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Avoiding unwanted pregnancy - The role of communication, information and knowledge in the use of contraception among young Norwegian women
Abstract
Despite relatively easy access to contraceptives, a liberal attitude to pregnancies out of wedlock and a widespread family planning education in schools, too a high number of adolescent women in Oslo, the capital of Norway, become pregnant and resort to abortions. The aim of this study was to identify some new entry points to sexuality, contraceptive, abortion and post-abortion counselling. Using a qualitative approach, we interviewed 102 young women in Oslo who were seeking either an abortion or contraceptives. The study demonstrated that contraceptive awareness is good, but that there are different levels of consistency in contraceptive use among women, and that even women with few partners and fairly good contraceptive compliance sometimes experience unplanned pregnancy. The study reviews some issues of importance where communication with young women could be improved. These issues include better formal information about OCs, increased information on emergency contraception, better condom promotion, and an attempt to involve better informed adults, including paramedical professional counselling. In addition, contraceptive prescriptions should accord to the type of behaviour and the relationships the young women have.
... Par ailleurs, la grossesse (et plus encore le désir d'enfant) est parfois une démarche de comblement des carences de l'enfance (Marcelli, 2000, cité dans Faucher et al, 2002. En effet, les violences physiques, les carences affectives et les négligences éducatives pendant la petite enfance apparaissent fortement corrélées avec la parentalité précoce (Rainey et al., 1995, cités par Faucher et al., 2002Uzan, 1998 ;Hillis et al., 2004) Alors que l'accent est parfois mis sur la non ou la mauvaise utilisation d'une contraception comme facteur principal pour expliquer la survenue d'une grossesse à l'adolescence, plusieurs études montrent que les adolescentes auraient une bonne connaissance des moyens de contraception en général (Sundby et al., 1999 ;Jewell et al., 2000). Toutefois, compte-tenu des caractéristiques de la sexualité à l'adolescence, où les rapports sexuels peuvent être sporadiques et non planifiés (Loignon, 1996), elles n'auraient peut-être pas suffisamment connaissance de la contraception d'urgence (Sundby et al., 1999). ...
... En effet, les violences physiques, les carences affectives et les négligences éducatives pendant la petite enfance apparaissent fortement corrélées avec la parentalité précoce (Rainey et al., 1995, cités par Faucher et al., 2002Uzan, 1998 ;Hillis et al., 2004) Alors que l'accent est parfois mis sur la non ou la mauvaise utilisation d'une contraception comme facteur principal pour expliquer la survenue d'une grossesse à l'adolescence, plusieurs études montrent que les adolescentes auraient une bonne connaissance des moyens de contraception en général (Sundby et al., 1999 ;Jewell et al., 2000). Toutefois, compte-tenu des caractéristiques de la sexualité à l'adolescence, où les rapports sexuels peuvent être sporadiques et non planifiés (Loignon, 1996), elles n'auraient peut-être pas suffisamment connaissance de la contraception d'urgence (Sundby et al., 1999). D'autres études rapportent qu'un certain nombre de fausses croyances continuent de circuler parmi les adolescentes, comme le fait par exemple de ne pas risquer de grossesse lors d'un premier rapport sexuel. ...
... Un certain nombre d'auteurs soulignent le rôle du partenaire dans l'utilisation ou non d'une contraception par la jeune fille. Selon Sundby et al., (1999), l'utilisation ou non de contraception semble dépendre de la communication entre les partenaires. La timidité et les difficultés à discuter de sujets sensibles tels que la sexualité ou la contraception seraient des facteurs qui peuvent influencer l'échec de la contraception. ...
... According to sundby and there [7], use Where no of contraception seems to depend of the communication between the partners. The timidity and the difficulties at to discuss of sensitive topics such as sexuality or contraception are factors that can influence contraceptive failure. ...
... This is dichotomous (yes/no), of modalities (total influence, partial, non-existent). The variables intermediaries who there are associated are to number of seven (7) at to know the context of the action, the negotiation, the goal of the action, the strength of affectivity, the strength of the habit, the background of the action and the circumstances of the action all of nature qualitative dichotomous (Yes No), of modalities (total, partial, non-existent influence). The second variable is the esteem of self. ...
This study aims to analyze the relationship between gender, self-esteem, the communication parents/teenagers and the behaviours at risk of pregnancies early in environment school. She carries on a sample of six hundred four (604) teenage girls and we selected three one hundred and five eight (358) students- adolescent girls from the sixth to the final year in the municipality of Yopougon whose age varies from 10 to 19 years. Thus, we used as a sampling technique the proportional allocation of quotas. The sample is submitted to a questionnaire the results of which are analyzed using the method statistical who does not require than the quantification from data collected. The method qualitative at summer too used through content analysis more specifically indexing. Thus, the results of our investigation according to the chi of them of person calculated, we at permit of to confirm than gender has a significant effect on early pregnancy risk behaviors at the house of the teenage girls. Too, the variables intermediaries who are associated at the gender variable out of seven (7) three variables were confirmed, namely the context of the action, the goal of the action and the history of the action. Thereby, she come complete reflections on the links between gender, self-esteem, communication parents/teenagers and the behaviours at risk of pregnancies early in environment school.
... Le rôle du partenaire n'a guère été évoqué par les intervenants interrogés mais il fait l'objet de commentaires dans la littérature, notamment pour son impact sur l'utilisation ou non d'une contraception par la jeune fille. Une meilleure communication entre les deux partenaires sur des sujets sensibles tels que la sexualité ou la contraception, plus fréquente lorsque le couple est relativement stable, favoriserait la protection des rapports (Sundby et al., 1999, Loignon, 1996 La majorité des femmes aurait eu son premier rapport avec un partenaire plus âgé (Bozon et al, 1997). utiliser les moyens contraceptifs (Loignon, 1996). ...
... ). Ainsi, en Norvège (à Oslo), les jeunes sont globalement au courant des moyens de contraception (ils ont tous entendu parler de pilule et de stérilet et savent où et comment y avoir accès), mais ils ignorent beaucoup de la physiologie de la conception (par exemple, quelle est la période la plus fertile pour une femme)(Sundby et al. 1999). Par suite, ils n'utilisent pas de moyens contraceptifs car sous-estiment le risque de grossesse. ...
... They are also familiar with the culture in which health practices are embedded, which is one reason that such grassroots health workers better achieve health education objectives (bij de Vaate, Coleman, Manneh, & Walraven, 2002; Dunn, Pirie, & Hellerstedt, 2003; Larkey, et al., 1999; Norr, Tlou, & Matshidiso, 2004; Pallikadavath, Foss, & Stones, 2004). Finally, women's satisfaction with health care is also dependent on their level of interaction with the care providers (Lambke & Kavanaugh, 1999; Lendahls, ¨ Ohman, Liljestrand, & Håkansson, 2002; Olsson, Sandman, & Jansson, 1996; Sundby, Svanemyr, & Maehre, 1999). The new knowledge that village women had received concerning their well-being seemed to make them more self-confident because someone with some status in the village found their health to be important. ...
... Women might worry how their husbands and society would look upon them if they learn too much or adopt new practices because of health education . This is connected to women's roles in society (Currie & Wiesenberg, 2003; Sundby, Svanemyr, & Maehre, 1999), a subject that is beyond the scope of this article. People being interviewed may respond in a certain way because they know they are part of a study, particularly when the health worker who provided them with information is present during the interview. ...
... Women with fewer financial resources may not be able to access family planning services in a timely manner because of the long waiting times in public clinics and the expensive costs of private clinics (Hemminki et al. 1997). Long waiting periods may result in women becoming pregnant before the appointment, as suggested by a study on the contraceptive use of young Norwegian women (Sundby, Svanemyr, and Maehre 1999). Chapter 5 showed that women with unstable relationships, and perhaps with less stable lives overall, had an elevated risk of abortion. ...
... However, it may be that adolescents who struggle in school do not benefit from sex education in school as much as others. Furthermore, ordinary school teachers may not know enough of contraceptive methods to teach about possible side effects or other concerns young women may have regarding contraception, as suggested by a study in Norway (Sundby, Svanemyr, and Maehre 1999). Thus, there is a need for additional channels of distributing information on contraceptive use and sexuality. ...
