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Background: Genetic disorders are common in the Eastern Mediterranean region due to the high prevalence of consanguineous marriages. This study explores the awareness and attitudes of pregnant women in Mashhad, the biggest city in northeastern Iran, toward genetic disorders and the decision-making process regarding pregnancy termination. This study included 297 pregnant women across five hospitals in Mashhad, Iran. They filled out a checklist comprised of demographic data and questions about abortion decisions facing a child with various genetic disorders or undesired gender. Results: The majority (75%) agreed with abortion in cases of anencephaly, while only 19% accepted it for undesired gender. Education level was associated with abortion agreement for various conditions, including cleft lip or palate, Alzheimer's disease, Turner syndrome, cystic fibrosis, phenylketonuria, Huntington's disease, autism, fragile X syndrome, and epilepsy. Additionally, the number of children was correlated with congenital blindness, Duchenne muscular dystrophy, autism, Proteus syndrome, Klinefelter syndrome, anencephaly, mental retardation (MR), quadriplegia, and severe learning disability and mental health (LDMH). Age was associated with conditions such as epilepsy, congenital blindness, schizophrenia, and severe LDMH. Furthermore, a history of anomalies in previous pregnancies was linked to Klinefelter syndrome, Turner syndrome, dwarfism, and quadriplegia. The number of pregnancies was also correlated with severe LDMH, dwarfism, and Klinefelter syndrome, while job status was related to epilepsy, Alzheimer's disease, and dwarfism. Conclusion: The findings emphasize the importance of comprehensive genetic counseling, informed decision-making in prenatal care, advocating for policy reviews, and culturally sensitive guidelines in Iran. [ABSTRACT FROM AUTHOR]

Background: Termination of pregnancy continues to be one of the major public health problems. The prevalence and determinants associated with pregnancy termination among women from low-middle income countries such as Tanzania have previously not been thoroughly investigated. Therefore, this study aims to explore the prevalence and determinants associated with pregnancy termination among Tanzanian women. Methods: Data for this study was extracted from the 2022 Tanzania Demographic and Health Survey (TDHS). A total of 15,254 women aged 15–49 years, clustered in selected enumerated areas, participated in the survey. A modified Poisson regression model with sampling weights was used to find the factors that are associated with pregnancy termination. Results: The prevalence of pregnancy termination was 14.3% (95% CI: 13.81–14.75%). Our findings reveal that several factors are significantly associated with pregnancy termination. In particular, women's age, level of education, marital status, history of pregnancy losses, wealth status, attempt to delay or avoid getting pregnant outside the ideal birth spacing, and recent internet use, total children ever born, desire for more children, were significantly associated with pregnancy termination. Women who reside in rural areas, those covered by health insurance and those using contraceptives had a significantly lower likelihood of terminating pregnancy compared to their counterparts. Conclusions: The findings highlighted that the prevalence of terminating pregnancy is alarming in Tanzania, signaling a significant public health challenge. To address the concerning rates of pregnancy termination, the government of Tanzania and other institutions are advised to enhance the accessibility and quality of healthcare services for women, particularly in rural and underserved areas. Bridging socio-economic inequalities and removing geographic barriers to healthcare access will ensure women receive timely and adequate support. [ABSTRACT FROM AUTHOR]

Objective: Fetal cardiac anomalies are the most commonly diagnosed structural anomalies. In these cases, Maternal-Fetal Medicine (MFM) specialists are tasked with counseling patients on a spectrum of diagnoses as well as their prognostic implications. A recent study of pediatric cardiologists demonstrated that personal beliefs regarding termination impact the counseling provided to patients. Our objective was to study whether the personal beliefs of MFMs impact counseling of patients with severe fetal cardiac anomalies and to compare these providers to their cardiology counterparts. Methods: We conducted an anonymous cross-sectional survey of MFMs in New England that assessed personal beliefs and counseling practices when diagnosing hypoplastic left heart syndrome (HLHS). We subsequently compared these providers to the previously surveyed cardiologists. Results: A total of 34 respondents representing a broad spectrum of age and experience across several states in New England were analyzed. When presented with the statement "some life is always better than no life at all," 79% (n = 27) of respondents disagreed and all respondents (n = 34) offered termination, palliative care, and treatment options when counseling patients with HLHS. Additionally, while 74% (n = 25) of providers would personally support a decision to terminate a pregnancy with HLHS, 94% (n = 32) would professionally support the decision to pursue termination. MFMs and cardiologists differed in their responses to "some life is better than no life" and the belief that termination should be offered, though differences did not reach statistical significance. However, with respect to the providers' personal and professional support of the decision to terminate the pregnancy, the groups of respondents varied significantly in their level of support, both professionally and personally with fewer cardiologists supporting this decision. Conclusion: When diagnosing a severe and potentially fatal congenital cardiac anomaly, counseling by MFMs was largely unaffected by personal beliefs regarding termination of pregnancy. While this is consistent with previously published data on counseling practices among pediatric cardiology specialists, some important differences between the specialties were seen. [ABSTRACT FROM AUTHOR]

Pregnancy termination, also referred to as abortion, is a contentious subject in many countries. Uganda's culture requires young people to remain celibate; they therefore suffer from restricted access to any sexual and reproductive health information, products, and services, including contraceptives. Girls who are pregnant in Uganda are oppressed in various ways, including being expelled from school. Since abortion is illegal under Ugandan law, those abortions that take place are assumed to have a high risk of being unsafe. Most previous studies in the African context have thus focused on the phenomenon of unsafe abortion. Adolescent abortion is characterized by a rhetoric of pathology that frames girls as victims of deadly unsafe abortion practices. This paper aims to critique the view that pregnant adolescent girls are merely vulnerable victims who passively accept the denial of SRH services, including abortion. We analyzed the life histories of 14 girls in Uganda who had undergone pregnancy termination. Our findings showed that adolescent girls are not passive victims of the structural barriers to abortion. They use their agency to obtain knowledge, make decisions, successfully terminate pregnancy, and conceal the information as needed. It is therefore important for policymakers to acknowledge the agency of adolescent girls in regard to pregnancy termination and how this recognition could be of benefit in terms of devising appropriate supports for them. [ABSTRACT FROM AUTHOR]

