2 poles, those giving primacy to individual interests, as in the US, and those giving primacy to collective interests, as in France.

Fundamental discrepancies in abortion estimates and abortion-related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases.

PubMed

Koch, Elard; Aracena, Paula; Gatica, Sebastián; Bravo, Miguel; Huerta-Zepeda, Alejandra; Calhoun, Byron C

2012-01-01

In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100,000 live births). Currently, approximately 98% of maternal deaths in Mexico are related to causes other than induced abortion, such as hemorrhage, hypertension and eclampsia, indirect causes, and other pathological conditions. Therefore, only marginal or null effects would be expected from changes in the legal status of abortion on overall maternal mortality rates. Rather, maternal health in Mexico would greatly benefit from increasing access to emergency and specialized obstetric care. Finally, more reliable methodologies to assess abortion-related deaths are clearly required.

Women's knowledge and attitudes surrounding abortion in Zambia: a cross-sectional survey across three provinces

PubMed Central

Cresswell, Jenny A; Schroeder, Rosalyn; Dennis, Mardieh; Owolabi, Onikepe; Vwalika, Bellington; Musheke, Maurice; Campbell, Oona; Filippi, Veronique

2016-01-01

Objectives In Zambia, despite a relatively liberal legal framework, there remains a substantial burden of unsafe abortion. Many women do not use skilled providers in a well-equipped setting, even where these are available. The aim of this study was to describe women's knowledge of the law relating to abortion and attitudes towards abortion in Zambia. Setting Community-based survey in Central, Copperbelt and Lusaka provinces. Participants 1484 women of reproductive age (15–44 years). Primary and secondary outcome measures Correct knowledge of the legal grounds for abortion, attitudes towards abortion services and the previous abortions of friends, family or other confidants. Descriptive statistics and multivariable logistic regression were used to analyse how knowledge and attitudes varied according to sociodemographic characteristics. Results Overall, just 16% (95% CI 11% to 21%) of women of reproductive age correctly identified the grounds for which abortion is legal. Only 40% (95% CI 32% to 45% of women of reproductive age knew that abortion was legally permitted in the extreme situation where the pregnancy threatens the life of the mother. Even in urban areas of Lusaka province, only 55% (95% CI 41% to 67%) of women knew that an abortion could legally take place to save the mother's life. Attitudes remain conservative. Women with correct knowledge of abortion law in Zambia tended to have more liberal attitudes towards abortion and access to safe abortion services. Neither correct knowledge of the law nor attitudes towards abortion were associated with knowing someone who previously had an induced abortion. Conclusions Poor knowledge and conservative attitudes are important obstacles to accessing safe abortion services. Changing knowledge and attitudes can be challenging for policymakers and public health practitioners alike. Zambia could draw on its previous experience in dealing with its large HIV epidemic to learn cross-cutting lessons in effective mass communication on what is a difficult and sensitive issue. PMID:27000784

The effects of the 1993 anti-abortion law in Poland.

PubMed

Nowicka, W

1996-12-01

Poland's "anti-abortion" law, which has been in effect since March 1993, is one of the most restrictive in Europe. Under this law, abortion is allowed only when there is justifiable suspicion that the pregnancy constitutes a threat to the life or a serious threat to the health of the mother, that the fetus is irreversibly damaged, or that the pregnancy resulted from an illegal act. Nevertheless, women continue to seek abortions at all costs, and the anti-abortion law has led to creation of "underground" abortion services and "abortion tourism." The existence of underground abortion services (with most available in large cities) is documented through the proliferation of advertisements that contain certain catch phrases, through the testimony of women who have received abortions from private gynecologists, through anonymous statements issued by physicians who perform abortions, and by a government report. Abortion costs range from US$400-800, whereas an average monthly salary in Poland is US$300. As an alternative, an estimated 16,000 Polish women travel to neighboring countries to receive an abortion. The social consequences of the anti-abortion law include an increasing number of abandoned children or infants and an increasing number of teenage pregnancies and late pregnancies. The anti-abortion law has proved to be more restrictive in practice than on paper as women with a right to legal abortion and all the required documentation are refused the procedure. Affected women fail to lodge complaints with the Ministry of Health because they want to put the situation behind them or because they are afraid they will be prosecuted. Other effects of the law are that Poles live in permanent fear of pregnancy and suffer terrible guilt when they resort to abortion. Many obstacles impede use of contraceptives in Poland, and implementation of mandated sex education is chaotic and uneven with most teachers justifiably claiming that they are unqualified to teach this subject.

Emotional Sequelae of Abortion: Implications for Clinical Practice.

ERIC Educational Resources Information Center

Lemkau, Jeanne Parr

1988-01-01

Summarizes literature on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Discusses characteristics of woman, social support and cultural milieu around the abortion, the medical environment and abortion procedure itself, and events subsequent to abortion which may cause conflict. Discusses implications…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anastasiou, Charalampos; Duhr, Claude; Dulat, Falko

In this study, we compute the gluon fusion Higgs boson cross-section at N 3LO through the second term in the threshold expansion. This calculation constitutes a major milestone towards the full N 3LO cross section. Our result has the best formal accuracy in the threshold expansion currently available, and includes contributions from collinear regions besides subleading corrections from soft and hard regions, as well as certain logarithmically enhanced contributions for general kinematics. We use our results to perform a critical appraisal of the validity of the threshold approximation at N 3LO in perturbative QCD.

Study of η and η' Photoproduction at MAMI.

PubMed

Kashevarov, V L; Ott, P; Prakhov, S; Adlarson, P; Afzal, F; Ahmed, Z; Akondi, C S; Annand, J R M; Arends, H J; Beck, R; Braghieri, A; Briscoe, W J; Cividini, F; Codling, R; Collicott, C; Costanza, S; Denig, A; Downie, E J; Dieterle, M; Ferretti Bondy, M I; Fil'kov, L V; Fix, A; Gardner, S; Garni, S; Glazier, D I; Glowa, D; Gradl, W; Gurevich, G; Hamilton, D J; Hornidge, D; Howdle, D; Huber, G M; Käser, A; Kay, S; Keshelashvili, I; Kondratiev, R; Korolija, M; Krusche, B; Linturi, J; Lisin, V; Livingston, K; MacGregor, I J D; MacRae, R; Mancell, J; Manley, D M; Martel, P P; McGeorge, J C; McNicol, E; Middleton, D G; Miskimen, R; Mornacchi, E; Mullen, C; Mushkarenkov, A; Neiser, A; Oberle, M; Ostrick, M; Otte, P B; Oussena, B; Paudyal, D; Pedroni, P; Polyanski, V V; Rajabi, A; Reicherz, G; Robinson, J; Rosner, G; Rostomyan, T; Sarty, A; Schott, D M; Schumann, S; Sfienti, C; Sokhoyan, V; Spieker, K; Steffen, O; Strandberg, B; Strakovsky, I I; Strub, Th; Supek, I; Taragin, M F; Thiel, A; Thiel, M; Tiator, L; Thomas, A; Unverzagt, M; Wagner, S; Watts, D P; Werthmüller, D; Wettig, J; Witthauer, L; Wolfes, M; Workman, R L; Zana, L

2017-05-26

The reactions γp→ηp and γp→η^{'}p are measured from their thresholds up to the center-of-mass energy W=1.96  GeV with the tagged-photon facilities at the Mainz Microtron, MAMI. Differential cross sections are obtained with unprecedented statistical accuracy, providing fine energy binning and full production-angle coverage. A strong cusp is observed in the total cross section for η photoproduction at the energies in the vicinity of the η^{'} threshold, W=1896  MeV (E_{γ}=1447  MeV). Within the framework of a revised ηMAID isobar model, the cusp, in connection with a steep rise of the η^{'} total cross section from its threshold, can only be explained by a strong coupling of the poorly known N(1895)1/2^{-} state to both ηp and η^{'}p. Including the new high-accuracy results in the ηMAID fit to available η and η^{'} photoproduction data allows the determination of the N(1895)1/2^{-} properties.

Analysis of Waveform Retracking Methods in Antarctic Ice Sheet Based on CRYOSAT-2 Data

NASA Astrophysics Data System (ADS)

Xiao, F.; Li, F.; Zhang, S.; Hao, W.; Yuan, L.; Zhu, T.; Zhang, Y.; Zhu, C.

2017-09-01

Satellite altimetry plays an important role in many geoscientific and environmental studies of Antarctic ice sheet. The ranging accuracy is degenerated near coasts or over nonocean surfaces, due to waveform contamination. A postprocess technique, known as waveform retracking, can be used to retrack the corrupt waveform and in turn improve the ranging accuracy. In 2010, the CryoSat-2 satellite was launched with the Synthetic aperture Interferometric Radar ALtimeter (SIRAL) onboard. Satellite altimetry waveform retracking methods are discussed in the paper. Six retracking methods including the OCOG method, the threshold method with 10 %, 25 % and 50 % threshold level, the linear and exponential 5-β parametric methods are used to retrack CryoSat-2 waveform over the transect from Zhongshan Station to Dome A. The results show that the threshold retracker performs best with the consideration of waveform retracking success rate and RMS of retracking distance corrections. The linear 5-β parametric retracker gives best waveform retracking precision, but cannot make full use of the waveform data.

The ship edge feature detection based on high and low threshold for remote sensing image

NASA Astrophysics Data System (ADS)

Li, Xuan; Li, Shengyang

2018-05-01

In this paper, a method based on high and low threshold is proposed to detect the ship edge feature due to the low accuracy rate caused by the noise. Analyze the relationship between human vision system and the target features, and to determine the ship target by detecting the edge feature. Firstly, using the second-order differential method to enhance the quality of image; Secondly, to improvement the edge operator, we introduction of high and low threshold contrast to enhancement image edge and non-edge points, and the edge as the foreground image, non-edge as a background image using image segmentation to achieve edge detection, and remove the false edges; Finally, the edge features are described based on the result of edge features detection, and determine the ship target. The experimental results show that the proposed method can effectively reduce the number of false edges in edge detection, and has the high accuracy of remote sensing ship edge detection.

Stationary statistical theory of two-surface multipactor regarding all impacts for efficient threshold analysis

NASA Astrophysics Data System (ADS)

Lin, Shu; Wang, Rui; Xia, Ning; Li, Yongdong; Liu, Chunliang

2018-01-01

Statistical multipactor theories are critical prediction approaches for multipactor breakdown determination. However, these approaches still require a negotiation between the calculation efficiency and accuracy. This paper presents an improved stationary statistical theory for efficient threshold analysis of two-surface multipactor. A general integral equation over the distribution function of the electron emission phase with both the single-sided and double-sided impacts considered is formulated. The modeling results indicate that the improved stationary statistical theory can not only obtain equally good accuracy of multipactor threshold calculation as the nonstationary statistical theory, but also achieve high calculation efficiency concurrently. By using this improved stationary statistical theory, the total time consumption in calculating full multipactor susceptibility zones of parallel plates can be decreased by as much as a factor of four relative to the nonstationary statistical theory. It also shows that the effect of single-sided impacts is indispensable for accurate multipactor prediction of coaxial lines and also more significant for the high order multipactor. Finally, the influence of secondary emission yield (SEY) properties on the multipactor threshold is further investigated. It is observed that the first cross energy and the energy range between the first cross and the SEY maximum both play a significant role in determining the multipactor threshold, which agrees with the numerical simulation results in the literature.

Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy.

PubMed

Heresbach, Denis; Chauvin, Pauline; Hess-Migliorretti, Aurélie; Riou, Françoise; Grolier, Jacques; Josselin, Jean-Michel

2010-06-01

Computed tomography colonography (CTC) has an acceptable accuracy in detecting colonic lesions, especially for polyps at least 6 mm. The aim of this analysis is to determine the cost-effectiveness of population-based screening for colorectal cancer (CRC) using CTC with a polyp size threshold. The cost-effectiveness ratios of CTC performed at 50, 60 and 70 years old, without (PL strategy) or with (TS strategy) polyp size threshold were compared using a Markov process. Incremental cost-effectiveness ratios (ICER) were calculated per life-years gained (LYG) for a time horizon of 30 years. The ICER of PL and TS strategies were 12 042 and 2765 euro/LYG associated to CRC prevention rates of 37.9 and 36.5%. The ICER of PL and TS strategies dropped to 9687 and 1857 euro/LYG when advanced adenoma (AA) prevalence increased from 6.9 to 8.6% for male participants and 3.8-4.9% for female participants or to 9482 and 2067 euro/LYG when adenoma and AA annual recurrence rates dropped to 3.2 and 0.25%. The ICER for PL and TS strategies decreased to 7947 and 954 euro/LYG or when only two CTC were performed at 50 and 60-years-old. Conversely, the ICER did not significantly change when varying population participation rate or accuracy of CTC. CTC with a 6 mm threshold for polypectomy is associated to a substantial cost reduction without significant loss of efficacy. Cost-effectiveness depends more on the AA prevalence or transition rate to CRC than on CTC accuracy or screening compliance.

Analysis of Publically Available Skin Sensitization Data from REACH Registrations 2008–2014

PubMed Central

Luechtefeld, Thomas; Maertens, Alexandra; Russo, Daniel P.; Rovida, Costanza; Zhu, Hao; Hartung, Thomas

2017-01-01

Summary The public data on skin sensitization from REACH registrations already included 19,111 studies on skin sensitization in December 2014, making it the largest repository of such data so far (1,470 substances with mouse LLNA, 2,787 with GPMT, 762 with both in vivo and in vitro and 139 with only in vitro data). 21% were classified as sensitizers. The extracted skin sensitization data was analyzed to identify relationships in skin sensitization guidelines, visualize structural relationships of sensitizers, and build models to predict sensitization. A chemical with molecular weight > 500 Da is generally considered non-sensitizing owing to low bioavailability, but 49 sensitizing chemicals with a molecular weight > 500 Da were found. A chemical similarity map was produced using PubChem’s 2D Tanimoto similarity metric and Gephi force layout visualization. Nine clusters of chemicals were identified by Blondel’s module recognition algorithm revealing wide module-dependent variation. Approximately 31% of mapped chemicals are Michael’s acceptors but alone this does not imply skin sensitization. A simple sensitization model using molecular weight and five ToxTree structural alerts showed a balanced accuracy of 65.8% (specificity 80.4%, sensitivity 51.4%), demonstrating that structural alerts have information value. A simple variant of k-nearest neighbors outperformed the ToxTree approach even at 75% similarity threshold (82% balanced accuracy at 0.95 threshold). At higher thresholds, the balanced accuracy increased. Lower similarity thresholds decrease sensitivity faster than specificity. This analysis scopes the landscape of chemical skin sensitization, demonstrating the value of large public datasets for health hazard prediction. PMID:26863411

Basic Diagnosis and Prediction of Persistent Contrail Occurrence using High-resolution Numerical Weather Analyses/Forecasts and Logistic Regression. Part I: Effects of Random Error

NASA Technical Reports Server (NTRS)

Duda, David P.; Minnis, Patrick

2009-01-01

Straightforward application of the Schmidt-Appleman contrail formation criteria to diagnose persistent contrail occurrence from numerical weather prediction data is hindered by significant bias errors in the upper tropospheric humidity. Logistic models of contrail occurrence have been proposed to overcome this problem, but basic questions remain about how random measurement error may affect their accuracy. A set of 5000 synthetic contrail observations is created to study the effects of random error in these probabilistic models. The simulated observations are based on distributions of temperature, humidity, and vertical velocity derived from Advanced Regional Prediction System (ARPS) weather analyses. The logistic models created from the simulated observations were evaluated using two common statistical measures of model accuracy, the percent correct (PC) and the Hanssen-Kuipers discriminant (HKD). To convert the probabilistic results of the logistic models into a dichotomous yes/no choice suitable for the statistical measures, two critical probability thresholds are considered. The HKD scores are higher when the climatological frequency of contrail occurrence is used as the critical threshold, while the PC scores are higher when the critical probability threshold is 0.5. For both thresholds, typical random errors in temperature, relative humidity, and vertical velocity are found to be small enough to allow for accurate logistic models of contrail occurrence. The accuracy of the models developed from synthetic data is over 85 percent for both the prediction of contrail occurrence and non-occurrence, although in practice, larger errors would be anticipated.

Comparison of an IgG-Specific Enzyme-Linked Immunosorbent Assay Cutoff of 0.4 Versus 0.8 and 1.0 Optical Density Units for Heparin-Induced Thrombocytopenia.

PubMed

Ritchie, Brianne M; Connors, Jean M; Sylvester, Katelyn W

2017-04-01

Previous studies have demonstrated optimized diagnostic accuracy in utilizing higher antiheparin-platelet factor 4 (PF4) enzyme-linked immunosorbent assay (ELISA) optical density (OD) thresholds for diagnosing heparin-induced thrombocytopenia (HIT). We describe the incidence of positive serotonin release assay (SRA) results, as well as performance characteristics, for antiheparin-PF4 ELISA thresholds ≥0.4, ≥0.8, and ≥1.0 OD units in the diagnosis of HIT at our institution. Following institutional review board approval, we conducted a single-center retrospective chart review on adult inpatients with a differential diagnosis of HIT evaluated by both antiheparin-PF4 ELISA and SRA from 2012 to 2014. The major endpoints were to assess incidence of positive SRA results, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy at antiheparin-PF4 ELISA values ≥0.4 OD units when compared to values ≥0.8 and ≥1.0 OD units. Clinical characteristics, including demographics, laboratory values, clinical and safety outcomes, length of stay, and mortality, were collected. A total of 140 patients with 140 antiheparin-PF4 ELISA and SRA values were evaluated, of which 23 patients were SRA positive (16.4%) and 117 patients were SRA negative (83.6%). We identified a sensitivity of 91.3% versus 82.6% and 73.9%, specificity of 61.5% versus 87.2% and 91.5%, PPV of 31.8% versus 55.9% and 63.0%, NPV of 97.3% versus 96.2% and 94.7%, and accuracy of 66.4% versus 86.4% and 88.6% at antiheparin-PF4 ELISA thresholds ≥0.4, ≥0.8, and ≥1.0 OD units, respectively. Our study suggests an increased antiheparin-PF4 ELISA threshold of 0.8 or 1.0 OD units enhances specificity, PPV, and accuracy while maintaining NPV with decreased sensitivity.

Abortion Decision and Ambivalence: Insights via an Abortion Decision Balance Sheet

ERIC Educational Resources Information Center

Allanson, Susie

2007-01-01

Decision ambivalence is a key concept in abortion literature, but has been poorly operationalised. This study explored the concept of decision ambivalence via an Abortion Decision Balance Sheet (ADBS) articulating reasons both for and against terminating an unintended pregnancy. Ninety-six women undergoing an early abortion for psychosocial…

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

Mental health and abortion: review and analysis.

PubMed

Ney, P G; Wickett, A R

1989-11-01

This survey of studies which relate to the emotional sequelae of induced abortion, draws attention to the need for more long-term, in-depth prospective studies. The literature to this point finds no psychiatric indications for abortion, and no satisfactory evidence that abortion improves the psychological state of those not mentally ill; abortion is contra-indicated when psychiatric disease is present, as mental ill-health has been shown to be worsened by abortion. Recent studies are turning up an alarming rate of post-abortion complications such as P.I.D., and subsequent infertility. The emotional impact of these complications needs to be studied. Other considerations looked at are the long-term demographic implications of abortion on demand and the effect on the medical professions.

Pregnancy outcome of threatened abortion with demonstrable fetal cardiac activity: a cohort study.

PubMed

Tongsong, T; Srisomboon, J; Wanapirak, C; Sirichotiyakul, S; Pongsatha, S; Polsrisuthikul, T

1995-08-01

Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy. To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not. Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies. Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p < 0.05). Preterm delivery was also higher, but was not statistically significant. First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without.

The politicization of abortion and the evolution of abortion counseling.

PubMed

Joffe, Carole

2013-01-01

The field of abortion counseling originated in the abortion rights movement of the 1970s. During its evolution to the present day, it has faced significant challenges, primarily arising from the increasing politicization and stigmatization of abortion since legalization. Abortion counseling has been affected not only by the imposition of antiabortion statutes, but also by the changing needs of patients who have come of age in a very different era than when this occupation was first developed. One major innovation--head and heart counseling--departs in significant ways from previous conventions of the field and illustrates the complex and changing political meanings of abortion and therefore the challenges to abortion providers in the years following Roe v Wade.

Religion and attitudes toward abortion and abortion policy in Brazil.

PubMed

Ogland, Curtis P; Verona, Ana Paula

2011-01-01

This study examines the association between religion and attitudes toward the practice of abortion and abortion policy in Brazil. Drawing upon data from the 2002 Brazilian Social Research Survey (BSRS), we test a number of hypotheses with regard to the role of religion on opposition to the practice of abortion and its legalization. Findings indicate that frequently attending Pentecostals demonstrate the strongest opposition to the practice of abortion and both frequently attending Pentecostals and Catholics demonstrate the strongest opposition to its legalization. Additional religious factors, such as a commitment to biblical literalism, were also found to be significantly associated with opposition to both abortion issues. Ultimately, the findings have implications for the future of public policy on abortion and other contentious social issues in Brazil.

