CAN ABORTION MORTALITY BE ELIMINATED? WE BELIEVE THE ANSWER IS YES

Abortion mortality is an important global public health problem but a relatively neglected area of epidemiologic study. Deaths and complications from unsafe abortion are commonplace in many countries. The World Health Organization (WHO) estimates about 22 million unsafe abortions are performed worldwide each year and about 47,000 women die from unsafe abortion and 99% of these deaths occur in less developed regions of the world

Slowing the stork : better health for women through family planning

Each year 500,000 women die from causes related to pregnancy - 99 percent of them in developing countries. While many of those pregnancies are unwanted and could have been prevented by family planning, only a minority of developing country couples use effective contraceptive methods. For some women, pregnancy represents a major health risk. Others, of lower risk, do not want any more children. This paper discusses the factors which determine women's use of contraceptives, and how family planning programs reach the large numbers of women at risk from further pregnancies. The most successful family planning policies offer women a variety of contraceptive methods tailored to specific age groups and educational levels. Much program experience suggests that family planning is one of, if not the most cost-effective means of averting maternal deaths. The savings generated by family planning services could be invested in saving the lives and health of women who do want to have more children.Health Monitoring&Evaluation,Adolescent Health,Reproductive Health,Early Child and Children's Health,Gender and Health

Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study

Background: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis. Methods: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on livebirths, antenatal care coverage, and syphilis testing, seropositivity, and treatment in antenatal care. For 2012 estimates, we used data collected between 2009 and 2012. We updated the 2008 estimates using data collected between 2000 and 2008, compared these with 2012 estimates using data collected between 2009 and 2012, and performed subanalyses to validate results. Findings: In 2012, an estimated 930 000 maternal syphilis infections caused 350 000 adverse pregnancy outcomes including 143 000 early fetal deaths and stillbirths, 62 000 neonatal deaths, 44 000 preterm or low weight births, and 102 000 infected infants worldwide. Nearly 80% of adverse outcomes (274 000) occurred in women who received antenatal care at least once. Comparing the updated 2008 estimates with the 2012 estimates, maternal syphilis decreased by 38% (from 1 488 394 cases in 2008 to 927 936 cases in 2012) and congenital syphilis decreased by 39% (from 576 784 to 350 915). India represented 65% of the decrease. Analysis excluding India still showed an 18% decrease in maternal and congenital cases of syphilis worldwide. Interpretation: Maternal and congenital syphilis decreased worldwide from 2008 to 2012, which suggests progress towards the elimination of mother-to-child transmission of syphilis. Nonetheless, maternal syphilis caused substantial adverse pregnancy outcomes, even in women receiving antenatal care. Improved access to quality antenatal care, including syphilis testing and treatment, and robust data are all important for achieving the elimination of mother-to child transmission of syphilis. Funding: The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction in WHO, and the US Centers for Disease Control and Prevention

Causes of Death Among Women Aged 10-50 Years in Bangladesh, 1996-1997

Limited information is available at the national and district levels on causes of death among women of reproductive age in Bangladesh. During 1996-1997, health-service functionaries in facilities providing obs-tetric and maternal and child-heath services were interviewed on their knowledge of deaths of women aged 10-50 years in the past 12 months. In addition, case reports were abstracted from medical records in facilities with in-patient services. The study covered 4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%) occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes, 6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and medical causes during pregnancy respectively. Cardiac problems (11.7%), infectious diseases (11.3%), and system disorders (9.1%) were the major medical causes of deaths. Pregnancy-associated causes included direct maternal deaths (20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest proportion of deaths among women aged 10-19 years was due to injuries (39.3%) with suicides accounting for 21.7%. The largest pro\uadportion of direct obstetric deathsoccurred among women aged 20-29 years (30.5%). At least one quarter (24.3%) of women (n=28,998)did not receive any treatment prior to death, and 47.8% received treatment either from a registered physician or in a facility. More focus is needed on all causes of deaths among women of reproductive age in Bangladesh

