Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure

"When America Sneezes, the World Catches a Cold" What does overturning Roe v. Wade mean for women's reproductive health in Africa?

Communities and countries and ultimately the world are only as strong as the health of their women." - Michelle Obama, 2016 On 24 June 2022, the Supreme Court of the United States (SCOTUS) decided on Dobbs v Jackson Women's Health Center, overturning the historic Roe v. Wade decision that has, since 1973, confirmed and enshrined the constitutional right of a woman to seek an abortion1 . Restrictions to legal, safe abortions are known to have serious repercussions for maternal and infant health. Evidence shows that restricting access to abortion does not reduce the number of abortions; it only makes abortion less safe and more likely to lead to preventable complications, including maternal death. Conversely, expanding access to safe, legal abortion­a common medical procedure that carries very little risk when performed by a trained provider in an appropriate environment­is associated with improved maternal health outcomes. Further, illegal abortion results in negative societal outcomes, including chronic morbidity for the individual woman; economic burdens to women and their communities when they cannot work or finish school; and added stress to families, communities, and already over-stretched public health systems.

Roe vs. Wade: US prevarication poses threat to sub-Saharan Africa

Roe vs. Wade is a well-publicized decision of the US Supreme Court in January 1973 in which the court ruled 7-2 that the US constitution protects the liberty of a pregnant woman to choose to have an abortion without excessive government restriction1. Since then, various governments and States in the United States have applied this decision rather inconsistently, and indeed, abortion has become one of the most controversial issues in US political history2. In early May 2022, this prevarication reached its zenith when a leaked document showed that the US Supreme Court might be contemplating reversing itself on its former decision, and thereby limit women's rights to safe abortion3. If this happens, it would mean that abortion could instantly become illegal in 26 out of the 50 US States. This possibility could be reached as early as June or early July 2022. The implications of restrictive abortion law in 26 American States would not be difficult to contemplate. It would mean a major reversal of the gains in women's health and social well-being that have been achieved over the past decades, something that should be unthinkable for a major developed and exemplary country like the US. In truth, restrictive abortion laws have never been known to reduce women's desire to seek induced abortion, anywhere. It only makes the procedure more difficult to access and therefore more dangerous and unsafe for women. What the change in the law therefore means is that women requiring pregnancy termination would have to travel to other States in the US or possibly outside the country to seek safe abortion care, resulting in untold hardships. It would re-enact the case of another developed country like Romania that witnessed severe hardships and increased mortality of women after abortion became legally restricted in 1967 under President Nicolae Ceausescu4. The situation changed from 1990 when the restriction on abortion was lifted following the Romania revolution.

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options.The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared prepost differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40)

Prevalence and associated risk factors of Hepatitis B and C virus infections among mothers in Jimma, South West Ethiopia: a community-based study

Background: Viral hepatitis affects over 400 million people globally with 6 to 10 million people newly infected each year. Viral hepatitis infectious agents such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the greatest threats to the liver and can cause liver cancer. One of the most important modes of transmission of these viruses is a vertical transmission from mother to child. The aim of this study is to assess the prevalence of HBV and HCV infection as well as its associated risk factors among mothers in Jimma. Methods: A community-based cross-sectional study was conducted among 455 mothers in Jimma from June to December 2016. Simple random sampling was employed to recruit study participants and informed consent was obtained. From each mother, about 5ml of blood was collected and tested for HBsAg, anti-HBc, and HCVAg/Ab using ELISA. Chi-square and logistic regression tests were used to assess statistically significant associations between dependent and independent variables. P-values less than 0.05 were considered statistically significant. Result: HBsAg, anti-HBc and HCVAg/Ab prevalence was 5.7%, 30.5% and 2.5%, respectively. Multivariate logis-ic regression analysis showed that history of hospital admission (AOR = 3.098; P <0.040) and abortion (AOR = 15.514, P <0.001) remained independent predictors of HBsAg seropositivity. Conclusion: Hospital admission and abortion are the major risk factors for hepatitis B and C virus infection among mothers. Awareness creation for adult HBV vaccine and health education on modes of transmission should be promoted and strengthened

