Induced abortion is not associated with a higher likelihood of depression in Curaçao women.

OBJECTIVE: To investigate the risk of developing a depression after induced abortion. METHODS: A prospective cohort study conducted in Curaçao which involved 92 women having an induced abortion and 37 women delivering after an unplanned or unwanted pregnancy, who served as controls. All participants completed the Center of Epidemiological Studies Depression (CES-D) scale before and two to three weeks after the abortion or delivery. RESULTS: Following the abortion, significantly fewer women were at risk of depression (30%) as compared to when still pregnant (60%). Mean depression scores were significantly lower after- than before the procedure. The likelihood of depression post-abortum (30%) was similar to that after delivery of an unplanned/unwanted child (22%). Even though women in the abortion group more often reported having suffered from depression in the past than controls, they were not at greater risk of depression after their pregnancy had ended. CONCLUSION: Curaçao women's risk of developing a depression following an (early) induced abortion is not greater than that after carrying to term an unplanned/unwanted pregnancy. We recommend that the results of this study be taken into account in case the Curaçao government should consider legalisation of induced abortion in the near future.

Attitude toward contraception and abortion among Curaçao women. Ineffective contraception due to limited sexual education?

BACKGROUND: In Curaçao is a high incidence of unintended pregnancies and induced abortions. Most of the induced abortions in Curaçao are on request of the woman and performed by general practitioners. In Curaçao, induced abortion is strictly prohibited, but since 1999 there has been a policy of connivance. We present data on the relevance of economic and socio-cultural factors for the high abortion-rates and the ineffective use of contraception. METHODS: Structured interviews to investigate knowledge and attitudes toward sexuality, contraception and abortion and reasons for ineffective use of contraceptives among women, visiting general practitioners. RESULTS: Of 158 women, 146 (92%) participated and 82% reported that their education on sexuality and about contraception was of good quality. However 'knowledge of reliable contraceptive methods' appeared to be--in almost 50% of the cases--false information, misjudgements or erroneous views on the chance of getting pregnant using coitus interruptus and about the reliability and health effects of oral contraceptive pills. Almost half of the interviewed women had incorrect or no knowledge about reliability of condom use and IUD. 42% of the respondents risked by their behavior an unplanned pregnancy. Most respondents considered abortion as an emergency procedure, not as contraception. Almost two third experienced emotional, physical or social problems after the abortion. CONCLUSIONS: Respondents had a negative attitude toward reliable contraceptives due to socio-cultural determined ideas about health consequences and limited sexual education. Main economic factors were costs of contraceptive methods, because most health insurances in Curaçao do not cover contraceptives. To improve the effective use of reliable contraceptives, more adequate information should be given, targeting the wrong beliefs and false information. The government should encourage health insurance companies to reimburse contraceptives. Furthermore, improvement of counseling during the abortion procedure is important.

Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao.

OBJECTIVE: To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curaçao, where induced abortion is severely restricted by law. METHODS: In a prospective study 330 women received 200 mg mifepristone and were instructed to take four tablets (800 µg) of misoprostol via the buccal route 24-36 h later, at home. One week later, follow-up took place. RESULTS: The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64-70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea. CONCLUSION: Home administration of buccal misoprostol 24-36 h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curaçao, where induced abortion is legally restricted.

Health status of shut-ins in the Marigot Health District, Commonwealth of Dominica

In the Commonwealth of Dominica, the health and disability status of 108 people who, fo various reasons, are confined to their homes -- the so-called "shut-ins" -- were studied. Eighty per cent of them were over 65 years of age and 10 percent were children. Most shut-ins were independent in self-care but dependent in general activities. Their overall health was poor. Twenty-one suffered from diseases of the musculo-skeletal system c.q. osteoarthritis. 13 from blindness of various origins, 13 from neurological diseases, 13 from CVA, psychosis or dementia and 13 from different other diseases. One-third suffered from more than one disease. A special programme would be required to optimize the home-care for the shut-ins and to encourage them to become more active (AU)

Health status of shut-ins in the Marigot Health District, Dominica - abstract

The health status of 108 homebound people (shut-ins) in the Marigot Health District, Dominica, was evaluated by visiting, interviewing and examining them during the months of November 1991 to January 1992. Objective parameters were obtained by an interview about age, sex, marital status, diagnoses and caretaker of the shut-in. The health status and disability were measured by means of 4 questionnaires: The Barthel-ADL Index, The Frenchay Activities Index (FAI), the Dartmouth COOP Functional Health Assessment Charts/WONCA and the Duke Health Profile. An analysis and cross-tabulation of the 4 questionnaires and the objective parameters were done. The results show a considerable independence for the Activities of Daily Life (Barthel-SDL Index), but a very low level of general, physical, social and household activities (COOP and FAI). The most frequent diagnoses (causing their being `shut-in') were arthritis, blindness, neurological and mental disorders, stroke and psychiatric diseases. The caretaker was a family member, mostly a woman in approximately 90 per cent of cases. We concluded that most shut-ins are taken pretty good care of by their family as far as basic life-necessities, most are independent in self-care, but dependent in general activities while their overall health is poor (AU)