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  2006   
Article de périodique

Rossier, C.; Guiella, G.; Ouedraogo, A.; Thieba, B.

Estimating clandestine abortion with the confidants method--results from Ouagadougou, Burkina Faso
2006, Social Science Medicine, N°62, 1, p. 254-266

Mots clés : avortement illégal; complications postavortement; incidence; réseaux sociaux
Pays : Burkina Faso

Résumé : Data on abortion in sub-Saharan Africa are rare and non-representative. This study presents a new method to collect quantitative data on clandestine abortion, the confidants method, applied in 2001 in Ouagadougou, Burkina Faso. Preliminary qualitative work showed that individuals are aware of their close friends' induced abortions: women usually talk to their peers about the unintended pregnancy and ask them for help in locating illegal abortion providers. In a survey of 963 women of reproductive age representative of the city of Ouagadougou, we asked respondents to list their close relations, and, for each of them, and for each of the 5 years preceding the survey, whether they had an induced abortion. According to these data, there are 40 induced abortions per 1000 women aged 15-49 in Ouagadougou annually, and 60 per 1000 women aged 15-19. Adverse health consequences followed 60% of the reported induced abortions, and 14% of them received treatment in a hospital. Extrapolating these results to the entire city, we estimate that its hospitals treat about 1000 cases of abortion complications a year. Hospital data indicate that these centers admitted 984 induced abortions (adding all "certainly", "probably" and "possibly" induced abortions in the WHO protocol) in 2001; the age distribution of patients admitted for induced abortion also corresponds to the confidants method's projections ("certainly" induced abortions only). At least two biases could affect the abortion rates estimated by the confidants method, pertaining to the selection of the sample of relations and to the varying number of third parties involved in the abortion process. The confidants method, which is similar in its principle to the sisterhood method used to estimate maternal mortality levels, might generate accurate estimates of illegal abortion in certain contexts if these two biases are controlled for. Further testing is necessary.

Site web : http://authors.elsevier.com/JournalDetail.html?PubID=315 Precis=DESC

  2005   
Article de périodique

Nyanzi, S.; Nyanzi, B.; Bessie, K.

"Abortion? That's for women!" Narratives and experiences of commercial motorbike riders in south-western Uganda
2005, African Journal of Reproductive Health, N°9, 1, p. 142-61

Mots clés : attitude; avortement; avortement provoqué, homme; avortement provoqué, loi; avortement provoqué, religion; chrétien/religion; collecte; comportement sexuel; comportements; connaissance; contraception d'urgence/ contraception postcoitale; Entretien; facteur démographique; facteurs religieux; focus group/enquête; homme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); méthodologie; perception; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; religion
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : Although constitutionally illegal, induced abortion is a vital reproductive health option in Uganda. This paper analyses men's narratives about meanings of, and experiences with, abortion. Men play significant roles in abortion as instigators, facilitators, collaborators, transporters, advisors, informers, supporters or punishment givers. Many participants were knowledgeable about abortion. Attitudes were ambivalent, with initial reactions of denial and relegation of abortion to women's private domains. Further exploration, however, revealed active support and involvement of men. Interpretations of abortion ranged from 'dependable saviour' to 'deceptive sin'. Though a private action, abortion is socially scripted and often collectively determined by wider social networks of kinsmen, the community, peers, law and religion. A disjuncture exists between dominant public health discourse and the reality of local men who interact with women and girls as wives, lovers, sex sellers, mothers, daughters and sisters. Interventions targeting men about abortion should include safe sex education, provide safe abortion services and create stronger social support mechanisms. Policy and law should incorporate local knowledge and practice.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Fawcus, S. R.; van Coeverden de Groot, H. A.; Isaacs, S.

A 50-year audit of maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953-2002)
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, 9, p. 1257-1263

Mots clés : avortement provoqué, mortalité; Cause de décès; causes de décès /décès; complication grossesse; décès; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; épidémiologie; étude prospective; femme; grossesse; intervalle de confiance; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle
Pays : Afrique du Sud

Résumé : OBJECTIVE: To audit trends in maternal mortality in the Peninsula Maternal and Neonatal Service (PMNS) over a 50-year period, with respect to rates and patterns of causation. DESIGN: Retrospective and prospective audit. SETTING: The PMNS, an integrated perinatal service composed of primary, secondary and tertiary facilities in Cape Town. Population All women giving birth in the area of the Cape Peninsula served by the PMNS over the 50-year period. METHODS: Data on maternal deaths were collected for 1953-2002 inclusive, from annual obstetric and gynaecological reports. Three triennia (1954-1956, 1981-1983 and 1999-2001) were selected for a detailed comparison of trends in rates and causes of death. MAIN OUTCOME MEASURES: Maternal mortality rates (MMRs). Causes of maternal deaths. RESULTS: Total deliveries increased from 7315 in 1953 to 27,575 in 2002. The MMR declined from 301 deaths per 100,000 deliveries in 1953 to 31.2 in the triennium, 1987-1989. From 1999, the MMR increased, reaching 112 in 2002. Comparing 1954-1956 (MMR of 253.9) with 1981-1983 (MMR of 43.8), there was a marked decline in the MMR related to hypertension (80.4 to 11.3), haemorrhage (50.8 to 4.2), abortion (55 to 4.2), suspected pulmonary embolism (25.4 to 2.8), pregnancy-related sepsis (8.5 to 4.2) and cardiac disease (21.2 to 2.8). Comparing 1981-1983 (MMR of 43.8) with 1999-2001 (MMR of 59.4), there was a decline in the MMR associated with abortion (4.2 to 0). The MMR for haemorrhage, suspected pulmonary embolism and cardiac disease remained the same. There was a slight increase in the MMR attributed to hypertension (11.3 to 14.5) and pregnancy-related sepsis (4.2 to 7.3). There was a marked increase in the MMR associated with non-pregnancy-related infections/AIDS (4.2 to 18.2). CONCLUSIONS: The MMR for all causes of maternal death declined significantly from 1953 to 1981 as a result of several interventions. From 1999, there has been a non-significant increase in MMR, predominantly due to the burden of HIV/AIDS-related mortality. [Journal Article; In English; England]


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Weeks, A.; Alia, G.; Blum, J.; Winikoff, B.; Ekwaru, P.

A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion
2005, Obstetrics and Gynecology, N°106, 3, p. 540-547

Mots clés : avortement; biologie; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; évaluation; facteur démographique; femme; Misoprostol/méthode/cytotec; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; prostaglandins/hormones; rapport de recherche; santé; santé publique; Sécurité; traitement/soin
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : The objective was to compare the safety, efficacy, and acceptability of misoprostol and manual vacuum aspiration for the treatment of incomplete abortion in a hospital setting in Kampala, Uganda. Three hundred seventeen women with clinically diagnosed incomplete first-trimester abortions were randomized to treatment with either manual vacuum aspiration or 600 _g misoprostol orally to complete their abortions. All women received antibiotics posttreatment and were followed up 1-2 weeks later. Regardless of treatment allocation, nearly all women in this study successfully completed their abortions with either oral misoprostol or manual vacuum aspiration (96.3% versus 91.5%, relative risk 1.05, 95% confidence interval 0.98-1.14). Complications were less frequent in those receiving misoprostol than those having manual vacuum aspiration (0.9% versus 9.8%, relative risk 0.1, 95% confidence interval 0.01-0.78). In the 6 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Rates of acceptability were similarly high among women in the 2 treatment groups, with 94.2% and 94.7% of women reporting that their treatment was satisfactory or very satisfactory in the misoprostol and manual vacuum aspiration groups, respectively. For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 µg oral misoprostol are safe, effective, and acceptable treatments. Based on availability of each method and the wishes of individual women, either option may be presented to women for the treatment of incomplete abortion. (author's)


Article de périodique

Owolabi, O. T.; Moodley, J.

A randomized trial of pain relief in termination of pregnancy in South Africa
2005, Tropical Doctor, N°35, 3, p. 136-139

Mots clés : adolescent; adulte/âge; adultère; Anesthésie; avortement; complication grossesse; curetage; curetage/méthode; douleur/complication; effets secondaires; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude prospective; grossesse; méthodologie
Pays : Afrique du Sud

Résumé : The aim of this prospective trial was to evaluate and compare paracervical block with diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii) diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL).There was a significant difference in pain scores during the procedure between groups (i) and (ii) (P < 0.001), and between groups (i) and (iii) (P < 0.001) in pain scores during the procedure. There was no difference in pain score between groups (ii) and (iii) (P = 0.144). Post procedure analysis of pain score also showed significant difference between group (i) on one hand, and groups (ii) and (iii) (P < 0.001), but no significant difference between groups (ii) and (iii)(P = 0.029).The local anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac and paracervical block provides better pain relief during and after the MVA. [Clinical Trial, Journal Article, Randomized Controlled Trial; In English; England]

Site web : http://www.rsmpress.co.uk/td_gfa.htm

Rapport

Prada, E.; Mirembe, F. M.; Ahmed, F. H.; Nalwadda, R.; Kiggundu, C.

Abortion and postabortion care in Uganda: a report from health care professionals and health facilities
2005 - in Occasional report n°17, The Guttmacher Institute

Mots clés : avortement; avortement à risque; complications postavortement; soin post-abortum; soin post-avortement; soins post avortement; taux d'avortement à risque; traitement/soin
Pays : Ouganda

Résumé : Women in Uganda today give birth to almost seven children, on average-two more children than they would prefer. In fact, nearly half of all births in 2000 were unwanted or mistimed, up from one-third of births only five years earlier. Only 23% of married women were using contraceptives in 2000, although this proportion was about five times that in 1988. Given such facts about the gap between their desired family size and their actual fertility, as well as their low likelihood of using contraceptives, it is not surprising that many women turn to abortion. Abortion is illegal in Uganda unless a woman's pregnancy endangers her life. As a result, the procedure is performed in secrecy and often under dangerous conditions. There are no official statistics even on abortion complications, but what data are available indicate that unsafe abortion in Uganda is a leading cause of maternal morbidity and mortality. Reliable, current data are needed, both to inform debate about the problem of unsafe abortion and to improve women's care. This report presents results from two surveys. One is a survey of health professionals, in which 53 experts on abortion in Uganda were asked their opinions and perceptions about abortion provision and postabortion care. The second is a survey of health facilities, in which senior professionals from a nationally representative sample of facilities that treat postabortion complications were interviewed about their own perceptions and actual service provision. (excerpt)

Site web : http://www.agi-usa.org/pubs/2005/05/28/or17.pdf

Article de périodique

Miller, S.; Billings, D. L.

Abortion and postabortion care: Ethical, legal, and policy issues in developing countries
2005, Journal of Midwifery Women's Health, N°50, 4, p. 341-343

Mots clés : avortement; avortement provoqué, loi; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); morbidité et mortalité maternelle; mortalité maternelle; politique avortement; santé maternelle; soin post-abortum; soin post-avortement; soins post avortement

Résumé : This case study of a woman who wants to terminate her pregnancy but does not have access to safe services explores the technical, ethical, and legal effects of the Mexico City Policy (Global Gag Rule) on health care providers working in developing countries. This woman's self-induced termination resulted in an incomplete abortion, and she sought care from a midwife. The current Mexico City Policy effectively limits a health care provider's ability to offer abortion services and counseling, even when these services are legal. The policy has an adverse impact on women's access to safe care. The provision of comprehensive postabortion care, not restricted by the Mexico City Policy, is the key to preventing abortion-related morbidity and mortality.


Article de périodique

Schuster, S.

Abortion in the Moral World of the Cameroon Grassfields
2005, Reproductive Health Matters, N°13, 26, p. 130-138

Mots clés : avortement à risque; avortement clandestin; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; croyance; grossesse non prévue; morbidité et mortalité maternelle; morbidité maternelle; mortalité maternelle; normes; soins post avortement; taux d'avortement à risque
Pays : Cameroun

Résumé : Despite high levels of unsafe abortion in Cameroon, remarkably limited attention has been paid to the moral dilemma for women who seek abortions. In-depth interviews were conducted with 65 Cameroonian Grasslands women within a hospital-based study, complemented by participant observation, use of hospital records and interviews with key informants. The paper demonstrates how a hidden moral code on abortion helps women to exercise individual agency despite prevailing moral values. At the same time, women's desire to keep abortion secret can impede adequate medical treatment, which in turn can increase the risk of complications and mortality. Abortion was more often condemned by the women because of the risk to their lives and of infertility rather than for religious reasons or because it is illegal. However, the economic and social realities of everyday life often overrode their fear of complications when they needed to end a pregnancy. The paper concludes that women have already broken through Cameroon's stringent restrictions on abortion through their practice. There is a large gap between what is permitted under the current law, which is colonial in origin, and women's need for legal abortion on broad socio-economic grounds. This calls for reflection on liberalisation of the present law.
Malgré des niveaux élevés d'avortement non médicalisé au Cameroun, le dilemme moral des femmes qui veulent interrompre leur grossesse a fait l'objet de bien peu d'études. Des entretiens ont été menés avec 65 Camerounaises des plaines dans le cadre d'une étude hospitalière, complétés par des observations des participantes, l'utilisation des dossiers médicaux et des entretiens avec des informateurs clés. L'article montre qu'un code moral privé sur l'avortement aide les femmes à agir malgré les valeurs morales dominantes. En même temps, le désir des femmes de garder l'avortement secret peut contrarier un traitement médical adapté, ce qui risque à son tour d'accroître les complications et la mortalité. Les femmes condamnaient plus souvent l'avortement en raison des risques de décès et de stérilité que pour des motifs religieux ou parce qu'il est illégal. Néanmoins, quand elles ont besoin d'une interruption de grossesse, les réalités économiques et sociales de la vie quotidienne l'emportent souvent sur leur crainte des complications. L'article conclut que la pratique des femmes aggrave les restrictions sévères du Cameroun sur l'avortement. Il existe un net écart entre ce qui est permis par la loi, d'origine coloniale, et le besoin qu'ont les femmes d'un avortement légal pour de vastes motifs socio-économiques. Cela exige de réfléchir à la libéralisation de la législation actuelle.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Isaac, K.

Abortion legislation in Eritrea: an overview of law and practice
2005, Medicine And Law, N°24, 1, p. 137-161

Mots clés : avortement légal; complication grossesse; femme; grossesse
Pays : Erythrée

Résumé : This article discusses legal issues related to the abortion provisions of the Transitional Penal Code of Eritrea. As is the case in many African countries, the current abortion law of Eritrea mainly was adopted from continental Europe four decades ago, reflecting the reality of the time. Despite the advancement in science and technology, which significantly determines the very definition and concept of abortion and contraception, the abortion law remains the same, save for minor amendments taken place in 1991. Due to the background of the abortion law and the shortcomings occurred during the amendment process, the law manifests legal gaps and limitations resulting in discrepancies between law and practice. The article, therefore, identifies and analyses the gaps of the abortion law in light of principles of criminal law, existing medical technology related to abortion, and experience of other countries


Article de périodique

Munasinghe, S.; van den Broek, N.

Abortions in adolescents
2005, Tropical Doctor, N°35, 3, p. 133-136

Mots clés : adolescent; adulte/âge; adultère; enfant /enfance; épidémiologie; grossesse adolescente; grossesse adolescente/grossesse; grossesse non prévue/grossesse non désirée; loi et jurisprudence; qualité des soins; service de santé; Statistique
Pays : Afrique subsaharienne

Résumé : This review discusses the problem of abortion in adolescents across the world and highlights the gaps in knowledge. It also examines the need for adolescent-friendly services.

Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Croce-Galis, M.

Adolescents in Uganda: sexual and reproductive health
2005, Research in Brief

Mots clés : adolescent; âge; avortement; comportement sexuel; comportements; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; grossesse non prévue/grossesse non désirée; infection VIH; Infections génitales/IST/MST; jeune/adolescent; maîtrise de la fécondité; maladie; population; premier rapport/ sexualité; prévention; programme de santé; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : Nearly one-quarter of Uganda's population is between the ages of 10 and 19. Many of these young people are at risk or already struggling with the consequences of an unplanned pregnancy or a sexually transmitted infection (STI), including HIV/AIDS. To minimize these risks and secure a healthy future for adolescents, it is necessary that policymakers, journalists, service providers and advocates have solid evidence regarding the sexual and reproductive health needs of Ugandan youth. This Research in Brief summarizes key research findings on Ugandan adolescents' sexual and reproductive health behaviors and needs, with particular emphasis on HIV/AIDS, and points the way forward toward improving policies and programs. (excerpt)

Site web : http://www.agi-usa.org

Article de périodique

Okonofua, F. E.; Shittu, S. O.; Oronsaye, F.; Ogunsakin, D.; Ogbomwan, S.

Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria
2005, Acta Obstetricia et Gynecologica Scandinavica, N°84, p. 270-280

Mots clés : avortement; curetage; curetage/méthode; déterminant fécondité; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur économique; facteurs économiques; fécondité; Infections génitales/IST/MST; intervention chirurgicale; intervention chirurgicale/méthode; maladie sexuellement transmissible/MST/IST; médecin/personnel de santé; méthodologie; personnel de santé; planning familial; planning familial, acceptante; prévention; rapport de recherche; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; traitement/soin
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D C). Nearly 28% reported the use of MVA followed by D C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country. (author's)


Générique

Rossier, C.; Guiella, G.; Ouedraogo, A.; Thieba, B.

Avortement clandestin à Ouagadougou et conséquences sur la santé des femmes. Une étude basée sur la méthode des confidentes.
2005, Les travaux de l'UERD, N°16, p. 25

Mots clés : avortement illégal; Avortement illégal; avortement provoqué; réseaux sociaux; transition de la fécondité
Pays : Afrique; Burkina Faso

Résumé : Les données existant sur l'avortement illégal en Afrique sub-saharienne sont rares et non représentatives. La présente étude met en oeuvre une nouvelle méthode de collecte de données quantitatives sur les avortements clandestins, la méthode des confidentes. Une application de cette méthode à Ouagadougou, capitale du Burkina Faso, permet d'estimer le taux annuel d'avortement à 40 avortements provoqués pour 1000 femmes agées de 15 à 49 ans ; les adolescentes seraient les plus touchées par ce phénomène (60 avortements provoqués pour 1000 pour les 15-19 ans) ; 60 % des femmes qui ont eu un avortement provoqué auraient été atteintes dans leur santé, et 14% seraient soignées dans un centre de référence de la ville : ces centres accueilleraient environ 1100 avortements provoqués par an. Les statistiques des centres de santé de référence de Ouagadougou indiquent qu'environ 1000 avortements provoqués sont accueillis dans ces structures par an ; par ailleurs, la distribution par âge des patientes admises pour complication d'avortement provoqué est la même que la structure projetée par la méthode des confidentes. Ces deux éléments plaident en faveur de la validité de la méthode. Une comparaison avec des données similaires collectées en milieu rural Burkinabé montre que le taux d'avortement augmente avec l'entrée en transition de la fécondité.
Data on illegal abortion in sub-Saharan Africa are rare and non-representative. This study presents a new method to collect quantitative data on clandestine abortion, the confidants' method, applied in 2001 in Ouagadougou, Burkina Faso. According to our estimates, there are 40 induced abortions per 1000 women aged 15-49 in Ouagadougou annually, and even more among adolescents (60 per 1000 women 15-19) ; adverse health consequences affect 60% of women who had an abortion, and 14% enter the city's hospitals, which received an estimated 1100 abortion complications a year. Hospital data indicate that this centers admit about 1000 induced abortions annually ; the age distribution of patients admitted for induced abortion also corresponds to the confidants' method's projections. Theses two results argue in favor of the reliability of the method. A comparison with similar data collected in rural Burkina indicate that abortion rates increase with the entry into fertility transition.


Congrès

Rossier, C.

Avortement provoqué et baisse de la fécondité en Afrique de l'Ouest
2005, La régulation de la fécondité en Afrique. Transformations et différenciations au tournant du XXI e siècle., Conférence virtuelle du GRIPPS avec le LPED comme institution hôte, Marseille

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; transition de la fécondité
Pays : Burkina Faso

Article de périodique

Oladapo, O. T.; Coker, A. A.

Bowel prolapse and gangrene following vaginal vault perforation: an example of the menace of criminal abortion in Nigeria
2005, Tropical Doctor, N°35, 3, p. 177-8

Mots clés : avortement; complications postavortement
Pays : Nigeria
Site web : http://www.rsmpress.co.uk/td_gfa.htm

Rapport

Martinho, D.; Gebreselassie, H.; Bique, C.; Victorino, M. T. A.; Gallo, M. F.; Mitchell, E. M. H.; King, K. O.; Jamisse, L.; Correa, D. M.; de Almeida, E.; Chavane, L.

Confronting maternal mortality: The status of abortion care in public health facilities in Mozambique
2005, NC, Ipas, p. 40

Mots clés : complication; morbidité et mortalité maternelle; mortalité maternelle; soin de santé
Pays : Mozambique

Résumé : As with many African nations emerging from civil war and in the throes of structural adjustment, contraceptive prevalence in Mozambique is low and maternal mortality is high-1000 maternal deaths per 100,000 live births (WHO, 2004b). The high volume and high cost of abortion complications exact a heavy toll on the nation's overburdened health system. Postabortion care admissions represent more than 55% of all obstetrical complications treated in Mozambique (Jamisse et al, 2004). In response to the high morbidity and mortality rates, the Mozambican Ministry of Health, with technical and financial support from Ipas, conducted a comprehensive assessment of abortion-related services in 45 public-health facilities in 2002-2003. The goal of the assessment was to inform interventions to best serve women's reproductive-health needs and reduce maternal morbidity and mortality in Mozambique. The assessment consisted of interviewing health-care providers on abortion and postabortion service delivery and training and interviewing clients on abortion-related service quality.


Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Akpadza, K.; Agba, K.; Tete, V. K.; Baeta, S.; Attignon, A.; Adabra, K.; Hodonou, K. A. S.

Connaissance et pratique de la contraception par les patientes admises pour avortement provoqué clandestin à la clinique de gynécologie-obstétrique du CHU Tokoin, Lomé
2005, Médecine d'Afrique Noire, N°52, p. 345-351

Mots clés : contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; planning familial; planning familial, acceptante
Pays : Togo

Résumé : L'avortement provoqué clandestin, devenu une préoccupation quotidienne à la clinique de Gynécologie-Obsté-trique du CHU Tokoin-Lomé, suscite inquiétudes et interrogations eu égard à la vulgarisation de la contraception au Togo et la multiplication des Centres de Planification Familiale à Lomé. Pour répondre aux interrogations, identifier les causes des avortements provoqués clandestins reçus à la clinique, et déterminer le profil des patientes, nous avons mené une étude portant sur la connaissance et la pratique de la contraception par les responsables de cet acte.
Les résultats suivants ont été obtenus : - la moyenne d'âge des patientes était de 22 ans, - les âges extrêmes étaient 13 ans et 44 ans, - 32,57 % des patientes étaient analphabètes, - 19,70 % étaient élèves, - 83,33 % étaient célibataires, - 85,60 % des patientes connaissaient l'existence des méthodes modernes de contraception ; 22,72 % ignoraient le lieu où elles peuvent se procurer ces méthodes. Les décideurs de l'avortement étaient la gestante (48,49 % des cas), le procréateur (29,54 % des cas), le couple (12,12 % des cas), les parents (9,85 % des cas). Trois principaux motifs ont été évoqués pour interrompre la grossesse. Il s'agissait des motifs socio-professionnels (39,40 %), des motifs familiaux (29,54 %), des motifs économiques (21,21 %).
L'inconscience (43,18 %), l'ignorance des méthodes contraceptives (14,40 %), le refus du partenaire (12,87 %), l'insuffisance de l'information (12,12 %) et la peur des effets secondaires des contraceptifs (8,33 %) ont été cités par les patientes pour justifier la non-utilisation des méthodes contraceptives.
Ces résultats recommandent le renforcement de la communication pour le changement de comportement chez nos patientes en activité génitale.

Site web : http://www.santetropicale.com/Kiosque/man/sommaire.asp?id_article=378 action=lire

Article de périodique

Meel, B. L.

Criminal abortion and concealment of birth in Transkei region, South Africa
2005, Medicine, Science, And The Law, N°45, 1, p. 57-60

Mots clés : complication grossesse; confidentialité; droit des femmes; grossesse; issue grossesse; loi et jurisprudence
Pays : Afrique du Sud

Résumé : The objective was to estimate the incidence of criminal abortions and concealment of births in Transkei. This paper presents a review of the records of the medico-legal register at Umtata General Hospital from 1993-2003. There were 37 cases of premature concealed births and conceptus material brought to the attention of medico-legal investigators between 1993 and 2003. Of these, 26 (70.3%) were concealed births, and 11 (29.7%) were abortion products. There is great variability in the incidence of abortion and concealment of births during this period. There were nine cases in 1993 and three in 2003. No case was reported in 1994. There was only a single case reported in each of the years 1995, 1997 and 2001, and four cases in each of the years 1996, 1998 and 2002. In 1998 there were eight cases, the highest for any year after promulgation of the Abortion Act. There is no significant difference in the number of cases reported for medico-legal investigation of criminal abortion and concealment of births before and after the Abortion Act which came into effect in 1997. [Journal Article; In English; England]


Article de périodique

Jewkes, R. K.; Rees, H.

Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act
2005, South African Medical Journal, N°95, 4, p. 250

Mots clés : avortement provoqué, mortalité; complication grossesse; grossesse; législation; mortalité
Pays : Afrique du Sud

Résumé : [Letter; In English; South Africa]

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Rapport

Hessini, L.

Ensuring women's access to safe abortion : essential strategies for achieving the millennium development goals
2005

Mots clés : avortement; soin post-abortum; soin post-avortement; soins post avortement

Résumé : Approved by world leaders in September 2000, the eight Millennium Development Goals (MDGs) are time-bound targets for ending poverty, improving health and promoting gender equality. This flyer examines the global abortion situation within the MDG framework, revealing how the elimination of unsafe abortion can help achieve the MDGs while promoting social and economic justice, human rights and public health.

Site web : http://www.ipas.org/publications/en/MDGFLY_E05_en.pdf

Article de périodique

Benson, J.

Evaluating abortion-care programs: Old challenges, new directions
2005, Studies in Family Planning, N°36, 3, p. 189-202

Mots clés : avortement; avortement provoqué, loi; avortement sans risque; évaluation; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); service de santé

Résumé : The evaluation of abortion-care programs and policies has been largely neglected by both national governments and international organizations. This article provides a conceptual framework for evaluating the intermediate outcomes of a safe abortion program, including laws and policies, women's care-seeking behavior, and the quality of, access to, and use of services. The methodological challenges in evaluating these outcomes are described. For each outcome, key indicators for measuring progress in program implementation are offered, along with country examples of successful evaluation approaches. The article concludes with recommendations for improvements in infrastructure, resource availability, and political commitment to support evaluation of safe abortion programs.

Site web : http://www.ipas.org/english/press_room/press_room_pdfs/Benson_SIFP_09_05.pdf

Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Sepou, A.; Gaye, A.; Dumont, A.

How far do clandestine abortion providers go in Africa?
2005, Médecine Tropicale, N°65, 1, p. 64-66

Mots clés : avortement clandestin
Pays : Afrique

Résumé : A 28-year-old, gravida 2, para 2 was admitted to undergo abortion in the third quarter. The procedure consisting of mechanical induction of labor using plastic catheters was performed by a male nurse. The day after placement of the catheters the patient began labor and gave uneventful birth to female infant weighing 2900 grams. The procedure undertaken to destroy the fetus led to the birth of a normal healthy child. Mechanical induction after full-term pregnancy (rarely performed in our areas) is unwarranted if pregnancy is ongoing. Due to his ignorance of the late stage of pregnancy and of the potential consequences of the procedure, the male nurse had exposed the patient to risk of severe trauma. Although the outcome was favorable for the patient, action must be taken to control intermediate level health care workers whose practices can endanger the population. [Journal Article; In French; France]


Congrès

Singh, S.

Incidence of unsafe abortion an resulting mortality and morbidity: A review of data, methods and information gaps
2005, Workshop on research on the economic impact of abortion-related mortality and morbidity, New York (USA), April 26, The Alan Guttmacher Institute, p. 29

Mots clés : avortement à risque; avortement provoqué, mortalité; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; incidence; méthodologie; morbidité; mortalité; taux d'avortement à risque
Pays : Afrique; Amérique latine; caraibe; Europe

Article de périodique

Oye-Adeniran, B. A.; Adewole, I. F.; Umoh, A. V.; Iwere, N.; Gbadegesin, A.

Induced abortion in Nigeria: findings from focus group discussion
2005, African Journal of Reproductive Health, N°9, 1, p. 133-41

Mots clés : adoption; attitude; avortement; avortement provoqué, loi; avortement provoqué, religion; chrétien/religion; collecte; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; facteurs religieux; fécondité; focus group/enquête; grossesse non prévue/grossesse non désirée; législation; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); méthodologie; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; religion
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Dickens, B. M.

Interactions of law and ethics affecting reproductive choice
2005, Medicine And Law, N°24, 3, p. 549-559

Mots clés : avortement; éthique; ligature des trompes / stérilisation; loi / législation; stérilisation/contraception
Pays : Afrique du Sud

Résumé : Controversies affecting reproductive choice can often be resolved within interactions of legal and ethical decision-making. This paper addresses three topics, following the methodology presented in Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law, by R.J. Cook, B.M. Dickens and M.F. Fathalla (Oxford University Press, 2003). The book's 15 case studies each addresses medical, ethical, legal and human rights aspects, and structural approaches at clinical, healthcare system and societal levels. STERILIZATION: Individual self-determination supports legal and ethical rights of intellectually competent persons to sterilization. Sterilization of intellectually compromised persons was historically abused, causing reactions of excessively protective prohibition. ABORTION: Most developed countries have liberalized abortion legislation, thereby reducing abortion-related mortality and morbidity, but many developing countries retain repressive colonial laws. Over 95% of the estimated 20 million unsafe abortions annually occur in developing countries. COURT-ORDERED CAESAREAN DELIVERIES: A concern in developed countries is the willingness of some courts to order Caesarean procedures over competent women's objections. [Journal Article, Legal Cases; In English; South Africa]


Article de périodique

Bop, C.

Islam And Women's Sexual Health And Rights In Senegal.
2005, Muslim World Journal of Human Rights, N°2, 1 (3), p. 30

Mots clés : activité sexuelle / sexualité; avortement; coït/sexualité; droit de l'homme; islam; planning familial; planning familial, acceptante; sexualité
Pays : Sénégal

Résumé : The objective of this study is to analyse the tensions between conceptualizations about Islam, women's sexual health and rights in Senegal. Sexual rights are defined here as the right to choose
a partner, the right to enjoy sex without fear of violence or disease, and the right to physical integrity. These rights are examined through legal, Islamic and International frameworks in the context of their relevance to Senegal. The general population's, and Ulamas', positions, attitudes and behaviours about these rights were collected through interviews and focus group discussions. These research methods revealed a strong opposition, from both men and women, to women's individual choice and control over her body as far as family planning, sexuality, or abortion are concerned. Most respondents regarded these rights as "Western." In their view, the idea of equality embedded in international human rights conflicts with local cultures and religion. At the level of service delivery, a large number of health care providers still believe that unmarried women should not be given information or family planning methods. Also revealed is how Islam is used to construct and legitimize existing reproductive and sexual roles and deprive women of rights in these areas. Part of the reason why women rights are not observed relate to the failure by Senegal to enforce international human rights treaties and conventions that it has already signed. Failure by Senegalese women's associations to give priority to sexual rights, has also contributed to lack of real progress in this area. This study is meant to be used by Senegalese women's rights activist and human rights organizations, as, inter alia, a tool for advocacy for the advancement of women's
sexual health and rights.

Site web : http://www.bepress.com/mwjhr

Congrès

Guillaume, A.

L'avortement, un mode de régulation de la fécondité dans les villes du Sud ?
2005 - in AUF, Villes du Sud. Dynamiques, diversités et enjeux démographiques et sociaux., Cotonou, Bénin, p. 20

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; santé de la reproduction; ville
Pays : Afrique

Résumé : Dans cette communication nous analyserons les conditions du recours à l'avortement dans les villes africaines en mettant l'accent sur les conditions du recours à ces avortements : méthodes, profil des femmes et raisons de ces avortement. Nous analyserons également les relations entre contraception et avortement dans la régulation de la fécondité. Cette étude reposera sur le travail des synthèse réalisé « L'avortement en Afrique : une revue de la littérature des années 1990 à nos jours ». Des comparaisons seront faites à partir du travail identique réalisé en Amérique Latine.


Article de périodique

le Roux, P. A.; van der Spuy, Z. M.

Labor induction abortion utilizing trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor
2005, Contraception, N°71, p. 343-347

Mots clés : âge; avortement; avortement provoqué, mortalité; biologie; complication grossesse; contraception d'urgence/ contraception postcoitale; décès fotal; Dynamique démographique; effets secondaires; essais clinique; facteur démographique; grossesse; méthodologie; Misoprostol/méthode/cytotec; mortalité; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; reproduction; traitement/soin
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Labor induction abortion in the second trimester is a difficult problem in developing countries because antiprogestins are either not available or unaffordable. When prostaglandins are used alone for labor induction abortion without antiprogestin pretreatment, the induction to delivery interval and the treatment failure rate increase. Trilostane, an inhibitor of 3ß-hydroxysteroid dehydrogenase enzyme system, was given to 93 women between 13 and 19 weeks gestation. The trilostane dosage used was 120 mg twice daily for the first 24 h, and then 240 mg twice daily for the next 24 h. The women returned after 48 h for hospital admission. The women were randomized to three different misoprostol regimens: low-dose vaginal group (200 µg every 4 h), high-dose vaginal group (initial dose of 400 µg followed by 200 µg every 4 h) and vaginal-oral group (400 µg vaginally followed by 200 µg orally every 4 h). The median induction to abortion times were 17, 8.3 and 9.4 h, respectively. The latter two groups had significantly shorter induction to delivery times (p<.05). The most common side effects were a burning feeling in the face (47.7%) and nausea (13.3%). Overall, trilostane side effects were mild and self-limiting and did not interfere with therapy. In conclusion, trilostane can be give as out-patient therapy prior to admission for prostaglandin administration in labor induction abortion. (author's)

Site web : http://www.contraceptionjournal.org/

Article de périodique

Gondo, D.; Abauleth, R.; Dagnan, S.; Beat, S.; Boni, S.; Bohoussou, K.

Le préjudice corporel et financier des avortements provoqués; à propos de 300 cas colligés dans le service de gynécologie et d'obstétrique du C.H.U. de Cocody
2005, Médecine d'Afrique Noire, N°52, 02, p. 77-80

Mots clés : avortement; complications postavortement; coûts
Pays : Côte d'Ivoire

Résumé : Objectif : évaluer le préjudice corporel et le coût financier des avortements provoqués
Patientes et méthodes : il s'agit d'une étude transversale descriptive sur une période de 6 mois (juillet-décembre 2000) qui s'est déroulée dans le service de gynécologie et d'obstétrique du Centre Hospitalier et Universitaire de Cocody.
Résultats : les moyens utilisés ont été les moyens mécaniques dans 50 % des cas, les produits chimiques dans 42 % et dans 8 % des cas, il s'agissait d'une association des 2. Les signes cliniques ont été dominés par les hémorragies, les douleurs, les tableaux de choc. Les étiologies ont été les restes ovulaires, les perforations utérines et autres organes, les infections et intoxications médicamenteuses. Les interventions pratiquées ont consisté en évacuations utérines par curetage, laparotomies avec drainage de collections suppurées, hystérectomies, annexectomies, antibiothérapie et réanimation. Nous avons dénombré 4 décès sans préjuger des séquelles futures. Les coûts de ces actes ont été entièrement à la charge des patientes et leurs familles. Ils ont varié de 11.000 francs CFA pour les curetages à 126.830 francs CFA pour les cas nécessitant une laparotomie. La durée de l'hospitalisation a varié d'un jour à 47 jours auxquels il faut ajouter l'arrêt de travail.
Conclusion et recommandations : Le développement des soins après l'avortement devrait contribuer à baisser la mortalité, la morbidité et le coût de la prise en charge.

Site web : http://www.santetropicale.com/Kiosque/man/sommaire.asp?id_article=284 action=lire

Article de périodique

Ujah, I. A. O.; Aisien, O. A.; Mutihir, J. T.; Vanderjagt, D. J.; Glew, R. H.; Uguru, V. E.

Maternal mortality among adolescent women in Jos, north-central, Nigeria
2005, Journal of Obstetrics and Gynaecology, N°25, 1, p. 3-6

Mots clés : adolescent; avortement provoqué, mortalité; complication grossesse; grossesse; grossesse adolescente; grossesse adolescente/grossesse; morbidité et mortalité maternelle; mortalité; mortalité maternelle; statistique
Pays : Nigeria

Résumé : The adolescent maternal mortality ratio is high in Jos, north-central Nigeria. The main causes of maternal deaths among the adolescents were unsafe abortion, eclampsia and sepsis. The Hausa/Fulani ethnic group constituted the largest ethnic group of adolescent maternal deaths in our study. The risk factors for adolescent maternal mortality found in our study were illiteracy, non-utilisation of antenatal services and Hausa/Fulani ethnic group. (author's)


Article de périodique

Lema, V. M.; Changole, J.; Kanyighe, C.; Malunga, E. V.

Maternal mortality at the Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi
2005, East African Medical Journal, N°82, 1, p. 3-9

Mots clés : adolescent; avortement provoqué, mortalité; Cause de décès; causes de décès /décès; complication grossesse; décès; grossesse; mortalité
Pays : Malawi

Résumé : Background: Maternal mortality in Malawi continues to increase despite the global SMI and national safe motherhood programme's efforts to reduce it.
Objectives: To identify the social, demographic and reproductive profiles of women suffering a maternal death, the main immediate causes and the operational factors.
Design: A retrospective descriptive survey.
Setting: The Gogo-Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi, from January 1, 1999 to December 31, 2000.
Subjects: All women who suffered a maternal death in the unit.
Results: There were a total of 204 maternal deaths and 19,859 live births, giving a Maternal mortality ratio (MMR) of 1027.2/100,000 live births. Their ages ranged from 16 to 40 years. Adolescents comprised 20.6%, while the majority, (56.4%), were aged 15 - 24 years. Almost half of the group, (43.4%), were para 1 and less, with a range of 0 to 12. The top five causes of death were puerperal sepsis, (29.4%); postabortal complications, (23.5%); other infectious conditions, (20.1%); obstetric haemorrhage, (10.6%), and eclampsia, (6.4%). Some of the identified operational factors included delay in accessing and receiving emergency obstetric care, poor quality services, HIV infection/ AlDS and unsafe induced abortion following unwanted pregnancy.
Conclusion and recommendations: Most of the causes and operational factors for maternal deaths are easily avoidable. The country needs to make more commitment and investments necessary to mitigate these deaths.

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Round up: Medical Abortion

Medical Abortion
2005, Reproductive Health Matters, N°13, 26, p. 165-167

Mots clés : avortement médical

Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Berer, M.

Medical Abortion: A Fact Sheet
2005, Reproductive Health Matters, N°13, 26, p. 20-24

Mots clés : avortement médical

Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

International Consortium for Medical Abortion (ICMA)

Medical Abortion: Expanding Access to Safe Abortion and Saving Women's Lives
2005, Reproductive Health Matters, N°13, 26, p. 11-12

Mots clés : avortement médical; avortement provoqué, mortalité; avortement sans risque; mortalité

Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Berer, M.

Medical Abortion: Issues of Choice and Acceptability
2005, Reproductive Health Matters, N°13, 26, p. 25-34

Mots clés : acceptabilité; avortement médical

Résumé : Although more than one method of abortion has been available for many years, in most countries the provider chooses the method and may be skilled in one method only. This paper discusses choice and acceptability of medical abortion from the perspective of both women and abortion providers and argues that choice of method is important for both. Safety, efficacy, number of visits, how the method works, how long it takes for the abortion to be complete and cost all affect acceptability. Medical abortion is considered more natural because it happens in women's own bodies and can take place at home before nine weeks of pregnancy; surgical abortion with vacuum aspiration is simple and over quickly. Unless the costs of both methods are similar, however, women and providers will tend towards whichever is the cheaper option, limiting choice. Medical abortion is effective from when a woman misses her period through 24 weeks of pregnancy, and more women and providers need to be made aware of this. In legally restricted situations, complications tend to be less serious and easier to treat with early medical abortion than after unsafe invasive methods. Ideally, both medical and surgical methods should be available, but each can be provided without the other.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Cooper, D.; Dickson, K. E.; Blanchard, K.; Cullingworth, L.; Mavimbela, N.; von Mollendorf, C.; van Bogaert, L. J.; Winikoff, B.

Medical abortion: the possibilities for introduction in the public sector in South Africa
2005, Reproductive Health Matters, N°13, 26, p. 35-43

Mots clés : avortement médical
Pays : Afrique du Sud

Résumé : Medical abortion is safe and effective and has been approved for use in early termination of pregnancy in South Africa since 2001. The Department of Health is currently considering its introduction in the public health sector. The attitudes of women seeking abortion and of health care providers towards medical abortion have not previously been described. Data were derived from a quantitative survey of 673 women attending abortion services in the provinces of Gauteng, Mpumalanga and the Western Cape. In-depth interviews in Soweto and Cape Town were conducted with 20 public health doctors, nurses, a social worker and facility managers, and in Cape Town with four provincial policymakers. Although medical abortion was not yet being offered, 21% of women interviewed were early enough in pregnancy (eight weeks or less) to be eligible for medical abortion. Access to health facilities, including those for abortion, was reasonable for urban women but more limited for rural women. Rural women also incurred greater travel costs to reach a facility. Most women thought medical abortion would be acceptable and would have been willing to try it, had it been available. Policymakers and providers were supportive, as they felt medical abortion could relieve the burden on current services. How to increase access to abortion services in rural areas needs to be addressed.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Moodliar, S.; Bagratee, J. S.; Moodley, J.

Medical vs. surgical evacuation of first-trimester spontaneous abortion
2005, International Journal of Gynecology and Obstetrics, N°91, p. 21-26

Mots clés : avortement; avortement spontané; avortement spontané/fausse couche; biologie; complication grossesse; contraception d'urgence/ contraception postcoitale; Dynamique démographique; enquête; étude/études; facteur démographique; facteurs économiques; grossesse; maladie; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; reproduction
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : The objective was to determine whether management of incomplete first-trimester abortion with vaginal misoprostol in an under-resourced setting is a viable treatment option. A total of 94 women were randomized to 600 µg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow-up visit 2 weeks following complete abortion. The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow-up visit. However, more women who received the medical treatment would recommend it or choose it in the future. Medical management using 600 µg of misoprostol in 2 doses is effective to treat incomplete first-trimester abortions in an under-resourced setting when there is no evidence of uterine sepsis. (author's)


Article de périodique

Jerbi, M.; Hidar, S.; Sahraoui, S.; Essaidi, H.; Fekih, M.; Bibi, M.; Chaieb, A.; Khairi, H.

Mifépristone à la dose de 100 mg dans les avortements médicamenteux
2005, Journal De Gynecologie, Obstetrique et Biologie De La Reproduction, N°34, 3-C1, p. 257 - 261

Mots clés : avortement médical; avortement médicamenteux; Mifepristone /RU486; Misoprostol/méthode/cytotec
Pays : Tunisie

Résumé : But. Évaluation de l' efficacité et de la tolérance de la mifépristone à la dose de 100 mg relayée 48 heures plus tard par du misoprostol à la dose de 400 µg par voie orale dans l'interruption volontaire de grossesse de moins de 57 jours d'aménorrhée.
Matériel et méthode. Étude rétrospective sur 8 mois et demi de 762 cas d'interruption volontaire de grossesse. La mifépristone est utilisée à la dose de 100 mg à J1 après un examen clinique et une échographie pelvienne. Le misoprostol est donné par voie orale à la dose de 400 µg à J3. La patiente est gardée en observation les 4 premières heures suivant le misoprostol. Une visite de contrôle à J15 est systématiquement réalisée. Le critère de jugement principal est l' efficacité du protocole définie par l'expulsion totale sans recours à une aspiration chirurgicale.
Résultats. Les avortements médicamenteux représentent 42 % de l'ensemble des avortements . Seize pour cent des grossesses étaient de moins de 43 jours, 76 % de 43 à 49 jours et 8 % de 50 à 56 jours ; 80,2 % des expulsions sont survenues dans les 4 premières heures suivant la prise du misoprostol. Une seule expulsion est survenue avant la prise du misoprostol. Le taux de succès dans notre série est de 94,4 %. Le taux d' échec augmente avec l'âge de la grossesse. Les effets secondaires sont dominés par les douleurs. Six cas d'hémorragie ont nécessité une aspiration chirurgicale en urgence. Aucune patiente n'a été transfusée. Quatre-vingt-seize pour cent des patientes se sont présentées à la visite de contrôle. Le taux d'acceptabilité a été de 94 %.
Conclusion. La mifépristone à la dose de 100 mg relayée 48 heures plus tard par du misoprostol à la dose de 400 µg par voie orale est une méthode efficace et sûre dans les interruptions médicales de grossesses précoces.
Objectives. To assess the clinical efficacy of mifepristone 100mg followed two days later by misoprostol 400µg orally in women undergoing medical termination of pregnancy up to 56 days gestational age.
Materials and methods. Retrospective study over 8.5 months of 762 cases early medical abortion. 100 mg mifepristone was used on day 1 after clinic visit and vaginal ultrasonography. Misoprostol 400µg was administered orally on day 3. Following administration of prostaglandin, women were observed in the ward for 4 hours. A control visit on day 15 was systematic. Success was defined as a complete uterine evacuation without the need for surgical intervention.
Results. Medical terminations accounted for 42% of all abortions. 16% of women were pregnant for «42 days, 76% for 43 to 49 days and 8% for 50 to 56 days. Termination occurred within 4 hours after administration of misoprostol in 80.2% of the women. Only one woman aborted within 48 hours of mifepristone administration only. The success rate in this study was 94.4% and the failure rate increased with the gestational age. Pain was the predominant side effect. Six cases of bleeding required a surgical intervention. No patient required transfusion. 96% of patients attended a control visit on day 15. The acceptability rate of the method has been 94%.
Conclusion. Mifepristone 100mg followed two days later by misoprostol 400µg orally is safe and effective for early termination of pregnancy.


Article de périodique

Weeks, A. D.; Fiala, C.; Safar, P.

Misoprostol and the debate over off-label drug use
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, 3, p. 269-272

Mots clés : avortement provoqué, méthode; complication grossesse; femme; grossesse; morbidité et mortalité maternelle; mortalité maternelle

Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Okonofua, F. E.

Misoprostol and women's health in Africa
2005, African Journal of Reproductive Health, N°9, 1, p. 7-9, 10-13

Mots clés : avortement provoqué, mortalité; biologie; complication grossesse; Dynamique démographique; facteur démographique; grossesse; législation; maladie; Misoprostol/méthode/cytotec; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Nations Unies; OMS; organisation; population; prostaglandins/hormones; santé; santé de la reproduction; traitement/soin
Pays : Afrique

Résumé : In March 2005, the World Health Organization (WHO) announced that it has included misoprostol in its essential drug list as part of a regimen for the termination of pregnancy in the first trimester of pregnancy. This welcome development has important implications for the promotion of women's health worldwide and for women in sub-Saharan Africa in particular. Available evidence indicates that countries in sub- Saharan Africa have some of the highest rates of maternal mortality in the world. Of the estimated 550,000 maternal deaths in the world annually, 270,000 deaths (nearly 50%) are known to occur in African countries. The WHO estimates that for every 100,000 live births in Africa, there are 1000 maternal deaths, compared with 276 for Asia, 190 for Latin America and 10 for Europe. Indeed, one in 16 women is estimated to die in her reproductive years from a pregnancy-related cause in many parts of Africa. These alarming rates of maternal morbidity and mortality, which have shown no signs of abating, call for concerted and realistic action to save mothers and newborns in the region. (excerpt)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Westheimer, E.; Raghavan, S.; Lankoande, J.; Dao, B.; Taylor, J.; Bique, C.; Winikoff, B.