Abstract Pregnancy termination is still a sensitive and continuing public health issue due to several political, economic, religious, and social concerns. This study assesses the applications of machine learning models in the prediction of pregnancy termination using data from eleven national datasets in East Africa. Nine machine learning models, namely: Random Forests (RF), Decision Tree, Logistic Regression, Support Vector Machine, eXtreme Gradient Boosting (XGB), AdaBoost, CatBoost, K-nearest neighbor, and feedforward neural network models were used to predict pregnancy termination, with six evaluation criteria utilized to compare their performance. The pooled prevalence of pregnancy termination in East Africa was found to be 4.56%. All machine learning models had an accuracy of at least 71.8% on average. The RF model provided accuracy, specificity, precision, and AUC of 92.9%, 0.87, 0.91, and 0.93, respectively. The most important variables for predicting pregnancy termination were marital status, age, parity, country of residence, age at first sexual activity, exposure to mass media, and educational attainment. These findings underscore the need for a tailored approach that considers socioeconomic and regional disparities in designing policy initiatives aimed at reducing the rate of pregnancy terminations among younger women in the region.

Abstract Background Unplanned pregnancy could be a socio-economic burden for many young women in sub-Saharan Africa (SSA) which often leads to pregnancy termination. The role of age at sexual debut in pregnancy termination in countries with lower income remains unknown. Hence, this study examines the association between age at sexual debut and pregnancy termination among sexually active young women between the ages of 15 -24 in 23 SSA countries. Methods Cross-sectional secondary datasets from the most recent Demographic and Health Survey conducted in 23 countries in SSA conducted between 2010 and 2018 among 34,343 sexually active young women were analysed using bivariate and multivariable logistic regression to examine the association between age at sexual debut and pregnancy termination with statistical significance of p

Pregnancy termination, also referred to as abortion, is a contentious subject in many countries. Uganda’s culture requires young people to remain celibate; they therefore suffer from restricted access to any sexual and reproductive health information, products, and services, including contraceptives. Girls who are pregnant in Uganda are oppressed in various ways, including being expelled from school. Since abortion is illegal under Ugandan law, those abortions that take place are assumed to have a high risk of being unsafe. Most previous studies in the African context have thus focused on the phenomenon of unsafe abortion. Adolescent abortion is characterized by a rhetoric of pathology that frames girls as victims of deadly unsafe abortion practices. This paper aims to critique the view that pregnant adolescent girls are merely vulnerable victims who passively accept the denial of SRH services, including abortion. We analyzed the life histories of 14 girls in Uganda who had undergone pregnancy termination. Our findings showed that adolescent girls are not passive victims of the structural barriers to abortion. They use their agency to obtain knowledge, make decisions, successfully terminate pregnancy, and conceal the information as needed. It is therefore important for policymakers to acknowledge the agency of adolescent girls in regard to pregnancy termination and how this recognition could be of benefit in terms of devising appropriate supports for them.

Abstract Objectives Undergoing women of pregnancy termination (PT) significantly faces the problem of physical and mental health. This study aims to assess the prevalence and socioeconomic disparity factors of PT in Bangladesh. This study analyzed data from the 2017–18 Bangladesh Demographic and Health Survey. Researchers employed chi-square tests to identify relationships between categorical variables and logistic regression to pinpoint factors associated with PT. To assess the socioeconomic variation of PT, the analysis utilized concentration curves, concentration indices, and decomposition techniques. Results The study found that 21.0% of reproductive-aged women in Bangladesh had ever terminated a pregnancy. Our study revealed that women from Chittagong and Sylhet regions, with wealthier backgrounds, aged 30 or older, employed in business, taking short birth intervals, and whose husband/partner was 35 or older, were more likely to have had a pregnancy termination with statistical significance (p

Abstract Pregnancy termination remains a complex and sensitive issue with approximately 45% of abortions worldwide being unsafe, and 97% of abortions occurring in developing countries. Unsafe pregnancy terminations have implications for women’s reproductive health. This research aims to compare black box models in their prediction of pregnancy termination among reproductive-aged women and identify factors associated with pregnancy termination using explainable artificial intelligence (XAI) methods. We used comprehensive secondary data on reproductive-aged women’s demographic and socioeconomic data from the Demographic Health Survey (DHS) from six countries in East Africa in the analysis. This study implemented five black box ML models, Bagging classifier, Random Forest, Extreme Gradient Boosting (XGB) Classifier, CatBoost Classifier, and Extra Trees Classifier on a dataset with 338,904 instances and 18 features. Additionally, SHAP, Eli5, and LIME XAI techniques were used to determine features associated with pregnancy termination and Statistical analysis were employed to understand the distribution of pregnancy termination. The results demonstrated that machine learning algorithms were able to predict pregnancy termination on DHS data with an overall accuracy ranging from 79.4 to 85.6%. The ML classifier random forest achieved the highest result, with an accuracy of 85.6%. Based on the results of the XAI tool, the most contributing factors for pregnancy termination are wealth index, current working experience, and source of drinking water, sex of household, education level, and marital status. The outcomes of this study using random forest is expected to significantly contribute to the field of reproductive healthcare in East Africa and can assist healthcare providers in identifying individuals’ countries at greater risk of pregnancy termination, allowing for targeted interventions and support.

Aims/BackgroundDesign/MethodsResultsConclusionTerminating a desired pregnancy due to foetal anomalies has been linked to significant distress. It is however less clear what long-term psychological implications the parents face in the aftermath. This systematic review aimed to explore the mental health outcomes of parents after the termination of pregnancy due to foetal anomaly (TOPFA) after gestational week 12 + 0.Following the PRISMA guidelines and using the PEO (Problem, Exposure, Outcome) framework, we conducted a comprehensive search across six electronic databases. The search was restricted to English studies published since 2000. Eligible studies provided quantitative assessments of mental health outcomes post-TOPFA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Given the heterogeneity in outcome measures, the findings were synthesised narratively.Of the 2261 papers identified, 11 studies (four cross-sectional and seven cohort studies) were included. Results demonstrated variations in symptoms of trauma-related stress, depressive symptoms, and grief reactions across the different studies post-TOPFA. Variations were found to be related to time since TOPFA and the difference in assessment tools used. Factors investigated as predictors of mental health outcomes, including gestational age, educational level, and religion, showed inconsistent findings, though partner support consistently correlated with lower levels of grief. Male partners, included in two studies, generally reported fewer symptoms of psychological distress.This review explores a range of mental health outcomes and highlights the need for better quality studies that consider the psychological impact of TOPFA on partners. Further, this systematic review stresses the need of standardisation in measurement tools for assessing mental health symptoms. [ABSTRACT FROM AUTHOR]