Safe abortion: WHO technical and policy guidance.

PubMed

Cook, R J; Dickens, B M; Horga, M

2004-07-01

In 2003, the World Health Organization published its well referenced handbook Safe Abortion: Technical and Policy Guidance for Health Systems to address the estimated almost 20 million induced abortions each year that are unsafe, imposing a burden of approximately 67 thousand deaths annually. It is a global injustice that 95% of unsafe abortions occur in developing countries. The focus of guidance is on abortion procedures that are lawful within the countries in which they occur, noting that in almost all countries, the law permits abortion to save a woman's life. The guidance treats unsafe abortion as a public health challenge, and responds to the problem through strategies concerning improved clinical care for women undergoing procedures, and the appropriate placement of necessary services. Legal and policy considerations are explored, and annexes present guidance to further reading, international consensus documents on safe abortion, and on manual vacuum aspiration and post-abortion contraception.

Effect of abortion protesters on women's emotional response to abortion.

PubMed

Foster, Diana Greene; Kimport, Katrina; Gould, Heather; Roberts, Sarah C M; Weitz, Tracy A

2013-01-01

Little is known about women's experiences with and reactions to protesters and how protesters affect women's emotional responses to abortion. We interviewed 956 women seeking abortion between 2008 and 2010 at 30 U.S. abortion care facilities and informants from 27 of these facilities. Most facilities reported a regular protester presence; one third identified protesters as aggressive towards patients. Nearly half (46%) of women interviewed saw protesters; of those, 25% reported being "a little" upset, and 16% reported being "quite a lot" or "extremely" upset. Women who had difficulty deciding to abort had higher odds of reporting being upset by protesters. In multivariable models, exposure to protesters was not associated with differences in emotions 1 week after the abortion. Protesters do upset some women seeking abortion services. However, exposure to protesters does not seem to have an effect on women's emotions about the abortion 1 week later. Copyright © 2013 Elsevier Inc. All rights reserved.

International developments in abortion laws: 1977-88.

PubMed Central

Cook, R J; Dickens, B M

1988-01-01

During the period between 1977 and the first quarter of 1988, 35 countries liberalized their abortion laws and four countries limited grounds for the procedure. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but a number of other indications have been created such as adolescence, advanced maternal age, family circumstances, and AIDS or HIV infection. A number of countries have redesigned their abortion laws as part of a comprehensive package to facilitate access to and delivery of contraception, voluntary sterilization, and abortion services. Abortion litigation has increased and stimulated the liberalization of abortion provisions and the support of women's autonomous choice within the law. In Canada, the entire criminal prohibition of abortion was held unconstitutional for violating women's integrity and security. In contrast, Latin American and other constitutional developments may limit legal abortion to instances of danger to women's lives. PMID:3048126

The stigmatisation of abortion: a qualitative analysis of print media in Great Britain in 2010

PubMed Central

Purcell, Carrie; Hilton, Shona; McDaid, Lisa

2014-01-01

The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as ‘risky’, and in association with other ‘discredited’ social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse. PMID:25115952

Abortion Providers' Experiences with Medicaid Abortion Coverage Policies: A Qualitative Multistate Study

PubMed Central

Dennis, Amanda; Blanchard, Kelly

2013-01-01

Objective To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. Data Source From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. Study Design In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data Extraction Data were transcribed verbatim before being coded. Principal Findings In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Conclusions Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. PMID:22742741

Induced abortion among Brazilian female sex workers: a qualitative study.

PubMed

Madeiro, Alberto Pereira; Diniz, Debora

2015-02-01

Prostitutes are vulnerable to unplanned pregnancies and abortions. In Brazil, abortion is a crime and there is no data about unsafe abortions for this population. The study describes how prostitutes perform illegal abortions and the health consequences thereof. Semi-structured interviews with 39 prostitutes from three cities in Brazil with previous induced abortion experience were conducted. Sixty-six abortions, with between one and eight occurrences per woman, were recorded. The majority of the cases resulted from sexual activity with clients. The inconsistent use of condoms with regular clients and the consumption of alcohol during work were indicated as the main causes of unplanned pregnancies. The main method to perform abortion was the intravaginal and oral use of misoprostol, acquired in pharmacies or on the black market. Invasive measures were less frequently reported, however with more serious health complications. The fear of complaint to the police meant that most women do not inform the health team regarding induced abortion. The majority of prostitutes aborted with the use of illegally-acquired misoprostol, ending abortion in a public hospital with infection and hemorrhagic complications. The data indicate the need for a public policy focusing on the reproductive health of prostitutes.

Perspectives on induced abortion among Palestinian women: religion, culture and access in the occupied Palestinian territories.

PubMed

Shahawy, Sarrah; Diamond, Megan B

2018-03-01

Induced abortion is an important public health issue in the occupied Palestinian territories (OPT), where it is illegal in most cases. This study was designed to elicit the views of Palestinian women on induced abortion given the unique religious, ethical and social challenges in the OPT. Sixty Palestinian women were interviewed on their perceptions of the religious implications, social consequences and accessibility of induced abortions in the OPT at Al-Makassed Islamic Charitable Hospital in East Jerusalem. Themes arising from the interviews included: the centrality of religion in affecting women's choices and views on abortion; the importance of community norms in regulating perspectives on elective abortion; and the impact of the unique medico-legal situation of the OPT on access to abortion under occupation. Limitations to safe abortion access included: legal restrictions; significant social consequences from the discovery of an abortion by one's community or family; and different levels of access to abortion depending on whether a woman lived in East Jerusalem, the West Bank, or Gaza. This knowledge should be incorporated to work towards a legal and medical framework in Palestine that would allow for safe abortions for women in need.

[Epidemiology of induced abortion in Côte d'Ivoire].

PubMed

Vroh, Joseph Benie Bi; Tiembre, Issaka; Attoh-Toure, Harvey; Kouadio, Daniel Ekra; Kouakou, Lucien; Coulibaly, Lazare; Kouakou, Hyacinthe Andoh; Tagliante-Saracino, Janine

2012-06-08

The objective of this study was to examine induced abortion in Côte d'Ivoire. A nationwide cross-sectional descriptive study of induced abortion was carried out in 2007 among 3,057 women aged 15-49 years. The study showed that induced abortion is a widespread practice in Côte d'Ivoire, with a prevalence estimated at 42.5%. The women who had undergone an abortion were generally under 25, unmarried, and illiterate, and had used contraception. More than half (52.1%) of all induced abortions were performed at home by traditional abortionists or were self-induced with plants or decoctions. The main reasons for induced abortion were concern about the reaction of parents (27.7%), age (22.2%), a lack of financial resources (21.3%) and the desire of women to continue their education. More than half of the participants (55.8%) stated that they had suffered complications, which were more common after a home abortion than after a hospital abortion. Political and legal measures or reforms aimed at changing abortion laws in Côte d'Ivoire and better access to family planning are required in order to prevent or treat the social issue of induced abortion.

Abortion and Islam: policies and practice in the Middle East and North Africa.

PubMed

Hessini, Leila

2007-05-01

This paper provides an overview of legal, religious, medical and social factors that serve to support or hinder women's access to safe abortion services in the 21 predominantly Muslim countries of the Middle East and North Africa (MENA) region, where one in ten pregnancies ends in abortion. Reform efforts, including progressive interpretations of Islam, have resulted in laws allowing for early abortion on request in two countries; six others permit abortion on health grounds and three more also allow abortion in cases of rape or fetal impairment. However, medical and social factors limit access to safe abortion services in all but Turkey and Tunisia. To address this situation, efforts are increasing in a few countries to introduce post-abortion care, document the magnitude of unsafe abortion and understand women's experience of unplanned pregnancy. Religious fatāwa have been issued allowing abortions in certain circumstances. An understanding of variations in Muslim beliefs and practices, and the interplay between politics, religion, history and reproductive rights is key to understanding abortion in different Muslim societies. More needs to be done to build on efforts to increase women's rights, engage community leaders, support progressive religious leaders and government officials and promote advocacy among health professionals.

Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States

PubMed Central

Neuhaus, John M.; Foster, Diana G.

2015-01-01

Objectives. We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. Methods. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility’s gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. Results. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. Conclusions. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term. PMID:26469674

Abortion providers' experiences with Medicaid abortion coverage policies: a qualitative multistate study.

PubMed

Dennis, Amanda; Blanchard, Kelly

2013-02-01

To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data were transcribed verbatim before being coded. In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. © Health Research and Educational Trust.

Theorizing Time in Abortion Law and Human Rights

PubMed Central

Erdman, Joanna N.

2017-01-01

Abstract The legal regulation of abortion by gestational age, or length of pregnancy, is a relatively undertheorized dimension of abortion and human rights. Yet struggles over time in abortion law, and its competing representations and meanings, are ultimately struggles over ethical and political values, authority and power, the very stakes that human rights on abortion engage. This article focuses on three struggles over time in abortion and human rights law: those related to morality, health, and justice. With respect to morality, the article concludes that collective faith and trust should be placed in the moral judgment of those most affected by the passage of time in pregnancy and by later abortion—pregnant women. With respect to health, abortion law as health regulation should be evidence-based to counter the stigma of later abortion, which leads to overregulation and access barriers. With respect to justice, in recognizing that there will always be a need for abortion services later in pregnancy, such services should be safe, legal, and accessible without hardship or risk. At the same time, justice must address the structural conditions of women’s capacity to make timely decisions about abortion, and to access abortion services early in pregnancy. PMID:28630539

Knowledge and perception of the Nigerian Abortion Law by abortion seekers in south-eastern Nigeria.

PubMed

Adinma, E D; Adinma, J I B; Ugboaja, J; Iwuoha, C; Akiode, A; Oji, E; Okoh, M

2011-11-01

One in four pregnancies worldwide is voluntarily terminated. Approximately 20 million terminations are performed under unsafe conditions, mostly in developing countries with restrictive abortion laws. A total of 100 consecutive abortion-seekers were interviewed, to ascertain their knowledge and perceptions on the Nigerian Abortion Law. The majority (55.0%) of the respondents were students. Most of them (97%) had at least secondary education and the majority (62.0%) were within the 20-24 years age range. Only 31.0% of the women interviewed were aware of the Nigerian Abortion Law. While 16% perceived the law as being restrictive, 2% opined that' it was alright'; 1% perceived it as very restrictive and 12% had no opinion on the abortion law. Knowledge of the abortion law had no significant relationship with either the educational level of the respondent or the number of previous pregnancy terminations and overall demand for abortion services. It is necessary to ensure a wide dissemination of the abortion law and its provisions to the Nigerian public, in order to arm them with the necessary information to participate actively in debates on abortion law reforms.

Conducting collaborative abortion research in international settings.

PubMed

Gipson, Jessica D; Becker, Davida; Mishtal, Joanna Z; Norris, Alison H

2011-01-01

Nearly 20% of the 208 million pregnancies that occur annually are aborted. More than half of these (21.6 million) are unsafe, resulting in 47,000 abortion-related deaths each year. Accurate reports on the prevalence of abortion, the conditions under which it occurs, and the experiences women have in obtaining abortions are essential to addressing unsafe abortion globally. It is difficult, however, to obtain accurate and reliable reports of attitudes and practices given that abortion is often controversial and stigmatized, even in settings where it is legal. To improve the understanding and measurement of abortion, specific considerations are needed throughout all stages of the planning, design, and implementation of research on abortion: Establishment of strong local partnerships, knowledge of local culture, integration of innovative methodologies, and approaches that may facilitate better reporting. This paper draws on the authors' collaborative research experiences conducting abortion-related studies using clinic- and community-based samples in five diverse settings (Poland, Zanzibar, Mexico City, the Philippines, and Bangladesh). The purpose of this paper is to share insights and lessons learned with new and established researchers to inform the development and implementation of abortion-related research. The paper discusses the unique challenges of conducting abortion-related research and key considerations for the design and implementation of abortion research, both to maximize data quality and to frame inferences from this research appropriately. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Parental Consent for Abortion and the Judicial Bypass Option in Arkansas: Effects and Correlates

PubMed Central

Joyce, Ted

2010-01-01

CONTEXT In 2005, Arkansas changed its parental notification requirement for minors seeking an abortion to a parental consent law, under which a minor can obtain an abortion without consent after obtaining a judicial waiver. METHODS Using state Department of Health data on 7,463 abortions among 15–19-year-olds over the period 2001–2007, an analysis of abortion and second-trimester abortion rates among Arkansas minors relative to rates among older teenagers evaluated the influence of the 2005 change in the law. Linear and logistic regression analyses estimated the changes in rates among different age-groups, and assessed the likelihood of minors’ using the bypass procedure or having a second-trimester abortion. RESULTS No association was found between the change in the law and either the abortion rate or the second-trimester abortion rate among minors in the state. Ten percent of all abortions among minors were obtained through the judicial bypass procedure, and minors aged 15 or younger who had an abortion were less likely than those aged 17 to get a waiver (odds ratio, 0.2). Minors who used the bypass option were less likely than those who obtained parental consent to have a second-trimester abortion (0.5), and they terminated the pregnancy 1.1 weeks earlier, on average, than did minors who had gotten such consent. CONCLUSIONS States that convert a parental notification statute to a parental consent statute are unlikely to experience a decrease in abortions among minors. PMID:20887286

Parental consent for abortion and the judicial bypass option in Arkansas: effects and correlates.

PubMed

Joyce, Ted

2010-09-01

In 2005, Arkansas changed its parental notification requirement for minors seeking an abortion to a parental consent law, under which a minor can obtain an abortion without consent after obtaining a judicial waiver. Using state health department data on 7,463 abortions among 15-19-year-olds over the period 2001-2007, an analysis of abortion and second-trimester abortion rates among Arkansas minors relative to rates among older teenagers evaluated the influence of the 2005 change in the law. Linear and logistic regression analyses estimated the changes in rates among different age-groups, and assessed the likelihood of minors' using the bypass procedure or having a second-trimester abortion. No association was found between the change in the law and either the abortion rate or the second-trimester abortion rate among minors in the state. Ten percent of all abortions among minors were obtained through the judicial bypass procedure, and minors aged 15 or younger who had an abortion were less likely than those aged 17 to get a waiver (odds ratio, 0.2). Minors who used the bypass option were less likely than those who obtained parental consent to have a second-trimester abortion (0.5), and they terminated the pregnancy 1.1 weeks earlier, on average, than did minors who had gotten such consent. States that convert a parental notification statute to a parental consent statute are unlikely to experience a decrease in abortions among minors. Copyright © 2010 by the Guttmacher Institute.

Abortion patients' perceptions of abortion regulation.

PubMed

Cockrill, Kate; Weitz, Tracy A

2010-01-01

Most states regulate abortion differently than other health care services. Examples of these regulations include mandating waiting periods and the provision of state-authored information, and prohibiting private and public insurance coverage for abortion. The primary purpose of this paper is to explore abortion patients' perspectives on these regulations. We recruited 20 participants from three abortion providing facilities located in two states in the U.S. South and Midwest. Using a survey and semistructured interview, we collected information about women's knowledge of abortion regulation and policy preferences. During the interviews, women weighed the pros and cons of abortion regulations. We used grounded theory analytical techniques and matrix analysis to organize and interpret the data. We discovered five themes in these women's considerations of regulation: responsibility, empathy, safe and accessible health care, privacy, and equity. Women in the study generally supported policies that they felt protected women or informed decisions. However, most women also opposed laws mandating two-day abortion appointments for women who were traveling long distances. Women tended to favor financial coverage of abortion, arguing that it could help poor women afford abortion or reduce state expenditures. Overall the study participants' opinions on abortion policy reflect key values for advocates and policy makers to consider: responsibility, empathy, safe and accessible health care, privacy, and equity. Future work should examine abortion regulations in light of these shared values. Laws that promote misinformation or prohibit accommodations of unique circumstances are not consistent the positions articulated by the subjects in our study. Copyright 2010 Jacobs Institute of Women

Why don't humanitarian organizations provide safe abortion services?

PubMed

McGinn, Therese; Casey, Sara E

2016-01-01

Although sexual and reproductive health services have become more available in humanitarian settings over the last decade, safe abortion services are still rarely provided. The authors' observations suggest that four reasons are typically given for this gap: 'There's no need'; 'Abortion is too complicated to provide in crises'; 'Donors don't fund abortion services'; and 'Abortion is illegal'. However, each of these reasons is based on false premises. Unsafe abortion is a major cause of maternal mortality globally, and the collapse of health systems in crises suggests it likely increases in humanitarian settings. Abortion procedures can be safely performed in health centers by mid-level providers without sophisticated equipment or supplies. Although US government aid does not fund abortion-related activities, other donors, including many European governments, do fund abortion services. In most countries, covering 99 % of the world's population, abortion is permitted under some circumstances; it is illegal without exception in only six countries. International law supports improved access to safe abortion. As none of the reasons often cited for not providing these services is valid, it is the responsibility of humanitarian NGOs to decide where they stand regarding their commitment to humanitarian standards and women's right to high quality and non-discriminatory health services. Providing safe abortion to women who become pregnant as a result of rape in war may be a more comfortable place for organizations to begin the discussion. Making safe abortion available will improve women's health and human rights and save lives.

The cost of postabortion care and legal abortion in Colombia.

PubMed

Prada, Elena; Maddow-Zimet, Isaac; Juarez, Fatima

2013-09-01

Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

Abortion and sex determination: conflicting messages in information materials in a District of Rajasthan, India.

PubMed

Nidadavolu, Vijaya; Bracken, Hillary

2006-05-01

Public information campaigns are an integral component of reproductive health programmes, including on abortion. In India, where sex selective abortion is increasing, public information is being disseminated on the illegality of sex determination. This paper presents findings from a study undertaken in 2003 in one district in Rajasthan to analyse the content of information materials on abortion and sex determination and people's perceptions of them. Most of the informational material about abortion was produced by one abortion service provider, but none by the public or private sector. The public sector had produced materials on the illegality of sex determination, some of which failed to distinguish between sex selection and other reasons for abortion. In the absence of knowledge of the legal status of abortion, the negative messages and strong language of these materials may have contributed to the perception that abortion is illegal in India. Future materials should address abortion and sex determination, including the legal status of abortion, availability of providers and social norms that shape decision-making. Married and unmarried women should be addressed and the participation of family members acknowledged, while supporting independent decisions by women. Sex determination should also be addressed, and the conditions under which a woman can and cannot seek an abortion clarified, using media and materials accessible to low-literate audiences. Based on what we learned in this research, a pictorial booklet and educator's manual were produced, covering both abortion and sex determination, and are being distributed in India.

Do Women Presenting for First and Second-Trimester Abortion Differ Socio-Demographically?

PubMed Central

Aggarwal, P; Agarwal, P; Zutshi, V; Batra, S

2013-01-01

Background: To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion. Aim: To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester). Materials and Methods: Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis. Results: Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion. Conclusion: Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion. PMID:23919187

Psychiatric symptoms and pregnancy distress in subsequent pregnancy after spontaneous abortion history

PubMed Central

Haghparast, Elahe; Faramarzi, Mahbobeh; Hassanzadeh, Ramezan

2016-01-01

Objectives: Spontaneous abortion is one of the most important complications of pregnancy with short and long adverse psychological effects on women. This study assesses the implications of a spontaneous abortion history has on women’s psychiatric symptoms and pregnancy distress in subsequent pregnancy less than one years after spontaneous abortion. Methods: A case-control study was conducted on pregnant women of Babol city from September 2014 to May 2015. In this study, 100 pregnant women with spontaneous abortion history during a year ago and 100 pregnant women without spontaneous abortion history were enrolled. All the participants in two groups completed the Symptom Checklist-90-Revised (SCL-90-R), and pregnancy Distress Questionnaire (PDQ). Results: Women with spontaneous abortion history had significantly higher mean of many subscales of SCL-90 (depression, anxiety, somatization, obsessive-compulsiveness, interpersonal sensitivity, psychoticism, hostility, paranoid, and Global Severity Index) more than women without spontaneous abortion history. Also, women with spontaneous abortion history had significantly higher mean of two subscales of PDQ concerns about birth and the baby, concerns about emotions and relationships) and total PDQ more than women without spontaneous abortion history. Conclusion: Pregnant women with less than a year after spontaneous abortion history are at risk of psychiatric symptoms and pregnancy distress more than controls. This study supports those implications for planning the post spontaneous abortion psychological care for women, especially women who wanted to be pregnant during 12 month after spontaneous abortion. PMID:27882001

Family planning utilization and factors associated among women receiving abortion services in health facilities of central zone towns of Tigray, Northern Ethiopia: a cross sectional Study.

