The provision of abortion care represents a great ethical challenge to physicians, particularly in countries where the law states that abortion is a crime. The concept that it is a crime carries a stigma that is worse than that associated with other acts qualified by law as crimes. This stigma leads to at least two different kinds of unethical behavior. One is the refusal to provide safe abortion services to women who comply with the legal requirements, alleging conscientious objection, and the other is to discriminate against women with complications of induced abortion. Both unethical behaviors may be associated with severe consequences for the health of women whose care was refused or delayed. Less attention is given to the ethical obligation to prevent induced abortion from recurring by offering postabortion contraception to comply with the ethical obligation of preventing harm to the patients for whose care they are responsible.
2017 Written by Anibal Faúndes, Laura Miranda in Article Keywords
Safe abortion is not only a matter of law and policy. It is not sought in a vacuum. There are socio-cultural dimensions that inform decisions to seek termination of pregnancy. Where education and employment are not easily accessible, young women and girls are pushed towards early marriage. Where violence against women is rife, this increases the risk of unwanted pregnancies and unsafe abortion. Understanding these societal dimensions of reproductive health care ensures a holistic approach to the challenges that impede its full realisation. This paper examines the framework that regulates the right to abortion and the inherent deficiencies in that law. The constitutional provisions on safe abortion are explored particularly in terms of the extent to which they improve the legal framework and create opportunities for actualising the right.
2017 Written by Charles Okeyo Owuor in Article Keywords
BACKGROUND: According to the World Health Organization (WHO) estimate, one-third of pregnancies end in miscarriage, stillbirth, or induced abortion in the world. There are various reasons for a woman to seek induced abortion. However, limited information is available so far in the country and particularly in the study area. Therefore, the aim of the current study was to identify the determinants of induced abortion among clients coming for abortion care services at Bahirdar Felegehiwote referral hospital, Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted from September to December 2014. Interview administered questioner was used to collect primary data. Enumeration and systematic random sampling (K = 3) method was used to select 175 cases and 350 controls. A binary logistic regression model was fitted to identify determinant factors. Odds ratio with 95% CI was computed to assess the strength and significance of the association. RESULTS: All sampled cases and controls were actually interviewed. The likelihood of abortion was higher among non-married women [AOR: 18.23, 95% CI: 8.04, 41.32], students [AOR: 11.46, 95% CI: 6.29, 20.87], and women having a monthly income of less than 500 ETB [AOR: 11.46, 95% CI: 6.29, 20.87]. However, the likelihood of abortion was lower among women age greater than 24 years [AOR: 0.29, 95% CI: 0.11, 0.79] and who had the previous history of induced abortion [AOR: 0.31, 95% CI: 0.15, 0.65]. CONCLUSIONS: The…
2017 Written by Fikreselassie Tilahun, Abel Fekadu Dadi and Getachew Shiferaw in Article Keywords
OBJECTIVE: To evaluate the results of an intervention by the Societé de Gynécologues et Obstétriciens du Burkina (SOGOB) to improve postabortion care (PAC) in rural areas of Burkina Faso. METHODS: From June 1, 2012, to May 31, 2013, SOGOB increased capacity for PAC by providing training in health care and equipment to 45 rural health facilities. Performance in PAC in the year before intervention (June 1, 2011, to May 31, 2012) was compared with that in the year following intervention (June 1, 2013, to May 31, 2014). RESULTS: The number of cases of incomplete abortion managed within a year increased from 1812 before the intervention to 2738 afterwards. Before capacity building, none of the health facilities was using misoprostol for management of incomplete abortion. After capacity building, misoprostol was used in 805 (29.4%) cases. The use of inappropriate methods to empty the uterus decreased (27.5% [498/1812] vs 1.4% [38/2738]; P
2017 Written by Sibraogo Kiemtore, Hyacinthe Zamane, Danlotoma P. Kain, Yobi A. Sawadogo, Issa Ouedraogo, Ali Ouedraogo, Jean Lankoande in Article
BACKGROUND: Unmet need for contraception in several sub-Saharan African countries, including Ghana, remains high, with implications for unintended pregnancies and unsafe abortion, associated maternal morbidity and mortality. In this paper, we analysed for any associations between unmet/met need for contraception and the prevalence of abortion. METHODS: The paper utilizes the 2014 Ghana Demographic Health Survey dataset. Applying descriptive statistics initially, and later, a binary logistic regression, we estimate two different models, taking into account, unmet/met need for contraception (Model 1) and a multivariable one comprising socioeconomic, spatial, cultural and demographic behaviour variables (Model 2) to test the associations between unmet/met need for contraception in Ghana. RESULTS: One-fourth (25%) of sampled women in 2014 had ever had an abortion. The bivariate results showed that women who reported “no unmet” considerably tended to report abortion more than the reference category – not married and no sex in the last 30 days. The elevated odds among respondents who indicated “no unmet need” persisted even after controlling for all the relevant confounders. Relatedly, unlike women with an unmet need for spacing, women who desired to limit childbearing had a slightly higher tendency to report an abortion. CONCLUSION: The linkage between unmet need for contraception appears more complex, particularly when the connections are explored post-abortion. Thus, while an abortion episode is most likely due to unintended pregnancy, contraception may still not be used, after an…
2017 Written by Joshua Amo-Adjei, Eugene K.M. Darteh in Article Keywords
BACKGROUND: Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. METHODS: Unmatched case–control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. RESULTS: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to…
2017 Written by Mussie Alemayehu, Henock Yebyo, Araya Abrha Medhanyie, Alemayehu Bayray, Misganaw Fantahun and Gelila Kidane Goba in Article Keywords
Abortion has been a social menace and its assessment has depended on one's socio-legal views. Past scholars have concluded that abortion is either a felony or homicide; there is no known empirical study on socio-cultural implications of abortion to marriage in Igbomina tribe in Nigeria. The paper examines the socio-cultural attitudes of Igbomina tribe toward marriage and abortion in Osun and Kwara state, Nigeria. Questionnaire was administered to 1036 (Osun: 516; Kwara: 518) respondents mainly women in 14-45 years, 108 (Rural Women: 78, Traditional Health Practitioners: 30) respondents were interviewed and 156 (Single Lady: 90; Married Women: 66) Focus Group Discussions were held. Most (99.8%) respondents were not involved in abortion because 81.2% described induced abortion as a taboo. Majority (78.3%) respondents have seen more than forty women who died from miscarriage in traditional shrines and 59.7% passed through one-miscarriage or pregnancy complications but were denied access to abortion. Any form of abortion resulted in divorce, ban from eating natural foods, marry outside the clan or total exile from the land. The paper concludes that only positive counseling, informational and educative services could bring about attitudinal change.
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…
2017 Written by Tadele Melese, Dereje Habte, Billy M. Tsima, Keitshokile Dintle Mogobe, Kesegofetse Chabaesele, Goabaone Rankgoane, Tshiamo R. Keakabetse, Mabole Masweu, Mosidi Mokotedi, Mpho Motana, Badani Moreri-Ntshabele in Article