Women's Health Commons^™

Induced Abortions And Unintended Pregnancies In Pakistan, 2012, Population Council

Reproductive Health

The 2012–13 PDHS (Pakistan Demographic and Health Survey) shows that gains in contraceptive prevalence over the past decade have been small, and unmet need has remained high. Using data from a 2012 national study on post-abortion care, we estimate 2.2 million abortions occurred in Pakistan in 2012, and an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 for 2002. Even accounting for an underestimation of abortion incidence (private sector abortion services could not be included) in the prior study, the abortion rate in Pakistan has likely increased substantially between 2002 and …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape: A Review Of Policies, Programmes And Country Experiences In Sub-Saharan Africa, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

This study examined how pregnancy prevention and management services (specifically, the provision of emergency contraception, pregnancy testing and counseling, and termination or referral for termination of pregnancy services) feature within post-rape care services in sub-Saharan Africa. The study drew on a range of sources via a desk review, as well as on information provided through key informant interviews. The existence of numerous national guidelines in the region demonstrates countries’ desire to respond to this public health and legal challenge. However, if left in their current state, the gaps and inconsistencies observed across most national guidelines contribute to a violation of …

Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian

Reproductive Health

A review of literature and analysis of large surveys were carried out with funding from the STEP UP consortium led by Population Council to build a coherent body of robust research-based evidence on the situation in India in the context of unmet need for family planning (FP) and safe abortion services. The study found that there is insufficient training of different cadres of health staff in the public health system on abortion provision, post-abortion care, FP counseling of young couples, emergency contraception, and IUD insertion/removal. Despite service delivery guidelines in India expecting providers to provide FP counseling during antenatal visits, …

Libertarian Patriarchalism: Nudges, Procedural Roadblocks, And Reproductive Choice, Govind Persad

Georgetown Law Faculty Publications and Other Works

Cass Sunstein and Richard Thaler's proposal that social and legal institutions should steer individuals toward some options and away from others-a stance they dub "libertarian paternalism"-has provoked much high-level discussion in both academic and policy settings. Sunstein and Thaler believe that steering, or "nudging," individuals is easier to justify than the bans or mandates that traditional paternalism involves.

This Article considers the connection between libertarian paternalism and the regulation of reproductive choice. I first discuss the use of nudges to discourage women from exercising their right to choose an abortion, or from becoming or remaining pregnant. I then argue that …

Bad Medicine: Abortion And The Battle Over Who Speaks For Women's Health, Andrea D. Friedman

William & Mary Journal of Race, Gender, and Social Justice

No abstract provided.

Roe V. Wade At 40, Gerard V. Bradley

Journal Articles

Under the leadership of Chief Justice Warren Burger, who joined it in 1969, the Supreme Court departed from the course taken during the 16-year tenure of his predecessor, Earl Warren. The Burger Court rolled back precedents in criminal procedure and obscenity, while stopping the drive to universalize welfare rights and equalize public schooling expenditures. Roe v. Wade (1973), on the other hand, extended the Warren Court's deepest commitments: sexual liberation, obviously; equality, with respect to both race and class; and even church-state separation, insofar as the Roe Justices identified opposition to abortion with Catholic dogma. These more or less "progressive" …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape And Defilement In Sub-Saharan Africa: A Regional Overview, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

No abstract provided.

Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …

Availability, Use And Quality Of Care For Medical Abortion Services—Preliminary Results Of Two Components: Kiis And The Pharmacy Study, Wilson Liambila, Harriet Birungi, Francis Onyango, Brian Mdawida, Vitalis Akora, Thoai Ngo, Kate Reiss

Reproductive Health

No abstract provided.

Increasing Access To Safe Abortion In Rural Maharashtra: Outcomes Of A Comprehensive Abortion Care Model, Shireen J. Jejeebhoy, A.J. Francis Zavier, Rajib Acharya, Shveta Kalyanwala

Reproductive Health

This assessment of a Comprehensive Abortion Care (CAC) model was conducted by the Population Council on behalf of the Consortium for Safe Abortions in India. The goal of the Consortium is to increase access to legal, safe, and comprehensive abortion services, including post-abortion family planning, in the public health system, and especially among the rural poor. This report describes the CAC model implemented in Aurangabad district, Maharashtra, and examines the extent to which the model improved (a) the availability and quality of abortion services in public sector facilities, and (b) women’s awareness and experiences with regard to abortion services. It …