Induced abortion is an understudied topic in part because of a lack of reliable data due to underreporting of abortion in surveys. The debate about whether teen pregnancies push women into socioeconomic disadvantage would benefit from longer follow-up periods and reliable data. This thesis studies which socio-demographic characteristics are associated with the likelihood of abortion, provides more precise estimates than previous studies on the socioeconomic risk factors of repeat abortion, and examines socioeconomic outcomes of women with different teen pregnancy histories. I use register data over the reproductive life span of Finnish women born in 1955–59, 1965–69 and 1975–79 (N=274,908). There is no underreporting of abortion in these data. The thesis consists of four sub-studies. The first examined the socioeconomic gradient in the risk of first abortion using event-history analysis. Low education was associated with higher risk of abortion and the gap increased over time. Selection into education and varying access to family planning services were the likely mechanisms. The second study found an educational gradient in the likelihood of repeat abortion, which has become more common over time, indicating a need of an intervention. The third sub-study examined the association between the timing of abortion and union dissolution using multi-process modelling. There were correlated unobserved characteristics associated with both unstable relationships and a higher likelihood of an abortion. Finally, I compared socioeconomic outcomes of women who had a birth, an abortion, or no pregnancy in adolescence. Results using the Karlson-Holm-Breen mediation method showed teen abortion did not mediate the relationship between parental and own socioeconomic position but teen birth did through accumulation of disadvantage. Overall the results show there is a group of women who do not benefit from contraceptive services as much as others. These findings are of importance, as reliable information on abortion is not typically available.
... The fear of rejection by her partner, the discomfort related with talking about sexuality and the lack of self-confidence could hinder adolescents from suggesting the use of contraception to their partners [8]. None the less communication between partners favours the use of contraception [14]. ...
... Surprisingly, Hickey's findings on the misunderstanding of EC were similar to results of earlier studies on international samples, which suggest that little progress in education has been made despite increased effort and access to EC. For example, Sundby et al. studied 100 women in Norway and found that most lacked knowledge of the use and side effects of EC [13]. Similarly, Tyden studied 762 women in Sweden who requested EC and found that 83% were younger women, 13% had had a previous abortion, and 20% had used EC multiple times [14]. ...
Purpose: Women under age 25 have the highest rates of unintended pregnancies, emergency contraception (EC), and abortion. EC has not shown to prevent unintended pregnancies; yet some advocate for more availability. This study examined EC use and abortion among university students. Methods: This was a descriptive, international study. Demographic and reproductive data were collected on university students; (1) those that had an abortion and (2) those who did not. Chi-Squared and Fisher Exact Testing were used. Results: The sample included 151 students, including 89 who had an abortion. Significant differences were found between the abortion group and the no abortion group in: contraceptive use (88% vs. 69%, p < 0.020), emergency contraceptive use (73% vs. 29% p < 0.001), and frequency of emergency contraceptive use (62% vs. 27%, p < 0.001). Over 10% of the abortion group used EC from 4-6 times as opposed to 1.6% of those who were never pregnant. Discussion: The abortion group used EC more than the no abortion group, suggesting EC did not prevent pregnancy. We recommend to evaluate for: (1) for EC use, side effects, (2) high risk sexual behavior, (3) selfdestructive tendencies, and promote healthy, self-protection and positive self-image measures.
... considered. 14,15 The experiences and opinions of peers and family members influence young women. In many cases, their opinions are more valuable to women than a clinician's opinion. ...
Introduction:
Approximately 80% of college-aged women are at risk of unintended pregnancy. The American College of Obstetricians and Gynecologists recommends long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs), as first-line pregnancy prevention for adolescents and young women. Yet, less than 5% of 15- to 19-year-old women using a method of contraception use LARC. Limited research explores young women's concerns about IUDs.
Methods:
As part of a larger women's health research study, researchers conducted 53 in-depth interviews with women, aged 18 to 24 years enrolled in a midsized liberal arts college in the southeastern United States. Analytical techniques from the grounded theory approach were used to code line-by-line and identify themes emerging from these data.
Results:
Fear of causing harm or infertility through IUD use emerged as a significant barrier to uptake. Negative and often unfounded beliefs about IUDs led to silence and limited observability of IUDs in daily life and health care contexts. Identity as a fertile woman emerged as an antecedent factor to the compatibility of IUDs with participants' values and beliefs.
Discussion:
The link between fear of infertility and perceived identity was found to be a major factor in young women's contraceptive decision making. In order to increase uptake of IUDs, the beliefs of women must be addressed.
... 67 Leaving the contraceptive responsibility in the hands of women has been reported as a recurring tactic among men in previous studies. 72,97,98,108,109 Since all available contraceptive methods except the male condom are applicable to women only, a general attitude may have arisen of women's being the "natural" contraceptive users. ...
... When addressing women's knowledge of and attitudes towards FP methods, researchers frequently focus on side effects, effectiveness or correct use (Sundby et al. 1999). Women's opinions about mechanisms of action have been much less investigated and research is usually concentrated on the EC pill (Campbell et al. 2008, Gould et al. 2002, Jackson et al. 2000. ...
To assess women's attitudes towards the mechanisms of action of birth control methods.
When addressing women's knowledge of and attitudes towards birth control methods, researchers frequently focus on side effects, effectiveness or correct use. Women's opinions about mechanisms of action have been much less investigated, and research is usually concentrated on the EC pill.
Cross-sectional study.
Women, aged 18-49, from Germany, France, the UK, Sweden and Romania were randomly selected (n = 1137). They were asked whether they would use a method that may work after fertilisation or after implantation and whether they would continue using it after learning it may have such effects. Logistic regression was performed to evaluate the influence of certain characteristics on women's attitudes.
Almost half of women in Romania and Germany would not use methods with postfertilisation effects, while the lowest percentages were found in Sweden and in France. Regarding methods with postimplantation effects, higher percentages were found in all the countries. Highly educated women and those using a highly effective method were more likely to use methods with postfertilisation effects. On the contrary, married women, those who stated that human life begins at fertilisation and women with middle/high religiosity were less likely to consider using methods that may act after fertilisation.
One-third of European women reported that they would not consider using a method that may have postfertilisation effects.
Given that postfertilisation effects may not be acceptable to some women, informing them of which methods may have these effects is essential to obtaining complete informed consent and to promoting women's autonomy.
... Essas suposições ganham especial importância quando se constata que baixas condições sócio-econômicas e de escolaridade, em países em desenvolvimento como o Brasil, podem atuar como fatores de risco para gravidez indesejada 15 . Entretanto também podem estar mais relacionadas às práticas sexuais do que ao conhecimento formal sobre métodos contraceptivos 16,17 . ...
This study focused on knowledge and use of emergency contraception among 4,210 adolescents (14-19 years) enrolled in public schools in Pernambuco State, Brazil. Information was collected using the Global School-Based Student Health Survey, previously validated. Knowledge, frequency, and form of use of emergency contraception were investigated. Independent variables were classified as socio-demographic and those related to sexual behavior. Most adolescents reported knowing and having received information about the method, but among those who had already used it, only 22.1% had done so correctly. Adjusted regression analysis showed greater likelihood of knowledge about the method among girls (OR = 5.03; 95%CI: 1.72-14.69) and the sexually initiated (OR = 1.52; 95%CI: 1.34-1.75), while rural residents were 68% less knowledgeable. Rural residents showed 1.68 times higher odds (CI95%: 1.09-2.25) of incorrect use, while girls showed 71% lower likelihood of incorrect use. Sexual and reproductive education is necessary, especially among male and rural adolescents.
... patients at two academic family medicine clinics in the United States, found that 24% of women responded that EC pill worked before fertilization, 36% before implantation, 6% after implantation and 34% were unsure about the mechanism of action [20]. Low knowledge about EC is also frequent regarding indications, timing of administration, adverse effects or efficacy [18,20,26]. Studies about OCs and IUDs find that knowledge about risks, benefits and side effects are deficient [27][28][29]. ...
Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women.
Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women's characteristics associated with their knowledge of mechanisms of action.
The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Fewer than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β=0.22, 95% confidence interval 0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects.
European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.
... Dislike of school reflects the educational dimension of social exclusion. It has been recognised that merely good knowledge of sexual matters does not ensure responsible behaviour and prevention of unwanted pregnancies (Marston and King, 2006; Sundby et al., 1999). Compulsory sexuality education, as a part of human studies in primary school, was introduced in Estonia only in 1996. ...
