HIV and induced abortion among migrants from sub-Saharan Africa living in Île-de-France: Results of the PARCOURS study.

Introduction: HIV heavily affects sub-Saharan African women living in France and can impact reproductive decisions. It was investigated whether HIV was associated with induced abortion in pregnancies held after migration by women from sub-Saharan Africa living in Île-de-France. Methods: We used data on ANRS Parcours, a retrospective life event survey conducted in health facilities in the metropolitan region of Paris, between February 2012 and May 2013, with migrants from sub-Saharan Africa. Data on the history of pregnancies were collected among women living with HIV (HIV group) and those attending primary care centers (reference group). We investigated 242 women in the reference group, who had 729 pregnancies, and the 277 women in the HIV group, who had 580 pregnancies. The association between abortion and HIV was evaluated using clustered logistic models, successively adjusted for women and pregnancy characteristics, for the whole sample, and stratified by pregnancy intendedness. Results: In the reference group, 11.0 % of pregnancies were terminated in abortion, the same situation as 14.1 % in the HIV group (p = 0.124). HIV was not associated with abortion in the crude and adjusted models. However, after adjustments, HIV exhibited a non-significant trend towards reducing the likelihood of abortion, particularly when considering the intendedness of pregnancy variable. Conclusions: Factors that shape the overall context of women's lives and pregnancies, which are shared with the reference group, may have a more significant impact on reproductive decision-making than HIV alone. Health services must pay attention to the intendedness of pregnancies, providing advice and support on the prevention of mother-to-child transmission to women living with HIV who intend to become pregnant, in addition to strengthening the provision of family planning and the prevention of unintended pregnancies.

[Women's rescuers network: Community support for self-managed abortion in Argentina]. / Socorristas en red: Soporte comunitario a la autogestión del aborto en Argentina.

The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

La disponibilidad de medicamentos para producir un aborto, sobre todo en contextos de acceso restringido, transformó las prácticas y permitió que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar, interactuando o no con el sistema de salud. Este estudio recupera la experiencia de una organización feminista de la comunidad que, desde la provincia de Neuquén, se extiende a todo el país, generando una red de cuidados comunitarios. Se realizó un estudio exploratorio descriptivo, con enfoque cualitativo con el propósito de analizar las experiencias de las mujeres que facilitan el acceso al aborto permitido en Argentina. A través de entrevistas en profundidad a tres líderes de la colectiva feminista La Revuelta y de entrevistas semiestructuradas a 33 integrantes de las grupas socorristas, realizadas entre noviembre de 2019 y diciembre de 2020, describimos su historia y los procesos de trabajo y crecimiento; exploramos sus motivaciones y sentimientos y caracterizamos las interacciones de dichas organizaciones con los sistemas de salud público y privado. Los resultados de este trabajo coinciden con la conversación y la producción bibliográfica internacional acerca de estas organizaciones y sus particularidades y con la necesidad de incorporar estos cuidados a los sistemas de salud institucionales.

The prevalence and correlates of unintended pregnancy among female sex workers in South China: a cross-sectional study.

BACKGROUND: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. METHODS: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. RESULTS: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71-4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74-7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14-0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10-0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. CONCLUSIONS: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW.

Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited.To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy.Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week.The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW.

Lifetime induced abortions and live births. A 40-year historical cohort study.

OBJECTIVE: Little is known about whether induced abortions are associated with the final lifetime number of live births (life births). The objective of this study was to examine the association of number of life births with number of abortions a female has had in her lifetime. METHODS: In a national cohort design, we followed all Danish females from ages 15 to 44 years through the period 1977-2017 for induced abortions and live births. For each lifetime number of induced abortions, the average number of life births were assessed, and rates with 95% confidence limits calculated. RESULTS: The study included 409 497 females who completed 222 482 induced abortions and 831 742 live births. In 265 573 (64.9%) females who did not have any induced abortion, the average number of life births was 2.09 (95% CI 2.08-2.10). For females with 1 (23.4%), 2 (7.4%), 3 (2.6%), 4 (1.0%), and ≥5 (0.7%) induced abortions during their reproductive lifespan, the average number of life births was 1.88 (1.87-1.89), 1.99 (1.98-2.00), 2.09 (2.06-2.11), 2.13 (2.09-2.15), and 2.25 (2.21-2.29), respectively. The increase in number of life births in females with 1 to females with 5+ induced abortions was 4.7% for each additional induced abortion. CONCLUSION: We found number of induced abortions during a woman's reproductive lifespan to be positively correlated to the number of live births. This association is likely explained by a high fecundity in females with multiple pregnancies including induced abortions, and suggests that even several induced abortions do not compromise a woman's general reproductive end points.