Misoprostol for treatment of incomplete abortion in Sub-Saharan Africa
2005, Contraception, N°72, 3, p. 239

Mots clés : avortement incomplet; Misoprostol/méthode/cytotec

Résumé : Introduction: A number of studies have described the use of misoprostol for treatment of incomplete abortion. Several studies have revealed a single 600 Ag oral dose of misoprostol to be highly effective in treating incomplete abortion. It is commonly thought that this treatment could prove to be as safe and effective as standard surgical treatment. However, this has not been studied sufficiently to confirm the utility and acceptability of misoprostol for incomplete abortion in a variety of settings. Materials and Methods: Over 1000 women in Burkina Faso, Ghana, Mozambique and Tanzania seeking treatment for incomplete abortions, either spontaneous or induced, with uterine size less than 12 weeks LMP were enrolled in the study.Women were randomized
to receive either 600 Ag of oral misoprostol in one dose, or standard surgical treatment [manual vacuum aspiration (MVA) in these settings]. Women returned for follow-up and evaluation of abortion status 1 week after initial treatment. Any woman who had not had a complete expulsion was offered an extended follow-up visit in 1 week or an immediate surgical evacuation.Womenwith complete abortions underwent an exit interview. Success was defined as a complete abortion without recourse to surgical intervention at any time. Results: The success rates were above 90% for both the misoprostol and MVA arms. Greater than 90% of women in both groups reported being either satisfied or very satisfied with the treatment and that side effects were tolerable. Conclusion: Six hundred micrograms of oral misoprostol alone for the treatment of incomplete abortion appears to be as safe and effective as surgical intervention (MVA).

Site web : http://www.contraceptionjournal.org/

Article de périodique

Essilfie-Appiah, G.; Hofmeyr, G. J.; Moodley, J.

Misoprostol in obstetrics and gynaecology - benefits and risks
2005, South African Journal of Obstetrics and Gynaecology, N°11, 1, p. 9-10

Mots clés : avortement; biologie; complication grossesse; complications postavortement; contraception d'urgence/ contraception postcoitale; enquête; étude de cas; étude/études; facteur démographique; facteurs de risque; facteurs économiques; grossesse; maladie; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; santé; santé publique; Sécurité
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : The well-documented effectiveness of misoprostol in several gynaecological and obstetric applications has resulted in enthusiasm for its use that has overtaken the need for careful assessment of potential risks. Since misoprostol has become freely available for termination of pregnancy (TOP) and for induction of labour at or near term, we have seen an increase in the incidence of uterine hyper stimulation, preterm labour, induced abortion above 20 weeks' gestation, meconium-stained liquor in the latent phase of labour, fetal distress and cases of uterine rupture associated with the use of high doses of misoprostol. The purpose of these case reports and brief literature review is to highlight the benefits and risks associated with the current unregistered use of misoprostol in clinical practice and in the community. (excerpt)


Article de périodique

Yolande, H.; Namory, K.; Delphine, F.; Mamadou Hady, D.; Mamadou Diouldé, B.

Misoprostol use for labor induction in developing countries: a prospective study in Guinea
2005, European Journal of Obstetrics, Gynecology and Reproductive Biology, N°122, 1, p. 40-44

Mots clés : avortement; biologie; complications postavortement; contraception d'urgence/ contraception postcoitale; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude prospective; étude/études; facteur démographique; grossesse; maladie; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Guinée

Résumé : The purpose of this study was to assess the efficacy, side effects and cost of misoprostol regimens in various obstetrical situations frequently occurring in developing countries. One hundred and four parturient women with indications for labor induction received different regimens of misoprostol in the range of 50-800 mg according to their gestational age. Misoprostol was administered by the vaginal route, every 6 h without exceeding four doses. All indications for labor induction concerned women with a gestational age of more than 30 weeks, except in the intrauterine death cases. The mean overall duration of labor was 7.8 h (±4.6 h). The mean amount of misoprostol used was 226 mg (±196 mg). The difference in the mean labor duration between the four indications for induction was statistically significant (P < 0.01). It was also significant for the mean total dose of misoprostol used. Total dose of misoprostol and Bishop score were inversely proportional. Two caesarean deliveries and two uterine ruptures were recorded, but no maternal deaths. The mean Apgar score was 8.0 (±1) at 1 min and 9.5 (±0.8) at 5 min. In our series, four fetal deaths occurred. The mean cost of misoprostol for labor induction was around US$ 1, with a range of e 0.05-4. The use of vaginal misoprostol appears to be relevant in developing countries in cases where labor induction is indicated. Nevertheless, the advantages of misoprostol (low cost, facility of storage) are counter-balanced by side-effects (C-section, uterine rupture) which can be harmful for the mother and also for the newborn.
L'objectif de la présente étude a été d'évaluer l'efficacité, les effets secondaires et le coût des traitements à base de misoprostol dans les diverses situations obstétriques fréquemment rencontrées dans les pays en développement. Un groupe de 104 femmes parturientes candidates à l'induction de travail ont été placées sous différents régimes à base de misoprostol, allant de 50 à 800 mg selon leur âge gestationnel. Le misoprostol a été administré par voie vaginale toutes les 6 heures, à raison de quatre doses maxima. Toutes les femmes candidates à l'induction de travail avaient dépassé le seuil des 30 semaines de gestation, en-dehors des cas de mort foetale intra-utérine. La durée totale moyenne du travail a été de 7,8 h (±4,6 h). La quantité moyenne de misoprostol utilisée a été de 226 mg (±196 mg). La différence de durée moyenne du travail entre les quatre catégories d'indications a été statistiquement significative (P < 0,01). Elle a également été significative pour la dose totale moyenne de misoprostol utilisée. La dose totale de misoprostol et le score de Bishop ont été inversement proportionnels. Deux accouchements par césarienne et deux ruptures utérines ont été enregistrés, mais aucun décès maternel. Le score d'Apgar moyen a été de 8,0 (±1) à 1 min. et de 9,5 (±0.8) à 5 min. Quatre décès foetaux ont eu lieu dans le groupe de l'étude. Le coût moyen du traitement à base de misoprostol pour l'induction du travail a été d'1 USD (moyenne : 0,05-4). L'utilisation de misoprostol vaginal semble justifiée dans les pays en développement, dans les cas où l'induction du travail est indiquée. Néanmoins, les avantages du misoprostol (faible coût, facilité de stockage) sont contrebalancés par des effets secondaires (césarienne, rupture utérine) qui peuvent nuire à la mère ainsi qu'au nouveau-né.


Article de périodique

Sherris, J.; Bingham, A.; Burns, M. A.; Girvin, S.; Westley, E.; Gomez, P.

Misoprostol use in developing countries: result from a multicountry study
2005, International Journal of Gynecology and Obstetrics, N°88, p. 76-81

Mots clés : biologie; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; femme; méthodologie; Misoprostol/méthode/cytotec; Organisation et Administration; personnel de santé; pharmacie; pharmacien; planning familial; planning familial, acceptante; population; programme; programme d'activités; prostaglandins/hormones; santé; santé publique; Sécurité; système de santé; traitement/soin

Résumé : The objective was to identify information and service delivery needs for obstetric/gynecologic uses of misoprostol in developing countries. The study included a survey of reproductive health providers in 23 countries and a qualitative study of misoprostol use in four developing countries. Researchers used purposive sampling methods for the survey and qualitative study and conducted a descriptive statistical analysis of survey data and computer-assisted text-based content analysis of qualitative data. In some developing countries, women frequently access misoprostol through pharmacies and self-medicate to induce early abortion. Some clinicians expressed concern about this use of misoprostol, but many stated that its availability had reduced serious complications resulting from unsafe abortions. Although misoprostol is routinely used for a range of off-label obstetric/gynecologic indications, evidence-based, up-to-date information about safety, effectiveness, and appropriate regimens is not widely available. This information is requested by providers, including pharmacists. Women need information and guidance about its use. (author's)


Article de périodique

Mbugua, F.

Murder charge for abortion doctor divides medical profession in Kenya
2005, BMJ. British Medical Journal, N°330, p. [2]

Mots clés : avortement; avortement provoqué, mortalité; causes de décès /décès; complication grossesse; contraception d'urgence/ contraception postcoitale; crime; décès; Dynamique démographique; facteur démographique; fotus; grossesse; médecine; mortalité; planning familial; planning familial, acceptante; population; problème social; reproduction; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : The prominent Kenyan obstetrician and gynaecologist Dr John Nyamu remains in police custody after his arrest on 27 May last year on murder charges. Dr Nyamu is charged with unlawfully killing two fetuses that were among 15 found in rubbish bags near a Nairobi housing estate. His trial is set to start on 9 February. Charged jointly with him are two nurses, Ms Marion Wambui Kibathi and Ms Mercy Kaimuri Mathai. According to police sources, autopsy results indicated that three of the fetuses were at least seven months old (40, 36, and 32 weeks) at the time the pregnancies were terminated. The fetuses were found in plastic bags by a river outside a Christian institution, together with medical waste and a register of patients from one of the clinics of Dr Nyamu's Reproductive Health Services company. The discovery came three weeks after the release of a study of abortion in Kenya, conducted jointly by the Ministry of Health, the Kenya Medical Association, and two non-governmental organisations. The study, which covered only 60 public hospitals, estimated that up to 800 unsafe abortions are performed every day in Kenya, leading to an average of 2600 deaths each year. Several members of parliament called for the legalisation of abortion when the study was released. (excerpt)

Site web : http://bmj.bmjjournals.com/cgi/content/full/330/7481/10-e

Congrès

Nouetagni, S.

Pauvreté et régulation de la fécondité au Cameroun.
2005, La régulation de la fécondité en Afrique. Transformations et différenciations au tournant du XXI e siècle., Conférence virtuelle du GRIPPS avec le LPED comme institution hôte, Marseille, p. 22

Mots clés : abstinence post-partum; avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; pauvreté; transition de la fécondité
Pays : Cameroun

Article de périodique

Weeks, A.; Lavender, T.; Nazziwa, E.; Mirembe, F. M.

Personal accounts of "near-miss" maternal mortalities in Kampala, Uganda
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, p. 1302-1307

Mots clés : avortement provoqué, mortalité; collecte; Dynamique démographique; Entretien; facteur démographique; femme; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; obstacles; Organisation et Administration; population; programme; Programme d'évaluation; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : To explore the socio-economic determinants of maternal mortality in Uganda through interviews with women who had 'near-misses'. Design Observational study using qualitative research methods. Setting The postnatal and gynaecology wards of large government hospital in Kampala, Uganda. Sample Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre-eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4). Methods The semi-structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software. Results The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women's attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health-seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhuman care. There were no reports of bribery. Conclusion Women with near-miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality. (author's)


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Billings, D. L.; Benson, J.

Postabortion care in Latin America: policy and service recommendations from a decade of operations research
2005, Health Policy And Planning, N°20, 3, p. 158-166

Mots clés : avortement à risque; complication grossesse; grossesse; soin post-abortum; soin post-avortement; soins post avortement; taux d'avortement à risque
Pays : Kenya; Mexique

Résumé : Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. Postabortion care (PAC) using preferred technologies and a woman-centred approach to treat the complications of unsafe abortion can save women's lives and improve their reproductive health, as well as reduce costs to health systems. This article reviews results from 10 major PAC operations research projects conducted in public sector hospitals in seven Latin American countries, completed and published between 1991 and 2002. The studies show that following relatively modest interventions, the majority of eligible patients were being treated with manual vacuum aspiration (MVA), a method preferred for safety and other reasons over the method conventionally used in the region, sharp curettage (SC). A number of studies showed improvements in contraceptive counselling and services when these were integrated with clinical treatment of abortion complications, resulting in substantial increases in contraceptive acceptance. Finally, data from several studies showed that, in most settings, reorganizing services by moving treatment out of the operating theatre and reclassifying treatment as an ambulatory care procedure substantially reduced the resources used for PAC, as well as the cost and average length of women's stay in the hospital. These studies suggest that comprehensive PAC can and should be available to all women in Latin America. Such efforts should be coupled with work to improve primary prevention, including better contraceptive services to prevent unwanted pregnancy and safe, legal abortion services to reduce the number of clandestine and unsafe abortions.


Article de périodique

Population council

Postabortion family planning benefits clients and providers
2005, Program briefs, N°4, p. 4

Mots clés : avortement; Clients; clinique/service de santé; contraception d'urgence/ contraception postcoitale; counseling; Organisation et Administration; planning familial; planning familial, acceptante; programme; programme d'activités; programme planification familiale; rapport; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya; Russie

Résumé : Abstract: A woman's fertility can return quickly after an abortion or miscarriage--as soon as two weeks after (Bongaarts 1983). Yet recent data show high levels of unmet need for family planning among women who have been treated for incomplete abortion. This leaves many women at risk of another unintended pregnancy and in some cases subsequent repeated abortions and abortion-related complications (Savelieva et al. 2002). Thus it is vital for programs to provide a comprehensive package of postabortion care (PAC) services that includes medical treatment; family planning counseling and other reproductive health services such as sexually transmitted infection (STI) evaluation and treatment, HIV counseling and possibility testing; and community support and mobilization. Facilities that can effectively treat women with incomplete abortions can also provide contraceptive services, including counseling and appropriate methods. Appropriate pre-discharge contraception can be provided in conjunction with all emergency procedures including inpatient and outpatient dilation and curettage (D C) and manual or electric vacuum aspiration. Any provider who can treat incomplete abortion can also provide most family planning methods. (excerpt)

Site web : http://www.popcouncil.org/pdfs/frontiers/pbriefs/PB4_PAC_05.pdf

Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Senbeto, E.; Alene, G., D,; Abesno, N.; Yeneneh, H.

Prevalence and associated risk factors of Induced Abortion in Northwest Ethiopia
2005, Ethiopian Journal of Health Development, N°19, 1, p. 37-44

Mots clés : avortement provoqué; facteurs de risque; prévalence
Pays : Ethiopie

Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Article de périodique

Adanu, R. M. K.; Ntumy, M. N.; Tweneboah, E.

Profile of women with abortion complications in Ghana
2005, Tropical Doctor, N°35, 3, p. 139-42

Mots clés : aspects socio-économiques; avortement; complications postavortement; facteurs socio-économiques; hôpital; hôpital publique; hôpital universitaire
Pays : Ghana

Résumé : A cross-sectional study of 150 women was performed at the gynaecology department of the Korle-BuTeaching Hospital to describe the characteristics of patients with complications of induced or spontaneous abortions, and to find out the reasons behind induced abortions. In all, 31% of the study sample presented with complications of induced abortions. This group was younger, of lower parity, more educated, with lower economic potential, in less stable relationships and with a higher knowledge of modern contraceptive methods than the group with spontaneous abortions. The chief reason for procuring an induced abortion was the presence of relationship problems with the subject's partner. We conclude that measures to prevent induced abortions and their subsequent problems will yield major results if directed at women in their early 20s with at least primary education, no children, low economic potential, not in a stable relationship and who have had a previous induced abortion.

Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Ahmed, F. H.; Prada, E.; Bankole, A.; Singh, S.; Wulf, D.

Reducing unintended pregnancy and unsafe abortion in Uganda
2005

Mots clés : avortement; avortement provoqué, mortalité; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; enquête; enquête démographique et de santé/EDS; facteur démographique; famille; fécondité; femme; grossesse non prévue/grossesse non désirée; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; politique de population; politique/programme; population; rapport de recherche; taille famille
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : This report examines key changes since the late 1980s in the reproductive and contraceptive behavior and preferences of Ugandan women, assesses the extent to which births are unplanned and summarizes what is known about unsafe abortion in the country. To capture recent trends, the report provides information for 1988, 1995 and 2000-years for which comparable national survey data on these issues are available. To highlight the large differences across the country and the need for attention to variations in policies and programs, it includes measures for the four major regions of Uganda, and for urban and rural residents. The purpose of the report is to increase awareness of, and attention to, Ugandan women's reproductive health care needs. We hope that policymakers, public health advocates and health care professionals will use the report's findings to develop informed policies and programs that could help reduce unintended pregnancies and lessen the negative impact of unplanned births and unsafe abortions on the health and lives of Ugandan women. (excerpt)


Article de périodique

Hussain, R.; Bankole, A.; Singh, S.; Wulf, D.

Reducing unintented pregnancy in Nigeria
2005, Research in Brief, p. 8

Mots clés : avortement à risque; naissance non prévue; taux d'avortement à risque
Pays : Nigeria

Résumé : This report compares the childbearing aspirations of Nigerian women with their actual experience. It focuses on the high level of mistimed and unwanted births occurring in Nigeria a s a result of low levels of contraceptive use among women in many parts of the country. The report reveals wide variation in levels of contraceptive use among married and sexually active unmarried women. Both groups have a significant unmet need for family planning, but the reasons for their need differ. The study directs attention toward far-reaching health policy and program responses that will be required to reduce mistimed and unwanted pregnancies and unsafe abortions in Nigeria.


Article de périodique

Mitsunaga, T. M.; Larsen, U. M.; Okonofua, F. E.

Risk factors for complications of induced abortions in Nigeria
2005, Journal of Women's Health, N°14, 6, p. 515-528

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; épidémiologie; facteur démographique; facteurs de risque; facteurs économiques; grossesse; mesure; méthodologie; planning familial; planning familial, acceptante; population; prévalence; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : The prevalence and risk factors for unsafe abortions and their complications are not well defined. A cross-sectional study of patient-reported reproductive history was conducted in three hospitals in southwest Nigeria from 1998 to 1999. Data on pregnancy outcomes and sociodemographic characteristics were collected for 1836 women ages 15-49 seeking family planning and antenatal services. Independent predictors for complications from induced abortion of first pregnancies were analyzed using logistic regression models. Four hundred twenty-four women (29.7%) terminated their first pregnancy. As many as 43.1% of women unmarried at first pregnancy had an abortion, and being unmarried at pregnancy was the strongest predictor of abortion in the adjusted model. Almost 30% experienced complications at the time of abortion (heavy bleeding, high fever, and other), and 22.9% reported complications subsequent to and within 6 weeks of abortion. Heavy bleeding and 6-week complications were significantly associated with age at pregnancy, circumcision, and religion, and 87.6% of women with 6-week complications reported complications for 1 day. Type of provider was the sole significant predictor of fever, and doctor provider reduced the risk of fever. Induced abortion and related complications were common despite the widespread provision by doctors. Policies and programs should address improving abortion practices and postabortion care, increasing contraceptive use, and reducing the practice of female circumcision. (author's)


Article de périodique

Rasch, V.; Yambesi, F.; Kipingili, R.

Scaling up postabortion contraceptive service -- results from a study conducted among women having unwanted pregnancies in urban and rural Tanzania
2005, Contraception, N°72, 5, p. 377-382

Mots clés : âge; avortement; collecte; comportement reproductif; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; Entretien; étude comparée; étude/études; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme planification familiale; programme post-abortum; programme post-abortum, coût; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : It is well recognized that unwanted pregnancies and unsafe abortion are significant public health problems in sub-Saharan Africa. At the International Conference on Population and Development held in Cairo in 1994, postabortion care was prioritized as a means to reduce maternal morbidity and mortality associated with unsafe abortion. However, only a few postabortion care programs have been implemented and most of them have been confined to urban settings. The present study describes the magnitude of the problem of unwanted pregnancies among women with incomplete abortion in urban and rural Tanzania and evaluates the outcome of a postabortion care intervention.MethodsData were collected among 781 women admitted with incomplete abortion in Dar es Salaam region (urban Tanzania) and 575 women in Kagera region (rural Tanzania).ResultsSixty-seven percent of the women in urban Tanzania and 42% in rural Tanzania stated that their pregnancy was unwanted. Contraceptive acceptance among women with unwanted pregnancies was high; 93% in urban Tanzania and 71% in rural Tanzania left with a contraceptive method.ConclusionThe high proportion of women with unwanted pregnancies in urban and rural Tanzania underlines the need of scaling up postabortion contraceptive service.

Site web : http://www.contraceptionjournal.org/

Article de périodique

Jewkes, R. K.; Rees, H.; Dickson, K. E.; Brown, H.; Levin, J.

The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, 3, p. 355-359

Mots clés : avortement; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; épidémiologie; hôpital; hôpital publique; hôpital universitaire; méthodologie
Pays : Afrique du Sud

Résumé : OBJECTIVE: In 1996 termination of pregnancy was legalised in South Africa. This article examines the impact of age on the epidemiology of incomplete abortion after legislative change. It draws comparison with the findings of a similar study undertaken in 1994. DESIGN: Multicentre, prospective, descriptive study. SETTING: Forty-seven public hospitals in all nine provinces. SAMPLE: A stratified random sample of all hospitals treating gynaecological emergencies was drawn. All women of gestation under 22 weeks who presented with incomplete abortion during three weeks of data collection in 2000 were included. METHODS: A data capture sheet completed by a clinician from the case notes. MAIN OUTCOME MEASURES: Demographic characteristics and clinical findings on admission by age of women. RESULTS: Overall, there was a significant increase in the proportion of cases with no signs of infection on admission (from 79.5% to 90.1%) and a significant decrease in evidence of interference on evacuation (4.5% to 0.6%) between 1994 and 2000. Substantial age differentials were seen. Women over 30 were significantly less likely than those 21-30 years or under 21 to be low severity (65.5% vs 75.2% vs 76.4%, P= 0.0087) and more likely to have offensive products (16.3% vs 6.0% vs 6.4%, P= 0.01) than the younger women. CONCLUSIONS: Legalisation of abortion had an immediate positive impact on morbidity, especially in younger women. This is an important change as teenagers had the highest morbidity in 1994. The trend is supported by evidence from the 1999-2001 Confidential Enquiry into Maternal Deaths, which further suggested that abortion mortality dropped by more than 90% since 1994. [Journal Article, Multicenter Study; In English; England]


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Singh, S.; Prada, E.; Mirembe, F. M.; Kiggundu, C.

The Incidence of Induced Abortion in Uganda
2005, International Family Planning Perspectives, N°31, 4, p. 183-191

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; enquête méthodologique; estimation; méthode d'avortement, effets secondaires; prestataires; taux d'avortement / taux
Pays : Ouganda

Résumé : CONTEXT: Although Uganda's law permits induced abortion only to save a woman's life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS: A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS: Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country's most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women's health, increased access to contraceptive services is needed for all women.

Site web : http://www.agi-usa.org/pubs/journals/3118305.html

Reproduced with the permission of The Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Gebreselassie, H.; Gallo, M. F.; Monyo, A.; Johnson, B. R.

The magnitude of abortion complications in Kenya
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, 9, p. 1229-1235

Mots clés : avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; grossesse; maladie; mesure; méthodologie; morbidité; mortalité; planning familial; planning familial, acceptante; population; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Objective To estimate and describe the magnitude of abortion complications presenting at public hospitals in Kenya. Design Cross-sectional descriptive study. Setting Hospital-based. Population Records of all women presenting prior to 22 weeks of gestation with abortion-related complications at selected hospitals during a three-week study period. All public tertiary and provincial hospitals were included; stratified random sampling was employed to select a subset of 54 district hospitals nationwide. Methods Data collectors identified 809 patients with abortion complications on all hospital wards and completed a standardised questionnaire for each by extracting information from the patient's hospital record. Main ouctome measures Incidence, aetiology, morbidity and mortality of abortion complications. Results Most women (80%) presented with incomplete abortion. Approximately 34% of the women had reached the second trimester of pregnancy. Adolescents (14-19 years old) accounted for approximately 16% of the study sample. Manual vacuum aspiration was used to manage 80% of first trimester cases. The projected annual number of women with abortion complications admitted to public hospitals in Kenya is 20,893. The case fatality rate was estimated to be 0.87% (95% CI 0.71-1.02%), so an estimated 182 (95% CI 148-213) of these women die annually. The annual incidence of incomplete abortion and other abortion-related complications per 1000 women aged 15 to 49 years is projected to be 3.03. Conclusions The high rate of abortion-related morbidity and mortality documented in the study highlights the critical need to address the issue of unsafe abortion in Kenya.


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Graphique / Tableau

Center for Reproductive Rights

The world's abortion laws poster 2005
2005, New York. (USA), Center for Reproductive Rights

Mots clés : avortement; loi / législation
Site web : http://www.crlp.org/publications.html

Rapport

Fetters, T.; Akiode, A.; Ponce de Leon, R. G.; Benson, J.

Turning training into practice: Findings of an impact evaluation of postabortion care training in Nigeria
2005, New York, Ipas, p. 31

Mots clés : soin post-abortum; soin post-avortement; soins post avortement
Pays : Nigeria

Résumé : Since the inception of the global postabortion care (PAC) model in the 1990s, health-care providers around the world have participated in a variety of PAC-skills trainings. Although it is believed that such trainings lead to improvements in the quality and accessibility of PAC services, this study is one of the first to systematically assess the effectiveness and impact of such trainings over time. The goal of this study was to determine whether and how effectively health-care providers in Nigeria have been able to put their PAC training into practice. The study hypothesized that the providers' ability to use their PAC skills would be influenced by a combination of institutional, environmental and individual factors. The study involved 201 Nigerian health-care providers, including obstetrician-gynecologists (ob-gyns), physicians and nurse-midwives, who had participated in PAC trainings in 2001 and 2002. The content of their trainings included: PAC assessment and diagnosis; uterineevacuation procedure and techniques; introduction to medication abortion; pain management; infection prevention; management of complications; counseling; referral to other reproductive-health services; contraceptive counseling and method provision; manual vacuum aspiration (MVA) instrument reuse and storage; and post-procedure and follow-up care. In addition to interviewing the trained providers, researchers interviewed the supervisors and administrators of the wards in each of the 192 facilities represented. Study results indicated that most providers were satisfied with the PAC training they received, though more nurse-midwives tended to find the clinical-practice component unsatisfactory. More than a third of the trained providers had shared their new PAC skills with others, particularly with nurse-midwives, at their own or other health-care facilities. Almost all physicians had performed a uterine evacuation after participating in a training session while just over one-half of nurses and nurse-midwives had done so. Physicians working in hospitals were more likely to have performed MVA since the training than their counterparts in primary-health centers, while the reverse was true for nurse-midwives. Although more than one-half of the trained nurse-midwives (56%) reported that they had performed at least one uterine evacuation since their training course, at the time of this study many of these respondents reported that they were not currently using these skills because their facility either did not have MVA instruments, did not have PAC patients or did not allow nursemidwives to perform uterine-evacuation procedures with MVA. Problematically, nursemidwives working in tertiary hospitals, including teaching institutions, where clinical behavior
is modeled were least likely to be allowed to use MVA. Although more that three-fourths of facilities had functioning MVA kits, almost half the providers reported that their facilities did not have enough MVA instruments to meet patients' needs. The results show that significant improvements in the health-care providers' attitudes, behaviors and practices resulting from PAC training have been sustained over a period of one to two years. Positive outcomes of the trainings include, specifically: faster services, better care for patients, improved facility infrastructure and equipment, and fewer complications, thanks to increased use of MVA and more attention to high-quality services. These improvements have not gone unchallenged, however: resistance to change, rigid health systems, staff shortages, limited funds and/or a lack of supportive management have slowed progress in some places. The single most important outcome of PAC trainings is improved care for women. Increasing the effectiveness and sustainability of PAC programs is not an academic exercise; it saves women's lives. The ultimate challenge is to ensure that access to such life-saving services is enjoyed by all women in Nigeria and around the world.

Site web : http://www.ipas.org/publications/en/TRGPRAC_E05_en.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Osiemo, R.

Unsafe abortion in Kenya
2005, Tropical Doctor, N°35, 3, p. 159-60

Mots clés : adolescent; avortement à risque; complication grossesse; complications postavortement; grossesse; morbidité et mortalité maternelle; mortalité maternelle; taux d'avortement à risque
Pays : Kenya
Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Rasch, V.; Lyaruu, M. A.

Unsafe Abortion in Tanzania and the Need for Involving Men in Postabortion Contraceptive Counseling
2005, Studies in Family Planning, N°36, 4, p. 301-310

Mots clés : avortement à risque; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; rôle des hommes; taux d'avortement à risque
Pays : Tanzanie

Résumé : Targeting male partners involved in unsafe abortions for contraceptive counseling could be an important strategy for decreasing the incidence of unwanted pregnancies, yet few postabortion-care programs have attempted to involve these men. To assess the need for and determine the content of postabortion contraceptive counseling for men, this study examined the contraceptive knowledge, attitudes, and practices of male partners of women who have had an unsafe abortion. A survey was administered to 213 men accompanying female partners receiving hospital care after having undergone an unsafe abortion in Dar es Salaam, Tanzania, and 20 of these men participated in in-depth interviews. Sixteen percent of the men surveyed accompanied an extramarital partner, and of those, only 44 percent reported having practiced contraception in the last six months, compared with 81 percent of the men accompanying their wives and 83 percent accompanying their girlfriends. In general, the men wished to support their partners in practicing contraception, and the majority were willing to participate in contraceptive counseling. These findings suggest that male partners should be included in postabortion contraceptive counseling, which should be sensitive to the nature of the partners' relationship, the risk of HIV transmission, and the importance of promoting gender equality.


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Jewkes, R. K.; Gumede, T.; Westaway, M. S.; Dickson, K. E.; Brown, H.

Why are women still aborting outside designated facilities in metropolitan South Africa?
2005, BJOG : An International Journal Of Obstetrics And Gynaecology, N°112, 9, p. 1236-1242

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; Evaluation des services de santé; facteur culturel; facteur démographique; grossesse; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; qualité des soins; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Objective To explore why South African women still abort outside designated services where there is substantial legal service provision. Design Descriptive study. Setting Three hospitals in Gauteng Province in South Africa. Sample Forty-six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities. Methods An interviewer-administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open-ended questions explored the circumstances of induction. Main focus of interviews Methods of induction used, barriers to legal service use. Results Nearly two-thirds of women (n = 38) had self-induced or had consulted a traditional healer. A minority of these women (n = 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a 'natural' response to a health problem (unwanted pregnancy). Several women (n = 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty-four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law. Conclusions Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women of self-medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity. (author's)


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Berer, M.

Why Medical Abortion Is Important for Women
2005, Reproductive Health Matters, N°13, 26, p. 6-10

Mots clés : avortement médical

Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

  2004   
Rapport

Mitchell, E. M. H.; Mwaba, K.; Makoala, M. S.; Trueman, K.

A facility assessment of termination of pregnancy (TOP) services in Limpopo province, South Africa
2004, Ipas

Mots clés : ajustement des données; avortement; contraception d'urgence/ contraception postcoitale; évaluation; Evaluation des services de santé; facteur démographique; femme; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; qualité des soins; rapport de recherche; Recommandations; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : This report offers a comprehensive overview of the current status of healthcare facilities in Limpopo Province, South Africa that offer termination of pregnancy (TOP) services, and those that are designated to offer them but are not yet prepared to do so. We highlight evidence of achievement and commitment to high standards of care, while pinpointing areas for needed improvement in the management and delivery of termination of pregnancy services. This baseline report is intended to generate discussion and perhaps debate about the way forward for enabling reproductive-choice at the local level in Limpopo and similar contexts. The challenges described in this document are significant, but the needs of women and the voices of providers documented herein are compelling reminders of why overcoming these challenges is so important. (excerpt)


Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Rasch, V.; Massawe, S.; McHomvu, Y.; Mkamba, M.; Bergström, S.

A longitudinal study on different models of postabortion care in Tanzania
2004, Acta Obstetricia et Gynecologica Scandinavica, N°83, 6, p. 570-575

Mots clés : avortement; avortement spontané; avortement spontané/fausse couche; complication grossesse; complications postavortement; déterminant fécondité; enquête longitudinale; évaluation; facteur démographique; fécondité; grossesse; maladie; méthodologie; planning familial; planning familial, acceptante; population; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : The objective was to identify women having unsafe abortions and elucidate whether an acceptable follow-up rate among these women can be retrieved. Study population. One thousand three hundred and fifty-seven women attended Temeke Municipal Hospital, Dar es Salaam with an abortion-related diagnosis. Women having unsafe abortions were identified by an empathetic dialogue, offered a contraceptive service and asked to return for follow-up. Three different ways of achieving follow-up information were tested. In phase 1, a combination of hospital-based and home-based interviews was utilized, in phase 2, an additional 1-month control visit was added to the protocol, and in phase 3, the contraceptive counseling and service was provided by technically well-skilled counselors. Seven hundred and eighty-eight women were identified as having had unsafe abortions and 491 women as spontaneous abortions. Women having unsafe abortions were younger, more often single and of higher parity than women having spontaneous abortions. The follow-up rate achieved varied from 47%_72%, being lowest in phase 1 and highest in phase 3. The two most common reasons for loss to follow-up were the interviewer's inability to locate the respondent's house either because of an unspecific or a remote address (58%) and migration (29%). If hospital-based and confidential home-based interviews are used combined and if the women having unsafe abortions are counseled by technically well-skilled counselors, it is possible to achieve a reasonable follow-up rate among women having unsafe abortions. (author's)


Article de périodique

Kissling, F.

Abortion as stigma. More is at stake in the abortion rights backlash than abortion itself
2004, Countdown 2015: Sexual and Reproductive Health and Rights for All, Spec No, p. 88-91

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; discrimination sociale; évaluation; facteur démographique; facteurs économiques; grossesse; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Nations Unies; organisation; planning familial; planning familial, acceptante; politique de population; politique/programme; population; problème social

Résumé : In the effort to make the Cairo consensus a reality, no issue has been more controversial than abortion. Most of the industrialised world and the larger developing countries passed liberal abortion laws by the mid-1970s, around the time when women's rights and autonomy began to be widely recognised. But abortion remains illegal in most African and Latin American countries and some parts of Asia, except in cases of rape or incest or when a woman's life is in jeopardy. Even then, it is often difficult for women to find safe and legal services. New actors in the world of political and social conservatism have recently joined forces with the institutional Catholic Church, bolstering its opposition to all forms of reproductive health. The result has been a shrewd takeover of the terms of debate on abortion and a severe public backlash against it. The threat, however, is not just to the legal right to abortion: every kind of reproductive health service and family planning method is now under siege. In the early 1990s there was growing international consensus that safe and legal abortion was a public health imperative, a human right and a compassionate response to unintended and unsustainable pregnancies. Now, however, we have doubt, hesitation and in some cases, a full-scale retreat. Public courage is at a low ebb and will not resurge without a strong push. (excerpt)


Article de périodique

Asman, O.

Abortion in Islamic countries--legal and religious aspects
2004, Medicine And Law, N°23, 1, p. 73-89

Mots clés : complication grossesse; femme; grossesse; islam; loi; loi et jurisprudence
Pays : Egypte; Koweït; Tunisie

Résumé : The debate over abortion is still controversial as ever. As one of every four people in the world is of the Muslim religion, it is important to learn more about the Islamic point of view toward this dilemma in medical ethics. The first part of this paper gives a general view of the sources of Islamic law and discusses modern developments in Islamic medical ethics regarding abortion. The second part focuses on the legal aspects of abortion in different Islamic states, dealing with the need to supply solutions to women who for different reasons wish to abort and at the same time enact laws that would not contradict Islamic principles. A study of three Muslim states (Egypt, Kuwait and Tunisia) demonstrates three different approaches toward legalizing abortion--a conservative approach, a more lenient approach, and a liberal one--all within Islamic oriented states. This leads to a conclusion that a more liberal attitude regarding abortion is possible in Islamic states, as long as traditional principles are taken into account. [Journal Article, Review, Review, Tutorial; 69 Refs; In English; South Africa]Specialty IndexingSource ID: KIE - 116888KIE Keywords: Genetics and Reproduction; Legal Approach; Religious ApproachGeneral Note: KIE Bib: abortion/foreign countries; abortion/legal aspects; abortion/religious aspects


Article de périodique

Brookman-Amissah, E.; Moyo, J. B.

Abortion law reform in sub-Saharan Africa: no turning back
2004, Reproductive Health Matters, N°12, 24, p. 227-234

Mots clés : avortement; avortement provoqué, mortalité; complication grossesse; femme; grossesse; loi et jurisprudence; mortalité; Sécurité
Pays : Afrique; Kenya

Résumé : Stigma and silence surrounded unsafe abortion in Africa until the International Conference on Population and Development in 1994. Up to five million unsafe abortions are performed in Africa every year, with young women disproportionately affected. This paper summarises the colonial origins of current abortion laws and efforts in the region to provide post-abortion care. Much as it helps to save lives, however, post-abortion care will not eliminate unsafe abortion. There is a need to do away with restrictive laws. The paper describes efforts in several countries to change the law, focusing on Kenya, where organised opposition to reforming the law has emerged and led to the arrest of three service providers. Regional bodies, including the African Union, have taken a stand on abortion within the wider context of safe motherhood and reducing maternal mortality, and advocacy for better abortion laws is increasing across the region. As more girls remain in school and the marriage age increases, the inadequate provision of family planning and abortion care will cause Africa to lose many young women through unsafe sexual activity, unwanted pregnancy, unsafe abortion, early childbearing and HIV infection. The time has come in Africa for a commitment to eliminate deaths and disability from unsafe abortion and respect women's right to decide the number and spacing of their children. [Journal Article; In English; Netherlands]


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Nunes, F.

Abortion: Thinking Clearly About Controversial Public Policy
2004, African Journal of Reproductive Health, N°8, 3, p. 11-26

Mots clés : avortement; équité; loi / législation; politique/programme

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Round Up:Service delivery

Abortions common but illegal in Egypt
2004, Reproductive Health Matters, N°12, 24, p. 218

Mots clés : avortement; comportement reproductif; contraception d'urgence/ contraception postcoitale; coût; déterminant fécondité; Dynamique démographique; facteur démographique; facteur économique; facteurs économiques; fécondité; grossesse; grossesse non prévue/grossesse non désirée; personnel de santé; planning familial; planning familial, acceptante; population; rapport; santé; service de santé; système de santé; taux d'avortement / taux
Pays : Afrique; Egypte

Résumé : Abortion is illegal in Egypt unless the woman's life is in imminent danger. Damage to the fetus is not accepted as a reason for abortion, a legal position emphasised by a recent fatwa that says that ''it is impermissible for the mother to induce abortion [even] if it is proven that the fetus is deformed or suffers from mental retardation.. . It is not a justifiable excuse". Nevertheless, women regularly find ways to end unwanted pregnancies. A 1996 study among 1,300 Egyptian women by the Cairo Demographic Centre found that one-third had attempted to terminate a pregnancy. Other studies suggest that about one-third of abortions are carried out without medical supervision, with women trying traditional remedies or overdoses of aspirin or quinine, at a risk to their own lives. (excerpt)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Rapport

Mitchell, E. M. H.; Trueman, K.; Gabriel, M.; Fine, A.; Manentsa, N.

Accelerating the pace of progress in South Africa: An evaluation of the impact of values clarification workshops on termination of pregnancy access in Limpopo Province
2004, Johannesburg, South Africa, Ipas, p. 44

Mots clés : avortement sans risque; éducation pour la santé
Pays : Afrique du Sud

Résumé : Although legal barriers to safe abortion in South Africa were lifted in 1996 after years of struggle, pervasive misunderstanding of the abortion law persists. Ipas South Africa collaborated with the Women's Health Directorate of the Limpopo Department of Health and Welfare (DoH) to create a provincial strategy for expanding and increasing access to termination of pregnancy (TOP) services for women who need them. Together, Ipas and the Limpopo DoH conducted 22 values clarification (VC) workshops for approximately 645 community members and health-care providers in the province in 2002 and 2003. The workshops were designed to encourage attitudes and behaviours that favour the protection of women's reproductive rights at the community level and greater compliance with the Choice on Termination of Pregnancy (CTOP) Act at the health-facility level. This study employed a retrospective multi-method design to assess the impact of the workshops at the individual, community and facility levels. Qualitative and quantitative assessments of personal transformation were collected from 193 workshop attendees. Knowledge, attitudinal and behavioural indicators of change were measured. To gauge the impact of the workshops on the type and quantity of services offered, site visits were conducted in 20 hospitals and clinics before and after the intervention.


Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Rasch, V.; Massawe, S.; Yambesi, F.; Bergström, S.

Acceptance of contraceptives among women who had an unsafe abortion in Dar es Salaam
2004, Tropical Medicine and International Health, N°9, 3, p. 399-405

Mots clés : avortement; clinique/service de santé; comportement reproductif; comportements; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; counseling; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; méthodologie; planning familial; planning familial, acceptante; population; préservatif/ condom; programme d'activités; programme planification familiale; programme post-abortum; programme post-abortum, coût; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : To assess the need for post-abortion contraception and to determine if women who had an unsafe abortion will use a contraceptive method to avoid repeated unwanted pregnancies and STDs/HIV. Women attending Temeke Municipal Hospital, Dar es Salaam, after an unsafe abortion or an induced abortion performed at the hospital (n = 788) were counselled about contraception and the risk of contracting STDs/HIV. A free ward-based contraceptive service was offered and the women were asked to return for follow-up. Participants (90%) accepted the post-abortion contraceptive service. Of these, 86% stated they were still using contraception 1-6 months after discharge. Initially, 55% of the women accepted to use condoms either alone or as part of double protection. After 1-6 months this proportion had dropped to 18%. Single women were significantly more likely to use condoms. High-quality contraceptive service counselling can induce women to use contraception after having had an unsafe abortion. The results of our study are encouraging and should be used to convince policy makers of the need to implement such services at municipal level to reduce the number of repeated unsafe abortions. (author's)


Article de périodique

Enosolease, M. E.; Offor, E.

Acceptance rate of HIV testing among women seeking induced abortion in Benin City, Nigeria
Taux d'acceptation du test du VIH chez les femmes à la recherché de l'avortement provoqué à Benin City, Nigeria
2004, African Journal of Reproductive Health, N°8, 2, p. 91-100

Mots clés : avortement; comportement sexuel; relation sexuelle
Pays : Nigeria

Résumé : Quoique la campagne contre le VIH ait été intensive, elle a été concentré surtout sur les implications sur la santé publique. Pratiquement très peu d'attention a été consacrée à l'encouragement du public à connaître leur situation sérologique du VIH. Ainsi, le vrai degré du problème de la santé publique causé par cette infection n'est pas connu. Des données précises sur le problème de la santé sont critiques pour la planification nationale en ce qui concerne des mesures préventives et interventionnelles. A l'aide d'un questionnaire semi-structuré et auto-administré, nous avons interviewé 1051 femmes qui recherchaient l'avortement provoqué dans quatre cliniques selectionnées au hazard à Benin City entre janvier et septembre 2002. Les échantillons sanguins de celles qui ont accepté le test du VIH ont été collectés et ont été dépistés au Centre Hospitalier Universitaire de Benin City. Les femmes avaient entre 16 et 46 ans (moyenne 31, 1 ñ 6,7 ans). Cent trente-sept femmes (13%) avaient accepté le test du VIH. Parmi les 1051 femmes, 1001 (95,2%) avaient des partenaires sexuels multiples et 722 (68,8%) avaient systématiquement des rapports sexuels non-protégés. Elles étaient toutes conscientes du VIH/SIDA. Les femmes les plus âgées avaient plus de probabilité d'accepter volontairement le test du VIH que les femmes plus jeunes. Le taux d'acceptation pour le test du VIH était faible à la fois chez les femmes qui travaillent et chez celles qui ne travaillent pas, mais encore plus faible chez les femmes au foyer à plein temps (p = 0,01). Nous recommandons donc que les programmes de campagne contre le VIH comprennent des stratégies qui visent à susciter l'intérêt public dans le test du VIH volontaire.
Quoique la campagne contre le VIH ait été intensive, elle a été concentré surtout sur les implications sur la santé publique. Pratiquement très peu d'attention a été consacrée à l'encouragement du public à connaître leur situation sérologique du VIH. Ainsi, le vrai degré du problème de la santé publique causé par cette infection n'est pas connu. Des données précises sur le problème de la santé sont critiques pour la planification nationale en ce qui concerne des mesures préventives et interventionnelles. A l'aide d'un questionnaire semi-structuré et auto-administré, nous avons interviewé 1051 femmes qui recherchaient l'avortement provoqué dans quatre cliniques selectionnées au hazard à Benin City entre janvier et septembre 2002. Les échantillons sanguins de celles qui ont accepté le test du VIH ont été collectés et ont été dépistés au Centre Hospitalier Universitaire de Benin City. Les femmes avaient entre 16 et 46 ans (moyenne 31, 1 ± 6,7 ans). Cent trente-sept femmes (13%) avaient accepté le test du VIH. Parmi les 1051 femmes, 1001 (95,2%) avaient des partenaires sexuels multiples et 722 (68,8%) avaient systématiquement des rapports sexuels non-protégés. Elles étaient toutes conscientes du VIH/SIDA. Les femmes les plus âgées avaient plus de probabilité d'accepter volontairement le test du VIH que les femmes plus jeunes. Le taux d'acceptation pour le test du VIH était faible à la fois chez les femmes qui travaillent et chez celles qui ne travaillent pas, mais encore plus faible chez les femmes au foyer à plein temps (p = 0,01). Nous recommandons donc que les programmes de campagne contre le VIH comprennent des stratégies qui visent à susciter l'intérêt public dans le test du VIH volontaire


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Congrès

Willems, M.

Adolescence et maternité : l'âge de la maternité et les risques liés à l'accouchement à Ouagadougou (Burkina Faso)
2004, Santé de la Reproduction du Nord au Sud : de la connaissance à l'action : Chaire Quetelet 2004, Louvain-la-Neuve, p. 21

Mots clés : avortement; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; maternité; méthodologie; première naissance
Pays : Burkina Faso

Article de périodique

Croce-Galis, M.

Adolescents in Burkina Faso: sexual and reproductive health
[Adolescents au Burkina Faso : santé sexuelle et reproductive]
2004, Research in Brief., N°3, p. 4

Mots clés : adolescent; âge; avortement; comportement sexuel; comportements; connaissance; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; éducation; éducation sexuelle; facteur démographique; facteurs; infection VIH; jeune/adolescent; maîtrise de la fécondité; maladie; planning familial; planning familial, acceptante; population; programme de santé; rapport de recherche; santé; santé de la reproduction
Pays : Burkina Faso

Résumé : Half of the population in Burkina Faso is under the age of 15. Many of these young people will become sexually experienced in their teens and, thus, will be at risk of or experience an unplanned pregnancy or a sexually transmitted infection (STI), including HIV/AIDS. To minimize these risks and secure a healthy future for adolescents, it is necessary that policymakers, journalists, service providers and advocates have solid evidence regarding the sexual and reproductive health needs of Burkinabè youth. This Research in Brief documents what is known about Burkinabè adolescents' sexual and reproductive health behaviors and needs, with particular emphasis on HIV/AIDS, and points the way forward toward improving policies and programs. (excerpt)


Article de périodique

Ashenafi, M.

Advocacy for legal reform for safe abortion
Plaidoyer pour une réforme de la loi en faveur de l`avortement sans risqué
2004, African Journal of Reproductive Health, N°8, 1, p. 79-84

Mots clés : avortement; avortement provoqué, loi; célibataire; communication; connaissance; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; droit de l'homme; droits reproductifs; excision/ mutilation génitale féminine; facteur culturel; facteur démographique; facteur politique; femme; groupes de femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; nuptialité; plaidoyer; planning familial; planning familial, acceptante; population; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : In Ethiopia, violation of women's reproductive rights is both a cause and a manifestation of women's disempowerment. Obstacles to full realisation of Ethiopian women's reproductive health and rights include the persistence of harmful traditional practices such as female genital mutilation, early marriage and abduction, as well as the disturbing prevalence of rape and HIV/AIDS. Unsafe abortion represents a particularly serious threat to women's health and lives. Ethiopia's status as a signatory to the Convention to Eliminate all Forms of Discrimination Against Women (CEDAW) and its constitutional guarantee of women's equality demand more aggressive action to eradicate such practices and inequities. After years of lobbying by women's organisations, parliamentarians are now reviewing a draft of the 1957 penal code, which includes numerous provisions addressing some of these practices and other conditions that underlie women's poor social and health status. (author's)
En Ethiopie, la violation des droits de reproduction de la femme est une cause et une manifestation du manque du pouvoir de s´assumer. Parmi les obstacles à la pleine réalisation des droits de la santé de reproduction de la femme éthiopienne sont la persistence des pratiques traditionnelles nuisibles telles la mutilation génitale féminine, le mariage précose et l`abduction ainsi que la prédominance inquiétante du viol et du VIH/SIDA. L`avortement à risque représente une menace à la sante´de la femme et à sa vie. Le statut de l`Ethiopie comme signataire à la Convention pour l`Elimination de toutes formes de Discrimination Contre la Femme (CEDCF) et sa garantie constitutionnelle de l`égalité féminine exige une action plus agressive pour éliminer de telles pratiques et injustices. Après des années de sollicitation par des organismes féminins, les parlementaires rédigent le brouillon du code pénal de 1957 qui contient de nombreuses dispositions pour aborder certaines de ces pratiques et d`autres conditions qui sous-tendent l` état social et de santé faible de la femme


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Oye-Adeniran, B. A.; Long, C. M.; Adewole, I. F.