Käesolevas uurimuses analüüsiti noorte naiste seksuaaltervise erinevaid näitajaid: suundumusi teismeliste raseduste esinemises kiirete sotsiaal-majanduslike muudatuste perioodil aastatel 1992−2001, hinnati teismelise sünnitaja vanuse efekti perinataalsele tulemile, uuriti teismeliste planeerimata rasedustega seotud individuaalseid ja perekondlikke tegureid ning hinnati eelneva indutseeritud abordi seost platsentaarperioodi tüsistustega. Uuringuperioodil vähenes märgatavalt nii teismeliste sünnituste kui indutseeritud abortide üldarv, samuti abortiivsus- ja sündimuskordajad 1000 teismelise kohta. Teismelistel oli suurenenud enneaegsuse ja madala sünnikaaluga lapse sünni risk võrreldes 20−24aastaste emadega. Surnultsünni risk polnud teismelistel emadel suurem. 17aastastel ja noorematel tütarlastel oli suurenenud lapse surma risk neonataalses ja postneonataalses perioodis, mis ilmselt tulenes enneaegsusest. Planeerimata raseduse risk teismeeas oli seotud madala teadmiste tasemega rasestumisvastaste vahendite ja suguorganite talitluse kohta ning negatiivse hoiakuga kooliskäimise suhtes ja alkoholi sagedase kasutamisega pereliikmete poolt. Esimese trimestri kirurgiline abort anamneesis oli esmassünnitajatel seotud tüsistuste (emakaõõne manuaalne revisioon, platsenta manuaalne eemaldamine, emakaõõne abrasioon) riski tõusuga sünnituse platsentaarperioodis.The general objective of this study was to get additional knowledge of young women’s sexual health and behaviour in Estonia. We examined trends in teenage pregnancies in Estonia during the years of rapid socio-economic changes in 1992−2001, assessed the risk of young maternal age on perinatal outcome – low birth weight, preterm birth, stillbirth, neonatal and postneonatal death. We investigated individual and familial factors associated with teenage unintended pregnancy and analysed the risk of complications in the third stage of labour in deliveries following surgically induced abortion(s). Both the number and rates of teenage births and abortions declined remarkably in Estonia during the years of rapid socio-economic changes. Mother’s age of 19 years and less may be a risk factor for low birth weight and preterm births. Risk of stillbirths is not higher among teenagers. The risk of neonatal and postneonatal death of the newborn child is higher among younger teenagers aged 17 years and less, presumably due to increased risks in preterm birth. Low level of knowledge about the functioning of reproductive organs and contraception, and dislike of school (individual factors), as well as the reporting of alcohol abuse by family members (familial factor), were associated with higher risk of unintended teenage pregnancy. A positive association was observed between one or more first trimester surgically induced abortions and the risk of complications in the third stage of labour (retained placenta and/or tissue and/or haemorrhage needing manual revision of uterine cavity or curettage) in subsequent singleton vaginal delivery.
... Leaving the contraceptive responsibility in the hands of women has been reported as a recurring tactic among men. 16,17,[27][28][29] Perhaps because all available contraceptive methods except the male condom and vasectomy are applicable to women only, a general attitude has arisen that women are the "natural" contraceptive users. ...
Swedish law permits abortion at the request of a pregnant woman until the 18th week of gestation. However, the extent to which the decision is truly the woman's own is subject to debate; women are often influenced, directly or indirectly, by the attitudes of their partners, family and friends or by social norms.
Individual in-depth interviews about the pregnancy and the abortion decision were conducted 3-4 weeks postabortion with 25 women aged 16-20 at different periods in 2003, 2005 and 2007. Interviews were audio-taped, transcribed verbatim and analyzed using latent content analysis.
The main reasons for unplanned pregnancy were underestimation of pregnancy risk and inconsistent contraceptive use. Pregnancy prevention was perceived as the woman's responsibility. The abortion decision was accompanied by mixed emotions, and was seen as a natural yet difficult choice. Social norms and the negative attitudes of family and friends strongly influenced the decision. Partners and parents were regarded as the most important sources of support. After the abortion, the women felt pressured by contraceptive counselors to use highly effective contraceptives despite their previous negative experiences or worries about side effects.
Swedish teenagers' basic right to decide whether to have an abortion may be limited by societal norms and disapproval of teenage childbearing. Given the perception that women are responsible for contraception, programs need to emphasize that pregnancy prevention is a shared responsibility; greater efforts to include males in prevention practices are needed.
... Essas suposições ganham especial importância quando se constata que baixas condições sócio-econômicas e de escolaridade, em países em desenvolvimento como o Brasil, podem atuar como fatores de risco para gravidez indesejada 15 . Entretanto também podem estar mais relacionadas às práticas sexuais do que ao conhecimento formal sobre métodos contraceptivos 16,17 . ...
This study focused on knowledge and use of emergency contraception among 4,210 adolescents (14-19 years) enrolled in public schools in Pernambuco State, Brazil. Information was collected using the Global School-Based Student Health Survey, previously validated. Knowledge, frequency, and form of use of emergency contraception were investigated. Independent variables were classified as socio-demographic and those related to sexual behavior. Most adolescents reported knowing and having received information about the method, but among those who had already used it, only 22.1% had done so correctly. Adjusted regression analysis showed greater likelihood of knowledge about the method among girls (OR = 5.03; 95%CI: 1.72-14.69) and the sexually initiated (OR = 1.52; 95%CI: 1.34-1.75), while rural residents were 68% less knowledgeable. Rural residents showed 1.68 times higher odds (CI95%: 1.09-2.25) of incorrect use, while girls showed 71% lower likelihood of incorrect use. Sexual and reproductive education is necessary, especially among male and rural adolescents.
... However, while accurate knowledge and skills about contraception and sex are necessary, research has consistently shown that simply improving knowledge about the risks involved in unsafe sexual behaviour does not significantly affect subsequent intention to use contraception 5,6 . Sundby et al. 7 also found that, despite very good contraceptive awareness amongst their young female participants, consistency of use varied, and even consistent users became pregnant sometimes. In spite of the acknowledged link between lower socio-economic status and unintended pregnancy, adolescents from middle-class backgrounds also face this outcome 4 . ...
Britain has high rates of unintended adolescent pregnancy compared to other European countries. Relatively little is known about the beliefs, attitudes and experiences of using hormonal contraceptive methods amongst middle-class adolescents, and mention of their views in the literature will add to the knowledge in this area. The current qualitative study addresses these issues to some extent.
Middle-class 16-18-year-old men and women were interviewed about their understanding and use of hormonal contraceptives. The interviews were transcribed verbatim and transcripts subjected to an adaptation of interpretative phenomenological analysis (IPA).
Six emergent themes represent important aspects of these adolescents' experiences: negative experiences, experiences unrelated to pregnancy prevention, mistrust of the pill, risk reduction, issues of communication and trust, and perceptions of pill promotion by adults.
The findings illustrate the complexities inherent in contraceptive health care in relation to hormonal methods and highlight not only potential targets for enhancing effective use, but the importance of the way such information is disseminated.
Purpose
The aim of this study is to identify the aspects associated with resistance to contraception, providing healthcare workers with the necessary tools to increase compliance with contraception and, ultimately, reduce the rate of voluntary abortions.
Material and methods
We performed a review of the literature published in Medline between 1st January 2000 and 31st July 2020. We included studies based on qualitative analyses, describing women’s perception and attitudes towards contraception, including a population aged 15 years or older and conducted in either Europe or North America.
Results
A total of 23 articles were included in the study. Resistance to contraceptive uptake was most frequently due to ambivalence about pregnancy, with up to 54% of ambivalent women reporting not using any means of contraception, and communication issues with the partner and/or health care provider, with a positive association found between communication with the partner and contraceptive use (OR 1.07; p < .050). Additional barriers to contraceptive use were the quality of the relationship with the partner, the perception of the risk of becoming pregnant after unprotected sexual intercourse, and unfamiliarity with contraception.
Conclusions
Family planning consultations should acknowledge the aspects that influence contraceptive uptake and address them as part of their consultations.
The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions.
Objectives
To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are.
Data sources
We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders.
Review methods
To address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback.
Results
We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research.
Limitations
Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations.
Conclusions
We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK.
Study registration
This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.
Funding
The National Institute for Health Research Health Technology Assessment programme.
