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Susheela Singh - One of the best experts on this subject based on the ideXlab platform.
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the incidence of Abortion and unintended pregnancy in india 2015
The Lancet Global Health, 2018Co-Authors: Susheela Singh, Ann M. Moore, Chander Shekhar, Rajib Acharya, Melissa Stillman, Manas Ranjan Pradhan, Jennifer J Frost, Harihar Sahoo, Manoj Alagarajan, Rubina HussainAbstract: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.
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global regional and subregional classification of Abortions by safety 2010 14 estimates from a bayesian hierarchical model
The Lancet, 2017Co-Authors: Bela Ganatra, Caitlin Gerdts, Brooke Ronald Johnson, Susheela Singh, Gilda Sedgh, Clementine Rossier, Ozge Tuncalp, Anisa Assifi, Akinrinola BankoleAbstract:Summary Background Global estimates of unsafe Abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating Abortion safety is needed owing to the increased availability of simple methods for safe Abortion (eg, medical Abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where Abortion is legally restricted, and the need to account for the multiple factors that affect Abortion safety. Methods We used all available empirical data on Abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of Abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe Abortion and WHO guidelines on safe Abortion to categorise Abortions as safe or unsafe and to further divide unsafe Abortions into two categories of less safe and least safe. Findings Of the 55· 7 million Abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) Abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe Abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of Abortion, the proportion of unsafe Abortions was significantly higher in countries with highly restrictive Abortion laws than in those with less restrictive laws. Interpretation Increased efforts are needed, especially in developing countries, to ensure access to safe Abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
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Characteristics of women obtaining induced Abortions in selected low- and middle-income countries
2017Co-Authors: Sophia Chae, Sheila Desai, Marjorie Crowell, Gilda Sedgh, Susheela SinghAbstract:BackgroundIn 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.ObjectivesTo examine the characteristics of women obtaining induced Abortions in LMICs.MethodsWe 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).ResultsWomen 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.ConclusionsThese 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.
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Abortion incidence and unintended pregnancy in nepal
International Perspectives on Sexual and Reproductive Health, 2016Co-Authors: Mahesh Puri, Susheela Singh, Rubina Hussain, Aparna Sundaram, Anand Tamang, Marjorie CrowellAbstract: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. International Perspectives on Sexual and Reproductive Health, 2016, 42(4): 197-209. Prior to its amendment in 2002, the Abortion law in Nepal was highly restrictive: Abortion was permitted only to save a woman's life. (1) Moreover, unsafe Abortion was common, and deaths from Abortion-related complications accounted for more than half of maternal deaths that occurred in major hospitals. (2) In 2002, the Country Code of Nepal (Muluki Ain) was amended to grant all women the right to terminate a pregnancy at up to 12 weeks' gestation on demand, at up to 18 weeks' gestation if the pregnancy resulted from rape or incest, and at any gestational age with a doctor's recommendation if the pregnancy poses a danger to the woman's life or her physical or mental health or if there is a risk of fetal abnormality or impairment. (1) In addition, the revised law prohibits sex-selective Abortions and Abortions done without the consent of the woman. During the past decade, the Ministry of Health has developed strategies for implementing the law and expanding access to safe and legal services. These strategies include training clinicians to perform Abortions, providing them with necessary equipment, and certifying providers and health facilities (3) (both of which need government approval to provide Abortion services). (4,5) All health facilities that have official approval to provide Abortions are expected to perform first-trimester Abortions. A few lower-level facilities, such as health posts, are approved only to provide medical Abortion up to nine weeks' gestation. To provide Abortions after the first trimester, facilities need separate approval and are required to have staff members trained and certified to provide such Abortions. Abortion legalization has led to a decrease in the number of women presenting with severe Abortion complications, (6,7) and it has contributed to a decline in the country's maternal mortality ratio, which fell from 580 maternal deaths per 100,000 live births in 1995 to 190 deaths per 100,000 live births in 2013. (8) Nonetheless, unsafe Abortions--that is, procedures carried out by an unapproved provider in an unapproved facility, potentially under unsafe conditions and using unsafe methods--remain a concern in Nepal. According to the 2011 Nepal Demographic and Health Survey (DHS), a quarter of the women who reported having had an Abortion in the past five years had had postAbortion complications. …
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Abortion incidence and postAbortion care in Rwanda.