Advocacy for Reform of the Abortion Law in Nigeria
2004, Reproductive Health Matters, N°12, 24, Supplement 1, p. 209-217

Mots clés : avortement; loi et jurisprudence; Sécurité
Pays : Nigeria

Résumé : Safe abortion services are only legal in Nigeria to save the life of the woman. Widespread incidence of unsafe induced abortions often results in death or irreparable harm to women. The Campaign Against Unwanted Pregnancy (CAUP) was launched on 17 August 1991 to address this public health crisis through advocacy for reform of the abortion law, research, education and preparation of service providers, and development of a constituency to support provision of safe abortion to the full extent of the law. CAUP commissioned an evaluation in 2004 to examine and analyse the work of the campaign during its 14 years of existence, which included a review of documents, a participatory learning workshop with CAUP, and almost 50 interviews with different stakeholders. This article, adapted from the evaluation report, tells how CAUP took a taboo topic and, in the midst of an extremely complex political and cultural environment, made it a legitimate subject for public discussion and debate. The Campaign undertook groundbreaking research on abortion in Nigeria. Service providers are being trained to provide, to the full extent of the law, safe abortions and post-abortion care, and advocacy efforts are continuing to lay the groundwork for improving the abortion law.
Les services d'avortement medicalise ne sont autorises au Nigeria que pour sauver la vie de la femme. Les nombreuses interruptions de grossesse a risque se terminent souvent par la mort de la femme ou des sequelles permanentes. La Campagne contre les grossesses non desirees (CAUP) a ete lancee le 17 aout 1991 pour regler cette crise de sante publique par le plaidoyer pour la reforme de la loi sur l'avortement, la recherche, la formation des prestataires de services, et la creation de groupes de soutien des avortements surs conformes a la loi. En 2004, la CAUP a commandite une evaluation pour analyser son travail pendant ses 14 ans d'existence, avec un examen de documents, un atelier d'apprentissage actif et pres de 50 entretiens avec differents acteurs. Cet article, adapte du rapport d'evaluation, montre comment la CAUP a aborde un sujet tabou et en a fait un theme legitime de debat public, dans un environnement politique et culturel extremement complexe. La CAUP a entrepris des recherches pionnieres au Nigeria. Les prestataires de services sont formes pour pratiquer, en conformite avec la loi, des avortements surs et des soins post-avortement, et les activites de plaidoyer se poursuivent pour preparer une amelioration de la loi sur l'avortement.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Shah, I. H.; Ahman, E.

Age patterns of unsafe abortion in developing country regions
2004, Reproductive Health Matters, N°12, 24, p. 9-17

Mots clés : adolescent; adulte/âge; adultère; âge; avortement; complication grossesse; grossesse; grossesse adolescente; grossesse adolescente/grossesse; Sécurité

Résumé : Globally, 19 million women are estimated to undergo unsafe abortions each year. Age patterns of unsafe abortion are critical for tailoring effective interventions to prevent unsafe abortion and for providing post-abortion care. This paper estimates the incidence and the rate of unsafe abortion among women aged 15-44 in the Africa, Asia (excluding Eastern Asia), and Latin America/Caribbean regions, where a woman is likely to have close to one unsafe abortion by age 44. For developing regions as a whole, two-thirds of unsafe abortions occur among women aged 15-30 and 14% among women under age 20. The age pattern of unsafe abortions differs markedly between regions, however. Almost 60% of unsafe abortions in Africa are among women under age 25 and almost 80% are among women under 30. In Asia 30% of unsafe abortions are in women under 25 and 60% in women under 30. In Latin America and the Caribbean, women aged 20-29 account for more than half of unsafe abortions with almost 70% in women under 30. Over 40% of unsafe abortions among adolescents in the developing world occur in Africa, where one in four unsafe abortions takes place during adolescence. Young (under age 25) women in Africa, those over age 25 in Asia and women aged 20-35 years in Latin America and the Caribbean are in the greatest need of interventions to prevent unsafe abortion and good quality post-abortion care. [Journal Article; In English; Netherlands]


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Ngwena, C.

An appraisal of abortion laws in southern Africa from a reproductive health rights perspective
2004, Journal of Law, Medicine Ethics, N°32, 4, p. 708-717

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; éthique; facteur démographique; grossesse; législation; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; population; rapport de recherche; santé; santé de la reproduction; santé publique
Pays : Afrique; Afrique subsaharienne

Résumé : Reproductive rights are, of course, broader than access to safe, legal abortion services. Nonetheless, access to safe abortion services is an inextricable element of effective realization of reproductive health, not least on account of the maternal mortality and morbidity that is linked to unsafe illegal abortion. An estimated 200,000 unsafe abortions take place each year in southern Africa. If southern africans countries are genuinely committed to the protection and promotion of women's rights, then they must make good their obligations in dismantling archaic and anachronistic laws. Despite an abundance of the rhetoric of commitment to the realization of equality and reproductive rights for women, the majority of SADC countries have been slow, if not averse, to liberalizing abortion law. Instead, they have held on to their colonial bequest of unduly restrictive and inaccessible abortion regimes at the cost of oppressing women, and jettisoning the goal of achieving gender equality. It is important to note that merely liberalizing abortion law should not be an end in itself. As Zambian reforms demonstrate, decriminalization does not, by itself, secure equitable access to safe abortion. South African reforms have shown that, where there is a commitment of ressources to ensure an enabling public health sector infratructure, unsafe aboriton will fast become a malady of the past. Adequate material ressources, and trained and willing health personel are critical to access to safe abortion. Legal reform of restrictive abortion laws is essential, but paper rights are not enough.

Site web : http://www.aslme.org/pub/jlme/index.php?volume=715 volume_go=Go

Article de périodique

Gallo, M. F.; Gebreselassie, H.; Victorino, M. T. A.; Dgedge, M.; Jamisse, L.; Bique, C.

An assessment of abortion services in public health facilities in Mozambique: women's and providers' perspectives
2004, Reproductive Health Matters, N°12, 24, Supplement 1, p. 218-226

Mots clés : adolescent; adulte/âge; adultère; complication grossesse; femme; grossesse; santé publique
Pays : Mozambique

Résumé : Complications of unsafe abortion contribute to high maternal mortality and morbidity in Mozambique. In 2002, the Ministry of Health conducted an assessment of abortion services in the public health sector to inform efforts to make abortion safer. This paper reports on interviews with 461 women receiving treatment for abortion-related complications in 37 public hospitals and four health centres in the ten provinces of Mozambique. One head of both uterine evacuation and contraceptive services at each facility was also interviewed, and 128 providers were interviewed on abortion training and attitudes. Women reported lengthy waiting times from arrival to treatment, far longer than heads of uterine evacuation services reported. Similarly, fewer women reported being offered pain medication than head staff members thought was usual. Less than half the women said they received follow-up care information, and only 27% of women wanting to avoid pregnancy said they had received a contraceptive method. Clinical procedures such as universal precautions to prevent infection were less than adequate, in-service training was less than comprehensive in most cases, and few facilities reviewed major complications or deaths. Use of dilatation and curettage was far more common than medical or aspiration abortion methods. Current efforts by the Ministry to improve abortion care services have focused on training of providers in all these matters and integration of contraceptive provision into post-abortion care.
Les complications des avortements a risque contribuent au taux eleve de mortalite et morbidite maternelles au Mozambique. En 2002, le Ministere de la sante a evalue les services d'avortement dans le secteur public. Il a interroge 461 femmes traitees pour des complications de l'avortement dans 37 hopitaux publics et 4 centres de sante dans les 10 provinces du Mozambique, ainsi que le chef des services d'evacuation uterine et de contraception de chaque centre ; 128 prestataires ont egalement ete interroges sur la formation et les attitudes a l'egard de l'avortement. Les femmes ont declare avoir attendu longtemps avant d'etre traitees, plus longtemps que ne l'ont indique les chefs des services d'evacuation uterine. De meme, le nombre de femmes disant qu'on leur avait propose des antalgiques etait inferieur a la proportion jugee habituelle par les chefs de service. Moins de la moitie des femmes ont signale avoir recu des informations sur les soins post-avortement, et seulement 27% des femmes voulant eviter une grossesse ont declare avoir recu une methode contraceptive. Les procedures cliniques telles que les precautions d'hygiene etaient inadequates, la formation en cours d'emploi etait loin d'etre complete, et peu de centres examinaient les raisons des complications majeures ou des deces. L'emploi de la dilatation et du curetage etait beaucoup plus frequent que les methodes d'avortement medicamenteux ou par aspiration. Les efforts du Ministere pour ameliorer les services d'avortement se sont centres sur la formation des praticiens dans tous ces domaines et l'integration de la contraception dans les soins apres avortement.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Sepou, A.; Ngbale, R.; Yanza, M. C.; Domande Modanga, Z.; Nguembi, E.

Analyse des avortements à la maternité de l'hôpital communautaire de Bangui
2004, Médecine Tropicale, N°64, p. 61-65

Résumé : L'avortement est l'interruption précoce de la grossesse qui pose peu de problèmes s'il est spontané alors que l'ACP est souvent suivi de complications plus ou moins graves. Les cas de plus en plus nombreux d'avortements dans le service nous a amené à entreprendre cette étude pour : évaluer la fréquence des ACP dans le service ; déterminer les caractéristiques démographiques des femmes qui pratiquent les ACP et identifier les complications. Malades et méthodes : Nous avons mené une étude transversale sur une période d'un an dans le service. N'ont été recrutés que les avortements en cours ou les avortements incomplets. Les aménorrhées non gravidiques et les grosses-ses extra-utérines étaient exclues du travail. Les données cliniques et sociales étaient collectées à partir des fiches conçues pour la circonstance par l'équipe de recherche. L'analyse des données a permis d'obtenir les résultats suivants. Résultats : Pour 5292 hospitalisations en gynécologie, nous avons enregistré 719 avortements (13,6 %), parmi lesquels 43,4 % d'ACP. L'âge moyen des patientes était de 24,7 ans avec des extrêmes de 13 et 39 ans. L'avortement spontané était plus fréquent chez les femmes mariées alors que chez les élèves/étudiantes c'était plutôt l'ACP. Les grossesses désirées étaient plus signalées par les femmes mariées contrairement aux célibataires qui posaient le problème de grossesses non désirées. L'ACP était plus pratiqué par les élèves et étudiantes. Les raisons évoquées pour la pratique des ACP étaient surtout d'ordre économique (61,5 %). Les méthodes utilisées pour ces ACP étaient dominées par les associations médicamenteuses (39,1 %), suivies des méthodes mécaniques (26,0 %). Parmi les complications observées, les infections sévères et le décès n'ont concerné que les femmes ayant pratiqué les ACP. Conclusion : La fréquence des ACP dans le service est inquiétante, d'autant que les femmes concernées sont des jeunes et que les complications sont graves. Des actions visant la vulgarisation des méthodes contraceptives en milieu scolaire et universitaire seront menées pour éviter les grossesses non désirées qui poussent souvent ces jeunes aux ACP.


Rapport

Organisation Mondiale de la Santé (OMS)

Avortement médicalisé : Directives techniques et stratégiques à l'intention des systèmes de santé
2004, Genève, OMS, p. 106

Mots clés : avortement provoqué; médecine traditionnelle/ méthodes; méthode d'avortement; méthode d'avortement,; méthodes; normes; Organisation et Administration

Résumé : On estime à 46 millions chaque année le nombre de grossesses interrompues volontairement, dont 19 millions dans des conditions estimées dangereuses.
Environ 13 % des décès liés à la grossesse ont été attribués à des complications d'un avortement pratiqué dans de mauvaises conditions, ce qui représente probablement à peu près 68 000 décès par an.
Dans les pays en développement, le risque de décès par suite des complications liées à un avortement pratiqué dans de mauvaises conditions est plusieurs centaines de fois supérieur au risque lié à un avortement pratiqué par des professionnels dans de bonnes conditions. Les complications faisant suite à un avortement pratiqué dans de mauvaises conditions entraînent de graves séquelles pour la santé des femmes, telles que l'infécondité.Chapitre 1Résumén
Comme aucune méthode contraceptive n'est sûre à 100 %, il y aura toujours des grossesses non désirées que les femmes chercheront à interrompre.
Dans presque tous les pays, la loi autorise l'avortement pour sauver la vie de la mère et, dans la plupart, elle l'autorise pour préserver la santé physique et mentale de la femme.
Les services d'avortement médicalisé prévus par la loi doivent donc être fournis par des personnels de santé qualifiés, appuyés par des politiques, des règlements et une infrastructure des systèmes de santé, y compris le matériel et les fournitures, de façon que les femmes aient un accès rapide à ces services.


Rapport

Rakgoasi, D.; Campbell, E.

Botswana adolescent sexual practice and health
2004, Study Report No. 54, Dakar, Senegal, Union for African Population Studies, Small Grants Programme,, p. 68

Mots clés : abstinence/contraception; activité sexuelle / sexualité; adolescent; âge; attitude; avortement; coït/sexualité; comportement à risque; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; revue littérature; santé; sexualité
Pays : Afrique; Afrique subsaharienne; Botswana

Résumé : The issue of adolescent sexuality and its consequences is not new in Botswana. For a number of years, there has been considerable concern about high levels of teenage pregnancy and their effects on the individual and society. The emergence and rapid spread of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among the country's population has resulted in massive campaigns to sensitise people about the seriousness of sexually transmitted diseases and information on how to minimise the risk of infection. Prior to the discovery of the first AIDS case in Botswana in 1987, genital herpes simplex was probably the most serious sexually transmitted disease (STD) that sexually active people in the country were exposed to. Still, for a country with less than one million people aged 10 years and over in 1991 (Botswana, 1994a), there is an alarming occurrence of STD cases. The number of outpatients with STDs increased from 126,370 in 1987 to 164,242 in 1990 (an average annual growth rate of 9.1%); and the most common diseases are gonorrhoea and syphilis (Botswana, 1994b). The subsequent decline to 135,343 STD cases in 1993 (Botswana, 1995) may be partly explained by a remarkable rise in condom use due to AIDS awareness campaign throughout the country. With an increase in the number of AIDS cases from 2 in 1987 to 1149 in 1993, AIDS moved from being the eighth to the fourth cause of inpatient deaths between 1991 and 1993 (Botswana, 1995). While improved medical technology has ensured that other STDs (beside genital herpes) can be treated, AIDS still remains fatal and untreatable. Notwithstanding the social and economic implications of adolescent sexual practices, there has been no investigation into the attitude-behaviour interrelationship of the subject. Much of the statements on this issue are speculative. Realizing that exposure to STDs (including HIV and AIDS) is determined by attitudes toward and practice of sex, the proposed study is designed to throw light on the underlying factors in adolescents. This study began in 2 July, 1997. Primary data for the study was obtained from randomized sample survey in Gaborone (Botswana's capital city) and four villages. The information from this survey is strengthened through in-depth interviews of adolescents in Gaborone and a sample village. It is anticipated that this report will be of interest to academics as well as planners and policy makers. It should also be of service to NGOs in Botswana. (excerpt)


Article de périodique

Hord, C.; Wolf, M.

Breaking the cycle of unsafe abortion in Africa
2004, African Journal of Reproductive Health, N°8, 1, p. 29-36

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; comportement reproductif; contraception d'urgence/ contraception postcoitale; déterminant fécondité; droit de l'homme; droits reproductifs; Dynamique démographique; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; politique/programme; population; programme de santé; santé; santé de la reproduction; santé maternelle
Pays : Afrique

Résumé : Globally, nearly half of all maternal deaths from unsafe abortion occur in Africa. Abortion-related deaths and injuries are especially tragic, because when properly performed, abortion is one of the safest of all medical procedures. Factors contributing to this neglected public health crisis include inadequate health care resources and infrastructure, restrictive laws and policies, stigma, and women's lack of empowerment. Actions needed include making high quality abortion care more available and accessible, especially at the primary care level and to the full extent permitted by law. Others include removing medically unnecessary policy and legal restrictions on abortion; and better informing health care professionals, women and communities about the impact of unsafe abortion and the circumstances under which abortion can be legally obtained. (author's)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Okonofua, F. E.

Breaking the silence on prevention of unsafe abortion in Africa
2004, African Journal of Reproductive Health, N°8, 1, p. 7-10

Mots clés : avortement provoqué, mortalité; complication grossesse; congrès; femme; grossesse; mortalité; Sécurité
Pays : Afrique

Résumé : It is estimated that nearly 70,000 women die annually from the complications of unsafe abortion around the world. Over 69,000 of these deaths occur in developing countries while 23,000 occur in sub-Saharan African countries alone, representing an estimated 680 deaths per 100,000 abortion procedures in Africa...


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Oye-Adeniran, B. A.; Adewole, I. F.; Umoh, A. V.; Fapohunda, O. R.; Iwere, N.

Characteristics of Abortion Care Seekers in South-Western Nigeria
2004, African Journal of Reproductive Health, N°8, 3, p. 81-91

Mots clés : avortement; grossesse non prévue; jeunes; prévalence contraceptive
Pays : Nigeria

Résumé : This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic.
Caractéristiques des chercheuses des soins de l'avortement au sud-ouest du Nigéria.Cette étude prospective centrée sur l'hôpital a été menée pour comprendre les caractéristiques des chercheuses des soins post avortement au sud-ouest du Nigéria. Les renseignements ont été recueillis à l'aide d'un questionnaire de la part de 1876 femmes, à la recherche de l'avortement auprès des hôpitaux, les résultats montrent que la majorité (60%) avaient entre 15 et 24 ans dont les adolescentes ayant entre 1519 constituaient 32,7%. La majorité (63,2%) constituaient une proportion importante (30,2%) des chercheuses de l'avortement. Les étudiantes constituaient le seul groupe le plus nombreux, alors que l'activité économique la plus fréquemment avancées pour l'interruption de grossesse étaient le statut estudiantin et ne voulant pas avoir des enfants alors qu'elles n'étaient pas encore mariées. La plupart (35,5%) des femmes ont fait la connaissance des dispensateurs de soins grâce à leurs amis. La prévalence contraceptive moyenne chez les chercheuses des soins de l'avortement était de 27,4%. Il est évident, d'après ces résultats que les jeunes gens, surtout les adolescentes en scolarisation, devraient être les cibles de l'éducation sexuelle compréhensive surtout étant donné la pandémie actuelle qu'est le VIH/SIDA.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Wolf, M.

Communique from the "Action to Reduce Maternal Mortality in Africa" regional consultation on unsafe abortion. March 5-7, 2003, Addis Ababa, Ethiopia
2004, African Journal of Reproductive Health, N°8, 1, p. 99-104

Mots clés : avortement provoqué, mortalité; complication grossesse; grossesse; morbidité et mortalité maternelle; mortalité; mortalité maternelle

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Round up: Service delivery

Community-based involvement improves abortion care in rural South Africa
2004, Reproductive Health Matters, N°12, 24, p. 218

Mots clés : avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; évaluation; facteur démographique; grossesse; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; population; Programme d'évaluation; qualité des soins; rapport; santé; santé publique; service de santé; service de santé communautaire/offre/service de santé; zone rurale
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Since 1994 the Choice on Termination of Pregnancy Act has given South African women the legal right to terminate their pregnancies without requiring permission from medical professionals, husbands or others. However, quality abortion care is still mainly available in urban settings and used by those who can afford to pay privately. The fragmented and overburdened health-care system, combined with patriarchal and conservative values, a lack of medical sophistication among women and the physical distance between home and the nearest approved centre, means that the reality for rural women has barely changed. In Limpopo region a series of workshops has helped to mobilise the community to improve this situation. A range of religious and traditional leaders, hospital managers, health care workers, municipal councillors, mayors, teachers and staff from community-based organisations were brought together to examine access issues. (excerpt)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Oye-Adeniran, B. A.; Adewole, I. F.; Umoh, A. V.; Ekanem, E. E.; Gbadegesin, A.; Iwere, N.

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria
2004, African Journal of Reproductive Health, N°8, 3, p. 103-115

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; grossesse non prévue

Résumé : Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion.
Enquête à base communautaire sur la grossesse non-désirée au sud-ouest du Nigéria. La grossesse non-désirée et par conséquence l'avortement à risque, demeure un des problèmes majeurs de la santé de reproduction qu'on devrait aborder. Malheureusement, il y a une pauvreté de renseignement à l'égard de ce problème au niveau de la communauté. Cette étude a donc examiné la prévalence de la grossesse non-désirée dans la communauté ainsi que les facteurs qui y sont associés, y compris des points de vue, des perceptions et attitudes des membres de la communauté envers la grossesse non-désirée et les traits comportementaux du nécessitaux sur la grossesse non-désirée. Nous avons recueilli des renseignements auprès des 3,743 femmes dans des communautés rurales et urbaines dans deux Etats nigérians que sont Lagos et Edo. A un certain moment de leur vie, 26% des répondants avaient eu des grossesse non-désirées alors que la prévalence de l'avortement était de 21,7%. De courts intervales de maissance (21,1%), de coût considérable de l'éducation des enfants (20,1%) l'interruption de la scolarité (20,1%) et le fait d'être célibataire (17,3%) étaient les raisons les plus communes données pour ne pas vouloir des grossesses. La plupart des répondantes (91,3%) étaient conscientes d'une forme ou d'une autre du contraceptif, mais le taux d'usage n'était que de 36,6% alors que le taux d'usage courant était de 23,4%. Et l'avortement et l'usage du contraceptif ont été liés de manière significative aux niveau croissants de scolarisation. La grossesse non-désirée constitue un problème même au niveau de la communauté et il faut davantage de recherche pour comprendre la disparité persistente entre la connaissaince du contraceptif et l'usage, puisque l'usage accru réduira la grossesse non-désirée et l'avortement provoqué.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Nyende, L.; Towobola, O. A.; Mabina, M. H.

Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death
2004, East African Medical Journal, N°81, 4, p. 179-182

Mots clés : avortement; avortement provoqué, mortalité; biologie; Clients; contraception d'urgence/ contraception postcoitale; décès fotal; Dynamique démographique; effets secondaires; essais clinique; facteur démographique; méthodologie; Misoprostol/méthode/cytotec; mortalité; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme d'activités; prostaglandins/hormones; rapport de recherche; traitement/soin
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Objective: To compare the efficacy of vaginal and oral misoprostol for the induction of labour in women with intra-uterine foetal death (IUFD). Design: A prospective randomised clinical trial, comparing 200µg oral and 200µg vaginal misoprostol, six hourly for a minimum of four doses for the induction of labour in women with IUFD. Setting: Ga-Rankuwa hospital (Department of Obstetrics and Gynaecology), Pretoria, South Africa. It is a tertiary institution serving predominantly black indigenous population. Main outcome measures: The primary outcome measure was the induction to delivery time, and secondary outcome measures were the number of patients requiring augmentation with oxytocin and all complications were noted. Results: Twenty women were randomised to the vaginal route and 18 to the oral route. The induction to delivery time was shorter with vaginal misoprostol (13.5 +/- 8.3 hrs) compared to oral misoprostol (21.4 +/- 13.9 hrs; p< 0.05). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. More women (10/18) who received oral misoprostol required oxytocin augmentation to complete the induction of labour compared with 4/20 women in the vaginal group (p<0.05; Odds Ratio 2.8; 95% CI 1.36 - 4.24). There were no cases of failed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misoprostol (44.5%) compared to vaginal misoprostol (20%). This difference gives an overall Odds Ratio of 2.2 at 95% CI of 1.6-2.8(p<0.05). Conclusion: Vaginal misoprostol achieved successful induction of labour in women with IUFD in a shorter time than oral misoprostol with significantly less side effects. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Ali, M. M.; Cleland, J. G.; Shah, I. H.

Condom use within marriage : a neglected HIV intervention
2004, Bulletin of the World Health Organization, N°82, 3, p. 180-186

Mots clés : avortement; avortement provoqué; célibataire; grossesse non prévue/grossesse non désirée; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie

Résumé : Objective To assess the contraceptive effectiveness of condoms versus oral contraceptive pills and estimate the reproductive consequences of a major shift from pill to condom use. Methods Secondary analysis was performed on nationally representative cross-sectional surveys of women in 16 developing countries. Findings In the 16 countries, the median per cent of married couples currently using condoms was 2%, compared with 13% for the pill. Condom users reported a higher 12-month failure and higher method-related discontinuation rates than pill users (9% and 44% vs 6% and 30%, respectively). condom users were more likely to report subsequent abortion following failure (21% vs 14%), and also more likely to switch rapidly to another method (76% vs 58%). The reproductive consequences, in terms of abortion and unwanted births, of a hypothetical reversal of the relative prevalence of condom and pill were estimated to be minor. The main reason for this unexpected result is that the majority of abortions and unwanted births arise from non-use of any contraceptive method.
Conclusion A massive shift from the more effective oral contraceptive pills to the less effective condom would not jeopardize policy goals of reducing abortions and unwanted births. However, such a shift would potentially have an added benefit of preventing human immunodeficiency virus (HIV) infections, especially in countries with generalized HIV epidemics.
L'utilisation du préservatif chez les couples mariés : une intervention anti-VIH reléguée à l'arrière plan Objectif Evaluer l'efficacité contraceptive du préservatif par rapport à la pilule et déterminer les conséquences qu'aurait sur le plan génésique l'abandon généralisé de la pilule au profit du préservatif. Méthodes On a procédé à l'analyse secondaire d'enquêtes transversales nationalement représentatives faites parmi des femmes de 16 pays en développement. Résultats Dans les 16 pays, le pourcentage médian de couples mariés qui utilisent le préservatif était de 2 %, contre 13 % pour la pilule. Les couples utilisant le préservatif ont signalé un taux d'échec plus élevé sur 12 mois et un taux d'arrêt de la méthode plus élevé que ceux qui utilisaient la pilule (9 % et 44 % contre 6 % et 30 %, respectivement). Chez les couples qui utilisaient le préservatif, la probabilité d'un avortement après un échec
contraceptif était plus forte (21 % contre 14 %), de même que la probabilité du passage rapide à une autre méthode (76 % contre 58 %). Dans l'hypothèse d'un inversement de la prévalence relative du préservatif et de la pilule, les conséquences sur le plan génésique, qu'il s'agisse d'avortements ou de grossesses non désirées, ont été jugées mineures. Ce résultat inattendu s'explique essentiellement par le fait que la majorité des avortements et des
grossesses non désirées résulte de la non-utilisation d'une méthode contraceptive, quelle qu'elle soit.
Conclusion L'abandon généralisé de la pilule contraceptive, très efficace, au profit du préservatif, qui l'est moins, ne compromettrait pas les buts fixés en matière de réduction des avortements et des grossesses non désirées. Cependant, une telle évolution pourrait avoir pour avantage supplémentaire de prévenir les cas d'infection par le virus de l'immunodéficience humaine (VIH), particulièrement dans les pays où l'infection à VIH a pris des proportions épidémiques.

Site web : http://whqlibdoc.who.int/bulletin/2004/Vol82-No3/bulletin_2004_82(3)_180-186.pdf

Article de périodique

Hewett, P. C.; Mensch, B. S.; Erulkar, A. S.

Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods
2004, Sex Transm Infect, N°80, 2, p. 43-48

Mots clés : activité sexuelle / sexualité; adolescent; coït/sexualité; collecte; enquête; enquête CAP; enquête fécondité; enquête méthodologique; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; entretien / enquête; méthodologie; sexualité
Pays : Kenya

Résumé : OBJECTIVES: To investigate in a district in Kenya the level and consistency of reporting of sexual behaviour among adolescent girls randomly assigned to two modes of survey interview: face to face interview and audio computer assisted self-interview (ACASI). METHODS: The analysis is based on a subsample of over 700 never married girls aged 15-21 years in Kisumu, Kenya, drawn from a population based survey of over 2100 respondents. A questionnaire with 69 questions was used, two thirds of which were considered sensitive, including questions about risky sexual behaviour, alcohol and drug use, contraceptive practice, pregnancy, induced abortions, and births. RESULTS: ACASI produced significantly higher reporting of sex with a relative, stranger, or older man, and higher reporting of coerced sex. However, differences by mode for ever had sex and sex with a boyfriend were not significant. Relative to ACASI, the interviewer administered mode produced highly consistent reporting of sexual activity, both within the main interview and between the main and exit interviews. CONCLUSIONS: Both the mode of survey administration and the probing for various behaviours significantly affect the observed prevalence of sexual activity. The ACASI results suggest that adolescent girls in Kenya have more complex and perilous sex lives than traditional face to face surveys of sexual activity indicate. The level of consistency in the interviewer mode is argued to be suspect, particularly given the much lower levels of reporting, relative to ACASI, for types of sexual partners and coerced sexual activity

Site web : http://sti.bmjjournals.com/cgi/reprint/80/suppl_2/ii43

Congrès

Calvès, A. E.

Décision d'avorter et déterminants des avortements clandestins chez les jeunes de Yaoundé
2004, Chaire Quetelet : Santé de la Reproduction au Nord et au Sud. De la connaissance à l'action., Louvain la Neuve, Belgique, p. 18

Mots clés : avortement provoqué
Pays : Cameroun

Résumé : Au Cameroun, comme dans la plupart des pays africains, les avortements provoqués sont interdits par la loi et sont généralement effectués clandestinement, souvent dans des conditions sanitaires douteuses. Les complications pour la santé qui résultent de ces avortements clandestins sont nombreuses et peuvent mener à des infirmités permanentes, à la stérilité, ou même à la mort . Les progrès récents dans la scolarisation des filles, la tendance à se marier plus tard et l'incidence élevée de l'activité sexuelle chez les célibataires, jumelés à une faible utilisation de la contraception, ont augmenté le nombre de grossesses non désirées et d'avortements chez les jeunes, particulièrement en milieu urbain . À l'aide de données biographiques recueillies auprès de femmes et d'hommes âgés de 20 à 30 ans à Yaoundé, la capitale du Cameroun, cette recherche se penche sur les déterminants
du recours à l'avortement provoqué et le processus de prise de décision en matière d'avortement dans ce groupe d'âge.


Article de périodique

Lithur, N. O.

Destigmatising abortion: expanding community awareness of abortion as a reproductive health issue in Ghana
Déstigmatisation de l`avortement
2004, African Journal of Reproductive Health, N°8, 1, p. 70-73

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; discrimination sociale; droit de l'homme; droits reproductifs; facteur culturel; facteur démographique; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; population; problème social; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performance of abortion in three circumstances, the Ghana reproductive health service policy did not have any induced legal abortion services component to cover the three exceptions until it was revised in 2003. The policy only had 'unsafe and post-abortion' care components, and abortions performed in health facilities operated by the Ghana Health Service were performed under this component. Though the policy has been revised, women and girls who need abortion services in Ghana more often resort to the backstreet dangerous methods and procedures. Criminalisation of abortion and those who perform abortions has contributed to unsafe abortion, the second leading cause of maternal deaths in Ghana. Most of these are performed outside the formal health service structures. Traditionally, abortion is perceived as a shameful act and the community may shun and give a woman who has caused an abortion derogatory names. Would provision of legal abortion services be culturally acceptable within a Ghanaian community? Yes, if they are made aware of the reproductive health benefits of providing safe abortion services. Three major strategies that would help to destigmatise abortion in the community are (1) the liberal interpretation of the three exceptions to the law on abortion; (2) expanding community awareness of its reproductive health benefits; and (3) improving and increasing access to legal abortion services within the formal health facilities. (author's)
Accroissement de la conscience communautaire de l`avortement comme un probléme de la santé de reproduction au Ghana. La stigmatisation de l`avortement au Ghana a été rendu facile par la tradition et les valeurs culturelles, les perceptions sociales, les enseignements religieux et la criminalisation. L`avortement est illégal au Ghana sauf en trios cas. Bien que la loi permet l`avortement en trios cas, la politique du Service de la Santé de Reproduction du Ghana, n`avait aucun service de l`avortement légal provoqué pour couvrir les trios exceptions avant sa revision en l`an 2003. La politique n`avait que des coustituants du soin pour `l' avortement à risque et le post-avortement' et tous les avortements pratiqués dans les institutions de santé gérées par le Service de Santé du Ghana ont été réalises sous ce constituant. Bien que la politique soit revisée, les femmes et les filles qui ont besoin des services d`avortement au Ghana ont recours, le plus souvent, aux procédures et aux méthodes clandestines dangereuses. La criminalisation de l`avortement et ceux qui se font avorter ont contribué à l`avortement à risque, la deuxiéme cause principale des décés maternels au Ghana. La plupart d`entre eux ont lieu en dehors des structures de service de santé formelles. Traditionnellement, l`avortement est perçu comme un acte honteux et la femme qui se fait avorter risque d` être évitée et dénigrée par la communauté. Est.ce que l`assurance des services d`avortemet légal sera culturellement acceptable au sein d`une communauté ghanéenne? Oui, si l'on la sensibilise aux avantages des services d`avortement. Trois stratégies principales qui aideront à déstigmatiser l`avortement dans la communauté sont (1)l`interprétation libérale des trois exceptions à la loi sur l`avortement (2) l`extension de la conscience de la communauté sur les avantages de la santé de reproduction; et (3) l`amélioration et l`augmentation de l`accès aux services d`avortement légal dans le cadre des institutions formelles de santé.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Thonneau, P. F.; Matsuda, T.; Goyaux, N.; Djanhan, Y.; Yace-Soumah, F.; Welffens-Ekra, C.

Determinants of maternal deaths in induced abortion complications in Ivory Coast
2004, Contraception, N°70, 4, p. 319-326

Mots clés : avortement; avortement provoqué, mortalité; Cause de décès; complications postavortement; contraception d'urgence/ contraception postcoitale; culture; curetage; curetage/méthode; déterminant culturel; Dynamique démographique; facteur culturel; facteur démographique; facteurs économiques; grossesse; intervention chirurgicale; intervention chirurgicale/méthode; maladie; médecine; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé; traitement/soin
Pays : Afrique; Afrique subsaharienne; Côte d'Ivoire

Résumé : Persistently high levels of maternal mortality have been reported in Abidjan, the capital of Ivory Coast, with a high prevalence of deaths related to complications of induced abortion. In order to assess the determinants of maternal deaths in induced-abortion complications, this study investigated women admitted to the gynecological departments of four reference hospitals throughout Ivory Coast. Information concerning abortion events was collected by means of a questionnaire during a confidential, face-to-face interview. Medical records were used to collect clinical data and final vital status. In our series, 60% of women declared that they induced abortion themselves at their home; a large majority mentioned "insertion of objects into the vagina" or "ingestion of traditional plants" for this purpose. On the other hand, 40% declared that abortion had been performed by a health worker, mostly at a health facility and by using surgical methods (dilatation and curettage). Less-educated women were more likely to have chosen to induce abortion themselves at home, and more-educated women had undergone abortion through a health professional. Our findings highlight the role of both women and health professionals in responsibility for induced abortion complications. (author's)
Des niveaux systématiquement élevés de mortalité maternelle ont été enregistrés à Abidjan, la capitale de la Côte d'Ivoire, avec une forte prévalence des décès causés par des complications lors d'avortements provoqués. Afin d'évaluer les déterminants des décès maternels par suite de complications lors d'avortements provoqués, cette étude s'est penchée sur des femmes admises aux départements de gynécologie de quatre grands hôpitaux à travers le pays. Les informations relatives aux avortements ont été recueillies par le biais d'un questionnaire, au cours d'un entretien confidentiel en tête-à-tête. Les dossiers médicaux ont été consultés pour obtenir des données cliniques et sur le statut vital des sujets. Dans notre série, 60 % des femmes ont déclaré avoir provoqué l'avortement elles-mêmes à leur domicile ; une grande majorité d'entre elles ont parlé d'" insertion d'objets dans le vagin " ou d'" ingestion de plantes médicinales " pour y arriver. Par contre, 40 % ont déclaré s'être faites avortées par un agent de santé, généralement dans un établissement sanitaire et à l'aide de méthodes chirurgicales (dilatation et curetage). Les femmes moins instruites étaient plus enclines à choisir de provoquer l'avortement elles-mêmes à leur domicile, tandis que les femmes plus instruites s'étaient adressées à des professionnels de la santé. Nos conclusions soulignent la part de responsabilité qu'ont à la fois les femmes et le personnel de santé dans les complications liées aux avortements provoqués. (de l'auteur)

Site web : http://www.contraceptionjournal.org/

Article de périodique

Singh, S.; Audam, S.; Wulf, D.

Early childbearing in Nigeria: a continuing challenge
2004, Research in Brief, N°2

Mots clés : adolescent; âge; aspects socio-économiques; avortement; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; éducation sexuelle; enquête; enquête démographique et de santé/EDS; facteur démographique; facteurs économiques; facteurs socio-économiques; fécondité; jeune/adolescent; planning familial; planning familial, acceptante; population; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; Statut socio-économique; système de santé; taux de fécondité; taux natalité
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Between 1980 and 2003, the birthrate among Nigerian women aged 15-19 decreased by 27% (from 173 to 126 births per 1,000 women this age). Nonetheless, 46% of women nationally and about 70% of those in some regions still give birth before their 20th birthday. Nigerian women who start having children while they are still adolescents face severe social and health disadvantages, including curtailed educational opportunities, which reduce women's social and economic status long term, elevated rates of perinatal death, and maternal complications and death. This report provides a profile of the current childbearing experience of adolescent women in Nigeria, explores the factors associated with widely varying levels of teenage childbearing across the country and identifies the continuing reproductive health needs of young Nigerian women. The report provides data for the nation as a whole, as well as for the country's major regions, to help inform decision-making at both the national and regional levels. It does not attempt to synthesize the substantial body of in-depth research on issues related to adolescent childbearing in Nigeria, which consists largely of small-scale studies that do not permit national generalizations or regional comparisons. (excerpt)


Article de périodique

Roberts, C.; Moodley, J.; Esterhuizen, T.

Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa
2004, Journal of Obstetrics and Gynaecology, N°24, 4, p. 441-445

Mots clés : attitude; avortement; comportements; connaissance; contraception; contraception d'urgence; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; Dynamique démographique; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; étudiant; étudiant/scolarisation; facteur démographique; famille; méthodologie; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; traitement/soin; université
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : The aim of this study was to assess the knowledge, use and attitude to the use of emergency contraception among tertiary students in Durban, South Africa through the use of a self-administered confidential questionnaire. A scoring system was developed to analyse the response of each student. A total of 436 students (56.5%) had heard of emergency contraception. Few knew the specific methods of emergency contraception and only 11.8% knew the correct time limit in which it must be used. Only 60 students (7.8%) knew how effective emergency contraception was in preventing pregnancy. Ninety-one students (11.8%) had used emergency contraception and 50% responded that if they had to, they would use it or recommend it to a friend. A logistic regression model showed that the predictors for a high knowledge score were: University of Natal students, having heard of emergency contraception, having used it before and having received formal sex education. Overall, knowledge and use of emergency contraception by tertiary students is limited. There is a need for carefully designed education programmes and promotion of emergency contraception on campuses. (author's)


Article de périodique

Berhane, Y.; Abdela, A.

Emergency obstetric performance with emphasis on operative delivery outcome: does it reflect the quality of care?
2004, Ethiopian Journal of Health Development, N°18, 2, p. 96-106

Mots clés : avortement provoqué, mortalité; biologie; Cause de décès; complication grossesse; décès fotal; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; Evaluation des services de santé; facteur démographique; facteurs de risque; grossesse; intervention chirurgicale; intervention chirurgicale/méthode; issue grossesse; maladie; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Organisation et Administration; population; programme; Programme d'évaluation; qualité des soins; rapport de recherche; reproduction; santé; service de santé; service de santé communautaire/offre/service de santé; service d'urgence; système de santé; traitement/soin
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : In Ethiopia, in the previous studies, the rates of perinatal and maternal mortality were reported as one of the highest in the world. Objective: The purpose of the study was to analyze the rates of variables-specific perinatal deaths, maternal and perinatal case fatality rates and to determine common indications of operative deliveries with their out come indicators. A retrospective one-year medical record review of major emergency obstetric performance was conducted in Tikur Anbessa specialized hospital. During the study period, 3897 women with pregnancy related problems were admitted and managed as an emergency cases: 92% with gestational age of 28 weeks above, 5.8% abortion, 2.0% ectopic pregnancy and 0.2% gestational trophoblastic disease. The 3583 women gave birth to 3672 babies, of which, 337 were perinatal deaths, making the gross perinatal and early neonatal mortality rates 91.8 and 26.1/1000 births each, respectively. The three leading causes of perinatal mortality were malpresentation (13.1%), uterine rupture (12.5%) and obstructed labor (11.9%), with obstructed labor and eclampsia the highest case-fatality rates (86.9-100% and 72.7%, respectively). The maternal mortality ratio was 1107.5/100,000 live births and the top three-implicated causes were postabortal complications (28.9%), eclampsia (21.1%) and ruptured uterus (15.8%). Operative (abdominal or vaginal) deliveries were performed for 43.1% babies. Fetal distress was the commonest indication for operative deliveries (32.5%) as well as the commonest cause of low Apgar scores at the 1st minute (61.4%). Three-fourths of the total perinatal deaths were stillbirths, 94.2% referred. About half (48.9%) of the total causes of perinatal deaths were mechanical factors, predominantly obstructed labor that could have been totally averted if the system of basic obstetric care was properly established. Preventable obstetric complications such as abortion, eclampsia and uterine rupture are still the foremost causes of maternal deaths. (author's)


Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Rapport

Schenck-Yglesias, C.

Evaluation of postabortion care service delivery in Malawi
2004, JHP-25, Baltimore, Maryland, JHPIEGO, p. 10

Mots clés : demande; demande d'avortement; évaluation; méthodologie; politique/programme; programme de santé; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Malawi

Résumé : A postabortion care (PAC) needs assessment undertaken in 2000 by the Malawi Ministry of Health and Population Reproductive Health Unit, JHPIEGO, and EngenderHealth showed that systemic improvements were needed to improve comprehensive PAC services for women throughout the country. Previous study data had already shown that nearly a third of maternal deaths were due to complications of abortion, and the needs assessment confirmed deficiencies in the level of care available at the time for these patients at Malawi hospitals. In 2001, the Ministry of Health and Population (MOHP) in Malawi and JHPIEGO, through the United States Agency for International Development (USAID) Training in Reproductive Health (TRH) award, began to implement a project to introduce comprehensive PAC services on a broad scale to Malawi. The program components included: (1) advocacy and policy development, (2) PAC training, (3) provision of materials and equipment, (4) organization of services, (5) expansion of PAC services, and (6) supervision, in order to increase the availability, quality, and use of comprehensive PAC services throughout Malawi. This report presents the methodology and results of a process evaluation conducted by the MOHP RHU, JHPIEGO, and EngenderHealth in October 2002 to assess progress in achieving Malawi's National PAC program goals at the initial 14 implementation hospitals. This evaluation was anticipated at the outset of the program and was considered part of the MOHP's ongoing monitoring and quality assurance efforts. (excerpt)


Article de périodique

Hajri, S.; Blum, J.; Gueddana, N.; Saadi, H.; Maazoun, L.

Expanding medical abortion in Tunisia: women's experiences from a multi-site expansion study
2004, Contraception, N°70, p. 487-491

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; facteur démographique; facteurs économiques; grossesse; hormones; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; RU 486; santé; santé publique; Sécurité; traitement/soin
Pays : Afrique; Tunisie

Résumé : From November 2000 to July 2001, 321 consenting women were enrolled at four sites across the country in an effort to demonstrate that mifepristone medical abortion could safely be used by providers throughout Tunisia. Women who met the study's inclusion criteria were given 200 mg oral mifepristone and offered the choice of taking 400 µg oral misoprostol 2 days later either at home or at the clinic. At follow-up, women were examined to determine completed abortion status and surveyed to gauge their satisfaction with the method. Ninety-six percent of women had a successful abortion using this method. Women expressed a strong preference for home use of misoprostol, indicating that it is more confidential (34%), easier (28%) and requires fewer clinic visits (28%). The high rate of success, demonstrated safety and acceptability of the method in new facilities and with new providers suggests that medical abortion can be safely expanded to new settings with reasonable levels of training and supervision. (author's)
De novembre 2000 à juillet 2001, 321 femmes réparties dans quatre sites différents ont accepté de contribuer à démontrer que l'avortement médical au mifepristone pouvait être utilisé en toute sécurité par des fournisseurs partout en Tunisie. Des femmes remplissant les critères d'inclusion de l'étude ont reçu 200 mg de mifepristone et avaient la possibilité de décider de prendre 400 µg de misoprostol oral deux jours plus tard soit chez elles soit à la clinique. Dans le cadre du suivi, on a examiné les femmes en vue de déterminer si elles avaient subi un avortement complet et on a procédé à une enquête sur leur degré de satisfaction. Quatre-vingt seize pour cent des femmes ont eu un avortement réussi en utilisant cette méthode. Les femmes ont exprimé une forte préférence pour la prise du traitement à la maison, en indiquant que c'était plus confidentiel, (34%), plus facile (28%) et qu'elle demandait moins de visites à la clinique (28%). Ce taux élevé de réussite a montré la sécurité et l'acceptabilité de la méthode dans des structures nouvelles et avec de nouveaux fournisseurs et laisse penser qu'il est possible d'étendre l'avortement médical à des milieux nouveaux en toute sécurité et avec des niveaux raisonnables de formation et d'encadrement. (de l'auteur)

Site web : http://www.contraceptionjournal.org/

Article de périodique

Morroni, C.; Myer, L.; Cooper, D.

Failed contraception? letter
2004, South African Medical Journal, N°94, 8, p. 600

Mots clés : analyse démographique; avortement; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; échec de contraception; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; facteurs économiques; méthodologie; planning familial; planning familial, acceptante; population
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : We read with interest the article by Van Bogaert regarding contraceptive use among women seeking termination of pregnancy (TOP). Given the high burden of unwanted pregnancy in South Africa this research is of great importance. However we take issue with the specific methodological approach and subsequent inferences that may be drawn regarding contraceptive effectiveness. Specifically, the use of non-pregnant women attending gynaecological outpatient services as a control group, without statistical adjustment for underlying differences that may confound this comparison, is problematic. Despite the author's assertion that the 'demography was comparable' in the two groups, the data presented in Tables I and II show that the controls are substantially older and have greater parity compared with women seeking TOP. For example, almost 40% of controls were over 30 years of age, compared with approximately 20% of women seeking TOP. While statistical methods could be used to adjust for these differences, no such methods were employed in the study, and only unadjusted associations are reported. (excerpt)

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Chapitre d'ouvrage

Feyisetan, B. J.; Bankole, A.

Fertility transition in Nigeria: trends and prospects
2004 - in United Nations;Department of Economic and Social Affairs;Population Division, Expert Group Meeting on Completing the Fertility Transition, New York, p. 506-528

Mots clés : âge; avortement provoqué, mortalité; célibataire; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; infection VIH; maladie; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; mortalité; nuptialité; planning familial; planning familial, acceptante; population; sida; Syndrome d'immunodéficience acquise/sida; taux d'avortement / taux; transition de la fécondité; transition démographique
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : This paper has three major objectives. The first is to demonstrate that a sustained fertility transition has begun in Nigeria. The second is to identify some factors that might have contributed to the decline and the third objective is to argue in favor of further declines in fertility and propose a level of fertility by the time the fertility transition is completed. None of the objectives is easy to achieve considering the dearth of comparable nationally representative data. (excerpt)

Site web : http://www.un.org/esa/population/publications/completingfertility/RevisedBANKOLEpaper.PDF

Article de périodique

Anonymous

Field report. Lessons from introducing postabortion care in Egypt
2004, Population Briefs, N°10, 3, p. [4]

Mots clés : avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; éducation; évaluation; facteurs économiques; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); organisation; personnel de santé; planning familial; planning familial, acceptante; Programme de formation; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; USAID
Pays : Afrique; Egypte

Résumé : Complications from unsafe or incomplete abortion include hemorrhage, severe infection, and shock. These conditions can arise with either induced or spontaneous abortion, also known as miscarriage, and can kill a woman if not treated promptly. Population Council research has shown that women who experience complications from miscarriage or unsafe abortion are among the most neglected of all reproductive health care patients. In the early 1990s, Population Council staff in Egypt began discussions with government representatives about a program of work to improve postabortion care in that country. This initiative eventually developed from research investigations to program implementation. "Lessons learned in this endeavor offer insights into working with sensitive topics like abortion and female genital cutting," says Nahla Abdel-Tawab, Population Council public health researcher in Cairo. (excerpt)

Site web : http://www.popcouncil.org/publications/popbriefs/pb10(3)_5.html

Reproduced with the permission of Population Council : http://www.popcouncil.org/280084

Générique

Guillaume, A.

Fréquence et conditions du recours à l'avortement
2004, Santé de la reproduction au temps du Sida en Afrique; Les Collections du CEPED - Rencontres (FR), Nogent-sur Marne (FR), CEPED, p. 73-94

Mots clés : avortement; législation; morbidité et mortalité maternelle; mortalité maternelle
Pays : Afrique

Reproduced with the permission of Ceped : http://ceped.cirad.fr

Article de périodique

Berer, M.