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

“I have no choice”: Influences on contraceptive use and abortion among women in the Democratic Republic of the Congo

In 2015, the Democratic Republic of the Congo (DRC) recorded an estimated maternal mortality ratio of 693/100,000 live births. Strict abortion laws, high fertility rates, low contraceptive prevalence, and lack of emergency obstetric care all contribute to the high maternal mortality ratio. This study explored influences on contraceptive use and abortion in the DRC. Qualitative in-depth interviews were conducted with 32 women and 10 healthcare providers in four provinces. Participants were recruited at health centers and households in the study communities. Thematic analysis was used and identified that Congolese women‘s contraceptive decision-making was shaped by a range of external influences rather than their own independent decisions. Nonautonomous decisions and strict abortion laws influenced the methods used to abort a pregnancy, exposing risks of infection, complication, and fatality. These findings highlight that Congolese women‘s decisions about their fertility and family planning are constrained by policy and socio-cultural influences. (Afr J Reprod Health 2019; 23[1]: 128-138). Keywords: Democratic Republic of the Congo, Qualitative Research, Maternal Mortality, Contraception, Abortion En 2015, la République démocratique du Congo (RDC) a enregistré un taux de mortalité maternelle estimé à 693/100 000 naissances vivantes. Des lois strictes en matière d'avortement, des taux de fécondité élevés, une faible prévalence contraceptive et le manque de soins obstétricaux d'urgence contribuent tous au taux de mortalité maternelle élevé. Cette étude a exploré les influences sur l'utilisation de contraceptifs et l'avortement en RDC. Des entretiens qualitatifs approfondis ont été menés avec 32 femmes et 10 prestataires de soins de santé dans quatre provinces. Les participants ont été recrutés dans des centres de santé et des ménages dans les communautés de l'étude. Une analyse thématique a été utilisée et a révélé que la prise de décision des femmes congolaises en matière de contraception était modelée par une gamme d‘influences externes plutôt que par leurs propres décisions indépendantes. Les décisions non autonomes et les lois strictes sur l'avortement ont influencé les méthodes utilisées pour avorter une grossesse, exposant ainsi les risques d'infection, de complication et de décès. Ces résultats montrent que les décisions des femmes congolaises concernant leur fécondité et leur planification familiale sont limitées par des influences politiques et socioculturelles.  Mots-clés: République démocratique du Congo, qualitative, mortalité maternelle, contraception, avortement 

No fathers' names: a risk factor for infant mortality in the State of Georgia, USA

Many studies have explored maternal and infant factors as risks for infant mortality, but little attention is given to paternal factors. In Georgia, listing a father's name on the birth certificate is optional for married couples and possible after paternal acknowledgment for unmarried couples. The authors evaluated father's name reporting as a paternity measure and risk for infant mortality. Using the linked 1989-1990 birth and death certificates of singleton Georgia infants to calculate relative risks (RRs), infant mortality rates for 38,943 infants with no father's names listed were compared to rates for 178,100 with father's names listed. Compared with the rate for married women listing names, the death rates were higher for unmarried mothers not listing fathers (relative risk, RR=2.5; 95% CI 2.3-2.7), unmarried mothers listing fathers (RR=1.4; 95% CI 1.3-1.6), and married women not listing fathers (RR=2.3; 95% CI 1.6-3.1). Increased risks remained after stratifying by maternal race, age, adequacy of prenatal care and medical risks; and congenital malformations, birthweight, gestational age, and small-for-gestational age. Using logistic regression to examine for effect modification and to adjust for these factors together, the adjusted relative risks for death varied across different groups without fathers' names, regardless of marital status. For example, it remained statistically higher for infants with no father listed and without effect-modifying conditions such as low birthweight (estimated RR=2.0; 95% CI 1.6-2.4). Although these findings suggest paternal involvement, as measured by listing fathers' names, is protective against low birthweight and infant mortality, further evaluation is needed.Infant mortality Social support Fathers Father absence Marital status Husbands Single parent