The efficacy of early office hysteroscopy in preventing intrauterine adhesions after abortion: a randomized controlled trial.

BACKGROUND: Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. METHODS: A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. RESULTS: The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. CONCLUSIONS: Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .

The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022.

OBJECTIVE: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

Case report: Peritonitis secondary to traumatic bowel perforation during second-trimester surgical abortion.

INTRODUCTION AND IMPORTANCE: Uterine perforation and bowel injury are rare but potentially life-threatening complications of surgical abortion. Early diagnosis results in easier management and better prognosis. We report here a case of a 39-year-old presented with peritonitis secondary to traumatic bowel perforation after second-trimester surgical abortion. CASE PRESENTATION: A 39-year-old Gravida 3 Para 2 presented with acute abdominal pain two days after second trimester induced abortion. On physical examination, the patient was febrile and hypotensive with diffuse abdominal tenderness. Emergency abdomino-pelvic-CT showed generalized peritonitis with pneumoperitoneum. The patient underwent an emergency laparotomy. Per operative exploration revealed a perforation of the fundus of the uterus and the sigmoid portion of the large intestine, resulting in stercoral peritonitis. We proceeded with thorough cleansing of the abdominal cavity with physiological serum, followed by partial colectomy including the perforated sigmoid and a Hartmann's procedure. The patient was admitted to the post-operative intensive care unit for 18 days and discharged on day 27 after the surgery. Intestinal continuity restoration was performed six months after the surgery. CLINICAL DISCUSSION: Given the severity of second trimester pregnancy termination complications, efforts should be made to promote contraception and medical first-trimester pregnancy termination. Any unusual symptom after surgical induced abortion should lead to suspect uterine perforation. CONCLUSION: Uterine perforation during induced abortion is usually asymptomatic and can generally be managed conservatively. However, bowel injury may result in peritonitis, requiring immediate laparotomy and resection of perforated bowel. CT-scans can help diagnose this rare complication.

Developing a comprehensive abortion prevention program for couples based on I-change model: study protocol for a mixed method research.

BACKGROUND: In countries where abortion laws are stringent, induced abortions are prevalent. The limited availability of abortion services within these regions amplifies the likelihood of maternal complications and mortality. Induced abortions represent a significant public health concern in Iran and are characterized by a multitude of intricate factors that remain largely unexplored. Gaps in knowledge persist pertaining to the influences driving induced abortion within the Iranian context. To adequately address the issue of induced abortion, it is imperative to discern the determinants that shape the decision-making process. The primary objective of this study was to design an intervention program focused on mitigating the occurrence of induced abortion within couples, with an emphasis on identifying the key factors that contribute to this phenomenon. METHODS: This study comprises three phases. In the first phase, a qualitative approach based on the I-change model will be employed to identify the factors influencing induced abortion. The second phase involves a systematic review to identify the determinants of induced abortion and strategies to prevent induced abortion. In the third phase, the outcomes of the qualitative approach and systematic review will be shared with experts and specialists using the Delphi method to categorize and prioritize strategies. Subsequently, based on the final consensus, a comprehensive program will be developed to prevent induced abortion. DISCUSSION: This study introduces an I-change model-based program for the prevention of induced abortion. The prevention of induced abortion holds great significance in mitigating maternal morbidity and mortality, curtailing healthcare expenses, and fostering population growth rates. The research findings will be disseminated via reputable peer-reviewed journals and communicated to the academic and medical communities. This dissemination aims to provide valuable insights that can contribute to the advancement of induced abortion and abortion prevention programs.