PubMed

Hagos, Goshu; Tura, Gurmesa; Kahsay, Gizienesh; Haile, Kebede; Grum, Teklit; Araya, Tsige

2018-06-05

Abortion remains among the leading causes of maternal death worldwide. Post-abortion contraception is significantly effective in preventing unintended pregnancy and abortion if provided before women leave the health facilty. However, the status of post-abortion family planning (PAFP) utilization and the contributing factors are not well studied in Tigray region. So, we conduct study aimed on family planning utilization and factors associated with it among women receiving abortion services. A facility based cross-sectional study design was conducted among women receiving abortion services in central zone of Tigray from December 2015to February 2016 using a total of 416 sample size. Women who came for abortion services were selected using systematic random sampling technique.. The data were collected using a pre-tested interviewer administered questionnair. Data were coded and entered in to Epi info 7 and then exported to SPSS for analysis. Descriptive statisticslike frequencies and mean were computed to display the results. Both Bivariable and multivariable logistic regression was used in the analysis. Variables statistically significant at p < 0.05 in the bivariable analysis were checked in multivariable logistic regration to identify independently associated factors. Then variables which were significantly associated with post abortion family planning utilization at p-value < 0.05 in the multivariable analysis were declared as significantly associated factors. A total of 409 abortion clients were interviewed in this study with 98.3% of response rate. Majority 290 (70.9%) of study participants utilized contracepives after abortion. Type of health facility, the decision maker on timing of having child, knowledge that pregnancy can happen soon after abortion and husband's opposition towards contraceptives were significantly associated with Post-abortion family planning ustilization. About one-third of abortion women failed to receive contraceptive before leaving the facility. Private facilities should strengthen utilization of contraceptives on post abortion care service. Health providers should provide counseling on timing of fertility-return following abortion before women left the facility once they receive abortion care. Women empowerment through enhancing community's awareness focusing on own decision making in the family planning utilization including the partner should be strengthened.

Woman-centered research on access to safe abortion services and implications for behavioral change communication interventions: a cross-sectional study of women in Bihar and Jharkhand, India.

PubMed

Banerjee, Sushanta K; Andersen, Kathryn L; Buchanan, Rebecca M; Warvadekar, Janardan

2012-03-09

Unsafe abortion in India leads to significant morbidity and mortality. Abortion has been legal in India since 1971, and the availability of safe abortion services has increased. However, service availability has not led to a significant reduction in unsafe abortion. This study aimed to understand the gap between safe abortion availability and use of services in Bihar and Jharkhand, India by examining accessibility from the perspective of rural, Indian women. Two-stage stratified random sampling was used to identify and enroll 1411 married women of reproductive age in four rural districts in Bihar and Jharkhand, India. Data were collected on women's socio-demographic characteristics; exposure to mass media and other information sources; and abortion-related knowledge, perceptions and practices. Multiple linear regression models were used to explore the association between knowledge and perceptions about abortion. Most women were poor, had never attended school, and had limited exposure to mass media. Instead, they relied on community health workers, family and friends for health information. Women who had knowledge about abortion, such as knowing an abortion method, were more likely to perceive that services are available (β = 0.079; p < 0.05) and have positive attitudes toward abortion (β = 0.070; p < 0.05). In addition, women who reported exposure to abortion messages were more likely to have favorable attitudes toward abortion (β = 0.182; p < 0.05). Behavior change communication (BCC) interventions, which address negative perceptions by improving community knowledge about abortion and support local availability of safe abortion services, are needed to increase enabling resources for women and improve potential access to services. Implementing BCC interventions is challenging in settings such as Bihar and Jharkhand where women may be difficult to reach directly, but interventions can target individuals in the community to transfer information to the women who need this information most. Interpersonal approaches that engage community leaders and influencers may also counteract negative social norms regarding abortion and associated stigma. Collaborative actions of government, NGOs and private partners should capitalize on this potential power of communities to reduce the impact of unsafe abortion on rural women.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

PubMed Central

Devjee, Jaymala; Moodley, Jack

2017-01-01

Background Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. Conclusion This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs. PMID:28369061

Attitudes of medical students to induced abortion.

PubMed

Buga, G A B

2002-05-01

Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can only be offered under conditions where legislation has been passed for legal termination of unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the attitudes of doctors and other healthcare workers to induced abortion. Medical students as future doctors may have attitudes to abortion that will affect the provision of safe abortion. Little is known about the attitudes of South African medical students to abortion. To assess sexual practices and attitudes of medical students to induced abortion and to determine some of the factors that may influence these attitudes. A cross-sectional analytic study involving the self-administration of an anonymous questionnaire. The questionnaire was administered to medical students at a small, but growing, medical school situated in rural South Africa. Demographic data, sexual practices and attitudes to induced abortion. Two hundred and forty seven out of 300 (82.3%) medical students responded. Their mean age was 21.81 +/- 3.36 (SD) years, and 78.8% were Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single, 68.6% were already sexually experienced, and their mean age at coitarche was 17.24+/-3.14 (SD) years. Although overall 61.2% of the respondents felt abortion is murder either at conception or later, the majority (87.2%) would perform or refer a woman for abortion under certain circumstances. These circumstances, in descending order of frequency, include: threat to mother's life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to mother's mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents would perform or refer for abortion on demand, 12.8% would neither perform nor refer for abortion under any circumstances. Religious affiliation and service attendance significantly influenced some of these attitudes and beliefs. Although many of the medical students personally felt abortion is murder, the majority are likely to perform or refer patients for abortion under certain circumstances; only about a tenth are likely to perform or refer patients for abortion on demand.

A decade of progress providing safe abortion services in Ethiopia: results of national assessments in 2008 and 2014.

PubMed

Dibaba, Yohannes; Dijkerman, Sally; Fetters, Tamara; Moore, Ann; Gebreselassie, Hailemichael; Gebrehiwot, Yirgu; Benson, Janie

2017-03-04

Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia. This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis. There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased. Ten years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels.

[Bioethics and abortion. Debate].

PubMed

Diniz, D; Gonzalez Velez, A C

1998-06-01

Although abortion has been the most debated of all issues analyzed in bioethics, no moral consensus has been achieved. The problem of abortion exemplifies the difficulty of establishing social dialogue in the face of distinct moral positions, and of creating an independent academic discussion based on writings that are passionately argumentative. The greatest difficulty posed by the abortion literature is to identify consistent philosophical and scientific arguments amid the rhetorical manipulation. A few illustrative texts were selected to characterize the contemporary debate. The terms used to describe abortion are full of moral meaning and must be analyzed for their underlying assumptions. Of the four main types of abortion, only 'eugenic abortion', as exemplified by the Nazis, does not consider the wishes of the woman or couple--a fundamental difference for most bioethicists. The terms 'selective abortion' and 'therapeutic abortion' are often confused, and selective abortion is often called eugenic abortion by opponents. The terms used to describe abortion practitioners, abortion opponents, and the 'product' are also of interest in determining the style of the article. The video entitled "The Silent Scream" was a classic example of violent and seductive rhetoric. Its type of discourse, freely mixing scientific arguments and moral beliefs, hinders analysis. Within writings about abortion three extreme positions may be identified: heteronomy (the belief that life is a gift that does not belong to one) versus reproductive autonomy; sanctity of life versus tangibility of life; and abortion as a crime versus abortion as morally neutral. Most individuals show an inconsistent array of beliefs, and few groups or individuals identify with the extreme positions. The principal argument of proponents of legalization is respect for the reproductive autonomy of the woman or couple based on the principle of individual liberty, while heteronomy is the main principle of opponents. Opponents have taken an active approach in decomposing their beliefs into different strands to be argued. Their assertions that the fetus is a person from conception or a person in potential have forced proponents of legalized abortion to argue in a largely reactive mode.

Repeat induced abortions in Georgia, characteristics of women with multiple pregnancy terminations: secondary analysis of the Reproductive Health Survey 2010.

PubMed

Pestvenidze, Ekaterine; Berdzuli, Nino; Lomia, Nino; Gagua, Tinatin; Umikashvili, Lia; Stray-Pedersen, Babill

2016-10-01

To examine the multi-faceted characteristics of women with repeat induced abortions and assess post-abortion family planning service provision in Georgia. We performed secondary analysis of the data from the Georgian Reproductive Health Survey 2010. A logistic regression model was used to assess the socio-demographic and behavioral factors, contraceptive practices in relation to repeat induced abortions for 2203 women of reproductive age with at least one induced abortion. The Chi-Square test was used to evaluate provision of post-abortion family planning services. Among the targeted women, 70% (n=1539) had repeat induced abortions. The odds of terminating pregnancy raised exponentially with age (OR 3.12, 95% CI: 2.11-4.61), number of complete pregnancies (3 vs. 0-1 complete pregnancies: OR 3.25, 95% CI: 2.36-4.48) and lower education (OR 1.38, 95% CI: 1.10-1.73). The current use of contraception had a protective effect on the occurrence of repeat induced abortions (OR 0.69, 95% CI: 0.53-0.89 for modern and OR 0.68, 95% CI: 0.50-0.92 for traditional methods). The contraceptive counseling and family planning method was provided only to 32% and 6% of post-abortion women, respectively before discharge from the clinic. Repeat induced abortions were found to be significantly more common (P<0.05) among women who did not receive any post-abortion contraceptive at the site of care (n=1627/1929) compared to those who left the abortion facility with family planning method (n=94/125). Low education, higher age, high parity and non-usage of contraceptives carry an increased risk of repeat induced abortions. Post-abortion family planning service delivery is limited in Georgia. Mandating provision of universal post-abortion contraception at the sites of care has a potential to reduce repeat induced abortions and should become a standard of practice for all clinics providing abortion services in Georgia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Decriminalization of abortion: a common purpose in Latin America].

PubMed

1993-12-01

In the conviction that abortion is a fundamental right of women and that its illegal practice constitutes a serious threat to life, several Latin American women's groups have united to work for decriminalization. The groups have been attempting to increase public awareness of the consequences of illegal abortion. Official silence on the topic appears to deny the existence of a problem. Proposals in the different Latin American countries are adapted to their political and legal circumstances. In Argentina, a campaign has been underway for nearly two years to collect signatures for a petition for a law concerning contraception and abortion. The National Network for Women's Health and other groups have held regional and national workshops on the issue. In Bolivia, radio and television programs have been broadcast in Spanish and indigenous languages on the right to choose, reproductive health, and sex education. Abortion was debated in Brazil during the process of constitutional reform, but it remains illegal. Illegal abortion continues to be a reality and women's groups are lobbying for decriminalization. Abortion is considered a crime in Colombia's penal code. Attempts to legalize abortion have been rejected by the legislature without debate. The practice of abortion under the circumstances has become a lucrative business whose lack of regulation has resulted in a growing number of maternal deaths. Attempts are underway in Costa Rica to legalize abortion in cases of rape or incest. Studies show that illegal abortion is the third most important cause of maternal death. A bill to legalize abortion is under study in Chile's Parliament but has not been approved. Abortion is illegal but common in Ecuador. Efforts are underway in Mexico and Nicaragua to encourage debate on abortion. Peru's Health Commission was recently prevented from classifying abortion for any reason other than grave congenital anomaly as homicide. Abortion has been legal in Puerto Rico since 1974, but amendments and laws to limit this right are under study. A bill to legalize abortion is under study in Venezuela and is being promoted by feminist groups.

Estimating the efficacy of medical abortion.

PubMed

Trussell, J; Ellertson, C

1999-09-01

Comparisons of the efficacy of different regimens of medical abortion are difficult because of the widely varying protocols (even for testing identical regimens), divergent definitions of success and failure, and lack of a standard method of analysis. In this article we review the current efficacy literature on medical abortion, highlighting some of the most important differences in the way that efficacy has been analyzed. We then propose a standard conceptual approach and the accompanying statistical methods for analyzing clinical trials of medical abortion and to explain how clinical investigators can implement this approach. Our review reveals that research on the efficacy of medical abortion has closely followed the conceptual model used for analysis of surgical abortion. The problem, however, is that, whereas surgical abortion is a discrete event occurring in the space of a few minutes or less, medical abortion is a process typically lasting from several days to several weeks. In this process, two events may occur that are not possible with surgical abortion. First, the woman can opt out of the process before a fair determination of efficacy can be made. Second, the process of medical abortion allows time for surgical interventions that may be convenient for the clinician but not strictly necessary from a medical perspective. Another difference from surgical abortions is that, for medical abortions, different medical abortion protocols specify different waiting periods, giving the drugs less time to work in some studies than in others before a determination of efficacy is made. We argue that, when analyzing efficacy of medical abortion, researchers should abandon their close reliance on the analogy to surgical abortion. In fact, medical abortion is more appropriately analyzed by life table procedures developed for the study of another fertility regulation technology; contraception. As with medical abortion, a woman initiating use of a contraceptive method can change her mind after some period of exposure and opt out. Also, as with medical abortion, a contraceptive can fail, usually with the risk of failure depending heavily on whether or not the woman follows the protocol for that method precisely. Finally, as with medical abortion, medical conditions may arise that necessitate discontinuing use of the contraceptive method. In both cases, these medical conditions are sometimes open to interpretation or subject to the skill, judgment, or experience of the clinician involved. The appropriate information to collect for a multiple decrement life table analysis of medical abortion includes data on compliance with the protocol, timing of the event of interest (abortion) when it is observable, and, because we argue that these should be regarded as events of interest, a typology of any surgical interventions that are conducted during the woman's participation in the study.

Abortion surveillance--United States, 2003.

PubMed

Strauss, Lilo T; Gamble, Sonya B; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed

2006-11-24

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2003. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49, and for 2003, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49. A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002. The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002. The abortion rate was 16 per 1,000 women aged 15-44 years for 2003, the same as for 2002. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998-2003. During 2001-2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged <25 years (51%). Of all abortions for which gestational age was reported, 61% were performed at < or =8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2002, steady increases have occurred in the percentage of abortions performed at < or =6 weeks' gestation, with a slight decline in 2003. A limited number of abortions were obtained at >15 weeks' gestation, including 4.2% at 16--20 weeks and 1.4% at > or =21 weeks. A total of 36 reporting areas submitted data documenting that they performed and enumerated medical (nonsurgical) procedures, making up 8.0% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. During 1990-1997, the number of legal induced abortions gradually declined. When the same 47 reporting areas are compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002 and again decreased in 2003. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002 and a further decrease in 2003. In 2001 and 2002, as in the previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.

Abortion surveillance--United States, 2004.

PubMed

Strauss, Lilo T; Gamble, Sonya B; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed

2007-11-23

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2004. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49; for 2003 and 2004, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49. A total of 839,226 legal induced abortions were reported to CDC for 2004 from 49 reporting areas, representing a 1.1% decline from the 848,163 legal induced abortions reported by 49 reporting areas for 2003. The abortion ratio, defined as the number of abortions per 1,000 live births, was 238 in 2004, a decrease from the 241 in 2003. The abortion rate was 16 per 1,000 women aged 15-44 years for 2004, the same since 2000. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998-2004. In 2003 (the most recent years for which data are available), 10 women died as a result of complications from known legal induced abortion. No death was associated with known illegal abortion. The highest percentages of reported abortions were for women who were known to be unmarried (80%), white (53%), and aged <25 years (50%). Of all abortions for which gestational age was reported, 61% were performed at < or =8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2004, steady increases have occurred in the percentage of abortions performed at < or =6 weeks' gestation, except for a slight decline in 2003. A limited number of abortions were obtained at >15 weeks' gestation, including 4.0% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.7% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. During 1990--1997, the number of legal induced abortions gradually declined. When the same 47 reporting areas are compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002 and again decreased in 2003 and 2004. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002 and a further decrease in both 2003 and 2004. In 2003, as in the previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.

Congenital middle ear abnormalities with absence of the oval window: diagnosis, surgery, and audiometric outcomes.

PubMed

Su, Yu; Yuan, Hu; Song, Yue-shuai; Shen, Wei-dong; Han, Wei-ju; Liu, Jun; Han, Dong-yi; Dai, Pu

2014-08-01

Congenital absence of the oval window (CAOW) is a rare condition in which the stapes footplate fails to develop, resulting in a significant conductive hearing loss in the affected ear. The purpose of this study was to describe the surgical management and outcomes of patients with CAOW undergoing the oval window drill-out (OWD) procedure. A retrospective chart review of patients with CAOW between 1996 and 2011 was performed. Clinical data of patients who underwent OWD were collected. Seventy-nine patients (103 ears) were confirmed using exploratory tympanotomy as having congenital stapes anomalies and CAOW without any anomalies of the tympanic membrane and external auditory canal. Demographic data, CT findings, operative findings, complications, and preoperative/postoperative audiometry data of patients who underwent OWD were collected. The preoperative and postoperative audiologic findings were analyzed in 42 patients (56 ears) with complete data. Hearing restoration surgery was aborted for various reasons in 14 cases. Six patients underwent revision operations for worsening hearing after their first surgery. The average preoperative 4 tone air conduction threshold was 67 dB; the average 6-month postoperative four tone air conduction threshold was 49 dB, and the average postoperative hearing gain was 18 dB. For the 56 ears, the average 4 tone air conduction threshold 6 months after surgery was significantly lower than the preoperative threshold. The oval window drill-out procedure is a viable operation for patients with congenital absence of the oval window, and it is important for surgeons to develop personalized treatment programs to improve patients' hearing with minimal complications.

Effectiveness of a behavior change communication intervention to improve knowledge and perceptions about abortion in Bihar and Jharkhand, India.

PubMed

Banerjee, Sushanta K; Andersen, Kathryn L; Warvadekar, Janardan; Pearson, Erin

2013-09-01

Although abortion became legal in India in 1971, many women are unaware of the law. Behavior change communication interventions may be an effective way to promote awareness of the law and change knowledge of and perceptions about abortion, particularly in settings in which abortion is stigmatized. To evaluate the effectiveness of a behavior change communication intervention to improve women's knowledge about India's abortion law and their perceptions about abortion, a quasi-experimental study was conducted in intervention and comparison districts in Bihar and Jharkhand. Household surveys were administered at baseline in 2008 and at follow-up in 2010 to independent, randomly selected cross-sectional samples of rural married women aged 15-49. Logistic regression difference-in-differences models were used to assess program effectiveness. Analysis demonstrated program effectiveness in improving awareness and perceptions about abortion. The changes in the odds of knowing that abortion is legal and where to obtain safe abortion services were larger between baseline and follow-up in the intervention districts than the changes in odds observed in the comparison districts (odds ratios, 16.1 and 1.9, respectively). Similarly, the increase in women's perception of greater social support for abortion within their families and the increase in perceived self-efficacy with respect to family planning and abortion between baseline and follow-up was greater in the intervention districts than in the comparison districts (coefficients, 0.17 and 0.18, respectively). Behavior change communication interventions can be effective in improving knowledge of and perceptions about abortion in settings in which lack of accurate knowledge hinders women's access to safe abortion services. Multiple approaches should be used when attempting to improve knowledge and perceptions about stigmatized health issues such as abortion.

Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003.

PubMed

Prada, Elena; Atuyambe, Lynn M; Blades, Nakeisha M; Bukenya, Justine N; Orach, Christopher Garimoi; Bankole, Akinrinola

2016-01-01

In Uganda, abortion is permitted only when the life of a woman is in danger. This restriction compels the perpetuation of the practice in secrecy and often under unsafe conditions. In 2003, 294,000 induced abortions were estimated to occur each year in Uganda. Since then, no other research on abortion incidence has been conducted in the country. Data from 418 health facilities were used to estimate the number and rate of induced abortion in 2013. An indirect estimation methodology was used to calculate the annual incidence of induced abortions ─ nationally and by major regions. The use of a comparable methodology in an earlier study permits assessment of trends between 2003 and 2013. In 2013, an estimated 128,682 women were treated for abortion complications and an estimated 314,304 induced abortions occurred, both slightly up from 110,000 and 294,000 in 2003, respectively. The national abortion rate was 39 abortions per 1,000 women aged 15-49, down from 51 in 2003. Regional variation in abortion rates is very large, from as high as an estimated 77 per 1,000 women 15-49 in Kampala region, to as low as 18 per 1,000 women in Western region. The overall pregnancy rate also declined from 326 to 288; however the proportion of pregnancies that were unintended increased slightly, from 49% to 52%. Unsafe abortion remains a major problem confronting Ugandan women. Although the overall pregnancy rate and the abortion rate declined in the past decade, the majority of pregnancies to Ugandan women are still unintended. These findings reflect the increase in the use of modern contraception but also suggest that a large proportion of women are still having difficulty practicing contraception effectively. Improved access to contraceptive services and abortion-related care are still needed.

Association between perceived social support and induced abortion: A study in maternal health centers in Lima, Peru

PubMed Central

Rodríguez-Medina, Angélica; Piscoya, Alejandro; Bernabe-Ortiz, Antonio

2018-01-01

Objectives This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. Methods/Principal findings A cross-sectional study enrolling women aged 18–25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%–49.3%), and 17.4% (95%CI: 13.1%– 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81–3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14–3.30) after controlling for confounders. Conclusions There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed. PMID:29649229

Attitudes toward Abortion among Providers of Reproductive Health Care.