The UK has the highest rate of teenage pregnancies in Western Europe, a fifth are repeat pregnancies. Unintended conceptions can result in emotional, psychological and educational harm to teenage girls, often with enduring implications for their life chances. Babies of teenage mothers have increased mortality in their first year and increased risk of poverty, educational underachievement and unemployment later in life, with associated societal costs.
Methods and analysis We will conduct a streamed, mixed-methods systematic review to find and evaluate interventions designed to reduce repeat unintended teen pregnancies.
Our aims are to identify Who is at greater risk of repeat unintended pregnancies? Which interventions are effective, cost-effective, how they work, in what setting and for whom? What are the barriers and facilitators to intervention uptake? Traditional electronic database searches will be augmented by targeted searches for evidence ‘clusters’ and guided by an advisory group of experts and stakeholders. To address the topic's inherent complexities, we will use a highly structured, innovative and iterative approach combining methodological techniques tailored to each stream of evidence. Quantitative data will be synthesised with reference to Cochrane guidelines for public health interventions. Qualitative evidence addressing facilitators and barriers to the uptake of interventions, experience and acceptability of interventions will be synthesised thematically. We will apply the principles of realist synthesis to uncover theories and mechanisms underpinning interventions. We will conduct an integration and overarching narrative of findings authenticated by client group feedback.
Ethics and dissemination We will publish the complete review in ‘Health Technology Assessment’ and sections in specialist peer-reviewed journals. We will present at national and international conferences in the fields of public health, reproductive medicine and review methodology. Findings will be fed back to service users and practitioners via workshops run by the partner collaborators.
The pressure swing adsorption (PSA) models discussed here are divided into three categories: partial differential equation model, electrical analogue model and neural network model. The partial differential equation model, including equilibrium and kinetic models, has provided an elementary viewpoint for PSA processes. Using the simplest equilibrium models, some influential factors, such as pressurization with product, incomplete purge, beds with dead volume and heat effects, are discussed respectively. With several approximate assumptions i.e., concentration profile in adsorbent, "frozen" column, symmetry and heat effects of bed wall, the more complex kinetic models can be simplified to a certain degree at the expense of a limited application. It has also been found that the electrical analogue model has great flexibility to handle more realistic PSA processes without any additional hypothesis.
One in five pregnancies in the UK ends in abortion. The great majority of those pregnancies are unintended, resulting from incorrect, inconsistent or non-use of contraception, rather than contraception failure. We undertook a synthesis of qualitative research with women who have unintended pregnancies as a new approach to understanding contraceptive behaviour. A literature search was carried out using four databases. Identified studies were screened against pre-set inclusion criteria. Included studies were quality assessed. Analysis followed a meta-ethnographic approach. A total of 236 studies were identified, of which nine were included. Six categories involved in contraceptive behaviour were identified - access, method factors, knowledge, societal influence, personal beliefs and motivations and relationship factors. A model of contraceptive behaviour was developed. Contraceptive behaviour is a complex, multifactorial process. Interventions targeting one aspect are unlikely to make a difference; however identifying and affecting the important factors within a population may improve contraception adherence.
The aims of this study were to investigate the knowledge, attitudes and behavior of female high school and university students concerning contraception. The study was performed at the Alexandra University Hospital in Athens. A total of 297 female students participated in the study. A questionnaire was used to evaluate the depth of knowledge and attitude of respondents concerning contraception. Our findings suggest students have a defective knowledge of contraception. Their main source of information were friends but the majority would prefer to receive information from doctors. The most popular contraceptive method was the male condom. The attitude and behavior of young women in our study were consequently defective. In conclusion, there is a need to provide students with correct, detailed and broad-based information on conception and contraception as part of the school curriculum to help them acquire adequate knowledge and develop appropriate attitudes on contraception and sexual health.
Dieses Kapitel bietet einen Überblick über Formen, Konsequenzen und Determinanten sexuellen Risikoverhaltens. Im Mittelpunkt
standen sexuell übertragbare Infektionen sowie unbeabsichtigte Schwangerschaften. Zunächst wurden die Formen sexuell übertragbarer
Krankheiten und ihre epidemiologische Entwicklung dargestellt. Hierbei wurde deutlich, dass sich die Hauptbetroffenengruppen
im europäischen Raum verschieben. Die unterschiedlichen Theorien zur Erklärung des sexuellen Risikoverhaltens wurden dargestellt
(„AIDS-Risk-Reduction-Model“; „Information-Motivation-Behavioral Skills Model“ sowie die PSI-Theorie). Dabei kann bislang
kaum eines der etablierten Modelle das sexuelle Risikoverhalten in seiner Breite prädizieren. Die PSI-Theorie bietet hier
Möglichkeiten, die allerdings bislang noch nicht empirisch untermauert wurden. Im Bereich der unbeabsichtigten Schwangerschaften
ist die Forschungsintensität verglichen mit der HIV-bezogenen psychologischen Forschung gering, was auch die entsprechenden
theoretischen Modelle sowie die Präventionsbemühungen einschließt.
To assess the compliance with the isotretinoin Pregnancy Prevention Programme (PPP) by evaluating the use of prescribed contraceptives among isotretinoin users. The PPP contains a requirement for the use of contraceptive methods for women of childbearing potential.
A drug utilisation study was performed using data from a drug prescription database (containing Dutch community pharmacy data) covering a population of 500 000 patients. Contraceptive use in female isotretinoin users and in a reference group of female non-isotretinoin users (aged 15-49 years) was compared using data from 1999 until 2006 in 2-year periods. Descriptive statistics were used.
Of the female isotretinoin users (n = 651), 52%-54% filled prescriptions on contraceptives in strict accordance to the PPP, used before, during, and after discontinuation of isotretinoin, compared with 39%-46% in the reference group. A more liberal approach of a minimum of one prescription for a contraceptive method showed 61%-64% use of contraceptives among isotretinoin users. Similar patterns were seen when data were broken down in age groups. Furthermore, a higher proportion of female patients using isotretinoin prescribed by general practitioners used prescribed contraceptives compared with those receiving isotretinoin by specialists.
Compliance with the contraceptive use according to a PPP for a teratogenic drug such as isotretinoin is 52%-64%, which is lower than anticipated. Reasons for the low compliance will need to be clarified before further measures can be taken. Copyright © 2012 John Wiley & Sons, Ltd.
Objective: The aim of this study is to compare the incidence of unwanted pregnancies in women under
35 and those over 35 years, compare the results with the previous data, and also to determine the
causes of unwanted pregnancies in these women
Materials and methods: This cross-sectional study (descriptive - analysis) is performed on 400 pregnant
women who had referred to the laboratories of Shiraz. Ten laboratories were randomly selected from
different parts of Shiraz. The subjects were interviewed during the period of three months they referred for
the result of their pregnancy test. Questionnaire included demographic information, how to use the
methods of contraception, how to treat women with unwanted pregnancies, and the history of pregnancy.
The chi-square tests, t-test, and logistic regression were utilized in order to compare two groups of women
under 35 and over 35 and also to determine the factors related to unwanted pregnancies.
Results: In this study, the prevalence of unwanted pregnancies in women under study was 14.7%. The
incidence of pregnancy in women under 35 and those over 35 was 13.3% and 33.3%, respectively. The
difference between the groups was found to be statistically significant (p=0.01).
Conclusion: the percentage of unwanted pregnancies has reduced in Shiraz and this is indicative of the
success of family planning. However the percentage of unwanted pregnancies in women over 35 is still high.
Due to the fact that these women use unreliable methods training courses should be planned for them.
We looked at early pregnancy and parenthood as an opportunity to broaden our understanding of the reproductive health education needs met by adolescent girls.
We conducted an in-depth interview study with 12 adolescent mothers.
To become a mother at a young age was perceived as meaningful to all the participants. The participants expressed a need to be addressed as adult parents, who want the best for their child. A variety of psychosocial and health needs emerged over a time span ranging from starting to be sexually active to after the child was born. Social isolation was found to be an important factor of vulnerability.
The health needs of adolescent mothers extend well beyond counselling around the decision to continue or terminate pregnancy, and subsequent information on contraception methods to avoid further pregnancies. Adolescent mothers need to be supported in their transition to parenthood, and special care should be provided to girls who are socially isolated.
