Revisión de un estudio por Koch et al. sobre el impacto de las restricciones al aborto en la mortalidad materna en Chile

En este comunicado se describen las fallas conceptuales y metodológicas graves que invalidan algunas de sus conclusiones concernientes al aborto y a la mortalidad materna del estudio de Koch y otros. Por lo cuál no altera el acervo de evidencia existente sobre el impacto de las restricciones al aborto sobre la mortalidad materna. En particular, dado que las leyes de aborto en Chile ya eran altamente restrictivas antes de 1989, el estudio no demuestra que el restringir significativamente las leyes de aborto no produzca un impacto negativo en la salud de las mujeres

Necesidad y uso de servicios de aborto por parte de adolescentes en países en desarrollo

Hoja informativa que ofrece una revisión sobre la provisión de servicios de aborto a adolescente

Unintended pregnancy: magnitude and correlates in six urban sites in Senegal

BACKGROUND: In Senegal, unintended pregnancy has become a growing concern in public health circles. It has often been described through the press as a sensational subject with emphasis on the multiple infanticide cases as a main consequence, especially among young unmarried girls. Less scientific evidence is known on this topic, as fertility issues are rarely discussed within couples. In a context where urbanization is strong, economic insecurity is persistent and the population is globalizing, it is important to assess the magnitude of unintended pregnancy among urban women and to identify its main determinants. METHODS: Data were collected in 2011 from a representative sample of 9614 women aged 15–49 years in six urban sites in Senegal. For this analysis, we include 5769 women who have ever been pregnant or were pregnant at the time of the survey. These women were asked if their last pregnancy in the last two years was ‘wanted ’then’, ‘wanted later’ or ‘not wanted’. Pregnancy was considered as unintended if the woman responded ‘wanted later’ or ‘not wanted’. Descriptive analyses were performed to measure the magnitude of unintended pregnancies, while multinomial logistic regression models were used to identify factors associated with the occurrence of unintended pregnancy. The analyses were performed using Stata version 12. All results were weighted. RESULTS: The results show that 14.3% of ever pregnant women reported having a recent unintended pregnancy. The study demonstrates important distinctions between women whose last pregnancy was intended and those whose last pregnancy was unintended. Indeed, this last group is more likely to be poor, from a young age (< 25 years) and multiparous. In addition, it appears that low participation of married women in decision-making within the couple (management of financial resources) and the lack of discussion on family planning issues are associated with greater experience of unintended pregnancy. CONCLUSION: This study suggests a need to implement more targeted programs that guarantee access to family planning for all women in need. In urban areas that are characterized by economic insecurity, as in Senegal, it is important to consider strategies for promoting communication within couples on fertility issues

Capacity of the health system to provide safe abortion and post-abortion care in refugee settings in Ethiopia: Evidence Brief

The Baobab Research Programme Consortium (RPC), in collaboration with the Guttmacher Institute, implemented the application of the Abortion Incidence Complications Method (AICM) in refugee settings in Ethiopia. Little is known about the health system’s capacity to provide post-abortion care (PAC) or safe abortion care (SAC) services as these have been less studied, especially in the context of refugee settings. This brief assesses the availability of SAC and PAC for women living in humanitarian settings in Ethiopia

Increasing boys' and girls' intention to avoid teenage pregnancy: a cluster randomised control feasibility trial of an interactive video drama based intervention in post-primary schools in Northern Ireland

Background: Adolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions. Objectives: To determine the value and feasibility of conducting an effectiveness trial of the If I Were Jack Relationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness. Design: Cluster randomised Phase II feasibility trial with an embedded process and economic evaluation. Intervention: A teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships. Main outcome measures: Abstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions. Results: The intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of delivering If I Were Jack (mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness. Conclusion: Trial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted. Future work: Progression to a Phase III effectiveness trial. Trial registration: Current Controlled Trials ISRCTN99459996. Funding: This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information

Measuring abortion incidence, severity of complications, and health facilities’ capacity to provide abortion care in refugee settings in Uganda: Technical report

Unsafe abortion remains an avoidable cause of maternal mortality and morbidity in East Africa. However, little is known about abortion incidence or abortion-related complications among refugee populations in Uganda, which hosts the largest number of refugees in Africa (estimated at 1.6 million refugees in 2023). To fill this critical evidence gap and support program planning and advocacy, the Baobab Research Program Consortium (RPC), in collaboration with the Guttmacher Institute, implemented the first-ever Abortion Incidence Complications Method (AICM) in refugee settings in Uganda. The main objectives of this study were to measure the incidence of abortion; determine the severity of abortion-related complications; and assess the capacity of the health system to offer post-abortion care to women living in all 13 refugee settlements in Uganda

Unintended pregnancy, induced abortion, and abortion-related complications among women in humanitarian settings in Uganda: Evidence Brief

The Baobab Research Programme Consortium (RPC), in collaboration with the Guttmacher Institute, implemented the first-ever application of the Abortion Incidence Complications Method (AICM) in refugee settings in Uganda. Complementing this effort, the Baobab RPC also conducted a household survey on unintended pregnancy among women residing in these humanitarian contexts. The data presented herein are derived from these two rigorous studies and offer critical insights into the prevalence, drivers, and consequences of unsafe abortion and unintended pregnancy in displacement settings. These findings contribute to a growing body of evidence aimed at informing policy, programming, and resource allocation for sexual and reproductive health and rights (SRHR) in refugee-hosting countries

Incidence of induced abortion and severity of abortion-related complications among women in refugee settings in Ethiopia: Evidence Brief

Humanitarian crises disrupt essential services, making it difficult for people to access basic care, including sexual and reproductive health (SRH) services. While data on SRH services in humanitarian settings is lacking, even less is known about how common abortion is or the severity of abortion-related complications in these settings. This evidence brief provides estimates of the incidence of induced abortion among refugee women in Ethiopia and the proportion of these abortions that occurred within the formal health care system. This brief also presents information on the management and severity of abortion-related complications among women living in refugee settings in Ethiopia. The data presented in this brief are based on the application of the Abortion Incidence Complications Method (AICM) in these refugee settings

Measuring abortion incidence, severity of complications, and health facilities’ capacity to provide abortion care in refugee settings in Ethiopia: Technical report

Humanitarian crises disrupt essential services, making it difficult for people to access basic care, including sexual and reproductive health (SRH) services. While data on SRH services in humanitarian settings is lacking, even less is known about how common abortion is or the severity of abortion-related complications in these settings. Using a modified application of the Abortion Incidence and Complications Methodology (AICM), this study aimed to estimate the incidence of induced abortion, determine the severity of abortion related complications, and assess the capacity of the health system to offer safe abortion and quality postabortion care among refugee women in 23 of all 24 refugee camps in Ethiopia