PubMed

Dodge, Laura E; Haider, Sadia; Hacker, Michele R

2016-01-01

Access to abortion continues to decrease in the United States. The aim of this study was to explore attitudes toward abortion among clinicians who provide reproductive health care. Clinician members of several reproductive health professional organizations completed a self-administered survey that assessed their attitudes toward abortion. A total of 278 clinicians who provided clinical reproductive health services within the United States were included. Nearly all strongly agreed that abortion should be available in cases of rape (89.6%), incest (89.2%), life endangerment (93.2%), health endangerment (91.0%), and fetal anomaly (85.9%). Although most strongly disagreed that spousal notification (81.3%) and spousal consent (86.6%) should be required for married women, fewer strongly disagreed that parental notification (57.6%) and parental consent (66.9%) should be required for minors. Respondents were generally supportive of private insurance coverage (70.1% strongly agreed) and Medicaid coverage (65.0% strongly agreed) for abortion services. Support for legal abortion and public funding of abortion were significantly associated with being female (both p ≤ .03) and having no personal religious affiliation (both p ≤ .04). Younger respondents and men were more supportive of third-party involvement and mandatory counseling (all p ≤ .02). Abortion providers were significantly more supportive of abortion access (legality of abortion, public and private funding, no third-party involvement, and no mandated counseling) than nonproviders (all p < .001). Although reproductive health care providers were generally supportive of legal abortion and funding for abortion, lower support among younger respondents may indicate future difficulties in maintaining a clinical workforce that is willing to provide abortion care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review

PubMed Central

Park, Min Hae; Shakur, Haleema; Free, Caroline

2011-01-01

Abstract Objective To compare medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. Methods A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Popline were searched. Failure to abort completely, side-effects and acceptability were the main outcomes of interest. Odds ratios and their 95% confidence intervals (CIs) were calculated. Estimates were pooled using a random-effects model. Findings Nine studies met the inclusion criteria (n = 4522 participants). All were prospective cohort studies that used mifepristone and misoprostol to induce abortion. Complete abortion was achieved by 86–97% of the women who underwent home-based abortion (n = 3478) and by 80–99% of those who underwent clinic-based abortion (n = 1044). Pooled analyses from all studies revealed no difference in complete abortion rates between groups (odds ratio = 0.8; 95% CI: 0.5–1.5). Serious complications from abortion were rare. Pain and vomiting lasted 0.3 days longer among women who took misoprostol at home rather than in clinic. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic. Conclusion Home-based abortion is safe under the conditions in place in the included studies. Prospective cohort studies have shown no differences in effectiveness or acceptability between home-based and clinic-based medical abortion across countries. PMID:21556304

NSAIDs and spontaneous abortions – true effect or an indication bias?

PubMed Central

Daniel, Sharon; Koren, Gideon; Lunenfeld, Eitan; Levy, Amalia

2015-01-01

Aim The aim of the study was to characterize the extent of indication bias resulting from the excessive use of NSAIDs on the days preceding a spontaneous abortion to relieve pain. Methods We used data from a retrospective cohort study assessing the risk for spontaneous abortions following exposure to NSAIDs. Three definitions of exposure for cases of spontaneous abortions were compared, from the first day of pregnancy until the day of spontaneous abortion and until 3 and 2 days before a spontaneous abortion. Statistical analysis was performed using multivariate time programmed Cox regression. Results A sharp increase was observed in the dispensation of indomethacin, diclofenac and naproxen, and a milder increase was found in the use of ibuprofen during the week before a spontaneous abortion. Non- selective COX inhibitors in general and specifically diclofenac and indomethacin were found to be associated with spontaneous abortions when the exposure period was defined until the day of spontaneous abortion (hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04, 1.28; HR 1.31, 95% CI 1.08, 1.59 and HR 3.33, 95% CI 2.09, 5.29, respectively). The effect disappears by excluding exposures occurring on the day before the spontaneous abortion for non-selective COX inhibitors and on the last week before the spontaneous abortion for indomethacin. In general, decreasing HRs were found with the exclusion of exposures occurring on the days immediately before the spontaneous abortion. Conclusions The increased use of NSAIDs during the last few days that preceded a spontaneous abortion to relieve pain associated with the miscarriage could bias studies assessing the association between exposure to NSAIDs and spontaneous abortions. PMID:25858169

Delivering Medical Abortion at Scale: A Study of the Retail Market for Medical Abortion in Madhya Pradesh, India

PubMed Central

Powell-Jackson, Timothy; Acharya, Rajib; Filippi, Veronique; Ronsmans, Carine

2015-01-01

Background Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972. Methods We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion. Results Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor’s prescription – a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent. Conclusions The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women’s health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion. PMID:25822656

Attitude towards induced abortion in Bangladesh.

PubMed

Ahmad, R

1979-01-01

In practice the Bangladesh law, allowing abortion only to save the life of the mother, is essentially obsolete. The government has recognized the role of abortion in curing rapid population growth, and it is believed that the attitude towards abortion in Bangladesh is at least not unfavorable. The attempt was made to determine whether this belief is corroborated by the available facts. Data from the Bangladesh Fertility Survey provides a unique framework for discussion of current attitude towards and prevalence of abortion in Bangladesh. The Bangladesh Fertility Survey (BFS) was conducted on a nationally representative sample of 6513 ever-married women under age 50. An overwhelming majority of Bangladeshi women (over 88%) approved of abortion if the woman had conceived as a result of rape and premarital sex. Danger to mother's life (53% approving) was a more acceptable basis for abortion than danger of a malformed child (30%). Abortion on economic grounds was acceptable to only 17% of women. Urban women held more liberal views on abortion than rural residents. Educated couples were found to be more approving of abortion than the less educated. Women with parity 4 or more viewed abortion more favorably than those with lower parity. This was more pronounced among women under the age of 30. The most conservative approval of abortion was expressed by the older women who had a parity of less than 4. Women with the most liberal views on abortion were also contracepting and relying on efficient contraceptive methods. Wider support for abortion was expressed by currently married, fecund, nonpregnant women who were currently using contraception, and this support was more pronounced among women aged 30 and older.

Ugandan opinion-leaders' knowledge and perceptions of unsafe abortion.

PubMed

Moore, Ann M; Kibombo, Richard; Cats-Baril, Deva

2014-10-01

While laws in Uganda surrounding abortion remain contradictory, a frequent interpretation of the law is that abortion is only allowed to save the woman's life. Nevertheless abortion occurs frequently under unsafe conditions at a rate of 54 abortions per 1000 women of reproductive age annually, taking a large toll on women's health. There are an estimated 148,500 women in Uganda who experience abortion complications annually. Understanding opinion leaders' knowledge and perceptions about unsafe abortion is critical to identifying ways to address this public health issue. We conducted in-depth, semi-structured interviews with 41 policy-makers, cultural leaders, local politicians and leaders within the health care sector in 2009-10 at the national as well as district (Bushenyi, Kamuli and Lira) level to explore their knowledge and perceptions of unsafe abortion and the potential for policy to address this issue. Only half of the sample knew the current law regulating abortion in Uganda. Respondents understood that the result of the current abortion restrictions included long-term health complications, unwanted children and maternal death. Perceived consequences of increasing access to safe abortion included improved health as well as overuse of abortion, marital conflict and less reliance on preventive behaviour. Opinion leaders expressed the most support for legalization of abortion in cases of rape when the perpetrator was unknown. Understanding opinion leaders' perspectives on this politically sensitive topic provides insight into the policy context of abortion laws, drivers behind maintaining the status quo, and ways to improve provision under the law: increase education among providers and opinion leaders. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Selected legal developments in reproductive health in 1991.

PubMed

Boland, R

1992-01-01

Because of American preoccupation with abortion, worldwide reproductive health issues in 1991 received scant attention, despite many important changes. With the fall of Communism, Eastern European governments struggle in the legislatures and the courts to regulate abortion, particularly Poland, Czechoslovakia, Hungary, and the newly unified Federal Republic of Germany. Two international tribunals ruled narrowly on the restrictive Irish abortion law and international treaties ratified by Ireland protecting freedom of speech, leaving the Irish law intact. Spain's Supreme Court relaxed restrictions on abortion and for the 1st time allowed abortions for social reasons. Frances' highest administrative court ruled that the French government exceeded its authority in ordering the distribution of RU 497 (mifepristone), but ruled that French abortion law, allowing abortions in the 1st 10 weeks in "situations of distress," did not violate international treaties guaranteeing the "right to life." England approved use of RU 486 under English abortion law, with medical restrictions. The Canadian Supreme Court agreed to review a province's legislation that had the effect of limiting access to abortions via medical and hospital regulations. The Islamic, developing countries of Pakistan and the Sudan replaced colonial laws with more liberal abortion rules tailored to Islamic law. Pakistan decriminalized early abortions when given to provide (undefined) "necessary treatment" the Sudan allows abortions during the 1st 90 days. Peru reduced the penalties for some abortions. In Latin America, only Cuba allows abortions on request in early pregnancy. Iran, China, and the former USSR tightened and encouraged compliance with their family planning regulations. Fear of AIDS prompted several countries to tighten condom regulations. Artificial insemination, embryo research and surrogate motherhood also received attention.

[Induced abortion and medical science (Author's Transl)].

PubMed

Hall, F

1980-06-01

Although French law allows each member of a medical department to determine whether or not he will perform an abortion, abortion is not an operation which saves life, but destroys it. Abortion does not revive a pathological problem, but social or personal distress, and the justification for abortion comes from outside the medical sphere. The body is becoming merely an agent of pleasure, and religious, ideological, philosophical, and moral principles are ignored. Abortion is a "blind spot" in medical science.

Association between induced abortion history and later in vitro fertilization outcomes.

PubMed

Wang, Yao; Sun, Yun; Di, Wen; Kuang, Yan-Ping; Xu, Bing

2018-06-01

To establish an effective and safe clinical fertility strategy by investigating the relationship between abortion history and pregnancy outcomes of in vitro fertilization (IVF) treatment. In the present retrospective cohort study, data from IVF treatment cycles performed at a reproductive center in China between October 1, 2014, and October 31, 2015, were assessed. Outcomes were compared between women with a history of induced abortion and those without. There were 1532 IVF treatment cycles included; 454 patients had a history of induced abortion and 1078 did not. The spontaneous abortion rate was significantly higher (30/170 [17.6%] vs 41/420 [9.8%]; P=0.002) and the endometrium was significantly thinner (8.8 ± 1.8 vs 9.7 ± 1.8 cm; P=0.001) among patients with a history of induced abortion compared with those without. In a subgroup analysis of patients with a history of induced abortion, women who had undergone surgical abortions had a lower live delivery rate compared with medical abortions (29/76 [38%] vs 101/378 [27%]; P=0.039). Further, women who had a history of more than two surgical abortions had lower live delivery and clinical pregnancy rates (both P<0.05). A history of induced abortion was associated with worse IVF outcomes, especially a history of more than two surgical abortions. © 2018 International Federation of Gynecology and Obstetrics.

Second trimester abortion laws globally: actuality, trends and recommendations.

PubMed

Boland, Reed

2010-11-01

There are important and compelling reasons why women have second trimester abortions, which constitute a significant percentage of all abortions performed. Laws vary widely around the world on the legality of these abortions. In many cases, they are quite restrictive. Indeed, the later in pregnancy an abortion is sought, the more restrictive the law tends to be. However, many laws say little about second trimester or later abortions. This article reviews the laws of the 191 countries around the world for which information is available and categorizes them by legal indications, which include preservation of the woman's life, health reasons, pregnancy due to sex offences, fetal impairment, socio-economic reasons and on request. Given that there are serious reasons why women have second trimester abortions, and that the laws in many countries do not make these abortions legally available, this paper makes recommendations on how laws and regulations can be changed in order better to respond to women's needs. While most countries may not decriminalise all abortions in the near future, especially second trimester abortions, less comprehensive legislative and regulatory reforms are possible. These include recommendations aimed at ensuring that abortions are carried out safely and as early as possible in pregnancy, and improving access to safe abortions by removing unnecessary legal and regulatory restrictions. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Prevalence of Abortion and Contraceptive Practice among Women Seeking Repeat Induced Abortion in Western Nigeria

PubMed Central

Lamina, Mustafa Adelaja

2015-01-01

Background. Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. Method. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. Results. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. Conclusion. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high. PMID:26078881

Abortion.

PubMed

1993-05-01

The Alan Guttmacher Institute's State Reproductive Health Monitor "Legislative Proposals and Actions" provides US legislative information on abortion. The listing contains information on pending bills: the state, the identifying legislative number, the sponsor, the committee, the date the bill was introduced, a description of the bill, and when available the bill's status. The bills cover: 1) clinic licensing, e.g., requiring outpatient health care facilities in which abortions are performed, to have malpractice liability insurance; 2) comprehensive statues, which require parental notification before minor may obtain abortions, mandate abortion counseling to all women 24 hours before the abortion can be performed and prohibit disciplining or discharging a state employee for refusing to provide abortion counseling; 3) fetal personhood and rights, e.g. providing that life is vested in each person at fertilization; 4) fetal research and remains; 5) gender of fetus, which regulate abortions relative to sex selection in pregnancies; 6) harassment regulation; 7) informed consent and waiting periods detailing the risks and alternatives to abortion, and the 24-hour waiting period; 8) insurance coverage, e.g., eliminating language banning the coverage of abortions for state workers, and prohibiting disclosure by a health insurance carrier to the employer of a claimant that the claimant had a surgical abortion; 9) legality of abortion, urging Congress to reject he Freedom of Choice Act; 10) parental consent and notification; 11) postviability requirements; 12) public funding; 13) reporting requirements; 14) reproductive rights, and 15) spousal and paternal consent and notification.

"Choosing Life": Birth Mothers on Abortion and Reproductive Choice.

PubMed

Sisson, Gretchen

2015-01-01

As the least-chosen option when faced with an unplanned pregnancy, adoption remains largely unexamined as a reproductive choice. Although the anti-abortion movement promotes adoption as its preferred alternative to abortion, little is known of birth mothers' pregnancy decision making and whether adoption was chosen in lieu of abortion. I conducted in-depth interviews with 40 women who had placed infants for adoption from 1962 to 2009. Participants were asked about all aspects of their adoption experiences, including their pregnancy decision making and thoughts on abortion. Interview transcripts were analyzed using grounded theory to find unifying themes speaking to reproductive choice. Participants' stories revealed widely varying ideas about abortion. Many were opposed to abortion, but a greater number supported abortion as a reproductive choice, although one they did not choose for themselves. Birth mothers were most often choosing between adoption and parenting, not adoption and abortion. Most participants would have preferred to parent, but did not because of external variables. Mixed experiences with adoption also influenced participants' long-term ideas about reproductive choice. Findings suggest that the anti-abortion framing of adoption as a preferable alternative to abortion is inconsistent with birth mothers' pregnancy decision-making experiences and their feelings about adoption. Reducing social barriers to both abortion and parenting will ensure that adoption is situated as a true reproductive choice. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Feelings of Well-Being Before and After an Abortion.

ERIC Educational Resources Information Center

Hittner, Amy

1987-01-01

Examined feelings of well-being in 217 women who had abortions. Results suggest that, compared to women who have not had abortions, those who choose abortion feel more negatively. Of women choosing abortion, those who are already mothers are most likely to be depressed and lonely, followed by those from lower educational and socioeconomic…

The Impact of State Abortion Policies on Teen Pregnancy Rates

ERIC Educational Resources Information Center

Medoff, Marshall

2010-01-01

The availability of abortion provides insurance against unwanted pregnancies since abortion is the only birth control method which allows women to avoid an unwanted birth once they are pregnant. Restrictive state abortion policies, which increase the cost of obtaining an abortion, may increase women's incentive to alter their pregnancy avoidance…

45 CFR 156.280 - Segregation of funds for abortion services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Segregation of funds for abortion services. 156... for abortion services. (a) State opt-out of abortion coverage. A QHP issuer must comply with a State law that prohibits abortion coverage in QHPs. (b) Termination of opt out. A QHP issuer may provide...

Nursing and Hospital Abortions in the United States, 1967-1973.

PubMed

Haugeberg, Karissa

2018-03-21

Before elective abortion was legalized nationally in 1973 with the U.S. Supreme Court decision Roe v. Wade, seventeen states and the District of Columbia liberalized their abortion statutes. While scholars have examined the history of physicians who had performed abortions before and after it was legal and of feminists' work to expand the range of healthcare choices available to women, we know relatively little about nurses' work with abortion. By focusing on the history of nursing in those states that liberalized their abortion laws before Roe, this article reveals how women who sought greater control over their lives by choosing abortion encountered medical professionals who were only just beginning to question the gendered conventions that framed labor roles in American hospitals. Nurses, whose workloads increased exponentially when abortion laws were liberalized, were rarely given sufficient training to care for abortion patients. Many nurses directed their frustrations to the women patients who sought the procedure. This essay considers how the expansion of women's right to abortion prompted nurses to question the gendered conventions that had shaped their work experiences.

Medical abortion in Australia: a short history.

PubMed

Baird, Barbara

2015-11-01

Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015. Copyright © 2015 Elsevier Inc. All rights reserved.

Trump's Abortion-Promoting Aid Policy.

PubMed

Latham, Stephen R

2017-07-01

On the fourth day of his presidency, Donald Trump reinstated and greatly expanded the "Mexico City policy," which imposes antiabortion restrictions on U.S. foreign health aid. In general, the policy has prohibited U.S. funding of any family-planning groups that use even non-U.S. funds to perform abortions; prohibited aid recipients from lobbying (again, even with non-U.S. money) for liberalization of abortion laws; prohibited nongovernment organizations from creating educational materials on abortion as a family-planning method; and prohibited health workers from referring patients for legal abortions in any cases other than rape, incest, or to save the life of the mother. The policy's prohibition on giving aid to any organization that performs abortions is aimed at limiting alleged indirect funding of abortions. The argument is that if U.S. money is used to fund nonabortion programs of an abortion-providing NGO, then the NGO can simply shift the money thus saved into its abortion budget. Outside the context of abortion, we do not reason this way. And the policy's remaining three prohibitions are deeply troubling. © 2017 The Hastings Center.

Therapeutic abortion follow-up study.

PubMed

Margolis, A J; Davison, L A; Hanson, K H; Loos, S A; Mikkelsen, C M

1971-05-15

To determine the long-range psychological effects of therapeutic abortion, 50 women (aged from 13-44 years), who were granted abortions between 1967 and 1968 Because of possible impairment of mental and/or physical health, were analyzed by use of demographic questionnaires, psychological tests, and interviews. Testing revealed that 44 women had psychiatric problems at time of abortion. 43 patients were followed for 3-6 months. The follow-up interviews revealed that 29 patients reacted positively after abortion, 10 reported no significant change and 4 reacted negatively. 37 would definitely repeat the abortion. Women under 21 years of age felt substantially more ambivalent and guilty than older patients. A study of 36 paired pre- and post-abortion profiles showed that 15 initially abnormal tests had become normal. There was a significant increase in contraceptive use among the patients after the abortion, but 4 again became pregnant and 8 were apparently without consistent contraception. It is concluded that the abortions were therapeutic, but physicians are encouraged to be aware of psychological problems in abortion cases. Strong psychological and contraceptive counselling should be exercised.

Social Determinants and Access to Induced Abortion in Burkina Faso: From Two Case Studies

PubMed Central

Ouédraogo, Ramatou

2014-01-01

Unsafe abortion constitutes a major public health problem in Burkina Faso and concerns mainly young women. The legal restriction and social stigma make abortions most often clandestine and risky for women who decide to terminate a pregnancy. However, the exposure to the risk of unsafe induced abortion is not the same for all the women who faced unwanted pregnancy and decide to have an abortion. Drawn from a qualitative study on the issue of abortion in Ouagadougou, Burkina Faso's capital, the contrasting cases of two young women who had abortion allow us to show how the women's personal resources (such as the school level, financial resources, the compliance to social norms, the social network, etc.) may determine the degree of vulnerability of women, the delay to have an abortion, the type of care they are likely to benefit from, and the cost they have to face. This study concludes that the poorest always pay more (cost and consequences), take longer to have an abortion, and have more exposure to the risk of unsafe abortion. PMID:24790605

Misinformation on abortion.

PubMed

Rowlands, Sam

2011-08-01

To find the latest and most accurate information on aspects of induced abortion. A literature survey was carried out in which five aspects of abortion were scrutinised: risk to life, risk of breast cancer, risk to mental health, risk to future fertility, and fetal pain. Abortion is clearly safer than childbirth. There is no evidence of an association between abortion and breast cancer. Women who have abortions are not at increased risk of mental health problems over and above women who deliver an unwanted pregnancy. There is no negative effect of abortion on a woman's subsequent fertility. It is not possible for a fetus to perceive pain before 24 weeks' gestation. Misinformation on abortion is widespread. Literature and websites are cited to demonstrate how data have been manipulated and misquoted or just ignored. Citation of non-peer reviewed articles is also common. Mandates insisting on provision of inaccurate information in some US State laws are presented. Attention is drawn to how women can be misled by Crisis Pregnancy Centres. There is extensive promulgation of misinformation on abortion by those who oppose abortion. Much of this misinformation is based on distorted interpretation of the scientific literature.