HIV/AIDS, sexual and reproductive health: intersections and implications for national programmes
2004, Health Policy and Planning, N°19, Sup. 1, p. I62-I70

Mots clés : maîtrise de la fécondité; planning familial; planning familial, acceptante; préservatif/ condom; prévention; transmission mère enfant
Pays : Tanzanie

Résumé : HIV and AIDS have a myriad of effects on sexual and reproductive health and rights, and sexual and reproductive health services are critical for women and men with HIV and AIDS. Yet there has been a dearth of visible, in-depth mainstream attention to the links between sexual and reproductive health and prevention and treatment of HIV/AIDS since the early 1990s among major stakeholders internationally. This paper argues that access to essential sexual and reproductive health care should be provided in HIV/AIDS prevention, care and treatment programmes, and appropriate forms of prevention and treatment of HIV/AIDS should be included in all sexual and reproductive health services as a public health priority, particularly in sex education, family planning and abortion services, pregnancy-related care, sexually transmitted infection (STI) services and services addressing sexual violence. The paper analyzes existing barriers to linking and integrating these services, e.g. at country level due to the traditional training of health workers to implement vertical programmes, separate sources of funding for National AIDS Control Programmes and sexual and reproductive health services, and in international donor programme and UN agency structures. This paper calls for leadership to be exercised by donors, all the UN agencies working together, governments, health service managers and providers, NGOs and advocates in both fields to develop and implement these linkages at country level. Finally, it is crucial that UNAIDS, WHO, UNFPA, UNICEF, the Global Fund to Fight AIDS, TB and Malaria and those working to reach the targets set by the Millennium Development Goals come on board in these efforts.

Site web : http://www.oxfordjournals.org/heapol/about.html

Rapport

Fetters, T.; Akiode, A.; Oji, E.

How far is too far? Searching for postabortion care in Kano State hospitals
2004, NY, Ipas, p. 15

Mots clés : morbidité et mortalité maternelle; mortalité maternelle; soin post-abortum; soin post-avortement; soins post avortement
Pays : Nigeria

Résumé : Unintended pregnancy and unsafe abortion continue to be significant problems in Nigeria. The maternal mortality ratio, estimated at 1,129 per 100,000 live births by the World Health Organization (WHO), is among the world's highest. Despite national efforts to reduce maternal mortality, including a Safe Motherhood Initiative, an estimated 50,000 women die yearly from causes related to pregnancy and childbirth, primarily sepsis, prolonged or obstructed labor, hypertensive diseases of pregnancy, hemorrhage, or complications of unsafe abortion. Many more suffer the stigma or pain of severe reproductive morbidity. In order to develop a clearer understanding of abortion care in Northern Nigeria, the research being done has this following specific objectives:
- Increase understanding concerning the community-level dynamics of emergency - obstetric care and unsafe abortion - Strengthen efforts to prevent unwanted pregnancy with a focus on youth. - Mobilize community members and groups to play a role in preventing unsafe - abortion and improving emergency obstetric care. - Increase awareness of and access to safe, affordable emergency obstetric care - services. - Contribute to public education efforts surrounding national legal reform. - Document and evaluate the impact of intervention

Site web : http://www.ipas.org/publications/en/FARKANO_E04_en.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Kinoti, S. N.; Gaffikin, L.; Benson, J.

How research can affect policy and programme advovacy: example from a three-country study on abortion complications in sub-Saharan Africa
2004, East African Medical Journal, N°81, p. 63-70

Mots clés : Accessibilité; avortement; complications postavortement; coûts; prévalence; programme de santé; service planification familiale
Pays : Malawi; Ouganda; Zambie
Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Odunsi, S. B.

Human Rights, Maternal Deaths, and Dehumanization: Another Look at Nigeria's Abortion Laws
2004, Gender and Behaviour, N°2, p. 200-214

Mots clés : avortement; droit de l'homme; loi / législation
Pays : Nigeria

Résumé : Abortion is a phenomenon that cannot be wished away. Its apparent inevitability has necessitated various jurisdictions adorning it with cloaks of regulated legitimacy. Nigeria, however, maintains a highly conservative rigidity on the issue, leading to rather unfortunate consequences - Human Rights desecration inclusive. This paper aims to appraise Nigeria's legal position on abortion. With comparative analysis of the legal positions in other jurisdictions and relevant human rights provisions, critique and recommendation for reforms of Nigeria's stance will be proffered.

Site web : http://www.ajol.info/journal_index.php?jid=244 ab=aim

Article de périodique

Fasubaa, O. B.; Ojo, O. D.

Impact of post-abortion counselling in a semi-urban town of Western Nigeria
2004, Journal of Obstetrics and Gynaecology, N°24, 3, p. 298-303

Mots clés : avortement; clinique/service de santé; comportement sexuel; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; counseling; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; maîtrise de la fécondité; méthodologie; planning familial; planning familial, acceptante; population; programme d'activités; programme post-abortum; programme post-abortum, coût; rapport de recherche; ville/résidence; zone urbaine
Pays : Afrique; Nigeria

Résumé : This study is designed to evaluate the impact of post-abortion counseling in bringing about changes in sexual behaviour among patients who had treatment for an induced abortion and/or its complication in the department of gynecology and obstetrics of Wesley Guild Hospital Ilesa and Folasola Specialist Hospital between January 1999 and December 2001. A structured questionnaire designed to evaluate the impact of counseling was administered to 108 patients, who formed part of 238 patients who had undergone induced abortion and who benefited from the behaviourial contract counseling technique. The results showed that the percentage of women using contraception increased from 30 (27.8%) to 53 (49.1%) at the time of interview. The number of subjects with multiple sexual partners fell from about 62 (58%) to 12 (11%). About 24 (45%) found access to contraception difficult. Major factors influencing contraceptive usage and change in behaviour include suffering experienced at the time of termination 26 (49%) and knowledge of contraception 19 (36%). The study advocates post-abortion counseling as a tool to increasing contraceptive usage in women and influencing behaviourial changes positively towards health promotives measures. (author's)


Article de périodique

Mosoko, J. J.; Delvaux, T.; Glynn, J. R.; Zekeng, L.; Macauley, I.

Induced abortion among women attending antenatal clinics in Yaounde, Cameroon
2004, East African Medical Journal, N°81, 2, p. 71-77

Mots clés : avortement; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; facteur démographique; grossesse; planning familial; planning familial, acceptante; population; population urbaine; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; soin prénatal; système de santé; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Cameroun

Résumé : Unsafe abortion is a public health concern because of its impact on maternal morbidity and mortality. The objective of this study was to document on induced abortion in Yaounde, Cameroon. Design: Cross-sectional study. Setting: Six antenatal clinics in Yaounde, Cameroon. Women attending antenatal clinics between October and December 1998 were included in the study and interviewed. Nulliparous were women with no previous delivery and muitiparous were defined as women who had at least one previous delivery. Out of the 1532 women, five hundred seventy-two were nulliparous and 960 were multiparous. Of the nulliparous women 17% reported a previous abortion ever; this proportion exceeded 35% in those over 24 years. For muitiparous women, the proportion who reported an abortion (between the last birth and present pregnancy) was 22%. In multivariate analysis on the group of nulliparous women, older age, having used modern contraception and having spent more than two years in the city were significantly associated with induced abortion. In the multiparous group, older age, having a full time job and antenatal clinic were significantly associated with induced abortion. This study shows that induced abortion is a common practice in urban Cameroon. Because of restrictive laws, a substantial proportion of these abortions are likely to be unsafe, with the risk of associated complications. There is a need for expanded comprehensive sexual and reproductive health services. (author's)
L'avortement à risque est un problème de santé publique du fait de son impact sur la morbidité maternelle et la mortalité. Cette étude a eu pour dessein de documenter la situation des avortements provoqués à Yaoundé, au Cameroun. Concept : Étude transversale. Contexte : six services de consultation prénatale à Yaoundé, Cameroun. Les femmes fréquentant des services de consultation prénatale entre les mois d'octobre et décembre 1998 ont été intégrées à cette étude et interrogées. Les femmes sans antécédent d'accouchement ont été définies comme étant des femmes nullipares et celles ayant déjà eu au moins un accouchement ont été définies comme étant des femmes multipares. Sur les 1 532 femmes concernées, cinq cent soixante-douze d'entre elles étaient des femmes nullipares et 960 des femmes multipares. Parmi les femmes nullipares, 17 % d'entre elles ont indiqué n'avoir jamais vécu précédemment d'avortement ; cette proportion a dépassé les 35 % chez celles âgée de plus de 24 ans. Parmi les femmes multipares, la proportion de celles ayant déjà vécu un avortement a été de 20 %(entre la dernière naissance et la grossesse en cours). L'analyse à variables multiples portant sur le groupe de femmes nullipares, d'âge plus avancé, a révélé une corrélation entre les avortements provoqués et le fait d'avoir eu recours à des méthodes contraceptives modernes et d'avoir vécu plus de deux années en ville. Chez le groupe des femmes multipares, d'âge plus avancé, l'analyse a démontré une corrélation entre les avortements provoqués et le fait de travailler à plein temps et de fréquenter des services de consultation prénatale. Cette étude révèle que les avortements provoqués sont une pratique courante dans les zones urbaines du Cameroun. Du fait de l'existence de lois restrictives, ces avortements sont dans une large proportion susceptibles d'être dangereux, et comportent un risque de complications associées. Il y a un besoin réel de développer des services complets orientés sur la santé reproductive et sexuelle. (de l'auteur)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Sai, F.

International commitments and guidance on unsafe abortion
2004, African Journal of Reproductive Health, N°8, 1, p. 15-28

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; déterminant fécondité; droit de l'homme; droits reproductifs; Dynamique démographique; facteur démographique; fécondité; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; santé; santé de la reproduction
Pays : Afrique

Résumé : Most of Africa's 54 countries have restrictive abortion laws, outdated remnants of former colonial laws that result in nearly five million unsafe abortions annually. To stem maternal mortality and morbidity, it is essential to look beyond strictly medical or health system approaches to solving this critical public health problem. The issue must be approached from a human rights perspective that emphasises the individual's right to self-determination. This article examines ways in which advocates can use established human rights standards, international consensus documents, and the World Health Organization's new technical and policy guidance for health systems to press for safer abortion care for African women. (author's)
Engagements internationaux et conseils sur l`avortement à risqué. La plupart des 54 pays de l`Afrique ont des lois restrictives sur l`avortement, des vestiges périmés des anciennes lois coloniales qui occasionnent presque cinq millions avortements à risque chaque année. Pour enrayer la mortalité et la morbidité maternelles, il est essentiel de dépasser le niveau des approches basées purement sur le systéme médical ou de santé pour résoudre ce problème critique de santé pubique. ll faut aborder le problème de la perspective de droits de l`homme qui met l'accent sur les droits de l'individu à l'auto-detérmination. Cet article étudie les façons dont les défenseurs peuvent se servir des normes établies des droits de l`homme, des documents de consensus international et le nouveau guide de la politique et la technique de l`Organisation mondiale de la santé pour lutter en faveur de l`avortement moins à risque pour la femme africaine. (Rev Afr Santé Reprod 2004; 8[1]:15-28)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Bolton, P.

Introduction of post-abortion care in a conservative context: the case of Niger
[Introduction des soins post-avortement dans un contexte conservateur : le cas du Niger]
2004, Global HealthLink, 125, p. 10-11, 16

Mots clés : avortement provoqué, religion; chrétien/religion; communication; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur politique; facteurs économiques; islam; méthodologie; personnel de santé; plaidoyer; politique/programme; programme de santé; projet pilote; religion; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Niger

Résumé : Niger, vast and dry, is a very poor country even by comparison to its West African neighbors. It is ranked next-to-last in the U.N. Development Index, above only war-torn Sierra Leone. On average, girls marry by 15 years of age, and give birth before their 18th birthdays, At 7.5 births per woman, total fertility rates are among the world's highest, yet less than one in five births is attended by skilled personnel. Over her lifetime, a Nigérien woman faces a one in 10 threat of dying from maternal causes - even higher than the one in 16 risk for sub-Saharan Africa overall. Culturally, Niger is a deeply traditional, pronatalist society with strong religious values. It has among the most restrictive abortion laws in the world (only to save the woman's life), and there is very low social tolerance for abortion. Discussions around abortion-related questions tend to be uncomfortable and contentious. Yet hospital personnel treat many women with complications of induced abortion. (excerpt)
Immense et sec, le Niger est un pays très pauvre même par rapport à ses voisins ouest africains. Il se classe à l'avant-dernier rang dans les Indicateurs du Développement de l'ONU, précédent seulement la Sierra Leone, pays en proie à la guerre. En moyenne, les filles se marient à quinze ans et sont mère avant leur dix-huitième anniversaire. Avec 7,5 naissances par femme, les taux de fertilité totale sont parmi les plus élevés du monde; cependant moins d'une naissance sur cinq se fait en présence d'une personne qualifiée. Au cours de sa vie, une femme nigérienne doit faire face à un risque de un sur dix d'être un cas de mortalité maternelle - même supérieur au risque de un sur seize pour l'Afrique sub-saharienne en général. Culturellement, la société nigérienne est profondément traditionnelle et pro-nataliste, avec de fortes valeurs religieuses. Ses lois sur l'avortement sont parmi les plus restrictives au monde (seulement pour sauver la vie à la femme), il y a un très bas niveau de tolérance pour l'avortement. Les discussions sur les questions en rapport avec l'avortement ont tendance à être désagréables et houleuses. Cependant, le personnel hospitalier traite beaucoup de femmes présentant des complications dues à un avortement volontaire. (extrait)


Ouvrage

Bolton, P.; Burton, N.; Diallo, I.; Diallo, R.; Dieng, T.

Issues in postabortion care: scaling-up services in Francophone Africa,
2004, Washington, D.C.,, Academy for Educational Development [AED], Support for Analysis and Research in Africa [SARA],, p. 78

Mots clés : avortement provoqué, loi; clinique/service de santé; communication; contraception d'urgence/ contraception postcoitale; counseling; droit de l'homme; droits reproductifs; facteur démographique; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Organisation et Administration; plaidoyer; planning familial; planning familial, acceptante; politique/programme; population; programme; programme d'activités; programme de santé; santé; santé de la reproduction; santé maternelle; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique

Résumé : This report summarizes core issues in taking PAC (postabortion care) services to scale in Francophone Africa. It serves to complement the report from the international PAC workshop held in Mombasa, Kenya, in May 2000; as such this report focuses on discrete issues, though some overlap is necessary. Participants gathered to learn from each other and generate practical actions plans to expand PAC in their countries. Beyond the conference, the regional committee and resource persons pledged their continued support to reduce the performance gaps that still exist among both providers and health systems for optimal delivery of quality PAC services. To help maintain the momentum, the conference organizers and members of the Francophone PAC Initiative Committee urge the United Nations Population Fund (UNFPA), USAID, WHO and other institutions to help intensify the call to action. (excerpt)


Rapport

Mimche, H.; Bios Nelem, C.; Wogaing, J.

L'avortement au Cameroun. L'état des savoirs
2004, Yaoundé, Association de lutte contre les violences faires aux femmes (ALVF),Centre pour la santé de la reproduction des adolescents et des femmes (CESRAF),, p. 43

Mots clés : avortement; complications postavortement; coûts; législation; médecine traditionnelle/ méthodes; méthode d'avortement; méthode d'avortement,; méthodes; raisons

Matériel audiovisuel

Guillaume, A.; Molmy, W. c.

L'avortement en Afrique. Une revue de la littérature des annés 1990 à nos jours / Abortion in Africa. A review of litterature from the 1990's to the present day
2004, Les Numériques du CEPED, Paris, CEPED

Mots clés : adolescent; avortement; avortement provoqué, coût; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; coût; déterminant fécondité; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; fécondité; législation; mesure; méthodologie; niveau; raisons
Pays : Afrique

Résumé : Cette publication consiste en une revue de la littérature sur la question de l'avortement en Afrique. Elle comprend une base de données bibliographiques contenant environ 600 références, interrogeables à partir de mots-clés, ainsi qu'une synthèse thématique organisée autour de 6 chapitres qui analysent : les conditions du droit à l'avortement - difficultés méthodologiques des études sur l'avortement - l'analyse du profil sociologique des femmes qui recourent à l'avortement, en particulier la pratique chez les adolescentes, et les motifs de ce recours à l'avortement- les méthodes d'avortement - les conséquences sanitaires, économiques et sociales de l'avortement et les relations entre avortement et contraception). (Résumé d'auteur)
This publication is a review of literature on the subject of abortion in Africa. It includes a bibliographic database containing around 600 references, which may be accessed via key words, as well as a thematic summary divided into six chapters. Il analysed : - the laws - methodology and measurement - sociological profil of women who abort , the adolescents, the reasons for abortion - abortion method - sanitary (morbidity, mortality), economic and social consequencies - abortion and contraception

Site web : http://ceped.cirad.fr/avortement/switch.html

Reproduced with the permission of Ceped : http://ceped.cirad.fr

Congrès

Gbetoglo, D.

L'avortement provoqué chez les jeunes à Lomé : conditions de recours et motifs
2004, Chaire Quetelet : Santé de la Reproduction au Nord et au Sud. De la connaissance à l'action., Louvain la Neuve, Belgique, p. 22

Mots clés : adolescent; avortement incomplet/complication; avortement provoqué; avortement provoqué, complication; complication; contraction utérine/complication; illégalité; méthode d'avortement, effets secondaires
Pays : Togo

Résumé : Au Togo, les données chiffrées sur l'avortement provoqué sont rares et ne permettent pas d'obtenir une mesure de l'importance du phénomène qui est pourtant lourd de conséquences. L'étude exploitée dans le cadre de cet article est la première d'envergure à s'intéresser spécialement au phénomène. Cette étude - auprès d'un échantillon aléatoire et représentatif de 4755 femmes âgées de 15 à 49 ans - a été réalisée à Lomé en 2002 dans un contexte où
l'on a observé une baisse drastique de la fécondité sans constater une augmentation conséquente de la pratique contraceptive ni une influence sensible des autres déterminants de la fécondité ; ce qui a " jeté de graves soupçons " sur l'avortement provoqué. Malgré l'illégalité du phénomène d'avortement provoqué au Togo, une proportion non négligeable d'adolescentes et de jeunes âgés de 15 à 24 ans y a recours à Lomé. Le niveau du phénomène est relativement élevé dans ce groupe de femmes où parmi celles qui ont été enceintes au moins une fois, les 2/5 (39%) ont eu un avortement provoqué. Parmi les jeunes de 15-24 ans ayant déjà recouru au moins une fois à l'avortement provoqué, la majorité (80%) a expérimenté la pratique une fois seulement alors que 16% l'ont faite deux fois. Un peu plus de la moitié des avortements provoqués chez ces jeunes (53,4%) a été réalisée soit par des tradithérapeutes, soit à domicile avec des produits et des breuvages préparés par l'enquêtée, le partenaire auteur de la grossesse ou des amies. Par ailleurs, la majorité des avortements pratiqués par un personnel de santé a été réalisé dans un centre de soins moderne (95,6%). A la suite de leur avortement provoqué, environ les 2/3 des jeunes (66%) ont eu des complications d'ordre sanitaire. Les hémorragies, les maux de reins et les infections constituent les principaux problèmes de santé auxquels sont confrontées les jeunes de Lomé ayant réalisé des avortements provoqués. Les causes du recours à l'avortement sont plurielles, allant des raisons de convenance personnelle aux raisons économiques en passant par des raisons socio-culturelles et de planification familiale. Des raisons comme le viol, la poursuite de la scolarité et le fait de ne pas être mariée au moment de la grossesse sont associées positivement au recours à l'avortement provoqué. Ainsi, le risque qu'une grossesse soit terminée par un avortement est multiplié par 6 si la grossesse est arrivée quand la fille était encore élève. Il convient alors d'accorder une attention particulière à la sexualité des jeunes en vue de réduire ou mieux d'éviter les risques liés à la grossesse non souhaitée ou précoce.

Site web : http://www.demo.ucl.ac.be/cq04/textes/Gbetoglo.pdf

Congrès

Guillaume, A.

L'avortement provoqué en Afrique : un problème mal connu, lourd de conséquences
2004, Santé de la Reproduction du Nord au Sud : de la connaissance à l'action : Chaire Quetelet 2004, Louvain-la-Neuve, p. 19

Mots clés : adolescent; avortement; avortement provoqué, coût; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; coût; déterminant fécondité; fécondité; législation; mesure; niveau; raisons
Pays : Afrique

Article de périodique

Mayi-Tsonga, S.; Pither, S.; Meye, J. F.; Ndombi, I.; Nkili, M. T.; Ogowet, N.

L'hysterectomie obstetricale d'urgence. A propos de 58 cas au Centre hospitalier de Libreville.
[Emergency obstetrical hysterectomy: about 58 cases at Libreville Hospital Centre]
2004, Sante, N°14, 2, p. 89-92

Mots clés : avortement; complications postavortement; décès fotal; hôpital; hôpital publique; hôpital universitaire; morbidité et mortalité maternelle; mortalité maternelle; soin d'urgence
Pays : Gabon

Résumé : OBJECTIVE: To evaluate the incidence, indications and prognosis of this surgery in our daily practice in order to suggest preventive action. PATIENTS AND METHOD: This is a retrospective study over a period of 10 years, from January 1, 1992 to December 31, 2001. Using patient's documents, parameters have been analysed as followed: age, parity, antecedent of uterine surgery, indications, surgery technique, foeto-maternal prognosis. RESULTS: The frequency of this intervention is 0.07%. The average age of patients was 31 years and the average parity was 6. The indications were: 44 cases of haemorrage (76%) and 14 cases of post-abortum infection (24%). Sub-total hysterectomy was performed on all the patients. We have observed 14 cases of maternal death (24%) and 24 cases of foetal death (57%). CONCLUSION: The frequency of this surgery is weak in our daily practice, compared with other Black African countries. But foeto-maternal prognosis is severe. A better sensibilisation of the population on prenatal consultations benefits and the setting up of a real national strategy of obstetrical emergency care constitute a means to prevent this type of surgery.


Congrès

Bakass, A.; Fazouane, A.

La pratique de l'avortement au Maroc
2004, Chaire Quetelet : Santé de la Reproduction au Nord et au Sud. De la connaissance à l'action, Louvain la Neuve, Belgique

Mots clés : avortement; estimation
Pays : Maroc

Article de périodique

Hyams, A.

Legalizing abortion does not reduce serious medical consequences
2004, Tropical Doctor, N°34, 1, p. 62

Mots clés : avortement; complication grossesse; effets secondaires; femme; grossesse; morbidité et mortalité maternelle; mortalité maternelle
Pays : Nigeria
Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Population Council

Lessons from introducing postabortion care in Egypt
2004, Population Briefs, N°10, 3, p. 2

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires; soin post-abortum; soin post-avortement; soins post avortement
Pays : Egypte

Résumé : Complications from unsafe or incomplete abortion include hemorrhage, severe infection, and shock. These conditions can arise with either induced or spontaneous abortion and can kill a woman if not treated promptly. Research has shown that women who experience complications from miscarriage or unsafe abortion are among the most neglected of all reproductive health care patients. In the early 1990s, Council staff in Egypt began discussions with government representatives about a program of work to improve post abortion care in that country. This initiative eventually developed from research investigations to program implementation, offering insights into working with sensitive topics like abortion and female genital cutting.

Site web : http://www.popcouncil.org/publications/popbriefs/pb10(3)_5.html

Reproduced with the permission of Population Council : http://www.popcouncil.org/

Rapport

Otsea, K.

Lives worth saving: abortion care in sub-Saharan Africa since ICPD. A progress report
2004, p. 42

Mots clés : aspects socio-économiques; avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; facteurs économiques; facteurs socio-économiques; genre; grossesse; morbidité et mortalité maternelle; mortalité; mortalité maternelle; organisation; planning familial; planning familial, acceptante; population; santé; santé de la reproduction; santé publique; Sécurité; Statut de la femme
Pays : Afrique

Résumé : In every part of the world, in every era of history, women from all walks of life have obtained abortions to end unintended pregnancies. Despite the history and universality of women's need for safe abortion care, access to abortion is neither socially nor legally sanctioned in many parts of the world. As a result, almost half of the women seeking abortions each year-19 million- must resort to untrained providers working in unsanitary conditions. A quarter of these unsafe abortions occur in Africa. Each year, the failure to meet women's needs for safe abortion services results in nearly 70,000 deaths and untold injuries to women (WHO, 2003). Women in Africa suffer disproportionately and make up 44% of these abortion deaths (WHO, 1998). These deaths are almost entirely avoidable: contraception can greatly reduce the need for abortion and, when properly performed, abortion is extremely safe. Similarly, prompt access to care for the treatment of complications almost always results in a good outcome. Therefore, these preventable deaths represent enormous shortcomings in the delivery of essential health and contraceptive services and the failure of laws, policies, providers, and societies to respond to women's needs. (excerpt)


Article de périodique

de Bruyn, M.

Living with HIV: challenges in reproductive health care in South Africa
Vivre avec le VIH: défis dans les soins de la santé de reproduction en Afrique du Sud
2004, African Journal of Reproductive Health, N°8, 1, p. 92-98

Mots clés : abus sexuel; agression sexuelle; avortement provoqué; collecte; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; crime; déterminant fécondité; droit de l'homme; droits reproductifs; Dynamique démographique; Entretien; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; infection VIH; maladie; méthodologie; planning familial; planning familial, acceptante; population; problème social; rapport de recherche; Recherche; revue littérature; santé; santé de la reproduction
Pays : Afrique; Afrique du Sud

Résumé : Women in Africa are facing discrimination and challenges in relation to HIV/AIDS, particularly regarding their sexual and reproductive health care. This includes a lack of information regarding HIV and pregnancy, difficulties with contraceptive use, negative attitudes towards childbearing, and problems in accessing safe legal abortions. This paper addresses these issues in South Africa, based on an interview study with eight key informants and a literature review. The South African experience should inform policy-making and programmes in relation to HIV and reproductive health care in other African countries. (author's)
Vivre avec le VIH: défis dans les soins de la santé de reproduction en Afrique du Sud. Les femmes africaines font face à la discrimination et aux défis par rapport au VIH/SIDA, surtout quand il s'agit des services de la santé sexuelle et de reproduction. Ajouté à ceci est le manque de renseignement concernant le VIH et la grossesse, les difficultés liées à l'emploi des contraceptifs, les attitudes négatives envers la maternité et les problèmes d'accès aux avortements légaux et sans danger. Cet article étudie ces problèmes en Afrique du Sud en se fondant sur une étude effectuée à travers des intérieurs, à l'aide des huit principaux interviews et une analyse de la littérature. L'expérience sud-africaine devrait servir d'exemple pour la formulation des politiques et des programmes par rapport au VIH et les services de santé de reproduction dans d'autres pays africains.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Hajri, S.

Medical abortion: the Tunisian experience
L'avortement médical: l`expérience tunisienne
2004, African Journal of Reproductive Health, N°8, 1, p. 63-69

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; éducation; essais clinique; facteur démographique; femme; hormones; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; population; Programme de formation; prostaglandins/hormones; rapport de recherche; RU 486; santé; service de santé; système de santé; taux d'avortement / taux
Pays : Afrique; Tunisie

Résumé : This paper reports the Tunisian experience of medical abortion. The project started in 1998 with a small introductory study at the obstetric and gynaecology department of a university hospital and was later extended step by step to other family planning and public health centres that provided abortion services. The study was first conducted on 264 women using the modified regimen of 200mg mifepristone, followed 48 hours later by 400µg misoprostol in women seeking pregnancy of maximum 56 days of amenorrhoea. This gave a success rate of 91.1%. Results from further studies in other locations showed increasing success rates of 94.4% and 95.6%, with high acceptability and satisfaction among users and providers. The registration and effective introduction of medical abortion was quite rapid. Following successful conduct of the pilot study, intervention programmes were designed and implemented to improve the capacity of providers in providing safe medical abortion. (author's)
Cette étude traite de la pratique de l'avortement médical en Tunisie. Le projet a débuté en 1998 sous forme d'une étude à échelle réduite menée dans le service de gynécologie-obstétrie d'un hôpital universitaire, puis a été progressivement étendu à d'autres centres de santé communautaire et de planification familiale proposant des services d'avortement médical. L'étude a initialement porté sur 264 femmes enceintes (à 56 jours d'aménorrhée maximum), auxquelles il a été prescrit un régime simplifié de mifepristone 200 mg, suivi 48 heures plus tard d'une administration de misoprotol 400 pg. Le traitement a été fructueux chez 91,1 % de ces femmes. Des études supplémentaires menées dans d'autres sites témoignent de taux croissants de succès (94,4 % et 95,6 %), accompagnés de niveaux élevés d'acceptabilité et de satisfaction parmi les usagers et les prestataires de soins. L'admission des patientes et l'exécution de l'avortement médical étaient des procédures relativement rapides. Suite au succès de cette étude pilote, des programmes d'intervention ont été élaborés et mis en oeuvre afin d'améliorer l'aptitude des prestataires à pratiquer des avortements médicaux sans risques. (de l'auteur)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Berer, M.

National laws and unsafe abortion : the parameters of change
2004, Reproductive Health Matters, N°12, 24, supplement 1, p. 1-8

Mots clés : avortement provoqué, loi; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire)

Résumé : Unsafe abortion and associated morbidity and mortality in women are completely avoidable. This paper reports on an analysis of the association between legal grounds for abortion in national laws and unsafe abortion, drawing on an unpublished study and using estimates of the incidence of and mortality from unsafe abortion using information from the sources used to estimate the incidence of unsafe abortion and associated mortality in 2000. Although legal grounds alone may not reflect the way in which the law is applied, nor the quality of services offered, a clear pattern was found in more than 160 countries indicating that where legislation allows abortion on broad indications, there is a lower incidence of unsafe abortion and much lower mortality from unsafe abortions, as compared to legislation that greatly restricts abortion. The data also show that most abortions become safe mainly or only where women's reasons for abortion, and the legal grounds for abortion coincide. This is a compelling public health argument for making abortion legal on the broadest possible grounds. A wide range of actions have formed part of national campaigns for safe, legal abortion over the past century, covering law reform, provision of safe services, ensuring quality of care, training for providers and information and support for women. Safe abortion is an essential health service for women, as essential for sexual and reproductive health as safe contraception, and safe pregnancy and delivery care. In spite of sometimes powerful opposition and terrible setbacks, the public health imperative is gaining ground in many parts of the globe.
Les avortements à risque et la morbidité et mortalité qu'ils entraînent ne sont pas une fatalité. Cet article analyse l'association entre les indications légales de l'avortement dans les législations nationales et les avortements à risque, se fondant sur une étude non publiée des estimations de l'incidence des avortements à risque et de la mortalité qu'ils provoquent. Si les motifs légaux ne peuvent seuls refléter la manière dont la loi est appliquée, pas plus que la qualité des services proposés, un modèle a clairement été observé dans plus de 160 pays: les législations prévoyant de nombreuses indications pour l'avortement vont de pair avec une incidence inférieure d'avortements à risque et une mortalité liée nettement plus faible que les législations restrictives. La plupart des avortements deviennent sûrs lorsque les raisons qui poussent les femmes à avorter coïncident avec les motifs légaux d'avortement. C'est là un argument de poids pour légaliser l'avortement le plus largement possible. Au siècle dernier, les campagnes nationales ont utilisé des mesures très variées pour légaliser et médicaliser l'avortement, notamment réformer la législation, garantir des services sûrs et la qualité des soins, former les prestataires, informer et soutenir les femmes. Des avortements sans risque constituent un service de santé essentiel pour les femmes, aussi essentiel pour leur santé génésique qu'une contraception et des soins obstétriques adaptés. Malgré une opposition parfois puissante et de terribles revers, cet impératif de santé publique gagne du terrain dans de nombreuses régions du globe.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Fadalla, F. A.; Mirghani, O. A.; Adam, I.

Oral misoprostol vs. vaginal misoprostol for termination of pregnancy with intrauterine fetal demise in the second-trimester
2004, International Journal of Gynecology and Obstetrics, N°86, 1, p. 52-53

Mots clés : avortement; avortement provoqué, mortalité; biologie; complication grossesse; contraception; contraception d'urgence/ contraception postcoitale; contraception orale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; décès fotal; Dynamique démographique; étude comparée; étude/études; facteur démographique; grossesse; issue grossesse; méthodologie; Misoprostol/méthode/cytotec; mortalité; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; reproduction; spermicides
Pays : Afrique; Soudan

Résumé : Misoprostol, a synthetic prostaglandin E/1 analog widely prescribed for the prevention and treatment of peptic ulcer, has become an important drug in obstetrics and gynecology. We have recently reported its ability to bring about cervical changes, uterine contractions, and successful induction of labor at term. Misoprostol has also been found to be effective in inducing abortion, and therefore offers an effective alternative to the available medical and surgical options in second-trimester abortion. Because of the different pharmacokinetics when given orally or vaginally, the optimum dosage and route of administration have not been definitively determined w4x. We performed a prospective randomized-controlled clinical trial at Wad Medeni Teaching Hospital to compare the efficacy of oral misoprostol with that of vaginal misoprostol for pregnancy termination in cases of intrauterine fetal demise in the second trimester. (excerpt)


Article de périodique

Marchant, T.; Mushi, A. K.; Nathan, R.; Mukasa, O.; Abdulla, S.

Planning a family: priorities and concerns in rural Tanzania
La planification d'une famille: priorité et soucis dans la Tanzanie rurale
2004, African Journal of Reproductive Health, N°8, 2, p. 111-124

Mots clés : adolescent; âge; avortement; complication grossesse; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; facteur démographique; fécondité; grossesse; jeune/adolescent; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; rapport de recherche; reproduction; santé; santé de la reproduction; zone rurale
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : A fertility survey using qualitative and quantitative techniques described a high fertility setting (TFR 5.8) in southern Tanzania where family planning use was 16%. Current use was influenced by rising parity, educational level, age of last born child, breastfeeding status, a preference for longer than the mean birth interval (32 months), not being related to the household head, and living in a house with a tin roof. Three principal concerns amongst women were outlined from the findings. First, that there is a large unmet need for family planning services in the area particularly among teenagers for whom it is associated with induced abortion. Second, that family planning is being used predominantly for spacing but fears associated with it often curtail effective use. Third, that service provision is perceived to be lacking in two main areas - regularity of supply, and addressing rumours and fears associated with family planning. Reproductive health interventions in the area should ultimately be more widespread and, in particular, abortion is highlighted as an urgent issue for further research. The potential for a fast and positive impact is high, given the simplicity of the perceived needs of women from this study. (author's)
Une enquête sur la fertilité menée à l'aide des techniques qualitatives et quantitatives, a fait une description d'un cadre d'une haute fertilité (TFR 5.8) en Tanzanie du sud où l'emploi de la planification familiale était actuellement de 16%. L'emploi courant était influencé par la parité en hausse, le niveau de l'éducation, l'âge du dernier enfant, le statut de l'allaitement, la préférence pour une durée plus longue de l'intervalle de naissance moyenne (32 mois), le fait de ne pas être un parent du chef de la famille et le fait que l'on habite dans une maison à un toit d'étain. L'étude a précisé trois principaux soucis chez les femmes. D'abord, il y a un grand besoin non-satisfait des services de planification familiale dans la région, surtout parmi les adolescentes pour qui ils sont liés à l'avortement provoqué. Deuxièmement, qu'on se sert de la planification surtout l'espacement des naissances mais les craintes liées à la planification familiale entravent l'emploi effectif. Troisièmement, que la prestation des services n'est pas perçue comme étant suffisante dans deux domaines principaux - la fréquence de la prestation et les tentatives de resourdre les problèmes de rumeurs et des craintes liées à la planification familiale. Les interventions sur le plan de la santé publique dans le domaine devront être en fin de compte beaucoup plus répandues; et nous avons surtout précisé que l'avortement est un problème urgent qui mérite davantage des recherches. Il existe le potentiel pour un impact rapide et positif, étant donné la simplicité des besoins aperçus des femmes, d'après cette étude.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Frankel, N.; Nyaga, N.

Planning for sustainable access to technology: an essential element of safe abortion care
2004, African Journal of Reproductive Health, N°8, 1, p. 52-56

Mots clés : aspiration manuelle

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Rapport

Girvin, S.

Postabortion Care for Adolescents: Results from Research in the Dominican Republic and Malawi
2004, Engenderhealth, p. 12

Mots clés : adolescent; avortement à risque; soin post-abortum; soin post-avortement; soins post avortement; taux d'avortement à risque
Pays : Malawi; République dominicaine

Résumé : Between 2 million and 4 million adolescents are estimated to have unsafe abortions (either induced or spontaneous) each year, accounting for an estimated 14% of the unsafe abortions performed in developing countries. To determine how facilities can better meet adolescents' needs for postabortion care (PAC), EngenderHealth conducted studies at hospitals in the Dominican Republic and Malawi examining the experiences of adolescents who received PAC services and providers who deliver them. Specifically, the researchers sought to determine what problems adolescents face in obtaining PAC, these adolescents' perceptions of the care they receive, how PAC for adolescents can be improved, and what information and services adolescent PAC clients want and need.
This report summarizes the results of those studies and provides recommendations for improving adolescent PAC services. It also highlights some challenges to adolescents' ability to prevent pregnancy and barriers to quality PAC services for adolescents.

Site web : http://www.engenderhealth.org/res/offc/pac/adolescent/pdf/pac_adol_report.pdf

Article de périodique

Sibuyi, M. C.

Provision of abortion services by midwives in Limpopo province of South Africa
2004, African Journal of Reproductive Health, N°8, 1, p. 75-78

Mots clés : avortement; comportement reproductif; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; personnel de santé; planning familial; planning familial, acceptante; population; Programme de formation; santé; santé de la reproduction; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : South Africa's Choice on Termination of Pregnancy (CTOP) Act of 1996 allows provision of abortion on request up to 12 weeks of gestation and permits midwives who have completed required training to conduct termination of pregnancies. This unique codification of midwives' role in abortion care reflects legislators' recognition that the right to safe legal abortion would be meaningless to the vast majority of South African women who live in remote rural areas unless appropriate steps were taken to ensure their access to such services and an understanding that, by dint of their numbers and skills, this cadre of health care providers have much to offer. Though not without considerable challenges, experience from Limpopo Province demonstrates the important impact of involving midlevel providers has had in expanding the availability and accessibility of safe legal abortion. (author's)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Congrès

Rossier, C.

Quantifier les avortements clandestins : un état de la recherche
2004, Chaire Quetelet : Santé de la Reproduction au Nord et au Sud. De la connaissance à l'action., Louvain La Neuve, Belgique, p. 23

Mots clés : avortement clandestin; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; méthodologie

Résumé : Dans les pays où l'avortement reste illégal, c'est-à-dire dans la plupart des pays pauvres, la production de données quantitatives sur l'avortement clandestin demeure un problème d'actualité. De nombreux obstacles se dressent devant la production de données quantitatives sur l'avortement provoqué, surtout là où elle est illégale et / ou sanctionnée moralement (Barreto et al., 1992). Mais de nombreuses stratégies ont également été mises en oeuvre au fil des années pour surmonter ces obstacles. Nous faisons ici un état des lieux de ces stratégies, en réfléchissant dans un premier temps sur l'adéquation entre le but de la recherche et le type de collecte envisagé, ce qui nous amènera à examiner les questions d'échantillonnage, puis en proposant un examen critique des sources de données disponibles sur ce thème.


Rapport

Academy for Educational Development. SARA Project

Questions aux soins après avortement : extension des services en Afrique francophone
2004, Washington DC (US), USAID : AED, p. 94

Mots clés : accès aux soins; avortement; morbidité et mortalité maternelle; mortalité maternelle; service de santé; service de santé communautaire/offre/service de santé; violence sexuelle
Pays : Afrique subsaharienne

Résumé : ll a été largement documenté que les conséquences et complications provenant de l 'avortement à risque sont à l 'origine d 'un grand nombre de décès maternels.En Afrique subsaharienne,le problème est aggravé par les besoins en planning familial qui demeurent insatisfaits. l 'environnement politique entourant les soins pour les complications de l 'avortement n 'est pas particulièrement favorable;souvent la question n 'est pas perçue comme une priorité de santé au niveau national.Ce rapport résume les questions cruciales liées à l 'extension des services de SAA en Afrique francophone de l 'Ouest.

Site web : http://www.popcouncil.org/pdfs/frontiers/reports/questions_aux_ssa.pdf

Article de périodique

Teklehaimanot, K. I.; Smith, C. H.

Rape as a legal indication for abortion: implications and consequences of the medical examination requirement
2004, Medicine And Law, N°23, 1, p. 91-102

Mots clés : complication grossesse; femme; grossesse; loi

Résumé : A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.


Article de périodique

Adanu, R. M. K.; Tweneboah, E.

Reasons, fears, and emotions behind induced abortions in Accra, Ghana
2004, Discovery and Innovation, p. 1-9

Mots clés : raisons
Pays : Ghana

Résumé : Induced abortion is reported to be the third leading cause of maternal mortality worldwide. Accra being a capital city with its accompanying problems of rapid population increases and issues of migration also has its own problems with abortion. Figures from the Obstetrics and Gynaecology unit of Korle-Bu Teaching Hospital in Accra give abortion as the third leading cause of maternal mortality. However, data from the Pathology unit of the same hospital, show induced abortion as the leading cause of maternal mortality in Accra. This study looks into an aspect of abortion that has been little studied - the reasons behind induced abortions.


Article de périodique

Olukoya, P.

Reducing maternal mortality from unsafe abortion among adolescents in Africa
Réduction de la mortalitée maternelle occasionée par l`avortement à risque parmi les adolescentes en Afrique
2004, African Journal of Reproductive Health, N°8, 1, p. 57-62

Mots clés : abstinence/contraception; adolescent; avortement; avortement provoqué, mortalité; comportement reproductif; comportement sexuel; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; éducation sexuelle; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; grossesse non prévue/grossesse non désirée; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; santé de la reproduction
Pays : Afrique

Résumé : Initiation of sexual behaviour is a normal part of human development and it often occurs during adolescence. This is common and universal to all societies and cultures around the world with profound implications for sexual and reproductive health. Adolescence is the period when much of the changes that are associated with becoming an adult take place. These are changes which societies expect and welcome. Unsafe abortion is a major cause of maternal mortality among adolescents in Africa. The need for a public health response to unsafe abortion in Africa is compelling. It is important to focus on primary prevention including the provision of appropriate sexuality education and information as well as supportive services to allow adolescents to prevent unwanted pregnancy. Secondary prevention efforts include prompt diagnosis and treatment of complications by ensuring that services are made more responsive to the needs of adolescents, and by improving access to and quality of care for them. Post-abortion care in adolescents must include contraception as well as several elements of life planning. (author's)
Le déclenchement de comportement sexuel constitue une partie normale du développement humain et il se produit souvent pendant l`adolescence. Ceci est commun et universel à toutes les societés et cultures partout dans le monde, ayant des implications profondes pour la santé sexuelle et de reproduction. L'adolescence est la période où une grande partie des changements liés à la transition en âge adulte ont lieu. Ce sont des changements auxquels la société s`attend et fait bon accueil. L´avortement à risque est une cause importante de la mortalité maternelle parmi des adolescentes en Afrique. La nécessité d`une réponse de la santé publique à l`avortement à risque est irrefutable. Il est important de concentrer sur la prévention primaire y compris l`assurance d`une éducation et information sexuelle appropriées comme services de soutien pour permettre aux adolescentes d`éviter la grossesse non-désirées. Les efforts de la prévention secondaire comprennent le diagnostic et le traitement prompts des complications en assurant que des services deviennent plus sensibles aux besoins des adolescentes et en améliorant l`accès au soin de qualité à leur profit. Le soin post-avortement pour les adolescentes doit comprendre la contraception et plusieurs autres éléments de la planification familiale.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Cleland, J. G.; Ali, M. M.

Reproductive consequences of contraceptive failure in 19 developing countries
2004, Obstetrics and Gynecology, N°104, 2, p. 314-320

Mots clés : avortement; avortement provoqué, mortalité; comportement reproductif; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; décès fotal; déterminant fécondité; Dynamique démographique; échec de contraception; enquête; enquête démographique et de santé/EDS; état matrimonial; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; mortalité; nuptialité; planning familial; planning familial, acceptante; population; rapport de recherche

Résumé : OBJECTIVE: To ascertain the contribution of contraceptive failure to unintended births and fetal loss in developing countries. METHODS: Nationally representative survey data from married women in 19 developing countries were analyzed. All surveys contained retrospective monthly calendars of contraceptive use and pregnancies for a 5-year period preceding each survey. Information on the intendedness of live births, ascertained earlier in the interview, were linked to the calendar data. Single-decrement life table analysis was applied to episodes of use to estimate failure probabilities. The reproductive consequences of failure were established by simple tabulation. Logistic regression was used to explore the determinants of fetal loss. RESULTS: Reported contraceptive failure rates were similar to those derived from studies conducted mainly in the United States. About three fourths of pregnancies resulting from contraceptive failure were carried to term, and all but 16% of those were classified by the mother as unwanted or mistimed. Just over one tenth ended in fetal loss, either induced or spontaneous. Analysis of determinants of fetal loss suggested that a large proportion were induced. The median contribution of failure to all unintended births for all 19 surveys was about 15%, and the contribution to fetal loss was 12%. CONCLUSION: The contribution of contraceptive failure in developing countries is much lower than the estimate of 50% in the United States. Despite the substantial increases in contraceptive practice that have occurred in Asia, Latin America, the Middle East, and to a lesser extent, Africa, the level of use is still below the 75% mark achieved in most industrialized countries. Nonuse of contraception remains the dominant direct cause of unintended births, and family planning promotion should remain a public health priority


Article de périodique

Okonofua, F. E.

Rupture du silence par rapport à la prévention de l'avortement à risque en Afrique
2004, African Journal of Reproductive Health, N°8, 1, p. 9-10

Mots clés : avortement provoqué, mortalité; complication grossesse; congrès; femme; grossesse; mortalité; Sécurité
Pays : Afrique

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Brookman-Amissah, E.

Saving African women's lives from unsafe abortion--everyone has a role to play
2004, African Journal of Reproductive Health, N°8, 1, p. 11-14

Mots clés : avortement provoqué, mortalité; complication grossesse; congrès; femme; grossesse; mortalité; programme de santé

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Otoide, V. O.

Targeting Adolescents for Family Planning and Post Abortion Care
2004, Tropical Journal of Obstetrics and Gynaecology, N°21, 1, p. 65-68

Mots clés : activité sexuelle / sexualité; adolescent; coït/sexualité; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; information; planning familial; planning familial, acceptante; sexualité; soins post avortement

Résumé : Context: Adolescent sexuality and its outcome in developed and developing countries differs most significantly at the point of prevention of adverse reproductive outcome.
Objective: This article reviews the role of health care providers in meeting the peculiar challenges of the adolescent population in developing countries.
Method of literature search: A review of journal articles and electronic databases (Medline and Popline)
Conclusion: Health care providers are at a unique advantage in improving adolescent reproductive health. The focus should be the provision of information and contraception maximizing the windows of opportunity created by the contact of young people to the healthcare system and follows illegal abortion services.

Site web : http://www.ajol.info/journal_index.php?jid=79 ab=tjog

Article de périodique

Olivier, M. A. J.; Bloem, S.

Teachers speak their minds about abortion during adolescence
2004, South African Journal of Education, N°94, 3, p. 177-182

Mots clés : avortement provoqué, homme; étudiant; étudiant/scolarisation; femme; gynécologue; homme; médecine
Pays : Afrique du Sud; Australie

Résumé : Debates on abortion have escalated following the implementation in 1997 of the new law that legalises abortion from the age of twelve years in South Africa. Very often the person that opts for an abortion is merely an adolescent, who is still en route to adulthood. The adolescent's teacher shares the responsibility of the parent to accompany the adolescent to this procedure. The primary objective of the research was to determine from a socio-educational perspective what specific view teachers have of an abortion during adolescence. In order to achieve this, a qualitative method of research was used, with data being collected by means of focus-group interviews, through purposive sampling. The transcriptions were subjected to descriptive analysis. The findings of the research are presented and guidelines offered to teachers on more effectively accompanying the adolescent of our present-day society who plans to have an abortion or has had one.


Rapport

Marston, C.; Cleland, J. G.