Induced abortion is restricted in Iran, and many married women with unintended pregnancies resort to clandestine procedures, resulting in adverse health outcomes. Induced abortion contributes to 2.3% of maternal mortality rates in the country. Understanding the factors influencing abortion is crucial for designing effective preventive interventions. Due to cultural and political sensitivities, reliable data on the determinants of induced abortion in Iran, particularly from the perspective of male partners, remain scarce. Existing research primarily focuses on women's views, neglecting the potential influence of men on abortion-related decisions. This study aims to bridge this gap by investigating the determinants of induced abortion in couples and developing a comprehensive couple-based abortion prevention program in Iran. Employing a mixed-methods approach, this study explored the factors associated with couples' decisions regarding abortion. Subsequently, a systematic review will identify existing knowledge on abortion determinants and preventive strategies. On the basis of this comprehensive understanding, an evidence-informed abortion prevention plan will be devised. The findings of this study can inform policymakers and population/reproductive health experts, ultimately aiming to reduce the burden of negative health and social consequences associated with abortion, leading to cost reductions and improved health outcomes for women, families, and society.

Defying the odds: Facilitating integration of abortion care into clinical practice in the United States.

OBJECTIVES: We sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion provision. STUDY DESIGN: In this qualitative study, we conducted semistructured interviews with a national sample of obstetrician-gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach. RESULTS: We interviewed 14 obstetrician-gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies. CONCLUSIONS: Institutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices. IMPLICATIONS: Maximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.

Examining service delivery patterns before and after implementation of a direct-to-patient telehealth service providing medication abortion in Australia.

In August 2016, MSI Australia (MSIA) brought to scale a direct-to-patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre- and post-periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas.

How have changes in accessibility and public funding influenced contraceptive use among Norwegian adolescents? A cohort study.

INTRODUCTION: The Norwegian Government introduced in 2002 a reimbursement scheme for hormonal contraceptives to adolescents at the same time as public health nurses and midwives received authorization to prescribe hormonal contraceptives. This study examines the impact of increased accessibility and public funding on hormonal contraceptive use among adolescents. MATERIAL AND METHODS: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989-1990, 1994-1995, and 1999-2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi-squared test, survival analysis, and Joinpoint regression analysis with p-values < 0.05. RESULTS: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen-only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long-acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002. CONCLUSIONS: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long-term first-time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long-term first-time hormonal contraceptive users.

Induced abortion and ectopic pregnancy: A systematic review and meta-analysis.

OBJECTIVE: Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP). METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software. RESULTS: A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81-2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92-1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88-15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38-2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001-2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution. CONCLUSION: This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women's fertility.

Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial.

BACKGROUND: International guidelines recommend placement of intrauterine devices immediately after second-trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. OBJECTIVE: This study aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at 2 to 4 weeks after second-trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at 2 to 4 weeks after the abortion, in terms of the proportion of intrauterine device use after 6 months, with maintained safety and acceptability. STUDY DESIGN: In this open-label, randomized, controlled, superiority trial, we recruited participants at 8 abortion clinics in Sweden. Eligible participants were aged ≥18 years, requesting medical abortion with gestation ≥85 days, and opting for use of a postabortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in nonnormal continuous variables were analyzed with the Mann-Whitney U test, and differences in dichotomous variables with the chi-square or Fisher exact tests. A P value <.05 was considered statistically significant. Group differences are presented by modified intention-to-treat and per-protocol analyses. RESULTS: Between January 2019 and June 2022, we enrolled 179 participants, of whom 90 were assigned to the intervention and 89 to the control arm. Enrollment was prematurely stopped after an interim analysis exceeded a predefined intrauterine device expulsion rate of 20%. According to modified intention-to-treat analysis, use of intrauterine device after 6 months was 50.7% (34/67) in the intervention group vs 71.6% (48/67) in the control group (proportion difference, 20.9%; 95% confidence interval, 4.4%-35.9%; P=.02). The intrauterine device expulsion rate was 30.1% (22/73) in the intervention group vs 2.9% (2/70; P<.001) in the control group. Other adverse events were rare and patient acceptability was high in both groups. CONCLUSION: Intrauterine device placement within 48 hours after second-trimester medical abortion was nonsuperior in terms of the proportion of intrauterine device use after 6 months when compared with placement after 2 to 4 weeks. Placement within 48 hours after second-trimester abortion can be used in selected individuals after counseling on expulsion risk.

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey.