Early abortion services in the United States: a provider survey.

PubMed

Benson, Janie; Clark, Kathryn Andersen; Gerhardt, Ann; Randall, Lynne; Dudley, Susan

2003-04-01

The objective of this study was to describe the availability of early surgical and medical abortion among members of the National Abortion Federation (NAF) and to identify factors affecting the integration of early abortion services into current services. Telephone interviews were conducted with staff at 113 Planned Parenthood affiliates and independent abortion providers between February and April 2000, prior to FDA approval of mifepristone. Early abortion services were available at 59% of sites, and establishing services was less difficult than or about what was anticipated. Sites generally found it easier to begin offering early surgical abortion than early medical abortion. Physician participation was found to be critical to implementing early services. At sites where some but not all providers offered early abortion, variations in service availability resulted. Given the option of reconsidering early services, virtually all sites would make the same decision again. These data suggest that developing mentoring relationships between experienced early abortion providers/sites and those not offering early services, and training physicians and other staff, are likely to be effective approaches to expanding service availability.

Velocity Requirements for Abort From the Boost Trajectory of a Manned Lunar Mission

NASA Technical Reports Server (NTRS)

Slye, Robert E.

1961-01-01

An investigation is made of the abort velocity requirements associated with failure of a propulsion system for a manned lunar mission. Two cases are considered: abort at less than satellite speed, which results in maximum decelerations in the following entry, and abort at greater than satellite speed with immediate return to earth. The velocity requirements associated with the latter problem are found to be substantial (several thousand feet per second) and are found to be even more severe if boost trajectories which lead to burnout at high altitudes or large flight-path angles are used. The velocity requirements associated with abort at less than satellite speed are found to be less severe than those for abort at greater than satellite speed except for nonlifting vehicles. It is found that abort rockets sufficient for abort at greater than satellite speed can be used to reduce maximum decelerations in entries following an abort at lower speeds. This reduction is accomplished by use of the abort rockets to decrease entry angle immediately prior to entry into the atmosphere.

Macro- and Micro-Political Vernaculizations of Rights: Human Rights and Abortion Discourses in Northern Ireland.

PubMed

Pierson, Claire; Bloomer, Fiona

2017-06-01

How abortion is dealt with in law and policy is shaped through the multiple political and societal discourses on the issue within a particular society. Debate on abortion is constantly in flux, with progressive and regressive movements witnessed globally. This paper examines the translation of human rights norms into discourses on abortion in Northern Ireland, a region where abortion is highly restricted, with extensive contemporary public debate into potential liberalization of abortion law. This paper emanates from research examining political debates on abortion in Northern Ireland and contrasts findings with recent civil society developments, identifying competing narratives of human rights with regard to abortion at the macro- and micro-political level. The paper identifies the complexities of using human rights as a lobbying tool, and questions the utility of rights-based arguments in furthering abortion law reform. The paper concludes that a legalistic rights-based approach may have limited efficacy in creating a more nuanced debate and perspective on abortion in Northern Ireland but that it has particular resonance in arguing for limited reform in extreme cases.

Ensuring Access to Safe, Legal Abortion in an Increasingly Complex Regulatory Environment.

PubMed

Paul, Maureen; Norton, Mary E

2016-07-01

Restrictions on access to abortion in the United States have reached proportions unprecedented since the nationwide legalization of abortion in 1973. Although some restrictions aim to discourage women from having abortions, many others impede access by affecting the timeliness, affordability, or availability of services. Evidence indicates that these restrictions do not increase abortion safety; rather, they create logistic barriers for women seeking abortion, and they have the greatest effect on women with the fewest resources. In this commentary, we recall the important role that obstetrician-gynecologists (ob-gyns) have played, both before and after Roe v. Wade, in facilitating access to safe abortion care. Using the literature on abortion safety and access as a foundation, we propose several practical ideas about what we as ob-gyns can do to address the current threat to abortion access, whether or not we provide abortion services in practice. We hope that this commentary will encourage discourse within our profession and prompt other suggestions. As ob-gyns who are dedicated to addressing health disparities and promoting the health and well-being of our patients, we can make a difference.

Women's existential experiences within Swedish abortion care.

PubMed

Stålhandske, Maria L; Ekstrand, Maria; Tydén, Tanja

2011-03-01

To explore Swedish women's experiences of clinical abortion care in relation to their need for existential support. Individual in-depth interviews with 24 women with previous experience of unwanted pregnancy and abortion. Participants were recruited between 2006 and 2009. Interviews were analysed by latent content analysis. Although the women had similar experiences of the abortion care offered, the needs they expressed differed. Swedish abortion care was described as rational and neutral, with physical issues dominating over existential ones. For some women, the medical procedures triggered existential experiences of life, meaning, and morality. While some women abstained from any form of existential support, others expressed a need to reflect upon the existential aspects and/or to reconcile their decision emotionally. As women's needs for existential support in relation to abortion vary, women can be disappointed with the personnel's ability to respond to their thoughts and feelings related to the abortion. To ensure abortion care personnel meet the physical, psychological and existential needs of each patient, better resources and new lines of education are needed to ensure abortion personnel are equipped to deal with the existential aspects of abortion care.

[Abortion and rights. Legal thinking about abortion].

PubMed

Perez Duarte, A E

1991-01-01

Analysis of abortion in Mexico from a juridical perspective requires recognition that Mexico as a national community participates in a double system of values. Politically it is defined as a liberal, democratic, and secular state, but culturally the Judeo-Christian ideology is dominant in all social strata. This duality complicates all juridical-penal decisions regarding abortion. Public opinion on abortion is influenced on the 1 hand by extremely conservative groups who condemn abortion as homicide, and on the other hand by groups who demand legislative reform in congruence with characteristics that define the state: an attitude of tolerance toward the different ideological-moral positions that coexist in the country. The discussion concerns the rights of women to voluntary maternity, protection of health, and to making their own decisions regarding their bodies vs. the rights of the fetus to life. The type of analysis is not objective, and conclusions depend on the ideology of the analyst. Other elements must be examined for an objective consideration of the social problem of abortion. For example, aspects related to maternal morbidity and mortality and the demographic, economic, and physical and mental health of the population would all seem to support the democratic juridical doctrine that sees the clandestine nature of abortion as the principal problem. It is also observed that the illegality of abortion does not guarantee its elimination. Desperate women will seek abortion under any circumstances. The illegality of abortion also impedes health and educational policies that would lower abortion mortality. There are various problems from a strictly juridical perspective. A correct definition of the term abortion is needed that would coincide with the medical definition. The discussion must be clearly centered on the protected juridical right and the definition of reproductive and health rights and rights to their own bodies of women. The experiences of other countries with decriminalization of abortion should also be assessed. Factors considered should include the true impunity of abortion, public health problems and socioeconomic problems generated by the state through criminalization of abortion, and the psychological and economic implications for women of the criminal status of abortion. Systems of decriminalization should be examined to decide which would be appropriate for Mexico. These systems include authorizing complete freedom of choice for the 1st trimester and permitting abortion only for specific indications. All penal codes in Mexico now use the system of abortion for specific indications. Few cases are accepted for legal pregnancy termination.

Unintended Pregnancy, Induced Abortion, and Mental Health.

PubMed

Horvath, Sarah; Schreiber, Courtney A

2017-09-14

The early medical literature on mental health outcomes following abortion is fraught with methodological flaws that can improperly influence clinical practice. Our goal is to review the current medical literature on depression and other mental health outcomes for women obtaining abortions. The Turnaway Study prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic. Rates of depression are not significantly different between women obtaining abortion and those denied abortion. Rates of anxiety are initially higher in women denied abortion care. Counseling on decision-making for women with unintended pregnancies should reflect these findings.

'High profile health facilities can add to your trouble': Women, stigma and un/safe abortion in Kenya.

PubMed

Izugbara, Chimaraoke O; Egesa, Carolyne; Okelo, Rispah

2015-09-01

Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal.

PubMed

Suh, Siri

2014-05-01

Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications. Copyright © 2014 Elsevier Ltd. All rights reserved.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam.

PubMed

Nguyen, Phuong Hong; Nguyen, Son Van; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Mai, Lan Tran; Luong, Loan Thi Thu; Pham, Hoa Quynh

2012-11-29

Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Data were drawn from a cross-sectional survey of 1,281 women aged 18-49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20-2.16) and repeat abortion (OR=2.22, 95% CI: 1.48-3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam

PubMed Central

Nguyen, Phuong Hong; Van Nguyen, Son; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Tran Mai, Lan; Thi Thu Luong, Loan; Pham, Hoa Quynh

2012-01-01

Background Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. Objective This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Design and methods Data were drawn from a cross-sectional survey of 1,281 women aged 18–49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. Results One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20–2.16) and repeat abortion (OR=2.22, 95% CI: 1.48–3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. Conclusions GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs. PMID:23195517

Post-abortion and induced abortion services in two public hospitals in Colombia.

PubMed

Darney, Blair G; Simancas-Mendoza, Willis; Edelman, Alison B; Guerra-Palacio, Camilo; Tolosa, Jorge E; Rodriguez, Maria I

2014-07-01

Until 2006, legal induced abortion was completely banned in Colombia. Few facilities are equipped or willing to offer abortion services; often adolescents experience even greater barriers of access in this context. We examined post abortion care (PAC) and legal induced abortion in two large public hospitals. We tested the association of hospital site, procedure type (manual vacuum aspiration vs. sharp curettage), and age (adolescents vs. women 20 years and over) with service type (PAC or legal induced abortion). Retrospective cohort study using 2010 billing data routinely collected for reimbursement (N=1353 procedures). We utilized descriptive statistics, multivariable logistic regression and predicted probabilities. Adolescents made up 22% of the overall sample (300/1353). Manual vacuum aspiration was used in one-third of cases (vs. sharp curettage). Adolescents had lower odds of documented PAC (vs. induced abortion) compared with women over age 20 (OR=0.42; 95% CI=0.21-0.86). The absolute difference of service type by age, however, is very small, controlling for hospital site and procedure type (.97 probability of PAC for adolescents compared with .99 for women 20 and over). Regardless of age, PAC via sharp curettage is the current standard in these two public hospitals. Both adolescents and women over 20 are in need of access to legal abortion services utilizing modern technologies in the public sector in Colombia. Documentation of abortion care is an essential first step to determining barriers to access and opportunities for quality improvement and better health outcomes for women. Following partial decriminalization of abortion in Colombia, in public hospitals nearly all abortion services are post-abortion care, not induced abortion. Sharp curettage is the dominant treatment for both adolescents and women over 20. Women seek care in the public sector for abortion, and must have access to safe, quality services. Copyright © 2014. Published by Elsevier Inc.

Abortion law in Muslim-majority countries: an overview of the Islamic discourse with policy implications.

PubMed

Shapiro, Gilla K

2014-07-01

Religion plays a significant role in a patient’s bioethical decision to have an abortion as well as in a country’s abortion policy. Nevertheless, a holistic understanding of the Islamic position remains under-researched. This study first conducted a detailed and systematic analysis of Islam’s position towards abortion through examining the most authoritative biblical texts (i.e. the Quran and Sunnah) as well as other informative factors (i.e. contemporary fatwas, Islamic mysticism and broader Islamic principles, interest groups, and transnational Islamic organizations). Although Islamic jurisprudence does not encourage abortion, there is no direct biblical prohibition. Positions on abortion are notably variable, and many religious scholars permit abortion in particular circumstances during specific stages of gestational development. It is generally agreed that the least blameworthy abortion is when the life of the pregnant woman is threatened and when 120 days have not lapsed; however, there is remarkable heterogeneity in regards to other circumstances (e.g. preserving physical or mental health, foetal impairment, rape, or social or economic reasons), and later gestational development of the foetus. This study secondly conducted a cross-country examination of abortion rights in Muslim-majority countries. A predominantly conservative approach was found whereby 18 of 47 countries do not allow abortion under any circumstances besides saving the life of the pregnant woman. Nevertheless, there was substantial diversity between countries, and 10 countries allowed abortion ‘on request’. Discursive elements that may enable policy development in Muslim-majority countries as well as future research that may enhance the study of abortion rights are discussed. Particularly, more lenient abortion laws may be achieved through disabusing individuals that the most authoritative texts unambiguously oppose abortion, highlighting more lenient interpretations that exist in certain Islamic legal schools, emphasizing significant actors that support abortion, and being mindful of policy frames that will not be well-received in Muslim-majority countries.

Complications of unsafe abortion in sub-Saharan Africa: a review.

PubMed

Benson, J; Nicholson, L A; Gaffikin, L; Kinoti, S N

1996-06-01

The Commonwealth Regional Health Community Secretariat undertook a study in 1994 to document the magnitude of abortion complications in Commonwealth member countries. The results of the literature review component of that study, and research gaps identified as a result of the review, are presented in this article. The literature review findings indicate a significant public health problem in the region, as measured by a high proportion of incomplete abortion patients among all hospital gynaecology admissions. The most common complications of unsafe abortion seen at health facilities were haemorrhage and sepsis. Studies on the use of manual vacuum aspiration for treating abortion complications found shorter lengths of hospital stay (and thus, lower resource costs) and a reduced need for a repeat evacuation. Very few articles focused exclusively on the cost of treating abortion complications, but authors agreed that it consumes a disproportionate amount of hospital resources. Studies on the role of men in supporting a woman's decision to abort or use contraception were similarly lacking. Articles on contraceptive behaviour and abortion reported that almost all patients suffering from abortion complications had not used an effective, or any, method of contraception prior to becoming pregnant, especially among the adolescent population; studies on post-abortion contraception are virtually nonexistent. Almost all articles on the legal aspect of abortion recommended law reform to reflect a public health, rather than a criminal, orientation. Research needs that were identified include: community-based epidemiological studies; operations research on decentralization of post-abortion care and integration of treatment with post-abortion family planning services; studies on system-wide resource use for treatment of incomplete abortion; qualitative research on the role of males in the decision to terminate pregnancy and use contraception; clinical studies on pain control medications and procedures; and case studies on the provision of safe abortion services where legally allowed.

Attitudes and preferences toward the provision of medication abortion in an urban academic internal medicine practice.

PubMed

Page, Cameron; Stumbar, Sarah; Gold, Marji

2012-06-01

Mifepristone offers internal medicine doctors the opportunity to greatly expand access to abortion for their patients. Almost 70% of pregnancy terminations, however, still occur in specialized clinics. No studies have examined the preferences of Internal Medicine patients specifically. Determine whether patient preference is a reason for the limited uptake of medication abortion among internal medicine physicians. Women aged 18-45 recruited from the waiting room in an urban academic internal medicine clinic. A semi-structured questionnaire was used to determine risk of unintended pregnancy and attitudes toward abortion. Support for provision of medication abortion in the internal medicine clinic was assessed with a yes/no question, followed by the open-ended question, "Why do you think this clinic should or should not offer medication abortion?" Subjects were asked whether it was very important, somewhat important, or not important for the internal medicine clinic to provide medication abortion. Of 102 women who met inclusion criteria, 90 completed the survey, yielding a response rate of 88%. Twenty-two percent were at risk of unintended pregnancy. 46.7% had had at least one lifetime abortion. Among those who would consider having an abortion, 67.7% responded yes to the question, "Do you think this clinic should offer medication abortions?" and 83.9% stated that it was "very important" or "somewhat important" to offer this service. Of women open to having an abortion, 87.1% stated that they would be interested in receiving a medication abortion from their primary care doctor. A clinically significant proportion of women in this urban internal medicine clinic were at risk of unintended pregnancy. Among those open to having an abortion, a wide majority would consider receiving it from their internal medicine doctor. The provision of medication abortion by internal medicine physicians has the potential to greatly expand abortion access for women.

Complicated unsafe abortion in a Nigerian teaching hospital: pattern of morbidity and mortality.

PubMed

Akinlusi, Fatimat Motunrayo; Rabiu, Kabiru Afolarin; Adewunmi, Adeniyi Abiodun; Imosemi, Oreose Donald; Ottun, Tawaqualit Abimbola; Badmus, Saidah Adetokunbo

2018-03-25

Addressing unsafe abortion in developing countries may propel a rapid decline in overall maternal death. A retrospective review of patients with complicated unsafe abortion was conducted in a Nigerian Tertiary Hospital. In order to provide evidence that may inform policy changes, we describe patients' clinical profiles, abortion providers, and morbidity and mortality patterns. Of 3122 gynaecological admissions, 231 (7.4%) had unsafe abortion-related complications. The majority (53.2%) of admissions were between 16 and 25 years. Single women constituted 51% while 57% were nulliparous. Common presentations were abdominal pain (62%), fever (54%) and vaginal bleeding (53%). The most frequent complications were anaemia (55%) and retained products of conception (47%). Doctors reportedly performed 42% of abortions. There were 392 maternal mortalities; 39 (9.9%) from unsafe abortions and sepsis was responsible in 31 (80%) patients. Abortion remains a major public health issue. Youths are mostly involved. Doctors were reportedly the highest abortion providers. Mortality is high, occurring mostly from sepsis. Impact Statement What is already known on this subject? Doctors are reported as being involved in a high proportion of unsafe abortions in low and middle income countries where abortion remains a significant contributor to maternal mortality and morbidity. What the results of this study add? Our study agrees with existing literature that doctors reportedly performed most of the unsafe abortions. It also found that doctors were reported as abortion providers in the majority (35.9%) of those unsafe abortions that ended in mortality. What the implications are of these findings for clinical practice and/or further research? There is a need to conduct studies that will verify the status of abortion providers rather than rely on clients' report; and also inspect facilities to confirm adherence to minimum medical standards. Such research findings will be needed prior to local and possibly national healthcare interventions and policy changes.

Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina.

PubMed

Zurbriggen, Ruth; Keefe-Oates, Brianna; Gerdts, Caitlin

2018-02-01

Legal restrictions on abortion access impact the safety and timing of abortion. Women affected by these laws face barriers to safe care that often result in abortion being delayed. Second-trimester abortion affects vulnerable groups of women disproportionately and is often more difficult to access. In Argentina, where abortion is legally restricted except in cases of rape or threat to the health of the woman, the Socorristas en Red, a feminist network, offers a model of accompaniment wherein they provide information and support to women seeking second-trimester abortions. This qualitative analysis aimed to understand Socorristas' experiences supporting women who have second-trimester medication abortion outside the formal health care system. We conducted 2 focus groups with 16 Socorristas in total to understand experiences accompanying women having second-trimester medication abortion who were at 14-24 weeks' gestational age. We performed a thematic analysis of the data and present key themes in this article. The Socorristas strived to ensure that women had the power of choice in every step of their abortion. These cases required more attention and logistical, legal and medical risks than first-trimester care. The Socorristas learned how to help women manage the possibility of these risks and were comfortable providing this support. They understood their work as activism through which they aim to destigmatize abortion and advocate against patriarchal systems denying the right to abortion. Socorrista groups have shown that they can provide supportive, women-centered accompaniment during second-trimester medication abortions outside the formal health care system in a setting where abortion access is legally restricted. Second-trimester self-use of medication abortion outside of the formal health system supported by feminist activist groups could provide an alternative model for second-trimester care worldwide. More research is needed to document the safety and effectiveness of this accompaniment service-provision model. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

PubMed Central

Suh, Siri

2014-01-01

Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications. PMID:24608117

Access to Contraceptives in Countries With Restrictive Abortion Laws: The Case of Brazil.

PubMed

Borges, Ana Luiza Vilela; Tsui, Amy Ong; Fujimori, Elizabeth; Hoga, Luiza Akiko Komura

2016-01-01

We aimed to determine whether current contraceptive use is affected by a history of abortion for women from a country with abortion-restricted laws. This is an analysis of 2006 Brazil Demographic and Health Survey. Nonpregnant women whose first pregnancy occurred in the previous 5 years were selected for this study (n = 2,181). We used propensity score matching to compare current contraceptive use among women with induced or spontaneous abortion and women with no abortion. We found differences in the use, but women with a history of abortion did not report more effective contraceptive than women with no abortion, as we expected.

[Induced abortion: a vulnerable public health problem].