Clinical presentation and management outcome of emergency adolescent gynecological disorders at federal teaching hospital, abakaliki, Nigeria

Background: Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist. Objectives: The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki. Materials and Methods: This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart. Results: The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15­19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases. Conclusion: Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study

Comparison of Manual Vacuum Aspiration and Misoprostol in the Management of Incomplete Abortion

Background: Incomplete abortions can be managed expectantly; surgically and medically (using misoprostol). Expectant management is safe in places where women have access to information; appropriate care and follow-up; however; in isolated and poor areas women who come for help need an intervention.Objective: To compare the efficiency of manual vacuum aspiration (MVA) and misoprostol in the treatment of incomplete abortion.Patients and method: This was a prospective study over five months from March to August 2015. All patients admitted with a diagnosis of incomplete abortion were recruited into the study.Results: 308 patients with incomplete abortion were randomized into two treatment groups - MVA (done under local anaesthesia) and misoprostol (400 micrograms by the vaginal route). MVA was successfully performed for all patients. Two patients presented with anaemia. In the misoprostol group; 23 patients had vaginal bleeding; and 10 persistence of incomplete abortion. Conclusion: MVA is more effective than misoprostol with less complications in the treatment of incomplete abortion when it is done by a trained person

Induced Abortion in Nigeria

Objective: To obtain information on societal attitude to the issues of family planning; unwanted pregnancy; abortion; adoption of children and laws relating to them. Design: Focused group discussions. Setting: Twelve subgroups in the urban and rural areas of Ogun State; Nigeria were identified; and focus group sessions held for each subgroup. Subjects: Males and females; with their ages ranging from 15 years to above 50 years drawn from different segments of the community. Intervention: A set of guidelines/questions for the FGD were developed; field-tested and used. Main outcome measures: Rich information on such relevant issues as family planning; unwanted pregnancy; abortion and adoption of children; and the laws relating to them. Results: Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level of awareness of contraceptives and attributed its low use to negative side-effects; high cost and provider bias. More Christians than Muslims favoured planning of pregnancies. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted; if paternity of pregnancy is in dispute; or if it would save the family from shame as in rape or incest. Participants supported the enactment of laws that would make adoption of unwanted children easier. Conclusion: There is a need for policymakers to address the issue of abortion and unwanted children; and enact acceptable abortion and adoption laws to protect the rights of women and children in Nigeria

Knowledge and Perception on Consequences of Abortion among Adolescents in Amassoma Community; Bayelsa State

Unsafe abortion has been described as a schoolgirl's problem in Nigeria; where 80 of patients admitted to hospitals with abortion-related complications are adolescent girls. Hence; this research study was conducted to assess knowledge and perception on consequences of abortion among adolescents in Amassoma Community; Bayelsa State; Nigeria. A simple size of 120 respondents was drawn from the target population using purposive sampling technique. Data were collected using questionnaire and the information obtained was analyzed using descriptive and inferential statistics and level of significant was set at 5. The study revealed that majority of the respondents 61 were between the ages of 17-21 years with a minimum age of 12years and maximum age of 25 years; with a mean age of 18 and standard deviation of 2.28. The study revealed that majority of the respondents 89 had adequate knowledge of the consequences of abortion and believed that abortion is a sin and is done by immoral girls; yet more than half 60 of the respondents will encourage a person to do abortion and will even consider abortion in case of unwanted pregnancy. Majority of the respondent opined that abortion can be done in case of rape; mental illness and when the mother's life is in danger but 40 of the respondents said they will never go for an abortion under any circumstances. The study also revealed that there was a significant association between the age of respondents and the level of knowledge; as well as significant association between the level of knowledge and perception on the consequences of abortion with p 0.05. It is recommended that Public enlightenment programmes on unsafe abortion and its consequences should be given to adolescents for value clarification and proper attitude transformations

Characteristics of Women Having First-Trimester Termination of Pregnancy at a District Hospital in Kwazulu-Natal

