Effect of co-positivity for brucellosis and tuberculosis on milk yield and fertility of Holstein cows.

This study aimed to determine whether cows detected as tuberculosis (bTB) reactors and seropositive to brucellosis (bBR), as well as co-positive to bBR and bTB (bBR-bTB) and with a complete lactation before slaughter, were associated with reduced milk production and fertility. A total of 8068 productive and reproductive records of high-yielding Holstein cows from a single large dairy herd with a high prevalence of bTB and bBR were collected from 2012 to 2015. Lactation derived either from calving (n = 6019) or hormonally induced lactation (n = 2049), and all cows received growth hormone throughout lactation. For cows not induced into lactation, pregnancy rate to first service for healthy cows (C; 26.6%) was higher (P < 0.01) than bBR (15.2%), bTB (15.8%), and bBR-bTB (1.3%) cows. For induced cows, pregnancy rate to first service did not differ significantly among C, bBR, and bTB (14.5-17.3%) cows, but the percentage success of first service was extremely low (1.3%; P < 0.01) in bBR-bTB cows. Services per pregnancy (only pregnant cows) were lowest for C (3.3 ± 2.9; P < 0.01) and highest (6.4 ± 3.4) for bBR-bTB non-induced cows. This variable was lowest for C (2.9 ± 2.5; P < 0.01) and highest for bBR-bTB non-induced cows (6.3 ± 3.1). Pregnancy rate to all services did not differed for C (79.5%), bBR (76.7%), and bTB (75.9%) but was lower (58.9%; P < 0.01) for bBR-bTB non-induced cows. For induced cows this variable was highest for bBR (53.3%) and lowest for bBR-bTB (34.1%; P < 0.01) non-induced cows. 305-d milk production was increased by 4%, and total milk yield by 7% in TB-positive cows compared to that of the negative cows non-induced hormonally into lactation. This study showed the negative impact of the co-positivity for bTB and bBR on the reproductive efficiency of Holstein cows, although positive bTB and bBR tests enhanced milk yield.

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series / Tendência de abortos espontâneos e induzidos na região semiárida do Nordeste do Brasil: uma série transversal

Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 - 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 - 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 - 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Resumo Objetivos: este estudo objetiva estimar as taxas, fatores associados e tendência das taxas de aborto no Nordeste do Brasil. Métodos: série de estudos transversais realizada no Ceará, um dos estados mais pobres do país. Uma amostra de cerca de 27000 mulheres em idade reprodutiva foi utilizada. A ocorrência de aborto foi aferida através de informação dada pela participante e taxas foram calculadas usando estimativas populacionais oficiais. As tendências e associações entre fatores socioeconômicos e reprodutivos foram estudadas através de modelos regressivos. Resultados: foi identificada tendência de redução nas taxas de abortamento. Para aborto induzido, os determinantes foram não ter um parceiro fixo, ter utilizado camisinha na última relação sexual, ter tido o primeiro filho com menos de 25 anos (AOR= 5,21; ACI: 2,9 - 9,34), e ter tido a primeira relação com menos de 13 anos (AOR= 5,88; ACI: 3,29 - 10,51). Para o espontâneo, ter estudado menos de oito anos, conhecimento sobre a pílula do dia seguinte (AOR= 26,44; ACI: 17,9 - 39,05), e não ter filhos (AOR= 3,43). Conclusões: as taxas podem ser subestimadas por serem auto relatadas. Estar na adolescência e ter conhecimento sobre métodos contraceptivos foram associados aos dois tipos de aborto, enquanto nível educacional com o espontâneo e estado conjugal com induzido. Programas para reduzir taxas de abortamento deveriam focar em mulheres solteiras e com baixa educação.