PubMed

Requena, M

1991-03-01

Induced abortion is an urgent public health problem that can be controlled if it is approached in its true complexity and with a social and humanist perspective. Induced abortion has been discussed in Chile since the last century, but not always openly. Abortion is not just an individual and collective medical problem, it is also an ethical, religious, legal, demographic, political, and psychological problem. Above all it is a problem of human rights. In the past 60 years, more than 50 countries representing 76% of the world population have liberalized their abortion legislation. Around 980 million women have some degrees of access of legal abortion. The magnitude of illegal abortion is difficult to determine because of the desire of women to hide their experiences. Estimates of the incidence of abortion in Chile made some 25 years ago are no longer valid because of the numerous social changes in the intervening years. The number of abortions in Chile in 1987 was estimated using an indirect residual method at 195,441, of which 90%, or 175,897, were induced. By this estimate, 38.8% of pregnancies in Chile end in abortion. Data on hospitalizations for complications of induced abortion show an increase from 13.9/1000 fertile aged women in 1940 to 29.1 in 1965. By 1987, with increased contraceptive usage, the rate declined to 10.5 abortions per 1000 fertile aged women. The cost of hospitalization for abortion complications in 1987, despite the decline, was still estimated at US $4.3 million, a large sum in an era of declining health resources. The problem of induced abortion can be analyzed by placing it in the context of elements affecting the desire to control fertility. 4 complexes of variables are involved: those affecting the supply of contraceptive, the demand for contraceptives, the various costs of fertility control measure, and alternatives to fertility control for satisfying various needs. The analysis is further complicated when efforts are made to understand the dynamics of the process. Awareness of fertility control is a social process that matures slowly. Contraception and abortion have different significance for fertility control, with contraception preventing pregnancy and abortion is a sense curing it. Chile has progressed far in its fertility control awareness. 2/3 of sexually active women use some form of contraception. At the same time, induced abortion is also used. It is estimated that 58% of abortions occur after a contraceptive failure. It appears that recourse to abortion would be minimized if strategies centered on supply of contraceptives were complemented by stronger efforts to develop awareness of fertility control. Delivery of contraceptives should be accompanied by complete information on their effective use. Efforts should be targeted especially at groups at high risk abortion, including adolescents and women hospitalized for complications.

[Comparison between lymphocytic infiltration in early spontaneous abortions and in elective abortions with signs of disruption at the chorio-decidual interface].

PubMed

Caliendo, L

2007-12-01

The aim of the study was to compare lymphocytic infiltrations in early spontaneous abortions with those with signs of disruption at the chorio-decidual interface in elective abortions. Determinations were performed on preparations received at the Anatomy-Pathology Services of Ospedale San Paolo, Savona (Italy) in 2005. Immunohistochemistry studies were performed using antisera CD3, CD4 and CD14 with a DAB detection kit on a Ventana BenchMark automated slide staining system. The material was grouped into three classes: early spontaneous abortions (class 1); elective abortions with signs of disruption at the chorio-decidual interface (class 2); elective abortions without such signs (class 3). Preparations from classes 1 and 2 shared a similar picture of lymphocytic activation and the presence of macrophagic elements. The test results demonstrated that the proportion of the T cell population increased with the rise in CD8+ lymphocytes in both class 1 and class 2 preparations. The results indicate that T-cell-mediated immune activation may the cause or one of the causes of spontaneous abortion and that the effects of disruption at the chorio-decidual interface observed in elective abortion provide a clue to initial signs of loss of pregnancy. From the discovery of a population without evident signs of active abortion (elective abortion with a disturbed chorio-decidual interface) but with evidence of initial lymphocytic activation compared with that devoid of such signs (elective abortion) one can conjecture that lymphocytic activation is a major factor in the process leading to early spontaneous abortion.

Study on Clinical Presentation and Outcome of Septic Abortion and Its Relationship with Person Inducing Abortion.

PubMed

Nahar, S; Akhter, S; Ahamed, F; Akhtar, K; Noor, F

2017-10-01

Abortion is a global problem. Maternal mortality and morbidity is still high due to uncontrolled abortion mainly induced abortion which may turn to septic abortion. A total of 50 cases of septic abortion cases admitted in Dhaka Medical College Hospital were included in this study. This cross sectional study was designed to find out the clinical presentation and outcome of septic abortion from January 2010 to January 2011. Out of 50 cases of septic abortion admitted where 44(88%) were induced abortion. Majority of the cases were parous (2-3 parity 32%; 4-6 parity 38%; and 6+ parity 4%) and housewives 42(84%), living with their husbands 49(98%), hailing from urban, semi urban and urban slums. Nineteen (38%) having no education and 21(42%) had primary education. Most of the women 20(45.45%) wanted no more child, decided to terminate pregnancy not to overburden their families or due to disturbed marital relationship. The termination of pregnancy was carried out in first trimester 20(40%) and between (13-16) weeks it was 17(34%). Complications of septic abortion still remain a lethal threat to the life and health of women. The death rate was found 6(12%). And the leading causes of death were generalized peritonitis with septicaemia 3(50%), septicaemia with renal failure 2(33.30%), septic abortion with Disseminated Intravascular Coagulation 1(16.70%). Effective and widespread contraceptive use and continuing health and sex education remain pivotal if the incidence of septic abortion and their complications are to be reduced.

Costs and consequences of abortions to women and their households: a cross-sectional study in Ouagadougou, Burkina Faso

PubMed Central

Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute

2015-01-01

Little is known about the costs and consequences of abortions to women and their households. Our aim was to study both costs and consequences of induced and spontaneous abortions and complications. We carried out a cross-sectional study between February and September 2012 in Ouagadougou, the capital city of Burkina Faso. Quantitative data of 305 women whose pregnancy ended with either an induced or a spontaneous abortion were prospectively collected on sociodemographic, asset ownership, medical and health expenditures including pre-referral costs following the patient’s perspective. Descriptive analysis and regression analysis of costs were performed. We found that women with induced abortion were often single or never married, younger, more educated and had earlier pregnancies than women with spontaneous abortion. They also tended to be more often under parents’ guardianship compared with women with spontaneous abortion. Women with induced abortion paid much more money to obtain abortion and treatment of the resulting complications compared with women with spontaneous abortion: US$89 (44 252 CFA ie franc of the African Financial Community) vs US$56 (27 668 CFA). The results also suggested that payments associated with induced abortion were catastrophic as they consumed 15% of the gross domestic product per capita. Additionally, 11–16% of total households appeared to have resorted to coping strategies in order to face costs. Both induced and spontaneous abortions may incur high expenses with short-term economic repercussions on households’ poverty. Actions are needed in order to reduce the financial burden of abortion costs and promote an effective use of contraceptives. PMID:24829315

Prolonged grieving after abortion: a descriptive study.

PubMed

Brown, D; Elkins, T E; Larson, D B

1993-01-01

Although flawed by methodological problems, the research literature tends to provide support for the assumption that induced abortion in the 1st trimester is not accompanied by enduring negative psychological sequelae. In cases where such sequelae are reported, the morbidity is attributed to a pre-existing psychiatric condition or circumstances precipitating the choice of abortion. However, detailed descriptive letters from 45 women prepared in response to a request by a pastor of an upper-middle-class Protestant congregation in Florida indicate that prolonged grieving after abortion may be more widespread phenomenon than previously believed. Letter writers ranged in age from 25-60 years; 75% were unmarried at the time of the procedure and 29% aborted before the legalization of abortion in the US. The most frequently cited long-term sequela, especially among those who felt coerced to abort, was a continued feeling of guilt. Fantasies about the aborted fetus was the next most frequently mentioned experience. Half of the letter writers referred to their abortions, as "murder" and 44% voiced regret about their decision to abort. Other long-term effects included depression (44%), feelings of loss (31%), shame (27%), and phobic responses to infants (13%). For 42% of these women, the adverse psychological effects of abortion endured over 10 years. Since letter-writers came from a self-selected population group with a known bias against abortion and only negative experiences were solicited, these experiences must be regarded as subjectives and anecdotal. However, they draw attention to the need for methodologically sound studies of a possible prolonged grief syndrome among a small percentage of women who have abortions, especially when coercion is involved.

[Legal abortion in an Indian state].

PubMed

Baskara, N; Kanbargi, R

1978-01-01

The number of abortions in India increased steadily since 1972, the year in which it was legalized. This study examines the characteristics of abortion seekers in the state of Karnataka, which has a population of 29.3 million inhabitants. Data analyzed are about 8073 abortions done in the 35 hospitals authorized to perform the procedure; most of them are state hospitals, and some are private. In 1972 there were 721 abortions, compared to 5544 in 1974. 80% of these were performed in only 12 of the 35 hospitals. In average there were 13-14 abortions a month/hospital, and 8 abortions per doctor qualified to perform it. The majority of abortion seekers were between 30-34 in 1972, but between 25-29 in the following years; 92% were married; 46% had parity over 3, and 37% parity over 4. 84% were Hindu, 7% Muslim, and 9% Christian. Data suggested that the number of illiterate women seeking abortion is increasing. 84% of abortions were performed during the first trimester of pregnancy, mostly by curettage and vacuum aspiration. 13% were second trimester abortions done by saline solution or hysterotomy. The percentage of women accepting contraception after abortion was 33% in 1972 and only 36% in 1974. Tubal ligation seemed to be the preferred method, followed by insertion of IUD. There are still relatively few legal abortions performed in Karnataka; this is due partly to the fact that most hospitals are located in urban areas, and that it can be extremely difficult for a woman living in the countryside to reach it.

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

PubMed Central

2012-01-01

Unsafe abortion's significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal's restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal's Ministry of Health and Population, enabled the country subsequently to introduce and scale up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination. Important elements of this successful model of scaling up safe legal abortion include: the pre-existence of postabortion care services, through which health-care providers were already familiar with the main clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public- and private-sector actors; reliance on public-health evidence in formulating policies governing abortion provision, which led to the embrace of medical abortion and authorization of midlevel providers as key strategies for decentralizing care; and integration of abortion care into existing Safe Motherhood and the broader health system. While challenges remain in ensuring that all Nepali women can readily exercise their legal right to early pregnancy termination, the national safe abortion program has already yielded strong positive results. Nepal's experience making high-quality abortion care widely accessible in a short period of time offers important lessons for other countries seeking to reduce maternal mortality and morbidity from unsafe abortion and to achieve Millennium Development Goals. PMID:22475782

Unintended pregnancy and abortion in Uganda.

PubMed

Hussain, Rubina

2013-01-01

Unintended pregnancy is common in Uganda, leading to high levels of unplanned births, unsafe abortions, and maternal injury and death. Because most pregnancies that end in abortion are unwanted, nearly all ill health and mortality resulting from unsafe abortion is preventable. This report summarizes evidence on the context and consequences of unintended pregnancy and unsafe abortion in Uganda, points out gaps in knowledge, and highlights steps that can be taken to reduce levels of unintended pregnancy and unsafe abortion, and, in turn, the high level of maternal mortality.

Mapping Shallow Landslide Slope Inestability at Large Scales Using Remote Sensing and GIS

NASA Astrophysics Data System (ADS)

Avalon Cullen, C.; Kashuk, S.; Temimi, M.; Suhili, R.; Khanbilvardi, R.

2015-12-01

Rainfall induced landslides are one of the most frequent hazards on slanted terrains. They lead to great economic losses and fatalities worldwide. Most factors inducing shallow landslides are local and can only be mapped with high levels of uncertainty at larger scales. This work presents an attempt to determine slope instability at large scales. Buffer and threshold techniques are used to downscale areas and minimize uncertainties. Four static parameters (slope angle, soil type, land cover and elevation) for 261 shallow rainfall-induced landslides in the continental United States are examined. ASTER GDEM is used as bases for topographical characterization of slope and buffer analysis. Slope angle threshold assessment at the 50, 75, 95, 98, and 99 percentiles is tested locally. Further analysis of each threshold in relation to other parameters is investigated in a logistic regression environment for the continental U.S. It is determined that lower than 95-percentile thresholds under-estimate slope angles. Best regression fit can be achieved when utilizing the 99-threshold slope angle. This model predicts the highest number of cases correctly at 87.0% accuracy. A one-unit rise in the 99-threshold range increases landslide likelihood by 11.8%. The logistic regression model is carried over to ArcGIS where all variables are processed based on their corresponding coefficients. A regional slope instability map for the continental United States is created and analyzed against the available landslide records and their spatial distributions. It is expected that future inclusion of dynamic parameters like precipitation and other proxies like soil moisture into the model will further improve accuracy.

Therapeutic abortion in Islam: contemporary views of Muslim Shiite scholars and effect of recent Iranian legislation

PubMed Central

Hedayat, K M; Shooshtarizadeh, P; Raza, M

2006-01-01

Abortion is forbidden under normal circumstances by nearly all the major world religions. Traditionally, abortion was not deemed permissible by Muslim scholars. Shiite scholars considered it forbidden after implantation of the fertilised ovum. However, Sunni scholars have held various opinions on the matter, but all agreed that after 4 months gestation abortion was not permitted. In addition, classical Islamic scholarship had only considered threats to maternal health as a reason for therapeutic abortion. Recently, scholars have begun to consider the effect of severe fetal deformities on the mother, the families and society. This has led some scholars to reconsider the prohibition on abortion in limited circumstances. This article reviews the Islamic basis for the prohibition of abortion and the reasons for its justification. Contemporary rulings from leading Shiite scholars and from the Sunni school of thought are presented and reviewed. The status of abortion in Muslim countries is reviewed, with special emphasis on the therapeutic abortion law passed by the Iranian Parliament in 2003. This law approved therapeutic abortion before 16 weeks of gestation under limited circumstances, including medical conditions related to fetal and maternal health. Recent measures in Iran provide an opportunity for the Muslim scholars in other countries to review their traditional stance on abortion. PMID:17074823

Therapeutic abortion in Islam: contemporary views of Muslim Shiite scholars and effect of recent Iranian legislation.

PubMed

Hedayat, K M; Shooshtarizadeh, P; Raza, M

2006-11-01

Abortion is forbidden under normal circumstances by nearly all the major world religions. Traditionally, abortion was not deemed permissible by Muslim scholars. Shiite scholars considered it forbidden after implantation of the fertilised ovum. However, Sunni scholars have held various opinions on the matter, but all agreed that after 4 months gestation abortion was not permitted. In addition, classical Islamic scholarship had only considered threats to maternal health as a reason for therapeutic abortion. Recently, scholars have begun to consider the effect of severe fetal deformities on the mother, the families and society. This has led some scholars to reconsider the prohibition on abortion in limited circumstances. This article reviews the Islamic basis for the prohibition of abortion and the reasons for its justification. Contemporary rulings from leading Shiite scholars and from the Sunni school of thought are presented and reviewed. The status of abortion in Muslim countries is reviewed, with special emphasis on the therapeutic abortion law passed by the Iranian Parliament in 2003. This law approved therapeutic abortion before 16 weeks of gestation under limited circumstances, including medical conditions related to fetal and maternal health. Recent measures in Iran provide an opportunity for the Muslim scholars in other countries to review their traditional stance on abortion.

Representations of the subject 'woman' and the politics of abortion: an analysis of South African newspaper articles from 1978 to 2005.

PubMed

Macleod, Catriona Ida; Feltham-King, Tracey

2012-01-01

A key element in cultural and gender power relations surrounding abortion is how women who undergo an abortion are represented in public talk. We analyse how women were named and positioned, and the attendant constructions of abortion, in South African newspaper articles on abortion from 1978 to 2005, a period during which there were radical political and legislative shifts. The name 'woman' was the most frequently used (70% of articles) followed by 'girl/teenager/child' (25%), 'mother' (25%), 'patient' (11%) and 'minor' (6%). The subject positionings enabled by these names were dynamic and complex and were interwoven with the localised, historical politics of abortion. The 'innocent mother' and the bifurcated 'patient' (woman/foetus) positionings were invoked in earlier epochs to promote abortion under medical conditions. The 'dangerous mother' and woman as 'patient' positionings were used more frequently under liberal abortion legislation to oppose and to advocate for abortion, respectively. The positioning of the 'girl/teenager/child' as dependent and vulnerable was used in contradictory ways, both to oppose abortion and to argue for a liberalisation of restrictive legislation, depending on the attendant construction of abortion. The neutral naming of 'woman' was, at times, linked to the liberal imaginary of 'choice'.

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

PubMed Central

Storeng, Katerini T.; Ouattara, Fatoumata

2014-01-01

In Burkina Faso, abortion is legally restricted and socially stigmatised, but also frequent. Unsafe abortions represent a significant public health challenge, contributing to the country's very high maternal mortality ratio. Inspired by an internationally disseminated public health framing of unsafe abortion, the country's main policy response has been to provide post-abortion care (PAC) to avert deaths from abortion complications. Drawing on ethnographic research, this article describes how Burkina Faso's PAC policy emerged at the interface of political and moral negotiations between public health professionals, national bureaucrats and international agencies and NGOs. Burkinabè decision-makers and doctors, who are often hostile to induced abortion, have been convinced that PAC is ‘life-saving care’ which should be delivered for ethical medical reasons. Moreover, by supporting PAC they not only demonstrate compliance with international standards but also, importantly, do not have to contend with any change in abortion legislation, which they oppose. Rights-based international NGOs, in turn, tactically focus on PAC as a ‘first step’ towards their broader institutional objective to secure safe abortion and abortion rights. Such negotiations between national and international actors result in widespread support for PAC but stifled debate about further legalisation of abortion. PMID:25132157

Medical versus surgical abortion methods for pregnancy in China: a cost-minimization analysis.

PubMed

Xia, Wei; She, Shouzhang; Lam, Tai Hing

2011-01-01

Both medical and surgical abortions are popular in developing countries. However, the monetary costs of these two methods have not been compared. 430 women seeking abortions were recruited in 2008. Either a medical or surgical method was used for the abortion. We adopted the perspective of a third-party payer. Cost-minimization analysis was used based on all charges for the overall procedures in an out-patient clinic in Guangzhou, China. 219 subjects (51%) chose a medical method (mifepristone and misoprostol), whereas 211 subjects (49%) chose a surgical method. The efficacy in the surgical group was significantly higher than in the medical group (100 vs. 90%, p < 0.001). Surgical abortion incurred much more costs than medical abortion on average after initial treatment. When the subsequent costs were accumulated within the 2-week follow-up, the mean total cost in the medical group increased significantly due to failure of abortion and persistent bleeding. Patients undergoing medical abortion eventually incurred equivalent expenses compared to patients undergoing surgical abortion (p = 0.42). There was no difference in the mean final costs between the two abortion methods. Complications of persistent bleeding and failure to abort (requiring surgical intervention) in the medical treatment group increased the final mean total cost substantially. Copyright © 2011 S. Karger AG, Basel.

The undue burden of paying for abortion: An exploration of abortion fund cases.

PubMed

Ely, Gretchen E; Hales, Travis; Jackson, D Lynn; Maguin, Eugene; Hamilton, Greer

2017-02-01

The results of a secondary data analysis of 3,999 administrative cases from a national abortion fund, representing patients who received pledges for financial assistance to pay for an abortion from 2010 to 2015, are presented. Case data from the fund's national call center was analyzed to assess the impact of the fund and examine sample demographics which were compared to the demographics of national abortion patients. Procedure costs, patient resources, funding pledges, additional aid, and changes over time in financial pledges for second-trimester procedures were also examined. Results indicate that the fund sample differed from national abortion patients in that fund patients were primarily single, African American, and seeking funding for second trimester abortions. Patients were also seeking to fund expensive procedures, costing an average of over $2,000; patients were receiving over $1,000 per case in pledges and other aid; and funding pledges for second trimester procedures were increasing over time. Abortion funding assistance is essential for women who are not able to afford abortion costs, and it is particularly beneficial for patients of color and those who are younger and single. Repeal of policy banning public funding of abortion would help to eliminate financial barriers that impede abortion access.

Abortion law, policy and services in India: a critical review.

PubMed

Hirve, Siddhivinayak S

2004-11-01

Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalisation of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women's access to safe abortion care.

High Prevalence of Leptotrichia amnionii, Atopobium vaginae, Sneathia sanguinegens, and Factor 1 Microbes and Association of Spontaneous Abortion among Korean Women.

PubMed

Seo, Sang Soo; Arokiyaraj, Selvaraj; Kim, Mi Kyung; Oh, Hea Young; Kwon, Minji; Kong, Ji Sook; Shin, Moon Kyung; Yu, Ye Lee; Lee, Jae Kwan

2017-01-01

Objective. The purpose of this study was to (i) determine the cervical microbial composition in different abortion samples and to (ii) investigate the correlation between spontaneous abortion and cervical microbes in Korean women. Methods. We collected cervical swabs from women who had never undergone abortion ( N = 36), had spontaneous abortion ( N = 23), and had undergone induced abortion ( N = 88) and subjected those samples to 16S rRNA pyrosequencing. Further, factor analysis and correlation between cervical microbiota and spontaneous abortion were evaluated by logistic regression analysis. Results. In spontaneous abortion women, 16 S rRNA gene sequences showed significant increases in Atopobium vaginae , Megasphaera spp., Gardnerella vaginalis , Leptotrichia amnionii , and Sneathia sanguinegens compared to women in nonabortion group. In multivariate logistic regression analysis, A. vaginae (OD = 11.27; 95% = 1.57-81) , L. amnionii (OD = 11.47; 95% = 1.22-107.94), S. sanguinegens (OD = 6.89; 95% = 1.07-44.33), and factor 1 microbes (OD = 16.4; 95% = 1.88-42.5) were strongly associated with spontaneous abortion. Conclusions. This study showed a high prevalence of L. amnionii, A. vaginae, S. sanguinegens , and factor 1 microbes in spontaneous abortion and association with spontaneous abortion in Korean women.

Research on apoptotic signaling pathways of recurrent spontaneous abortion caused by dysfunction of trophoblast infiltration.

