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Background: Obtaining representative abortion incidence estimates is challenging in restrictive contexts. While the confidante method has been increasingly used to collect this data in such settings, there are several biases commonly associated with this method. Further, there are significant variations in how researchers have implemented the method and assessed/adjusted for potential biases, limiting the comparability and interpretation of existing estimates. This study presents a standardized approach to analyzing confidante method data, generates comparable abortion incidence estimates from previously published studies and recommends standards for reporting bias assessments and adjustments for future confidante method studies. Methods: We used data from previous applications of the confidante method in Côte d'Ivoire, Ethiopia, Ghana, Java (Indonesia), Nigeria, Uganda, and Rajasthan (India). We estimated one-year induced abortion incidence rates for confidantes in each context, attempting to adjust for selection, reporting and transmission bias in a standardized manner. Findings: In each setting, majority of the foundational confidante method assumptions were violated. Adjusting for transmission bias using self-reported abortions consistently yielded the highest incidence estimates compared with other published approaches. Differences in analytic decisions and bias assessments resulted in the incidence estimates from our standardized analysis varying widely from originally published rates. Interpretation: We recommend that future studies clearly state which biases were assessed, if associated assumptions were violated, and how violations were adjusted for. This will improve the utility of confidante method estimates for national-level decision making and as inputs for global or regional model-based estimates of abortion. [ABSTRACT FROM AUTHOR]

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Background: Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers' competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders' experiences, recommendations for improvement, and lessons learned. Methods: Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results: Results from the workshops converged to suggest that the module contributed to increasing participants' theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions: When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system. [ABSTRACT FROM AUTHOR]

Background: Monitoring abortion rates is highly relevant for demographic and public health considerations, yet its reliable estimation is fraught with uncertainty due to lack of complete national health facility service statistics and bias in self-reported survey data. In this study, we aim to test the confidante methodology for estimating abortion incidence rates in Nigeria, Cote d'Ivoire, and Rajasthan, India, and develop methods to adjust for violations of assumptions. Methods: In population-based surveys in each setting, female respondents of reproductive age reported separately on their two closest confidantes' experience with abortion, in addition to reporting about their own experiences. We used descriptive analyses and design-based F tests to test for violations of method assumptions. Using post hoc analytical techniques, we corrected for biases in the confidante sample to improve the validity and precision of the abortion incidence estimates produced from these data. Results: Results indicate incomplete transmission of confidante abortion knowledge, a biased confidante sample, but reduced social desirability bias when reporting on confidantes' abortion incidences once adjust for assumption violations. The extent to which the assumptions were met differed across the three contexts. The respondent 1-year pregnancy removal rate was 18.7 (95% confidence interval (CI) 14.9–22.5) abortions per 1000 women of reproductive age in Nigeria, 18.8 (95% CI 11.8–25.8) in Cote d'Ivoire, and 7.0 (95% CI 4.6–9.5) in India. The 1-year adjusted abortion incidence rates for the first confidantes were 35.1 (95% CI 31.1–39.1) in Nigeria, 31.5 (95% CI 24.8–38.1) in Cote d'Ivoire, and 15.2 (95% CI 6.1–24.4) in Rajasthan, India. Confidante two's rates were closer to confidante one incidences than respondent incidences. The adjusted confidante one and two incidence estimates were significantly higher than respondent incidences in all three countries. Conclusions: Findings suggest that the confidante approach may present an opportunity to address some abortion-related data deficiencies but require modeling approaches to correct for biases due to violations of social network-based method assumptions. The performance of these methodologies varied based on geographical and social context, indicating that performance may be better in settings where abortion is legally and socially restricted. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals.Design: Secondary analysis of a nationwide cross-sectional study.Setting: Forty-two tertiary hospitals.Population: Women admitted for pregnancy-related complications.Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria.Main Outcome Measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance.Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival.Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival.Tweetable Abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year. [ABSTRACT FROM AUTHOR]

The available statistics indicate that over 1,000,000 abortions occur in Nigeria annually, representing about 33 abortions per 1,000 women of child bearing age. It has also been asserted that illegal abortion is responsible for about 11% of maternal death in Nigeria and 50% of such deaths involve adolescents and young women. Although, it may be difficult to confirm these reports and statistics by different researchers, mainly because of the absence of official figures owing to the clandestine nature of abortion in Nigeria, there is no doubt that abortions are generally procured by women for various reasons, namely: financial and emotional inability to care for a baby; fear of rejection by partners, parents, peer groups, religious and community leaders and society if the pregnancy is discovered; as means of birth control; physical and mental reasons; if they are too young or too sick to have a baby; desire to get rid of unwanted pregnancies arising from several reasons including rape or failure of contraception, etc. Unfortunately, the state of the law on abortion in Nigeria has failed to recognize these realities thereby unwittingly encouraging illegal abortions with the attendant consequences. This paper examines the state of the law on abortion in Nigeria in comparison with other jurisdictions with a view to demonstrating that the Nigerian law is archaic and in dire need of reform. [ABSTRACT FROM AUTHOR]