Induced and unsafe abortion 20 years after the International Conference on Population and Development, Cairo, 94: prevalence and sociodemographic characteristics. Favela México 70, São Vicente, São Paulo, Brazil / Aborto induzido e inseguro 20 anos após a Conferência Internacional de População e Desenvolvimento, Cairo, 94: prevalência e características sociodemográficas. Favela México 70, São Vicente, São Paulo, Brasil

Objective: This research aimed at calculating the prevalence of women with induced and unsafe abortion and spontaneous abortion as well as the sociodemographic characteristics associated to them in a low income population. Method: It consists of a cross-sectional study, with a random sample of women in fertile age from 15 to 49 years of age, living in Favela México 70, in São Vicente-SP, performed in the last quarter of 2008. The method used for the analysis of the data was the Multiple Multinomial Logistic Regression in order to determine the main independent variables associated to the occurrence of induced abortion, with CI=95% and p<0.05. The statistical analyses were performed with the help of the SPSS software, version 17.0.Results: Among the 860 women from 15 to 49 years of age living in this community, it was observed a median of 2 pregnancies for women without abortions and, for women who reported induced abortion, 51 women, a median of 4 pregnancies. It was also observed a mean of 2.53 live born children/women in the studied population. In the final Multiple Multinomial Logistic Regression model, there remained the following categorized independent variables: “number of live born children>2″ (OR=4.0), showing that women with 2 or more children have a 4-time-higher chance of inducing an abortion and “accepting abortion by lack of economic conditions” (OR=11.5), which indicates that women without economic conditions of continuing pregnancy and/or raising one more child present an 11.5-time-higher chance of inducing an abortion. Conclusions: It may be concluded that, by lack of an efficient contraception system and family planning, women with low income up to now, after 20 years of the International Conference on Population and Development, Cairo, 1994, resort to induced and unsafe abortion in order to diminish their own fertility and family size, in face of an unintended, unwanted or inopportune pregnancy.

Objetivo: Calcular a prevalência de mulheres com aborto provocado e inseguro e de aborto espontâneo, bem como as características sociodemográficas a eles associadas em uma população de baixa renda. Método: Estudo transversal, com amostra aleatória de mulheres em idade fértil de 15 a 49 anos, residentes na Favela México 70, em São Vicente (SP), efetuada no último trimestre de 2008. O método usado para a análise dos dados foi a regressão logística multinomial múltipla para determinar as principais variáveis independentes associadas à ocorrência de aborto provocado, com IC=95% e p<0,05. As análises estatísticas foram feitas com o auxílio do programa SPSS versão 17.0.Resultados: Entre as 860 mulheres de 15 a 49 anos residentes nessa comunidade observou-se mediana de duas gestações para as sem aborto. Para as que declararam aborto provocado, 51, uma mediana de quatro gestações. Foi observada ainda média de 2,53 filhos nascidos vivos/mulher na população em estudo. No modelo final de regressão logística multinomial múltipla permaneceram as seguintes variáveis independentes categorizadas: “número de filhos nascidos vivos>2″ (OR=4,0), mostra que as mulheres com dois ou mais filhos apresentam uma chance quatro vezes maior de provocar um aborto; e “aceitação do aborto por falta de condições econômicas” (OR=11,5), indica que as mulheres sem condições econômicas de prosseguir na gestação e/ou criar mais um filho apresentam chance 11,5 vezes maior de provocar um aborto.Conclusões: Por falta de um sistema eficaz de contracepção e de planejamento familiar, mulheres de baixa renda ainda hoje, após 20 anos da International Conference on Population and Development, Cairo, 1994, recorrem ao aborto provocado e inseguro para a diminuição da própria fecundidade e do tamanho da família, frente a uma gestação inesperada, não pretendida ou inoportuna.

Atualização das estimativas da magnitude do aborto induzido, taxas por mil mulheres e razões por 100 nascimentos vivos do aborto induzido por faixa etária e grandes regiões. Brasil, 1995 a 2013 / Update to the estimates of the magnitude of the induced abortion rates per thousand women and reasons for 100 live births induced abortionby age group and major regions. Brasil, 1995 to 2013