Simple Summary: Different strategies for the termination of pregnancy in humans have proven to be efficient and safe. However, few studies have investigated the utility of these regimens in non-human primates. Therefore, this review discusses the most relevant research reporting the termination of viable and non-viable pregnancies in primates. An overview of the clinically applicable drugs is presented, including dosage, administration route, safety, and efficacy. Limited information is available concerning the termination of pregnancy in non-human primates. Thus, a comprehensive review of this topic will be beneficial for veterinary staff in laboratories, zoos, and wildlife rehabilitation centers. The most relevant studies concerning the termination of viable and non-viable pregnancy in non-human primates were analyzed, and dosages, administration routes, adverse effects, and the efficacy of the drugs used are reported. The literature revealed that termination of pregnancy is most commonly performed in marmosets and macaques. The combination of mifepristone and misoprostol was reported to be effective and fast-acting in terminating first-trimester pregnancy in macaques, while cloprostenol was identified as the best agent for use in marmosets. This review also provides insights about the limitations of previously described methods of pregnancy termination and discusses potential alternatives and areas for future investigation. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh. [ABSTRACT FROM AUTHOR]

Objectives: Undergoing women of pregnancy termination (PT) significantly faces the problem of physical and mental health. This study aims to assess the prevalence and socioeconomic disparity factors of PT in Bangladesh. This study analyzed data from the 2017–18 Bangladesh Demographic and Health Survey. Researchers employed chi-square tests to identify relationships between categorical variables and logistic regression to pinpoint factors associated with PT. To assess the socioeconomic variation of PT, the analysis utilized concentration curves, concentration indices, and decomposition techniques. Results: The study found that 21.0% of reproductive-aged women in Bangladesh had ever terminated a pregnancy. Our study revealed that women from Chittagong and Sylhet regions, with wealthier backgrounds, aged 30 or older, employed in business, taking short birth intervals, and whose husband/partner was 35 or older, were more likely to have had a pregnancy termination with statistical significance (p < 0.05). Besides, concentration curves showed a higher prevalence of PT among wealthier women (CCI = 0.029, p < 0.001). Decomposition of this inequality revealed that a woman's wealth status was the largest contributor (74.98%) to the observed disparities, followed by exposure to mass media (41.82%), place of residence (34.35%), occupation (24.81%), and preceding birth interval (6.53%). Our study recommended that, in mitigating the above disparities, we should foster open discussions about underlying factors contributing to PT in Bangladesh. [ABSTRACT FROM AUTHOR]

Pregnancy termination remains a complex and sensitive issue with approximately 45% of abortions worldwide being unsafe, and 97% of abortions occurring in developing countries. Unsafe pregnancy terminations have implications for women's reproductive health. This research aims to compare black box models in their prediction of pregnancy termination among reproductive-aged women and identify factors associated with pregnancy termination using explainable artificial intelligence (XAI) methods. We used comprehensive secondary data on reproductive-aged women's demographic and socioeconomic data from the Demographic Health Survey (DHS) from six countries in East Africa in the analysis. This study implemented five black box ML models, Bagging classifier, Random Forest, Extreme Gradient Boosting (XGB) Classifier, CatBoost Classifier, and Extra Trees Classifier on a dataset with 338,904 instances and 18 features. Additionally, SHAP, Eli5, and LIME XAI techniques were used to determine features associated with pregnancy termination and Statistical analysis were employed to understand the distribution of pregnancy termination. The results demonstrated that machine learning algorithms were able to predict pregnancy termination on DHS data with an overall accuracy ranging from 79.4 to 85.6%. The ML classifier random forest achieved the highest result, with an accuracy of 85.6%. Based on the results of the XAI tool, the most contributing factors for pregnancy termination are wealth index, current working experience, and source of drinking water, sex of household, education level, and marital status. The outcomes of this study using random forest is expected to significantly contribute to the field of reproductive healthcare in East Africa and can assist healthcare providers in identifying individuals' countries at greater risk of pregnancy termination, allowing for targeted interventions and support. [ABSTRACT FROM AUTHOR]

BackgroundThe decisions of women with high-risk pregnancies to continue or terminate a pregnancy are complex and influenced by various factors. This scoping review synthesises the qualitative literature on the underlying motivations influencing these decisions.AimThis analysis explores the underlying motivations that influence women's decisions regarding the continuation or termination of pregnancy, considering the challenges and dilemmas this population faces.MethodsThis review was conducted following the Joanna Briggs Institute's methodology. No date restrictions were applied to the search. Titles and abstracts were screened to select original studies, and cross-checking was performed to avoid case overlap. We included studies that focused on the factors influencing women's decisions to either continue or terminate pregnancies when complications arose.ResultsEighteen studies involving women from different countries and cultural contexts were included. The review identifies four main themes driving these decisions: health considerations, religious convictions, social and political factors and ethical and moral dilemmas. Each theme interlinks to form a complex web of influences that significantly shape women's choices, illustrating how deeply personal, societal, and ethical contexts converge in these critical decisions. Significant emotional and cognitive factors, particularly hope, also play a crucial role. The findings highlight the complexity of the decision-making process and provide a deeper understanding of the personal, social, and spiritual dimensions involved.ConclusionsMultiple factors shape the complex decisions of women with high-risk pregnancies. Understanding these motivations is crucial to providing appropriate support and counselling. This review underscores the need for healthcare professionals to be aware of the diversity of factors involved and to adopt an individualized and context-sensitive approach in their practice, guiding their future actions.

