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Since the advent of prenatal sex-determination technologies in the mid-1980s, India has experienced an increasingly male-biased sex ratio at birth, presumably from sex-selective abortions. Abortions lengthen birth intervals, but we know little about how birth spacing has changed or the effects of these changes. I show that, although the overall length of birth intervals increased from 1970 to the mid-2010s, well-educated women with no sons had the most substantial lengthening, as well as the most male-biased sex ratios. Furthermore, most of these changes took place immediately after the introduction of prenatal sex-determination technologies. Consequently, some women without sons now have longer birth intervals than those with sons, reversing India's traditional spacing pattern. Women with low education continue short birth spacing when they have no sons, with only limited evidence of male-biased sex ratios. Because of the rapid lengthening of birth intervals, period fertility rates substantially overestimated how fast cohort fertility fell. Moreover, predicted cohort fertility is still 10%–20% above the period fertility rate. If the lengthening of birth intervals arises from repeated abortions, the associated short pregnancy spacing may counteract any positive effects of longer birth spacing. There is, however, no evidence of this effect on infant mortality. Judging from sex ratios, sex-selective abortion use is not declining.

SummaryOver 2 million abortions occur annually in Pakistan, mostly in a clandestine and unsafe environment. This is an area of grave concern for the reproductive health of women. A dearth of credible data and incomplete information make the problem more difficult to address. This qualitative study was conducted in semi-urban settings in Pakistan to record perceptions and practices concerning care seeking, experiences and outcomes regarding induced abortions and post-abortion care services. Women who had had induced abortions and abortion service providers were interviewed. Unwanted pregnancies and poverty were found to be the main reasons for seeking an abortion. Moreover, the unwanted pregnancies occurred due to low use of contraceptives, mainly due to a fear or past experience of their side-effects, unfamiliarity with correct usage and perceived inefficacy of the methods, especially condoms. There is an obvious need for practical and innovative interventions to address unmet need for birth spacing through improved access to contraceptives. Contraceptive providers should be provided with up-to-date and detailed training in family planning counselling, and perhaps allowed unrestricted provision of contraceptives. As a long-term measure, improvement in access to education and formal schooling could increase young girls’ and women’s knowledge of the benefits of family planning and the risks of unsafe abortion practices. Males must be involved in all the initiatives so that both partners are in agreement on correct and consistent contraceptive use.

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve.The official total abortion rate in Vietnam in 1992 was at least 2.5/woman, unusually high by international standards, especially for a country with a total fertility rate of 3.7 children/woman. This report summarizes current knowledge regarding abortion in Vietnam, drawing upon government registration statistics, a variety of survey data, and the author's observations and fieldwork in Vietnam during 1993 and part of 1994. Abortion appears to be concentrated among married women at the peak of childbearing age. The prevalence of repeat abortions reported in some provinces and survey responses suggest that some women are using abortion as a means of fertility control. At least three explanations can be advanced for Vietnam's high rate of abortion. First, like other poor socialist countries, Vietnam viewed the IUD and abortion as methods allowing maximum state control and monitoring of family planning. Although the number of contraceptive methods have improved marginally, Vietnam still lacks the resources to provide alternative choices. Second, the country's population policies, although not directly calling for abortion, raise the marginal costs of childbearing in some areas to such an extent that pregnancy termination becomes more acceptable. Third, the current trend toward modernization and development in the wake of free-market reforms of the mid-1980s contributes to premarital and unwanted pregnancy as it has in other countries. Relevant policy prescriptions would provide effective contraceptive alternatives that are acceptable, safe, and affordable, a goal that Vietnamese specialists hope to achieve. Unless these efforts continue, future declines in Vietnamese family size preferences may result in even higher rates of abortion.

Data from the Korean Fertility Survey were used to analyze the relationship between the use of abortion and contraception among married women in Korea, a society experiencing a rapid fertility decline. Fieldwork for the Korean WFS was conducted between August and December 1974 among a sample of 5420 ever married women aged 15-49. The WFS sample is a self-weighting, nationally representative probability sample based on a 3-stage design. The response rate was 95%. All indications are that the data are both representative of the universe of married women in the reproductive period and of high quality. For this report data collected from 4867 once married women with no history of prolonged marital separation were used. As the study purpose was to examine the interval specific utilization of fertility control measures, the sample was restricted to those with uninterrupted exposure to childbearing since the 1st marriage. These women represent 90% of all ever married women interviewed. The remaining 563 women were either no longer in their 1st marriage or had experienced periods of marital separation of sufficient length to affect fertility. At the time of the survey, contraception was currently being used by 46% of all exposed women. 31% of the currently married respondents reported having had at least 1 abortion; the average number per woman in this group was 1.9. Of the approximately 23,800 pregnancies occurring to women before the survey, 14% had ended in induced abortion. Use of induced abortion increased with the number of completed pregnancies a woman had. Only 11.3% of those who had never used a contraceptive method had an induced abortion. Among past, but not current contraceptive users, 41.2% have had an induced abortion. Among current (nonsterilized) users, 48.6% have had an induced abortion. Women were anywhere from 2-6 times as likely to have used contraception during a specified pregnancy interval in 1970-74 than were women a decade earlier. The data indicate that there has been an increase over time in the proportion of women having their 1st abortion early in the reproductive period. While slightly less than 2% of all 1st pregnancies ended in 1st abortion in 1960-64 period, almost 8% of the 1st pregnancies that occurred between 1970-74 ended in a 1st abortion. Use of induced abortion at the pregnancy outcome immediately subsequent to that of the 1st abortion follows a very different pattern from that of contraception. Those women whose 1st abortion occurred later in the reproductive cycle were more likely to use abortion in the subsequent pregnancy than were those whose 1st experience with induced abortion occurred early. The increasing use of abortion and contraception has markedly reduced higher order births.