Studies in family planning, 2012Co-Authors: Paulin Basinga, Susheela Singh, Ann M. Moore, Elizabeth E. Carlin, Francine Birungi, Fidele NgaboAbstract:Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe Abortions, and some experience health complications as a result. To estimate the incidence of induced Abortion, we conducted a national sample survey of health facilities that provide postAbortion care and a purposive sample survey of key informants knowledgeable about Abortion conditions. We found that more than 16,700 women received care for complications resulting from induced Abortion in Rwanda in 2009, or 7 per 1,000 women aged 15-44. Approximately 40 percent of Abortions are estimated to lead to complications requiring treatment, but about a third of those who experienced a complication did not obtain treatment. Nationally, the estimated induced Abortion rate is 25 Abortions per 1,000 women aged 15-44, or approximately 60,000 Abortions annually. An urgent need exists in Rwanda to address unmet need for contraception, to strengthen family planning services, to broaden access to legal Abortion, and to improve postAbortion care.
Stanley K Henshaw - One of the best experts on this subject based on the ideXlab platform.
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induced Abortion incidence and trends worldwide from 1995 to 2008
The Lancet, 2012Co-Authors: Gilda Sedgh, Stanley K Henshaw, Susheela Singh, Elisabeth Ahman, Iqbal Shah, Akinrinola BankoleAbstract:Summary Background 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. Methods 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. Findings 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 Interpretation 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. Funding UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation.
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Abortion in the united states incidence and access to services 2005
Perspectives on Sexual and Reproductive Health, 2008Co-Authors: Rachel K Jones, Stanley K Henshaw, Mia R Zolna, Lawrence B FinerAbstract:Accurate information about Abortion incidence and services is necessary to monitor levels of unwanted pregnancy and womens ability to access Abortion services. All known Abortion providers in the United States were contacted for information about Abortion services in 2004 and 2005. This information along with data from the U.S. Census Bureau was used to examine national and state trends in numbers of Abortions and Abortion rates proportions of counties and metropolitan areas without an Abortion provider and accessibility of Abortion services. An estimated 1.2 million Abortions were performed in the United States in 2005 8% fewer than in 2000. The Abortion rate in 2005 was 19.4 per 1000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1787 Abortion providers in 2005 only 2% fewer than in 2000. Some 87% of U.S. counties containing 35% of women aged 15-44 did not have an Abortion provider in 2005. Early medication Abortion offered by an estimated 57% of known providers accounted for 13% of Abortions (and for 22% of Abortions before nine weeks gestation). The average amount paid for an Abortion at 10 weeks was $413-after adjustment for inflation $11 less than in 2001. The numbers of Abortions and the Abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to Abortion services. (authors)
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induced Abortion estimated rates and trends worldwide
The Lancet, 2007Co-Authors: Gilda Sedgh, Stanley K Henshaw, Susheela Singh, Elisabeth Ahman, Iqbal ShahAbstract:Summary Background Information on incidence of induced Abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancy. Because unsafe Abortion is a cause of maternal morbidity and mortality, measures of its incidence are also important for monitoring progress towards Millennium Development Goal 5. We present new worldwide estimates of Abortion rates and trends and discuss their implications for policies and programmes to reduce unintended pregnancy and unsafe Abortion and to increase access to safe Abortion. Methods The worldwide and regional incidences of safe Abortions in 2003 were calculated by use of reports from official national reporting systems, nationally representative surveys, and published studies. Unsafe Abortion rates in 2003 were estimated from hospital data, surveys, and other published studies. Demographic techniques were applied to estimate numbers of Abortions and to calculate rates and ratios for 2003. UN estimates of female populations and livebirths were the source for denominators for rates and ratios, respectively. Regions are defined according to UN classifications. Trends in Abortion rates and incidences between 1995 and 2003 are presented. Findings An estimated 42 million Abortions were induced in 2003, compared with 46 million in 1995. The induced Abortion rate in 2003 was 29 per 1000 women aged 15–44 years, down from 35 in 1995. Abortion rates were lowest in western Europe (12 per 1000 women). Rates were 17 per 1000 women in northern Europe, 18 per 1000 women in southern Europe, and 21 per 1000 women in northern America (USA and Canada). In 2003, 48% of all Abortions worldwide were unsafe, and more than 97% of all unsafe Abortions were in developing countries. There were 31 Abortions for every 100 livebirths worldwide in 2003, and this ratio was highest in eastern Europe (105 for every 100 livebirths). Interpretation Overall Abortion rates are similar in the developing and developed world, but unsafe Abortion is concentrated in developing countries. Ensuring that the need for contraception is met and that all Abortions are safe will reduce maternal mortality substantially and protect maternal health.