Introdução: As estimativas do aborto induzido no Brasil eram imprecisas até o início dos anos 1990. Variavam entre 300 mil e 3,3 milhões de abortos clandestinos. Em 2000 foram estimados 22,3 abortos induzidos por 1.000 mulheres no Brasil, com base na metodologia proposta pelo Alan Guttmacher Institute. Objetivo: Atualizar as estimativas do aborto induzido no Brasil de 1995 a 2013.Método: A fonte dos dados primários foi o número de internações por aborto registrado no Sistema de Informações Hospitalares do Sistema Único de Saúde, desagregado por regiões e por faixa etária. O número de abortos induzidos foi estimado por intervalos. O limite superior foi definido com a multiplicação por cinco do número de internações. O limite inferior foi calculado com a multiplicação por quatro do número de internações. Considerou--se o percentual de sub-registro de 12,5% e a proporção de abortos espontâneos de 25%. Resultados: Entre 1995 e 2013, as internações de mulheres de 10 a 49 anos por complicações do aborto diminuíram 27% e a estimativa do número anual de abortos induzidos recuou 26%. Observou-se declínio do limite superior da razão de aborto induzido de 27/1.000 mulheres para 16/1.000. O mesmo foi notado para o limite inferior, de 21/1.000 para 12/1.000. Nas duas regiões com maior número de internações por complicações do aborto, Nordeste e Sudeste, observou-se redução significativa do número de casos, 35% e 27%, respectivamente.Constatou-se redução no risco de aborto induzido em todas as faixas etárias: 43% entre 15 e29 anos, 49% entre 20 e 29 anos, 26% entre 30 e 39 anos e 50% de 40 a 49 anos. A estimativa de abortos induzidos decresceu de 864.628 para 687.347 (limite inferior) e de 1.086.708 para865.160 (limite superior).

Introduction: Estimates of induced abortion in Brazil were inaccurate until the early 1990, varying between 300 million and 3.3 million clandestine abortions. In 2000, were estimated 22.3 abortions induced by 1000 women in Brazil, using the methodology proposed by the Alan Guttmacher Institute. Objective: Update estimates of induced abortion in Brazil during the period of 1995 to 2013. Method: The primary data source was the number of hospitalizations for abortion registeredin the Hospital Information System of the Unified Health System, disaggregated by regionand age group. The number of induced abortions has been estimated by interval upper limit, multiplying by five the number of hospitalizations, and by lower bound, by multiplying byfour the number of hospitalizations. It was considered under percentage record of 12.5% and the proportion of miscarriages of 25%. Results: Between 1995 and 2013, the hospitalizations of women from 10 to 49 years by complications from abortion decreased by 27% and the estimate of the annual number of induced abortions declined 26%. It was observed decline of upper limit of induced abortion ratio of 27/1000 women for 16/1000. The same was noticed for the lower bound of 21/12/1000to 1000. In the two regions with the highest number of hospitalizations for complications of abortion, Northeast and Southeast, showed significant reduction in the number of cases of 35% and 27% respectively. Found a great reduction in the risk of induced abortion, of 43% between 15 and 29 years, 49% between 20 and 29 years old, 26% between 30 and 39 years and 50% of 40 to 49 years. The estimation of induced abortions decreased from 864,628 to 687,347 (lower limit), and from 1,086,708 to 865,160 (upper limit). Conclusion: Both the reason of abortion per 100 live births and the rate of induced abortions per thousand women aged 15 to 49 years in Brazil showed decrease in the studied period.

Family planning is reducing abortions.

PIP: This news brief presents the US President's wife's statement on the association between use of family planning and a decline in abortions worldwide. Hillary Rodham Clinton attended the Sixth Conference of Wives of Heads of State and Government of the Americas held in La Paz, Bolivia. The conference was suitably located in Bolivia, a country with the highest rates of maternal mortality in South America. Bolivia has responded by launching a national family planning campaign coordinated between government, nongovernmental, and medical organizations. Half of Bolivian women experience pregnancy and childbirth without the support of trained medical staff. Mortality from abortion complications account for about half of all maternal deaths in Bolivia. Voluntary family planning workers teach women about the benefits of child spacing, breast feeding, nutrition, prenatal and postpartum care, and safe deliveries. Bolivia has succeeded in increasing its contraceptive use rates and decreasing the number of safe and unsafe abortions. Bolivia's program effort was supported by USAID. USAID provided technical assistance and funds for the establishment of a network of primary health care clinics. Mrs. Clinton visited one such clinic in a poor neighborhood in La Paz, which in its first six months of operation provided 2200 consultations, delivered 200 babies, registered 700 new family planning users, and immunized 2500 children. Clinics such as this one will be affected by the US Congress's harsh cuts in aid, which reduce funding by 35% and delay program funding by 9 months. These US government cuts in foreign aid are expected to result in an additional 1.6 million abortions, over 8000 maternal deaths, and 134,000 infant deaths in developing countries. An investment in population assistance represents a sensible, cost-effective, and long-term strategy for improving women's health, strengthening families, and reducing abortion.^ieng

[Physicians denounce precariousness of reproductive health in the country and propose an addendum to the Brazilian document for the Cairo conference]. / Medicos denunciam precariedade da saude reprodutiva no Pais e propoem adendo ao documento brasileiro para Conferencia do Cairo.