We identified several avenues for health education and counselling to adolescent mothers, from primary prevention to reduce incidence of early pregnancies to tertiary prevention to reduce negative health outcomes for both mother and child.
To study the experiences of teenagers using contraceptives at an out-patient abortion clinic and to explore the reasons behind their choices.
Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.
One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.
The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was unsatisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to initiate it. Friends and the Internet were the main sources for acquiring information.
The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women's attitudes and perceptions in 2001 and 2007.
The questionnaires were distributed from university pharmacies in 12 large cities across Finland.
The data were collected with two questionnaire surveys among women who used hormonal contraceptives in 2001 and 2007. In the 2001 survey the response rate was 53% (n = 264) and in the 2007 survey 55% (n = 436).
The number of respondents who considered professional information sources the most important information sources was markedly bigger in 2007 than in 2001 (P = 0.005). The most common source of information concerning the benefits of hormonal contraceptives was a physician (2001: 43%, 2007: 53%). The most common source of information concerning the risks of hormonal contraceptives was friends and relatives (43%) in 2001 and physician in 2007 (35%). Only a few percent of the respondents considered a pharmacy the most important information source both the 2001 and 2007 surveys.
The importance of health care professionals as sources of information concerning hormonal contraceptives has increased. However, role of pharmacists as information source was surprisingly small. Women who use hormonal contraceptives need more information from professional sources to alleviate possible fears associated with use.
The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners.
Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners.
The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception.
In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.
Despite the widespread use of medical contraception in France, the prevalence of abortion remains stable. A cross-sectional population-based survey was designed to study the characteristics of current contraceptive use in France, the different types of contraceptive failure, and the reasons reported for not using contraception.
A representative sample of 14 704 French households was randomly selected from the telephone directory. All women who in the last 5 years had had an abortion or whose last pregnancy was unintended were selected (n = 1034), whilst a fraction (n = 1829) of the other women were randomly selected. Altogether, 2863 women answered the questionnaire.
Only 2.7% of the women aged 18-44 years who did not wish to conceive and were sexually active did not use any contraception. However, 33% of pregnancies were estimated to be unplanned, of which 50% ended in an abortion. A total of 65% of the reported unplanned pregnancies occurred among women using contraception (21% the pill, 9% IUD, 12% condoms, 23% other method). The main reasons given for these contraceptive failures were the misuse of the methods or the failure of the partner to withdraw. Reasons for not using any contraception go beyond a simple lack of information.
The importance of-and the reasons mentioned for-contraceptive failure show a misadaptation between women's contraceptive needs and the method they use. Improving the training of family planning providers remains a major goal to ensure that women use a contraceptive method that fits their social and sexual lifestyle.
According to the Security Service Law in Israel, a pregnant soldier serving her compulsory military service, who decides to continue with the pregnancy, is discharged from military service. If she wishes to terminate the pregnancy (TOP) and continue serving in the army, she is referred to a civilian pregnancy termination committee.
This article aims to examine the incidence of pregnancies amongst soldiers during their compulsory military service (ages 18-20 years) and characterize the populations at risk.
Data reflecting yearly incidence of pregnancies, number of TOPs, discharges from military duty as a result of continuation of pregnancy and missed abortions amongst soldiers during their compulsory military duty were derived from the military social services records for the period 1997-2003. Socio-demographic variables, number of prior pregnancies, age of pregnancy, means of TOP, relationship with the other parent and his involvement regarding the pregnancy, were obtained from military records between the years 2002-2003.
The reported yearly incidence of pregnancies in 1997 was 18.6 per 1000 soldiers during their compulsory military service. In 2003, the incidence rose to 21.5 per 1000. The incidence of continuation of pregnancy, TOPs and missed abortions remained unchanged. Number-wise, the pregnancies occurred most often in Israeli-born, high-school educated young women. When stratifying by country of birth, however, the percentage of pregnancies within subgroups varied significantly. Half of the pregnancies were terminated by pharmaceutical means. In the majority of cases, the pregnancy resulted from a relationship lasting over half a year with a male partner, who was aware of the pregnancy and involved with the decisions regarding its outcome.
In recent years there has been a rise in the reported yearly incidence of pregnancies among soldiers aged 18-20 years serving their compulsory military service. These findings reiterate the need to increase the efforts in implementing sex education programs amongst educators and the responsible military authorities.
In this study, we used a narrow, but easily measured, indicator of how communication proceeded among health workers and women in Southern India. Anemia prevention during pregnancy was studied using a semistructured questionnaire. Participants included 5 nurses, 10 health aides, and 10 (traditional birth attendants) TBAs working with maternal health care and education, as well as 32 women seeking maternal health care. Those women who received health education where they lived, from health workers they knew, and together with participants familiar to them learned more about anemia prevention than others.
Little is known about how physicians' attitudes and knowledge of contraception could impact the unintended pregnancy rate in the United States. The objective of this study was to analyze survey data from physicians in primary care training programs in Pittsburgh, PA.
A cross-sectional survey was administered to primary care medical residents in Allegheny County, PA. Descriptive statistics were used to illustrate training, attitudes and knowledge regarding contraceptive management. A multivariable analysis was performed to elucidate associations between training, attitudes and behavior.
Of 143 residents surveyed, 74 (52%) responded. The mean score on contraceptive knowledge assessment was 54%. Obstetrics/gynecology residents performed consistently better on the knowledge index (p<.01). Among nonobstetrics/gynecology residents, formal training in contraception, female gender, ability to insert an intrauterine device and not being a family practitioner were independently associated with improved knowledge (p<.05).
Most of the responding graduating residents view contraception as an important component of primary care. However, young physicians have a contraceptive knowledge base that is inconsistent across primary care specialties. Improvement in this area might improve the unintended pregnancy rate in the United States.
The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP).
The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist.
It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental group, whereas there was no significant change for the control group.
The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future.
Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention.
One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.
This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.
A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.
A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.
This study shows that teenagers giving birth constitute a high-risk group for future unintended pregnancies and legal abortion.
Many women who experience sexual problems or who have been subjected to sexual abuse, do not seek help, and often health professionals avoid raising such issues. The aim of this study was to describe young women's sexual health and their views on a dialogue about aspects of sexuality in connection with a gynecologic examination.
Cross-sectional study. Women, 23, 26 and 29 years of age, called for gynecologic screening between March and July 2006 (n=488; response rate 75%). Descriptive statistics, multiple logistic regression and bivariate analysis were used.
The majority (95%) had a positive attitude towards sexuality, although many women reported sexual problems, and one-fifth (22%) were dissatisfied with their sex life. Women considered it appropriate to be asked about sexuality in general (92%), while a majority (72%) found questions about sexual abuse appropriate. However, depending on the area, the majority (76-99%) had never been asked such questions. Demographic variables, aspects of life, sexuality and sexual abuse were irrelevant for whether women considered it appropriate to be asked questions about aspects of sexuality, by a midwife/doctor in connection with a gynecologic examination.
The result can activate health professionals to initiate a dialogue about sexual issues among young women. In this way, many women who experience sexual problems or have been subjected to sexual abuse, may be provided the opportunity to improve their sexual health.
In 2001, a service dedicated to family planning was created within a large public hospital to improve patient care services. This retrospective chart review demonstrates the benefit of focusing these services in a specialty clinic.
A power analysis was performed and determined that a minimum of 136 charts were needed in each arm of the study to determine if, following an elective abortion, there was a significant increase in attendance at the scheduled postoperative visit. Secondary variables included analysis of contraceptive choice, incidence of continuation of injectable contraception and incidence of repeat pregnancy.
After counseling services were initiated, there was a 27% increase in the number of patients returning for the postoperative clinic appointment within 8 weeks [32% (61/191) in 1998 vs. 59% (80/136) in 2001; p<.0001]. There was also a significant decrease in patients without a plan for contraception, 29% in 1998 vs. 11% in 2001, and a decrease in repeat pregnancies from 9% in 1998 to 1.5% in 2001. There was no difference in patient adherence with injectable contraception.
Consolidation of abortion services improves subsequent use of contraception and reduces incidence of repeat pregnancy.
