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.
Patent Medicine Vendors (PMVs) can play a critical role in increasing access to emergency contraceptive pills (ECPs) in developing countries, but few studies have examined their knowledge and dispensing practices. Using cluster sampling, the authors selected and interviewed 97 PMVs (60.8 per cent female) in Oyo and Ogun States of Nigeria to assess their knowledge, dispensing practices, and referral for ECPs. About one-third (27.8 per cent) of respondents were not aware of ECPs, and only half knew that ECPs could prevent pregnancy. Forty per cent had ever dispensed ECPs. Reasons proffered by those who do not dispense ECPs included barriers from the State Ministry of Health, police, other regulatory agencies, and religious beliefs. Only 50.5 per cent have referral arrangements for clients. Strategies to increase access to ECPs through PMVs include training on counseling techniques and referral, effective government regulation, and community involvement. Where unsafe abortion is a major cause of maternal mortality, these strategies offer protection for many women in the future.
BACKGROUND: Ugandan law prohibits abortion under all circumstances except where there is a risk for the woman's life. However, it has been estimated that over 250 000 illegal abortions are being performed in the country yearly. Many of these abortions are carried out under unsafe conditions, being one of the most common reasons behind the nearly 5000 maternal deaths per year in Uganda. Little research has been conducted in relation to societal views on abortion within the Ugandan society. This study aims to analyze the discourse on abortion as expressed in the two main daily Ugandan newspapers. METHOD: The conceptual content of 59 articles on abortion between years 2006-2012, from the two main daily English-speaking newspapers in Uganda, was studied using principles from critical discourse analysis. RESULTS: A religious discourse and a human rights discourse, together with medical and legal sub discourses frame the subject of abortion in Uganda, with consequences for who is portrayed as a victim and who is to blame for abortions taking place. It shows the strong presence of the Catholic Church within the medial debate on abortion. The results also demonstrate the absence of medial statements related to abortion made by political stakeholders. CONCLUSIONS: The Catholic Church has a strong position within the Ugandan society and their stance on abortion tends to have great influence on the way other actors and their activities are presented within the media, as well as how stakeholders choose to convey their message, or choose Not to publicly debate the Issue in question at all. To decrease the number of maternal deaths, we highlight the need for a more inclusive and varied debate that problematizes the current situation, especially from a gender perspective.
This study explores students' narratives and discourses about adolescent pregnancy and abortion elicited via internet-based open-ended questions posed in response to a cartoon vignette. We report on content analysis of recommendations and strategies for how to manage the unplanned pregnancy of a fictional young couple and in their own personal lives. The responses of 614 young people were analysed. Strategies vary widely. They include giving birth, adoption, running away, abortion, denial, and postponement until discovery. Young people were also queried about unplanned pregnancy resolution among their peers. Discourse analysis reveals competing social scripts on abortion. Florid condemnation of abortion acts in the hypothetical cases contrasts with more frank and sober description of peers' real life abortion behaviour. Students' language is compared with that found in official curricula. The rhetorical devices, moralizing social scripts and dubious health claims about abortion in students' online narratives mirror the tenor and content of their academic curricula as well as Kenyan media presentation of the Issue. The need for factual information, dispassionate dialogue and improved contraceptive access is considerable.
"BACKGROUND: Unsafe abortion imposes heavy burdens on both individuals and society, particularly in low-income countries, many of which have restrictive abortion laws. Providing family planning counseling and services to women following an abortion has emerged as a key strategy to address this issue. STUDY DESIGN: This systematic review gathered, appraised and synthesized recent research evidence on the effects of post-abortion family planning counseling and services on women in low-income countries. RESULTS: Of the 2965 potentially relevant records that were identified and screened, 15 studies satisfied the inclusion criteria. None provided evidence on the effectiveness of post-abortion family planning counseling and services on maternal morbidity and mortality. One controlled study found that, compared to the group of non-beneficiaries, women who received post-abortion family planning counseling and services had significantly fewer unplanned pregnancies and fewer repeat abortions during the 12-month follow-up period. All 15 studies examined contraception-related outcomes. In the seven studies which used a comparative design, there was greater acceptance and/or use of modern contraceptives in women who had received post-abortion family planning counseling and services relative to the no-program group. CONCLUSIONS: The current evidence on the use of post-abortion family planning counseling and services in low-income countries to address the problem of unsafe abortion is inconclusive. Nevertheless, the increase in acceptance and/or use of contraceptives is encouraging and has the potential to be further explored. Adequate funding to support robust research in this area of reproductive health is urgently needed."