PIP: On June 21, 1994, in Sao Paulo, a meeting took place of reproductive health professionals: service providers, university professors, representatives of nongovernmental organizations, secretaries of health of states and municipalities. They issued a manifesto on reproductive health in Brazil. In view of the preparations for the 3rd International Conference on Population and Development to take place in Cairo in September, 1994, it is hoped that these points will be incorporated into the official platform and in government action plans. Reproductive health is a basic human right. The growth of population decreased in Brazil in the 1980s, yet assistance in the area of reproductive health is still insufficient and unsatisfactory. The population decrease did not result in the improvement of health care and family planning. Maternal morbidity and mortality rates are still high in Brazil, especially in the north-northeastern regions, where it is 10 times higher than the national rate. There are 5 maternal deaths per 100,000 live births in Canada, 8 in the US, and 140 in Brazil. 90% of these deaths could be avoided by routine reproductive health measures. Important causes of infant mortality in Brazil are malnutrition and infectious diseases, which could be prevented by lifting the low socioeconomic level and through vaccination and birth spacing. Although fertility has been on the decline, the fertility of 10-19 year old adolescents has increased significantly, leading to high mortality rates for their infants. An estimated 1.4 million abortions occur per year in Brazil with frequent complications because of its illegal, clandestine nature. It is also estimated that 6-8 million women have been sterilized, which is the primary means of family planning because of the lack of other contraceptive options. The combination of cesarean-tubal ligation operations has been institutionalized in health services, which creates major distortions in the delivery of health care. Sexually transmitted diseases are on the rise, and HIV infections are contracted mainly from sexual intercourse and IV drug abuse. Furthermore, it is absolutely necessary for men to participate in family planning education in order to raise the status of women.^ieng

In Chile, improved services and counselling reduce abortion incidence.

A major abortion study was carried out in three peri-urban communities of metropolitan Santiago, Chile. Its aim was to assess ways of identifying women at high risk of induced abortion and to lower the rates of induced abortion in areas where the occurrence of induced abortion was known to be high. The first phase consisted of a baseline survey of three low-income urban communities in metropolitan Santiago. On the basis of the results of this survey a predictive instrument was devised that was later used to identify women at high risk of abortion. The survey and work on the predictive instrument was followed by an intervention phase which lasted 18 months. This included: improved family planning services and visits to households of women classified as being at a high risk of induced abortion in one of the communities; improved services but no special home counselling in the second community; and no intervention in the third (control) community. An important finding was that even with highly committed and very well trained interviewers women underreported induced abortions or reported them as spontaneous abortions. The study, however, demonstrated clearly the impact of the intervention. Over a two-year period, the abortion rate fell by 20%, and in the area of some intervention by 9%; the rate increased by 30% in the control community. These findings have been used to improve family planning services in low-income communities and in the design of reproductive health services for adolescents in poor areas of the city.

Reproductive risks. Guatemala.

PIP: In Guatemala, where women exert little control over their reproductive lives, maternity is a risky undertaking. As a study a few years ago indicates, over 1/2 of all births are attended by untrained personnel. This situation is compounded by the health and socioeconomic conditions faced by Guatemalan women, who rarely receive the daily minimum caloric requirement. According to an epidemiological study in Guatemala City, 44% of pregnant women suffered from at least one parasite. These women were generally less educated, lived in worse sanitary conditions, and had a lower nutritional status than uninfected women. Between 1980-87, the overall maternal mortality rate in Guatemala was 110/100,000 live births, compared to a rate of 9/100,000 in the US. Many of these maternal deaths result from diseases and complications arising in the perinatal period, usually epileptic seizures, bleeding, premature labor, abortion, and postpartum infections. In addition to the women who die from pregnancy complications, many more are left permanently disabled. Complications such as infections and bleeding often result from illegal abortions, usually performed in unsanitary conditions by inexperienced individuals. Abortion rate estimates range from 4%-18% of all pregnancies. Guatemala bans abortion, except in a few life threatening conditions, when approval must be obtained from a committee and a physician. In reality, only women who can afford a private physician can secure approval for an abortion. While a 1985 WHO report argued that family planning is the first step in preventing illegal abortions and reducing maternal mortality, the growing anti-abortion movement in Guatemala has also begun to threaten support for family planning.^ieng

IPPF Brazil program confronts sterilization accusations.