Increasing Access To Safe Abortion In Rural Rajasthan: Outcomes Of A Comprehensive Abortion Care Model, Shireen J. Jejeebhoy, A.J. Francis Zavier, Rajib Acharya, Shveta Kalyanwala

Reproductive Health

This report describes an assessment by the Population Council of the Comprehensive Abortion Care (CAC) model implemented in Tonk district, Rajasthan. Findings highlight that at the time of the baseline survey, the availability of abortion services was limited; also evident was the poor quality of abortion-related care. Given this context, and given the short duration of implementation, the changes achieved by the intervention are promising. The district-level CAC model succeeded in strengthening facilities, training providers, and increasing women’s access to safe abortion services at the Primary Health Centre level. Community-level activities were less successful, attributable to a considerable extent to …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

Introduction Of Medical Abortion In Ghana, Emmanuel Kuffour, Selina F. Esantsi, Placide Tapsoba, Gloria Quansah Asare, Ian Askew

Reproductive Health

To significantly expand women’s access to modern family planning and comprehensive abortion care services a provisional license was awarded to Marie Stopes International-Ghana by the Ghana Food and Drugs Board for the introduction and provision of the first medical abortion regimen (mifepristone and misoprostol) in Ghana. The Population Council conducted this study to document the introduction process; findings from the study will provide much needed evidence to inform policy decisionmaking and the scale-up phase. Overall the study has shown that medical abortion is a viable option for Ghanaian women--an overwhelming number of those who have benefitted from the procedure are …

Determinan Abortus Di Indonesia, Titik Kuntari, Siswanto Agus Wilopo, Ova Emilia

Kesmas

Abortus menjadi masalah yang penting dalam kesehatan masyarakat karena berpengaruh terhadap morbiditas dan mortalitas maternal. Di Indonesia, belum ada data yang komprehensif tentang kejadian abortus, berbagai data yang ada sebelumnya berdasarkan survei dengan cakupan yang relatif terbatas. Abortus yang tidak aman bertanggung jawab terhadap 11% kematian ibu di Indonesia. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian abortus di Indonesia. Penelitian ini dilaksanakan dengan metode observasional menggunakan disain studi cross sectional. Data penelitian diperoleh dari data Survei Demografi dan Kesehatan Indonesia 2002-2003. Analisis data dilakukan secara bertahap yaitu: analisis univariat, analisis bivariat dan analisis multivariat dengan regresi logistik. …

Assessing Abortion-Related Experiences And Needs In Four Districts Of Maharashtra And Rajasthan, 2006, Shireen J. Jejeebhoy, A.J. Francis Zavier, Shveta Kalyanwala

Poverty, Gender, and Youth

Recognizing the urgent need to enable rural women to acquire accessible and high-quality abortion services in India, a consortium of organizations—including the Population Council—has come together with the goal of increasing access to legal, safe, and comprehensive abortion services, including postabortion family planning, in the public health system, especially among the rural poor. One of its key activities was to develop a comprehensive and evidence-based abortion care model suitable for rural women. The aim of this report is to shed light on community-level perspectives about abortion services and probe the experiences of women who had undergone abortion, to better understand …

The Role Of Abortion In The Last Stage Of Fertility Decline In Vietnam, Bussarawan Teerawichitchainan, Sajeda Amin

Poverty, Gender, and Youth

Vietnam’s rapid fertility decline can be explained by very high rates of contraceptive use and induced abortion, but despite the overall decline, fertility rates vary considerably across the country’s 54 ethnic groups. To explore the prospects for further fertility decline through use of abortion among high-fertility minority populations, this study analyzes unique data from the Vietnam National Health Survey to examine ethnic differentials in prevalence and determinants of abortion and contraception, using a new classification system for ethnicity. The report concludes that providing improved abortion services alone is unlikely to reduce fertility among high-fertility minority groups. Service provision needs to …

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Exploring The Choices Of Contraception And Abortion Among Married Couples In Tret, Rural Punjab, Pakistan, Muhammad Shafique Arif, Iram Kamran

Reproductive Health

In Pakistan, the contraceptive prevalence rate is 28 percent, unmet need for family planning services is 33 percent, and unwanted pregnancies are on the rise. A national study showed a fairly high induced abortion rate of 29 per 1,000 married women of reproductive age, and 1 out of 6 pregnancies resulted in induced abortion. This study explored how contraception and induced abortion are perceived as options for avoiding unwanted births by Pakistani men and women, to what extent they deliberately choose one over the other, and the language they use to talk about reproductive behavior decision-making. As noted in this …