Context: The immediate explanation that women often give for seeking induced abortion is that the pregnancy was unplanned or unwanted. However, the myriad social, economic and health circumstances that underlie such explanations have not yet been fully explored. Methods: Findings from 32 studies in 27 countries were used to examine the reasons that women give for having an abortion, regional patterns in these reasons and the relationship between such reasons and women's social and demographic characteristics. The data come from a range of sources, including nationally representative surveys, official government statistics, commu- nity-based studies and hospital- or clinic-based research. Results: Worldwide, the most commonly reported reason women cite for having an abortion is to postpone or stop childbearing. The second most common reason-socioeconomic concerns- includes disruption of education or employment; lack of support from the father; desire to pro- vide schooling for existing children; and poverty, unemployment or inability to afford additional children. In addition, relationship problems with a husband or partner and a woman's percep- tion that she is too young constitute other important categories of reasons. Women's charac- teristics are associated with their reasons for having an abortion: With few exceptions, older women and married women are the most likely to identify limiting childbearing as their main rea- son for abortion. Conclusions: Reasons women give for why they seek abortion are often far more complex than simply not intending to become pregnant; the decision to have an abortion is usually motivated by more than one factor. While improved contraceptive use can help reduce unintended preg- nancy and abortion, some abortions will remain difficult to prevent, because of limits to women's ability to determine and control all circumstances of their lives.
Context: Although abortion is illegal in Nigeria except to save the life of the woman, thousands of women resort to if each year. Information on the incidence of abortion and on the consequences of abortion outside the health care system is needed to develop policies and programs that will address the problem. Methods: Experienced physicians conducted interviews at a nationally representative sample of 672 health facilities in Nigeria that were considered potential providers of abortions or of treatment for abortion complications. The data were used to estimate the annual number of abortions and to describe the provision of abortion-related services. Results: Each year, Nigerian women obtain approximately 610,000 abortions, a rate of 25 abortions per 1,000 women aged 15-44. The rate is much lower in the pear, rural regions of northern Nigeria than in the more economically developed southern regions. An estimated 40% of abortions are performed by physicians in established health facilities, while the rest are performed by nonphysician providers. Of the abortions performed by physicians, 87% take place in privately owned facilities and 73% are performed by nonspecialist general practitioners. Three-quarters of physician providers use manual vacuum aspiration to perform abortions, and 51% of providers who treat abortion complications use this method Physician respondents believe that the main methods used by nurses, midwives and other nonphysicians to induce abortions are dilation and curettage, hormonal or synthetic drugs and insertion of solid or sharp objects. Conclusions: Although highly restricted, abortions fake place in large numbers in Nigeria, under both safe and unsafe conditions. Policies to improve access to contraceptive services would reduce unplanned pregnancy and abortion and, along with greater access to safe abortion would help preserve the health and lives of Nigerian women.
Abortion decision making by rural villagers in Thailand must be understood within its broader economic, social and ideological context. Abortion laws are highly restrictive in Thailand, yet abortions remain common. This paper examines rural villagers' normative constructions of the act of abortion and the 'socially embedded morality' they bring to discussions about abortion. The paper is based upon seven focus group discussions with women and men and long-term ethnographic fieldwork in rural north-east Thailand. Vignettes based upon real stories of women stimulated detailed discussion in the focus groups of the circumstances under which abortion is acceptable. The paper first discusses the social construction of abortion in Thailand, definitions of abortion as Buddhist sin and ethnomedical categorizations of the foetus. Then it describes the major themes that emerged from focus group discussions and interviews on abortion decision making. The material conditions of women and men's lives, changing constructions of children and motherhood, and gender relations were all found to influence reproductive health decisions. Abortion is described through social idioms that allow villagers to reconcile the practice of abortion with acceptable social norms.
This study sheds light on an important topic emerging in the sexual health debate – identifying the interpersonal nature of sexual relationships which influence condom use. Using the principles of grounded theory, in-depth interviews were conducted with heterosexual men and women to understand the impact of the dyadic context of ‘heterosex’ on decisions to use condoms, condom availability and partner support and receptivity to cooperate in safer sex practices. The study found that condom dialogues occur at two levels - ‘the interpersonal condom dialogues’ and the ‘internal or discursive condom dialogues’. These dialogues shape condom use/non-use negotiations and the sexual encounter. Individuals also enter into sexual relations with a dislike of condoms and a perception of condom sex as ‘other sex’, which sets the context for their sexual experiences. Gender constructions of socially ‘appropriate’ sexual behaviour for men and women are implicated in the decisions to use condoms. The study highlights the importance of promoting condom sex as good and pleasurable sex if education and public health intervention programmes are to be effective in changing attitudes towards safer sex practices.
Induced abortion is widely practised in Indonesia by both married and unmarried women. This paper draws on ethnographic research, conducted between 1996 and 1998, which focused on reproductive health and sexuality among young single women on the island of Lombok in Eastern indonesia. While abortion for married women is tacitly accepted especially for women with two or more children, premarital pregnancy and abortion remain a highly stigmatised and isolating experience for single women. Government family planning services are not legally permitted to provide contraception to single women and their access to reproductive health care is very limited. Abortion providers were highly critical of unmarried women who sought abortions, despite their willingness to carry out the procedure. The quality of abortion services offered to single women was compromised by the stigma attached to premarital sex and pregnancy. Women who experienced unplanned premarital pregnancy faced personal and familial shame, compromised marriage prospects, abandonment by their partners, single motherhood, a stigmatised child, early cessation of education, and an interrupted income or career, all of which were not desirable options. Young women were only able to legitimately continue premarital pregnancy through marriage. In the absence of an offer of marriage, single women necessarily resorted to abortion to avoid compromising their futures.
Thesis--Amsterdam. Summary in Dutch. Bibliography: p. 313-335. Includes index.
Factors associated with socioeconomic development such as increased education and urbanization were initially associated in sub-Saharan Africa with an increase in fertility. This was largely due to their eroding effects on durations of breastfeeding and postpartum abstinence, and in some regions also to lowered levels of infecundity. During the 1980's the second phase of the transition emerged in areas located in Eastern and Southern Africa. This phase is characterized by increasing proportions of users of modern contraception and by a decrease in desired family size. Such a decisive turn around did, however, not occur in situations with expanding economies, but rather during the crises of the last decade. The theory of the ‘crisis-led fertility transition’ can help to explain this outcome, but it also has its limitations. If the crisis deepens and hits the health and education sectors, negative effects emerge as crucial props such as female schooling levels and family planning provisions may suffer severe set-backs.
Ekiti Yoruba village women in southwest Nigeria make use of traditional and 'patent' medicines as abortifacients as well as D&Cs performed in urban centers to terminate unwanted pregnancies. This paper examines present day abortion practices and attitudes and relates them to traditional beliefs about conception, fetal development and infertility. These beliefs, along with factors of economy and access, help to explain the continued use of abortion as a form of birth control, despite the presence of other options. The paper concludes with a discussion of the current debate about legalizing abortion in Nigeria and a recommendation consonant with everyday village practice.
Although constitutionally illegal, induced abortion is a vital reproductive health option in Uganda. This paper analyses men's narratives about meanings of, and experiences with, abortion. Men play significant roles in abortion as instigators, facilitators, collaborators, transporters, advisors, informers, supporters or punishment givers. Many participants were knowledgeable about abortion. Attitudes were ambivalent, with initial reactions of denial and relegation of abortion to women's private domains. Further exploration, however, revealed active support and involvement of men. Interpretations of abortion ranged from 'dependable saviour' to 'deceptive sin'. Though a private action, abortion is socially scripted and often collectively determined by wider social networks of kinsmen, the community, peers, law and religion. A disjuncture exists between dominant public health discourse and the reality of local men who interact with women and girls as wives, lovers, sex sellers, mothers, daughters and sisters. Interventions targeting men about abortion should include safe sex education, provide safe abortion services and create stronger social support mechanisms. Policy and law should incorporate local knowledge and practice.