PIP: Even though Brazil's BEMFAM program stopped providing sterilization services over a year ago, many sources hostile to BEMFAM in the Brazilian government are still accusing it of misconduct. BEMFAM is sponsored by the International Federation of PLANNED Parenthood and was investigated and cleared of any wrong doing by the Brazilian government. In Brazil it is against the law to perform sterilization for the purposes of birth control, yet it is estimated that there are between 6-20 million such operations each year. Over 65% of the births in Brazil are by Caesarian section and it is common for women to ask their doctors to perform a tubal ligation at the same time. Abortion is illegal in Brazil, but there are an estimated 1.4-2.4 million abortions each year. 56% of Brazilian women use contraceptives, with 90% using either the pill or illegal sterilization. 90% of those who use the pill obtain it over the counter at pharmacies with inadequate knowledge on how to use it. 80% of the people receive their health care from the Brazilian government.^ieng

[Induced abortion: a vulnerable public health problem]. / El aborto inducido: un problema de salud publica vulnerable.

PIP: Induced abortion is an urgent public health problem that can be controlled if it is approached in its true complexity and with a social and humanist perspective. Induced abortion has been discussed in Chile since the last century, but not always openly. Abortion is not just an individual and collective medical problem, it is also an ethical, religious, legal, demographic, political, and psychological problem. Above all it is a problem of human rights. In the past 60 years, more than 50 countries representing 76% of the world population have liberalized their abortion legislation. Around 980 million women have some degrees of access of legal abortion. The magnitude of illegal abortion is difficult to determine because of the desire of women to hide their experiences. Estimates of the incidence of abortion in Chile made some 25 years ago are no longer valid because of the numerous social changes in the intervening years. The number of abortions in Chile in 1987 was estimated using an indirect residual method at 195,441, of which 90%, or 175,897, were induced. By this estimate, 38.8% of pregnancies in Chile end in abortion. Data on hospitalizations for complications of induced abortion show an increase from 13.9/1000 fertile aged women in 1940 to 29.1 in 1965. By 1987, with increased contraceptive usage, the rate declined to 10.5 abortions per 1000 fertile aged women. The cost of hospitalization for abortion complications in 1987, despite the decline, was still estimated at US $4.3 million, a large sum in an era of declining health resources. The problem of induced abortion can be analyzed by placing it in the context of elements affecting the desire to control fertility. 4 complexes of variables are involved: those affecting the supply of contraceptive, the demand for contraceptives, the various costs of fertility control measure, and alternatives to fertility control for satisfying various needs. The analysis is further complicated when efforts are made to understand the dynamics of the process. Awareness of fertility control is a social process that matures slowly. Contraception and abortion have different significance for fertility control, with contraception preventing pregnancy and abortion is a sense curing it. Chile has progressed far in its fertility control awareness. 2/3 of sexually active women use some form of contraception. At the same time, induced abortion is also used. It is estimated that 58% of abortions occur after a contraceptive failure. It appears that recourse to abortion would be minimized if strategies centered on supply of contraceptives were complemented by stronger efforts to develop awareness of fertility control. Delivery of contraceptives should be accompanied by complete information on their effective use. Efforts should be targeted especially at groups at high risk abortion, including adolescents and women hospitalized for complications.^ieng

[Abortion in Latin America. Induced abortion and its causes]. / El aborto en America Latina. El aborto inducido y sus causas.