BACKGROUND: Repeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women. METHODS: We used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15-49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables. RESULTS: Of the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25-34 years (AOR:2.16;95%CI = 1.66-2.79) or 35-49 years (AOR:2.95;95%CI:2.18-3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25-12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03-2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33-1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07-1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49-0.93), Northern (AOR:0.46;95%CI:0.24-0.88), Upper West (AOR:0.24; 95%CI: 0.12-0.50) and Upper East (AOR:0.49; 95%CI = 0.24-0.99) regions were less likely to have repeat induced abortion. CONCLUSION: The study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

Roe v. Wade Overturned: The Association of Acculturation with Interest in and Awareness of Hospital Services for Family Planning Among Hispanic Women.

Introduction: The overturning of Roe v. Wade impacted family planning services in many areas of the United States (US). Our study investigates the association of acculturation with interest in and awareness of family planning hospital services of contraception and elective termination of pregnancy among Hispanic women. Methods: We surveyed 306 Hispanic women at a public hospital in a Long Island suburb of New York City. Predictor variables were acculturation (language, media, ethnic social relations) measured by the Short Acculturation Scale for Hispanics and years lived in the US. Outcome variables were interest in and awareness of hospital services of family planning for elective abortion and non-elective non-abortion family planning methods. Results: For interest in hospital services, both language and ethnic social relations acculturation were significantly positively associated with almost all family planning methods whether abortion or non-abortion. However, media acculturation and years lived in the US were significantly positively associated with abortion but not the non-abortion methods. For awareness of hospital services, only language acculturation was significantly positively associated with abortion and some nonelective non-abortion family planning methods. Conclusion: We recommend that healthcare providers and hospitals should be aware of acculturation levels when providing counseling and information about family planning methods to Hispanic women.

Complex journeys of adolescents after induced abortion: A qualitative systematic review.

PROBLEM: Adolescents face unique challenges in accessing sexual healthcare, particularly regarding induced abortion experiences. Prior research, often quantitative or biased towards young adults, overlooks this. This review aims to address adolescents' specific post-abortion experiences to inform comprehensive reproductive healthcare needs. ELIGIBILITY CRITERIA: Qualitative and mixed-methods studies exploring the experiences of adolescents following induced abortion were included. Studies reporting these experiences from third-person perspectives were excluded. SAMPLE: Five electronic databases (CINAHL, PubMed, PsycINFO, Web of Science, and Embase) were searched from the databases' inception through March 2024. Of the 2834 articles retrieved, 45 studies were included in this review. RESULTS: Using a meta-synthesis approach combining Sandelowski & Barroso's qualitative metasummary with Braun & Clarke's thematic analysis, three main themes emerged: Post-abortion experiences and emotions, Social dynamics and support, and Life post-abortion and future perspectives. CONCLUSIONS: Adolescents who underwent abortion faced physical and emotional challenges, adopted various coping strategies, and had mixed experiences with social support and healthcare providers. To address these challenges, the provision of comprehensive reproductive health information, access to safe and legal abortion options, and support for their physical, social, and emotional well-being is necessary. Healthcare providers must ensure that adolescents are equipped with necessary skills to navigate their reproductive health journeys with informed choices and confidence. IMPLICATIONS: Future research exploring adolescents' experiences, considering cultural beliefs, involving multiple stakeholders, and conducting longitudinal studies, is warranted. Healthcare providers should implement practice changes, including providing accurate information, offering tailored mental health support, and undergoing adolescent-friendly training, to enhance care for adolescents.

Safety and effectiveness evaluation of a uterine direct visualization system in induced abortion. A multicenter clinical trial.

OBJECTIVES: While the decision of abortion is undeniably complex, there are situations where it becomes a necessary choice. In such circumstances, a secure abortion procedure is essential to safeguard the physical and mental well-being of women. A uterine direct visualization system was designed to fulfill the requirements and this study undertook an assessment of the system's safety and effectiveness within a medical facility setting. MATERIALS AND METHODS: Induced abortion requested women in 17 institutions across the country between December 2016 and February 2017 were enrolled. Subjects were separated to the study and control group randomly. Induced abortion was conducted by a uterine direct visualization system and an ultrasound-guided system in the study and control group, respectively. The clinical indexes collected during intra- and post-procedures were analyzed and compared between groups. RESULTS: Overall, 392 and 339 subjects were included in the study and control group, respectively. The baseline demographic and clinical characteristics were similar between two groups. Subjects in the study group had significant smaller number of uterine cavity entry (p < 0.001), less 2-h and 14-days postoperative bleeding (all p < 0.001), and less 14-days postoperative abdominal pain (p < 0.001). Significantly higher ratio of normal menstruation, in terms of incidence and duration after 60-days of operation, was observed in the study group (all p < 0.001). CONCLUSIONS: Induced abortion with uterine direct visualization system generate better outcome and less complication than the conventional ultrasound-guided abortion procedures.