Résumé Desgrées du Loû Annabel, Msellati P., Viho I., Welffens-Ekra C.-Le recours à l'avor- tement provoqué à Abidjan : une cause de la baisse de la fécondité ? En Côte d'Ivoire, la fécondité a baissé rapidement au cours des quinze dernières années : le nombre moyen d'enfants par femme est passé de 7,2 en 1980 à 5,7 en 1994, et ceci malgré une prévalence contraceptive encore très faible. Parmi les différents moyens d'espacement des naissances possibles, il en est un qui reste très mal connu dans ce pays, car illégal et souvent clandestin : le recours à l'avortement provoqué. Cette étude présente les niveaux de recours à l'avortement et leur évolution, à partir des vies génésiques de 1201 femmes enceintes dans la ville d'Abidjan. Il semble qu'il y ait actuellement en Côte d'Ivoire un recours à l'avortement provoqué fréquent (un tiers des femmes ont avorté au moins une fois), et que ce phénomène se soit récemment amplifié. La généralisation du recours à l'avortement se serait faite au cours des dix dernières années ; elle a touché toutes les classes d'âge, mais plus particulièrement les plus jeunes qui commencent à utiliser l'avortement dès le début de leur vie féconde, au contraire de leurs aînées qui l'utilisaient plutôt comme un moyen d'espacement et de limitation des naissances après les premières grossesses. Cette augmentation rapide du recours à l'avortement explique en partie la baisse de fécondité de la Côte d'Ivoire.
In this collection of essays ten anthropologists and two historians address the world-wide pattern of falling birth rates. Fertility has commonly been treated from a specialized demographic perspective, but there is today widespread dissatisfaction with conventional demographic approaches, which are criticized for neglecting the cultural, social, and political forces that affect reproductive behavior. For their part, anthropologists have only recently begun to apply their characteristic approaches to the study of reproduction. Drawing on new ethnographic and historical research and on a variety of theoretical approaches, the contributors to this book indicate some of the ways in which demography might take into account historical processes, political forces, and cultural conceptions.
This paper provides information on various aspects of illegally induced abortion among the Akan in southern Ghana. Discussed are the frequency of abortion, the techniques, the social circumstances in which it takes place, its medical, juridical and educational consequences, and value judgements about it. The most important conclusion is that the restrictiveness of the Ghanaian legislation has not been able to prevent or limit the incidence of abortion. Its outlawing has rather led to the use of dubious and highly dangerous means of causing abortion. Young women are the main victims of the present situation, both in terms of unequal educational opportunities and in terms of physical damage caused to them. A more appropriate family planning policy in combination with a legalization of abortion seems a reasonable solution.
A number of recent surveys show that fertility has begun to decline in Botswana, Zimbabwe, Kenya, and southern Nigeria. This study of an urban area in southwest Nigeria confirms a fertility decline and throws on the erosion of traditional supports for high fertility. The authors conclude that the sub-Saharan fertility transition is likely to differ during its early decades from the pattern established by the European and Asian transitions: the greatest demand for fertility control will come not from older women wishing to cease family building but from young married women who wish to maintain or lengthen traditional birth intervals even though the traditional mechanisms for achieving those ends are decaying. The onset of fertility decline is likely to be determined by the attainment of relatively low levels of infant and child mortality, substantial extension in female secondary education, an ample supply of contraceptives, and government leadership toward controlling family size.
Context: In Cote d'Ivoire, where contraceptive prevalence is low, abortion is thought to play an important role in the current fertility decline. However, data on abortion, which is illegal, are scarce. Methods: A retrospective survey on abortion and contraceptive practices was conducted in 1998 among 2,400 women who attended four general health centers in Abidjan. Multinomial logistic regression was performed to analyze the independent effects of social and demographic variables on the odds that women would adopt one of three fertility regulation behaviors instead of doing nothing at all. Results: Forty percent of women reported controlling their fertility through contraceptive use alone, 30% through reliance on both contraception and abortion and 3% through abortion alone; some 27% did nothing to control fertility. Muslims had consistently lower odds than Christians of adopting any of the three behaviors instead of doing nothing (odds ratios, 0.2-0.5). Being unmarried and better educated were associated with significantly elevated odds of adopting each of the three behaviors (odds ratios, 1.4-33.8). Finally, the odds of using abortion alone were significantly higher among women younger than 25 than among those aged 25-34 (2.0). Conclusions: The relationship between abortion and contraception is highly complex. Whereas women who do not have access to contraceptives or who experience method failure often resort to abortion, abortion can also trigger subsequent reliance on contraception.
In most of Africa features of land tenure and family organization that encourage high fertility remain largely intact. Because of unequal spatial distribution of the population, industrial development is constrained by insufficient markets; and income-earning opportunities in the vast sparsely populated regions are few. Long-fallow agriculture makes extensive use of the labour of women and children. This feature and common property practices make the status of men dependent upon family size. Young female age at marriage, large age differences between spouses, polygyny, unequal work burdens between the sexes, and low female educational levels keep the status of women low. Land reforms that give property to men may further erode the status of women. Since fathers pass most or all of the burden of family support onto mothers, men's motivation for family limitation is weak, and optimistic anticipations in the early years after independence made parents confident that they could support large families. However, income trends, non-agricultural employment opportunities, and expectations have changed for the worse in most of Africa, and this may induce many Africans to consider limiting family size. -from Author
Les motifs économiques sont souvent présentés comme prédominants dans l'amorce d'un parcours migratoire où les réseaux ethniques et familiaux jouent un rôle essentiel dans l'insertion des migrants. Il s'agirait cependant de nuancer cette idée couramment admise. En effet, un grand nombre de jeunes adultes étrangers qui vivent à Ouagadougou n'ont pas quitté leur pays pour des raisons matérielles et n'ont pas bénéficié des solidarités traditionnelles d'accueil. Pour beaucoup, la migration apparaît comme une aventure individuelle qui a pour objectif premier la recherche d'une certaine émancipation vis-à-vis des contraintes sociales et culturelles de leur milieu d'origine. (Résumé d'auteur)
Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.
Nine hundred fifty randomly selected secondary school girls were surveyed. Sexual activity was claimed by 29%, the youngest age was 12 years and age had no influence on the frequency of sexual intercourse. Multiple sexual partners, a high risk behaviour for contracting STD including AIDS was demonstrated in 33.7% and only 20.3% used orthodox methods of contraception. Induced abortion was procured by 23.5% and most were procured from unskilled personnel and by dangerous methods.
The first step in addressing the growing public health problem of abortion in sub-Saharan Africa is to gain a better understanding of the problem and its complexities. Abortion behavior is inextricably connected with issues of women's roles and opportunities, and until the various dimensions of abortion behavior and its socioeconomic context are understood, governments will have difficulty addressing the problem effectively. In addition, abortion needs to be studied within the broader framework of reproductive health. In a continent where fertility is highly valued and infertility prevalent, the interaction between abortion, practice of contraception, and fears of infertility must be fully understood if we are to have any hope of reducing the numbers of unwanted pregnancies and the morbidity and mortality caused by induced abortion.
In the context of a high and increasing incidence of unwanted pregnancy among Nigerian adolescents, a sample survey of never-married residents of the Ibadan area, aged 14 to 25 years, was conducted in 1982 to learn about their perceptions and practices relating to reproductive health. A substantial proportion of the young unmarried population is sexually active, and despite comparatively high contraceptive prevalence among that proportion, many are still engaging in sexual relations without benefit of contraceptive protection. Nearly half of the female students interviewed at both the secondary and university levels have been pregnant, as have two-thirds of those not currently enrolled in school. Among those respondents who had been pregnant, almost all reported that they voluntarily terminated their pregnancies. Existing and needed contraceptive services for the adolescent population are discussed.
Data from a 1989-1990 case-control study of contraceptive efficacy in Norway compare contraceptive use among women who requested an abortion (1,386 cases) with women who responded to a general fertility survey (2,627 controls). In a logistic regression analysis measuring contraceptive efficacy as the odds of avoiding a pregnancy that terminated in an induced abortion compared with the odds for nonuse, consistent condom use was found to lower fecundity by 88.9%, diaphragm use by 89.3%, the pill by 97.8%, the IUD by 97.6%, vasectomy by 99.5%, and female sterilization by 99.8%. The relative contraceptive efficacy of the condom, the IUD and the pill did not vary by marital status or parity but did vary with age; the proportion by which each of these methods reduced fecundity declined among successively older age-groups.
To investigate the use of contraception in a representative sample of Norwegian women.
Frequency distribution of contraceptive methods by age, marital status and partly strata.
A sample of 4,933 women were selected at random from the Central Population Register as participants in the second Norwegian fertility study (1988). The response rate was 81% (n = 4,019) and personal interviews of contraceptive use were carried out among 2,782 women who were fecund, sexually active and not pregnant. These women comprise the study population.