PIP: Although abortion legislation is restrictive in Latin America, the limited available data confirm the region¿s high volume of abortion. The average number of abortions per woman in Latin America is around 1.5, according to estimates of various authors. Abortion contributes an estimated one-fourth of deliberate fertility control in the region. Abortion rates depend on the degree of motivation for limiting births and the availability and use of contraception. The motivation for smaller families preceded widespread introduction of modern contraception into Latin America. Fertility began to decline before 1960 in a few countries and declined more rapidly thereafter, due principally to induced abortion. The decline continued as contraceptive usage increased rapidly and substantially in the 1970s and 1980s. Abortion rates remained high, basically because the desire for smaller families was widely diffused, while barriers of different kinds hampered access to modern contraception. Inadequate contraceptive supplies, restricted choice of methods, lack of access for women who are poor or single or adolescent, misguided fears about health effects, and poor understanding of the operation of health services may all constitute obstacles to contraceptive use. Contraceptive failure is not infrequent and is another factor in the persistence of abortion. Even within the framework of restrictive legislation, steps could be taken to reduce the problem of abortion: improving the supply and availability of contraceptives, improving the quality of services, promoting sex education, and improving the status of women.^ieng

[Abortion in Mexico. Social and public health problem]. / El aborto en Mexico. Problema social y de salud publica.

PIP: Published estimates of the annual incidence of abortion in Mexico have ranged from 50,000 to 6 million. Induced abortion is difficult to measure because it is a sensitive topic and an illegal act. Hospital records indicate that slightly fewer than 110,000 women were admitted in 1985 for abortion complications, but induced and spontaneous abortions were not distinguished, and no information was available on the proportion of induced abortions requiring hospitalization. Data from the 1987 Survey of Fertility and Health indicate that 14.3% of women aged 15-49 had had at least one spontaneous or induced abortion. Only 13% admitted having an induced abortion. The data suggest a rate of 12.2 abortions per 1000 fertile aged women in 1986, or 250,000 in Mexico. Among women ever pregnant, 22.7% had had at least one abortion, with the proportion rising to 34% at 45-49. Men aged 15-59 and women aged 15-49 were interviewed in Mexico City for the Survey of Reproductive Health, a project to develop a methodology for obtaining reliable data on induced abortion. The women reported that 9.3% of first pregnancies terminated in abortions, of which 58.4% were considered spontaneous, 28.8% were declared spontaneous but may have been induced, and 20.8% were reported as induced. The men reported that 10.6% of pregnancies ended in abortion, with 45.5% reported induced and only 4.5% considered probably induced. Despite limited available data, it is clear that induced abortion is a social and public health problem in Mexico.^ieng

[Population growth and the need to implement family planning programs]. / Crecimiento poblacional y la necesidad de implementar programas de planificacion familiar

PIP: This article discusses the value of family planning programs (FPP) in improvements in maternal and child health and contribution in raising people's standard of living. Access to FFP increases the contraceptive prevalence rate (CPR) with fertility rates dropping. This happened in Matlab, Bangladesh where the CPR rose to 45% as opposed to only 16% in the rest of the country. FPP helps prevent high numbers of abortions and keeps maternal mortality rates. For example when Chile began its program in 1963, 3% of couples used contraception. By 1978 the CPR rose to 23% and the death rates due to abortion fell from 118 to 24/1,000,000. The World Bank states that 85 developing countries, representing 95% of the population in The Third World, now offer FPP, and this has been achieved by offering couples information and access to contraception. However, most of these FPP are still not reaching the rural populations, the retention rates are low, and the administration of services is poor. A major social problem still remains-the high incidence of adolescent pregnancies. Worldwide it has been estimated that between 25-50% of maternal deaths could be prevented by the use of contraception to avoid high-risk or unwanted pregnancies. Worldwide between 20-30% of all unwanted pregnancies end up in abortions, legal or illegal. 80% of these abortions are illegal, with an estimated 100,000- 200,000 women dying annually. FP has many additional benefits including: 1) helping to make paternity a responsibility; 2) increasing people options and alternatives; and 3) helping mothers to space their pregnancies assuring better health for themselves and their children. Their success also depends on medical, political and financial support nationally and internationally.^ieng

[Induced abortion: a world perspective]. / Aborto inducido: una perspectiva mundial.