PubMed

Sun, Q; Zhang, X-L

2017-07-01

To study the apoptotic signaling pathways of recurrent spontaneous abortion caused by dysfunction of trophoblast infiltration. 60 patients with recurrent spontaneous abortion and normal abortion were selected consecutively as recurrent spontaneous abortion group and abortion group, respectively. Villous tissues were obtained and cell apoptosis was observed under a microscope; terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (Tunel) method was used to test the apoptosis rate. In situ hybridization was adopted to detect expressions of Fas messenger RNA (Fas mRNA) and Fas ligand messenger RNA (FasL mRNA); expression of Fas, FasL and protein kinase C (PKC) were examined by immunohistochemistry at protein level; fluorescence spectrophotometer was used to test Ca2+ level. The apoptosis rate, expressions of Fas mRNA, and FasL mRNA, expressions of Fas and FasL proteins, as well as Ca2+ level, were significantly higher in the recurrent spontaneous abortion group than in abortion group. The level of PKC protein was significantly lower in recurrent spontaneous abortion group than in abortion group (p<0.05). Fas-FasL and PKC signaling pathways, as well as Ca2+, may mediate the dysfunction of trophoblast infiltration, which leads to recurrent spontaneous abortion.

[Correlation of genomic DNA methylation level with unexplained early spontaneous abortion].

PubMed

Chao, Yuan; Weng, Lidong; Zeng, Rong

2014-10-01

To investigate the correlation of genomic DNA methylation level with unexplained early spontaneous abortion and analyze the role of DNMT1, DNMT3A and DNMT3B. Forty-five villus samples from spontaneous abortion cases (with 33 maternal peripheral blood samples) and 44 villus samples from induced abortion (with 34 maternal peripheral blood samples) were examined with high-pressure liquid chromatography (HPLC) to measure the overall methylation level of the genomic DNA. The expressions of DNMT mRNAs were detected using fluorescence quantitative-PCR in the villus samples from 33 induced abortion cases and 30 spontaneous abortion cases. Genomic DNA methylation level was significantly lower in the villus in spontaneous abortion group than in induced abortion group (P<0.01), but similar in the maternal blood samples between the two groups (P>0.05). The mean mRNA expression levels of DNMT1 and DNMT3A in the villus were significantly lower in spontaneous abortion group than in induced abortion group (P<0.05), but DNMT3B expression showed no significant difference between them (P>0.05). Insufficient genomic DNA methylation in the villus does exist in human early spontaneous abortion, and this insufficiency is probably associated with down-regulated expressions of DNMT1 and DNMT3A.

High Prevalence of Leptotrichia amnionii, Atopobium vaginae, Sneathia sanguinegens, and Factor 1 Microbes and Association of Spontaneous Abortion among Korean Women

PubMed Central

Seo, Sang Soo; Arokiyaraj, Selvaraj; Oh, Hea Young; Kwon, Minji; Kong, Ji Sook; Shin, Moon Kyung; Yu, Ye Lee; Lee, Jae Kwan

2017-01-01

Objective. The purpose of this study was to (i) determine the cervical microbial composition in different abortion samples and to (ii) investigate the correlation between spontaneous abortion and cervical microbes in Korean women. Methods. We collected cervical swabs from women who had never undergone abortion (N = 36), had spontaneous abortion (N = 23), and had undergone induced abortion (N = 88) and subjected those samples to 16S rRNA pyrosequencing. Further, factor analysis and correlation between cervical microbiota and spontaneous abortion were evaluated by logistic regression analysis. Results. In spontaneous abortion women, 16 S rRNA gene sequences showed significant increases in Atopobium vaginae, Megasphaera spp., Gardnerella vaginalis, Leptotrichia amnionii, and Sneathia sanguinegens compared to women in nonabortion group. In multivariate logistic regression analysis, A. vaginae (OD = 11.27; 95% = 1.57–81), L. amnionii (OD = 11.47; 95% = 1.22–107.94), S. sanguinegens (OD = 6.89; 95% = 1.07–44.33), and factor 1 microbes (OD = 16.4; 95% = 1.88–42.5) were strongly associated with spontaneous abortion. Conclusions. This study showed a high prevalence of L. amnionii, A. vaginae, S. sanguinegens, and factor 1 microbes in spontaneous abortion and association with spontaneous abortion in Korean women. PMID:29479540

Induced abortion in Taiwan.

PubMed

Wang, P D; Lin, R S

1995-04-01

Induced abortion is widely practised in Taiwan; however, it had been illegal until 1985. It was of interest to investigate induced abortion practices in Taiwan after its legalization in 1985 in order to calculate the prevalence rate and ratio of induced abortion to live births and to pregnancies in Taiwan. A study using questionnaires through personal interviews was conducted on more than seventeen thousand women who attended a family planning service in Taipei metropolitan areas between 1991 and 1992. The reproductive history and sexual behaviour of the subjects were especially focused on during the interviews. Preliminary findings showed that 46% of the women had a history of having had an induced abortion. Among them, 54.8% had had one abortion, 29.7% had had two, and 15.5% had had three or more. The abortion ratio was 379 induced abortions per 1,000 live births and 255 per 1,000 pregnancies. The abortion ratio was highest for women younger than 20 years of age, for aboriginal women and for nulliparous women. When logistic regression was used to control for confounding variables, we found that the number of previous live births is the strongest predictor relating to women seeking induced abortion. In addition, a significant positive association exists between increasing number of induced abortions and cervical dysplasia.

The Relationship between Neutralization Techniques and Induced Abortion

PubMed Central

Kalateh Sadati, Ahmad; Tabei, Seyed Ziaaddin; Salehzadeh, Hamzeh; Rahnavard, Farnaz; Namavar Jahromi, Bahia; Hemmati, Soroor

2014-01-01

Background: Induced abortion is not only a serious threat for women’s health, but also a controversial topic for its ethical and moral problems. We aimed to evaluate the relationship between neutralization techniques and attempting to commit abortion in married women with unintended pregnancy. Methods: After in-depth interviews with some women who had attempted abortion, neutralization themes were gathered. Next, to analyze the data quantitatively, a questionnaire was created including demographic and psychosocial variables specifically related to neutralization. The participants were divided into two groups (abortion and control) of unintended pregnancy and were then compared. Results: Analysis of psychosocial variables revealed a significant difference in the two groups at neutralization, showing that neutralization in the control group (56.97±10.24) was higher than that in the abortion group (44.19±12.44). To evaluate the findings more accurately, we examined the causal factors behind the behaviors of the abortion group. Binary logistic regression showed that among psychosocial factors, neutralization significantly affected abortion (95% CI=1.07-1.35). Conclusion: Despite the network of many factors affecting induced abortion, neutralization plays an important role in reinforcing the tendency to attempt abortion. Furthermore, the decline of religious beliefs, as a result of the secular context of the modern world, seems to have an important role in neutralizing induced abortion. PMID:25349851

Latin American women’s experiences with medical abortion in settings where abortion is legally restricted

PubMed Central

2012-01-01

Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used. Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades. This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal. Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support. Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and the fact that some women eventually need to seek medical care at a hospital where they might be sanctioned for having an abortion and even reported to the police. PMID:23259660

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso.

PubMed

Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute

2016-10-07

Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010.

Effects of price and availability on abortion demand.

PubMed

Gohmann, S F; Ohsfeldt, R L

1993-10-01

This study explained the variation in US state abortion demand due to the price of services, the net of insurance cost of birth services, the ability to pay, contraceptive use, individual attitudes regarding abortion, and government policy affecting cost of benefits of terminating an unintended pregnancy or of carrying to birth. The empirical model uses pooled data from 48 states for 1982, 1984, 1985, and 1987. Prices are deflated to 1977 dollars. Another two-staged least squares model is based on cross-sectional state level data for 1985. The dependent variable is the log of abortion per 1000 pregnancies. Other variables pertain to income, education, labor force, family planning, tax, aid to families with dependent children, religion, and abortion-related measures. The results of the cross-sectional analysis are consistent with Medoff's and Garbacz's findings. The estimated coefficient of per capita income is positive with a point elasticity ranging from 0.62 to 1.0. The model with the most complete specifications has an abortion price elasticity range from -0.75 to -1.3 and is statistically significant when religion measures are excluded. The Hausman test shows the pro-choice variable significantly correlated with the error term. The net price of birth services is not statistically significant. Catholic religion and no religion are only significant when the abortion provider variable is excluded. The suggestion is that the effect of Catholicism is ambiguous. In the pooled analysis, the fixed effects model is used to control for abortion attitudes and other unobserved factors. Abortion demand includes abortion per 1000 pregnancies, the ratio of abortions to pregnancies, and the logarithm of abortions per 1000 pregnancies. Higher income is associated with a higher abortion rate and elasticities of 0.76 and 0.35 and is associated with a higher pregnancy rate. The abortion ratio is found to be elastic with respect to price, and price elasticities are sensitive to choice of state abortion attitude measures. The availability of family planning services reduces the rate of pregnancy as well as the abortion rate and ratio.

Shuttle Abort Flight Management (SAFM) - Application Overview

NASA Technical Reports Server (NTRS)

Hu, Howard; Straube, Tim; Madsen, Jennifer; Ricard, Mike

2002-01-01

One of the most demanding tasks that must be performed by the Space Shuttle flight crew is the process of determining whether, when and where to abort the vehicle should engine or system failures occur during ascent or entry. Current Shuttle abort procedures involve paging through complicated paper checklists to decide on the type of abort and where to abort. Additional checklists then lead the crew through a series of actions to execute the desired abort. This process is even more difficult and time consuming in the absence of ground communications since the ground flight controllers have the analysis tools and information that is currently not available in the Shuttle cockpit. Crew workload specifically abort procedures will be greatly simplified with the implementation of the Space Shuttle Cockpit Avionics Upgrade (CAU) project. The intent of CAU is to maximize crew situational awareness and reduce flight workload thru enhanced controls and displays, and onboard abort assessment and determination capability. SAFM was developed to help satisfy the CAU objectives by providing the crew with dynamic information about the capability of the vehicle to perform a variety of abort options during ascent and entry. This paper- presents an overview of the SAFM application. As shown in Figure 1, SAFM processes the vehicle navigation state and other guidance information to provide the CAU displays with evaluations of abort options, as well as landing site recommendations. This is accomplished by three main SAFM components: the Sequencer Executive, the Powered Flight Function, and the Glided Flight Function, The Sequencer Executive dispatches the Powered and Glided Flight Functions to evaluate the vehicle's capability to execute the current mission (or current abort), as well as more than IS hypothetical abort options or scenarios. Scenarios are sequenced and evaluated throughout powered and glided flight. Abort scenarios evaluated include Abort to Orbit (ATO), Transatlantic Abort Landing (TAL), East Coast Abort Landing (ECAL) and Return to Launch Site (RTLS). Sequential and simultaneous engine failures are assessed and landing footprint information is provided during actual entry scenarios as well as hypothetical "loss of thrust now" scenarios during ascent.

Post legalisation challenge: minimizing complications of abortion.

PubMed

Ojha, N; Sharma, S; Paudel, J

2004-01-01

Abortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D and C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D and C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order.

High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized

PubMed Central

Melese, Tadele; Habte, Dereje; Tsima, Billy M.; Mogobe, Keitshokile Dintle; Chabaesele, Kesegofetse; Rankgoane, Goabaone; Keakabetse, Tshiamo R.; Masweu, Mabole; Mokotedi, Mosidi; Motana, Mpho; Moreri-Ntshabele, Badani

2017-01-01

Background Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications. Methods A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients’ records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed. Result A total of 619 patients’ records were reviewed with a mean (SD) age of 27.12 (5.97) years. The majority of abortions (95.5%) were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%). Offensive vaginal discharge (17.9%), tender uterus (11.3%), septic shock (3.9%) and pelvic peritonitis (2.4%) were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2%) of the cases followed by hypovolemic and septic shock 65 (10.5%). There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively). Conclusion Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications. PMID:28060817

Women's experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study.

PubMed

Gerdts, Caitlin; Raifman, Sarah; Daskilewicz, Kristen; Momberg, Mariette; Roberts, Sarah; Harries, Jane

2017-10-02

In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population. We recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe abortion access needs. We enrolled 42 women, nearly one-third of whom reported they were sex workers. Thirty-four women (81%) reported having had one informal sector abortion within the past 5 years, 14% reported having had two, and 5% reported having had three. These women consumed home remedies, herbal mixtures from traditional healers, or tablets from an unregistered provider. Twelve sought additional care for potential warning signs of complications. Privacy and fear of mistreatment at public sector facilities were among the main reported reasons for attempting informal sector abortion. Most women (67%) cited other community members as their source of information about informal sector abortion; posted signs and fliers in public spaces also served as an important source of information. Women are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities. Some were unaware how or where to seek formal sector services, or believed the cost was too high. Many informal methods are ineffective and unsafe, leading to potential warning signs of complications and continued pregnancy. Sex workers may be at particular risk of unsafe abortion. Based on these results, it is essential that future studies sample women outside of the formal health sector. The use of innovative sampling methods would greatly improve our knowledge about informal sector abortion in South Africa.

[Induced abortion: a world perspective].

PubMed

Henshaw, S K

1987-01-01

This article presents current estimates of the number, rate, and proportion of abortions for all countries which make such data available. 76% of the world's population lives in countries where induced abortion is legal at least for health reasons. Abortion is legal in almost all developed countries. Most developing countries have some laws against abortion, but it is permitted at least for health reasons in the countries of 67% of the developing world's population. The other 33%--over 1 billion persons--reside mainly in subSaharan Africa, Latin America, and the most orthodox Muslim countries. By the beginning of the 20th century, abortion had been made illegal in most of the world, with rules in Africa, Asia, and Latin America similar to those in Europe and North America. Abortion legislation began to change first in a few industrialized countries prior to World War II and in Japan in 1948. Socialist European countries made abortion legal in the first trimester in the 1950s, and most of the industrialized world followed suit in the 1960s and 1970s. The worldwide trend toward relaxed abortion restrictions continues today, with governments giving varying reasons for the changes. Nearly 33 million legal abortions are estimated to be performed annually in the world, with 14 million of them in China and 11 million in the USSR. The estimated total rises to 40-60 million when illegal abortions added. On a worldwide basis some 37-55 abortions are estimated to occur for each 1000 women aged 15-44 years. There are probably 24-32 abortions per 100 pregnancies. The USSR has the highest abortion rate among developed countries, 181/1000 women aged 15-44, followed by Rumania with 91/1000, many of them illegal. The large number of abortions in some countries is due to scarcity of modern contraception. Among developing countries, China apparently has the highest rate, 62/1000 women aged 15-44. Cuba's rate is 59/1000. It is very difficult to calculate abortion rates in countries where the procedure is illegal. On the basis of hospital reports and other fragmentary information, the true rate appears to be relatively high in Latin America and the Far East. The abortion rate for Latin America in the mid-1970s was estimated at 65/1000 fertile aged women, and rates were believed to be higher in urban areas. Sub-Saharan Africa, where women desire very large families, apparently had the lowest rates. Up to 68% of pregnancies in the USSR, 57% in Rumania, and 55% in Japan may end in abortion. The proportion in developing countries ranged from 8% in Vietnam to 43% in China. Women undergoing abortion in developed countries tend to be young, childless, and single, while those in developing countries tend to be older, high parity, and married. Abortion mortality is still high in countries where large numbers of illegal abortions are performed by unqualified personnel, as in many parts of Latin America.

EEG Classification with a Sequential Decision-Making Method in Motor Imagery BCI.

PubMed

Liu, Rong; Wang, Yongxuan; Newman, Geoffrey I; Thakor, Nitish V; Ying, Sarah

2017-12-01

To develop subject-specific classifier to recognize mental states fast and reliably is an important issue in brain-computer interfaces (BCI), particularly in practical real-time applications such as wheelchair or neuroprosthetic control. In this paper, a sequential decision-making strategy is explored in conjunction with an optimal wavelet analysis for EEG classification. The subject-specific wavelet parameters based on a grid-search method were first developed to determine evidence accumulative curve for the sequential classifier. Then we proposed a new method to set the two constrained thresholds in the sequential probability ratio test (SPRT) based on the cumulative curve and a desired expected stopping time. As a result, it balanced the decision time of each class, and we term it balanced threshold SPRT (BTSPRT). The properties of the method were illustrated on 14 subjects' recordings from offline and online tests. Results showed the average maximum accuracy of the proposed method to be 83.4% and the average decision time of 2.77[Formula: see text]s, when compared with 79.2% accuracy and a decision time of 3.01[Formula: see text]s for the sequential Bayesian (SB) method. The BTSPRT method not only improves the classification accuracy and decision speed comparing with the other nonsequential or SB methods, but also provides an explicit relationship between stopping time, thresholds and error, which is important for balancing the speed-accuracy tradeoff. These results suggest that BTSPRT would be useful in explicitly adjusting the tradeoff between rapid decision-making and error-free device control.

Thorough statistical comparison of machine learning regression models and their ensembles for sub-pixel imperviousness and imperviousness change mapping

NASA Astrophysics Data System (ADS)

Drzewiecki, Wojciech

2017-12-01

We evaluated the performance of nine machine learning regression algorithms and their ensembles for sub-pixel estimation of impervious areas coverages from Landsat imagery. The accuracy of imperviousness mapping in individual time points was assessed based on RMSE, MAE and R2. These measures were also used for the assessment of imperviousness change intensity estimations. The applicability for detection of relevant changes in impervious areas coverages at sub-pixel level was evaluated using overall accuracy, F-measure and ROC Area Under Curve. The results proved that Cubist algorithm may be advised for Landsat-based mapping of imperviousness for single dates. Stochastic gradient boosting of regression trees (GBM) may be also considered for this purpose. However, Random Forest algorithm is endorsed for both imperviousness change detection and mapping of its intensity. In all applications the heterogeneous model ensembles performed at least as well as the best individual models or better. They may be recommended for improving the quality of sub-pixel imperviousness and imperviousness change mapping. The study revealed also limitations of the investigated methodology for detection of subtle changes of imperviousness inside the pixel. None of the tested approaches was able to reliably classify changed and non-changed pixels if the relevant change threshold was set as one or three percent. Also for fi ve percent change threshold most of algorithms did not ensure that the accuracy of change map is higher than the accuracy of random classifi er. For the threshold of relevant change set as ten percent all approaches performed satisfactory.

Combining functional and structural tests improves the diagnostic accuracy of relevance vector machine classifiers

PubMed Central

Racette, Lyne; Chiou, Christine Y.; Hao, Jiucang; Bowd, Christopher; Goldbaum, Michael H.; Zangwill, Linda M.; Lee, Te-Won; Weinreb, Robert N.; Sample, Pamela A.

2009-01-01

Purpose To investigate whether combining optic disc topography and short-wavelength automated perimetry (SWAP) data improves the diagnostic accuracy of relevance vector machine (RVM) classifiers for detecting glaucomatous eyes compared to using each test alone. Methods One eye of 144 glaucoma patients and 68 healthy controls from the Diagnostic Innovations in Glaucoma Study were included. RVM were trained and tested with cross-validation on optimized (backward elimination) SWAP features (thresholds plus age; pattern deviation (PD); total deviation (TD)) and on Heidelberg Retina Tomograph II (HRT) optic disc topography features, independently and in combination. RVM performance was also compared to two HRT linear discriminant functions (LDF) and to SWAP mean deviation (MD) and pattern standard deviation (PSD). Classifier performance was measured by the area under the receiver operating characteristic curves (AUROCs) generated for each feature set and by the sensitivities at set specificities of 75%, 90% and 96%. Results RVM trained on combined HRT and SWAP thresholds plus age had significantly higher AUROC (0.93) than RVM trained on HRT (0.88) and SWAP (0.76) alone. AUROCs for the SWAP global indices (MD: 0.68; PSD: 0.72) offered no advantage over SWAP thresholds plus age, while the LDF AUROCs were significantly lower than RVM trained on the combined SWAP and HRT feature set and on HRT alone feature set. Conclusions Training RVM on combined optimized HRT and SWAP data improved diagnostic accuracy compared to training on SWAP and HRT parameters alone. Future research may identify other combinations of tests and classifiers that can also improve diagnostic accuracy. PMID:19528827

The Response of Abortion Demand to Changes in Abortion Costs

ERIC Educational Resources Information Center

Medoff, Marshall H.

2008-01-01

This study uses pooled cross-section time-series data, over the years 1982, 1992 and 2000, to estimate the impact of various restrictive abortion laws on the demand for abortion. This study complements and extends prior research by explicitly including the price of obtaining an abortion in the estimation. The empirical results show that the real…

76 FR 44591 - Notice of Hearing: Reconsideration of Disapproval of Indiana State Plan Amendments (SPA) 11-011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... perform abortions or maintain or operate facilities where abortions are performed, except for hospitals or... restrictions on Federal funding of abortion services. Section 1116 of the Act and Federal regulations at 42 CFR... providers that perform abortions or maintain or operate facilities where abortions are performed, except for...

Abortion work: strains, coping strategies, policy implications.