2,782 women were sexually active during the last month prior to the interview and thus in potential need of contraception. More than 50% of the women used either oral contraceptives (21%) or IUDs (30%). The use of oral contraceptives decreased linearly with age from a user rate of 60% among women 20-24 years old to 1.5% among women 40-44 years of age. The use of IUDs increased from 6% in the youngest age group to nearly 40% among women aged 30-39 years of age. Oral contraceptives were preferentially used by childless women or those with only one child, while IUDs were most often used by women with two or more children. The sterilisation rate increased by age and in the 40-44 age group one out of every three women was sterilised. Non-use was most frequent among the subgroups of women who planned children in the future. Use of condoms and other coitus-dependent contraceptives varied less with age, marital status and parity than did the use of OC, IUDs or sterilisation.
The user pattern concerning different contraceptive methods reflects the general guidelines for contraceptives in Norway. The fact that nearly 70% of the women were in one of the three categories--OC or IUD users, or one of the partners was sterilised--reveals that the awareness and knowledge of modern contraception is high in Norwegian society.
Reliable quantitative data on abortion are sorely needed, particularly in developing countries. Past experience in large-scale survey research has demonstrated that direct questioning on this subject results in significant underreporting. This article presents results of an experiment to collect data on induced abortion in Côte d'Ivoire within the context of a family planning operations research study. First, questions were employed to broach the topic of unwanted pregnancy in a value-free manner, and then the potential for a variety of actions, including abortion, was acknowledged. The results indicate that approximately 25 percent of all women attending a family planning clinic on the day of the survey had had an induced abortion. The use of improved abortion-related questions shows promise for providing more complete measurement of a neglected dimension of women's reproductive health.
The aim of the study was to analyze the reasons for the failure of contraception and the reasons for not using any contraception among women seeking a legal abortion on social grounds. The women were also asked about their knowledge of contraception methods, including postcoital contraception.
We interviewed 200 women applying for a legal abortion within the first trimester of pregnancy about contraception, the contraceptive methods used, and the possible reasons for failure of contraception.
Of all the women interviewed, 93% claimed to have adequate knowledge of contraception. At the time of conception 11.5% used safe methods (OCs 8%, IUDs 3.5%), 63% used less safe methods, and 26% were without contraception. Only 25% of the pill users had no explanation for the failure. 76.7% of the condom users reported that the condom was broken, had slipped off or its use had been irregular. The concern about side effects was the most common reason for not using safe contraceptives (25%).
The women claimed to have enough information about contraceptives, and postcoital contraception was also familiar, but the knowledge on how to use them in practice was inadequate. Irregular use and breaks in contraception were common. Despite the data based on Pearl indices, pills failed twice as often as IUDs. Counseling about the proper use of contraceptives is important, although the concern about the side effects appeared to be a big, unsolved problem.
Underreporting of induced abortion in survey research is a ubiquitous problem. The use of an indirect interview technique in which questions were asked about abortion in the context of unwanted pregnancy was described earlier as holding promise for increasing the response rate. This report reviews the mixed results from multicountry studies that used indirect technique. Exploratory qualitative studies are needed to identify a setting-specific context for discussing abortion. Because the subject of induced abortion is inherently sensitive, survey measurement of this practice is less precise than that of other, less controversial maternal health-care practices. This lack of precision should not deter the pursuit of the study of this critically important public-health-care concern.
In this study we attempted to learn why childbearing adolescents failed to use contraceptives prior to conception. We hypothesized that among adolescents who elect to bear their children, positive and/or ambivalent feelings about having a baby are the most frequently cited reasons for not having used contraceptives.
This is a cross-sectional, clinic-based survey of a racially and ethnically diverse group of 200 consecutively enrolled, poor, pregnant, 13-18-year-old patients in an adolescent-oriented maternity program. The participants completed a self-administered questionnaire which elicited information about environmental and personal risk factors for inconsistent use of contraceptives and information about the reasons they had not used contraceptives consistently prior to conception. Student's t-tests, Chi-square, and logistic regression analyses were used.
The most frequently cited reasons for not using contraceptives prior to conception were: "I didn't mind getting pregnant" (20%) and "I wanted to get pregnant" (17.5%), followed by "I was using birth control but it didn't work (broke)" (12%), "I thought there was something wrong with me and I couldn't get pregnant" (9%) and "I just didn't get around to it" (9%). Teenagers who cited positive and/or ambivalent attitudes toward childbearing as their primary reason for not using contraceptives at the time of conception did not differ from others with regard to age, Medicaid status, gravidity, parity, frequency of living with parents, partner's age, depressive symptoms, or perceived family support. They were, however, more likely to have known the father of the baby for more than 6 months at the time of conception [odds ratio (OR) 2.53; 95% confidence interval (CI) 1.22-5.26) and to have dropped out of school (OR) 2.15; 95% CI 1.10-4.26].
The study hypothesis was supported. The absence of negative attitudes toward having babies rather than negative attitudes toward contraceptives is the most commonly cited reason for nonuse of contraceptives among childbearing adolescents. The results of this study may enable health care and social service providers to design more effective programs for preventing first and subsequent adolescent pregnancies.
The aim of this study was to describe the various methods of abortion used by women admitted to an obstetrics department in Abidjan (Ivory Coast) for abortion complications. The study was retrospective, and was based on the medical files of all 472 women admitted for abortion complications during a 3-year period (1993-1995). The introduction of plant stems into the uterus, the use of certain instruments, use of vaginal preparations, and ingestion of plants were the most common abortion methods. Seventeen maternal deaths were registered, giving a maternal mortality rate of 3.6%. A high number of previous pregnancies and the ingestion of plants to provoke abortion were factors associated with the highest risk for maternal death. Complications of "local" abortion methods accounted for a high proportion of maternal deaths.
This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14-19) were asked for socio-economic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationships with their partners, sexual behaviour, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most of the girls were in love with and enjoyed sex with their partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of STDs and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning services and in practice these services are not being provided. There is a need for youth-friendly family planning services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls.
PIP
1977 fertility histories of 4100 Norwegian women between ages 18-44 were used to study the innovation pattern of modern contraception in relation to regional and social variables. 84% of women who could have become pregnant during the 4 weeks prior to this survey had used birth control methods. Only 7% of those not desiring a pregnancy failed to use birth control. The IUD was the most frequently used method of contraception (34%), then condom (22%) and the pill (20%). Women from urban areas were more apt to use IUD and the pills than the more traditonal methods preferred by rural women. Higher percentages of women with higher education use contraception, but patterns of use do not differ significantly among social groups. In summarizing changes in the pattern of use during the 1960's and 1970's, researchers found that age at first birth in Norway is now older, while sexual debuts are occuring earlier.
Educated women in southern Cameroon both condemn abortion and practice it with some regularity. This apparent paradox arises because educated Cameroonian women use abortion as one of a set of strategies to manage the timing and social context of entry into motherhood. This paper is based on a body of research which included a demographic life history survey (N = 184), open-ended narrative interviews (N = 37), and participant observation over 10 months. The survey data included 61 reported abortions, giving a lower-bound estimate of the crude abortion rate of 19 per thousand woman-years of life. In southern Cameroon, sexual activity is socially tolerated in a wide variety of non-marital relationships, while childbearing is not. Thus, most of my informants, including those who reported having aborted, say that abortion is shameful; however, they view its moral and social consequences as less grave than those of a severely mistimed entry into socially recognized motherhood. That is, abortion persists in southern Cameroon because it is the lesser shame.
Despite high levels of unsafe abortion in Cameroon, remarkably limited attention has been paid to the moral dilemma for women who seek abortions. In-depth interviews were conducted with 65 Cameroonian Grasslands women within a hospital-based study, complemented by participant observation, use of hospital records and interviews with key informants. The paper demonstrates how a hidden moral code on abortion helps women to exercise individual agency despite prevailing moral values. At the same time, women's desire to keep abortion secret can impede adequate medical treatment, which in turn can increase the risk of complications and mortality. Abortion was more often condemned by the women because of the risk to their lives and of infertility rather than for religious reasons or because it is illegal. However, the economic and social realities of everyday life often overrode their fear of complications when they needed to end a pregnancy. The paper concludes that women have already broken through Cameroon's stringent restrictions on abortion through their practice. There is a large gap between what is permitted under the current law, which is colonial in origin, and women's need for legal abortion on broad socio-economic grounds. This calls for reflection on liberalisation of the present law.
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