ABSTRACT Objective Although the overall abortion‐related maternal mortality ratio has shown a downward trend in Ethiopia, the case‐fatality rate from abortion is still high. This study identified factors associated with delays in seeking an abortion until the second trimester at Jimma Medical Centre, Jimma, southwest Ethiopia. Methods From February to August 2023, we conducted a cross‐sectional study on pregnant women seeking safe abortion care. Participants were selected through systematic sampling from a sample size of 260 calculated based on a previous study's prevalence of second‐trimester abortion (19.2%), with 80% power and a 5% margin of error. Participants were selected using systematic sampling and data were collected by an interviewer‐administered questionnaire. P‐value adjusted odds ratios (AORs) with their 95% confidence interval (CI) were used to determine the association between variables. Results The study found a high prevalence of second‐trimester abortion at 58%. Factors significantly associated with delays in seeking abortion services until the second trimester included being from a rural area (AOR = 2.1, 95% CI: 1.2–3.8), experiencing social stigma (AOR = 4.2, 95% CI: 2.9–7.8), being unmarried (AOR = 1.6, 95% CI: 1.0–3.0), having limited knowledge of menstrual periods (AOR = 2.3, 95% CI: 1.2–4.6), delaying suspicion and testing for pregnancy (AOR = 18.2, 95% CI: 2.1–8.9–37.3), postponing the decision to have an abortion by more than 1 week (AOR = 4.9, CI: 1.0–23.7), and being a primigravidae (AOR = 2.1, CI: 1.1–4.1). Conclusions Being from a rural area, social stigma surrounding abortion, being unmarried, limited knowledge of menstrual periods, and being a primigravidae were found to be significantly associated with delays in seeking abortion services until the second trimester. A multifaceted approach and efforts should focus on improving access to healthcare resources in rural areas, reducing social stigma surrounding abortion through education and advocacy, and providing comprehensive reproductive health education to enhance knowledge about menstrual cycles and pregnancy testing adapting to local contexts including employing community‐based approaches, using visual and interactive tools, and ensuring cultural sensitivity.

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Abstract Background In countries where abortion laws are stringent, induced abortions are prevalent. The limited availability of abortion services within these regions amplifies the likelihood of maternal complications and mortality. Induced abortions represent a significant public health concern in Iran and are characterized by a multitude of intricate factors that remain largely unexplored. Gaps in knowledge persist pertaining to the influences driving induced abortion within the Iranian context. To adequately address the issue of induced abortion, it is imperative to discern the determinants that shape the decision-making process. The primary objective of this study was to design an intervention program focused on mitigating the occurrence of induced abortion within couples, with an emphasis on identifying the key factors that contribute to this phenomenon. Methods This study comprises three phases. In the first phase, a qualitative approach based on the I-change model will be employed to identify the factors influencing induced abortion. The second phase involves a systematic review to identify the determinants of induced abortion and strategies to prevent induced abortion. In the third phase, the outcomes of the qualitative approach and systematic review will be shared with experts and specialists using the Delphi method to categorize and prioritize strategies. Subsequently, based on the final consensus, a comprehensive program will be developed to prevent induced abortion. Discussion This study introduces an I-change model-based program for the prevention of induced abortion. The prevention of induced abortion holds great significance in mitigating maternal morbidity and mortality, curtailing healthcare expenses, and fostering population growth rates. The research findings will be disseminated via reputable peer-reviewed journals and communicated to the academic and medical communities. This dissemination aims to provide valuable insights that can contribute to the advancement of induced abortion and abortion prevention programs.

Hearing loss, the most prevalent human sensory impairment, can be helped when detected early. This article examined 854 IsraeliArab Christian and Muslim women who had hearing impaired children as regards undergoing prenatal invasive examinations, considering pregnancy termination because of deafness. Women with children with non-genetic hearing loss opted more for prenatal invasive tests and pregnancy terminations in both categories. Christian women opted for more invasive prenatal tests and more pregnancy terminations. Muslim genetic and medical personnel sensitive to religious views are needed to offer genetic counselling and promote awareness of treatment options, which will aid the parents in decision-making. [ABSTRACT FROM AUTHOR]

Background. The voluntary interruption of pregnancy (VIP) remains one of the most contentious issues worldwide, subject to different legal frameworks and cultural interpretations. Access to VIP is considered a fundamental right for women, recognized by international organizations such as the World Health Organization (WHO) and supported by the United Nations. It is estimated that 40-50 million abortions are performed each year, of which about 75% are in developing countries. IVG is legal in only 25 countries, while in the others, it is severely restricted or illegal, leading to an increase in risky and illegal practices. Methods. We consulted government and ministerial websites in European countries to gather data on current abortion laws. In addition, scientific articles and legislative documents compare regulations across some countries, especially from 2020 to today, analyzing differences, similarities and implications. Percentage data on the number of abortions in several European countries, including Italy, were analyzed. Conclusion. Our analysis revealed significant differences in abortion laws between European countries. In many countries, abortion is allowed at the request of the woman within a certain gestational age limit, which typically ranges between 10 and 24 weeks. However, in some countries, the restrictions are much stricter, with limitations making access to legal abortion very difficult or impossible. In conclusion, the Italian experience highlights the importance of considering local sociocultural dynamics in shaping IVG policies and highlights the need for an evidence-based approach to guarantee women right to reproductive health internationally, surrounding reproductive rights, gender equality, and public health policy. [ABSTRACT FROM AUTHOR]