Termination of pregnancy (TOP) is requested by some women for a variety of reasons and it is plausible that profiling their characteristics might help to target selected groups for counselling. This study aimed to determine the characteristics of women having a legal first-trimester TOP at a regional hospital in KwaZulu-Natal. The medical records of 254 women were retrospectively sampled and analysed from a total of 758 women who had a first-trimester TOP between January and December 2008. The women were aged 14-45 years (the most common age group was 20-29 years; a mean age of 25.3 years and a standard deviation of 5.9). The majority (75.6) reported that they had at least one child who was alive; 1.6 had previously had a TOP; 93.3 were single and 28.4 resided outside the health district in which the hospital was situated. Eighty-nine per cent had not used contraception before the index pregnancy. Fifty-eight per cent requested a TOP between 9 and 12 weeks of gestation (a mean of 8 weeks). Ninety-six per cent had a TOP because of socio-economic reasons. All of the women received counselling prior to undergoing TOP. In our patient population; women who had a legal TOP in the first trimester were in their twenties; single; parous; sexually active; not on a contraceptive and of poor socio-economic status. Women with these characteristics should be targeted for appropriate counselling on reproductive health matters

Contraceptive Use and Prevalence of Sexually Transmitted Infections among Women Seeking Termination of Pregnancy at a District Hospital in Kwazulu-Natal

Termination of pregnancy (TOP) is one of the components of female reproductive health and rights that are freely available in South Africa within the public health system; and yet unwanted pregnancies still remain a challenge. The objectives of this study were to determine the level of knowledge and use of contraceptive methods among women seeking TOP services and to evaluate the prevalence of human immunodeficiency virus (HIV) and other sexually transmitted infections in this group of women. This population-based study was conducted at Northdale Hospital in KwaZulu-Natal. Four hundred and ninety-seven women seeking TOP were interviewed over a period of six months; using a structured questionnaire. The mean age of the women was 25 years. The majority of the participants were black Africans (n = 424; 85.3;) and single (n = 423; 85); respectively. Most participants (n = 354; 71) were unemployed; having obtained a secondary school education level. The majority (n = 420; 84.5) indicated that they had previously used some form of contraception. However; condom use was used by only 18 (n = 78). The HIV prevalence among women requesting TOP was 39. Nearly half of the participants (45.9) had abnormal vaginal discharge and 50 of those who had tested for syphilis received an abnormal result. This study reinforces the need to intensify sexual and reproductive health programmes among women seeking TOP

Contraceptive knowledge and practices among pregnant females in Lower Umfolozi District War Memorial Hospital; KwaZulu-Natal

In South Africa there has been a decline in the proportion of women who have ever used contraception; while 30 to 50 of women present with unwanted and unplanned pregnancies. This study aimed to describe the contraceptive knowledge and practices among women aged 18 to 49; attending the antenatal clinic at LUDWM Hospital in KwaZulu-Natal; by means of a cross-sectional survey. The majority of the 286 respondents (76.6) were aged 18 to 29 years; 65.8 of the pregnancies were unplanned. Most (80.1) knew about injectable contraception. Condoms were used by 85.3; followed by injectable contraception (80) and oral contraceptives (62.5). Contraception was discontinued because of irregular vaginal bleeding (14) or weight gain (3.8). Of the women who planned for this pregnancy; 69 were using oral contraceptives. The general knowledge of modern contraception among the women was good; condoms were the contraception of choice; and most accessible. Employed women used emergency contraception and the withdrawal method more often than unemployed women. However; the most common forms of contraception used by both employed and unemployed women were condoms; oral contraceptives and injectable contraception. In this study the high unemployment rate; low education and limited access to modern contraception were associated with low contraceptive utilisation and high rates of unwanted pregnancies

Abortion Incidence and Postabortion Care in Rwanda

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. (StudieS in Family Planning 2012; 43[1]: 11-20)

An Unusual Case of Double Aneuploidy of Down Syndrome Associated with Triple x Syndrome: 48;xxx;21

Down syndrome is the most common chromosomal abnormality in humans with an estimated incidence of one case in 770 live births. However; the occurrence of double aneuploidy involving autosome and or sex chromosome is a very rare phenomenon in lives born and the majority of reported cases are presented in form of spontaneous abortions. Here; we are reporting a case of a Rwandan patient with combination of trisomy 21 and triple X syndrome. The proband was 8-month-old female with typical features of Down syndrome. In additional to Down syndrome features; the child presented with minor features of triple X syndrome characterized by hypotonia and seizures