The effects of contraception on obstetric outcomes
2004, WHO, p. 49

Mots clés : complication grossesse; comportement reproductif; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse; grossesse non prévue/grossesse non désirée; issue grossesse; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme planification familiale; rapport; reproduction; taux d'avortement / taux; taux de fécondité; taux grossesse
Pays : Afrique; Amérique latine

Résumé : The contribution of contraception to reductions in obstetric mortality and morbidity is universally acknowledged. One major pathway is by reducing the number of unwanted births. Each pregnancy and childbirth carry a health risk for the woman, and where obstetric services are poor, maternal mortality is still very high. In most Asian and Latin American countries for which relevant evidence exists, it is estimated that about 20% of births were unwanted at the time of conception. In Africa, where desired family sizes tend to be relatively high, the prevalence of unwanted births is typically lower, closer to 10%. On the assumption that unwanted births carry the same risk to the health of the mother as wanted births, it has recently been estimated that the global burden of disease attributable to unwanted births amounts to 4.6 million disability-adjusted life years (DALYs). Better use of effective contraception would reduce this substantial burden. In the extreme scenario, where all women who wanted to stop having children used effective methods of contraception, the burden would be eliminated, but for a small residue resulting from contraceptive failure. (excerpt) SA: La contribución de la anticoncepción a las reducciones en morbimortalidad obstétrica disfruta de reconocimiento universal. Una de las principales alternativas es reducir el número de embarazos no deseados. Cada embarazo y parto conlleva un riesgo de salud para la mujer y, en los lugares en que los servicios de obstetricia son deficientes, la mortalidad materna todavía es muy alta. En la mayoría de los países de Asia y América Latina para los que existen pruebas relevantes, se estima que aproximadamente el 20% de los nacimientos fueron deseados en el momento de la concepción. En África, donde el tamaño deseado de las familias suele ser relativamente grande, la prevalencia de nacimientos no deseados, por lo general, es más baja (aproximadamente 10%). Suponiendo que los embarazos no deseados conllevan el mismo riesgo para la salud materna que los deseados, hace poco se calculó que la carga mundial de enfermedades atribuibles a embarazos no deseados asciende a 4,6 millones de años de vida ajustados por discapacidad (AVAD). Un mejor uso de anticonceptivos eficaces reduciría esta importante carga. En una situación extrema, en la que todas las mujeres que desearan dejar de tener niños utilizarían métodos eficaces de anticoncepción, la carga se eliminaría, excepto poen el caso de fracaso en la anticoncepción. (extracto)

Site web : http://www.who.int/reproductive-health/publications/2004/effects_contraception/text.pdf

Article de périodique

Ehigieba, A. E.; Ighedosa, S. U.; Emore, O. F.; Onafowokan, O.

The management challenges of the complications of illegally induced abortions in Benin - City, Nigeria.
2004, Sahel Medical Journal, N°7, 3, p. 95-97

Mots clés : avortement provoqué; avortement provoqué, mortalité; complications postavortement; illégalité; mortalité
Pays : Nigeria

Résumé : Unsafe, induced abortion is one of the three major causes of maternal mortality in Nigeria. Important surgical complications of unsafe induced abortions include post-surgical sepsis and haemorrhage due to trauma to the uterus, cervix and intestines. This study examined the case records of patients with induced abortion requiring major surgical intervention to manage the complications during a five-year period at the University of Benin Teaching Hospital, Benin City, Nigeria. The results show that the most frequent surgical intervention was drainage of pelvic abscess in 38% of the patients. About 30% of` the patients ended up with severe structural damage to the pelvic organs, especially the uterus, with severe implication for the future fertility of these patients. This high risk of infection and significant structural damage is ascribed to the illegal status of abortion in Nigeria. The challenges that these surgical complications pose to the gynaecologist are discussed. The need to adequately equip and train clinicians to recognise and aggressively manage these complications is also discussed.


Article de périodique

Blum, J.; Hajri, S.; Chélli, H.; Mansour, F. B.; Gueddana, N.

The medical abortion experiences of married and unmarried women in Tunis, Tunisia
[L'expérience médicale de l'avortement chez des femmes mariées et célibataires à Tunis, en Tunisie]
2004, Contraception, N°69, 1, p. 63-69

Mots clés : avortement; biologie; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; hormones; méthodologie; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; prostaglandins/hormones; rapport de recherche; RU 486; santé; Sécurité; système de santé
Pays : Afrique; Tunisie

Résumé : The study explores the social dimensions of abortion in Tunisia and offers evidence supporting the provision of medical abortion to special populations, such as young and unmarried women. For this study we recruited 222 women (unmarried: n = 101, married: n = 121) at three clinics in Tunis, Tunisia, from April 1999 to March 2001. All eligible women who consented to participate were administered a simplified regimen of medical abortion consisting of 200 mg oral mifepristone + 400 µg oral misoprostol 2 days later either at home or in the clinic. Our results demonstrate that unmarried women (94.8%) are as likely as married women (94.1%) to have a successful abortion using this regimen. We noted a strong initial preference for home administration of misoprostol among both groups (unmarried: 73.3%, married: 80.2%), which grew even stronger after the procedure. Women indicated that home administration is desirable because transportation to the clinic is expensive (32.7%), home administration is more confidential (26.3%), easier and more convenient (12.8%). Both groups expressed a high degree of satisfaction with the method. Medical abortion with the option of home administration of misoprostol is safe and feasible for special populations; such as unmarried women in Tunisia. (author's)
Cette étude explore les dimensions sociales liées aux avortements pratiqués en Tunisie et apporte des preuves qui étayent la pratique de l'avortement chez les populations telles que les jeunes femmes et les femmes célibataires. Pour cette étude, nous avons recruté 222 femmes (célibataires : n = 101, mariées : n = 121) dans trois cliniques de Tunis, en Tunisie, du mois d'avril 1999 au mois de mars 2001. Toutes les femmes éligibles ayant consenti à participer à l'étude ont reçu un régime simplifié d'avortement médical de 200 mg de Mifepristone pris oralement, suivi de l'administration orale de 400 µg de Misoprostol deux jours plus tard, soit à la clinique, soit à domicile. Nos résultats démontrent que les femmes célibataires (94,8 %) sont tout aussi à même d'avoir un avortement réussi à la suite à ce régime que les femmes mariées (94,1 %). Nous avons observé une forte préférence initiale pour l'administration du Misoprostol à domicile chez les deux groupes (femmes célibataires : 73,3 %, femmes mariées : 80,2 %), qui s'est même intensifiée après la procédure. 32,7 % des femmes ont indiqué qu'elles préféraient prendre le médicament à domicile car se déplacer vers la clinique coûtait trop cher, 26,3 % des femmes ont déclaré que la prise du médicament à domicile était plus intime, et 12,8 % d'entre elles ont trouvé cette méthode à la fois plus facile et plus pratique. Les deux groupes ont exprimé un degré élevé de satisfaction envers cette méthode. L'avortement médical avec en option l'administration du Misoprostol à domicile est une méthode sûre et réalisable pour certaines populations telles que celle des femmes mariées en Tunisie. (de l'auteur)

Site web : http://www.contraceptionjournal.org/

Article de périodique

Braam, T.; Hessini, L.

The power dynamics perpetuating unsafe abortion in Africa: a feminist perspective
Pouvoir dynamique qui perpétue l`avortement à risque en Afrique: une perspective féministe.
2004, African Journal of Reproductive Health, N°8, 1, p. 43-51

Mots clés : avortement provoqué, loi; avortement provoqué, religion; chrétien/religion; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; droit de l'homme; droits reproductifs; facteur culturel; facteur démographique; facteur politique; famille; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; population; religion; santé; santé maternelle
Pays : Afrique

Résumé : Tens of thousands of African women die every year because societies and governments either ignore the issue of unsafe abortion or actively refuse to address it. This paper explores the issue of abortion from a feminist perspective, centrally arguing that finding appropriate strategies to reclaim women's power at an individual and social level is a central lever for developing effective strategies to increase women's access to safe abortion services. The paper emphasises the central role of patriarchy in shaping the ways power plays itself out in individual relationships, and at social, economic and political levels. The ideology of male superiority denies abortion as an important issue of status and frames the morality, legality and socio-cultural attitudes towards abortion. Patriarchy sculpts unequal gender power relationships and takes power away from women in making decisions about their bodies. Other forms of power such as economic inequality, discourse and power within relationships are also explored. Recommended solutions to shifting the power dynamics around the issue include a combination of public health, rights- based, legal reform and social justice approaches. (author's)
Des dizaines des milliers des femmes africaines meurent chaque année parce que les sociétés et les gouvernements négligent la question de l`avortement à risque ou refusent carrément de l`aborder. Cet article étudie la question de l`avortement d`une perspective féministe, en avançant l`argument que la recherche des stratégies appropriées qui permettent de reclamer le pouvoir de la femme au niveau individuel et social constitue un lévier central pour l`élaboration des stratégies efficaces pour augmenter l`accès de la femme aux services de l`avortement sans risque. L`article met l`accent sur le rôle central du patriarcat en modélant les façons dont le pouvoir se mousse au niveau des rapports individuels: sociaux, économiques et politiques. L`idéologie de la supériorité masculine nie le fait que l`avortement est une question importante de statut et encadre la moralité, la légalité et les attitudes socio-culturelles envers l`avortement. Le patriarcat sculpte des rapports de pouvior inégaùx et nie à la femme le pouvoir de prendre des décisions en matière concernant son corps. D`autres formes de pouvoir telles l'inégalité économique, le discours et le pouvoir au sein des rapports sont aussi explorés. Pour effectuer un changement dans la dynamique de pouvoir à l`égard du problème, nous préconisons, entre autres, une approche qui sera basée sur la santé publique, sur les droits, la réforme légale et la justice sociale.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Van Rooyen, M.; Smith, S.

The prevalence of post-abortion syndrome in patients presenting at Kalafong Hospital's Family Medicine Clinic after having a termination of pregnancy
2004, South African Family Practice, N°46, 5, p. 21-24

Mots clés : Interruption volontaire de grossesse / IVG
Pays : Afrique du Sud

Résumé : Background: Post-abortion syndrome (PAS) is said to be the emotional, psychological, physical and spiritual trauma caused by an abortion, which is an event outside the normal range of human experience. Post-abortion syndrome is a type of post-traumatic disorder and is characterised by a stressor (the abortion), the event being re-experienced, avoidance and/or numbing of general responsiveness, and physical symptoms such as insomnia and depression.
The question was asked whether the patients at Kalafong Hospital experienced any of the after-effects of a termination of pregnancy and whether these effects would fulfill the criteria of post-abortion syndrome.
Method: A prospective descriptive study was done over a six-month period. All female patients presenting at the Family Medicine Clinic of Kalafong Hospital who were known to have had a previous abortion on request were asked to participate in the study. After obtaining informed consent, a structured questionnaire on their psychological symptoms was completed by the participants with the help of the researcher. The questionnaire contained demographic data, as well as questions on the above-mentioned symptoms of PAS. To fulfill the criteria of PAS, the symptoms should have been present for more than a month and must have affected the subject's daily functioning.
Results: Of the 48 woman recruited, 16 (33%) fulfilled the criteria of PAS, and more than 50% of the women had had some or other emotional or psychological after-effect.
Conclusion: This study showed that one out of every three women presenting at Kalafong Hospital after abortion fulfilled the criteria of PAS. Since family physicians are committed to their patients and regard it as their duty to address problems prevalent in the community they serve, it is necessary to investigate further the possible link between termination of pregnancy and the emotional problems identified. It is imperative that women requesting termination of pregnancy receive comprehensive counseling prior to the procedure, as well as support thereafter, to ensure that they are not unnecessarily traumatised.


Article de périodique

Rogo, K. O.

Unsafe abortion and maternal mortality: is Africa prepared to face the reality?
2004, East African Medical Journal, N°81, 2, p. 61-62 (editorial)

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maternité sans risque; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; programme de santé; santé maternelle
Pays : Afrique

Résumé : Of the estimated 200 million pregnancies around the world each year, approximately one third are unwanted. Unwanted pregnancies contribute to poor maternal health outcomes in two ways: First, many pregnancies are unwanted because they threaten the woman's health or well-being; she may have an existing health problem, or lack the support and resources she needs to have a healthy pregnancy and raise a healthy child. Second, where women do not have access to safe abortion services, many unwanted pregnancies are terminated using unsafe procedures that can lead to the woman's death or disability. Both of these two factors are common place in Africa. Unsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both. Unsafe abortion is one of the five major causes of maternal mortality and accounts for 13% of maternal deaths globally but up to 50% in sub-Saharan Africa. Of the 46 million abortions that take place in a year, 20 million are considered unsafe, resulting in roughly 70,000 deaths and hundreds of thousands of disabilities. Almost all (95%) unsafe abortions occur in developing countries because the developed world has made it possible for women to easily prevent unwanted pregnancy by using contraceptives and having access to safe legal termination when needed. (excerpt)

Site web : http://www.ajol.info/journal_index.php?jid=53

Rapport

Ahman, E.; Shah, I. H.

Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2000.
2004, Geneve, World Health Organization, p. 82

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; demande; demande d'avortement; évaluation; Evaluation des services de santé; facteur démographique; facteurs de risque; grossesse; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; qualité des soins; rapport; santé; santé publique; Sécurité; service de santé; service de santé communautaire/offre/service de santé; système de santé

Résumé : Unsafe abortion is entirely preventable. Yet, it remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the past decade, the World Health Organization has developed a systematic approach to estimating the regional and global incidence of unsafe abortion and the mortality associated with it. Estimates based on figures for the year 2000 indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies end in an unsafe abortion, giving a ratio of one unsafe abortion to about seven live births. Almost all unsafe abortions occur in developing countries. Women who resort to unskilled or untrained abortion providers put their health and life at risk. Worldwide an estimated 68 000 women die as a consequence of unsafe abortion. In developing countries the risk of death is estimated at 1 in 270 unsafe abortion procedures. Where contraception is inaccessible or of poor quality, many women will seek to terminate unintended pregnancies, despite restrictive laws and lack of adequate abortion services. Prevention of unplanned pregnancies by improving access to quality family planning services must therefore be the highest priority, followed by improving the quality of abortion services, where legal, and of post-abortion care.


Congrès

Beguy, D.; Ametepe, F.

Utilisation de la contraception moderne et recours à l'avortement provoqué : deux mécanismes concurrents de régulation des naissances
2004, Chaire Quetelet : Santé de la Reproduction au Nord et au Sud. De la connaissance à l'action, Louvain la Neuve, Belgique, p. 16

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; régulation des naissances

Résumé : Dans la plupart des pays africains au Sud du Sahara, la fécondité est demeurée longtemps élevée mais le déclin est aujourd'hui en cours, avec des rythmes et des intensités variables. Plusieurs facteurs ont contribué à cette évolution. Bien qu'illégal, on peut l'évoquer le recours à l'avortement comme un des facteurs de la baisse de la fécondité à Lomé. De plus, dans la plupart des pays où l'avortement provoqué est en forte progression, les femmes y ont recours soit en remplacement de la contraception ou soit en complément de celle-ci lorsque les méthodes contraceptives sont mal utilisées. La contraception et l'avortement ne sont-ils pas devenus des moyens complémentaires ou concurrents de régulation des naissances à Lomé ? L'avortement provoqué est-elle une alternative à l'utilisation de la contraception moderne en matière d'espacement et/ou limitation des naissances ? Cet article tente de répondre à ces questions en analysant les effets respectifs de l'utilisation de la contraception et du recours à l'avortement provoqué sur la régulation des naissances et en documentant l'arbitrage qui s'opère entre les deux recours. Dans un premier temps, nous allons mettre en évidence les pratiques contraceptive et abortive à Lomé avant de mettre l'accent sur les relations existant entre avortement et contraception et enfin de voir comment ces deux pratiques s'articulent.


Article de périodique

Brookman-Amissah, E.

Woman-centred safe abortion care in Africa
2004, African Journal of Reproductive Health, N°8, 1, p. 37-42

Mots clés : avortement; avortement provoqué, loi; clinique/service de santé; contraception d'urgence/ contraception postcoitale; counseling; droit de l'homme; droits reproductifs; facteur démographique; facteur politique; femme; gouvernement; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; population; programme d'activités; santé; santé de la reproduction; service de santé; système de santé
Pays : Afrique

Résumé : Unsafe abortion in Africa affects not only women, but also their children, families and communities. To counter this extremely costly yet easily preventable problem, African nations must ensure that health systems are trained and equipped to help prevent unwanted pregnancy, to treat women in emergency situations, and to make safe abortion services available to the full extent of the law. One critical component of this process is comprehensive woman-centred care, an approach that emphasises access, choice and quality of services. This article examines this and the obstacles to safe abortion care, as well as how they can be overcome through broad-based partnerships. (author's)
Le soin d`avortement centré sur la femme en Afrique. L`avortement à risque en Afrique n'affecte pas que les femmes, mais aussi leurs enfants, leurs familles et leurs communautés. Pour combattre ce problème extrêmement coûteux et pourtant facilement évitable, les nations africaines doivent s`assurer que des systèmes de santé sont formés et équipés pour aider à prévenir la grossesse non-désirée, à soigner les femmes en cas d`urgence et à rendre disponible des services d`avortement à risque selon la loi. Une partie critique de ce processus est le soin compréhensif centré sur la femme, une approche qui met l`accent sur le choix et la qualité de services. Cet article examine ce problème et les obstacles au soin d`avortement sans risque, aussi bien que la manière dont ils peuvent être surmontés à travers les collaborations à tendances très variées.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

  2003   
Article de périodique

van Bogaert, L. J.

'Failed' contraception in a rural South African population
2003, South African Medical Journal, N°93, 11, p. 858-861

Mots clés : adolescent; adulte/âge; adultère; avortement; complication grossesse; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; effets secondaires; enfant /enfance; enquête; épidémiologie; femme; grossesse; grossesse non prévue/grossesse non désirée
Pays : Afrique du Sud

Résumé : OBJECTIVE: To investigate whether the free availability of contraception affects the need for termination of pregnancy (TOP). DESIGN: Case-control study. SETTING: South African rural hospital. POPULATION: Three thousand and ninety-five TOP seekers and 439 non-pregnant controls. METHODS: Structured questionnaire followed by ultrasonography. MAIN OUTCOME MEASURES: Current use or recent discontinuation of contraception and the reason for discontinuation. RESULTS: Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85.0% of controls. Injectable contraception (IC) was preferred by the controls and oral contraception (OC) by TOP seekers (chi 2 = 48.5, p Africa two main components of women's reproductive health and rights are freely available, namely contraception and TOP. Not using contraception is one of the main causes of unwanted pregnancy. Better education of both service providers and users is needed to improve use, compliance and perseverance with contraception.

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Fullerton, J.; Fort, A.; Johal, K.

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services
2003, Midwifery, N°19, 1, p. 17-26

Mots clés : adolescent; avortement; planning familial; planning familial, acceptante; service de santé; service de santé communautaire/offre/service de santé
Pays : Ghana

Résumé : OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services


Article de périodique

Srofenyoh, E. K.; Lassey, A. T.

Abortion care in a teaching hospital in Ghana
2003, International Journal of Gynecology and Obstetrics, N°82, 1, p. 77-78

Mots clés : adulte/âge; adultère; âge; avortement; avortement spontané; avortement spontané/fausse couche; complication grossesse; complications postavortement; contraception d'urgence/ contraception postcoitale; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; femme; grossesse; hôpital; hôpital publique; hôpital universitaire; maladie; méthodologie; planning familial; planning familial, acceptante; population; Programme de formation; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : With 40.7% of all admissions, complications of abortion are still by far the leading indication for admission into the acute Gynecology wards of the Korle-Bu Teaching Hospital (KBTH). Primary level health facilities in Accra are staffed by midwifes and medical officers who are rarely trained, or equipped to provide postabortion care services. Studies had shown that the use of Manual vacuum aspiration (MVA) with paracervical block by midlevel providers is feasible and safe. Uterine evacuation using MVA is considered by WHO as a life-saving skill which should therefore be a basic training requirement for all medical officers, midwives and other midlevel health professionals who work with pregnant women. The transfer of these services to the primary institutions will inevitably reduce the pressure on KBTH. (excerpt)


Thèse

Opara, V. N.

Abortion regime under the Nigerian criminal jurisprudence : a manmade disaster to human health human rights
2003, Toronto, University of Toronto, p. 94

Mots clés : avortement provoqué, loi; droit des femmes; jurisprudence; justice; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire)
Pays : Nigeria

Article de périodique

Dickson, K. E.; Jewkes, R. K.; Brown, H.; Levin, J.; Rees, H.

Abortion service provision in South Africa three years after liberalization of the law
2003, Studies in Family Planning, N°34, 4, p. 277-284

Mots clés : aspects socio-économiques; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; facteur démographique; facteur économique; facteurs économiques; facteurs socio-économiques; grossesse; inégalités; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; programme planification familiale; rapport de recherche; santé; service de santé; système de santé
Pays : Afrique; Afrique du Sud

Résumé : In 1996, South Africa introduced legislation that liberalized women's access to termination of pregnancy. This study presents the findings of a survey undertaken to describe the availability and accessibility of abortion services in 1999, three years after the law was passed. All facilities that bad been officially designated to perform these services were contacted by telephone to determine whether they were providing the services, their capacity, whether they were performing second trimester as well as first-trimester terminations, and how long women had to wait for these services. Nationally, 292 facilities had been designated, but in 1999 only 32 percent were functioning. Of the functioning facilities, 27 percent were in the private sector. Mapping of available services indicated that substantial parts of the country were entirely without such services. Half of tile country's induced abortions were being performed in Gauteng province, although only 19 percent of women of reproductive age were living there. This finding indicates that service provision in other provinces was inadequate or lacking. Although in the first years following the new legislation efforts were made to establish abortion services, this study reveals gross inequality in service availability. Strategies for improving coverage are suggested. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Chapitre d'ouvrage

Singh, S.; Henshaw, S. K.; Berentsen, K.

Abortion: A Worldwide Overview
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 15-48

Mots clés : avortement; méthodologie; niveau

Article de périodique

Mhlanga, R. E.

Abortion: developments and impact in South Africa
2003, British Medical Bulletin, N°67, p. 115-126

Mots clés : avortement légal; complication grossesse; grossesse; loi; loi et jurisprudence; tendance; tendance/ évolution
Pays : Afrique du Sud

Résumé : The article seeks to clarify the context of the Choice on Termination of Pregnancy Act, 1996 (Act No.92 of 1996), the factors that led to its adoption and implementation including the role of research in support of policy development, the expanded utilization of professional nurses, and the respect and promotion of women's right to life and well-being. The challenges that cropped up on the road to implementation and sustenance are also spelt out. It is important to evaluate the programme because this will assist South Africa to improve on the performance of service delivery. It will also assist other countries, both poor and rich, to progressively realize the promotion of human rights. Lastly, the article also seeks to identify areas that will lead to the improvement of women's lives, and ultimately societal development and health.

Site web : http://bmb.oxfordjournals.org/archive/

Article de périodique

Yeboah, R. W. N.; Kom, M. C.

Abortion: the Case of Chenard Ward, Korle Bu from 2000 to 2001
2003, Institute of African Studies : Research Review, N°19, 1, p. 57-66

Mots clés : avortement; hôpital universitaire
Pays : Ghana

Résumé : This paper examines the number of abortion cases attended to in the Chenard Ward of the Korle Bu Teaching Hospital, Accra during the years 2000 and 2001. A total of 1,935 abortion cases were handled in the year 2000 and 1,838 in 2001. Though there was a 5% decrease in the number of cases in 2001, there was an increase in 'incomplete abortions', which happened to be the most frequent, 78% and 83% in 2000 and 2001 respectively. The majority of the abortions were found among women in the age bracket 21-30: 58% in 2000 and 55% in 2001. There were also 63 (3.3%) and 42 (2.3%) abortions in 2000 and 2001 respectively between the ages of 41 and 50 years. These figures call for the intensification of the campaign for safer sex practices, family planning and the teaching that there is good care for those that call to the hospital early enough.

Site web : http://www.ajol.info/journal_index.php?jid=133 ab=iasrr

Article de périodique

Airede, L. R.; Ekele, B. A.

Adolescent maternal mortality in Sokoto, Nigeria
2003, Journal of Obstetrics and Gynaecology, N°23, 2, p. 163-5

Mots clés : adolescent; âge; aspects socio-économiques; avortement; avortement provoqué, mortalité; biologie; complication grossesse; contraception d'urgence/ contraception postcoitale; Dynamique démographique; éclampsie; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; facteurs de risque; facteurs économiques; facteurs socio-économiques; grossesse; hôpital; hôpital publique; hôpital universitaire; jeune/adolescent; maladie; maternité sans risque; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; rapport de recherche; santé; santé maternelle; service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : The aim of this study was to determine the magnitude of adolescent maternal deaths at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. We also studied the associated and causative factors, and recommended strategies for their prevention. This was a retrospective, cross-sectional study of adolescent maternal deaths that occurred at UDUTH, Sokoto from January 1990 to December 1999. There were 946 live births (LB) from adolescents and 46 maternal deaths during the study period. The maternal mortality ratio (MMR) in adolescents was 4863/100 000) LB and 2151/100 000 LB in the general hospital population. The mean age of the adolescents who died was 17 years. Risk factors included absence of routine antepartum, intrapartum and postpartum care, illiteracy and poverty. Eclampsia and prolonged obstructed labour were responsible for 76% of deaths. Abortion was an uncommon cause of maternal death in adolescents. There is an unacceptably high level of maternal mortality in adolescents at UDUTH, Sokoto. Tragically, most deaths are preventable. (author's)


Article de périodique

Itano, N.

Africa's family-planning funding drought
2003, Christian Science Monitor, p. [4]

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; demande; demande/ besoins; facteur politique; facteurs économiques; gouvernement; Nations Unies; organisation; Pays développé; planning familial; planning familial, acceptante; rapport; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Etats-Unis; Kenya

Résumé : According to the International Planned Parenthood Federation (IPPF), based in London, international funding for family planning fell 36.8 percent, to $356 million between 1994 and 2001. During the same period, funding for HIV/AIDS grew 300 percent, to $587 million. AIDS has also made the number of orphans skyrocket, making it increasingly difficult for families to absorb additional unplanned children. Adoption, advocated by groups like Pro-Life Kenya, is still rare. According to statistics from the United States government, only a few hundred African children are adopted by US families each year, most of them from Ethiopia. The fundamental problem, say family planning advocates, is that HIV/AIDS work is not integrated into general family planning programs. "Many governments and agencies are treating HIV/AIDS separately, as if it were not a sexual and reproductive health and rights issue," Steven Sinding, director general of IPPF told a conference earlier this year. "How can one view HIV/AIDS as anything but a fundamental sexual and reproductive health and rights problem?" (excerpt)

Site web : http://www.csmonitor.com/2003/1105/p07s02-woaf.htm

Article de périodique

Hollander, D.

Although abortion is highly restricted in Cameroon, it is not uncommon among young urban women
2003, International Family Planning Perspectives, N°29, 1, p. 49-50

Mots clés : adulte/âge; adultère; âge; aspects socio-économiques; avortement; complication grossesse; comportement sexuel; connaissances, attitudes, pratiques; déterminant fécondité; épidémiologie; facteurs socio-économiques; fécondité; femme; grossesse; homme; loi et jurisprudence; médecine traditionnelle/ méthodes; méthodes; Statistique
Pays : Cameroun

Résumé :
-


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Sepou, A.; Nguembi, E.; Yanza, M. C.; Ngbale, R.; Nali, M. N.

Analyse des avortements à la maternité de l'hôpital communautaire de Bangui
2003, Médecine d'Afrique Noire, N°50, p. 525-530

Mots clés : avortement; complications postavortement
Site web : http://www.santetropicale.com/Kiosque/man/5012.htm#5

Article de périodique

Faure, S.; Loxton, H.

Anxiety, depression and self-efficacy levels of women undergoing first trimester abortion
2003, South African Journal of Psychology, N°33, 1, p. 28-38

Mots clés : avortement; comportements; contraception d'urgence/ contraception postcoitale; planning familial; planning familial, acceptante; psychologie/facteur psychologique; rapport de recherche
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : This study examined the relationship between anxiety, depression, perceived self-efficacy and biographical variables, before and after the termination of a first trimester pregnancy. Seventy-six participants were recruited from three health facilities in the Western Cape, South Africa. Scores on the State-Trait Anxiety Scale, the Beck Depression Inventory and a Self-Efficacy Scale revealed that high levels of state-anxiety and moderate levels of depression were experienced before abortion. Levels of anxiety and depression generally decreased significantly within a three-week period after the abortion. High self-efficacy was related to lower levels of anxiety and depression. Higher levels of education and self-efficacy and low levels of depression, trait-anxiety and gestational age were significantly related to healthy short-term adjustment. It was shown that pre-abortion depression and self-efficacy scores had the power to predict post-abortion depression. (author's)


Chapitre d'ouvrage

Renne, E. P.

Changing Assessments of Abortion in a Northern Nigerian Town
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 119-138

Mots clés : avortement
Pays : Nigeria

Chapitre d'ouvrage

Levin, E.

Cleaning the Belly: Managing Menstrual Health in Guinea, West Africa
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 103-118

Mots clés : avortement; facteur politique; facteurs socioculturels
Pays : Guinée

Article de périodique

Tabbutt-Henry, J.; Graff, K.

Client-Provider Communication in Postabortion Care
2003, International Family Planning Perspectives, N°29, 3, p. 126-129

Mots clés : soin post-abortum; soin post-avortement

Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Chapitre d'ouvrage

Basu, A. M.

Concluding Remarks: The Role of Ambiguity
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 249-260

Mots clés : avortement; facteur politique; facteurs socioculturels

Article de périodique

Lukman, H. Y.; Ramadan, A. T.

Critical appraisal of the law enforcement in abortion care in Ethiopia
2003, East African Medical Journal, N°80, 11

Mots clés : soin pour avortement
Pays : Ethiopie

Résumé : OBJECTIVE: To illustrate the disparity in the law enforcement in abortion care and the widely reported induced abortion rates. DESIGN: A descriptive study. SETTING: The computer-entered data from the Federal Democratic Republic of Ethiopia Police Information and Documentation Center. MATERIALS AND METHODS: Two hundred and sixteen case files handled by the police in the last two years. The data of 326 subjects accused of alleged abortion related legal wrong doings were analysed for age, marital status, educational level, occupation and the due process in the court of law. The magnitude of induced abortions is reviewed from the available institutional based studies. RESULTS: The majority of aborting mothers, the service providers and their accomplices are found to be young, unmarried, poorly educated and of low socio-economic profile. The files that are under investigation and pending court rulings are remarkably high. The published incidence of induced abortion ratio of 318 per 1,000 live births is disproportionately greater than those that actually come under the attention of the law. CONCLUSION: The 1957 law is not officially repealed and its restrictive nature is not influencing the prevalence of illicitly induced abortions since the legal instruments are not fully operational. This is the consequence of fewer complaints advanced to the police and/or lack of obligatory reporting system of the events by the service delivery points.

Site web : http://www.ajol.info/journal_index.php?jid=53

Chapitre d'ouvrage

Kulczycki, A.

Demographic Research and Abortion Policy: limits to the Use of Statistics
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 65-78

Mots clés : avortement; politique/programme

Article de périodique

Chikovore, J.; Nystrom, L.; Lindmark, G.; Ahlberg, B. M.

Denial and violence: Paradoxes in men's perspectives to premarital sex and pregnancy in rural Zimbabwe
2003, African Sociological Review, N°7, 1, p. [17]

Mots clés : abus sexuel; adolescent; âge; agression sexuelle; attitude; avortement; comportement reproductif; comportement sexuel; comportements; crime; déterminant fécondité; Dynamique démographique; étude qualitative; facteur démographique; fécondité; femme; grossesse prémaritale; jeune/adolescent; maîtrise de la fécondité; méthodologie; planning familial; planning familial, acceptante; population; population rurale; problème social; psychologie/facteur psychologique; rapport de recherche; rural/résidence; violence domestique
Pays : Afrique; Zimbabwe

Résumé : This paper describes the perspectives of men on premarital sex and pregnancy in rural Zimbabwe. It is based on data collected using three qualitative methods including focus group discussions and individual interviews among men and women, and self-generated questions and statements among school youth. The paper illuminates the paradoxes of denial and violence implicit in the way men speak: as relatives on the one hand and as partners on the other regarding pregnancy in girls. The men say they react violently to premarital pregnancy, but neither do they tolerate sexual activity, or allow contraceptive information or service for unmarried daughters and sisters, even though their accounts paradoxically suggest that sexual abuse of young girls is rampant. Despite denying them preventive service and information, men speaking as partners expect girls to have knowledge about sexuality, the menstrual cycle and pregnancy. They blame their girlfriends for getting pregnant, despite indications from the accounts of the girls that it is male partners who pressure the girls into unprotected sexual activity. In such circumstances, the girls say the pregnancy may translate into unsafe, induced abortion. These are complexities at the micro-level that need to be understood for any meaningful programme to improve adolescent sexual and reproductive health. (author's)


Article de périodique

Corbett, M. R.; Turner, K. L.

Essential Elements of Postabortion Care: Origins, Evolution and Future Directions
2003, International Family Planning Perspectives, N°29, 3, p. 106-111

Mots clés : soin post-abortum; soin post-avortement

Résumé : no abstract


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Rossier, C.

Estimating induced abortion rates: a review
2003, Studies in Family Planning., N°34, 2., p. 87-102

Mots clés : enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; méthodologie
Pays : Afrique

Résumé : Legal abortions are authorized medical procedures, and as such, they are or can be recorded at the health facility where they are performed. The incidence of illegal, often unsafe, induced abortion has to be estimated, however. In the literature, no fewer than eight methods have been used to estimate the frequency of induced abortion: the "illegal abortion provider survey," the "complications statistics" approach, the "mortality statistics" approach, self-reporting techniques, prospective studies, the "residual" method, anonymous third party reports, and experts' estimates. This article describes the methodological requirements of each of these methods and discusses their biases. Empirical records for each method are reviewed, with particular attention paid to the contexts in which the method has been employed successfully. Finally, the choice of an appropriate method of estimation is discussed, depending on the context in which it is to be applied and on the goal of the estimation effort. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Rapport

Dohlie, M. B.; Mason, R. F.; Wahome, R.; Mulindi, R.

Exploring peer support networks for the provision of high-quality postabortion care by private nurse-midwives in Kenya
2003, Technical Report No. 49, Chapel Hill, North Carolina, IntraHealth International, PRIME Project, p. 33

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; évaluation; facteurs économiques; famille; méthodologie; organisation; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; programme; Programme de formation; Programme d'évaluation; réseaux sociaux; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; USAID
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : PRIME II collaborated with Engender Health to establish links between the public and private sectors and encourage the DPHNs who received PAC training from Engender Health, to provide support for the PAC-trained private nurse-midwives. Working with NNAK and NCK, the POLICY Project trained advocacy teams made up of NNAK members at the district level. These teams targeted colleagues in the public sector and community leaders to create support for private providers and delivery of PAC services at the community level. The concept of peer support/ intervision was introduced to PAC trainees towards the end of the first phase of the initiative in an effort to provide increased post-training support beyond the supervision provided by the DPHNs. In August 2001, the supervision stakeholders recommended a study to examine the peer support practices of private nurse-midwives that had evolved in some places. Documenting the current scope and practices of the clusters would provide useful information for forming such networks in the PAC program, which was being expanded to other areas. Moreover, the information collected on the clusters, supervisory practices, and factors that help or hinder good performance among the primary PAC providers would inform a new core-funded PRIME II peer support/intervision initiative. (excerpt)


Chapitre d'ouvrage

Togonu-Bickersteth, F.

Family planning and abortion: cultural norms versus actual practices in Nigeria
2003 - in Maguire, Daniel C., Sacred Rights: The Case for Contraception and Abortion in World Religions, New York, Oxford University Press,, p. 167-174.

Mots clés : avortement; célibataire; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; culture; déterminant culturel; déterminant fécondité; ethnie; ethnology; facteur culturel; fécondité; génétique; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; reproduction
Pays : Afrique subsaharienne; Nigeria

Thèse

Verkuyl, D. A. A.

Family planning as part of reproductive health, including the HIV/AIDS aspects, in Zimbabwe and Southern Africa
2003, Utrecht, Universiteit Utrecht, p. 332

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; hôpital; hôpital publique; hôpital universitaire; ligature des trompes / stérilisation; planning familial; planning familial, acceptante; sida; stérilisation/contraception; Syndrome d'immunodéficience acquise/sida
Pays : Zimbabwe

Chapitre d'ouvrage

Semde, G.; Laga, M.; Vuylsteke, B.

Family planning needs among female sex workers in Côte d'Ivoire
2003, Access to care; 13th International Conference on AIDS and STIs in Africa (ICASA), Nairobi, September 21st-26th, 2003; abstract book, Nairobi, N°2003, 154, p. Cited pages: 154.

Mots clés : avortement; grossesse non prévue
Pays : Côte d'Ivoire

Article de périodique

Melkamu, Y.; Enquselassie, F.; Ali, A.; Gebreselassie, H.; Yusuf, L.

Fertility awareness and post-abortion pregnancy intention in Addis Ababa, Ethiopia
2003, Ethiopian Journal of Health Development, N°17, 3, p. 167-174

Mots clés : âge; aspects socio-économiques; avortement; complication grossesse; contraception d'urgence/ contraception postcoitale; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; facteur démographique; facteurs économiques; facteurs socio-économiques; femme; grossesse; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; reproduction; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : Abortion related complications are known to be among the leading causes of maternal mortality and disabilities in developing countries. The aim of the study was to assess the knowledge of post-abortion patients, regarding return of fertility and pregnancy intentions. Cross sectional study was undertaken in four government hospitals in Addis Ababa, Ethiopia from November 2001 to February 2002. Four hundred post-abortion cases were interviewed at the point of their discharge to get information on their fertility awareness and future pregnancy intentions. Seventeen percent of the respondents who reported that the pregnancies were unwanted admitted some kind of interference with the pregnancy. Thirty six percent reported that they were assisted at clinics for inducing the abortion. Overall about 82% of them reported not having a plan to become pregnant in three months period following the abortion. Seventy three percent of them were not able to tell the time at which they could become pregnant if involved in sexual intercourse after the present abortion. This study revealed the urgent demand for quality services that should include education and provision of family planning counseling and methods. (author's)


Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Article de périodique

Ekanem, A., D,; Etuk, S., J,; Udoma, E., J,; Ekanem, I., A,

Fertility Profile Following Induced Abortion in Calabar, Nigeria
2003, Tropical Journal of Obstetrics and Gynaecology, N°20, 2, p. 89-92

Mots clés : avortement; stérilité
Pays : Nigeria

Résumé : Context: The incidence of induced abortion in Nigeria is high. Pelvic infection as a complication of this abortion is also common and with the rising prevalence of infertility in the population, there is a need to assess the impact of induced abortions on fertility in our women.
Objective: To establish the impact of induced abortion on the fertility rate of women in Calabar.
Design and Setting: Cross sectional descriptive study in Calabar, an urban community on the eastern flank of Nigeria's Atlantic coast.
Subjects and Methods: Women seeking gynaecological, antenatal and family planning services who gave their informed consent were recruited. Those of them who gave a history of induced abortion were interviewed in-depth. Their demographic characteristics and detailed information about their abortion history such as number of abortions, sites where the abortions were performed, the personnel providing the abortion services and complications arising from the abortions were obtained.
Results: Some 242 (40.3%) of the study subjects had undergone at least one induced abortion. The commonest late complications of induced abortion were secondary infertility (42.1%) and chronic pelvic infection (36.0%). Only 48.3% of the women who had induced abortions maintained their fertility while the remainder suffered secondary infertility ranging from three to eighteen years in duration. The fertility rate decreased with increasing number of abortions.
Conclusion: Induced abortion is a major factor in the high prevalence of secondary infertility in Calabar. Training of medical practitioners on post-abortion care may help to ameliorate the burden of secondary infertility in Nigeria.

Site web : http://www.ajol.info/journal_index.php?jid=79 ab=tjog

Rapport

Jacobstein, R.; Malema, D.; Ndambuki, S.; Ndede, F.; Malawezi, J.

Final assessment: long-term and permanent contraception (LTPC) and postabortion care (PAC) programs, 1999-2003, Malawi
2003

Mots clés : contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; éducation; évaluation; implants/contraception; organisation; Organisation et Administration; planning familial; planning familial, acceptante; programme; Programme de formation; programme planification familiale; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; stérilisation féminine; système de santé; USAID
Pays : Afrique; Afrique subsaharienne; Malawi

Résumé : This Report provides a Final Assessment of the Long-Term and Permanent Contraception (LTPC) and Postabortion Care (PAC) programs in Malawi. The Assessment was undertaken at the request of USAID, the major donor for these services in Malawi; it is the product of an 8-person, 5-organization Assessment Team drawn from organizations involved in FP/RH service provision: the Ministry of Population and Health (MOHP), Christian Health Association of Malawi (CHAM), Malawi Medical Council, Malawi Nurses and Midwives Council, and EngenderHealth. EngenderHealth led the conduct of the Assessment and generation of the Report. Despite its dearth of human and financial resources for health and its great burden of overall disease (e.g., 15% of Malawians aged 15-49 are HIV+), Malawi has made remarkable progress in providing FP/RH services to its citizens in the past decade. Use of modern contraception, less than 5% before 1990, has risen markedly, to 26% by 2000 (Malawi DHS), and use of female sterilization tripled from 1992 to 2000, to 5%. Thus approximately 20% of modern method contraceptive usage in Malawi today is represented by female sterilization. EngenderHealth, USAID's main vehicle for providing TA in LTPC and PAC, began working in Malawi in November 1999. EngenderHealth's goal has been to help MOHP and CHAM increase access, quality and use of LTPC, to reduce morbidity and mortality from incomplete abortion, and to break the cycle of repeated abortion by providing post-abortion FP. EngenderHealth's strategy has been to provide needed equipment and supplies, relevant in-service training, and related TA, focused especially on quality, counseling, infection prevention, and supervision. (excerpt)

Site web : http://www.dec.org/pdf_docs/PDABZ737.pdf

Article de périodique

Jegede, A. S.; Odumosu, O.

Gender and health analysis of sexual behaviour in south-western Nigeria
2003, African Journal of Reproductive Health, N°7, 1, p. 63-70

Mots clés : adolescent; adulte/âge; adultère; âge; attitude; avortement; avortement provoqué, homme; célibataire; comportement reproductif; comportement sexuel; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; enquête; enquête démographique et de santé/EDS; enquête planification familiale; enquête prévalence; facteur culturel; facteur démographique; famille; fécondité; femme; genre; grossesse non prévue/grossesse non désirée; homme; infection/complication; Infections génitales/IST/MST; jeune/adolescent; maladie; maladie sexuellement transmissible/MST/IST; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; nuptialité; planning familial; planning familial, acceptante; population; préservatif/ condom; psychologie/facteur psychologique; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : This paper reports the main results of a series of interviews conducted among the Yoruba of south-western Nigeria. Fifty men and fifty women differing in socio-demographic backgrounds were studied. The study revealed that during their first sexual experience; Yoruba girls are at risk of contacting sexually transmitted diseases and of having unplanned pregnancies because of the traditional control measures arid lack of adequate sex education even among those from non-traditional backgrounds. Choice of marriage partner is influenced by the kin, which encourages early marriage and multiple sexual relationships through polygyny. Yoruba men do not like contraceptives and the women suffer more of the consequences of sexual relationships than men. Sexual decision-making in Yoruba culture is characterised by certain specific problems of structural and cultural origins such as separate lifestyle of men and women, seeing the discussion of sexuality as a taboo, male dominance, and the perceived side effects of contraceptives. There is need for expanded sexual and reproductive health education strategies targeted at both males and females in this community especially among the adolescent group.
Cet article fait un rapport des principaux résultats d'une série d'entretiens que nous avons eus avec des Yoruba du sud-ouest du Nigéria. Cinquante hommes et cinquante femmes d'origine Yoruba domiciliés à Ibadan, mais qui viennent des milieux socio-démographiques différents, ont été étudiés. L'étude a été basée sur une analyse de leurs histoires sexuelles, à l'aide d'une méthode de recherche qualitative. La recherche a démontré que pendant la première expérience sexuelle, les filles Yoruba courent le risque de contracter les maladies sexuellement transmissibles et d'avoir des grossesses non-désirées. Ceci à cause des mesures de contrôle traditionneles et le manque d'éducation sexuelle adéquate même parmi ceux qui ne sont pas issus des milieux traditionnels. Le choix du conjoint est influencé par la famille qui encourage le mariage précoce et les rapports sexuels multiples à travers la polygynie. Les hommes Yoruba n'aiment pas les contraceptifs alors que les femmes souffrent plus les conséquences des rapports sexuels que les hommes. La prise de décision sexuelle dans la culture Yoruba est caractérisée par certains problèmes particuliers d'origine structurale et culturelle, tels les modes de vie différents des hommes et des femmes, la considération de la discussion sur la sexualité comme un tabou, la dominance masculine et les effets secondaires perçus des contraceptifs. Il y a la nécessité des stratégies de l'éducation sexuelle et de la santé reproductive qui viseront les femmes dans cette commumauté surtout parmi le groupe adolescent. (de l'auteur)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Thèse

Svanemyr, J.

Gender relations, reproduction and induced abortion in Ivory Coast
2003, Medicine, Olso, University of Oslo

Mots clés : avortement provoqué; genre
Pays : Afrique subsaharienne; Côte d'Ivoire

Article de périodique

Zebaze, R. M.

HIV infections in sub-Saharan Africa
2003, International Journal of STD and AIDS, N°14, 6, p. 428-9

Mots clés : biologie; comportement à risque; comportements; facteurs de risque; infection VIH; maladie; sida; Syndrome d'immunodéficience acquise/sida
Pays : Afrique; Afrique subsaharienne

Résumé : The study by Gisselquist et al. is of the utmost importance, as it helps health professionals and policy makers to face the bitter reality of a broken health system. In my opinion as a medical graduate with experience in practice in Cameroon, Central Africa in both rural and urban areas, it seems extremely unlikely that sexual behaviour or vertical transmission could explain the large number of new cases diagnosed daily. I do not, however, agree with the authors' analysis of other possible causes; I believe that too much importance is placed on unsafe injections by health professionals. (excerpt)

Site web : http://www.rsmpress.co.uk/std.htm

Article de périodique

Larsen, U. M.

Infertility in Central Africa
2003, Tropical Medicine and International Health, N°8, 4, p. 354-367

Mots clés : avortement provoqué; sous-fécondité
Pays : Cameroun; Gabon; République centrafricaine; Tchad

Résumé : OBJECTIVES To determine the prevalence and risk factors of primary and secondary infertility in the four Central African countries of Cameroon, Chad, Central African Republic and Gabon. METHODS Primary infertility was approximated by the percentage of women childless after at least 5 years of marriage. The percentage with no birth at least 5 years subsequent to a previous birth was considered to have secondary infertility. Logistic regression and discrete logistic regression models were estimated to determine the risk factors of primary and secondary infertility, respectively. The relatively few women who were defined as infertile and reported using a traditional or modern method of contraception at survey date were considered fertile to reduce bias from falsely classifying effective contraceptive users as infertile. RESULTS The prevalence of infertility was highest in Central African Republic and lowest in Chad: primary infertility ranged from 6.9% to 3.1% and secondary infertility for women aged 20-44 years ranged from 26.5% to 18.9%. Women married more than once vs. only once and formerly married women vs. women living with their husbands had higher odds of primary and secondary infertility. Also, younger cohorts had relatively higher risks of primary (born after 1970) and secondary infertility (born after 1960) compared with women born before 1960. In contrast, place of residence, religion, education of wife or husband and socio-economic status were generally not associated with primary or secondary infertility. CONCLUSIONS Infertility is still prevalent in Central Africa and new interventions aimed at reducing the incidence and social implications of pathologic infertility are needed.


Chapitre d'ouvrage

Caldwell, J. C.; Caldwell, P.

Introduction: Induced Abortion in a Changing World
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 1-14

Mots clés : aspect politique; avortement

Article de périodique

Mohammed, I.

Issues relating to abortions are complicated in Nigeria letter
2003, BMJ. British Medical Journal, N°326, 7382, p. 225

Mots clés : avortement; Avortement illégal; avortement provoqué, mortalité; avortement provoqué, religion; chrétien/religion; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; Dynamique démographique; facteur culturel; facteur démographique; médicament; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; religion
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : None of the responses to the news item on bmj.com considered the complex social and religious milieu in which Nigerians live. It is not the absence or paucity of medical expertise, health education, or activity by non-governmental organisations that drives pregnant girls to underground abortion clinics. Very strong cultural and religious stigmas are associated with extramarital sex in all regions of the country: not only Islam but also the Roman Catholic Church strongly oppose liberalisation of abortion. To legislate on abortion is a very tall order in Nigeria. (excerpt)

Site web : http://bmj.com

Article de périodique

Aziken, M. E.; Patrick I. Okonta; Adedapo B.A., A.