Background: In countries where abortion laws are stringent, induced abortions are prevalent. The limited availability of abortion services within these regions amplifies the likelihood of maternal complications and mortality. Induced abortions represent a significant public health concern in Iran and are characterized by a multitude of intricate factors that remain largely unexplored. Gaps in knowledge persist pertaining to the influences driving induced abortion within the Iranian context. To adequately address the issue of induced abortion, it is imperative to discern the determinants that shape the decision-making process. The primary objective of this study was to design an intervention program focused on mitigating the occurrence of induced abortion within couples, with an emphasis on identifying the key factors that contribute to this phenomenon. Methods: This study comprises three phases. In the first phase, a qualitative approach based on the I-change model will be employed to identify the factors influencing induced abortion. The second phase involves a systematic review to identify the determinants of induced abortion and strategies to prevent induced abortion. In the third phase, the outcomes of the qualitative approach and systematic review will be shared with experts and specialists using the Delphi method to categorize and prioritize strategies. Subsequently, based on the final consensus, a comprehensive program will be developed to prevent induced abortion. Discussion: This study introduces an I-change model-based program for the prevention of induced abortion. The prevention of induced abortion holds great significance in mitigating maternal morbidity and mortality, curtailing healthcare expenses, and fostering population growth rates. The research findings will be disseminated via reputable peer-reviewed journals and communicated to the academic and medical communities. This dissemination aims to provide valuable insights that can contribute to the advancement of induced abortion and abortion prevention programs. Plain English Summary: Induced abortion is restricted in Iran, and many married women with unintended pregnancies resort to clandestine procedures, resulting in adverse health outcomes. Induced abortion contributes to 2.3% of maternal mortality rates in the country. Understanding the factors influencing abortion is crucial for designing effective preventive interventions. Due to cultural and political sensitivities, reliable data on the determinants of induced abortion in Iran, particularly from the perspective of male partners, remain scarce. Existing research primarily focuses on women's views, neglecting the potential influence of men on abortion-related decisions. This study aims to bridge this gap by investigating the determinants of induced abortion in couples and developing a comprehensive couple-based abortion prevention program in Iran. Employing a mixed-methods approach, this study explored the factors associated with couples' decisions regarding abortion. Subsequently, a systematic review will identify existing knowledge on abortion determinants and preventive strategies. On the basis of this comprehensive understanding, an evidence-informed abortion prevention plan will be devised. The findings of this study can inform policymakers and population/reproductive health experts, ultimately aiming to reduce the burden of negative health and social consequences associated with abortion, leading to cost reductions and improved health outcomes for women, families, and society. [ABSTRACT FROM AUTHOR]

BackgroundTermination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa.MethodsData from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at p-values

This scoping review outlines the current understanding, challenges, available resources, and healthcare needs of women affected by intimate partner violence (IPV) who experience unintended pregnancy (UP). UPs are defined as unwanted, unplanned, or mistimed pregnancies. The impact of UP is multifaceted and carries several additional risks, particularly for women who experience IPV. The experiences and living conditions, including (mental) burdens, resources, care structures, and the needs of unintentionally pregnant women who have experienced IPV, remain mostly unexplored. The review will include the following criteria: (i) reproductive-aged women who have experienced IPV and UP; (ii) publications that provide detailed accounts of the experiences, circumstances, and/or needs of women with UP who have experienced IPV. This study will utilize the JBI methodology for scoping reviews and follow the PRISMA Protocol for Scoping Reviews (PRISMA-ScR). A total of 2,325 papers and gray literature published from 2000 to the present were identified. 1,539 literature items were included in the title and abstract screening. Two researchers will independently choose studies, perform data extraction, and perform data synthesis. Quantitative data will be narratively summarized and qualitative data will be analyzed using thematic analysis. The findings will identify research gaps and provide insights into an important topic of reproductive healthcare and the (mental) health situation of a particularly vulnerable group. This will be useful in defining indications for researchers, professionals, and policymakers in public, mental, and reproductive health to conceptualize interdisciplinary and empirical healthcare support for affected women.Systematic review registrationOpen Science Framework: https://doi.org/10.17605/OSF.IO/ZMVPE.

Abstract Background For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. Methods N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2–6 years after (T4) their late termination of pregnancy. Results Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2–6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). Conclusions Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience.

Abstract Background Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of community stakeholders is critical as gatekeepers and decision-makers to improve and strengthen pregnancy termination services for women in camps. However, there is paucity of evidence on their perspectives about pregnancy termination. This qualitative study aims to understand the perception and attitudes of Rohingya community stakeholders to pregnancy termination in the camps of Cox’s Bazar. Methods We used purposive sampling to select 48 participants from the community stakeholders, 12 from each group: majhis (Rohingya leaders), imams (religious leaders), school teachers, and married men. We conducted in-depth interviews of all the participants between May-June 2022 and October-November 2022. Data were coded on Atlas.ti and analysed using a thematic content analysis approach. Results Multiple socio-cultural and religious factors, gendered norms and stigma associated with pregnancy termination acted as barriers to women seeking services for it. From a religious stance, there was greater acceptance of pregnancy termination in the earlier period than in the later period of pregnancy. We observed that pregnancy termination among community stakeholders in earlier stages of pregnancy than later. However, circumstances, such as a woman’s marital status, whether she sought her husband’s permission or her ability of childcare capacity, were often framed by community stakeholders as ‘acceptable’ for pregnancy termination. Health concerns and social and contextual factors can influence community stakeholders supporting pregnancy termination. Conclusions The community stakeholders perspectives on barriers and enablers of pregnancy termination were variable with the context. These perspectives may support or impede women’s ability to choice to seek pregnancy termination services. To improve women’s choice to pregnancy termination, it is critical to consider roles of community stakeholders in creating their supporting attitudes to women’s choice and access, and to designing targeted culturally appropriate interventions with communities support and engagement.

Background: For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. Methods: N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2–6 years after (T4) their late termination of pregnancy. Results: Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2–6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). Conclusions: Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of vaginal misoprostol for second-trimester termination between pregnancies with a dead fetus in utero and those with a live fetus and to identify factors associated with the success rate. Methods: Singleton pregnancies with live fetuses and dead fetuses, between 14 and 28 weeks of gestation, with an unfavorable cervix, were recruited to have pregnancy termination with intravaginal misoprostol 400 mcg every 6 h. Results: Misoprostol was highly effective for termination, with a low failure rate of 6.3%. The effectiveness was significantly higher in pregnancies with a dead fetus (log-rank test; p: 0.008), with a median delivery time of 11.2 vs. 16.7 h. Fetal viability, fetal weight or gestational age, and an initial Bishop score were significantly associated with the total amount of misoprostol dosage used for induction. Fetal viability and gestational age/fetal weight were still independent factors after adjustment for other co-factors on multivariate analysis. Conclusion: Vaginal misoprostol is highly effective for second-trimester termination, with significantly higher effectiveness in pregnancies with a dead fetus. Also, the effectiveness is significantly associated with birth weight/gestational age, and initial Bishop score. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence suggests that pregnancy loss can lead to negative emotional outcomes, such as anxiety and depression, for women. However, limited knowledge exists regarding the long-term risk of mental disorders among individuals who have experienced pregnancy loss. Objective: To investigate the associations between pregnancy loss and the risk of common mental disorders. Methods: In the UK Biobank, a total of 218,990 women without any mental disorder at baseline were enrolled between 2006 and 2010 and followed until October 2022. Information on the history of pregnancy loss was obtained through self-reported questionnaires at baseline. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between pregnancy loss and common mental disorders. Results: During a median follow-up time of 13.36 years, there were 26,930 incident cases of common mental disorders. Incidence rates of common mental disorders were elevated among women with a history of stillbirth (HR 1.15, 95% CI: 1.07-1.23), miscarriage (HR 1.06, 95% CI: 1.02-1.10), or pregnancy termination (HR 1.21, 95% CI: 1.17-1.25) compared to those without such experiences. Furthermore, the risk of common mental disorders significantly increased in women with two or more miscarriages (HR 1.14, 95% CI: 1.08-1.19) or two or more pregnancy terminations (HR 1.39, 95% CI: 1.30-1.48). Conclusions: Pregnancy loss is associated with an increased risk of common mental disorders in women later in life. These findings may contribute to the enhancement of long-term monitoring and prevention of common mental disorders for women with such a history. [ABSTRACT FROM AUTHOR]