PIP: This article presents current estimates of the number, rate, and proportion of abortions for all countries which make such data available. 76% of the world's population lives in countries where induced abortion is legal at least for health reasons. Abortion is legal in almost all developed countries. Most developing countries have some laws against abortion, but it is permitted at least for health reasons in the countries of 67% of the developing world's population. The other 33%--over 1 billion persons--reside mainly in subSaharan Africa, Latin America, and the most orthodox Muslim countries. By the beginning of the 20th century, abortion had been made illegal in most of the world, with rules in Africa, Asia, and Latin America similar to those in Europe and North America. Abortion legislation began to change first in a few industrialized countries prior to World War II and in Japan in 1948. Socialist European countries made abortion legal in the first trimester in the 1950s, and most of the industrialized world followed suit in the 1960s and 1970s. The worldwide trend toward relaxed abortion restrictions continues today, with governments giving varying reasons for the changes. Nearly 33 million legal abortions are estimated to be performed annually in the world, with 14 million of them in China and 11 million in the USSR. The estimated total rises to 40-60 million when illegal abortions added. On a worldwide basis some 37-55 abortions are estimated to occur for each 1000 women aged 15-44 years. There are probably 24-32 abortions per 100 pregnancies. The USSR has the highest abortion rate among developed countries, 181/1000 women aged 15-44, followed by Rumania with 91/1000, many of them illegal. The large number of abortions in some countries is due to scarcity of modern contraception. Among developing countries, China apparently has the highest rate, 62/1000 women aged 15-44. Cuba's rate is 59/1000. It is very difficult to calculate abortion rates in countries where the procedure is illegal. On the basis of hospital reports and other fragmentary information, the true rate appears to be relatively high in Latin America and the Far East. The abortion rate for Latin America in the mid-1970s was estimated at 65/1000 fertile aged women, and rates were believed to be higher in urban areas. Sub-Saharan Africa, where women desire very large families, apparently had the lowest rates. Up to 68% of pregnancies in the USSR, 57% in Rumania, and 55% in Japan may end in abortion. The proportion in developing countries ranged from 8% in Vietnam to 43% in China. Women undergoing abortion in developed countries tend to be young, childless, and single, while those in developing countries tend to be older, high parity, and married. Abortion mortality is still high in countries where large numbers of illegal abortions are performed by unqualified personnel, as in many parts of Latin America.^ieng

[In situ IUD and pregnancy. Follow-up of 27 cases]. / Gravidez e DIU in situ. Evolucao de 27 casos.

PIP: 27 pregnant patients with IUDs in situ were diagnosed in health care centers in Belo Horizonte, MG, Brazil. The pregnancies were followed up and analyses of the complications were carried out in 2 groups. Group A consisted of 15 (55.6%) patients that did not have the IUD removed, and Group B consisted of 12 (44.5%) patients that had the IUD removed before the 12th week of pregnancy. 85.2% of the patients were using the Lippes Loop IUD, varying from 1 to 41 months. 48.1% of the patients were in age group 25-29, and 59.2% had between 2 and 3 children. In group A, 53.3% of the patients had spontaneous abortions, comparing with 8.3% in Group B, and 91.7% of the patients in that group had uncomplicated term deliveries. The results showed a significantly higher abortion rate in patients that did not have the IUD removed. The IUD should be removed as soon as possible when pregnancy is confirmed. If it is not possible, the patient should have careful follow-up.^ieng

[Fertility and maternal-infant health]. / Fecundidad y salud materno infantil

PIP: The Chilean Association for the protection of the Family was founded 21 years ago in response to serious problems in maternal and child health. A brief history of birth control programs in Chile shows that initial strong government support has been tempered since 1979 by concern over the sharp drop in the birth rate. The number of abortions in Chile has decreased from 28.7/1000 women of reproductive age in 1964 to 11.3/1000 in 1984. Maternal mortality has decreased from 28.6/10000 live births to 3.6/10000 in the same time. Thus these 2 objectives have been very successful. The sharpest decline in the birth rate has been among women over 35 years old, and women of low educational level, indicating perhaps that a greater proportion of children are being born to women most suited to have them. There has been a decrease in the proportion of high risk pregnancies. A high correlation has been found between economic indicators and fecundity, indicating that reproductive behavior is strongly influenced by economic contingencies. Maternal and infant mortality are multifactorial and many different approaches are needed to reduce them. Nevertheless, in the past 20 years, chile has been able to make significant advances in these areas.^ieng

[On the question of the illegality of abortion]. / Em questao a ilegalidade do aborto.