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Abortion incidence and services in the united states in 2000
Perspectives on Sexual and Reproductive Health, 2003Co-Authors: Lawrence B Finer, Stanley K HenshawAbstract:CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in Abortion. No nationally representative statistics on Abortion incidence or on the universe of Abortion providers have been available since 1996. METHODS: In 2001–2002 The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. Abortion providers collecting information for 1999 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys. RESULTS: From 1996 to 2000 the number of Abortions fell by 3% to 1.31 million and the Abortion rate declined 5% to 21.3 per 1000 women 15–44. (In comparison the rate declined 12% between 1992 and 1996.) The Abortion ratio in 2000 was 24.5 per 100 pregnancies ending in Abortion or live birth 5% lower than in 1996. The number of Abortion providers decreased by 11% to 1819 (46% were clinics 33% hospitals and 21% physicians’ offices); clinics provided 93% of all Abortions in 2000. In that year 34% of women aged 15–44 lived in the 87% of counties with no provider and 86 of the nation’s 276 metropolitan areas had no provider. About 600 providers performed an estimated 37000 early medical Abortions during the first six months of 2001; these procedures represented approximately 6% of all Abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all Abortions in 2000. CONCLUSIONS: Abortion incidence and the number of Abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical Abortion began to play a small but significant role in Abortion provision. (authors)
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the accessibility of Abortion services in the united states 2001
Perspectives on Sexual and Reproductive Health, 2003Co-Authors: Stanley K Henshaw, Lawrence B FinerAbstract:CONTEXT: A womans ability to obtain an Abortion is affected both by the availability of a provider and by access-related factors such as cost convenience gestational limits and the provision of early medical Abortion services. METHODS: In 2001-2002 The Alan Guttmacher Institute surveyed all known Abortion providers in the United States collecting information on their delivery of Abortion services and on the number of Abortions performed. RESULTS: A minority of Abortion providers offer services before five weeks from the last menstrual period (37%) or after 20 weeks (24% or fewer) but the proportions have increased since 1993. Providers estimate that one-quarter of women having Abortions in nonhospital facilities travel 50 miles or more for services and that 7% are initially unsure of their Abortion decisions. The majority of providers (59%) say that these clients usually receive Abortions during a single visit. An average self-paying client was charged $372 for a surgical Abortion at 10 weeks in 2001 up from $319 in 1997; only 26% of clients receive services billed directly than surgical Abortions. More than half (56%) of providers experienced antiAbortion harassment in 2000 but types of harassment other than picketing have declined since 1996. CONCLUSIONS: Abortion at very early and late gestations and early medical Abortion are more available than before but charges have increased and antiAbortion picketing remains at high levels. Thus many women still face substantial barriers to obtaining an Abortion. (authors)
Daniel Grossman - One of the best experts on this subject based on the ideXlab platform.
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change in second trimester Abortion after implementation of a restrictive state law
Obstetrics & Gynecology, 2019Co-Authors: Kari White, Sarah E Baum, K Hopkins, Joseph E Potter, Daniel GrossmanAbstract:OBJECTIVE To assess whether indicators of limited access to services explained changes in rates of second-trimester Abortion after implementation of a restrictive Abortion law in Texas. METHODS We used cross-sectional vital statistics data on Abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' Abortion law. We conducted monthly mystery client calls for information about Abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open Abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining Abortion care after the law's implementation and having a second-trimester Abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times. RESULTS Overall, 64,902 Texas-resident Abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of Abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P<.001; unadjusted odds ratio [OR] 1.45; 95% CI 1.40-1.50). Adjusting for distance to the nearest facility and facility network size reduced the odds of having a second-trimester Abortion after implementation (OR 1.17; 95% CI 1.10-1.25). Women living 50-99 miles from the nearest facility (vs less than 10 miles) had higher odds of second-trimester Abortion (OR 1.24; 95% CI 1.11-1.39), as did women in regions with less than one facility per 250,000 reproductive-aged women compared with women in areas that had 1.5 or more facilities (OR 1.57; 95% CI 1.41-1.75). After implementation, women waited 1 to 14 days for a consultation visit; longer waits were associated with higher odds of second-trimester Abortion. CONCLUSION Increases in second-trimester Abortion after the law's implementation were due to women having more limited access to Abortion services.