Background: A women-centered approach can improve the quality of patient care.Objective: To review issues in the provision of obstetric care from a patient-centered care perspective in Nigeria.Search Strategy: Using terms related to maternal and perinatal mortality, in combination with "Nigeria", MEDLINE, Embase, CINAHL, Web of Knowledge, and African Journal Online were searched, between December 1, 2013 and January 31, 2014, for articles in any language.Selection Criteria: Articles published in a Nigerian setting after 2000 that investigated causes of and circumstance surrounding maternal deaths and complications, or clinical practice related to maternal care were included.Data Collection and Analysis: Data were extracted by two reviewers using a standardized abstraction form and were analyzed from a patient-centered perspective.Main Results: The analysis included 57 studies. Clandestine induced abortions, lack of prenatal care, delays in seeking care, and the use of spiritual churches for delivery were found to contribute to adverse pregnancy outcomes.Conclusions: Healthcare systems respond inadequately to patients' needs in terms of abortion care, information sharing, transitioning between prenatal and obstetric care, and patients' non-medical needs. Data from clinician-led maternal death audits provided insights into how women-centered care can be provided; nonetheless, more-focused studies from a primarily patient-centered perspective are warranted. [ABSTRACT FROM AUTHOR]

The literature on self-managed abortion at later gestations is sparse, and more information is urgently needed in the US and elsewhere where this practice may become increasingly common. This analysis offers novel results on the effectiveness of self-managed medication abortion among people with pregnancies >9 weeks. In 2019–2020, as a part of The Studying Accompaniment Model Feasibility and Effectiveness (SAFE) Study, we recruited callers to safe-abortion hotlines in Argentina, Nigeria, and Southeast Asia who were seeking support for self-managed medication abortion. Via phone, participants completed a baseline survey prior to taking the medications, and up to three follow-up surveys over four weeks to ascertain abortion outcomes. We recruited 1,351 participants, of which 264 self-managed an abortion for a pregnancy that was 9–22 weeks' gestation; 149 (56%) respondents used mifepristone and misoprostol, while 115 (44%) used misoprostol alone. One week after taking the pills, 222 (91%) participants had a complete abortion — 87% with pills alone, and 4% with additional intervention. At last follow-up, 95% of participants had had a complete abortion (89% with pills alone, 5% with additional intervention; 93% of combined regimen users, and 97% of misoprostol-alone users). A minority of participants sought healthcare at a clinic or hospital at any point (30% of combined regimen users, 15% of misoprostol-alone users). Among those seeking care, most (60%) did so to confirm abortion completion, and a small minority (1.5%) received treatment indicative of a serious complication (blood transfusion). Self-managed medication abortion can be a safe and effective option for ending a pregnancy at 9+ weeks' gestation. [ABSTRACT FROM AUTHOR]

The article discusses a study that updated the 2012 data on the incidence of unintended pregnancies and abortions in Nigeria. Topics include collection of data from health care professionals in Nigerian health facilities as to women having unsafe abortions, obtaining treatment and experiencing complications. Conclusions indicated the rising number of unsafe abortions in Nigeria in 2015 and the need for improving access to contraceptives and services to lessen maternal mortality and morbidity.

To investigate the knowledge and practices regarding medical abortion and postabortion care in northern Nigeria among private physicians--the principal providers of such services in the area--122 doctors operating separate clinics in five states--Bauchi, Borno, Kaduna, Niger, and Taraba--were interviewed by means of a structured questionnaire. The results showed that 22 percent of the doctors reported that they terminate unwanted pregnancies, whereas nearly all reported that they manage complications of unsafe abortion. Manual vacuum aspiration and dilatation and curettage performed singly or in combination were the most common methods of abortion and postabortion care reported by the doctors. Only one doctor reported exclusive use of medical abortion in the first trimester, and three reported its exclusive use in the second trimester. Only 35 percent of the doctors listed misoprostol as a drug that they knew could be used for abortion and postabortion care, and only 12 percent listed mifepristone. By contrast, 49 percent listed inappropriate or dangerous drugs for use in abortion provision in the first and second trimesters of pregnancy. We conclude that private practitioners in northern Nigeria have limited knowledge of medical abortion and postabortion care, and that a capacity-building program on the subject should be instituted for them. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa has the highest death rate from induced abortion in the world, and young women in southern Nigeria are particularly likely to terminate their pregnancies. This study assesses the prevalence of and factors associated with induced abortion among 602 young women aged 15-24 who were surveyed in Edo State, Nigeria, in 2002. We find that 41 percent of all pregnancies reported by the young women surveyed were terminated, and we estimate the age-specific abortion rate for 15-19-year-olds in Edo State at 49 abortions per 1,000 women, which is slightly higher than previous local estimates and nearly double the countrywide estimate for women aged 15-49. We construct explanatory multivariate models to predict the likelihood that a young woman has experienced sexual intercourse, has become pregnant, and has undergone an induced abortion, controlling for important demographic and risk-behavior factors. Young women unmarried at the time of the interview are found to be significantly more likely than married women to have had an abortion. Young women who have experienced transactional or forced sex are also significantly more likely to report ever having had an abortion, as are young women who have experienced more than one pregnancy. We conclude with suggestions for modifying the content and target populations of behavioral change messages and programs in the area. [ABSTRACT FROM AUTHOR]