Objective Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. Study Design This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. Results Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41–4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. Conclusion Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. Key Points Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies. Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time. Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate. [ABSTRACT FROM AUTHOR]

Background: Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of community stakeholders is critical as gatekeepers and decision-makers to improve and strengthen pregnancy termination services for women in camps. However, there is paucity of evidence on their perspectives about pregnancy termination. This qualitative study aims to understand the perception and attitudes of Rohingya community stakeholders to pregnancy termination in the camps of Cox's Bazar. Methods: We used purposive sampling to select 48 participants from the community stakeholders, 12 from each group: majhis (Rohingya leaders), imams (religious leaders), school teachers, and married men. We conducted in-depth interviews of all the participants between May-June 2022 and October-November 2022. Data were coded on Atlas.ti and analysed using a thematic content analysis approach. Results: Multiple socio-cultural and religious factors, gendered norms and stigma associated with pregnancy termination acted as barriers to women seeking services for it. From a religious stance, there was greater acceptance of pregnancy termination in the earlier period than in the later period of pregnancy. We observed that pregnancy termination among community stakeholders in earlier stages of pregnancy than later. However, circumstances, such as a woman's marital status, whether she sought her husband's permission or her ability of childcare capacity, were often framed by community stakeholders as 'acceptable' for pregnancy termination. Health concerns and social and contextual factors can influence community stakeholders supporting pregnancy termination. Conclusions: The community stakeholders perspectives on barriers and enablers of pregnancy termination were variable with the context. These perspectives may support or impede women's ability to choice to seek pregnancy termination services. To improve women's choice to pregnancy termination, it is critical to consider roles of community stakeholders in creating their supporting attitudes to women's choice and access, and to designing targeted culturally appropriate interventions with communities support and engagement. [ABSTRACT FROM AUTHOR]

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Females mainly increase their reproductive success by improving the quality of their mates and need to be discriminative in their mate choices. Here, we investigate whether female mammals can trade up sire quality in sequential mate choice during already progressed pregnancies. A male-induced pregnancy termination (functional ‘Bruce effect’) could thus have an adaptive function in mate choice as a functional part of a pregnancy replacement. We used bank voles (Myodes glareolus) as a model system and exchanged the breeding male in the early second trimester of a potential pregnancy. Male quality was determined using urine marking values. Females were offered a sequence of either high- then low-quality male (HL) or a low- then high-quality male (LH). The majority of females bred with high-quality males independent of their position in the sequence, which may indicate a pregnancy replacement in LH but not in HL. The body size of the second male, which could have been related to the coercion of females by males into remating, did not explain late pregnancies. Thus, pregnancy replacement, often discussed as a counterstrategy to infanticide, may constitute adaptive mate choice in female mammals, and female choice may induce pregnancy replacement in mammals.

An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.

There is a demonstrated link between intimate partner violence (IPV) and pregnancy termination, and this association has received much attention in developed settings. Despite the high prevalence of IPV in Papua New Guinea (PNG), little is known about the association between these experiences and pregnancy termination. This study examined the association between IPV and pregnancy termination in PNG. The present study used population-based data from the PNG's first Demographic and Health Survey (DHS) conducted in 2016–2018. The analysis involved women aged 15–49 years who were in intimate unions (married or co-habiting). We used binary logistic regression modelling to analyse the association between IPV and pregnancy termination. Results were reported as crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Overall, 6.3% of women involved in this study had ever terminated a pregnancy, and 6 in 10 women (61.5%) reported having experienced IPV in the last 12 months preceding the survey. Of those women who experienced IPV, 7.4% had ever terminated a pregnancy. Women who had experienced IPV had a 1.75 higher odds of reporting pregnancy termination (cOR: 1.75; 95% CI: 1.29–2.37) than women who did not experience IPV. After controlling for theoretically and empirically relevant socio-demographic and economic factors, IPV remained a strong and significant determinant of pregnancy termination (aOR: 1.67, 95% CI: 1.22–2.30). The strong association between IPV and pregnancy termination among women in intimate unions in PNG calls for targeted policies and interventions that address the high prevalence of IPV. The provision of comprehensive sexual reproductive health, public education, and awareness creation on the consequences of IPV, regular assessment, and referral to appropriate services for IPV may reduce the incidence of pregnancy termination in PNG. [ABSTRACT FROM AUTHOR]

