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 It is based on a wide-ranging review of published and unpublished sources.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.

/pdf/making-abortions-safe-a-matter-of-good-public-health-policy-1ehkrvvzjl.pdf

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

Background: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. Methods: We conducted a large population-based survey of women aged 18–29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. Results: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%–12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%–14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%–3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07–1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84–0.91), geographic region (highlands: OR 1.56, 95% CI 1.23–1.97; jungle: OR 1.81, 95% CI 1.41–2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68–0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23–2.09; ≥ 3 partners: OR 2.79, 95% CI 2.12–3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01–1.72; ≥ 2 partners: OR 1.54, 95% CI 1.14–2.02). Overall, 49.0% (95% CI 47.6%–50.3%) of the women who reported being currently sexually active were not using contraception. Interpretation: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.

/pdf/clandestine-induced-abortion-prevalence-incidence-and-risk-14mxvti60g.pdf

Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country.

Recent developments in our understanding of the pathophysiology of polycystic ovary syndrome led to the introduction of new therapeutic approaches. It is apparent that a significant proportion of women with polycystic ovary syndrome have insulin resistance and compensatory hyperinsulinemia. Growing evidence indicates that elevated serum insulin induces hyperandrogenism, which in turn leads to anovulation and infertility. Hyperinsulinemia also contributes to the increased risk for cardiovascular disorders and type 2 diabetes mellitus. These concepts provide rationale for therapies focused on treatments of insulin resistance. In particular, weight loss and exercise have been shown to increase insulin sensitivity and improve ovulatory function. Metformin, an insulin-sensitizing agent, is particularly effective in women with polycystic ovary syndrome who have significant insulin resistance. Metformin use leads to a decrease in serum insulin and androgen levels as well as an improvement in ovulatory function. Moreover, it appears to ameliorate cardiovascular risk factors. Other approaches to ovulation induction in women with polycystic ovary syndrome include traditional therapies using clomiphene citrate or gonadotropins. In clomiphene-resistant subjects, one can consider laparoscopic ovarian drilling and other forms of partial ovarian resection or destruction.

Optimizing ovulation induction in women with polycystic ovary syndrome.

This study focuses on lowest income Mexican women attended for abortion-related complications in a public hospital. The objective was to investigate the women’s experience of having a so-called “spontaneous” abortion and their related strategies to avoid stigmatization. Four strategies emerge from women’s testimonies: presenting themselves as women who “play by the rules,” pleading ignorance of the pregnancy, stating that they had already accepted their pregnancy, or presenting the abortion as the result of an accident. Women use these strategies to deflect any blame to which they might be subjected and as a means of dealing with the stigma attached to a behavior that transgresses social norms regarding reproduction. Far from being passive receptors of the social imperative, which makes motherhood compulsory, women oscillate strategically within the margins of a seemingly uniform normative discourse and thereby ensure their moral survival. The authors discuss results within the framework of praxis theory.

Strategies Used by Low-Income Mexican Women to Deal with Miscarriage and “Spontaneous” Abortion

Induced abortion is a ubiquitous practice, experienced throughout time by a significant number (approximately 15 million per year) of women all over the world. Its psychological effects have been ignored in some countries and hotly debated in others. Research is hampered by serious methodological challenges and misunderstandings, most prominent among them being the failure to include a control group and the failure to take into consideration the patients' baseline, and the circumstances of both the decision to have an abortion and the abortion itself. Nevertheless the existing data point firmly to the conclusion that abortion has fewer adverse psychiatric sequelae than childbirth. Though some women experience sadness and guilt, these reactions tend to be transient and not to rise to the level of psychiatric disorder. Risk factors for subsequent psychiatric problems include per-existing psychiatric illness, lack of social supports, and coercion.

Psychiatric aspects of induced abortion

Most research on abortion in Latin America has focused on women who are hospitalized with abortion complications but little is known about the characteristics of women who are able to obtain clandestine procedures performed by trained personnel working in sanitary conditions. Analysis of medical records for 808 clients of an urban clandestine abortion service in South America was supplemented with observation of clinic operations for 6 weeks in 1995. Nearly 9 in 10 clients had at least a secondary education about three-quarters were younger than 30 and a similar proportion were unmarried. 54% had never given birth and 13% had had at least 1 prior abortion. Three-fifths of women had not been using a contraceptive method when they conceived; among users three-fifths had been using a traditional method. 3% experienced mild complications related to the procedure (e.g. heavy bleeding or pelvic pain) and another 2% reported serious complications (e.g. pelvic infection hemorrhage or suspected uterine perforation). To reduce the need for abortion it is important for family planning programs to include women who are young unmarried and highly educated in their outreach efforts. (authors)

Clandestine abortion in Latin America: a clinic profile.

This paper presents the results of in-depth interviews with ten clandestine abortion providers in urban Latin America. Three related issues are addressed: how abortion providers come to this line of work; their major difficulties; and their sources of job satisfaction. A variety of paths bring health professionals to the practice of abortion; common elements are a sense of calling, a desire to help women, personal experience with abortion, and a commitment to political change. Providers describe difficulties that include a lack of medical support, the need for secrecy, and threats of violence, extortion, and prosecution. In spite of difficulties, all providers report a great deal of fulfillment in their work, based on their satisfaction in saving women's lives, maintaining supportive relationships with colleagues, and empowering women.

Clandestine abortion in Latin America: provider perspectives.

University, Nueva Orleans, LA, EE.UU. La mayoría de los estudios publicados sobre el aborto en América Latina están basados en información recibida de mujeres que han sido hospitalizadas debido a complicaciones causadas por el procedimiento.1 Teniendo en cuenta la preocupación que existe con la morbilidad y mortalidad relacionadas con el aborto, este enfoque hace mucho sentido. No obstante, dicho enfoque excluye a las mujeres que no han sufrido complicaciones, y por lo tanto puede crear impresiones inexactas sobre las características de las mujeres que se someten a abortos. En particular, los estudios realizados en base de datos hospitalarios probablemente no son representativos de las mujeres de condiciones socioeconómicas relativamente elevadas que pueden obtener un aborto efectuado por personal médico en condiciones sanitarias adecuadas—un grupo poblacional considerado prioritario para los estudios de El Aborto Clandestino en América Latina: Perfil de una Clínica

El Aborto Clandestino en América Latina:Perfil de una Clínica

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Clandestine abortion in Latin America: a clinic profile.

Clandestine abortion in Latin America: provider perspectives.

El Aborto Clandestino en América Latina:Perfil de una Clínica