Avances En La Atención Postaborto En América Latina Y El Caribe: Investigando, Aplicando Y Expandiendo, Deborah L. Billings, Ricardo Vernon

Reproductive Health

This work by the Population Council and Ipas documents the intellectual, financial, and managerial effort that many organizations and institutions in Latin America and the Caribbean have made to achieve the objective of improving the quality and effectiveness of postabortion care services. This volume is a contribution to the preparation of directors, owners, and service providers, and to the creation and implementation of policies and programs based on scientific evidence, which will benefit women and the services themselves. Its five sections include an overview; results from country studies, and information about providers and program components; clinical care with various technologies, …

From Patna To Paris: Providing Safe And Humane Abortion, Carmen Barroso, Martha Brady, Batya Elul, Shelley Clark, Sneh Vishwanath, Sunanda Rabindranathan

Poverty, Gender, and Youth

With access to safe, legal abortion under severe constraint or debate in many parts of the world, less attention has been paid to the issue of quality of abortion care. This issue of Quality/Calidad/Qualité explores two programs that operate in very different settings but with a shared commitment to providing high-quality abortion care in a context of broader reproductive health services: the Clinique d’Orthogénie of Broussais Hospital in France and Parivar Seva Sanstha in India. In both programs, each woman or girl who arrives for abortion receives crucial basic care, including: appropriate medical treatment to ensure complete abortion and safe …

Senegal: Train More Providers In Postabortion Care, Frontiers In Reproductive Health

Reproductive Health

Recognizing unsafe abortion as a serious health problem, the government of Senegal adopted a national health strategy in 1997 that aims to halve the number of unsafe abortions by 2001. In 1997, the Center for Training and Research in Reproductive Health (CEFOREP) and the Obstetrics and Gynecology clinic (CGO) at Le Dantec University Teaching Hospital in Dakar introduced new clinical techniques to improve emergency treatment for women with complications from miscarriage or abortion. CGO and two other teaching hospitals served as pilot sites. Physicians, nurses, and midwives at the three sites received training in manual vacuum aspiration, family planning, and …

Senegal: Capacite A Más Proveedores En Atención Postaborto, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Kenya: Offer Family Planning On Hospital Wards, Frontiers In Reproductive Health

Reproductive Health

In Kenya, more than one in three women hospitalized for gynecological problems has complications from miscarriage or unsafe abortion. These women generally receive no information or services for family planning (FP) or other reproductive health needs. During 1996–97, the Kenya Ministry of Health, the Population Council, and Ipas tested three models for providing postabortion care (PAC) and FP information and services in two areas of the hospital. Researchers compared model effectiveness by using surveys before and after the intervention. As concluded in this brief, the most effective way to ensure that women being treated for incomplete abortion obtain FP is …

Kenia: Ofrezca Servicios De Planificación Familiar En Salas Hospitalarias, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Kenya: Identifying Rtis Remain Problematic: Prevention Is Essential, Frontiers In Reproductive Health

Reproductive Health

Since 1990, the Nakuru Municipal Council (Kenya) has implemented a multifaceted program to reduce the incidence of reproductive tract infections (RTIs), especially those that are sexually transmitted, including HIV/AIDS. Staff in the Council’s five health clinics use syndromic management guidelines, based on clients’ reported symptoms and clinical signs, to identify clients with RTIs. In 1998, the Population Council conducted a study to assess the accuracy of syndromic management and determine the best ways to integrate RTI management into existing antenatal (ANC) and family planning (FP) services. After an assessment of existing RTI services, 18 nurses from the five municipal clinics …

Kenia: La Identificación De Las Itr Sigue Siendo Un Problema: La Prevención Es Esencial, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Kenya: L'Identification Des Iar Demeure Hasardeuse: La Prévention Est Primordiale, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Estimating Costs Of Post-Abortion Services. General Hospital Aurelia Valdivieso, Oaxaca, Mexico, Population Council

Reproductive Health

Health care systems around the world are facing problems providing quality care with increasingly constrained resources. While modern practices and diagnostic tests have made pregnancy a much less risky event than in the past, not all pregnancies have a favorable outcome. Spontaneous abortion occurs in 15–45% of all known pregnancies, and studies show that 25% of all obstetric/gynecology hospital admissions are for incomplete abortion. Given the high level of resources devoted to treating this condition, it is imperative to develop cost-effective methodologies to provide quality care. Unsafe abortion performed by untrained and inexperienced providers is the fourth leading cause of …