"Siempre me critican": barreras de acceso a la salud reproductiva en Ocotal, Nicaragua

OBJETIVO: Determinar cómo perciben las mujeres de Ocotal, Nicaragua, las barreras de acceso a la atención de salud reproductiva; describir sus conocimientos acerca de los derechos reproductivos; y consignar sus opiniones acerca de la prohibición total del aborto en Nicaragua. MÉTODOS: De mayo a junio del 2014, se establecieron tres grupos de discusión en español en los que participaron 17 mujeres de dos barrios diferentes de la ciudad de Ocotal. Se utilizó una guía de discusión semiestructurada que constaba de preguntas de respuesta libre para dilucidar las perspectivas locales con respecto a los temas del grupo de discusión. RESULTADOS: Los obstáculos graves, incluidos 1) la violencia contra la mujer, 2) el machismo, 3) las críticas por parte de otros, y 4) la falta de comunicación y formación, limitan la capacidad de las mujeres para tomar sus propias decisiones de salud reproductiva. Las mujeres mostraron una carencia generalizada de conocimientos acerca de sus derechos reproductivos y los documentos internacionales de derechos humanos que los definen. Además, como consecuencia de sus ideas religiosas y culturales, la mayor parte de las mujeres apoyaron la prohibición total del aborto en el país en la mayor parte de las circunstancias, con la posible excepción de la violación. CONCLUSIONES: Se debe alentar a los hombres y mujeres de Ocotal a participar en los programas comunitarios diseñados para reducir la repercusión de los siguientes obstáculos para obtener atención de salud reproductiva: 1) la violencia contra la mujer y el machismo; 2) la educación sexual no estandarizada y la información acerca de sus derechos reproductivos insuficientes; y 3) la comunicación deficiente dentro de las familias y en la comunidad en general. Con objeto de reducir el estigma en torno a la salud y la actividad sexuales, las futuras campañas de salud pública orientadas a tratar las necesidades de salud reproductiva de las mujeres de Ocotal deben llevar a cabo en los barrios estos tipos de programas

Causes of Death Among Women Aged 10-50 Years in Bangladesh, 1996-1997

Limited information is available at the national and district levels on causes of death among women of reproductive age in Bangladesh. During 1996-1997, health-service functionaries in facilities providing obs-tetric and maternal and child-heath services were interviewed on their knowledge of deaths of women aged 10-50 years in the past 12 months. In addition, case reports were abstracted from medical records in facilities with in-patient services. The study covered 4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%) occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes, 6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and medical causes during pregnancy respectively. Cardiac problems (11.7%), infectious diseases (11.3%), and system disorders (9.1%) were the major medical causes of deaths. Pregnancy-associated causes included direct maternal deaths (20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest proportion of deaths among women aged 10-19 years was due to injuries (39.3%) with suicides accounting for 21.7%. The largest pro­portion of direct obstetric deathsoccurred among women aged 20-29 years (30.5%). At least one quarter (24.3%) of women (n=28,998)did not receive any treatment prior to death, and 47.8% received treatment either from a registered physician or in a facility. More focus is needed on all causes of deaths among women of reproductive age in Bangladesh

The hidden problems of illegal abortions in Thailand

High rates of unplanned pregnancy and induced abortion were reported among young women in Thailand. Complications from illegal and low standard abortion are a current major health problem in the country. Abortion is considered to be a life-destroying act that counts as a serious bap (sin or demerit) in Thai culture. The current abortion law in Thailand stipulates that abortion is illegal except when performed by a medical practitioner in circumstances considered necessary when the pregnancy endangers the woman's health or conception had occurred during a sexual offense such as rape or incest. However, most Thai people feel that the abortion law should be amended because Thai society has changed radically in its attitudes over the past decade. The debate over legal reform of this law is still active. Thailand needs a multi-disciplinary approach to reduce and prevent the number of unplanned pregnancies and unsafe abortions, with special attention paid to the most vulnerable group of women. Chiang Mai Medical Journal 2014;53(4):187-91