PubMed

Joffe, C

1979-11-01

As a result of the moral and social conflicts surrounding abortion, workers involved in counseling potential abortion recipients are subject to certain strains. The author uses observations made at one abortion clinic to support her conclusion that these strains, as well as the methods of coping developed by staff and administration, must be considered in formulating any policy on abortion.

The Impact of Legalized Abortion on High School Graduation through Selection and Composition

ERIC Educational Resources Information Center

Whitaker, Stephan

2011-01-01

This analysis examines whether the legalization of abortion changed high school graduation rates among the children selected into birth. Unless women in all socio-economic circumstances sought abortions to the same extent, increased use of abortion must have changed the distribution of child development inputs. I find that higher abortion ratios…

Abort Flight Test Project Overview

NASA Technical Reports Server (NTRS)

Sitz, Joel

2007-01-01

A general overview of the Orion abort flight test is presented. The contents include: 1) Abort Flight Test Project Overview; 2) DFRC Exploration Mission Directorate; 3) Abort Flight Test; 4) Flight Test Configurations; 5) Flight Test Vehicle Engineering Office; 6) DFRC FTA Scope; 7) Flight Test Operations; 8) DFRC Ops Support; 9) Launch Facilities; and 10) Scope of Launch Abort Flight Test

Accuracy of topographic index models at identifying ephemeral gully trajectories on agricultural fields

NASA Astrophysics Data System (ADS)

Sheshukov, Aleksey Y.; Sekaluvu, Lawrence; Hutchinson, Stacy L.

2018-04-01

Topographic index (TI) models have been widely used to predict trajectories and initiation points of ephemeral gullies (EGs) in agricultural landscapes. Prediction of EGs strongly relies on the selected value of critical TI threshold, and the accuracy depends on topographic features, agricultural management, and datasets of observed EGs. This study statistically evaluated the predictions by TI models in two paired watersheds in Central Kansas that had different levels of structural disturbances due to implemented conservation practices. Four TI models with sole dependency on topographic factors of slope, contributing area, and planform curvature were used in this study. The observed EGs were obtained by field reconnaissance and through the process of hydrological reconditioning of digital elevation models (DEMs). The Kernel Density Estimation analysis was used to evaluate TI distribution within a 10-m buffer of the observed EG trajectories. The EG occurrence within catchments was analyzed using kappa statistics of the error matrix approach, while the lengths of predicted EGs were compared with the observed dataset using the Nash-Sutcliffe Efficiency (NSE) statistics. The TI frequency analysis produced bi-modal distribution of topographic indexes with the pixels within the EG trajectory having a higher peak. The graphs of kappa and NSE versus critical TI threshold showed similar profile for all four TI models and both watersheds with the maximum value representing the best comparison with the observed data. The Compound Topographic Index (CTI) model presented the overall best accuracy with NSE of 0.55 and kappa of 0.32. The statistics for the disturbed watershed showed higher best critical TI threshold values than for the undisturbed watershed. Structural conservation practices implemented in the disturbed watershed reduced ephemeral channels in headwater catchments, thus producing less variability in catchments with EGs. The variation in critical thresholds for all TI models suggested that TI models tend to predict EG occurrence and length over a range of thresholds rather than find a single best value.

Decision-Making for Induced Abortion in the Accra Metropolis, Ghana.

PubMed

Gbagbo, Fred Yao; Amo-Adjei, Joshua; Laar, Amos

2015-06-01

Decision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners' consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions.

"Reclaiming the white daughter's purity": Afrikaner nationalism, racialized sexuality, and the 1975 Abortion and Sterilization Act in apartheid South Africa.

PubMed

Klausen, Susanne M

2010-01-01

This article examines the struggle over abortion law reform that preceded the enactment in 1975 of the first statutory law on abortion in South Africa. The ruling National Party government produced legislation intended to eliminate access to doctors willing to procure abortions in an attempt to prevent young, unmarried white women from engaging in premarital (hetero) sexual activity. It was also aimed at strictly regulating the medical profession’s actions with regards to abortion. The production of the abortion legislation was directly influenced by international struggles for accessible abortion and, more broadly, sexual liberation. The regime believed South Africa was being infiltrated by Western "immorality" and the abortion law was an attempt to buttress racist heteropatriarchal apartheid culture. Examining the abortion controversy highlights the global circulation of ideas about reproduction in the twentieth century and foregrounds a neglected dimension of the history of sexual regulation in apartheid South Africa: the disciplining and regulation of white female reproductive sexuality.

Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana.

PubMed

Hu, Delphine; Grossman, Daniel; Levin, Carol; Blanchard, Kelly; Adanu, Richard; Goldie, Sue J

2010-06-01

To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.

[Use of contraception and reasons for choosing abortion among abortion applicants].

PubMed

Hansen, S K; Birkebaek, J S; Husfeldt, C; Munck, C B; Nøddebo, S M; Petersson, B H

1996-10-07

The object of this study was to describe a group of women applying for legal abortion in relation to their use of contraception and reasons for choosing an abortion. During a period of 13 months (1991-92) a questionnaire was distributed to women applying for legal abortion at Hillerød Hospital in Denmark. Three hundred and thirty-nine women participated. Fifty-nine percent of the women had become pregnant although they had used contraception. As seen in other studies, women still state demographic factors as their most important reasons for choosing an abortion. Women with two or more children do not want to have more children. Single women do not want children without being in a stable relationship. Furthermore occupation and education were frequently stated as important reasons for having an abortion. Economy and housing were not main reasons but contributory factors. Thirty percent of the women expressed ambivalence about the choice of abortion at the time when the abort was due.

Identification and treatment of intra-abdominal fetal skeletal remains: A consequence of illicit and unsafe abortion.

PubMed

Rohilla, Minakshi; Kalpdev, Arun; Jain, Vanita

2015-06-01

The safety of abortions has always been a matter of concern for women's health. Unsafe abortion is one of the most neglected health-care problems in developing countries due to lack of awareness of the legal issues and limited access to authorised services often leading the women to poor quality of abortion in unsafe settings through untrained health personnel. Two rare cases of second trimester unsafe abortions are reported here in which women presented after several weeks with well-preserved remains of fetal skeleton in their abdomen along with complicated multiple visceral injuries. Both these second trimester abortions were performed by untrained village abortionists for sex selection and unwanted pregnancy in an unmarried adolescent girl. The management in the unmarried girl was further complicated due to undisclosed history of abortion. These reports of unsafe abortion highlight the need for clinicians to have a high index of suspicion for an undisclosed abortion when treating any morbid woman of reproductive age with a bizarre abdominal clinical picture.

Locus of control and decision to abort.

PubMed

Dixon, P N; Strano, D A; Willingham, W

1984-04-01

The relationship of locus of control to deciding on an abortion was investigated by administering Rotter's Locus of Control Scale to 118 women immediately prior to abortion and 2 weeks and 3 months following abortion. Subjects' scores were compared across the 3 time periods, and the abortion group's pretest scores were compared with those of a nonpregnant control, group. As hypothesized, the aborting group scored significantly more internal than the general population but no differences in locus of control were found across the 3 time period. The length of delay in deciding to abort an unwanted pregnancy following confirmation was also assessed. Women seeking 1st trimester abortions were divided into internal and external groups on the Rotter Scale and the lengths of delay were compared. The hypothesis that external scores would delay the decision longer than internal ones was confirmed. The results confirm characteristics of the locus of control construct and add information about personality characteristics of women undergoing abortion.

Pregnancy and the 40-Year Prison Sentence: How "Abortion Is Murder" Became Institutionalized in the Salvadoran Judicial System.

PubMed

Viterna, Jocelyn; Bautista, Jose Santos Guardado

2017-06-01

Using the case of El Salvador, this article demonstrates how the anti-abortion catchphrase "abortion is murder" can become embedded in the legal practice of state judicial systems. In the 1990s, a powerful anti-abortion movement in El Salvador resulted in a new legal context that outlawed abortion in all circumstances, discouraged mobilization for abortion rights, and encouraged the prosecution of reproduction-related "crimes." Within this context, Salvadoran women initially charged with the crime of abortion were convicted of "aggravated homicide" and sentenced to up to 40 years in prison. Court documents suggest that many of these women had not undergone abortions, but had suffered naturally occurring stillbirths late in their pregnancies. Through analysis of newspaper articles and court cases, this article documents how El Salvador came to prosecute obstetrical emergencies as "murder," and concludes that activism on behalf of abortion rights is central to protecting poor pregnant women from prosecution for reproduction-related "crimes."

State obligations to implement African abortion laws: employing human rights in a changing legal landscape.

PubMed

Ngwena, Charles G

2012-11-01

Women in the African region are overburdened with unsafe abortion. Abortion regimes that fail to translate any given abortion rights into tangible access are partly to blame. Historically, African abortion laws have been highly restrictive. However, the post-independence era has witnessed a change toward liberalizing abortion law, even if incremental for many jurisdictions. Furthermore, Article 14 of the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa has significantly augmented the regional trend toward liberalization by recognizing abortion as a human right in given circumstances. However, states are failing to implement abortion laws. The jurisprudence that is emerging from the European Court of Human Rights and United Nations treaty bodies is a tool that can be used to render African governments accountable for failure to implement domestic abortion laws. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Woman-centered research on access to safe abortion services and implications for behavioral change communication interventions: a cross-sectional study of women in Bihar and Jharkhand, India

PubMed Central

2012-01-01

Background Unsafe abortion in India leads to significant morbidity and mortality. Abortion has been legal in India since 1971, and the availability of safe abortion services has increased. However, service availability has not led to a significant reduction in unsafe abortion. This study aimed to understand the gap between safe abortion availability and use of services in Bihar and Jharkhand, India by examining accessibility from the perspective of rural, Indian women. Methods Two-stage stratified random sampling was used to identify and enroll 1411 married women of reproductive age in four rural districts in Bihar and Jharkhand, India. Data were collected on women's socio-demographic characteristics; exposure to mass media and other information sources; and abortion-related knowledge, perceptions and practices. Multiple linear regression models were used to explore the association between knowledge and perceptions about abortion. Results Most women were poor, had never attended school, and had limited exposure to mass media. Instead, they relied on community health workers, family and friends for health information. Women who had knowledge about abortion, such as knowing an abortion method, were more likely to perceive that services are available (β = 0.079; p < 0.05) and have positive attitudes toward abortion (β = 0.070; p < 0.05). In addition, women who reported exposure to abortion messages were more likely to have favorable attitudes toward abortion (β = 0.182; p < 0.05). Conclusions Behavior change communication (BCC) interventions, which address negative perceptions by improving community knowledge about abortion and support local availability of safe abortion services, are needed to increase enabling resources for women and improve potential access to services. Implementing BCC interventions is challenging in settings such as Bihar and Jharkhand where women may be difficult to reach directly, but interventions can target individuals in the community to transfer information to the women who need this information most. Interpersonal approaches that engage community leaders and influencers may also counteract negative social norms regarding abortion and associated stigma. Collaborative actions of government, NGOs and private partners should capitalize on this potential power of communities to reduce the impact of unsafe abortion on rural women. PMID:22404903

Incidence and socioeconomic determinants of abortion in rural Upper Egypt.

PubMed

Yassin, K M

2000-07-01

Because of a growing cultural and religious sensitivity and controversy over reproductive health issues, particularly abortion, this area remains relatively unexplored in Egypt. This study was conducted using a participatory approach to determine the morbidity and determinants of abortion in rural Upper Egypt. In all, 1025 women from six villages in Upper Egypt were included in the study. Information regarding the incidence of abortion, patterns of health care utilization and risk factors was obtained using a structured interview format. The local dialect was used in formulating questions and they were revised and amended by a panel of local leaders, interviewers and representatives of the study population. Interviewers were local educated (secondary or university level) female volunteers. Information about exposure to 17 risk factors was also collected and statistical analysis was done by estimating the odds ratio and applying a test of statistical significance. Then, a multivariate logistic regression model was applied to control for possible interactions and confounding effects. The results were that 40.6% (n=416) had aborted at least once; of them 24.6% (n=252) had aborted more than once and were designated as recurrent aborters. The lifetime prevalence of recurrent abortion was estimated to be 25% and nearly 21% of pregnancies were aborted. The incidence of abortion was estimated to be 265 per 1000 live birth. Only 21.9% (n=91) of women received medical care for the last abortion. The vast majority of women (92%, n=299) who did not seek medical help received help from traditional and domestic sources. These sources are midwife (59.9%, n=179), relative or neighbour (29.8%, n=89), and traditional practitioner (10.4%, n=31). The multivariate analysis revealed that the incidence of abortion is significantly associated with gravidity, consanguinity, and mother occupation, while recurrent abortion is associated with gravidity, consanguinity and woman's age at marriage. In conclusion, the morbidity of abortion is a serious public health problem in Egypt. Because the incidence rate is very high and because safe abortion is limited in Egypt, maternal mortality due to abortion is expected to be underestimated. Promotion of family planning is expected to have a significant impact on the incidence of abortion in Upper Egypt.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda – a qualitative study focusing on task sharing between physicians and midwives

PubMed Central

2014-01-01

Background Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians’ and midwives’ perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda. PMID:24447321

Pathways and consequences of unsafe abortion: a comparison among women with complications after induced and spontaneous abortions in Madhya Pradesh, India.

PubMed

Banerjee, Sushanta K; Andersen, Kathryn L; Warvadekar, Janardan

2012-09-01

This study aimed to understand women's pathways of seeking care for postabortion complications in Madhya Pradesh, India. The study recruited 786 women between July and November 2007. Data were collected on service provision, abortion-related complications, care-seeking behavior, knowledge about abortion legality and availability, methods used, symptoms, referral source, and out-of-pocket costs. Women seeking care for complications from induced abortion followed more complex pathways to treatment than women with complications of spontaneous abortion. More complex pathways were associated with higher out-of-pocket costs. Improving community awareness on legal aspects, safe abortion methods, and trained providers are necessary to reduce morbidity associated with unsafe abortion. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

[Voluntary abortion cost in France and prospective payment system: to raise the issue of so many misstatements].

PubMed

Betala Belinga, J-F; Valence, A; Zaccabri, A; Fresson, J

2010-11-01

Despite the implementation of prospective payment approach in France, induced legal abortion are still paid by capitation. Our aim was to evaluate the real cost of induced abortion in a public hospital in France. This study took place during the year 2008 in a public health hospital. Induced abortion cost was calculated according to national study cost's recommendations. The cost drawn from this was compared to what is paid by the medical insurance for spontaneous abortion. Induced abortion calculated cost was 562 €, the capitation amount was 286.86 €, the spontaneous abortion compensation amount was 645 €. Induced abortion should be paid by a prospective payment evaluation similar to diagnosis related groups approaches rather than a capitation payment, in order to reduce misstatements. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Preventing unsafe abortion and limiting its consequences: what can be done?

PubMed

Misago, C

1994-12-01

The continued illegality of induced abortion in Latin America has led to substantial, preventable maternal mortality and morbidity. The first strategy for preventing unsafe clandestine abortion is to reduce the incidence of unwanted pregnancy through measures such as improved access to effective contraception, post-abortion family planning counseling, health education campaigns aimed at promoting condom use among young people, involvement of men in family planning decision making, biomedical research on safer and more effective male and female contraceptive methods, and empowering women to demand the use of condoms or avoid unwanted intercourse. The second strategy is to reduce abortion-related mortality and morbidity through more effective clinical management of incomplete illegal abortions, introduction of menstrual regulation services, formation of women's solidarity groups aimed at discouraging the practice of self-induced abortion, and, ultimately, abortion legalization.

Understanding the effects of personal and school religiosity on the decision to abort a premarital pregnancy.

PubMed

Adamczyk, Amy

2009-06-01

Although much research has examined the relationship between religion and abortion attitudes, few studies have examined whether religion influences abortion behavior. This study looks at whether individual and school religiosity influence reported abortion behavior among women who become pregnant while unmarried. Hierarchical Logistic Models are implemented to analyze two waves of data from the National Longitudinal Study of Adolescent Health. Findings show that personal religiosity is unrelated to reported abortion behavior. However, conservative Protestants appear less likely to obtain abortions than mainline Protestants, Catholics, and women of non-Christian faiths. Regardless of personal religious affiliation, having attended a school with a high proportion of conservative Protestants appears to discourage abortion as women enter their twenties. Conversely, women from private religious high schools appear more likely to report obtaining an abortion than women from public schools.

Understanding abortion via different scholarly methodologies: book review essay.

PubMed

Erde, Edmund L

1986-01-01

Erde review three works that in his opinion have made important contributions to the abortion debate: Abortion Policy: An Evaluation of the Consequences For Maternal and Infant Health, by Jerome S. Legge, Jr. (Albany: State University of New York Press; 1985); Abortion and the Politics of Motherhood, by Kristen Luker (Berkeley: University of California Press; 1984); and Abortion: Moral and Legal Perspective, edited by J.L. Garfield and P. Hennessey (Amherst: University of Massachusetts Press; 1984). A later issue of the Journal of Medical Humanities and Bioethics will carry Erde's review of two additional scholarly books on abortion: Abortion: Understanding the Differences, edited by Sidney Callahan and Daniel Callahan (New York: Plenum Press; 1984), and Abortion and the Status of the Fetus, edited by William B. Bondeson, H.T. Engelhardt, Jr., S.F. Spicker, and D.H. Winship (Boston: D. Reidel; 1983).

[Legal and illegal abortion in Switzerland].

PubMed

Stamm, H

1970-01-01

Aspects of legal and illegal abortion in Switzerland are discussed. About 110,000 births, 25,000 therapeutic abortions (75% for psychiatric indications) and an estimated 50,000 illegal abortions occur annually in Switzerland. Although the mortality and morbidity of therapeutic aborti on are similar to those of normal births (1.4 per 1000 and 11%, respectively) the mortality and morbidity of criminal abortions are far greater (3 per 1000 and 73%, respectively). In the author's view, too strict an interpretatiok of Swiss abortion law (which permits abortion to avoid serious harm to the mother's health) does not take into account the severe and lasting emotional and psychological damage which may be caused by unwanted pregnancy, birth, and childraising. In the present social situation, the social and psychological support required by these women is not available; until it is, abortion is to be preferred.

[Study on the current status of spontaneous abortion of primigravid women in Jiaxing of Zhejiang province, China].

PubMed

Liang, Rui-ying; Ye, Rong-wei; Li, Hong-tian; Ren, Ai-guo; Liu, Jian-meng

2010-07-01

To study the current status of spontaneous abortion of primigravid women in Jiaxing areas of Zhejiang province of China. We analyzed the data from both perinatal healthcare surveillance program and spontaneous abortion, collected in Jiaxing areas by the Institute of Reproductive and Child Health, Peking University. The study population consisted of 14 769 primigravid women (excluding induced abortion, ectopic pregnancy and molar pregnancy as outcomes) attempting to become pregnant who registered between 1993 and 1995. 1454 spontaneous abortion cases were identified, with the spontaneous abortion rate as 9.8% (95%CI: 9.3% - 10.3%). The mean gestational weeks at pregnancy diagnosis were 7.6 ± 2.1 weeks, the mean gestational weeks at miscarriage were (10.1 ± 3.1) weeks and the incidence of first-trimester (≤ 12 weeks) spontaneous abortion was 7.3% (95%CI: 6.8% - 7.7%), accounting for 73.7% of all the spontaneous abortion cases. A peak for risk of miscarriage was around 8 - 13 weeks, accounting for 37.7% of all spontaneous abortion. The observed multiple Cox regression model showed that increased spontaneous abortion rates were observed in women with age at pregnancy ≥ 30, being peasants and with higher education level. The spontaneous abortion rate of primigravid women in Jiaxing areas was higher than in other areas of China. The maximum occurrence of spontaneous abortions was during period of 8-13 gestation weeks.

Medical abortion in early pregnancy: experience in China.

PubMed

Cheng, Linan

2006-07-01

When medical abortion was first introduced in China, prostaglandins (PGs) were used alone or in combination with Chinese herbs or steroid drugs, but the results were not satisfactory. Mifepristone is now produced in three companies in China and is commonly used with PGs for medical abortion. We performed a Chinese- and English-language literature review of medical abortion in early pregnancy in China. A large multicenter trial conducted in China showed that, when used with a PGF(2alpha) analogue, the complete abortion rate in women given multiple doses of mifepristone (total, 150 mg) was significantly higher than that in women given a single dose of 200 mg of mifepristone. Oral misoprostol (0.6 mg) with mifepristone is now the most commonly used regimen, with a complete abortion rate of over 93%. In China, medical abortion is currently restricted to pregnancies before 49 days, but some hospitals have recently extended the use of medical abortion to pregnancies beyond 49 days. Prolonged bleeding is the main medical abortion side effect and is more likely to occur if the blood levels of human chorionic gonadotrophin fall slowly or when the gestational sac is big. Prescription of testosterone propionate may reduce the duration of bleeding. Over 80% of Chinese women are satisfied with current medical abortion regimens and will choose medical abortion again if they need to terminate a future unwanted pregnancy. Currently, medical abortion is a safe, efficient and acceptable method for the termination of early pregnancy in China.