Post Operative Miscarriage Following Ruptured Appendix in Pregnancy

Acute appendicitis in pregnancy though rare; is the most common non- obstetric complication warranting emergency laparotomy. Gestational physiological changes make difficult the diagnosis and delay in diagnosis and surgery results in increased complications. We present a-24 year old primiparous lady at 16 weeks of gestation who was referred from a private hospital to the accident and emergency unit of the University of Port Harcourt Teaching Hospital with 6 days history of abdominal pain; fever and vomiting at an ultrasound gestational age of 16 weeks and managed as case of ruptured appendix in pregnancy. She had laparotomy and appendicectomy. Intraoperative findings were purulent peritoneal exudates; ruptured appendix with flakes of necrotic tissues and fecolith. She subsequently had post operative miscarriage 48hours after the surgery which was completed by manual vacuum aspiration. She did remarkably well and was discharged on the 7th post operative day. Delay in diagnosis of appendicitis in pregnancy and surgery correlates to a more advanced disease with an increased risk of appendiceal rupture; which may contribute to increased risk of further complications. Prompt surgical intervention should be performed when acute appendicitis is suspected during pregnancy

Utilization of Post-Abortion Care Services in Three Regional States of Ethiopia

Background: In Ethiopia; utilization of post-abortion care service is minimal and it seems that the expanding services are underutilized. The purpose of this study was to assess factors which influence decisions for utilization of abortion related services at community level. Methodology: The study was carried out in six selected districts (woredas) within the three big regions of the country; namely Amhara; Oromiya and SNNPR. The study employed a descriptive cross-sectional design. Both quantitative and qualitative study techniques; including structured interview questionnaires; focus group discussions (FGDs); and in-depth interviews. The study population comprised randomly selected 1;492 women of reproductive age; service providers; and key informants of the sampled districts. Results: Majority of respondents said that they prefer public health facilities. According to the respondents; the reason why women do not visit health facility for PAC services include lack of community support; unavailability of services; services are expensive; facilities are distantly located and lack of means of transportation. From the multivariate analysis it appears that public health facilities are preferred by younger respondents; those with no education; those with no history of unwanted pregnancy and those with better income. The qualitative study indicated that women do not go to health facilities for PAC mainly because of inappropriate treatment by providers at the health facilities. Conclusion: Public health facilities especially health centers are the most preferred but there are barriers that should improve. Introduction of supportive supervision should be considered as a tool for improving quality of care. A mechanism should be in place to obtain community opinion regularly and use it to continuously improve services. To correct some misconceptions and improve community awareness on abortion related issues community providers; including reproductive health agents and health extension workers can teach about availability of services and about abortion related complications

A Qualitative Exploration of HIV-Positive Pregnant Women's Decision-Making Regarding Abortion in Cape Town; South Africa

HIV-positive women's abortion decisions were explored by: (i) investigating influencing factors; (ii) determining knowledge of abortion policy and public health services; and (iii) exploring abortion experiences. In-depth interviews were held with 24 HIVpositive women (15 had an abortion; 9 did not); recruited at public health facilities in Cape Town; South Africa. Negative perceptions towards HIV-positive pregnant women were reported. Women wanted abortions due to socio-economic hardship in conjunction with HIV-positive status. Respondents were generally aware that women in South Africa had a right to free abortions in public health facilities. Both positive and negative abortion experiences were described. Respondents reported no discrimination by providers due to their HIV-positive status. Most respondents reported not using contraceptives; while describing their pregnancies as `unexpected'. The majority of women who had abortions wanted to avoid another one; and would encourage other HIV-positive women to try to avoid abortion. However; most felt abortions were acceptable for HIV-positive women in some circumstances. Data suggested that stigma and discrimination affect connections between abortion; pregnancy and HIV/AIDS; and that abortion may be more stigmatised than HIV/AIDS. Study results provide important insights; and any revision of reproductive health policy; services; counselling for abortion and HIV/AIDS care should address these issues