Knowledge and Perception of Emergency Contraception Among Female Nigerian Undergraduates
2003, International Family Planning Perspectives, N°29, 2, p. 84-87

Mots clés : contraception d'urgence; contraception d'urgence/ contraception postcoitale; étudiant; étudiant/scolarisation
Pays : Nigeria

Résumé : CONTEXT: The reproductive health hazards of unintended pregnancies and unsafe abortions are well documented. The potential of emergency contraceptives to prevent unwanted pregnancy in developed countries has been described, but in Nigeria, the awareness about the method is poor and no study has looked at efficacy.
METHODS: Between September and October 2001, a randomly selected sample of female undergraduate students at the University of Benin, Nigeria, were surveyed about their demographic information, sexual history and contraceptive use, and their awareness and knowledge of emergency contraception.
RESULTS: Of the 880 respondents, 43% were sexually active, 39% had ever practiced contraception and 34% had ever had an induced abortion. Overall, 58% of respondents reported knowing about emergency contraception; sexually active respondents were significantly more likely than those who were not and those who had ever practiced contraception were more likely than those who had not to be aware of emergency contraceptives. However, only 18% of respondents who reported knowing about emergency contraception knew the correct time frame in which emergency contraceptives must be used to be effective.
CONCLUSION: There is an urgent need to educate Nigerian young people about emergency contraception, emphasizing available methods and correct timing of use.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Etuk, S. J.; Ebong, I. F.; Okonofua, F. E.

Knowledge, attitude and practice of private medical practitioners in Calabar towards post-abortion care
Connaissance, attitude et pratique des praticiens médicaux privés à Calabar envers les soins post-avortements
2003, African Journal of Reproductive Health, N°7, 3, p. 55-64

Mots clés : avortement provoqué, loi; comportement reproductif; contraception d'urgence/ contraception postcoitale; croyance; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur culturel; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; infection/complication; Infections génitales/IST/MST; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maladie; maladie sexuellement transmissible/MST/IST; médecin/personnel de santé; méthodologie; personnel de santé; planning familial; planning familial, acceptante; population; Programme de formation; rapport de recherche; Recommandations; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion care and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria. (author's)
Cette etude a examiné la connaissance, l'attitude et la pratique des praticiens médicaux privés à Calabar à l'égard de l'avortement, des soins de post-avortement et de la planifiction familiale du post-avortement. Nous avons interviewé 48 praticiens privés, propriétaires des cliniques privées dans la ville, à l'aide d'un questionnaire structuré. Les résultats ont montré que 22,9% des médecins interrompent systématiquement des grossesses non-désirées quand les femmes le demandent alors que 83,3% d'eux soignent les femmes qui ont des complications des avortements dangereux. Les raisons principales données par certains médecins pour lesquelles ils interrompent les grossesses non-desirées étaient plutôt plus pour des considerations religieuses et morales que pour le respect pour la loi nigériane sur l'avortement. Seuls 18,2% emploient des procedures normales telle l'aspiration pneumatique manuelle (APM) pour le traitement des patients qui ont des problèmes de l'avortement et des complications de l'avortement. Bon nombre d'eux ne pratiquent pas systématiquement la planification familiale du post-avortement intégré et du traitement des MSTs. Il faut un programme compréhensif du stage de recyclage des praticiens privés à Calabar sur les principes et les pratiques de l'avortement sans risque, les soins post-avortement et la planification familiale. Ces aspects de la santé reproductive doivent être intégrés dans le programme de la formation médicale au Nigéria. Nous espérons que cette approche aidera à réduire le présent taux élevé de la morbidité et de la mortalité lié à l'avortement au Nigéria.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Chapitre d'ouvrage

Stambach, A.

Kutoa Mimba: Debates about Schoolgirl Abortion in Machame, Tanzania
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 79-102

Mots clés : avortement
Pays : Tanzanie

Article de périodique

Guillaume, A.

Le rôle de l'avortement dans la transition de la fécondité à Abidjan au cours des années 1990
2003, Population, N°58, 6

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; incidence; mesure; méthodologie; planning familial; planning familial, acceptante; population; population urbaine; rapport de recherche; transition de la fécondité; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Côte d'Ivoire

Résumé : A l'image de nombreux pays africains, la Côte d'Ivoire est entrée dans une phase de transition de sa fécondité, particulièrement marquée en milieu urbain. Ces changements se produisent dans un contexte de faible prévalence contraceptive ; la question du rôle des autres déterminants dans ces évolutions se pose en particulier celle de l'avortement.
Une étude menée dans la ville d'Abidjan auprès de femmes en consultation dans des centres de santé a permis d'analyser en détail les modes de régulation de la fécondité et les relations entre avortement et fécondité. L'avortement est une pratique de plus en plus fréquente, malgré son illégalité, notamment chez les jeunes femmes et dès le début de la vie féconde. Contraception et avortement sont parfois utilisés de façon complémentaire, l'avortement intervenant suite à l'échec d'une contraception (en particulier d'une méthode naturelle). Dans certains cas, après l'expérience d'un avortement le recours à des méthodes efficaces semble augmenter, bien que cela ne soit pas systématique. Les données présentées ici montrent qu'il n'est pas possible de comprendre la baisse de la fécondité à Abidjan, sans prendre en compte le rôle majeur des pratiques abortives.


Reproduced with the permission of Population : http://www.ined.fr/publications/population/index.html

Article de périodique

Dickens, B. M.

Legal duties to respect abortion choices
2003, Medicine And Law, N°22, 4, p. 693-700

Mots clés : avortement; avortement provoqué, religion; chrétien/religion; complication grossesse; droit de l'homme; femme; grossesse; loi; personnel de santé; religion
Pays : Afrique du Sud

Résumé : This paper addresses legal protection of individual choices to obtain abortion services, to decline to perform abortions on grounds of religious objection, and to participate in these procedures. It considers legal duties to respect women as decision-makers in their own lives, including when they decide to continue pregnancy. The choice to decline participation in abortions is an aspect of religious freedom available to physicians, nurses, and, for instance, pharmacists, but not artificial legal persons such as hospital and clinic corporations. Refusal does not extend to ancillary functions such as serving meals, routine pre-operative and post-operative care of abortion patients or typing abortion referral letters. Physicians practising in proximate care must be trained in appropriate medical management of incomplete and threatened abortion even when they would refuse to apply such techniques to induce abortion.


Article de périodique

Nash, E. S.

Legal termination of pregnancy
2003, SAMJ (South African Medical Journal), N°93, 2, p. 87

Mots clés : avortement; loi / législation
Pays : Afrique du Sud
Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Orji, E. O.; Adeyemi, A. B.; Esimai, O. A.

Liberalisation of abortion laws in Nigeria: the undergraduates' perspective
2003, J Obstet Gynaecol, N°23, 1, p. 63-6

Mots clés : avortement; loi / législation
Pays : Nigeria

Résumé : A study about 396 undergraduates of Obafemi Awolowo University, Ile-Ife, Nigeria concerning their opinopn on the liberalisation of abortion laws were investigated in May 2001. 22.7% of respondents supported the liberalisation of abortion laws in Nigeria because they believed that it would lead to reduction in associated morbidity and mortality, encourage more qualified personnel to perform it, encourage women to request abortion openly and encourage accurate statistics on abortion. However, the majority of the respondents opposed the liberalisation of abortion laws due to the fear that it would increase promiscuity, sexually transmitted diseases and abortion rates. Religious opposition and the belief that liberalisation would not reduce the level of poverty, ignorance and poor reproductive health facilities were the common factors leading to unwanted pregnancy and unsafe abortion in Nigeria.


Article de périodique

Brown, H.; Jewkes, R. K.; Levin, J.; Dickson-Tetteh, K.; Rees, H.

Management of incomplete abortion in South African public hospitals
2003, International Journal of Obstetrics and Gynaecology., N°110, 4, p. 371-377

Mots clés : antibiotiques; antibiotiques/ méthode; avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude prospective; étude/études; méthode d'avortement, effets secondaires; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; traitement/soin
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Objective: To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate. Design: A multicentre, prospective descriptive study. Setting South African public hospitals that manage gynaecological emergencies. Sample: Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included. Methods: A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaesthetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation. Main outcome measures: Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients. Results: There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation. Conclusions: The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post-abortion care programmes. (author's)


Article de périodique

Adefuye, P. O.; Sule-Odu, A. O.; Olatunji, A. O.; Lamina, M. A.; Oladapo, O. T.

Maternal Deaths from Induced Abortions
2003, Tropical Journal of Obstetrics and Gynaecology, N°20, 2, p. 101-104

Mots clés : avortement à risque; complication grossesse; grossesse; morbidité et mortalité maternelle; mortalité maternelle; taux d'avortement à risque
Pays : Nigeria

Résumé : Context: Unsafe abortion has grave implications for the life of a woman and her future reproductive career. Efforts to find the reasons underlying how a woman gets to the point of having an unsafe abortion, and means of preventing and minimising complications arising thereby are highly desirable.
Objective: To find the extent to which unsafe abortion contributes to maternal mortality in our environment.
Study Design, Setting and Subjects: A descriptive study of patients who were admitted for complications arising from induced abortions between January 1988 and December 2000 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with the data being obtained from case records.
Results: A total of 103 patients presented with complications arising from induced abortions. Twenty-one (20.4%) of these patients died as a result of complications arising thereby. During the same period, there were 71 deaths in the gynaecological ward. Thus, deaths from induced abortion accounted for 29.6% of all gynaecological deaths. There were 105 maternal deaths in the hospital during the period. Hence, induced abortions were responsible for 20% of all maternal deaths. The patients had various complications including 15 (71.4%) with septicaemia, 10 (47.6%) with anaemia, 7 (33.3%) each with jaundice and peritonitis.
Conclusion: Abortion-related maternal death is still a major contributor to maternal mortality in this environment. Women empowerment, easy access to good quality and cheap family planning methods and post abortion care and rationalisation of abortion law may help to halt this stream of deaths from unsafe abortions.

Site web : http://www.ajol.info/journal_index.php?jid=79 ab=tjog

Rapport

Ipas

Medical abortion - Implications for Africa
2003, NC, Ipas, p. 10

Mots clés : avortement médical; complication grossesse; grossesse; médecine traditionnelle/ méthodes; méthodes; service de santé; service de santé communautaire/offre/service de santé
Pays : Afrique

Résumé : Medical abortion is a new technology that can help eliminate the gaps in the continuum of safe and available abortion services in Africa. Over the last two decades, scientists and providers have identified and refined the use of several drugs that, when used correctly, can effectively and safely cause abortions.
Medical abortion holds particular promise for Africa where access to reproductive health services is very poor and where abortion-related morbidity and mortality are high. Despite a lower level of unintended pregnancies, women in Africa suffer the highest risk of abortion-related deaths in the world. This is a direct consequence of the poor conditions of reproductive health services in the region. Given this situation, African women stand to greatly benefit from medical abortion, a new technology that, by significantly increasing their access to safe abortion services, could save their lives and improve their health.

Site web : http://www.ipas.org/publications/en/Medical_Abortion/med_ab_africa_web_only_en.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Sen, A.

Missing women -- revisited
2003, BMJ. British Medical Journal, N°327, p. 1297-1298

Mots clés : avortement; avortement provoqué, mortalité; avortement provoqué, religion; chrétien/religion; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; facteur politique; mortalité; planning familial; planning familial, acceptante; population; religion; sex ratio
Pays : Afrique

Résumé : The concept of "missing women," which was presented in an editorial I wrote in this journal 11 years ago, refers to the terrible deficit of women in substantial parts of Asia and north Africa, which arises from sex bias in relative care. The numbers are very large indeed. For example, using as the standard for comparison the female:male ratio of 1.022 observed in sub-Saharan Africa (since women in that region receive less biased treatment), I found the number of missing women in China to be 44m, in India 37m, and so on, with a total that easily exceeded 100m worldwide, a decade or so ago. Others used different methods and got somewhat different numbers- but all very large (for example, Stephan Klasen's sophisticated demographic model yielded 89m for the countries in question). (excerpt)

Site web : http://bmj.comhttp://bmj.bmjjournals.com/cgi/reprint/327/7427/1297?maxtoshow= HITS=10 hits=10 RESULTFORMAT= author1=sen andorexactfulltext=and searchid=1138266853005_1084 FIRSTINDEX=0 sortspec=relevance resourcetype=1

Article de périodique

Ikechebelu, J. I.; Okoli, C. C.

Morbidity and mortality following induced abortion in Nnewi, Nigeria
2003, Tropical Doctor, N°33, 3, p. 170-2

Mots clés : avortement; morbidité et mortalité maternelle; mortalité maternelle
Pays : Nigeria
Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Oludiran, O. O.; Okonofua, F. E.

Morbidity and mortality from bowel injury secondary to induced abortion
2003, African Journal of Reproductive Health, N°7, 3, p. 65-68

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteurs économiques; grossesse; information; maladie; méthodologie; morbidité; planning familial; planning familial, acceptante; population; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Bénin

Résumé : Eight patients managed for bowel injury following induced abortion were studied for the pattern of morbidity and mortality. The patients were aged 18-39 years. Three of them were married, five were single. Two of the cases were detected at the time of termination of pregnancy. The interval from termination of pregnancy to presentation in hospital was two days to two weeks in the other six patients. Injury was in the ileum in three, jejunum in two and the sigmoid colon in three. Twenty surgical interventions were performed for primary treatment and management of complications. Major complications were abdominal wound dehiscence (5), faecal fistula (2) and postoperative diarrhoea (l). The duration of hospitalisation at the first admission ranged from seven to 163 days. The excessive morbidity is attributed to delay in presentation; most patients been seen after 72 hours. Primary repair of colonic injury is discouraged. No death was recorded. Literature is reviewed on the condition in West Africa and suggestion made on means of reducing morbidity from induced abortion. (author's)
Huit patientes suivies pour une lésion intestinale à la suite d'un avortement provoqué ont été soumises à une étude, en vue de déterminer le schéma de morbidité et de mortalité. L'âge de ces patientes variait entre 18 et 39 ans. Trois d'entre elles étaient mariées, et cinq célibataires. Deux des cas ont été détectés au moment de la fin de la grossesse. L'intervalle entre la fin de la grossesse et la présentation à l'hôpital a été de deux jours à deux semaines chez les six autres patientes. Chez trois patientes, la lésion était concentrée au niveau de l'iléon, du jéjunum chez deux d'entre elles et du côlon sigmoïde chez trois autres de ces femmes. Vingt interventions chirurgicales ont été réalisées dans le cadre du traitement de fond et des complications. Les complications principales ont été les suivantes : lâchage de suture abdominale (5), fistule fécale (2) et diarrhée postopératoire (l). La durée d'hospitalisation lors de la première admission a varié entre 7 et 163 jours. Le taux excessif de morbidité est attribuable au délai de présentation ; la plupart des patientes ont été vues 72 heures après présentation. La réparation principale de la lésion colique n'est pas une opération vraiment encouragée. Aucun décès n'a été signalé. La littérature sur la question en Afrique de l'Ouest est en phase de révision, et des suggestions sont élaborées, portant sur les moyens de réduire les taux de morbidité liés à un avortement provoqué. (de l'auteur)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Huntington, D.; Nawar, L.

Moving from Research to Program--The Egyptian Postabortion Care Initiative
2003, International Family Planning Perspectives, N°29, 3, p. 121-125

Mots clés : avortement; soins post avortement
Pays : Egypte

Résumé : no abstract


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Okonofua, F. E.

Need to intensify safe motherhood interventions in Africa
2003, African Journal of Reproductive Health, N°7, 3, p. 7-12

Mots clés : avortement; complication grossesse; femme; grossesse; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle

Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Thèse

Ratovondrahona, P. L.

Pauvreté et transition de la fécondité à Madagascar
2003, Bordeaux (FR), Université Bordeaux III, p. X + 428 + ANNEXES

Mots clés : avortement; comportement sexuel; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; mortalité infantile; nuptialité; pauvreté; système de santé; tendance de la fécondité; transition démographique
Pays : Madagascar

Résumé : Cette étude examine les évolutions divergentes de la fécondité à Madagascar, en relation avec l'évolution socio-économique du pays. L'analyse est abordée au niveau de la capitale et des provinces de la Grande Ile. Elle met en évidence une grande disparité spatiale se traduisant par une baisse significative de la fécondité dans la capitale, une amorce de déclin de la procréation dans certaines provinces (Antananarivo, Toamasina et Antsiranana), face à un maintien à des niveaux élevés dans d'autres (Mahajanga, Toliary et Fianarantsoa). L'étude des modalités de cette transition différenciée et l'impact de la pauvreté seront évalués et amèneront à travailler à deux niveaux : - au niveau des variables intermédiaires qui agissent directement sur la fécondité (comportements post-partum, contraception, avortement, comportements sexuels et nuptialité, mortalité des enfants)- au niveau des facteurs socio-économiques et culturels dont l'effet sur la fécondité passe par les variables intermédiaires. Divers facteurs exerçant une influence réputée négative sur la fécondité comme le niveau d'instruction, l'urbanisation ainsi que les conditions sanitaires, dont les services de planification familiale, sont étudiés.On appréciera les spécificités de l'évolution démographique à Madagascar où la pauvreté semble, dans certains endroits avoir limité le phénomène de transition et, au sein d'autres entités comme la capitale, a permis voir accéléré le processus de transition, entraînant la coexistence de plusieurs régimes démographiques. (Résumé d'auteur)


Article de périodique

Abdul, M. A.; Ameh, N.; Bako, A. U.

Post abortal broad ligament abscess: report of a case
2003, Nigerian Journal of Surgical Research, N°5, 3 4, p. 171-173

Mots clés : avortement illégal
Pays : Nigeria

Résumé : A case of postabortal Broad ligament abscess following an illegal induced abortion is presented. The diagnosis was made intraoperatively and the abscess drained at laparotomy. The difficulty in preoperative diagnosis of broad ligament abscess and problems of unsafe abortions in developing economies are highlighted. Preventive measures against morbidities/mortalities from unsafe abortions are suggested.


Article de périodique

Chudi, I. P.

Post-abortion care: a neglected aspect of reproductive health services in Nigeria
2003, African Journal of Reproductive Health, N°7, 3, p. 13-16

Mots clés : adolescent; âge; avortement; clinique/service de santé; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; counseling; déterminant fécondité; Dynamique démographique; éducation; éducation sexuelle; évaluation; facteur démographique; facteurs économiques; fécondité; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme d'activités; programme planification familiale; programme post-abortum; programme post-abortum, coût; psychologie/facteur psychologique; Recommandations
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Each year an estimated 20 million unsafe abortions take place worldwide, 95% of which occur in the developing world. Of the 1.1 billion adolescents aged 10-19 years, 85% live in developing countries. These boys and girls face multiple sexual and reproductive health risks. The young women, however, are especially vulnerable because of intersections between three conditions: unwanted pregnancy, unsafe abortion, and infection with HIV and other STDs. Unfortunately, post-abortion care is the least emphasized aspect of reproductive health in these areas where unsafe abortion contributes significantly to maternal morbidity and mortality. In Nigeria, increased unprotected sexual activity among male and female adolescents leading to unwanted pregnancies and illegal abortion is posing serious health problems. Approximately 610,000 abortions are performed in Nigeria annually, 60% of which are thought to be unsafe. The maternal mortality ratio in Nigeria is 1,500 deaths per 100,000 live births. Of these, 12% are estimated to be due to unsafe abortion. In some series, unsafe abortion accounted for up to 40% of maternal mortality. The average unsafe abortion mortality ratio in Africa is 110 deaths per 100,000 live births. Additionally, the high incidence of serious complications and mortality following unsafe abortion in Nigeria is worrisome. Many authors have severally emphasized these complications. (excerpt)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Marston, C.; Cleland, J. G.

Relationships between contraception and abortion: a review of the evidence
2003, International Family Planning Perspectives, N°29, 1, p. 6-13

Mots clés : avortement; complication grossesse; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; données; épidémiologie; femme; grossesse; incidence; loi et jurisprudence; prévalence; Statistique; taux natalité; tendance; tendance/ évolution
Pays : Cuba; Etats-Unis; Europe; Kazakhstan; Singapour; Tunisie

Résumé : CONTEXT: The relationship between levels of contraceptive use and the incidence of induced abortion continues to provoke heated discussion, with some observers arguing that use of abortion decreases as contraceptive prevalence rises and others claiming that increased use of family planning methods causes abortion incidence to rise. METHODS: Abortion trends are examined in countries with reliable data on abortion and with contraceptive prevalence information from two points in time showing increases in contraceptive use. The role of changes in fertility in mediating the relationship between abortion and contraception is also explored. RESULTS: In seven countries--Kazakhstan, Kyrgyz Republic, Uzbekistan, Bulgaria, Turkey, Tunisia and Switzerland--abortion incidence declined as prevalence of modern contraceptive use rose. In six others--Cuba, Denmark, Netherlands, the United States, Singapore and the Republic of Korea--levels of abortion and contraceptive use rose simultaneously. In all six of these countries, however, overall levels of fertility were falling during the period studied. After fertility levels stabilized in several of the countries that had shown simultaneous rises in contraception and abortion, contraceptive use continued to increase and abortion rates fell. The most clear-cut example of this trend is the Republic of Korea. CONCLUSIONS: Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Lema, V. M.

Reproductive awareness behaviour and profiles of adolescent post abortion patients in Blantyre, Malawi
2003, East African Medical Journal, N°80, 7, p. 339-344

Mots clés : adolescent; âge; avortement; comportement reproductif; connaissance; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; éducation; éducation sexuelle; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Malawi

Résumé : Adolescent sexuality and its sequelae are now acknowledged as major public health, social and economic problems in Malawi, for which appropriate programmes and services are being designed and implemented. To identify the profiles of adolescent post abortion patients, their reproductive and contraceptive knowledge and factors related to the index pregnancy. Setting: Queen Elizabeth Central Hospital, Blantyre, Malawi. Design: Cross-sectional, descriptive study. Methods: All adolescents treated for incomplete abortion, January to December 1997 were eligible. Data was collected by means of interviewer-administered questionnaire, one for each, during reproductive health education and/or post abortion contraceptive counselling and service provision. This was subsequently analysed using EPI-INFO 6.0 data analysis packages. Of the 465 adolescents treated during this period, 446 (95.9%) were enrolled in the study. Their mean age was 17.5 years (SD 1.3), that at menarche and sexual debut 14.3 years (SD 1.4) and 15.7 years (SD 1.75) respectively. The unmarried adolescents formed 43.9%, while students comprised 38.6% of the total. Their level and accuracy of knowledge on reproductive biology was poor. While their contraceptive knowledge was high, its use was very low, 70.9% vs 9.5% respectively. The number of sexual partners one had had ranged from 1 to 10 with a median of 1. The index pregnancy was reportedly unwanted by 45.1%. The young (< 16 years), more educated, single and students were more likely to have unwanted pregnancy. Sexual activity starts early in Malawi, with poor contraception, thus predisposing to unwanted pregnancy. Lack of appropriate reproductive awareness appears to be partly responsible for that. These need to be addressed through the national reproductive health programmes and services. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Gichangi, P. B.

Reproductive health awareness among adolescents (editorial)
2003, East African Medical Journal, N°80, 7, p. 337-338

Mots clés : adolescent; âge; avortement; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; éducation sexuelle; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; infection/complication; Infections génitales/IST/MST; jeune/adolescent; maladie; maladie sexuellement transmissible/MST/IST; planning familial; planning familial, acceptante; population; préservatif/ condom; santé; santé de la reproduction; système de santé
Pays : Afrique; Afrique subsaharienne

Résumé : By the end of 1997, there were 1.5 billion young people (between the ages of 10 and 24) in the world , 85% of them living in the developing countries. These young people face numerous reproductive heath challenges worldwide. Cardinal among these challenges include: unsafe sex, unwanted pregnancies, unsafe abortion, HIV/AIDS and other classical (sexually transmitted diseases) increased vulnerability to sexual abuse and lack of access to reproductive health services. These challenges are related to lack of and/or could be ameliorated by improving reproductive health awareness. Attitudes of adults such as denial of the fact that adolescents are sexually experienced at very tender age negatively impacts on improvement of reproductive awareness among adolescents. (excerpt)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Sunmola, A. M.; Dipeolu, M.; Babalola, S.; Adebayo, O. D.

Reproductive knowledge, sexual behaviour and contraceptive use among adolescents in Niger State of Nigeria
2003, African Journal of Reproductive Health, N°7, 1, p. 37-48

Mots clés : adolescent; âge; avortement; célibataire; comportement à risque; comportement reproductif; comportement sexuel; comportements; connaissance; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; enquête; enquête démographique et de santé/EDS; facteur culturel; facteur démographique; fécondité; infection VIH; infection/complication; Infections génitales/IST/MST; jeune/adolescent; maladie; maladie sexuellement transmissible/MST/IST; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; nuptialité; planning familial; planning familial, acceptante; population; préservatif/ condom; rapport de recherche; VIH
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Eight hundred and ninety six adolescents aged 11-25 years were recruited into this study using a multi-stage random sampling method. Overall, about 33% of them had already had first sexual experience but more males than females reported having experienced first sexual encounter. Only 3.6% of the respondents were married. One half of the sexually experienced adolescents had more than one sexual partner at the time of the study. A majority of the respondents (91.9%) had heard about HIV/AIDS and at least a STD. A wide disparity was found in knowledge and use of the contraceptive methods studied, ranging from 41.9% to 63.8% for knowledge and from 0.7% to 12.5% for use. Knowledge and use of condom was highest. For prevention of HIV/AIDS, more males than females thought condom was useful. More Gwari and Hausa respondents claimed that they did not use any family planning method during their first sexual relationship than Yoruba and Igbo respondents. There is need for reproductive health programmes to intensify efforts towards improving adolescents' attitudes to risky sexual behaviours and motivate them to undertake behaviours that would limit such risks. (author's)
Huit cent quatre-vingt-seize adolescents âgés de 11-25 ans ont été recrutés pour faire partie de cette étude qui a été effectué à l'aide de la méthode d'échantillonnage à multiples étapes. D'ensemble, environ 33% d'eux avaient déjà eu un premier rapport sexuel, mais il y avaient plus des hommes qui avaient déclaré avoir eu une première expérience du rapport sexuel. Seuls 3,6% des interrogés étaient mariés. La moitié des adolescents qui étaient sexuellement expérimentés avaient plus d'un partenaire sexuel au moment où l'étude a été menée. La majorité des interrogés (91,9%) étaient au courant de l'existence du VIH/SIDA et au moins d'une MST. Il y avait un grand écart entre la connaissance èt l'emploi des méthodes contraceptives, qui allait de 41,9% jusqu'à 63,8% pour la connaissance et de 0,7% à 12,5% pour l'emploi. La connaissance et l'emploi du préservatif étaient les plus élevés. Quant à la prévention du VIH/SIDA, il y avait plus des hommes que des femmes qui ont pensé que le préservatif était utile. Plus des interrogés d'origine gwari et haoussa que les interrogés d'origine yorubas et ibo ont déclaré qu'ils n'avaient pas employé la méthode de planification familiale au cours de leurs premiers rapports sexuels. Il faut que les programmes de la santé reproductive intensifient leurs efforts vers l'amélioration des attitudes des adolescents envers les comportements sexuels à risque et de les motiver de façon à ce qu'ils puissent se comporter de manière à réduire de tels risques. (de l'auteur)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Rapport

World Health Organisation (WHO)

Safe abortion : technical and policy guidance for health systems
2003, Geneve, WHO, p. 110

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; clinique/service de santé; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; grossesse; intervention chirurgicale; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maladie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Nations Unies; OMS; organisation; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme d'activités; santé; santé publique; Sécurité; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; traitement/soin

Résumé : An estimated 46 million pregnancies end in induced abortion each year. Nearly 20 million of these are estimated to be unsafe. About 13 per cent of pregnancy-related deaths have been attributed to complications of unsafe abortion, and probably number about 67,000 deaths annually. In developing countries, the risk of death following complications of unsafe abortion procedures is several hundred times higher than that of an abortion performed professionally under safe conditions. Complications resulting from unsafe abortion contribute to serious sequelae for women's health such as infertility.
Chapter 1 Summary Since no contraceptive is 100 per cent effective, there will continue to be unwanted pregnancies which women may seek to end by induced abortion. In almost all countries the law permits abortion to save the woman's life and in most countries abortion is allowed to preserve the physical and mental health of the woman. Safe abortion services, as provided by law, therefore need to be available, provided by well-trained health personnel supported by policies, regulations and a health systems infrastructure, including equipment and supplies, so that women can have rapid access.

Site web : http://whqlibdoc.who.int/publications/2003/9241590343.pdf

Thèse

Geelhoed, D. W.

Safe motherhood : reproductive health matters in rural Ghana
2003,  Leiden, Universiteit Leiden, p. 151  

Mots clés : avortement; avortement provoqué, mortalité; complication grossesse; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; grossesse; maternité; mortalité; santé de la reproduction; zone rurale
Pays : Ghana

Article de périodique

Feldman, R.; Maposhere, C.

Safer sex and reproductive choice: findings from "positive women: voices and choices" in Zimbabwe
2003, Reproductive Health Matters, N°11, 22, p. 162-173

Mots clés : avortement; comportement sexuel; comportements; comportements reproductifs; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; droit de l'homme; droits reproductifs; Dynamique démographique; facteur démographique; famille; femme; grossesse non prévue/grossesse non désirée; planning familial; planning familial, acceptante; population; préservatif/ condom; rapport de recherche; taille famille
Pays : Afrique; Zimbabwe

Résumé : Positive Women: Voices and Choices was an advocacy-research project developed by the International Community of Women Living with HIV/AIDS to explore the impact of HIV/AIDS on women's sexual and reproductive lives, challenge the violation of their rights and advocate improvements in policy and services. The project in Zimbabwe, the first one in three countries, was carried out from 1998 to 2001. This article presents selected findings from the Zimbabwe research report. It shows that HIV-positive women were unaware they were at risk before an HIV diagnosis, and that gender norms and economic dependence on husbands/partners restricted women's ability to control their sexual and reproductive lives. Prejudices that HIV-positive women should not be sexually active or have children meant women did not disclose their status to health workers, making it difficult for their needs to be acknowledged or addressed. Condom use was considered inappropriate in marriage. Younger childless women wanted to become pregnant, often in spite of previous miscarriage and stillbirths. Women with several children wanted to avoid further pregnancies, and contraceptive and condom use increased markedly after HIV diagnosis, especially among those attending support groups. Safe abortion was almost entirely inaccessible, though technically the law would have permitted it. Better economic opportunities for women, and integrated pregnancy and delivery care, family planning, STI and HIV-related services are needed which take account of HIV-positive women's needs. (author's)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

El-Tagy, A.; Sakr, E.; Sokal, D. C.; Issa, A. H.

Safety and acceptability of post-abortal IUD insertion and the importance of counseling
2003, Contraception, N°67, 3, p. 229-34

Mots clés : adolescent; adulte/âge; adultère; avortement; avortement spontané; avortement spontané/fausse couche; complication grossesse; counseling; dilatation curetage/ méthode; effets secondaires; grossesse; médecine traditionnelle/ méthodes; méthodes; planning familial; planning familial, acceptante
Pays : Egypte

Résumé : This nonrandomized observational clinical study evaluated the safety and acceptability of intrauterine device insertion either immediately or 2 weeks after abortion, according to the patient's preference. Participants were 300 women with first-trimester abortions who agreed to immediate or delayed insertion. End points were bleeding patterns, pregnancy, expulsion, perforation, infection and device removal at 2, 6 and 10 weeks after insertion, and acceptance rates before and after counseling procedures were improved. The overall initial acceptance rate was 35.8%, and the actual acceptance rate was 31.7%. After counseling procedures were improved, the initial and actual acceptance rates increased substantially (17.7% vs. 44.3% and 10.2% vs. 42.0%, respectively). Bleeding, expulsion rates and pain did not differ significantly between the immediate and delayed insertion groups after IUD insertion. No pregnancies, perforations or cases of pelvic inflammatory disease were recorded in either group. Immediate post-abortal insertion offers the advantage of being a painless procedure. The quality of counseling is critical to improving acceptance of post-abortion contraception.

Site web : http://www.contraceptionjournal.org/

Rapport

Onyango, S.; Mitchell, E. M. H.; Nyaga, N.; Turner, K. L.; Lovell, R.

Scaling up access to high-quality postabortion care in Kenya: An assessment of public and private facilities in Western and Nyanza Provinces
2003, NY, Ipas, p. 67

Mots clés : soins post avortement
Pays : Kenya

Résumé : This report offers an in-depth look at postabortion care (PAC), both in its availability and the potential to expand PAC in six districts in Western and Nyanza
Provinces in Kenya. This report is based on a multi-method facility assessment conducted in November 2002 as well as a survey of community members from Maendeleo ya Wanawake, Kenya's largest women's organization.We measured the quality of PAC in a representative sample of forty-one public, private and missionaffiliated facilities, as well as the capacity for introducing PAC into sixty-seven additional facilities.This project covers multiple levels of the health system, with particular emphasis on the primary and secondary levels of care.

Site web : http://www.ipas.org/publications/en/SCUPKEN_E03_en.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Makhlouf, A. M.; Al-Hussaini, T. K.; Habib, D. M.; Makarem, M. H.

Second-trimester pregnancy termination: comparison of three different methods
2003, Journal of Obstetrics and Gynaecology, N°23, 4, p. 407-411

Mots clés : avortement; avortement provoqué, coût; biologie; complication grossesse; contraception d'urgence/ contraception postcoitale; coût; essais clinique; étude comparée; étude/études; évaluation; facteur démographique; grossesse; méthodologie; Misoprostol/méthode/cytotec; Organisation et Administration; planning familial; planning familial, acceptante; population; prostaglandins/hormones; rapport de recherche; reproduction
Pays : Afrique; Egypte

Résumé : The object of this study was to compare intravaginal misoprostol and dinoprostone (prostaglandin E/2) for second-trimester pregnancy termination, and to examine the role of the nitric oxide donor, glyceryl trinitrate, as a possible alternative to prostaglandins to induce cervical ripening in second-trimester pregnancy termination. This was a randomised clinical trial. The trial involved pregnant women between 13 and 28 weeks' gestation admitted with clear medical or obstetric indications for pregnancy termination, and was carried out in the department of obstetrics and gynecology, Assiut University Hospital, Egypt. Patients were classified into Group A, where pregnancy termination was induced by vaginal misoprostol 100 micrograms every 4 hours with a maximum dose of 500 micrograms; Group B, where induction was by vaginal dinoprostone 6 mg every 6 hours with a maximum dose of 24 mg; and Group C, where induction involved vaginal glyceryl trinitrate 500 micrograms every 6 hours with a maximum dose of 2.5 mg. Twenty-four hours after the start of induction, the rate of complete abortion in the three groups was 100%, 66.67% and 0%, respectively. The rate of complete abortion was 100% in the nitric oxide (glyceryl trinitrate)-induced group after introducing a complementary procedure. The induction - abortion interval was significantly shorter, the number of doses needed was less and the maximum Bishop score reached was greater with misoprostol than with dinoprostone. A higher rate of side effects occurred with the misoprostol-induced group (74%) compared with the other two groups (46.6% and 0%). Misoprostol is a cheap, effective drug for second-trimester pregnancy termination with short induction abortion intervals but a higher rate of side effects. Prostin E/2 is also effective in termination of second-trimester pregnancy but is expensive and may require high doses to be administered. Glyceryl trinitrate is an effective drug for cervical ripening (softening) but it has no role in the stimulation of uterine contractions. (author's)


Rapport

Koster, W.

Secret strategies : women and abortion in Yoruba society, Nigeria
2003, Health, culture and society : studies in medical anthropology and sociology, Amsterdam, Aksant, p. 385

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; femme; régulation des naissances
Pays : Nigeria

Article de périodique

Glover, E. K.; Bannerman, A.; Pence, B. W.; Jones, H.; Miller, R.; Weiss, E.; Nerquaye-Tetteh, J.

Sexual health experiences of adolescents in three Ghanaian towns
2003, International Family Planning Perspectives, N°29, 1, p. 32-40

Mots clés : adolescent; adulte/âge; adultère; âge; avortement pour viol; complication grossesse; comportement sexuel; connaissances, attitudes, pratiques; enfant /enfance; épidémiologie; femme; genre; grossesse; homme; psychologie/facteur psychologique; sexualité sans risque; Statistique; viol; violence/abus sexuel
Pays : Ghana

Résumé : CONTEXT: Ghanaian youth are greatly affected by widespread social change, and their reproductive health needs may differ by social group, age and gender. METHODS: In-person interviews on sexual health issues were conducted with 704 never-married youth aged 12-24 in three Ghanaian towns. The sample included youth who were in school, in apprenticeship programs or in neither school nor apprenticeship programs (unaffiliated). RESULTS: More than half of the respondents had ever had sexual intercourse (52%), with the adjusted odds for females being 1.6 times those for males and the odds for unaffiliated and apprenticed youth being 2.5-3.2 times those for in-school youth. The odds of having had sex in the previous month were elevated for females (2.0) and apprentices (2.7). Both sexes tended to accept violence towards women, with unaffiliated youth showing the highest level of acceptance and in-school youth the lowest. Nearly all respondents (99%) knew of condoms, but fewer than half (48%) could identify any of four elements of correct use; females and sexually inexperienced youth were the least informed. Two-thirds of respondents considered it unacceptable for males to carry condoms, and three-quarters considered it unacceptable for females. Twenty-five percent of males and 8% of females reported having had a sexually transmitted infection. One-third of sexually experienced females reported having ever been pregnant; of those, 70% reported having had or having attempted to have an abortion. CONCLUSIONS: Adolescent reproductive health programs should be targeted to the needs of specific groups.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Moodley, J.

Short report : saving mothers: 1999 - 2001: original article
2003, South African Medical Journal, N°93, 5, p. 263-265

Mots clés : Cause de décès; causes de décès /décès; complication grossesse; décès; grossesse
Pays : Afrique du Sud

Résumé : The 'big five' causes of maternal death in South Africa in the 3 years 1999 - 2001 were non-pregnancy-related infection (mainly AIDS), complications of hypertension in pregnancy, obstetric haemorrhage, pregnancy-related sepsis and pre-existing medical conditions. Women 35 years and older were at greater risk of dying than younger women, and women in their first pregnancy or who had had 5 or more pregnancies were also at greater risk. Recommendations have been made by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) that address the problems of avoidable factors. If implemented, these should result in a reduction of maternal deaths.

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Rapport

Dabash, R.; Diagne, A.; Ndong, I.

Taking postabortion care services where they are needed: an operations research project testing PAC expansion in rural Senegal
[Porter les services de soins post-avortement aux populations qui en ressentent le besoin : projet de recherche opérationnelle en vue d'évaluer l'expansion des soins post-avortement (SPA) dans les zones rurales du Sénégal]
2003, p. 32

Mots clés : aspects socio-économiques; avortement; clinique/service de santé; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; counseling; facteur démographique; facteurs économiques; facteurs socio-économiques; grossesse; maîtrise de la fécondité; planning familial; planning familial, acceptante; population; prévalence contraceptive; programme; programme d'activités; santé; santé de la reproduction; santé publique; Sécurité; service d'urgence; Statut socio-économique; système de santé; USAID
Pays : Afrique; Sénégal

Résumé : Social and health indicators for Senegal suggest a low modern contraceptive prevalence (8.1%) and a high unmet need for family planning (33%), both of which contribute to high rates of unintended pregnancy. Many of these unintended pregnancies end in abortion. Additionally, complications from unsafe abortions contribute to the country's high maternal mortality and take a heavy toll on the lives of Senegalese women, particularly in rural areas. According to Ministry of Health (MOH) statistics for 1994 and 1995, the majority of abortion complications, including incomplete abortions, were reported at sub-regional district-level health sites. To date, the majority of efforts to expand post-abortion care (PAC) services have focused primarily on tertiary-level facilities, mostly urban hospitals. As a result of operations research (OR) demonstrating the impact of an integrated PAC model on quality of care, the MOH proposed to introduce national standards of care for PAC services. Unknown was how these protocols could be applied at lower reference levels (i.e., district health centers and below), particularly outside Dakar, where the majority of PAC cases are not handled by doctors but by mid-level providers who have not traditionally been trained to provide PAC treatment services. In response to these needs, EngenderHealth, in collaboration with the MOH, conducted an OR project to examine the feasibility of introducing an integrated three-element model of PAC services in secondary- and primary-level sites in two predominantly rural regions in Senegal. (excerpt)
Les indicateurs sociaux et de santé relatifs au Sénégal révèlent une faible prévalence des méthodes de contraception modernes (8,1 %) et un besoin élevé non couvert en matière de planning familial (33 %), deux facteurs qui contribuent à l'existence de taux élevés de grossesses non désirées. La plupart de ces grossesses non désirées se terminent par un avortement. En outre, les complications issues d'avortements peu sécurisés d'un point de vue sanitaire contribuent à l'existence d'un taux de mortalité maternelle élevé au sein du pays et sont source de nombreux décès parmi la population féminine du Sénégal, en particulier dans les zones rurales du pays. Selon les statistiques du Ministère de la Santé Publique (MSP) portant sur les années 1994 et 1995, la plupart des cas de complications dans l'avortement, y compris des avortements incomplets, ont eu lieu dans les centres de santé au niveau des districts ruraux. À ce jour, la majorité des efforts visant à étendre les services de soins post-avortement (SPA) ont surtout été concentrés autour des structures relevant du secteur tertiaire, le plus souvent au sein des hôpitaux des zones urbaines. Suite aux résultats de la recherche opérationnelle (RO) démontrant l'impact d'un modèle intégré de SAP sur la qualité des soins, le Ministère de la Santé Publique (MSP) a projeté d'implanter à l'échelle nationale des normes de soins applicables aux services de traitement des SPA. On ne savait pas de quelle manière ces protocoles pouvaient être appliqués à des niveaux de référence inférieurs (à savoir dans les centres de santé des circonscriptions, et structures de niveau inférieur), et en particulier en dehors de Dakar, où la majorité des cas de SAP ne sont pas gérés par des médecins mais par des dispensateurs de soins intermédiaires, qui n'ont pas suivi de formation traditionnelle en vue de pouvoir prodiguer des services portant sur le traitement des SAP. En réponse à ces besoins, l'organisation EngenderHealth, en collaboration avec le Ministère de la Santé Publique (MSP), a conduit un projet de RO (Recherche Opérationnelle). Ce projet vise à examiner la possibilité d'implanter un modèle intégré à trois composantes de services SPA au sein de centres de niveau secondaire et primaire dans deux régions majoritairement rurales du Sénégal. (extrait)

Site web : http://www.dec.org/pdf_docs/PNACU603.pdf

Rapport

Mitchell, E. M. H.; Halpern, C. T.; Farhat, T.; Kamathi, E. M.; Steibelt, E.

Teen Web Nairobi: results of a web-based project to survey and educate students about health
2003, Ipas,The Carolina Population Center,

Mots clés : adolescent; âge; avortement; communication; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; éducation; éducation sexuelle; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; grossesse; jeune/adolescent; méthodologie; partenaire sexuel; planning familial; planning familial, acceptante; population; préservatif/ condom; rapport de recherche; réseaux d'information
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : This report summarizes the results of the pioneering Teen Web Kenya study, which used the Internet as a research and educational tool in low-resource settings. We hope these results will galvanize further action among those who support policies and interventions to improve adolescents' access to reproductive-health information and services. We welcome input and ideas about how these findings can best stimulate and inform policies and practices aimed at the advancement of youth. This study paints a detailed portrait of the students of Nairobi's public secondary schools. They are both very keen and yet rather unprepared to join the adult world with its attendant responsibilities. We think you will find the results tell a compelling story that cannot be ignored. (excerpt)

Site web : http://www.ipas.org/publications/en/TEENWEBN_E04_en.pdf

Chapitre d'ouvrage

Mundigo, A. I.

The Challenge of Induced Abortion Research: Transdisciplinary Perspectives
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 49-64

Mots clés : aspect politique; avortement

Article de périodique

da Costa, P. C.; Donald, F.

The experience of person-role conflict in doctors expected to terminate pregnancies in the South African Public Sector
2003, South African Journal Of Psychology, N°33, 1, p. 10-18

Mots clés : avortement
Pays : Afrique du Sud

Résumé : This study examines the experiences of person-role conflict amongst doctors working in obstetrics and gynaecology with regard to the provision of abortion services in the public sector. Fifteen doctors were interviewed in order to assess their personal experiences and the role forces that were evident, especially in situations where doctors were confronted with the expectation that they terminate pregnancies either on demand or for social reasons. This study explores the role forces that are operating, attitudes towards abortion versus willingness to perform abortions, the potential impact on the quality of service provided, and the personal implications of person-role conflict for the doctors.


Thèse

Chapman, S. E.

The impact of unintended and unplanned pregnancy on maternal health care use : a panel study of Morocco
2003, Baltimore, MD, Johns Hopkins university,, p. 196

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; enquête par sondage; programme planification familiale; service de santé maternelle
Pays : Maroc

Article de périodique

Olatunji, A. O.; Sule-Odu, A. O.

The pattern of infertility cases at a university hospital
2003, West African Journal of Medicine, N°22, 3, p. 205-7

Mots clés : avortement; contraceptifs de barrière
Pays : Nigeria

Résumé : Pattern of infertility cases attending the gynaecologic out patient clinic of Ogun State University Teaching Hospital, Sagamu Nigeria is presented. The incidence of infertility was found to be 14.8% with a mean duration of 3.38 +/- 1.65 years. Secondary infertility predominated with 78.3% incidence. About three quarters (71.1%) were between 25 and 34 years of age and only 6.0% were below 25 years of age Nullipara constituted majority of cases with 56.6%. Past history of induced abortion was significantly present in those with tubal blockage. Male factor only was the cause in 26.8%, female factor only in 51.8% and both male and female factors were contributory in 21.4% cases. The male partners refused semen analysis in about one third of cases (32.5%).
L' objet de cet étude est basé sur la tendance des cas qui allaient au dispensaire gynécologique du centre hospitalo universitaire de l'Etat d'Ogun, Sagamu, Nigeria. L'incidence de la stérilité trouvée d' être 14,8% avec la durée moyenne de 3,38+ 1,65 ans. La stérilité sécondaire prédominante avec l'incidence de 78,3%. Environ trios quart soit 71,1% étaient entre 25 et 34 ans et 6,0% seulement était de moins de 25 ans. Nullipara a constitué la plus grande partie des cas avec 56,6%. Dossiers médicaux du passé sur l'avortement provoqué était manifesttement importants chez les patients atteints de l'obstruction tubale. Facteur de l'homme était seulement la cause en 26,8%. Facteurs des femmes seulement en 51,8% et les deux facteurs étaient concourants en 21,4% des cas. L'analyse du sperme réfusé des hommes chez environ un tiers des cas soit 32,5%.

Site web : http://www.ajol.info/journal_index.php?jid=177 tran=0 ab=0

Article de périodique

Yeneneh, H.; Andualem, T.; Gebreselassie, H.; Muleta, M.

The potential role of the private sector in expanding postabortion care in Addis Ababa, Amhara and Oromia regions of Ethiopia
2003, Ethiopian Journal of Health Development, N°17, 3, p. 157-165

Mots clés : avortement; client patient relation; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; curetage; curetage/méthode; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur économique; facteurs économiques; hygiène; intervention chirurgicale; intervention chirurgicale/méthode; méthodologie; planning familial; planning familial, acceptante; rapport de recherche; santé; santé publique; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; traitement/soin
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : Unsafe abortion is a major contributor of maternal mortality and morbidity in Ethiopia. High disease burden and underdeveloped infrastructure entail involvement of all partners in responding to health needs in the country. The private sector has apparently not been exploited to the fullest extent so far. Objective: To assess the potential of private facilities in expanding access to postabortion care (PAC). A cross-sectional study of private health facilities in Addis Ababa, Amhara and Oromia was conducted in 2001-2, using a pretested questionnaire and a checklist. We assessed 88, 31 and 32 facilities in Addis Ababa, Amhara and Oromia, respectively. Treatment was provided by 44%, 52% and 63% of the eligible facilities in Addis Ababa, Amhara and Oromia, respectively. Manual vacuum aspiration (MVA) was used in treating 61% of Addis Ababa patients whereas sharp curettage was used in over 80% of those in Amhara and Oromia. About 80% of women did not get postabortion family planning methods. Patient-provider interaction was generally satisfactory. High-level disinfection (HLD) of non-autoclavable instruments needed improvement. All medium and above clinics have at least one GP and many have nurse/midwives. The vast majority of facilities not giving the service would like to provide comprehensive PAC if staff are trained and equipment made available in the market. Private health facilities can contribute substantially if given the necessary guidance and support with proper monitoring and evaluation. (author's)


Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Article de périodique

Sibanda, A.; Woubalem, Z.; Hogan, D. P.; Lindstrom, D. P.