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Change in Second-Trimester Abortion After Implementation of a Restrictive State Law.
Obstetrics and gynecology, 2019Co-Authors: Kari White, Sarah E Baum, K Hopkins, Joseph E Potter, Daniel GrossmanAbstract:OBJECTIVE To assess whether indicators of limited access to services explained changes in rates of second-trimester Abortion after implementation of a restrictive Abortion law in Texas. METHODS We used cross-sectional vital statistics data on Abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' Abortion law. We conducted monthly mystery client calls for information about Abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open Abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining Abortion care after the law's implementation and having a second-trimester Abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times. RESULTS Overall, 64,902 Texas-resident Abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of Abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P
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women s experiences seeking Abortion care shortly after the closure of clinics due to a restrictive law in texas
Contraception, 2016Co-Authors: Liza Fuentes, Caitlin Gerdts, Kari White, K Hopkins, Joseph E Potter, Sharon Lebenkoff, Daniel GrossmanAbstract:Abstract Objective In 2013, Texas passed legislation restricting Abortion services. Almost half of the state's clinics had closed by April 2014, and there was a 13% decline in Abortions in the 6 months after the first portions of the law went into effect, compared to the same period 1 year prior. We aimed to describe women's experiences seeking Abortion care shortly after clinics closed and document pregnancy outcomes of women affected by these closures. Study design Between November 2013 and November 2014, we recruited women who sought Abortion care at Texas clinics that were no longer providing services. Some participants had appointments scheduled at clinics that stopped offering care when the law went into effect; others called seeking care at clinics that had closed. Texas resident women seeking Abortion in Albuquerque, New Mexico, were also recruited. Results We conducted 23 in-depth interviews and performed a thematic analysis. As a result of clinic closures, women experienced confusion about where to go for Abortion services, and most reported increased cost and travel time to obtain care. Having to travel farther for care also compromised their privacy. Eight women were delayed more than 1 week, two did not receive care until they were more than 12 weeks pregnant and two did not obtain their desired Abortion at all. Five women considered self-inducing the Abortion, but none attempted this. Conclusions The clinic closures resulted in multiple barriers to care, leading to delayed Abortion care for some and preventing others from having the Abortion they wanted. Implications The restrictions on Abortion facilities that resulted in the closure of clinics in Texas created significant burdens on women that prevented them from having desired Abortions. These laws may also adversely affect public health by moving women who would have had Abortions in the first trimester to having second-trimester procedures.
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Abortion experiences among Zanzibari women: a chain-referral sampling study
Reproductive Health, 2016Co-Authors: Alison Norris, Daniel Grossman, Bryna J. Harrington, Maryam Hemed, Michelle J. HindinAbstract:Background In Zanzibar, a semi-autonomous region of Tanzania, induced Abortion is illegal but common, and fewer than 12 % of married reproductive-aged women use modern contraception. As part of a multi-method study about contraception and consequences of unwanted pregnancies, the objective of this study was to understand the experiences of Zanzibari women who terminated pregnancies. Methods The cross-sectional study was set in Zanzibar, Tanzania. Participants were a community-based sample of women who had terminated pregnancies. We carried out semi-structured interviews with 45 women recruited via chain-referral sampling. We report the characteristics of women who have had Abortions, the reasons they had Abortions, and the methods used to terminate their pregnancies. Results Women in Zanzibar terminate pregnancies that are unwanted for a range of reasons, at various points in their reproductive lives, and using multiple methods. While clinical methods were most effective, nearly half of our participants successfully terminated a pregnancy using non-clinical methods and very few had complications requiring post Abortion care (PAC). Conclusions Even in settings where Abortion is illegal, some women experience illegal Abortions without adverse health consequences, what we might call ‘safer’ unsafe Abortions; these kinds of Abortion experiences can be missed in studies about Abortion conducted among women seeking PAC in hospitals.