The Protective Effect of Abortion on Preeclampsia: An Analysis of Current Research.

A review of the current literature on preeclampsia (PE) confirms that this pregnancy complication remains a common cause of maternal mortality. Within the last several decades, obstetric and gynecological researchers worldwide have indicated an association between prior abortions and the development of PE. Different studies have debated whether abortion is a protective or risk factor for PE. However, the most current literature demonstrates a stronger likelihood that a positive history of abortions will offer a protective effect against PE. This association has been supported by advancements in the reproductive immunology literature, which states complex fetal and paternal pathological mechanisms help to build maternal immunological tolerance, thus protecting expectant mothers from pregnancy complications. This literature review will compare studies supporting prior abortions offering a protective effect against PE with those stating prior abortions are a risk factor for the development of PE. Additionally, this critical review will discuss the advancements and current understanding of reproductive immunology and how it pertains to this association between positive abortion history and PE.

Association between previous surgical termination of pregnancy and pregnancy outcomes in frozen-thawed embryo transfer cycles of IVF/ICSI: a retrospective cohort study.

This study aimed to evaluate the effect of previous surgical termination of pregnancy (STP) on pregnancy outcomes in women undergoing FET cycles of IVF/ICSI. Retrospective cohort study. Reproductive Center of Maternal and Child Health Care Hospital in Lianyungang city. Data were selected from all IVF/ICSI FET cycles performed between January 2014 and December 2020. A total of 761 cycles met the criteria were included in this study. The primary outcome measures were clinical pregnancy and live birth rates. Secondary outcome measures were biochemical pregnancy rate, spontaneous abortion rate, and preterm birth rate. After adjustments for a series of potential confounding factors, the previous STP was an influential factor in reducing FET cycle clinical pregnancy rate compared with women who had not previously undergone STP (OR = 0.614, 95% CI 0.413-0.911, P = 0.016). The effect of the previous STP on the live birth rate was not statistically significant. (OR = 0.745, 95% CI 0.495-1.122, P = 0.159). Also, an increase in the number of previous STPs relative to only 1-time abortion was an independent risk factor in reducing clinical pregnancy rate and live birth rate (OR = 0.399,95% CI 0.162-0.982, p = 0.046; OR = 0.32,95% CI 0.119-0.857, p = 0.023). Previous STP was an independent factor contributing to the decline in FET cycle clinical pregnancy rates.

Effects of prior reproductive losses on risk of cardiovascular diseases within six months of a first live birth.

Objective: There is emerging evidence suggesting that pregnancy loss (induced or natural) is associated with an increased risk of cardiovascular diseases (CVD). This prospective longitudinal study investigates the effect of prior pregnancy losses on CVD risk during the first six months following a first live birth. Methods: Medicaid claims of 1,002,556 low-income women were examined to identify history of pregnancy losses, CVD, diabetes, and hyperlipidemia prior to first live birth. The study population was categorized into five groups: A: women with no pregnancy loss or CVD history prior to first live birth; B: women with pregnancy loss and no CVD prior to first live birth. C: women with a first CVD diagnosis after a first pregnancy ending in a loss and before their first live birth. D: women with CVD prior to first live birth and no history of pregnancy loss. E: women with both CVD and pregnancy loss prior to their first live birth. Results: After controlling for age, race, state of residence, and history of diabetes and hyperlipidemia, the risk of CVD in the six-month period following a first live birth were 15%, 214%, 79% and 129% more common for Groups B, C, D and E, respectively, compared to Group A. Conclusions: Pregnancy loss is an independent risk factor for CVD risk following a first live birth, both for women with and without a prior history of CVD. The risk is highest when CVD is first diagnosed after a pregnancy loss and prior to a first live birth.