The proximate determinants of the decline to below-replacement fertility in Addis Ababa, Ethiopia
2003, Studies in Family Planning, N°34, 1, p. 1-7

Mots clés : contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; fécondité; fécondité maritale; méthodologie; population; rapport de recherche; taux de fécondité; taux natalité; transition de la fécondité
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Guillaume, A.

The role of abortion in the fertility transition in Abidjan (Côte d'Ivoire) during the 1990s
2003, Population (english edition), N°58, 6, p. 657-686

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; incidence; mesure; méthodologie; planning familial; planning familial, acceptante; population; population urbaine; rapport de recherche; transition de la fécondité; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Côte d'Ivoire

Résumé : This article addresses the sensitive, complex and largely un- explored question of abortion in Africa, drawing on original survey data to complete data from the Demographic and Health Surveys .It focuses specifically on the determinants of fertility decline in an African metropolis, Abidjan. For a country where abortion is illegal and access to family planning limited, she explores the interaction between the recourse to abortion and contraceptive practices (natural or traditional versus modern). The author shows the role of abortion in fertility regulating strategies, which has potentially serious consequences both for women and for society in general


Reproduced with the permission of Population : http://www.ined.fr/publications/population/index.html

Chapitre d'ouvrage

Anarfi, J. K.

The Role of Local Herbs in the Recent Fertility Decline in Ghana: Contraceptives or Abortifacients?
2003 - in Basu, A. M., The sociocultural and political aspects of abortion - Global perspectives, Westport, Connecticut London, Westport, Connecticut London, p. 139-152

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; fécondité
Pays : Ghana

Ouvrage

Basu, A. M.

The sociocultural and political aspects of abortion - Global perspectives.
2003, Westport, Connecticut London, Praeger, p. 275

Mots clés : avortement provoqué; avortement provoqué, déterminant; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant; législation; Recherche; scolarité
Pays : Afrique; Bangladesh; Guinée; Mexique; Nigeria; Roumanie; Russie; Tanzanie

Résumé : Seeking to define the ways various cultures view pregnancy, miscarriage, and abortion, this multidisciplinary collection of essays seeks to illustrate how these views influence policy decisions and practices regarding abortion around the world. Putting questions of pro-life and pro-choice aside, the contributors provide demographic coverage of the issues involved and contextualize some of the personal realities that underlie the approximately 50 million abortions that are believed to take place yearly worldwide. While the political and social climates in which women seek abortions vary from place to place, many of the chapters try to understand the moral implications that guide the decision to end a pregnancy from the perspective of the those who seek to do so. Focusing primarily on developing nations, this important contribution to the literature on abortion provides readers with a careful overview of the different meanings attached to abortion depending on the cultural, social, and political climate. Areas covered include Tanzania, Bangladesh, West Africa, Ghana, Romania, Russia, Mexico, and Nigeria. General chapters on induced abortion, demographic research and abortion policy, and social pressures to abort are also included. This unique approach to the study of abortion will contribute to a greater understanding of a prominent social issue


Article de périodique

Geelhoed, D. W.; Visser, L.; Asare, K.; Schagen van Leeuwen, J. H.; van Roosmalen, J.

Trends in maternal mortality: a 13-year hospital-based study in rural Ghana
2003, European Journal of Obstetrics, Gynecology and Reproductive Biology, N°107, 2, p. 135-139

Mots clés : avortement provoqué, mortalité; Cause de décès; communication; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; études statistiques; facteur démographique; maladie; maternité sans risque; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; rapport de recherche; santé; santé maternelle; zone rurale
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : Objective: To measure the impact of the Safe Motherhood Initiative (SMI) on hospital-based maternal mortality since its start in 1987. Study design: Retrospective analysis of all 229 maternal deaths in a district hospital in rural Ghana, between 1 January 1987 and 1 January 2000. Main outcome measures were maternal mortality ratio and relative contribution of causes of maternal deaths to overall maternal mortality. Chi-square test was used to assess differences in proportions, and relative risks with confidence intervals were calculated. Results: The overall maternal mortality ratio of 1077/100,000 live births did not change significantly during the study period. However, the relative contributions of sepsis, hemorrhage, obstructed labor, anemia/sickle cell disease and (pre-) eclampsia diminished, while abortion complications increased significantly. Conclusions: The Safe Motherhood Initiative in the study area has contributed to the reduction of maternal mortality due to causes against which interventions were directed. Abortion complications as cause of maternal mortality need to be included in interventions and research. (author's)


Article de périodique

Grimes, D. A.

Unsafe abortion: the silent scourge
2003, British Medical Bulletin, N°67, 1, p. 99-113

Mots clés : avortement à risque; curetage; curetage/méthode; Misoprostol/méthode/cytotec; taux d'avortement à risque
Pays : Inde; Zambie

Résumé : An estimated 19 million unsafe abortions occur worldwide each year, resulting in the deaths of about 70,000 women. Legalization of abortion is a necessary but insufficient step toward improving women's health. Without skilled providers, adequate facilities and easy access, the promise of safe, legal abortion will remain unfulfilled, as in India and Zambia. Both suction curettage and pharmacological abortion are safe methods in early pregnancy; sharp curettage is inferior and should be abandoned. For later abortions, either dilation and evacuation or labour induction are appropriate. Hysterotomy should not be used. Timely and appropriate management of complications can reduce morbidity and prevent mortality. Treatment delays are dangerous, regardless of their origin. Misoprostol may reduce the risks of unsafe abortion by providing a safer alternative to traditional clandestine abortion methods. While the debate over abortion will continue, the public health record is settled: safe, legal, accessible abortion improves health.

Site web : http://bmb.oxfordjournals.org/archive/

Article de périodique

Moodley, J.; Akinsooto, V. S.

Unsafe abortions in a developing country: has liberalisation of laws on abortions made a difference?
Avortement dangereux dans un pays en développement
2003, African Journal of Reproductive Health, N°7, 2, p. 34-38

Mots clés : aspects socio-économiques; avortement; avortement provoqué, loi; avortement provoqué, mortalité; comportement reproductif; comportement sexuel; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude prospective; facteur démographique; facteurs économiques; facteurs socio-économiques; fécondité; femme; grossesse non prévue/grossesse non désirée; législation; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); méthodologie; morbidité; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; rapport de recherche; Statut socio-économique
Pays : Afrique du Sud; Afrique subsaharienne

Résumé : Unsafe abortion is still a major cause of maternal morbidity and mortality in Africa. To assess whether the introduction of legal abortions in South Africa has decreased admissions resulting from mid-trimester abortions, a prospective study of abortion cases admitted to the King Edward VIII Hospital, Durban, South Africa, over a four-month period was carried out. Two hundred and four women were admitted with incomplete abortion; 49% of which were spontaneous, 17% certainly induced, 10% probably induced, 18% possibly induced and 4.3% legally induced. A change in the laws on termination of pregnancy (TOP) has resulted in a decrease in cases of incomplete abortion being admitted to the gynaecological wards. However, illegal TOPs are still prevalent for a variety of reasons. There is need to place more emphasis on the delivery of efficient contraceptive services and reproductive health education for women.
La libéralisation des lois sur l'avortement légal a-t-elle fait une différence? L'avortement dangereux demeure encore une cause principale de la morbidité et mortalité maternelle en Afrique. Pour vérifier si l'introduction de l'avortement légal en Afrique du Sud a diminné les admissions occasionnées par les avortements qui se produisent dans le deuxième trimestre, nous avons mené une étude prospective sur les cas d'avortement qui ont été admis dans le King Edward VIII Hospital à Durban en Afrique du Sud, pendant quatre mois. Deux cent quatre femmes ont été admises pour l'avortement inachevé; 49% étaient spontanées, 17% étaient sûrement déclenchés, 10% étaient probablement déclenchés, 18% étaient peut-être déclenchés alors que 4,3% étaient légalement déclenchés. Une modification sur les lois de l'interruption de grossesse (IDG) a abouti à la réduction de cas d'interruption de grossesse qu'on admet dans les salles de gynécologie à l'hôpital; néanmoins, les IDG illégales sont encore prévalentes pour diverses raisons. Il faut mettre davantage l'accent sur la prestation efficace des services de contraceptifs et l'éducation de la santé reproductive au profit de la femme.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Jimoh, A. A. G.

Utilisation of Antenatal Services at the Provincial Hospital, Mongomo, Guinea Equatoria
Utilisation des services de soins prénatals à l'hôpital provincial de Mongomo, Guinée Equatoriale
2003, African Journal of Reproductive Health, N°7, 3, p. 49-54

Mots clés : avortement

Résumé : This prospective study was carried out to evaluate the utilisation of antenatal care at the Provincial Specialist Hospital, Mongomo, Guinea Equatoria, paying close attention to the confounding factors affecting effective antenatal care (ANC) delivery. Information was elicited from 200 pregnant women attending the antenatal clinic using a questionnaire. Previous antenatal clinic attendance was high (92.5%). However, with increasing gestation, the percentage of those who never had antenatal care increased. Poor ANC attendance is associated with more abortions and poor obstetric performance. Higher levels of education generally improved ANC attendance, particularly early booking for ANC. Hospital workers, husbands and parents were the greatest influence on ANC attendance. Universal education of the women, improved health education, community involvement and integration of traditional birth attendants (TBAs) are significant suggestions made by the patients for improving the delivery of antenatal care.
Cette étude prospective a été menée pour évaluer l'utilisation des services de soins prénatals à l'Hôpital Spécialisé Provincial à Mongomo en Guinée Equatoriale, en mettant l'accent sur les facteurs déconcertant qui affectent les prestations des soins prénatals (SP) efficaces. Nous avons recueilli des renseignements à l'aide des questionnaires au sein des 200 femmes enceintes qui fréquentaient des consultations prénatales. La fréquentation ultérieure de la consultation prénatale était élevé (92,5%). Pourtant, avec l'augmentation de la gestation, il y a eu une augmentation dans le pourcentage de celles qui n'avaient jamais eu des soins prénatals. Une faible fréquentation de la consultation prénatale est lié à des avortements supplémentaires et à des performances obstétriques médiocres. Des niveaux élevés d'éducation ont généralement amélioré la fréquentation à la consultation prénatale, surtout quand il s'agit des s'inscrire tôt pour la consultation prénatale. Les plus grandes influences sur la consultation prénatale était le personnel hospitalier, les maris et les parents. Une éducation universelle des femmes, une meilleure éducation de la santé, l'implication de la communauté et l'intégration des sages-femmes traditionnelles (SFT) sont parmi les propositions importantes données par les patientes pour améliorer la présentation des soins prénatals.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

  2002   
Article de périodique

Moosa, N.

A descriptive analysis of South African and Islamic abortion legislation and local Muslim community responses
2002, Medicine and Law, N°21, 2, p. 257-79

Mots clés : avortement; avortement provoqué, religion; chrétien/religion; loi / législation; religion
Pays : Afrique du Sud

Résumé : The issue of abortion has been the subject of much debate in the recent past in South Africa. Prior to 1996 abortion legislation was punitive and therefore one with which conservative Muslims could identify. Since 1996 the law has been liberalized and replaced by a new Act.


Article de périodique

Fasubaa, O. B.; Akindele, S. T.; Adelekan, A.; Okwuokenye, H.

A politico-medical perspective of induced abortion in a semi-urban community of Ile-Ife, Nigeria
2002, J Obstet Gynaecol, N°22, 1, p. 51-7

Mots clés : connaissances, attitudes, pratiques
Pays : Nigeria

Résumé : This study is designed to document a semi-urban community perspective on induced abortion in Ile-Ife, Nigeria, with a view to estimating community awareness, attitudes and implications of its existence in the community and providing relevant sociopolitical policies and pragmatic educational guidelines for policy makers to solve some of its problems within the Nigerian landscape and beyond. This was a cross-sectional study conducted in April 2000, at Oranfe community in Ile-Ife, South West, Nigeria, which has an estimated population of 5250 inhabitants. We used the survey method with the aid of a well-structured questionnaire. One hundred and eighty residents of the community were sampled as our subjects for this study. We used the cluster random sampling technique. The main outcome measures were the sociodemographic characteristics of the respondents, knowledge, attitude with perceived solutions to the problems of abortion and relationship of the sociodemographic factors to respondents' knowledge and attitude. The respondents were highly literate, as only 18(11.04%) had no formal education. Eighty-five (52.79%) had good knowledge of abortion while 45 (27.95%) and 31 (19.25%) had fair and poor knowledge, respectively. Thirty-eight (24.05%) respondents felt that the solution to the problems of induced abortion can be obtained through its legalisation; 31 (19.62%) respondents believed that the solution lies in liberalising laws on abortion; provision of safe abortion services was suggested by 30 (18.98%) respondents. One hundred and seven (66.88%) felt that legalisation of abortion will increase its practice while 53 (31.12%) felt that such legalisation will not increase the practice. Similarly, 55 (34.37%) of the respondents emphasised that legalisation would reduce the problems of induced abortion compared with 82 (51.25%) who felt otherwise. One hundred and twenty (73.61%) of the respondents did not believe that the position of the law in Nigeria can stop the practice of induced abortion. Solving the problems of induced abortion in Nigeria requires pragmatic and non-hypocritical sex educational policies, which are widely embracing to sensitise people in the community through public enlightenment programmes. (author's)


Article de périodique

Thonneau, P. F.; Goyaux, N.; Goufodji, S.; Sundby, J.

Abortion and maternal mortality in Africa
2002, New England Journal of Medicine, N°347, 24, p. 1984-1985

Mots clés : avortement; morbidité et mortalité maternelle; mortalité maternelle
Pays : Afrique

Résumé : no abstract


Article de périodique

Dickson-Tetteh, K.; Billings, D. L.

Abortion care services provided by registered midwives in South Africa
2002, International Family Planning Perspectives, N°28, 3, p. 144-150

Mots clés : avortement; collecte; contraception d'urgence/ contraception postcoitale; éducation; Entretien; évaluation; méthodologie; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; programme; Programme de formation; Programme d'évaluation; sage-femme/personnel de santé; santé; santé maternelle; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : South Africa's Choice on Termination of Pregnancy Act, which took effect in 1997, legalized abortion and stipulated that registered midwives can perform abortions for women with pregnancies of no more than 12 weeks' gestation. A program was initiated to train registered midwives throughout South Africa to provide abortion services at primary care facilities. From October 1999 through January 2000, an evaluation was conducted at 27 public health care facilities in South Africa's nine provinces to assess the quality of care provided by midwives who had been trained and certified to provide abortion services. Data were collected by observing abortion procedures and counseling sessions, reviewing facility records and patients' charts, and interviewing patients and certified midwives. Of 96 abortion procedures performed by 40 midwives, 85 involved manual vacuum aspiration. Midwives' clinical practice was rated "good" in 75% of the procedures. No complications occurred during abortion procedures or as a result of the procedures, and no abortion clients died. Midwives consistently provided women with contraceptive counseling after the abortion, and most clients (89%) received a contraceptive method before leaving the facility. The injectable was the only method that was available at all facilities; of the 90 clients who were interviewed about the contraceptive method they reviewed after their abortion, 75% had received this method. Few had received condoms (1%). Midwives can provide high-quality abortion services in the absence of physicians. Training in abortion care should be systematically integrated into midwives' basic training. This training should use postabortion counseling as an opportunity to inform women about dual protection from unwanted pregnancy and sexually transmitted infections. (author's)


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Rapport

Hord, C. E.; Xaba, M.

Abortion law reform in South Africa: report of a study tour, May 13-19, 2001
2002, Johannesburg, South Africa, Ipas, p. 35

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; étude/études; facteur politique; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; rapport; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : This report attempts to summarise some of the main strategies suggested and lessons described by the South African study tour hosts. Its objectives therefore are: to share experiences and lessons learned about South Africa's abortion law reform process with regard to: the legal reform process itself and the implementation of the law once it was passed. To be a useful reference guide and advocacy tool for the participants in the study tour, as well as others interested in changing abortion laws. (excerpt)


Reproduced with the permission of IPAS: http://www.ipas.org

Ouvrage

United Nations; Population Division

Abortion Policies. A global review - vol III Oman to Zimbabwe
2002, New York, United Nations, N°III, III, p. 241

Mots clés : avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; mortalité; planning familial; planning familial, acceptante; politique/programme; population

Résumé : This is the third of three volumes presenting a country-by-country examination of national policies concerning abortion. This volume concerns countries in alphabetical order from Oman to Zimbabwe. The information regards abortion policy, the fertility and mortality context in which abortion policy has been developed, and selected statistics on induced abortion. (ANNOTATION)


Article de périodique

Calvès, A. E.

Abortion risk and decisionmaking among young people in urban Cameroon
2002, Studies in Family Planning, N°33, 3, p. 249-260

Mots clés : adolescent; âge; analyse; avortement; biologie; comportements; contraception d'urgence/ contraception postcoitale; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; facteurs de risque; femme; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Cameroun

Résumé : This study examines the use of induced abortion among Cameroonian adolescents and young women, based on biographical data collected in 1997 among young women and men residing in Yaounde. Results suggest a high prevalence of abortion during adolescence and early adulthood (35% of all pregnancies reported). Although most clandestine abortions were performed by a physician or a nurse, the prevalence of abortion performed by nonmedical personnel or using unsafe methods is still high, and postabortion health complications are reported for about one-fourth of all abortions. Logistic regression models are used to examine the effect of women's, partners', and relationships' characteristics at the time of pregnancy on the odds that a pregnancy will be terminated through abortion. The analysis shows a significant effect of school enrollment, parity, and stability and social acknowledgment of the sexual relationship on the risk of having an abortion. Young men's involvement in decisions and their motivations concerning abortion are also examined. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Berer, M.

Abortion: women decide
2002, Reproductive Health Matters, N°10, 19, p. 220

Mots clés : Accessibilité; aspects légaux; avortement; complications postavortement; santé de la reproduction; Sécurité; service de santé; service de santé communautaire/offre/service de santé
Pays : Afrique; Argentine; Brésil; Colombie; Inde; Mexique; Nicaragua; Nigeria; Pologne; Portugal; Thaïlande

Résumé : This thematic issue reflects the changes taking place with regards to abortion in the past ten years. The papers were written by women's health advocates, medical professionals, researchers and others working for safe, legal abortion in their countries. They describe and analyse the history of efforts undertaken to make abortion safe and legal in their countries, as well as the setbacks and opposition they continue to face.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Ipas

Africa regional summary. The Ipas Africa Alliance for Women's Reproductive Health and Rights
2002, p. 2

Mots clés : facteur démographique; population; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique

Résumé : The Ipas Alliance works to reduce maternal deaths and injuries from unsafe abortion. It strives to increase women's access to sustainable high-quality abortion and related sexual and reproductive health services; and to improve the enabling environment to support women's ability to exercise their sexual and reproductive rights.
L'alliance IPAS oeuvre pour réduire les décès maternels et les affections dues à l'avortement dangereux. Elle lutte pour augmenter l'accès des femmes à l'avortement de qualité durable et aux services apparentés de la santé sexuelle et de reproduction; et afin d'améliorer l'environnement permettant de soutenir la capacité des femmes à exercer leurs droits sexuels et de reproduction.

Site web : http://www.ipas.org/english/where_ipas_works/africa/alliance/index.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Rapport

Brieger, W.

Annoted bibliography of social, demographic, cultural, and behavioral aspects of family planning and reproductive health in Nigeria
2002, Washington, Population technical assistance project (Poptech), LTG Associates Inc. USAID Nigeria,, p. 96

Mots clés : activité sexuelle / sexualité; avortement; bioéthique; choix; circoncision; corcition; coït/sexualité; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; culture; déterminant culturel; déterminant fécondité; droits; droits reproductifs; espacement naissance; facteur culturel; fécondité; genre; maternité sans risque; morbidité et mortalité maternelle; mortalité maternelle; offre contraceptive; prestataires; reproduction; santé de la reproduction; service de santé maternelle; sexe; sexualité; stérilité; taille famille
Pays : Nigeria

Résumé : This report contains an annoted bibliography of social, demographic, cultural, and behavioral aspects of family planning and reproductive health in Nigeria

Site web : http://www.poptechproject.com/pdf/02_081_010.pdf

Article de périodique

Buga, G. A.

Attitudes of medical students to induced abortion
2002, East African Medical Journal, N°79, 5, p. 259-262

Mots clés : attitude; avortement; avortement provoqué, religion; chrétien/religion; comportements; contraception d'urgence/ contraception postcoitale; croyance; culture; déterminant culturel; éducation; étudiant; étudiant/scolarisation; étudiants de médecine; facteur culturel; méthodologie; planning familial; planning familial, acceptante; psychologie/facteur psychologique; rapport de recherche; religion
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can only be offered under conditions where legislation has been passed for legal termination of unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the attitudes of doctors and other health care workers to induced abortion. Medical students as future doctors may have attitudes to abortion that will affect the provision of safe abortion. Little is known about the attitudes of South African medical students to abortion. A cross-sectional analytic study involving the self-administration of an anonymous questionnaire was conducted to assess sexual practices and attitudes of medical students to induced abortion and to determine some of the factors that may influence these attitudes. The questionnaire was administered to medical students at a small, but growing, medical school situated in rural South Africa. The main outcome measures include demographic data, sexual practices and attitudes to induced abortion. 247 out of 300 (82.3%) medical students responded. Their mean age was 21.81 +or- 3.36 (standard deviation [SD]) years, and 78.8% were Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single, 68.6% were already sexually experienced, and their mean age at coitarche was 17.24 +or- 3.14 (SD) years. Although overall 61.2% of the respondents felt abortion is murder either at conception or later, the majority (87.2%) would perform or refer a woman for abortion under certain circumstances. These circumstances, in descending order of frequency, include: threat to mother's life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to mother's mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents would perform or refer for abortion on demand, 12.8% would neither perform nor refer for abortion under any circumstances. Religious affiliation and service attendance significantly influenced some of these attitudes and beliefs. Although many of the medical students personally felt abortion is murder, the majority are likely to perform or refer to patients for abortion under certain circumstances; only about a 10th are likely to perform or refer patients for abortion on demand. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Iloabachie, G. C.; Onah, H. E.

Cervico-vaginal fistula from induced abortions causing subsequent spontaneous midtrimester abortions in Nigerians: case report
2002, Niger Postgrad Med J, N°9, 2, p. 99-101

Mots clés : avortement; avortement spontané; avortement spontané/fausse couche; complication; complication grossesse; durée grossesse; fistule vaginale; grossesse
Pays : Nigeria

Résumé : A report of three cases of cervico-vaginal fistula (CVF) from induced abortions causing subsequent spontaneous mid-trimester abortions and a literature review is presented. Restrictive abortion laws, low contraceptive usage and increased sexual activity consequent upon adverse socio-economic conditions have led to an increase in the prevalence of illegal abortions in Nigeria over the previous two decades. CVF appears to be an emerging complication of such abortions. Cervical cerclage is preferred to trachelorrhaphy in the management of such cases. However, where vaginally performed cerclage does not succeed, the abdominal route should be used as a last resort. After a previous induced abortion, clinicians managing the subsequent pregnancy need to search carefully for cervico-vaginal fistula, which may compromise that particular pregnancy. Appropriate contraceptive use and safe abortions using modern methods in cases of contraceptive failure will prevent such horrendous complications of induced abortions in Nigeria and other developing countries.


Chapitre d'ouvrage

Esiet, A. O.; Whitaker, C.

Coming to terms with politics and gender: the evolution of an adolescent reproductive health program in Nigeria
2002 - in Haberland, N.; ;Measham, D., Responding to Cairo; case studies of changing practice in reproductive health and family planning, New York, Population Council, p. 149-167

Mots clés : adolescent; avortement; culture; déterminant culturel; discrimination; éducation pour la santé; facteur culturel; genre; grossesse adolescente; grossesse adolescente/grossesse; morbidité et mortalité maternelle; mortalité maternelle; préservatif/ condom; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; VIH
Pays : Nigeria

Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Sule-Odu, A. O.; Olatunji, A. O.; Akindele, R. A.

Complicated induced abortion in Sagamu, Nigeria
2002, J Obstet Gynaecol, N°22, 1, p. 58-61

Mots clés : avortement
Pays : Nigeria

Résumé : A review of cases of induced abortion managed at Ogun State University Teaching Hospital, Sagamu from January 1988 to December 1997 is presented. One hundred and two cases were treated for various complaints and complications of induced abortion during the period of review. The findings in this series further highlight the urgent need to eliminate or reduce substantially the factors responsible for septic induced abortion.


Article de périodique

Fawole, A. A.; Aboyeji, A. P.

Complications from unsafe abortion: presentations at Ilorin, Nigeria
2002, Niger J Med, N°11, 2, p. 77-80

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires
Pays : Nigeria

Résumé : This is a retrospective evaluation of the 220 patients that presented at the University of Ilorin Teaching Hospital (UITH) with complications from unsafe abortions between 1st January, 1986 and 31st December 1999. History of previous induced abortion was agreed to by 80.5%, of patients while only 6.8% had previous contraceptive use. Sepsis 204(92.7%) with abscess formation in 64.9%, visceral injuries 62(28.2%) with haemoperitoneum in 25.9% and maternal mortality was recorded in 26.4% of the series. Findings are comparable with previous studies from this centre between 1981 and 1985 and with reports from other parts of the world. The need for behavioural change by the society and the re-training of physicians on post-abortal care is emphasized.


Article de périodique

Oye-Adeniran, B. A.; Umoh, A. V.; Nnatu, S. N.

Complications of Unsafe Abortion: A Case Study and the Need for Abortion Law Reform in Nigeria
2002, Reproductive Health Matters, N°10, 19, p. 18-21

Mots clés : morbidité et mortalité maternelle; mortalité maternelle; offre/ prestataire
Pays : Nigeria

Résumé : Complications of unsafe abortion account for 30-40% of maternal deaths in Nigeria. This paper reports a case of unsafe abortion by dilatation and curettage, carried out by a medical practitioner in a private clinic on a 20-year-old single girl in Lagos, Nigeria. The girl was 16 weeks pregnant. She suffered complications consisting of perforation of the vaginal wall through the utero-vesical space into the abdominal cavity with gangrenous loops of small intestine herniating through it. Information was obtained from her case notes and the operating theatre register. She had a resection and anastomosis of the small intestine and had to remain in hospital, where she made a full recovery, for two weeks. Unsafe abortion is fraught with many complications, including pelvic sepsis, septicaemia, haemorrhage, renal failure, uterine perforation and other genital tract injuries, and gastro-intestinal tract injuries. Where expert, emergency treatment for these is not available, women die. Unsafe abortion procedures, untrained abortion service providers, restrictive laws and high morbidity and mortality from abortion tend to occur together. We advocate for a review of the existing restrictive laws in Nigeria in order to reduce the high morbidity and mortality from unsafe abortion.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Geelhoed, D. W.; Nayembil, D.; Asare, K.; Schagen van Leeuwen, J. H.; van Roosmalen, J.

Contraception and induced abortion in rural Ghana
2002, Tropical Medicine and International Health, N°7, 8, p. 708-716

Mots clés : analyse; avortement; collecte; communauté; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; étude/études; mesure; méthodologie; planning familial; planning familial, acceptante; population; prévalence; prévalence contraceptive; rapport de recherche; résidence; zone rurale
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : This article describes the results of a community-based survey on birth control in a rural district in western Ghana. Structured interviews with 2179 women and men aged 15-49 years were used to study the prevalence of contraceptive methods and induced abortion. In addition, the influence of induced abortion on reported fertility in relation to residence and education was analyzed. The results show that 59.8% had used a contraceptive method at some time in life, while use of induced abortion was reported by 22.6% of respondents. Prevalence of ever-use of any method to avoid childbirth, contraception and/or induced abortion was 67.1%. Urban residence and higher education were associated with more induced abortions and higher use of contraceptive methods. Differences in use of induced abortion were partly responsible for the education and residence-related changes in fertility. Induced abortion needs to be considered when discussing methods in use to avoid childbirth in developing countries. (author's)


Chapitre d'ouvrage

Guillaume, A.; Desgrées du Loû, A.

Contraception et/ou avortement ? Une étude auprès de formations sanitaires d'Abidjan
2002 - in Guillaume, Agnes;Desgrees du Loû, Annabel;Zanou, Benjamin, Santé de la Reproduction en Afrique, Abidjan, Côte d'Ivoire, ENSEA, IRD, p. 267-296

Mots clés : avortement
Pays : Côte d'Ivoire

Article de périodique

Adewole, L. F.; Oye-Adeniran, B. A.; Iwere, N.; Oladokun, A.; Gbadegesin, A.; Babarinsa, L. A.

Contraceptive usage among abortion seekers in Nigeria
2002, West Afr J Med, N°21, 2, p. 112-4

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive
Pays : Nigeria

Résumé : A study on contraceptive usage among abortion seekers in 150 randomly selected health institutions in the most and the least urbanized states of the health zone B representing the South Western states of Nigeria was conducted over a period of 2 months. There were 1839 abortion seekers during the period.


Article de périodique

Desgrées du Loû, A.; Msellati, P.; Viho, I.; Yao, A.; Yapi, D.; Kassi, P.; Welffens-Ekra, C.; Mandelbrot, L.; Dabis, F.

Contraceptive use, protected sexual intercourse and incidence of pregnancies among African HIV-infected women. DITRAME ANRS 049 project, Abidjan 1995-2000
2002, International Journal of STD and AIDS, N°13, 7, p. 462-468

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; sida; Syndrome d'immunodéficience acquise/sida; VIH
Pays : Côte d'Ivoire

Résumé : The aim of this paper is to describe the adherence of African HIV+ women to the counselling provided after announcement of the result of the HIV test during pregnancy, focusing on early weaning to reduce post-natal transmission, protected sexual intercourse to avoid sexual transmission, and contraceptive use to avoid unexpected pregnancies. In 1999- 2000, a questionnaire on sexual and reproductive behaviours was administered to 149 HIV+ women followed in post-partum, informed and counselled in the ANRS 049 DITRAME project in Abidjan. Cote d'Ivoire. Duration of breastfeeding, post-partum amenorrhea and abstinence, contraceptive use and condom use were measured. Incidence of pregnancies during the first 24 months post partum was estimated and modelled by a Cox regression model. Average duration of breastfeeding was 7.9 months, average duration of post partum abstinence was 12.0 months, and 39% of women used contraceptives at the time of the survey. Frequency of condom use was 13%. Incidence of pregnancies was 16.5 per 100 women-years at risk. Half of these pregnancies were not desired and a third were terminated by induced abortion. The significant determinants of the pregnancy occurrence were the death of the previous child, the cessation of breastfeeding, the cessation of the post partum abstinence, and higher education. In conclusion, if counselling on early weaning can be followed by the HIV+ women, it is not easily the case for condom and contraceptive use. Hence, pregnancy incidence in the post-partum follow-up was high. The main strategy of these HIV+ women to avoid unexpected pregnancies as well as sexual transmission of HIV seems to be an increase of the duration of post-partum abstinence. The most educated women who cannot easily adopt this strategy are particularly exposed to unwanted pregnancies.

Site web : http://www.rsmpress.co.uk/std.htm

Rapport

Henry, R.; Fayorsey, C.

Coping with pregnancy; experiences of adolescents in Ga Mashi, Accra
2002, Calverton, Maryland, ORC Macro, MEASURE DHS+, p. 71

Mots clés : adolescent; âge; avortement; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; enquête; étude de cas; étude qualitative; étude/études; facteur démographique; fécondité; femme; grossesse; grossesse adolescente; grossesse adolescente/grossesse; grossesse non prévue/grossesse non désirée; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : Abstract: This study explores the strategies used by adolescent girls living in urban Accra, Ghana to cope with unintended pregnancies. It examines the processes leading to pregnancy and compares the strategy of terminating a pregnancy with that of carrying the pregnancy to term. The study was initiated in response to findings from the 1998 Ghana Demographic and Health Survey (GDHS) indicating that early pregnancy loss among girls age 15 to 19 was twice as high as that of other age groups, and pregnancy loss among urban teens was twice that of rural areas. (excerpt)

Site web : http://www.measuredhs.com/pubs/pdf/QRS5/copingwithpregnancy.pdf

Ouvrage

Bajos, N.; Ferrand, M.; Equipe GYNE

De la contraception à l'avortement . Sociologie des grossesses non prévues
2002 - in Publique, Questions en Santé, Paris, Inserm, p. 345

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; grossesse non prévue
Pays : France

Résumé :
-


Article de périodique

Bateman, C.

Department to take up GP abortion offer
2002, South African Medical Journal, N°92, 6, p. 406-407

Mots clés : avortement; avortement à risque; médecine; service d'avortement; taux d'avortement à risque
Pays : Afrique du Sud

Résumé : Reports on research that revealed gross inequities between rural and urban areas in terms of access to the estimated 300 abortion facilities countrywide

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Gharoro, E. P.; Igbafe, A. A.

Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases
2002, Acta Obstetricia et Gynecologica Scandinavica, N°81, 12, p. 1139-1143

Mots clés : adulte/âge; adultère; complication grossesse; déterminant fécondité; facteurs de risque; fécondité; grossesse; grossesse extra-utérine; incidence; laparotomie; population urbaine; ville/résidence; zone urbaine
Pays : Nigeria

Résumé : Background. Ectopic pregnancy is still a major health problem among women of childbearing age in our community. The majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with previous induced abortion(s) and or pelvic inflammatory disease. It remains a major challenge to the reproductive performance of women worldwide. Objective. The study is an analysis of the clinical profile of patients presenting with ectopic pregnancy, to investigate the current status of the incidence, predisposing risk factors and the management options available in Benin. Materials and methods. One hundred and fifty two cases of ectopic pregnancies managed at the University of Benin Teaching Hospital (UBTH) between January 1994 and December 1998 were analyzed. Clinical and socio-biological information were retrieved from patients' case notes, and supplemented by information from the operating theatre and ward registers. Results. The incidence of ectopic pregnancy during this study period was 1. 68% of total births and 6.74% of and gynecologic admissions. Nulliparous patients were 49.3%, while the peak age of incidence was 20-25 years. 95/152 (62.5%) of the patients had previous induced abortion(s), while pelvic adhesions were noted in 62/152 (40.85~%). 67.8% of the patients were not using any method of contraception, while 13.8% and 9.2% were using IUD and barrier methods, respectively. Abdominal pain, 2° amenorrhoea and irregular vaginal bleeding (83.6%, 77.5% and 73.7%, respectively) were the most frequent presenting complaints. 75/152 of the patients (49.3%) were in a state of shock, and 80.3% had ruptured tubal pregnancy at presentation. All patients had laparotomy, 54.6% and 34.9% had right and left salpingectomy, respectively. 831/52 of the patients (54.6%) had autotransfusion during surgery. Conclusion. In Benin, the majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with history of previous induced abortion(s) and or pelvic inflammatory disease. Management option is limited to laparotomy and salpingectomy. (author's)

Site web : http://www.blackwell-synergy.com/doi/abs/10.1034/j.1600-0412.2002.811207.x

Article de périodique

Abdul, I. F.; Balogun, O. R.; Anate, M.; Kasim, Y. M.; Saka, M. J.; Oganija, Y. S.

Effectiveness of Information, Education and Communication (IEC) on the Public Acceptability of Unsafe Abortion Solutions
2002, Tropical Journal of Obstetrics and Gynaecology, N°19, 1, p. 12-16

Résumé : Context: Public health measures suggested to curb the menace of unsafe abortions in developing countries include liberalization of abortion law, family life education and family planning. However public acceptability of these solution options are poor.
Objective: To examine the efficacy of information, education and communication (IEC) on the public acceptability of unsafe abortion solution options of contraception, family life education including sex education and liberalization of abortion laws. Our aim was to use IEC to improve public acceptability of the recommended solutions.
Methods: Trained questionnaire administrators interviewed randomly selected civil servants in Ilorin, Nigeria to asses the level of their acceptability of the various options. There were 95 respondents for the baseline interviews and 93 respondents for the post IEC interviews. The responses were compared pre- and post-IEC to assess the effectiveness of the IEC.
Results: Contraception for adults was the most acceptable solution to the public both pre- and post-IEC, the acceptability doubling (46.3% to 93.4%) after IEC. Contraception for adolescents, and family life education showed appreciable improved acceptability post IEC (25.3% to 40.2% and 40% to 67.4%) respectively Liberalization of abortion law also appreciated marginally in the amount of yes answers (14.8% to 18.5%). Ironically, the percentage of rejecters also appreciated from 78.9% to 79.3%, giving a very weak correlation coefficient of 0.42.
Conclusion: IEC is effective in improving public acceptability of unsafe abortion solutions. The need for an extension and sustenance of this intervention strategy to all segments of the society for effective advocacy is an imperative

Site web : http://www.ajol.info/journal_index.php?jid=79 ab=tjog

Article de périodique

Murthi, M.

Fertility Change in Asia and Africa
2002, World Development, N°30, 10, p. 1769-1778

Pays : Afrique; Chine; Inde

Résumé : There have been profound changes in fertility rates in Asia and Africa in the past two to three decades. The availability of new data allows a closer examination of fertility trends and underlying causes than has hitherto been possible. The papers examine the role of different explanatory factors in lowering fertility, including female education, declines in child mortality, urbanization, and the spread of mass media and "modern" consumer culture.


Article de périodique

Guillaume, A.; Desgrées du Loû, A.

Fertility regulation among women in Abidjan, Cote d'Ivoire: contraception, abortion or both?
(version en français : Limitation des naissances parmi les femmes d'Abidjan en Cote d'Ivoire: contraception, avortement ou les deux?, perspectives internationalles sur la planning familial, n° spécial 2002: 4-11)

2002, International Family Planning Perspectives, N°28, 3, p. 159-166

Mots clés : avortement; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; fécondité; femme; mesure; méthodologie; planning familial; planning familial, acceptante; population; prévalence; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Côte d'Ivoire

Résumé : In Cote d'Ivoire, where contraceptive prevalence is low, abortion is thought to play an important role in the current fertility decline. However, data on abortion, which is illegal, are scarce. A retrospective survey on abortion and contraceptive practices was conducted in 1998 among 2400 women who attended four general health centers in Abidjan. Multinomial logistic regression was performed to analyze the independent effects of social and demographic variables on the odds that women would adopt one of three fertility regulation behaviors instead of doing nothing at all. Results show that 40% of women reported controlling their fertility through contraceptive use alone, 30% through reliance on both contraception and abortion and 3% through abortion alone; some 27% did nothing to control fertility. Muslims had consistently lower odds than Christians of adopting any of the three behaviors instead of doing nothing (odds ratios (OR), 0.2-0.5). Being unmarried and better educated were associated with significantly elevated odds of adopting each of the three behaviors (OR, 1.4-33.8). Finally, the odds of using abortion alone were significantly higher among women younger than 25 than among those aged 25-34 (2.0). In conclusion, the relationship between abortion and contraception is highly complex. Whereas women who do not have access to contraceptives or who experience method failure often resort to abortion, abortion can also trigger subsequent reliance on contraception. (author's)


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Geelhoed, D. W.; Nayembil, D.; Asare, K.; van Leeuwen, J. H.; van Roosmalen, J.

Gender and unwanted pregnancy: a community-based study in rural Ghana
2002, J Psychosom Obstet Gynaecol, N°23, 4, p. 249-55

Mots clés : avortement
Pays : Ghana

Résumé : This study investigates attitudes concerning unwanted pregnancies in a rural district of western Ghana. Structured questionnaires were used to interview men and women between 15 and 49 years of age (n = 2179) to measure the prevalence of unwanted pregnancy, how often it led to induced abortion and to establish the reasons why a pregnancy was considered unwanted. . Pregnancies perceived by women as unwanted ended more often in an induced abortion than those unwanted by men. Reproductive health programs need to make contraceptives available, accessible and acceptable for both women and men. More research is needed to facilitate a clear understanding of the impact of gender on unwanted pregnancy and its prevention.


Article de périodique

Blanc, A. K.; Grey, S.

Greater than expected fertility decline in Ghana: untangling a puzzle
2002, Journal of Biosocial Science, N°34, 4, p. 475-495

Mots clés : analyse; avortement provoqué, déterminant; célibataire; comportement sexuel; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête démographique et de santé/EDS; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; fécondité; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; méthodologie; nuptialité; planning familial; planning familial, acceptante; population; prévalence contraceptive; rapport de recherche; taux de fécondité; taux natalité; transition de la fécondité
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : This study examines fertility decline that is larger than expected on the basis of recorded increases in contraceptive prevalence in Ghana. The primary sources of data are three Demographic and Health Surveys conducted in the country in 1988, 1993 and 1998. First, the trend in fertility and contraceptive prevalence in Ghana is considered and compared with the trend that would be expected on the basis of prior research. Next, an attempt is made to uncover the explanation behind this unexpected trend. Measures of the quality of the survey data are looked at, as well as trends in the proximate determinants of fertility: contraceptive use, marriage and sexual activity, postpartum insusceptibility and induced abortion. Finally, evidence is presented that couples adjust their coital frequency in accordance with their fertility preferences, behavior that would influence fertility rates but would not be captured by conventional measures of the proximate determinants of fertility. (author's) (© 2002 Cambridge University Press)


Reproduced with the permission of Journal of Biosocial Science: http://www.cambridge.org/uk/journals/journal_catalogue.asp?historylinks=ALPHA mnemonic=JBS

Article de périodique

Gisselquist, D.; Rothenberg, R.; Potterat, J.; Drucker, E.

HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission
2002, International Journal of STD and AIDS, N°13, 10, p. 657-666

Résumé : An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%-40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care. [Journal Article, Review; 106 Refs; In English; England]

Site web : http://www.rsmpress.co.uk/std.htm

Article de périodique

Anonymous

How to help women seeking abortions
2002, MRC News, N°33, 6, p. 23

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; éducation; éducation pour la santé; planning familial; planning familial, acceptante; Recommandations; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : As a result some women die, or incur life-long ill health, and disability including infertility wrought by continued use of unsafe, backyard, or illegal termination of pregnancy services. However, according to a review paper by Prof. Jack Moodley, Director of the Medical Research Council's Pregnancy Hypertension Research Unit, a partnership between the society and the state could help in turning around this sad state of affairs. "Unwanted pregnancies must be recognised as a specific health risk for women and their families. Besides unsafe abortions with resultant mortality and morbidity, unwanted pregnancies may also result in neglect or abandoned children and family violence," says Prof. Moodley. His study has again confirmed that even today women are still being denied access to termination of pregnancy services. Among others, hostile attitudes by health service providers citing moral reasons has inadvertently denied women control over their sexual and reproductive lives. (excerpt)


Congrès

Schuster, S.

Infertility and practice of induced abortion in the Anglophone Grassfields region of Cameroon
Infertilité et pratique de l'avortement provoqué dans la savane anglophone du Cameroun
2002, Conference on "Socio-Medical Perspective on Childlessness", Panaji, India, p. 14

Mots clés : âge; aspects socio-économiques; avortement; avortement provoqué, mortalité; complication; complication grossesse; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; culture; déterminant culturel; Dynamique démographique; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; état matrimonial; étude/études; facteur culturel; facteur démographique; facteurs économiques; facteurs socio-économiques; grossesse; jeune/adolescent; maladie; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; nuptialité; planning familial; planning familial, acceptante; population; rapport de recherche; reproduction; Statut socio-économique; stérilité
Pays : Afrique; Afrique subsaharienne; Cameroun

Résumé : The following examination is based on a qualitative study in an urban area in the anglophone Grassfields region of Cameroon over a period of sixteen months between 1996 and 1997. The objective of the study was to gain a deeper knowledge of why women induce abortions despite possible legal and medical consequences. This has been done by relocating medical issues into their local socio-cultural context and by integrating the special circumstances of women´s lives. Furthermore this study intended to explore to what extent cultural and social grounds prevent a greater acceptance of so called modern contraceptives, besides lack of information and availability. (excerpt)
L'examen suivant repose sur une étude qualitative effectuée dans une zone urbaine dans la savane anglophone du Cameroun sur une période de seize mois entre 1996 et 1997. L'objectif de l'étude était d'acquérir une connaissance plus profonde de la raison poussant les femmes à provoquer des avortements en dépit des conséquences légales et médicales possibles. Ceci a été effectué en replaçant les problèmes médicaux dans leur contexte socioculturel et en intégrant les circonstances spéciales de la vie des femmes. Qui plus est, cette étude a pour fin d'explorer dans quelle mesure les motifs culturels et sociaux, en plus du manque d'information et de disponibilité, font obstacle à une plus grande acceptation des dits contraceptifs modernes. (extrait)


Chapitre d'ouvrage

Guillaume, A.; Desgrées du Loû, A.; Zanou, B.

Introduction
51315
2002 - in Guillaume, Agnès;Desgrées du Loû, Annabel;Zanou, Benjamin, Santé de la reproduction en Afrique, Abidjan (CI), ENSEA, p. 1-12

Mots clés : adolescent; allaitement; avortement; complication grossesse; comportement sexuel; grossesse; régulation des naissances; santé de la reproduction; sida; Syndrome d'immunodéficience acquise/sida
Pays : Afrique subsaharienne; Tunisie

Rapport

International Projects Assistance Services (IPAS)

Ipas's vision. Protecting women's health, advancing women's reproductive rights
2002, New york, IPAS, p. 12

Mots clés : avortement provoqué; communication; droit de l'homme; femme; organisation; plaidoyer; planning familial; planning familial, acceptante; rapport; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé

Résumé : All women deserve better access to high-quality reproductive health care, including abortion services, and all women should be able to make the sexual and reproductive choices that are right without fearing for their lives. This document highlights Ipas' efforts in protecting women's health and advancing women's reproductive rights worldwide. Since 1973, Ipas has dedicated its work to stopping the senseless deaths and injuries of women from unsafe abortion. Making a vision of universal access to safe abortion care a reality requires a multi-pronged approach. Hence, Ipas has developed multidisciplinary expertise in: 1) training; 2) research; 3) advocacy; and 4) informing stakeholders and communities and building support for safe abortion. This document highlights Ipas' intensive efforts in protecting women's health and advancing women's reproductive rights. It presents the organization's work in Africa, Latin America, the Caribbean, Asia, North America, and Europe.

Site web : http://www.ipas.org

Rapport

Ipas

Ipas: Ethiopia
2002, Chapel Hill, North Carolina, IPAS, p. 2

Mots clés : facteur démographique; femme; population; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : In Ethiopia, abortion is legally permitted only when the woman's life or health is in grave danger. Nevertheless, abortion is the leading cause of hospital admissions among Ethiopian women, accounting for more than 50% of total gynecologic and obstetric admissions. Maternal death and injury remain high in Ethiopia-an estimated one out of seven women dies from complications of pregnancy. Only 8% of births have a skilled attendant present and emergency obstetric complications, including those related to unsafe abortion, are some of the major causes of maternal deaths in Ethiopia; some estimates attribute 53% of maternal deaths to abortion complications. This document describes Ipas activities to address these issues.

Site web : http://www.ipas.org/english/where_ipas_works/africa/ethiopia/index.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Rapport

Ipas

Ipas: Nigeria
2002, Chapel Hill, North Carolina, IPAS

Mots clés : facteur démographique; femme; population; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Unwanted pregnancy and unsafe abortion are significant public health problems in Nigeria. The use of modern contraceptives is low, and the maternal mortality ratio is one of t highest in the world. Approximately 10% of the world's maternal deaths occur in Nigeria. Despite national efforts to reduce maternal mortality, including the Safe Motherhood Initiative, an estimated 50,000 maternal deaths occur annually; approximately 40% are due to complications related to unsafe abortion. Adolescents are particularly at risk of experiencing unsafe abortion and its complications. This document describes Ipas activities to address these issues.

Site web : http://www.ipas.org/english/where_ipas_works/africa/nigeria/index.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Rapport

Ipas

Ipas: South Africa
2002, Chapel Hill, North Carolina, Ipas, p. 2

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; femme; planning familial; planning familial, acceptante; population; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Under South Africa's former apartheid system, contraceptive services were generally available and free, but they were provided largely as an effort to control population growth among black South Africans. Coercive family planning practices, poor quality of care and a restrictive abortion law led many women to rely on clandestine abortions to control their fertility. Hundreds of women died each year in hospital facilities as a result of clandestine abortions and thousands more were treated for abortion complications. This document describes Ipas activities to address these issues.

Site web : http://www.ipas.org/english/where_ipas_works/africa/south_africa/index.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Nelson, D.