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change in Abortion services after implementation of a restrictive law in texas
Contraception, 2014Co-Authors: Daniel Grossman, Kari White, Sarah E Baum, K Hopkins, Liza Fuentes, Amanda Jean Stevenson, Joseph E PotterAbstract:Abstract Objectives In 2013, Texas passed omnibus legislation restricting Abortion services. Provisions restricting medical Abortion, banning most procedures after 20weeks and requiring physicians to have hospital-admitting privileges were enforced in November 2013; by September 2014, Abortion facilities must meet the requirements of ambulatory surgical centers (ASCs). We aimed to rapidly assess the change in Abortion services after the first three provisions went into effect. Study design We requested information from all licensed Texas Abortion facilities on Abortions performed between November 2012 and April 2014, including the Abortion method and gestational age ( Results In May 2013, there were 41 facilities providing Abortion in Texas; this decreased to 22 in November 2013. Both clinics closed in the Rio Grande Valley, and all but one closed in West Texas. Comparing November 2012–April 2013 to November 2013–April 2014, there was a 13% decrease in the Abortion rate (from 12.9 to 11.2 Abortions/1000 women age 15–44). Medical Abortion decreased by 70%, from 28.1% of all Abortions in the earlier period to 9.7% after November 2013 (p Conclusions The closure of clinics and restrictions on medical Abortion in Texas appear to be associated with a decline in the in-state Abortion rate and a marked decrease in the number of medical Abortions. Implications Supply-side restrictions on Abortion — especially restrictions on medical Abortion — can have a profound impact on access to services. Access to Abortion care will become even further restricted in Texas when the ASC requirement goes into effect in 2014.
Rachel K Jones - One of the best experts on this subject based on the ideXlab platform.
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Abortion incidence and service availability in the united states 2014
Perspectives on Sexual and Reproductive Health, 2017Co-Authors: Rachel K Jones, Jenna JermanAbstract: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.
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Abortion incidence and service availability in the united states 2011
Perspectives on Sexual and Reproductive Health, 2014Co-Authors: Rachel K Jones, Jenna JermanAbstract:CONTEXT Following a long-term decline, Abortion incidence stabilized between 2005 and 2008. Given the proliferation of state-level Abortion restrictions, it is critical to assess Abortion incidence and access to services since that time. METHODS In 2012–2013, all facilities known or expected to have provided Abortion services in 2010 and 2011 were surveyed. Data on the number of Abortions were combined with population data to estimate national and state-level Abortion rates. Incidence of Abortions was assessed by provider type and caseload. Information on state Abortion regulations implemented between 2008 and 2011 was collected, and possible relationships with Abortion rates and provider numbers were considered. RESULTS In 2011, an estimated 1.1 million Abortions were performed in the United States; the Abortion rate was 16.9 per 1,000 women aged 15–44, representing a drop of 13% since 2008. The number of Abortion providers declined 4%; the number of clinics dropped 1%. In 2011, 89% of counties had no clinics, and 38% of women of reproductive age lived in those counties. Early medication Abortions accounted for a greater proportion of nonhospital Abortions in 2011 (23%) than in 2008 (17%). Of the 106 new Abortion restrictions implemented during the study period, few or none appeared to be related to state-level patterns in Abortion rates or number of providers. CONCLUSIONS The national Abortion rate has resumed its decline, and no evidence was found that the overall drop in Abortion incidence was related to the decrease in providers or to restrictions implemented between 2008 and 2011.
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Abortion incidence and access to services in the united states 2008
Perspectives on Sexual and Reproductive Health, 2011Co-Authors: Rachel K Jones, Kathryn KooistraAbstract:CONTEXT: The incidence of Abortion has declined nearly every year between 1990 and 2005, but this trend may be ending, or at least leveling off. Access to Abortion services is a critical issue, particularly since the number of Abortion providers has been falling for the last three decades. METHODS: In 2009 and 2010, all facilities known or expected to have provided Abortion services in 2007 and 2008 were contacted, including hospitals, clinics and physicians’ offices. Data on the number of Abortions performed were collected and combined with population data to estimate national and state-level Abortion rates. Abortion incidence, provision of early medication Abortion, gestational limits, charges and antiAbortion harassment were assessed by provider type and Abortion caseload. RESULTS: In 2008, an estimated 1.21 million Abortions were performed in the United States. The Abortion rate increased 1% between 2005 and 2008, from 19.4 to 19.6 Abortions per 1,000 women aged 15–44; the total number of Abortion providers was virtually unchanged. Small changes in national Abortion incidence and number of providers masked substantial changes in some states. Accessibility of services changed little: In both years, 35% of women of reproductive age lived in the 87% of counties that lacked a provider. Fifty-seven percent of nonhospital providers experienced antiAbortion harassment in 2008; levels of harassment were particularly high in the Midwest (85%) and the South (75%). CONCLUSIONS: The long-term decline in Abortion incidence has stalled. Higher levels of harassment in some regions suggest the need to enact and enforce laws that prohibit the more intrusive forms of harassment.