Background Women's reproductive health is associated with cardiovascular morbidity. However, an association of vaginal bleeding (VB) in pregnancy with diabetes and cardiovascular outcomes has scarcely been investigated. Methods We conducted a population-based cohort study in Denmark (1994–2018). Using nationwide registries, among 903 327 women we identified 1 901 725 pregnancies: 39 265 ended in childbirth and were affected by VB; 1 389 285 ended in childbirth and were unaffected by VB; 333 785 ended in a termination, and 139 390 ended in a miscarriage. The outcomes were diabetes types 1 and 2, hypertension, ischaemic heart disease including myocardial infarction, atrial fibrillation or flutter, heart failure and ischaemic and haemorrhagic stroke. We computed incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, calendar year of pregnancy end, morbidities and reproductive and socioeconomic factors, using inverse probability of treatment-weighted Cox proportional hazards regression. Results In analyses of VB-affected vs VB-unaffected pregnancies, aHRs were 1.15 (1.03–1.28) for diabetes type 1, 1.19 (1.13–1.26) for diabetes type 2, 1.19 (1.14–1.25) for hypertension, 1.26 (1.16–1.37) for ischaemic heart disease, 1.21 (1.03–1.42) for myocardial infarction, 1.32 (1.14–1.51) for atrial fibrillation or flutter and 1.23 (0.99–1.52) for heart failure. aHRs were 1.41 (1.26–1.57) and 1.46 (1.23–1.72) for ischaemic and haemorrhagic stroke, respectively. When contrasting VB-affected pregnancies with terminations, aHRs were up to 1.3-fold increased for diabetes and hypertension; however, when contrasting VB-affected pregnancies with miscarriages, estimates were below or close to the null value. Conclusions Women's risks of diabetes and cardiovascular outcomes later in life were increased following VB-affected vs VB-unaffected pregnancy or termination, but not following VB-affected pregnancy vs miscarriage. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of misoprostol only, Foley's catheter only, and combined misoprostol plus Foley's catheter for second-trimester pregnancy terminations. Methods: This retrospective study comprised 146 patients who underwent second-trimester pregnancy termination. Patients were divided into three groups: group 1 (n=62), misoprostol alone; group 2 (n=35), Foley catheter alone; and group 3 (n=49), combined group (Misoprostol plus Foley's catheter). The primary outcome in our study was determined by comparing the induction-abortion interval between methods. Secondary outcomes were termination in the first 24 h, complications including surgical removal of the placenta, and uterine rupture. Results: According to the termination methods, the total termination time of the cases, the duration of hospital stays, and the termination rates in the first 24 h did not show statistically significant differences according to the procedures performed (p>0.05). The doses of misoprostol in nullipara and multiparous cases were statistically significantly higher in those who received misoprostol alone than those who received Foley + Misoprostol (respectively p=0.029; p=0.002). It was found that misoprostol dose was statistically significantly lower in those with a history of cesarean delivery (p=0.004). Conclusion: Although the methods used in second trimester pregnancy terminations are not superior to each other in terms of efficiency, the combined method may be preferred in reducing the side effects associated with misoprostol, including a severe condition such as uterine rupture, in those with a history of cesarean section. [ABSTRACT FROM AUTHOR]

Abortion in South Africa is a complex topic, rife with augmenting and limiting political, social, religious, and cultural factors. This study explores multiple age groups within Cato Manor and whether the attitudes towards abortion and factors impacting the choice of where and whether to receive an abortion differ. The study employs a general qualitative approach with inserted narratives highlighting individual perspectives and stories. The sample cohort was identified using purposive sampling of women, obtained via convenience through the gatekeeper in the community. The participants are from two generations, and two expert interviews were conducted to gain various perspectives. The sample population is from the greater Cato Manor community, and the interviews were conducted in a semi-structured format. The main goal of this study is to understand how socio-cultural factors impact abortion attitudes within each generation in Cato Manor and if community attitudes impact women's decisions on how and where to obtain medical abortions. The findings show that negative attitudes towards abortion persist in Cato Manor due to religious and cultural rationale. Greater acceptance occurs among younger generations following abortion legalization in South Africa, yet prejudice remains. The research reveals a range of factors that may pressure women to obtain illegal abortion options to avoid community shame. [ABSTRACT FROM AUTHOR]

BackgroundAlmost 3 quarters of India's roughly 16 million annual abortions are done through medication abortion purchased from pharmacists outside of healthcare facilities. The quality of information provided by pharmacists about medication abortion is often poor.ObjectiveTo determine whether pharmacists selling medication abortion provide different information or ask different, potentially stigmatizing questions to clients by gender and marital status.Study designMystery clients presenting as 4 profiles (unmarried woman, unmarried man, married woman, and married man) purchasing medication abortion interacted with 111 pharmacists in 3 districts around Lucknow, Uttar Pradesh in 2018. Data were collected immediately after the interaction. The differences in the information conveyed and the questions asked by the pharmacists by mystery client characteristics were analyzed using logistic regression in Stata 15 MP.ResultsPharmacists very rarely asked intrusive, medically irrelevant questions and appeared willing to sell medication abortion to all the mystery clients regardless of gender, age, or marital status. However, the pharmacists were overall less likely to provide the female mystery clients with as comprehensive and correct information on medication abortion as they were to male mystery clients, particularly if female mystery clients presented as unmarried.ConclusionPharmacists are observed to provide differential and poorer quality information about medication abortion to women, especially if they seem unmarried, potentially putting women at risk of having a lower-quality and less supported experience of using the medication. However, the pharmacists' willingness to sell the medication to all mystery clients and the lack of intrusive questions and comments reinforces out-of-facility medication abortion as a way for individuals to access an often-stigmatized service. Interventions must find a way to either address this bias among pharmacists, or more practically, to provide high-quality information directly to the individuals seeking medication abortion.