PIP: The illegality of abortion in Brazil is questioned more and more. It would seem obvious that the prohibition of abortion would result in a decrease in the number of abortions, but upon closer observation, the opposite is true. Abortion related legislation in Brazil is among the most severe in the world. Both the physician and the patient are equally punishable, but this did not stop Brazilian women from having 3.5 million abortions/year. Countries with less severe laws have a much lower abortion rate. There have been extreme physiological and social consequences in Brazil as a result of abortion's illegality. The woman is not only a criminal, she is also a sinner in the eyes of the Church. In most cases, especially in low-income areas, abortion can lead to complications and death. Although there are no statistical data on the number of deaths due to illegal abortion, they would no doubt be alarming. An unwanted, unterminated pregnancy can have disastrous effects upon the mother, the child, and their relationship. These negative effects have been well documented. Prohibition will keep abortion out of the mainstream of national debate and aggravate the situation. A person's sexuality cannot be suppressed and considered evil. In lower income levels, unwanted pregnancy should not be a punishment for being poor. The legalization movement will grow, as it has in developed nations. The members of the Brazilian Society for Scientific Progress must remain active in the debate, because they cannot ignore something of such national importance.^ieng

Abortion epidemic in Latin America.

PIP: Recent surveys have shown that 3.4 million illegal abortions may be taking place in the Latin American countries every year, with a rate of around 45/1000 women of childbearing age. Yet only in Cuba can women have abortion on demand. In the other countries the penalty for the abortionist and the client is a prison sentence. The only way of measuring the frequency of abortion is through the numbers of women entering hospitals for treatment of postabortion complication, but not all countries publish hospitals statistics that are reliable. Surveys in Chile and Colombia for 1974 show a rate of 11.7-17.9/1000 women of fertile age undergoing illegal abortions, with only 1/3 resulting in complications. The law is not strictly enforced in these countries because the number of people that will have to be prosecuted is too large and because there is no place to care for the young children of women who will be prosecuted. Yet the abortion death rate (38% of total maternal deaths) is so high that a new policy must be drawn up, especially since women who have normal deliveries are sent home earlier to make room for those with abortion complications, resulting in a high infant mortality rate. In addition the rate of pregnancies among adolescents is very high due to the permissive social atmosphere combined with a lack of sex education in the schools. Studies that would allow international comparisons to show ways to prevent the consequences of illegal abortions are needed.^ieng

[The abortion problem in Latin America]. / Problematica del aborto en America Latina.

PIP: Abortion is one of the major female health problems in Latin America, and the cost of hospital treatment after illegal abortion often drains resources needed to treat other health problems. The number of abortions per year is not known, and it is not definitely known whether the contraceptive programs dating from the mid-1970's have decreased the incidence of abortion. Estimates for Colombia range up to 1/2 million annualy. Underreporting ofabortion is common even in countries where abortion is legal, and in those where it is illegal its incidence comes to light mainly in the case of complications. Information on abortion is difficult to obtain in interviews or surveys. The numerous specialized hospital studies of abortion do not give a true picture of the place of abortion in the community. Indirect indicators such as the number of abortion cases treated in clinics and hospitals, the percent of abortions with complications of hemorrhage or infection, the proportion of maternal deaths attributable to abortion, extrapolations from surveys, and others are compared to estimate its extent. In most Latin American countries such indicators have varied little over the years despite progress in health and family planning programs. The methodological problems in studying the incidence of abortion are aggravated by the high cost of most of the proposed studies.^ieng

[Statistical analysis of abortion data]. / Analysis estadistico de los datos sobre aborto.

PIP: The psychosocial antecedents of induced abortion must be clearly understood before rational discussion of appropriate statistical methodology for analysis of its incidence can be undertaken. The "desire for a child" is a specific concept at the moment when the decision is made to seek an abortion or carry the pregnancy to term. The 2 most important analytical instruments for assessing the incidence of abortion are the abortion rate and the proportion of abortions. Abortion rates are generally calculated as annual rates per 1000 women of reproductive age. Specific rates for age, civil status or other characteristics may also be calculated. The proportion of abortions is generally calculated as the number of abortions per 1000 live births or per 1000 pregnancies. Period rates of abortion are often impossible to obtain from survey data because the samples are too small, leading many investigators to publish their findings in terms of cumulative rates and proportions for groups of women of successive ages. Period rates are necessary to assess the extent of abortion in the present and immediate past, and adequate samples are essential.^ieng