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Susheela Singh – One of the best experts on this subject based on the ideXlab platform.
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 HealHealth 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.
global regional and subregional classification of Abortions by safety 2010 14 estimates from a bayesian hierarchical modelThe 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.
, 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.
Stanley K Henshaw – One of the best experts on this subject based on the ideXlab platform.
The Lancet, 2012Co-Authors: Gilda Sedgh, Susheela Singh, Stanley K Henshaw, Iqbal Shah, Elisabeth Ahman, 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.
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)
The Lancet, 2007Co-Authors: Gilda Sedgh, Susheela Singh, Stanley K Henshaw, 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.
Daniel Grossman – One of the best experts on this subject based on the ideXlab platform.
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.
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
women s experiences seeking Abortion care shortly after the closure of clinics due to a restrictive law in texasContraception, 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.
Rachel K Jones – One of the best experts on this subject based on the ideXlab platform.
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.
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.
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.
Hasan Bozkaya – One of the best experts on this subject based on the ideXlab platform.
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
the diagnostic value of beta human chorionic gonadotropin progesterone ca125 in the prediction of AbortionsJournal 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.