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Abortion in the united states incidence and access to services 2005
Perspectives on Sexual and Reproductive Health, 2008Co-Authors: Rachel K Jones, Stanley K Henshaw, Mia R Zolna, Lawrence B FinerAbstract:Accurate information about Abortion incidence and services is necessary to monitor levels of unwanted pregnancy and womens ability to access Abortion services. All known Abortion providers in the United States were contacted for information about Abortion services in 2004 and 2005. This information along with data from the U.S. Census Bureau was used to examine national and state trends in numbers of Abortions and Abortion rates proportions of counties and metropolitan areas without an Abortion provider and accessibility of Abortion services. An estimated 1.2 million Abortions were performed in the United States in 2005 8% fewer than in 2000. The Abortion rate in 2005 was 19.4 per 1000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1787 Abortion providers in 2005 only 2% fewer than in 2000. Some 87% of U.S. counties containing 35% of women aged 15-44 did not have an Abortion provider in 2005. Early medication Abortion offered by an estimated 57% of known providers accounted for 13% of Abortions (and for 22% of Abortions before nine weeks gestation). The average amount paid for an Abortion at 10 weeks was $413-after adjustment for inflation $11 less than in 2001. The numbers of Abortions and the Abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to Abortion services. (authors)
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underreporting of induced and spontaneous Abortion in the united states an analysis of the 2002 national survey of family growth
Studies in Family Planning, 2007Co-Authors: Rachel K Jones, Kathryn KostAbstract:Underreporting of induced Abortions in surveys is widespread, both in countries where the procedure is illegal or highly restricted and in those where it is legal. In this study, we find that fewer than one half of induced Abortions performed in the United States in 1997–2001 (47 percent) were reported by women during face-to-face interviews in the 2002 National Survey of Family Growth (NSFG). Hispanic and black women and those with low income were among the least likely to report their experience of Abortion. Women were also less likely to report Abortions that occurred when they were in their 20s. Second-trimester Abortions were more likely to be reported than first-trimester terminations. The levels of recent spontaneous Abortion reported in the 2002 NSFG were consistent with the accumulated body of clinical research, although substantially more lifetime pregnancy losses were reported on self-administered surveys than in face-to-face interviews. Subsequent research should explore strategies to improve information collected on Abortion, and, in the interim, research involving pregnancy outcomes should be adjusted for unreported induced Abortions.
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The diagnostic value of beta-human chorionic gonadotropin, progesterone, CA125 in the prediction of Abortions.
Journal of Obstetrics and Gynaecology, 2010Co-Authors: Mehmet A. Osmanagaoglu, I Erdoğan, S Eminağaoğlu, Süleyman Caner Karahan, S Ozgün, Gamze Çan, Hasan BozkayaAbstract:This study was conducted to investigate the effectiveness of serum levels of free beta-hCG, progesterone, CA125 and their combined use in the prediction of first trimester Abortions. A total of 140 singleton pregnant women between 5 and 13 weeks' gestational age were included as Group I (n = 21) who resulted in Abortion including missed Abortion, incomplete Abortion, complete Abortion and inevitable Abortion; Group II (n = 129) included normal pregnancies. When using the free beta-hCG level of
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the diagnostic value of beta human chorionic gonadotropin progesterone ca125 in the prediction of Abortions
Journal of Obstetrics and Gynaecology, 2010Co-Authors: Mehmet A. Osmanagaoglu, I Erdoğan, S Eminağaoğlu, Süleyman Caner Karahan, S Ozgün, Hasan BozkayaAbstract:This study was conducted to investigate the effectiveness of serum levels of free β-hCG, progesterone, CA125 and their combined use in the prediction of first trimester Abortions. A total of 140 singleton pregnant women between 5 and 13 weeks' gestational age were included as Group I (n = 21) who resulted in Abortion including missed Abortion, incomplete Abortion, complete Abortion and inevitable Abortion; Group II (n = 129) included normal pregnancies. When using the free β-hCG level of <20 ng/ml as a cut off point, the sensitivity, specificity, PPV and NPV were 91%, 82%, 46% and 98%, when using a progesterone of <15 ng/ml as a cut off point, they were 91%, 89%, 59%, 98%. The single measurement of free β-hCG or progesterone levels can be useful in the prediction of first trimester spontaneous Abortions, but using progesterone may be recommended since it has high availability and low cost.