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p

This article analyzes how and why a near-total abortion ban was recently secured by a populist ruling party with support from Catholic Church leaders and lay groups following earlier passage of one of the most restrictive abortion laws in Europe. The paper further examines the public health threats posed by these measures, which have long been under-researched. These policy shifts are situated within the deeply embedded context of Poland's abortion conflict and a setting that has long been challenging for reproductive health. The 1993 ban led to the resurgence of clandestine abortions, a near-total privatization of abortion services, and more women seeking abortion services overseas. In late 2020, the exemption for severe fetal anomalies that made up 97% of all legal abortion cases in prior years was eliminated. Neither ban has significantly reduced the number of women obtaining abortions, nor have they increased birth rates as anticipated by proponents who championed traditional family values that they equated with Catholicism and Polish national identity. The new blanket ban on abortion constitutes a health risk and a punitive measure achieved via a judgement of the Constitutional Tribunal stacked with loyalists by the ruling party. It did not reflect popular will, although societal attitudes on abortion are markedly less permissive than in much of Europe. Although the populist and religious right have realized their long-held goal of further restricting, if not eliminating, women's access to abortion services, compelling criticisms have been raised about how this move compromises women's health and autonomy. Ironically, the realization of this goal, which many Poles view as unduly extreme, may also undermine long-term support for both the political right and the Church. The wisdom of their move was widely questioned, sparked the largest protests since the end of Communist rule, and drew international criticism. It proved a polarizing action that alienated many young adults and may have accentuated a secularizing shift. Women and their partners are finding new ways to navigate many public health threats by increasingly traveling beyond Poland for safe abortion care and resorting to newly available medication abortion methods. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate whether a Muslim woman with a child afflicted with a genetic disease who is living at home would perform more prenatal tests and pregnancy terminations as opposed to a woman with a normal child living at home, and what demographic characteristics, if any, influenced this decision. The study included 771 Muslim women; 37.1% lived with a child afflicted with a genetic disease; and 62.9% did not. Muslim women with a child affected with a genetic disease living at home will undergo more prenatal testing and more pregnancy terminations. Village dwellers were more religious and consulted further with a religious authority. More city dwellers underwent prenatal tests and pregnancy terminations and received more health care and genetic counseling. In the villages populated by Muslims, more genetic counselling must be given, accompanied by guidance from religious Muslim authorities. [ABSTRACT FROM AUTHOR]

Our goal was to determine if differences exist in the attitudes of religious Muslim women living in Israel toward prenatal testing and pregnancy termination after undergoing in vitro fertilization (IVF) compared to the secular Muslim women who had undergone IVF. Six hundred and ninety-nine Muslim women from cities and villages participated, 47% city-dwellers; 53% village-dwellers; 50%-secular; 50%-religious. Secular women who had undergone IVF performed more invasive tests and terminated more pregnancies due to an abnormal fetus than religious women. More genetic counseling must be provided explaining the different prenatal tests and the problems in raising an abnormal child. [ABSTRACT FROM AUTHOR]

Intrauterine retention of fetal bone fragments is a rare complication that can be seen after pregnancy termination, especially in advanced gestational weeks. Here, we present a case of intrauterine fetal bone retention detected during routine gynecological examination in an asymptomatic woman whose pregnancy was terminated 12 years ago. Under local anesthesia and ultrasound guidance, the fetal bone was removed with a grasper. This case report highlights the importance of post-curettage ultrasound examination to ensure that no fetal tissue is left behind after termination of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Cesarean scar pregnancy (CSP) is a potentially life-threatening disease that has been steadily increasing in prevalence. Pregnancy termination is usually recommended given the risk of life-threatening complications. In some cases, patients refuse to terminate viable CSPs, even after counseling. Recent studies report that, even with a high burden of possible complications and maternal morbidity, many CSPs progress to live, close to term births. The aim of this study is to further demonstrate the natural history of viable cesarean scar pregnancies. Methods: We conducted a systematic review of original studies reporting cases of expectant management of CSPs with positive fetal heartbeats. Results: After selection, 28 studies were included in the review, with a total of 398 cases of CSP, 136 managed expectantly and 117 with positive fetal heartbeat managed expectantly. This study confirmed that the majority of patients experience live births, as 78% of patients selected for expectant management experienced live births at or close to term, with 79% developing morbidly adherent placenta, 55% requiring hysterectomy, and 40% having severe bleeding. Discussion: The optimal management protocol for CSP is still to be defined and more studies are needed to further elucidate this rare but rising disease. Our study provides information on the natural history of untreated CSPs and suggests that termination may not be the only option offered to the patient. [ABSTRACT FROM AUTHOR]

Deafness is the most common sensory disability in humans, influencing all aspects of life, However, early diagnosis of hearing impairment and initiating the rehabilitation process are of great importance to enable the development of language and communication as soon as possible. We examined the differences in attitudes towards performing prenatal invasive tests and pregnancy terminations in Jewish and Muslim women in Israel due to deafness. Overall, 953 Israeli women, aged 18–46 years with a mean age of 32.0 (SD = 7.12), were enrolled. Of those, 68.7% were city dwellers and 31.3% were village dwellers, and 60.2% were Muslim women and 39.8% were Jewish women. All participants had a child with a hearing impairment or deafness. The group with no genetic hearing loss performed more prenatal invasive tests and pregnancy terminations than those with genetic hearing loss in both ethnic groups. Jewish women performed more invasive prenatal tests and, consequently, a pregnancy termination. Secular Jewish women more frequently underwent pregnancy terminations due to fetal deafness. Further genetic counseling and information concerning IVF and PGD procedures should be provided to the Muslim population. [ABSTRACT FROM AUTHOR]

Objective: Existing abortion stigma research has rarely isolated the reason for termination; thus, the consequences of termination for medical reasons (TFMR) are poorly understood. We aimed to understand the association of stigma and social support with decision satisfaction in TFMR. Methods: We performed a cross-sectional study on the experiences of 132 individuals who had a TFMR in the second or third trimester. We recruited participants via Facebook. Most participants were non-Hispanic White (85.6%), between 31 and 40 years old (72.7%), highly educated (84.1% with a 4-year degree), and married (89.4%). Participants completed an online demographic data questionnaire, including questions about stigma and social support, and an adapted satisfaction with decision survey. We used t-tests to explore the connection of stigma and social support with decision satisfaction. Results: Results did not reveal an association between stigma and decision satisfaction, but showed that higher social support is associated with higher decision satisfaction. Decision satisfaction was higher in participants who experienced more than one source of support [t(130)?=?2.527, p?=?0.01], compared with those reporting only one source of support, and in those who experienced support from a relative [t(130)?=?1.983, p?=?0.049] and physician [t(130)?=?2.357, p?=?0.020] than in those who did not. Discussion: Social support can alleviate the suffering related to TFMR. Exploring how different forms of social support, including therapy groups, can impact decision satisfaction might help develop interventions to improve postabortion outcomes. Practice Implications: Provider training must encourage providers to (1) support patients having a TFMR and (2) connect patients with other sources of support.

Plain language summary There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa. We analysed a cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics. The prevalence of induced abortion was 19%, but varied by women’s sociodemographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), ever married (26.8%), those already diagnosed HIV positive before their index pregnancy (20.2%). About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.