This article examines lay narratives about abortion among adult men and women in Nyeri district, central Kenya. The women studied do Not champion or defend abortion and they do Not necessarily condemn it. To them, abortion shields Not merely against the shame of mistimed or socially unviable entry into recognized motherhood but more importantly against the negative socioeconomic consequences of mistimed or unnecessary childbearing and inconvenient entry into motherhood. The men, on the other hand, were generally condemnatory toward abortion, viewing it as women's strategy for concealing their deviation from culturally acceptable gender and motherhood standards. Induced abortion will persist in Kenya Not primarily because it protects against the shame associated with mistimed childbearing and entry into motherhood, but largely because women associate mistimed childbearing and inconvenient entry into motherhood with poverty and loss of marital viability. Kenyan women seeking abortion may also continue to rely on poor quality abortion services because qualified providers who clandestinely perform abortion charge prohibitively.
Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify Nodal points in pregnancy decision-making that can structure future investigations.
Labor induction abortion in the second trimester is a difficult problem in developing countries because antiprogestins are either Not available or unaffordable. When prostaglandins are used alone for labor induction abortion without antiprogestin pretreatment, the induction to delivery interval and the treatment failure rate increase. Trilostane, an inhibitor of 3beta-hydroxysteroid dehydrogenase enzyme system, was given to 93 women between 13 and 19 weeks gestation. The trilostane dosage used was 120 mg twice daily for the first 24 h, and then 240 mg twice daily for the next 24 h. The women returned after 48 h for hospital admission. The women were randomized to three different misoprostol regimens: low-dose vaginal group (200 microg every 4 h), high-dose vaginal group (initial dose of 400 microg followed by 200 microg every 4 h) and vaginal-oral group (400 microg vaginally followed by 200 microg orally every 4 h). The median induction to abortion times were 17, 8.3 and 9.4 h, respectively. The latter two groups had significantly shorter induction to delivery times (p<.05). The most common side effects were a burning feeling in the face (47.7%) and nausea (13.3%). Overall, trilostane side effects were mild and self-limiting and did Not interfere with therapy. In conclusion, trilostane can be given as out-patient therapy prior to admission for prostaglandin administration in labor induction abortion.
"Background: The use of misoprostol in the management of first trimester abortion is an evolving clinical practice in most parts of sub-Saharan Africa. Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion. Study Design: This was a non-randomized trial. Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Nigeria. Materials and Methods: Consented consecutive patients with first trimester missed abortion were recruited in the study. Each patient was given sublingual misoprostol 600 µg to be repeated after 6 hours if abortion process was not initiated. They were followed-up after two weeks and offered contraceptive counseling. However, if active vaginal bleeding persisted, patients were reviewed after 1 week, scanned and offered surgical evacuation (manual vacuum aspiration) on confirmation of residual products of conception. Telephone review was conducted for patients who defaulted follow-up. Data were analyzed using the Statistical Package for the Social Sciences version 16. P value was considered significant at a < 0.05 at 95% CI. Results: Sixty-one patients with missed abortion were managed between 1 st January and December 2013 with a mean age, parity and gestational age of 27.6 ± 5.6 years, 3.6 ± 2.3 and 7.6 ± 2.0 weeks, respectively. Fifty-six patients (92%) achieved complete evacuation. Mean interval between the first dose of misoprostol and abortion was 5.1 ± 2.2 hours and mean duration of vaginal bleeding was 5.9 ± 1.6 days (range: 3-14 days). Side effects were minor mainly nausea/vomiting, and all the patients with complete evacuation showed satisfaction with the method and preferred it to surgical evacuation. Conclusion: Misoprostol is very effective in the management of first trimester missed abortion in our setting and should be the treatment method of first choice."
Background: Unwanted pregnancy is the major cause of induced abortion, one of the leading causes of maternal mortality and morbidity in the world. Hundreds of thousands of women become pregnant without intending to, and many of them decide to end the pregnancies into abortion. Youth are more susceptible to unwanted pregnancies; this may be explained by the fact that premarital sexual activity is very common and reported to be on the rise in all parts of the world. This could be explained by the fact that youths are facing various problems with Regards to their reproductive health needs including contraceptive use. Objective: The study assessed the magnitude of unwanted pregnancies and induced abortion among female youths aged 15-24 years in shire town in 2015. Methodology: A cross sectional study, was conducted among youths aged 15-24 years in shire town using a Semi structured questionnaire. Descriptive statistics including chi square and p-value was applied. To reach each house hold Simple random sampling technique was used. Results: The mean age for fist sexual intercourse was 18 years. 57 % of the study respondents agreed to have used contraceptives, 33 % of all the pregnancies had unwanted pregnancy and 26 % of them ended up into abortions, out of all the abortions 87 % were induced. Out of all the abortions 74 % were the result of an unwanted pregnancy. Single youths were found to have more likely hood of having unwanted pregnancy and induced abortion with the proportion of 78 % x 2 = 48.02 , p<0.05) and 59 % x2 =32.4 P0.05) respectively. Conclusion: The prevalence of unwanted pregnancy and induced abortion were high, and most of the induced abortion was the result of unwanted pregnancy. There was low utilization of contraceptives among female youths. Female youths who were single, unmarried and students were found to have high likelihood of having unwanted pregnancy and induced abortion.