Search

The law in Bangladesh forbids abortion except to save a womans life. To determine the degree to which rural physicians in Bangladesh support the law this study surveyed the attitudes toward abortion of 376 physicians in rural health care centers. Virtually all of those interviewed (98.9%) indicated that they support the use of abortion in 1 or more circumstances not approved by the law. These attitudes and those of respondents in other surveys indicate that physicians and others approve of using abortion in circumstances proscribed by the current law which is based on the British Penal Code of 1860. (authors)

10174 female sterilization procedures performed in the University Dept. of Obstetrics and Gynecology at Kandang Kerbau Hospital (Singapore) during 1970-1975 were reviewed with the objective of estimating the pregnancy rates for women undergoing various procedures. 7989 (79%) of the tubal ligation procedures were performed by minilaparotomy 1650 (16%) by culdoscopy 314 (3%) by the vaginal approach and 221 (2%) by laparoscopy. The crude failure rate was .12 for minilaparotomy 1.21 for culdoscopy 2.23 for the vaginal approach and 3.17 for laparoscopy. Cumulative failure rates at 24 months were .34 for minilaparotomy 1.67 for culdoscopy 3.12 for the vaginal approach and 4.49 for laparoscopy. 8 of the 51 pregnancies reported were ectopic. Most of the failures were attributable to the technique of tubal ligation employed and the site of ligation. Technical reasons for the failures are discussed.

Between July and September 1983, a two-stage probability survey was conducted in Addis Ababa, Ethiopia to obtain data on pregnancy outcomes for all women aged 13-49 in 32,215 houses. The survey covered a two-year period, from 11 September 1981 to 10 September 1983. Of the 9,315 women who were pregnant during those two years, 45 died from complications of pregnancy, delivery, and the puerperium. The maternal mortality rate for 1982-83 was estimated to be 566 per 100,000 live births. Mortality was highest for nullipara, the unmarried, women employed as maids/janitresses, and students. The most common cause of death was abortion. It appears that reliable data on maternal mortality can be obtained retrospectively through a probability survey.

Bangladesh has the highest population density of any large country in the world and a population that continues to expand at a yearly rate of 2.5 percent. Sterilization has been the focus of the government's efforts to reduce the number of unwanted births and slow the growth rate: 159,000 women were sterilized in Bangladesh from July 1979 to June 1980,1 and a goal of 3.4 million sterilizations of men and women over the next five years has been set.2 Like all medical procedures, however, sterilization involves risks and benefits that must be weighed against the alternatives. This comparison has not been possible until now because of the lack of information regarding the safety of the country's sterilization program. This paper incorporates the results of a national study of sterilization and other recent reproductive health research in Bangladesh in a decision-analytic approach. This method enables us to estimate the number of pregnancies and deaths among the 159,000 sterilized women in the two years after sterilization and the expected number of pregnancies and deaths if the same group had not undergone sterilization. The comparison indicates that the current program results in fewer deaths and pregnancies than would have been expected.

Data from a 1982 sample survey of 3,830 married women below age 50 in a district of Beijing City are applied to the Bongaarts model of the proximate determinants of fertility. A total fertility rate (TFR) of 0.75 births per woman is estimated from the model, compared with a TFR of 1.24 actually observed from the survey. The estimated TFR (0.75) results from the assumed total fecundity (TF) of 15.30 births per woman being inhibited by the indexes of the proximate determinants of fertility, most notably non-marriage (.280), contraception (.315), and induced abortion (.586). The effects of two other proximate determinants, lactational infecundability and spousal separation, were negligible. Comparative data from other countries confirm that the study area has very low levels of fertility and marriage, a very high prevalence of induced abortion, and a small effect of lactational infecundability. The extremely low level of fertility was, thus, achieved through a high level of induced abortion. Future research needs and policy implications associated with the study are discussed.

Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.

In this study, age- and parity-specific birth data were used to estimate maternal mortality rates for 1982-83 at University Teaching Hospital in Lusaka, Zambia. Overall, 60 maternal deaths occurred during pregnancy or within 42 days after pregnancy termination, and four pregnancy-related deaths occurred more than 42 days after pregnancy termination. Nine of the 60 maternal deaths were caused by induced abortion, one by spontaneous abortion, twelve by hypertensive disease of pregnancy, ten by hemorrhage, nine by puerperal sepsis, and four by ectopic pregnancy. Of the 12 women who died from nonobstetric causes, one committed suicide because of an unwanted pregnancy. Women aged 35 years and older or who had had four previous pregnancies had a higher risk of dying than other women, especially by hemorrhage. The chief risk factors included not using an effective method of contraception, using an unsafe means to terminate unintended pregnancies, lack of prenatal care, refusing a blood transfusion (for religious reasons), and inadequately treating hypertensive disease of pregnancy. Overall, 31 of 60 women who died lacked adequate or appropriate medical care and 19 failed to obtain available health care. Medical management problems appeared to occur more frequently during the night-time medical shift.

Except for data from several geographically limited studies, little is known globally about the number and causes of death associated with surgical sterilization. To identify clinical characteristics and problems leading to deaths related to the procedures, the International Planned Parenthood Federation ( IPPF ) and the Centers for Disease Control (CDC) in the United States collaborated in a global mail survey of 4642 physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. Fifty-five sterilization-associated deaths which occurred from January 1, 1980 to June 30, 1982 were reported. The most frequently reported causes of death were infection, anesthetic complications, and hemorrhage. There were some regional differences in the relative frequencies of these causes. Most cases did not involve surgical accident. The characteristics most frequently associated with the reported fatal procedures were: interval sterilizations, minilaparotomy incision, tubal ligation and general anesthesia. Most deaths were attributable to the surgical sterilization procedure.To obtain information on the number and causes of deaths associated with surgical sterilization, the Centers for Disease Control (CDC) and the International Planned Parenthood Federation (IPPF) collaborated in a global mail survey of 4642 IPPF-affiliated physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. A total of 55 deaths (54 associated with tubal sterilization and 1 with vasectomy) were reported for the period January 1, 1980-June 30, 1982. The largest number of fatalities occurred in Asia (33) and Latin America (15). The median age at death was 32 years. Characteristics most frequently associated with the reported fatal procedures were interval sterilization (25 cases), minilaparotomy incision (19), tubal ligation (34), and general anesthesia (28). 38 of the tubal sterilization-associated deaths and the 1 vasectomy-related death were directly attributable to the sterilization procedure. The most frequently reported causes of death were infection (20 cases), anesthetic complications (12), and hemorrhage (8). Surgical accidents were reported for 17 of the tubal sterilization-associated fatalities. Some regional variation was noted in the relative frequencies of these causes. These data are known to reflect a substantial underreporting of sterilization-related mortality. In addition, the nonavailability of denominator data precluded estimation of the risk of death associated with surgical approach, method of tubal occlusion, timing of the sterilization procedure in relation to last pregnancy, or anesthesia. However, it can be stated that many of the deaths reported in this series could have been prevented by more adequate staff training, use of sterile equipment, and improved follow-up procedures. It is recommended that data on sterilization-related fatalities be reported to a central location to facilitate their aggregation and analysis.