Kenya: postabortion care adolescent reproductive health. Linking PAC with FP. Successful scale-up at the primary level. Results review
2002

Mots clés : clinique/service de santé; counseling; éducation; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; programme; programme d'activités; Programme de formation; programme planification familiale; programme post-abortum; programme post-abortum, coût; santé; service de santé; service de santé communautaire/offre/service de santé; soin de santé primaire; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : PRIME II scaled-up a primary-level postabortion care (PAC) program in three of Kenya's seven provinces, demonstrating on a broad scale that trained private-sector nurse-midwives can provide quality PAC services and handle a wide variety of complications and emergencies. A high percentage of the PAC clients receive family planning counseling and services, linking PAC with FP as an effective strategy to reduce unwanted pregnancies and prevent unsafe abortion. (excerpt)

Site web : http://www.prime2.org

Congrès

Guillaume, A.

L'avortement en Afrique : une pratique fréquente chez les adolescentes?
2002 - in AIDLEF, Enfants d'aujourd'hui. Diversité des contextes, pluralité des parcours, Dakar, p. 12

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive
Pays : Afrique

Résumé : L'avortement est un sujet mal connu en Afrique : illégal dans une majorité de pays africains, rares sont les données disponibles sur ce sujet. Ce problème de l'avortement se pose avec une acuité particulière chez les adolescentes. Leur sexualité n'est pas toujours socialement reconnue et admise, et ainsi leur accès à la planification familiale est dans certains pays difficile voire impossible : les programmes étant parfois " réservés " aux femmes mariées. La prévalence contraceptive des adolescentes est faible et repose sur des méthodes peu efficaces, de plus ces femmes n'ont pas toujours une autonomie suffisante pour gérer leur sexualité et demander ou imposer à leur partenaire le recours à une méthode préventive aussi bien pour les infections sexuellement transmissibles que les grossesses. L'avortement est la réponse à une grossesse non prévue et est utilisée parfois à la place de la contraception : sa fréquence est variable selon les pays mais les études sur les complications des avortements attestent de l'ampleur de ce phénomène chez les jeunes femmes (auteur)


Article de périodique

Buchmann, E. J.; Mensah, K.; Pillay, P.

Legal termination of pregnancy among teenagers and older women in Soweto, 1999-2001
2002, South African Medical Journal, N°92, 9, p. 729-31

Mots clés : adolescent; âge fécond; avortement; grossesses; Interruption volontaire de grossesse / IVG; issue grossesse; jeune/adolescent; médecine
Pays : Afrique du Sud

Résumé : Reports on two cross-sectional studies performed in 1999 and 2001 in Greater Soweto, Orange Farm and Lenasia to determine the proportion of pregnancies that end in termination of pregnancy(TOP), with special reference to maternal age. Finds that the use of TOP services was highest in women at the extremes of reproductive age

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Chapitre d'ouvrage

Gastineau, B.

Légalisation de l'avortement et planification familiale : l'expérience tunisienne
2002 - in Guillaume, A., Desgrees du Loû, A., Zanou B, Koffi N., Santé de la Reproduction en Afrique, Abidjan, Côte d'Ivoire, p. 243-264

Mots clés : avortement; législation; stérilité
Pays : Tunisie

Chapitre d'ouvrage

Gautier, A.

Les droits reproductifs en Afrique sub-saharienne
2002 - in Guillaume, A., Desgrees du Loû, A., Zanou B, Koffi N., Santé de la Reproduction en Afrique, 9-12 novembre 1999, ENSEA, Abidjan, Côte d'Ivoire, Abidjan, Côte d'Ivoire, p. 77-100

Mots clés : avortement; législation; santé de la reproduction; stérilité
Pays : Afrique

Article de périodique

Kodio, B.; de Bernis, L.; Ba, M.; Ronsmans, C.; Pison, G.; Etard, J.-F.

Levels and causes of maternal mortality in Senegal
2002, Tropical Medicine International Health, N°7, 6, p. 499-505

Mots clés : autopsie; avortement provoqué, mortalité; collecte; décès; Dynamique démographique; Entretien; facteur démographique; femme; mesure; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; statistique; système de santé
Pays : Afrique; Afrique subsaharienne; Sénégal

Résumé : OBJECTIVES: To report the findings of a direct, community- based, assessment of maternal : The objective of this study is to report the findings of a direct, community-based, assessment of maternal mortality and medical causes of death using verbal autopsy in three unique cohorts in rural Senegal. Data were collected from ongoing demographic surveillance systems. The authors obtained records of all deaths and births in women of age 15-49 over a period of 14 years in Niakhar, 10 years in Bandafassi and 13 years in Mlomp. Relatives of all women who died were interviewed using a standard questionnaire. Causes of death were assigned by three physicians independently. Maternal deaths were defined according to the 9th and 10th revisions of the International Classification of Diseases. The maternal mortality ratio was similar in Mlomp [436/100,000 live births (95% confidence interval 209-802)] and Niakhar [516/100,000 (413-636)] but significantly higher in the more remote area of Bandafassi [852 (587-1196)] [relative risk compared with Niakhar 1.6 (1.0-2.4)]. Two-thirds of the maternal deaths were from direct obstetric causes, hemorrhage being the most common. Abortion was rare. Demographic surveillance systems are useful tools for the measurement of maternal mortality provided special studies are carried out to arrive at the levels and causes of maternal death. The estimates of maternal mortality reported here are lower than those published by the WHO and UN Children's Fund but remain extremely high, particularly in the very remote areas with very limited health infrastructure, where as many as 1 in 19 women may be expected to die as a consequence of childbirth. (author's)
French Abstract: L'objectif de cette étude est de rapporter les résultats d'une évaluation directe, à l'échelon de la collectivité, sur la mortalité maternelle et les causes médicales de décès à l'aide d'une autopsie verbale dans trois cohortes uniques du Sénégal rural. Les données de systèmes surveillance démographique permanents furent recueillies. Les auteurs ont obtenu les dossiers de tous les décès et toutes les naissances de femmes âgées de 15 à 49 sur une période de 14 ans à Niakhar, de 10 ans à Bandafassi, et de 13 ans à Mlomp. Les parents de toutes femmes décédées furent interrogés à l'aide d'un questionnaire standard. Les causes de décès furent assignées par trois médecins indépendamment les uns des autres. Les décès maternels furent définis conformément aux 9ème et 10ème révisions de la Classification internationale des maladies. Le quotient de mortalité maternelle était similaire à celui de Mlomp [436/100 000 naissances vivantes(intervalle de confiance de 95 %, 209 à 802)] et Niakhar [516/100 000 (413 à 636)] mais nettement plus élevé dans le région la plus reculée de Bandafassi [852 (587 à 1196)] [risque relatif comparé à Niakhar 1,6 (1 à 2,4)]. Deux tiers des décès maternels étaient directement liés à des causes obstétriques, l'hémorragie étant la plus courante. Le taux d'avortement était rare. Les systèmes de surveillance démographique sont des outils utiles pour mesurer la mortalité maternelle, pourvu que des études spéciales soient effectuées afin d'arriver aux taux et causes du décès maternel. Les estimations de mortalité maternelle rapportées ci-après sont inférieures à celles publiées par l'OMS et le Fonds des Nations Unies pour l'enfance, mais elles demeurent extrêmement élevées, en particulier dans les régions très reculées pourvues d'une infrastructure sanitaire très limitée, où l'on peut anticiper le décès des suites d'une naissance de 1 femme sur 19. (de l'auteur)


Article de périodique

Berer, M.

Making Abortion a Woman's Right Worldwide
2002, Reproductive Health Matters, N°10, 19, p. 1-8

Mots clés : avortement; droits

Résumé : no abstract


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Berer, M.

Making Abortions Safe: A Matter of Good Public Health Policy and Practice
2002, Reproductive Health Matters, N°10, 19, p. 31-44

Mots clés : avortement provoqué, loi; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); service d'avortement

Résumé : Globally, abortion mortality constitutes at least 13% of maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing abortion mortality and morbidity in countries where they remain high is a matter of good public health policy, based on good medical practice, and an important part of initiatives to make pregnancy safer. This paper examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands: changes at national policy level; abortion training for service providers; the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Thèse

Rossier, C.

Measure and meaning of induced abortion in rural Burkina Faso
2002, Demography, UC Berkeley., Berkeley, UC Berkeley

Mots clés : enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; méthodologie
Pays : Afrique; Burkina Faso

Résumé : There is no recognized method to date to estimate the incidence of illegal abortion. Illegal abortion is an important cause of mortality in developing countries; an estimation tool will help promote policies to reduce abortion mortality. In demographic research, an estimation technique will help understand the role of abortion during fertility declines. In this dissertation, I develop a new survey method to estimate the incidence of illegal abortion, the Third Party Reporting (TPR) method. This technique asks survey respondents to report the abortions occurring in their social networks. I develop two versions of the TPR method: one where respondents report the abortions of the women who confide in them, and one where respondents report the abortions occurring in their community. I tested in one village of the Bazega province, Burkina Faso, three survey abortion estimation methods against an abortion rate obtained using ethnographic techniques (15.3 / 1000 women 15-49). The residual and the self-reporting methods yielded unsatisfactory estimates. The TPR method, applied in its "community" version, gave an estimate that was within 80% of the ethnographic estimate. However, I met difficulties in matching abortion cases when applying the "community" version of the TPR method. The "confidantes" version of the TPR should be further developed. Using the TPR method, I estimated the rate of induced abortion in nine villages in Bazega. More developed villages were characterized by lower fertility levels and higher abortion rates. These results substantiate demographic theories on the role of abortion at the beginning of fertility declines.
To better measure abortion, I investigated its local meaning. I found that abortion has an ambivalent meaning in Bazega, condemned as the marker of dishonorable sexual conduct, and tolerated as a means of avoiding shame. I found that different cultural models of birth control coexist in Bazega today; cultural change is progressive, socially differentiated, and conflicted. I found that new discourses oppose contraception and abortion, as do international family planning discourses; global and local visions of birth control are linked. Finally, I found that local birth control strategies in Bazega are not focused on modern contraception and the limitation of births


Article de périodique

Miller, S.; Billings D.L.; Clifford, B.

Midwives and Postabortion Care: Experiences, Opinions and Attitudes among Participants at the 24th Triennial Congress of the ICM
2002, Journal of Midwifery and Women's Health., N°47, p. 247-255

Mots clés : sage-femme/personnel de santé
Pays : Afrique du Sud; Allemagne; Arabie saoudite; Bangladesh; Belgique; Cambodge; Canada; Emirats arabes unis; Espagne; Ethiopie; Fidji; France; Ghana; Honduras; Inde; Indonésie; Iran; Islande; Israël; Italie; Jamaïque; Kenya; Malawi; Maroc; Népal; Norvège; Nouvelle-Zélande; Pakistan; Papouasie - Nouvelle Guinée; Paraguay; Philippines; Pologne; Soudan; Suède; Tanzanie; Zambie; Zimbabwe

Résumé : In general, midwifery practice does not include attending to women experiencing complications from unsafe abortion, despite its importance in the health and lives of millions of women around the world. This paper summarizes data collected from midwives from 41 different countries who attended the 25th Triennial Congress of the International Confederation of Midwives (ICM) in 1999, focusing on their experiences with and attitudes towards the provision of postabortion care (PAC) as well as barriers and facilitating factors for changes in PAC-related policies and practices within their countries. Midwives from developing countries, where complications from unsafe abortion present a serious public health problem, were cognizant of the need to authorize, train, and equip midwives in PAC, including uterine evacuation of incomplete abortion with manual vacuum aspiration (MVA). Changes in policy and practice are needed throughout the world so that women will have access to PAC services regardless of where they live. Ensuring that midwives are able to provide such services in the facilities where they work will help to reduce abortion-related morbidity and mortality. Entities such as ICM need to take an active role in promoting necessary changes.


Article de périodique

Kananda, M. K.; Umesumbu, C. H.; Ndidua, D.

Mortalité maternelle à la Clinique Bondeko durant l'année 2000
2002, Congo Médical, N°3, p. 413-419

Mots clés : avortement; Cause de décès; complications postavortement; éclampsie; hémorragie; hémorragie utérine/complication; incidence; morbidité et mortalité maternelle; mortalité maternelle; paludisme; prévention

Résumé : La mortalité maternelle est élevée à la Clinique Bondeko où le taux est de 803 pour 100.000 naissances vivantes. Ce taux est inférieur à la moyenne nationale et africaine selon les estimations de l'O.M.S.Les étiologies restent dominées par l'infection après avortement (33,3%), le paludisme (20,8%), la toxémie gravidique (20,8%) et l'hémorragie (12,5%).
Les causes de décès sont évitables dans 95% des cas et 83,4% des parturientes décédées venaient des maternités périphériques. Pour réduire le taux de la mortalité, il faut : - un effort national concerné ; - éviter la grossesse par une contraception efficace ; - savoir détecter et prendre en charge les complications de la grossesse.
Tout ceci demande : - une volonté politique ; - un réveil de la population ; - la compétence du personnel soignant.


Article de périodique

Anonymous

National tribunal on reproductive health and abortion
2002, Violence Watch, N°4, 2, p. 13

Mots clés : aspects socio-économiques; avortement; comportements; contraception d'urgence/ contraception postcoitale; crime; culture; déterminant culturel; droit de l'homme; droits reproductifs; évaluation; facteur culturel; facteur démographique; facteur politique; facteurs économiques; facteurs socio-économiques; genre; grossesse; groupes de femme; planning familial; planning familial, acceptante; population; problème social; santé; santé de la reproduction; Statut de la femme; violence; violence contre les femmes; violence domestique
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : A National Tribunal on Reproductive Health and Abortion was recently organised by the Civil Resource Development and Documentation Centre (CIRDDOC) Nigeria at the Women Development Centre, Ogba, Lagos South-West Nigeria. It was attended by tile country Representative of Macarthur foundation, the Lagos State government representative, Medical Practitioners, and NGO representatives. (excerpt)


Article de périodique

Mukenge, M.

PAC training on Victoria Island: making inroads
2002, PAC in Action, 2, p. 3

Mots clés : communication; comportement reproductif; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; maladie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme d'activités; programme planification familiale; programme post-abortum; programme post-abortum, coût; santé; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Since 1996, the Centre for the Study of Adolescence, the Kisumu Medical and Educational Trust (KMET) and the Pacific Institute for Women's Health (PIWH) have addressed the dynamics of unsafe abortion through the community-based abortion care initiative (COBAC). The COBAC initiative, implemented in Suba District in Western Kenya, aims to prevent unwanted pregnancy and unsafe abortion thereby reducing morbidity and mortality. COBAC is unique in that it emphasizes a high level of community involvement in framing the issue and defining and implementing solutions. From 1996 to 1999, the COBAC team conducted formative research that informed two elements of the COBAC intervention: a baseline survey of health providers and the development of an awareness-raising video. (excerpt)


Article de périodique

Egziabher, T. G.; Ruminjo, J. K.; Sekadde-Kigondu, C.

Pain relief using paracervical block in patients undergoing manual vacuum aspiration of uterus
2002, East African Medical Journal, N°79, 10, p. 530-534

Mots clés : Anesthésie; avortement; avortement provoqué, coût; contraception d'urgence/ contraception postcoitale; coût; douleur/complication; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; essais clinique; étude/études; évaluation; facteur démographique; facteurs économiques; grossesse; maladie; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; reproduction; traitement/soin
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Objective: To evaluate pain relief using paracervical nerve block with 1% lignocaine injection in patients undergoing uterine evacuation by Manual Vacuum Aspiration (MVA) for the treatment of incomplete abortion. Design: A-randomized double blind clinical trial. Setting: Marie Stopes Health Centre, Nairobi. Methods: One hundred and forty two patients were recruited between September and October 1997. The intervention was random assignment to the study group (paracervical block with 1% lignocaine) or the placebo group (paracervical block with sterile water for injection). Intra and post-operative assessment of pain was made using McGills and facial expression scales. Results: The untreated group experienced significantly more pain than the treated group, especially lower abdominal pain and backache. The pain was especially marked intraoperatively, less so 30 minutes post-operatively. Conclusion: Based on the findings of this study, any patient going for manual vacuum aspiration for the treatment of incomplete abortion should be given Paracervical block as it is cost effective, easy to perform and with less side effects. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Seleye-Fubara, D.; Etebu, E. N.; Ikimalo, J.

Pathology of Abortion-Related Deaths in Port Harcourt Nigeria
2002, Tropical Journal of Obstetrics and Gynaecology, N°19, 2, p. 104-106

Pays : Nigeria

Résumé : Context: Abortions contribute significantly to the problem of maternal mortality and morbidity in Nigeria and it is desirable to identify the pathological events that culminate in mortality in these patients.
Objective: To describe autopsy features observed in patients who died from abortion and its complications in a tertiary health centre in Nigeria.
Study Design, Setting and Subjects: The data was obtained from an autopsy study of coroner's cases whose deaths occurred after abortions over a sixteen-year period. The antecedent clinical data were obtained from the patients' case notes.
Results: Of the 81 autopsies done following maternal deaths during the study period, 38 were abortion- related. The deaths followed 15 and 23 first and second trimester abortions respectively. Majority of the victims (68.3%) were aged between 15 and 29 years. The identified major causes of death were septic shock (50% of cases), haemorrhagic shock (26.3%), anaemic heart failure (13.2%) and peritonitis (10.5%). People with no formal health care training were responsible for procuring abortion in 57.9% of the cases.
Conclusion: Mortality from abortion is usually preceded by septic or haemorrhagic shock. Aggressive resuscitative measures may help to salvage some of the patients, but the social and economic factors driving the increasing rates of unsafe abortions in the society must be tackled to reduce abortion-related maternal mortality significantly.

Site web : http://www.ajol.info/journal_index.php?jid=79 ab=tjog

Congrès

Guillaume, A.; Desgrées du Loû, A.

Planification familiale à Abidjan : contraception et/ou avortement ? Une étude auprès de consultantes de 4 formations sanitaires urbaines
2002, Santé de la reproduction en Afrique, Abidjan, ENSEA, FNUAP, IRD, p. 19

Mots clés : avortement; complication grossesse; déterminant fécondité; fécondité; grossesse
Pays : Côte d'Ivoire

Article de périodique

Okong, P.; Biryahwaho, B.; Bergström, S.

Post-abortion endometritis-myometritis and HIV infection
2002, International Journal of STD and AIDS, N°13, 11, p. 729-732

Mots clés : adulte/âge; adultère; âge; biologie; collecte; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; étude prospective; étude/études; facteur démographique; facteurs de risque; femme; infection VIH; infection/complication; Infections génitales/IST/MST; maladie; méthodologie; population; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : Summary: The objective was to explore if HIV-1 infection is a risk factor for postabortion endometritis± myometritis (PAEM) in an urban hospital in Kampala, Uganda. HIV-1 seroprevalence in women with and without post-abortion infection was established using two standard enzyme-linked immunosorbent assays. Fifty-two women with PAEM and 106 without PAEM infection were recruited. The HIV-1 seroprevalence was 17 (32.7%) among women with PAEM and 38 (36.5%) among women without post-abortion infection. HIV infection was not found to correlate with the risk for PAEM. HIV-1 seroprevalence in both groups was double that among antenatal clients in the same hospital, 14.6% in 1997. Life-threatening infections such as septicaemia, peritonitis and pelvic abscesses were observed among 12 cases (23%). HIV-1 infection was not shown to be a risk factor for PAEM, but women with abortions with and without PAEM have a higher prevalence of HIV-1 than antenatal clients. (author's)

Site web : http://www.rsmpress.co.uk/std.htm

Rapport

Herrick, J.

Postabortion care (PAC) programs for adolescents
2002, FOCUS YARH Briefs No. 5, Washington, D.C., Pathfinder International, p. 2

Mots clés : adolescent; facteur démographique; facteurs; jeune/adolescent; population; rapport; Recommandations; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Amérique latine; Brésil; Kenya

Résumé : The needs and life situations of female adolescents seeking postabortion care (PAC) and contraceptive counseling vary greatly depending on their age, marital status, and the circumstances of their pregnancies. For all young women who have had an abortion, making postabortion contraceptive services available is critical for preventing repeat abortions. Few adolescent-specific PAC programs exist anywhere in the world. Two of the first such programs in Kenya and Brazil are described and PAC recommendations are included. SA: Las necesidades y las situaciones de vida de las adolescentes que buscan atención postaborto (PAC, postabortion care) y asesoramiento sobre anticoncepción varían ampliamente en función de su edad, estado civil y de las circunstancias de sus embarazos. Para las mujeres jóvenes que hayan tenido un aborto, la disponibilidad de servicios de anticoncepción después de la intervención es fundamental para prevenir la repetición del aborto. En todo el mundo existen pocos programas específicos para adolescentes que buscan atención postaborto. Se describen dos programas de ese tipo en Kenia y en Brasil y se incluyen recomendaciones para las adolescentes.

Site web : http://www.pathfind.org/pf/pubs/focus/pubs/YARHBriefs/bri5fin.pdf

Rapport

Ransom, E. I.; Yinger, N. V.

Pour une maternité sans risques : comment éliminer les obstacles aux soins
2002, MEASURE Communication, Washington, D.C.,, Population Reference Bureau [PRB], p. 39

Mots clés : adolescent; jeune/adolescent; planning familial; planning familial, acceptante; santé de la reproduction; santé maternelle; soin post-abortum; soin post-avortement
Pays : Amérique latine; Europe

Résumé : Abstract: This booklet describes the current status of maternal health; gives an overview of efforts to address maternal morbidity (injuries sustained during pregnancy and childbirth) and mortality at the international level; suggests ways that governments can reduce maternal mortality; and highlights individual programs that are working to overcome the obstacles to maternal survival. The focus is on success, as illustrated by stories of women whose lives were saved by innovative programs. (excerpt)

Site web : http://www.phishare.org/files/263_PourUneMaternite.pdf

Chapitre d'ouvrage

Fassassi, R.; Vimard, P.

Pratique contraceptive et contrôle de la fécondité en Côte d'Ivoire
2002 - in Guillaume, A., Desgrees du Loû, A., Zanou B, Koffi N., Santé de la Reproduction en Afrique, Abidjan, Côte d'Ivoire, p. 189-216

Mots clés : avortement
Pays : Côte d'Ivoire

Article de périodique

Varga, C. A.

Pregnancy termination among South African adolescents
2002, Studies in Family Planning, N°33, 4, p. 283-298

Mots clés : adolescent; âge; avortement; collecte; comportement reproductif; comportements; connaissance; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; enquête longitudinale; Entretien; étude/études; facteur démographique; fécondité; focus group/enquête; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; méthodologie; perception; planning familial; planning familial, acceptante; population; population rurale; population urbaine; psychologie/facteur psychologique; rapport de recherche; rural/résidence; ville/résidence; zone urbaine
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Although African adolescents' risk of undergoing abortion and of related health complications is well-documented, little is known about the procedure's prominence in their lives and the pathways that lead to their reliance upon it. This study investigates abortion dynamics among male and female Zulu adolescents in KwaZulu/Natal, South Africa. It explores the role of abortion in young people's sexual and reproductive experience, its acceptability, the reasons and likelihood of young people's choosing abortion, and the commonly used methods of pregnancy termination. The study, a rural-urban comparison using focus-group discussions, narrative workshops, and role playing, involved surveys and in-depth interviews. Factors contributing to the commonplace nature of backstreet procedures among adolescents include: social stigma, inadequate knowledge of the legal status of abortion, and a complex group decision making process. Young people invoke "relative moralities" concerning adolescent abortion, recognizing and condoning it on a context-specific basis. Age, gender, and geographic differences are examined. The methodological triangulation used offers the opportunity for alternative theoretical and methodological approaches to research on abortion-related issues. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Jewkes, R. K.; Brown, H.; Dickson-Tetteh, K.; Levin, J.; Rees, H.

Prevalence of morbidity associated with abortion before and after legalisation in South Africa
2002, BMJ. British Medical Journal, N°324, 7348, p. 1252-3

Mots clés : avortement; avortement légal; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; étude/études; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maladie; médicament; mesure; méthodologie; morbidité; planning familial; planning familial, acceptante; prévalence; rapport de recherche
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : In South Africa, the Choice in Termination of Pregnancy Act, which allows abortion on request up to 20 weeks' gestation, has been legalized. Since its legalization in 1997, 40,000 legal abortions have been performed annually. In this paper, the impact of legislative change on morbidity and medical management by repeating the 1994 study of morbidity due to incomplete abortion among patients presenting to public hospitals in 2000 was examined. Data were collected over different 3-week periods between May and August on all women presenting to the randomly selected public hospitals (47 hospitals from the sampling frame of all public hospitals in the nine provinces of South Africa responsible for treating women with gynecological problems in 2000). A data capture sheet for each woman was completed from the hospital records by a healthcare staff in which three clinical severity categories were used for data analysis and interpretation. The Rao Scott F test was used to compare the categorical variables with the 1994 study. Overall, findings showed that the legalization of abortion in South Africa immediately decreased morbidity but the magnitude was not substantial. The trend towards lower technology partially reflects success of training programs for induced abortion; however, the findings suggest that further structured training in the use of manual vacuum aspiration with paracervical block and appropriate use of antibiotics and misoprostol would be substantial.

Site web : http://bmj.com

Article de périodique

JHPIEGO

Prevention of maternal mortality by the use of improved care following abortion. What can you do?
Prévention de la mortalité maternelle par le biais de soins aprés avortement améliorés. Que pouvez-vous faire?
2002, p. 21

Mots clés : avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; étude/études; études statistiques; facteur démographique; facteurs économiques; grossesse; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; Service de santé maternelle et infantile; soin de santé primaire; système de santé
Pays : Afrique; Afrique subsaharienne; Burkina Faso; Guinée

Résumé : The improvement in women's health is a key element to a certain number of health policies and programs in the region of West Africa. Since the 70s, many nations have demonstrated their commitment to this question by establishing health centers concentrating on maternal and infantile health (MIH) needs. Although MIH is a priority for the region, the health indicators show that there remains much to do in the area. The data suggest that complications from abortions contribute significantly to the deterioration of maternal health in the region. Complications due to abortion represent approximately 13 to 20% of all maternal deaths in Sub-Saharan Africa. It is estimated that at least 28% of maternal deaths in Burkina Faso, and 17% in Guinea result from complications related to abortions. (excerpt)
L'amélioration de la santé des femmes est un élément clé d'un certain nombre de politiques et programmes sanitaires dans la région de l'Afrique de l'Ouest. Depuis les années 70, beaucoup de pays ont montré leur engagement sur cette question en établissant des centres de santé se concentrant sur les besoins en santé maternelle et infantile (SMI). Bien que la SMI soit un priorité pour la région, les indicateurs sanitaires montrent qu'il reste encore beaucoup d'efforts à faire. Les donnée suggèrent que les complications de l'avortement contribuent de façon significative à la détérioration de la santé maternelle dans la région. Les complications dues à l'avortement représentent approximativement 13 à 20% de l'ensemble des décès maternels en Afrique sub-saharienne. On estime qu'au moins 28% des décès maternels au Burkina Faso et 17% en Guinée résultent de complications liées à l'avortement. (extrait)


Thèse

Mouvagha-Sow, M.

Processus matrimoniaux et procréation à Libreville, Gabon
2002, UFR de sciences sociales et administration, Nanterre, Université Paris X, p. 587

Mots clés : activité sexuelle / sexualité; avortement; coït/sexualité; comportement sexuel; nuptialité; rupture d'union; sexualité; violence domestique
Pays : Gabon

Article de périodique

Songane, F. F.; Bergström, S.

Quality of registration of maternal deaths in Mozambique: a community-based study in rural and urban areas
2002, Social Science Medicine, N°54, 1, p. 23-31

Mots clés : maternité sans risque; morbidité et mortalité maternelle; mortalité maternelle
Pays : Mozambique

Résumé : Maternal mortality is an important indicator used to assess the level of development of a country and particularly the coverage of health services. In Africa where the maternal mortality ratios are about 100 times higher than those of developed countries the situation is even worse due to problems of underregistration. In Mozambique the figures officially used are derived from the data of some hospitals in the main cities. This leaves out the 60% of pregnant women who do not attend health facilities. It was against this background that the present study was designed to be a prospective community-based study carried out in the central region of Mozambique involving a population of 207,369 inhabitants. The study covered a 12-month period, from 01/08/96 to 31/07/97 and found 214 deaths among women in reproductive age (15-49 yr) of whom 40 were classified as maternal deaths.
Gross underregistration was revealed, as the health institutions failed by 86% in recording maternal deaths, the same happening with other official sources, like the Civil Register and the Funeral Services registering only 9% of the maternal deaths.
This kind of study is however complex and labour intensive and a practical way of monitoring has to be found; for the region where the study took place close collaboration with private cemeteries appears to be a way to be further explored.


Chapitre d'ouvrage

Amegee, L. K.

Recours à l'avortement provoqué en milieu scolaire au Togo : mesure et facteurs du phénomène
2002 - in Guillaume, A., Desgrees du Loû, A., Zanou B, Koffi N., Santé de la reproduction en Afrique, Abidjan, Côte d'Ivoire, ENSEA, FNUAP, IRD, p. 297-320

Mots clés : activité sexuelle / sexualité; adolescent; avortement; coït/sexualité; complication grossesse; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; grossesse; méthodologie; sexualité
Pays : Togo

Chapitre d'ouvrage

Abdel-Tawab, N.; Huntington, D.; Osman, E.; Youssef, H.; Nawar, L.

Recovery from abortion and miscarriage in Egypt : Does counseling husbands help?
2002 - in Haberland, Nicole ;Measham, Diana, Responding to Cairo. Case studies of changing practice in reproductive health and family planning, New York, New York, Population Council, p. 186-204

Mots clés : avortement spontané; avortement spontané/fausse couche; clinique/service de santé; complications postavortement; facteur démographique; maladie; population; programme d'activités; rapport; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Egypte

Résumé : This book chapter describes a project that attempted to address some of the difficulties faced by Egyptian postabortion patients during their recovery by providing their husbands with appropriate counseling. The premise was that husbands who had received information about their wives' needs during recovery would provide more support to their wives and thus enhance their recovery. It was also believed that spousal counseling would help those women who did not want to become pregnant following recovery to use contraception.


Reproduced with the permission of Population Council : http://www.popcouncil.org/169276

Article de périodique

Johnson, B. R.; Ndhlovu, S. F., S. L.; Chipato, T.

Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception
2002, Studies in Family Planning, N°33, 2, p. 195-202

Mots clés : avortement; grossesse non prévue
Pays : Zimbabwe

Résumé : In many countries, women treated for complications from spontaneous or unsafely induced abortion lack access to contraceptive services. As a result, many of them soon have a subsequent unplanned pregnancy or a repeat abortion, placing their health at increased risk. This report presents the results of a prospective intervention study on postabortion family planning conducted in the two largest public hospitals in Zimbabwe. Women at Harare Central Hospital, in the capital, received a postabortion family planning intervention, and Mpilo Central Hospital, in Bulawayo, served as the control site. The study cohort was 982 women, 527 of whom were followed for a 12-month period. During the follow-up period, significantly more women used highly effective methods of contraception, significantly fewer unplanned pregnancies occurred, and fewer repeat abortions were performed at the intervention site than at the control site. These results offer compelling evidence that ward-based contraceptive services provided to women treated for incomplete abortion can significantly reduce subsequent unplanned pregnancies. The results also suggest that postabortion family planning services can reduce the incidence of repeat abortion.


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Rapport

de Bruyn, M.

Reproductive choice and women living with HIV AIDS
2002, Chapel Hill, North Carolina, Ipas, p. 30

Mots clés : avortement; collecte; complication grossesse; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; discrimination sociale; Dynamique démographique; Entretien; facteur démographique; fécondité; femme; grossesse; infection VIH; maladie; méthodologie; Pays développé; planning familial; planning familial, acceptante; politique/programme; population; problème social; programme de santé; reproduction; santé; santé de la reproduction; sida; Syndrome d'immunodéficience acquise/sida; VIH positif
Pays : Afrique; Afrique du Sud; Afrique subsaharienne; Australie; Inde; Kenya; Thaïlande

Résumé : One area in which stigma and discrimination affect women living with HIV/AIDS (WHA) is reproductive health. This report summarizes available information concerning barriers and discrimination that WHA face in exercising their full sexual and reproductive rights concerning pregnancy. It is based on an extensive review of the literature and interviews with key informants in Australia, India, Kenya, South Africa and Thailand. (excerpt)

Site web : http://www.ipas.org

Reproduced with the permission of IPAS: http://www.ipas.org

Rapport

Gebreselassie, H.; Fetters, T.

Responding to unsafe abortion in Ethiopia: a facility-based assessment of postabortion care services in public health sector facilities in Ethiopia
2002

Mots clés : avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; évaluation; Evaluation des services de santé; facteur démographique; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; qualité des soins; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : In Ethiopia, maternal deaths associated with complications of pregnancy and delivery are among the highest in the world. Several studies indicate that unsafe abortion accounts for up to 25-35% of these maternal deaths. The burden of unsafe abortion on women, their families and communities, and on the limited resources of the Ethiopian health system is enormous. In order to explore health systems issues and determine reliable baseline figures prior to program expansion, Ipas Ethiopia collaborated with the Regional Health Bureaus from July-September 2000, to conduct a cross-sectional postabortion care (PAC) assessment in three regions: Oromia, Amhara and Addis Ababa. The main objective of the assessment was to determine the current and future potential capacity and quality of PAC service delivery in public hospitals and health centers. A total of 120 health facilities were included in the study. The proportion of the total facilities located in each of the regions and included in the assessment is summarized in Table 1. (author's)


Ouvrage édité

Guillaume, A.; Desgrées du Loû, A.; Zanou, B.

Santé de la Reproduction en Afrique
2002, Abidjan, ENSEA, FNUAP, IRD, p. 366

Mots clés : adolescent; avortement; complication grossesse; comportement sexuel; grossesse; régulation des naissances; santé de la reproduction; sida; Syndrome d'immunodéficience acquise/sida
Pays : Côte d'Ivoire; Togo; Tunisie

Article de périodique

Vandecruys, H. I.; Pattinson, R. C.; Macdonald, A. P.; Mantel, G. D.

Severe acute maternal morbidity and mortality in the Pretoria Academic Complex: changing patterns over 4 years
2002, Eur J Obstet Gynecol Reprod Biol, N°102, 1, p. 6-10

Mots clés : avortement; morbidité; morbidité et mortalité maternelle; mortalité maternelle
Pays : Afrique du Sud

Résumé : To compare the severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria Academic Complex for the year 2000 and the years 1997-1999. SAMM and maternal mortality was identified at daily audit meetings. The audit was performed from 1 January 2000 to 31 December 2000 and compared with the data obtained from the original 2-year audit [Br J Obstet Gynecol 105 (1998) 985].


Article de périodique

Versnel, M.; Berhane, Y.; Wendte, J. F.

Sexuality and contraception among never married high school students in Butajira, Ethiopia
2002, Ethiopian Medical Journal, N°40, 1, p. 41-51

Mots clés : activité sexuelle / sexualité; avortement; coït/sexualité; complication grossesse; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; éducation sexuelle; étudiant; étudiant/scolarisation; grossesse; sexualité
Pays : Ethiopie

Résumé : This paper is relted to sexuality and contraception. A self-administered anonymous questionnaire was conducted to assess knowledge, attitude and practice of contraception and sexuality among 752 high school students in Butajira, Ethiopia


Article de périodique

Klufio, C. A.; Lassey, A. T.; Annan, B. D.

Socio-demographic and reproductive characteristics of mothers delivered at the Korle-Bu Teaching Hospital, Ghana
2002, East African Medical Journal, N°79, 4, p. 176-180

Mots clés : âge; âge fécond; aspects socio-économiques; avortement provoqué, mortalité; collecte; complication grossesse; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; Dynamique démographique; éducation; éducation pour la santé; enquête; Entretien; évaluation; facteur démographique; facteurs économiques; facteurs socio-économiques; grossesse; issue grossesse; jeune/adolescent; ligature des trompes / stérilisation; méthodologie; mortalité; planning familial; planning familial, acceptante; population; rapport de recherche; Recommandations; reproduction; Statut socio-économique; stérilisation féminine; stérilisation/contraception; taux d'avortement / taux
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : Objectives: To measure selected socio-demographic and reproductive history characteristics of parturients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, and to compute the risk load. Design: A non-randomised cross-sectional survey. Setting: Korle-Bu Teaching Hospital, Accra, Ghana. Subjects: Korle-Bu Teaching Hospital, a tertiary institution delivers about 11000 women annually. From 1st November to 12th December 1994, 961 parturients were studied out of 978 delivered during the study period. Seventeen questionnaires were excluded from analysis because of errors and omissions that could not be corrected before the parturients' discharge from hospital. Methods: The data sources were the patients' antenatal and delivery records, and a structured interviewer-administered questionnaire. Results: More than three per cent of the subjects were less than 18 years, and 10.8 % were over 35 years of age. Before the index delivery, 5.8% were grand multiparae. Eighteen per cent had never been to school. Seventeen per cent of parous subjects had experienced a perinatal death. The non-educated had significantly more births. The mean birth interval was less than two years in 26.4%. Fifty percent of those who had been previously pregnant had a history of at least one induced-abortion. Only 21.0% of the 961 subjects had ever-used a family planning method. The risk load was 53.0%. Conclusion: Analysis of the historical factors of parturients surveyed at the KBTH showed a high risk load related mainly to lack of education. Formal education of the female child and family health education of our women are recommended to reduce the high past abortion rate and risk load. Additionally, postpartum tubal ligation for those who have completed their families will further reduce the risk load. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Lema, V. M.; Mpanga, V.; Makanani, B. S.

Socio-demographic characteristics of adolescent post-abortion patients in Blantyre, Malawi
2002, East African Medical Journal, N°79, 6, p. 306-10

Mots clés : adolescent; âge; avortement; avortement incomplet/complication; avortement provoqué, complication; Clients; complication; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; jeune/adolescent; méthode d'avortement, effets secondaires; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme d'activités; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Malawi

Résumé : BACKGROUND: Unsafe sex, unwanted pregnancy and unsafe abortion are some of the emerging adolescent reproductive health challenges in Malawi. OBJECTIVES: To study socio-demographic characteristics of adolescent post-abortion patients and that of their male partners, with the aim of better understanding the determinants of adolescent fertility in Malawi, thus facilitating design of appropriate intervention strategies. DESIGN: A descriptive, cross-sectional study. SETTING: The Queen Elizabeth Central Hospital, Blantyre, Malawi. SUBJECTS: A total of 446 out of 465 eligible adolescents managed for incomplete abortion during the study period were enrolled from January 1st to December 31st 1997. RESULTS. Their mean age was 17.5 years (SD +/- 1.3), while that of their male partners was 22.4 years (SD +/- 3.4). The unmarried adolescents comprised 43.9% and students 38.6%. About 30.0% had attained secondary school level of education. The mean age at sexual debut was 15.7 years (SD +/- 1.75), about a year after that at menarche (14.3 years, (SD +/- 1.4)). The mean number of sexual partners they had had was 1.5 (SD +/- 0.86), the highest being 10. The index pregnancy was reportedly unwanted in 45. 1% of the total. The rate was higher among the young, single and students. They were also less likely to have informed their partners about the pregnancy or the abortion (p = 0.0001). About 52.8% of the female students were involved with fellow male students. Of the married adolescents, 4.4% reported having had extramarital affairs. CONCLUSION: There is need to design appropriate programmes to promote safe sex and reduce unwanted pregnancy and unsafe abortion with its potential sequelae among adolescents in Malawi. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Machungo, F.; Zanconato, G.; Persson, K.; Lind, I.; Jorgensen, B.

Syphilis, gonorrhoea and chlamydial infection among women undergoing legal or illegal abortion in Maputo
2002, International Journal of STD and AIDS, N°13, 5, p. 326-30

Mots clés : avortement; Avortement illégal; avortement légal; contraception d'urgence/ contraception postcoitale; demande d'avortement; gonorrhée/IST/MST; infection/complication; Infections génitales/IST/MST; maladie; maladie sexuellement transmissible/MST/IST; méthodologie; planning familial; planning familial, acceptante; rapport de recherche; syphilis/MST/IST
Pays : Afrique; Afrique subsaharienne; Mozambique

Résumé : The authors' objective were to compare the prevalence of sexually transmitted infections (STIs) in 103 women undergoing induced legal abortion (LA) and in 101 women with confirmed, recent illegal abortion (IA), in Maputo, Mozambique. For the purpose of this study, LA was considered the abortion provided in the Maputo Central Hospital with the approval of the Ministry of Health, and IA the one not provided through the approved facility, mentioned above. Women with IA were recruited in the outpatient gynecology ward and women with LA in the emergency gynecology ward in the Maputo Central Hospital, during the same time period. Serological tests for syphilis (rapid plasma reagin, enzyme linked immunosorbent-immunoglobulin G and fluorescent treponemal antibody absorption), gonorrhea (indirect hemagglutination) and chlamydia (microimmunofluorescence) were carried out. Direct immunofluorescence for detection of Chlamydia trachomatis antigen was done on endocervical smears from all the women. The prevalence of syphilis seropositivity in IA women is twice that of LA women (odds ratio [OR] 2.13; 95% confidence interval [CI] 0.55-9.95), with 10.9% and 4.9% respectively. Exposure to gonorrhea in these two groups is similar (OR 1.18; 95% CI 0.63-2.20), with seroprevalence of 31.1% in the LA and 34.7% in the IA group. The high titers are also similar in both groups. Serology findings for C. trachomatis indicate prevalence of seropositivity of 40.6% in the LA and 44.4% in the IA group with no significant difference (OR 1.17; 95% CI 0.64-2.13). In conclusion, STIs are highly prevalent in both IA and LA groups in Maputo. Urgent interventions are needed to reduce their prevalence and consequently their adverse consequences. (author's)

Site web : http://www.rsmpress.co.uk/std.htm

Congrès

Isiugo-Abanihe, I. M.; Isiugo-Abanihe, U. C.; Ofrey, R.

Teenage reproductive health problems in the riverine areas of Nigeria : the Nembe experience
50615
2002, Conférence Africaine de Population : la Population Africaine au 21ème Siècle,, Dakar (SN), UEPA, N°5, p. 393-411

Mots clés : activité sexuelle / sexualité; adolescent; âge; aspects socio-économiques; coït/sexualité; collecte; comportement sexuel; comportements; déscolarisation/scolarisation; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; étude/études; facteur démographique; facteurs économiques; facteurs socio-économiques; jeune/adolescent; méthodologie; Organisation et Administration; population; programme; psychologie/facteur psychologique; rapport; santé; santé de la reproduction; sexualité; Statut socio-économique
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : The research reported here was concluded in the riverine communities of Nembe in the oil-rich Bayelsa State of Nigeria in July 1996, as a baseline survey prior to the introduction of the Integrated Family-Life Education project. The project aimed at improving the reproductive health status of teenagers in an environment of widespread teenage pregnancy and childbearing. High level of sexual activity is evident among Nembe teenagers, as revealed by the level of sexually experience, coital frequency and sexual networking. Consequently, the levels of teenage pregnancy, childbearing, induced abortion and infection with sexually transmitted diseases are high. High levels of sexual activity are in part related to widespread poverty occasioned by environmental degradation resulting from oil exploration in the area, which has virtually destroyed fishing as the main occupation, both of men and women. The study found that the most serious problems confronting Nembe youth are inadequate education and lack of employment; teenage girls are therefore attracted to the migrant oil-men and others who could provide their material needs, a luxury for their poverty-stricken parent. Intervention programmes suggested to improve teenage reproductive health status include provision of vocational training, initiation of family-life education and counselling for in-school and out-of-school youth, improvement of the environment and improved parental responsibility for their children. Following from the results of this study, the IFLE project has been pre-occupied with school and community-based participatory intervention programmes in two Nembe communities in the past three years. (author's)


Article de périodique

Adewole, I. F.; Oye-Adeniran, B. A.; Iwere, N.; Oladokun, A.; Gbadegesin, A.

Terminating an unwanted pregnancy-the economic implications in Nigeria
2002, J Obstet Gynaecol, N°22, 4, p. 436-7

Mots clés : avortement; complications postavortement; durée de la grossesse; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; grossesse non prévue/grossesse non désirée; législation; méthodologie; service de santé; service de santé maternelle
Pays : Nigeria

Résumé : Induced abortion is still illegal in Nigeria and carries a stiff penalty of 14 years imprisonment for the abortion provider (Okagbue, 1990). Despite this, termination of an unwanted pregnancy is being carried out daily both by trained and untrained personnel, albeit with the utmost secrecy; except when it becomes complicated (Okagbue, 1990; Henshaw et al., 1998). The national survey indicated that about 610 000 pregnancy terminations occur in Nigeria yearly, and about 141 000 patients were treated for complications of pregnancy termination (Henshaw et al., 1998). Because of the unfavourable legal environment, patients with unwanted pregnancies could not turn legally to a government hospital, where personnel and facilities exist for an adequate and safe procedure. The majority of induced abortion seekers end up with 'quacks' at a very high risk to their health, as frequently these become complicated. The threats to a woman's health from unsafe abortion are considerable. It has been proven that this termination of unwanted pregnancy when performed by trained medical personnel could be safe. This has been shown in countries where abortion is legalised, many of which are now publishing low morbidity and morality figures following induced abortion. Despite the controversies surrounding termination of unwanted pregnancies, many medical doctors, specialists and non-specialists as well as non-medical personnel still provide services for pregnancy termination (Megafu and Ozumba, 1991; Adewole, 1992). In Nigeria, the situation is still gloomy. Complications of induced abortion are being treated daily in our health institutions. Several efforts have been made to quantify the financial cost of treating these complication based on the type of complication (Konje et al., 1992), the need for surgical and/or medical care, the need for blood transfusion and hospitalisation. What is the cost of pregnancy termination to the patient? (author's)


Rapport

Anonymous

The Advance Africa approach to best practices: a mini-compendium for postabortion care service delivery. Draft
2002, Arlington, Virginia,, MSH, Advance Africa, p. 40

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; Organisation et Administration; planning familial; planning familial, acceptante; programme; Programme d'évaluation; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Amérique latine; Inde; Mexique

Résumé : The following 'mini-compendium' has compiled practices in the field of Postabortion Care. Fifteen practices, none categorized as a best practice, have been included in this edition of the compendium. The reasons for including such a small number of practices can be attributed to several factors. First, the Advance Africa criteria for inclusion into the compendium mandates sufficient evidence must be available by which to evaluate the practice. Many additional program reports were identified, but did not include evidence-based data from interventions. Of these included, none provided sufficient evidence of impact or replicability to be classified as a best practice. Second, the compilers of this compendium may not have found all of the existing practices which could be included. Our search for additional practices continues. We encourage readers of this document to send us practices for inclusion in future editions. Third, monitoring and evaluation, which provide evidence, may not be part of the project's approach, due to financial constraints. Finally, the topic of abortion is controversial. Thus, evidence-based reports may be difficult to obtain because of lack of political/religious support. For example, one project report refrained from including the specific country name because of the strong political sentiments against postabortion care programs. As postabortion care becomes increasingly recognized as a critical health service to save women's lives, a best practices compendium will serve an important role in helping program managers identify appropriate interventions to strengthen postabortion care programs. (excerpt)
SA: El siguiente "minicompendio" es una recopilación de prácticas empleadas en el área de la atención postaborto. De las quince prácticas descritas en la presente edición, ninguna está catalogada como óptima. El motivo de incluir un número tan reducido obedece a diversos factores. En primer término, un requisito de los criterios de Advance Africa para incluir una práctica en el compendio es disponer de suficiente evidencia para evaluarla. Se identificaron numerosos informes de programas adicionales, pero no incluían datos basados en evidencia de las intervenciones. De las prácticas incluidas, ninguna aportaba la evidencia del impacto o la replicabilidad necesarias para clasificarse como óptima. En segundo lugar, es probable que los recopiladores de este compendio no hayan hallado todas las prácticas que podrían haberse incluido, de modo que continuamos nuestra búsqueda. Alentamos a los lectores de este documento a enviarnos prácticas para incluir en ediciones futuras. En tercer lugar, quizá la supervisión y la evaluación, que aportan evidencia, no integren el enfoque del proyecto debido a limitaciones financieras. Por último, el aborto es un tema polémico. Por consiguiente, los informes basados en la evidencia pueden ser difíciles de obtener por la falta de apoyo político y religioso. Por ejemplo, un informe del proyecto se abstuvo de incluir el nombre del país específico por los fuertes sentimientos políticos existentes contra los programas de atención postaborto. A medida que se reconozca a la atención postaborto como un servicio de salud crítico para salvar la vida de las mujeres, más útil resultará contar con un compendio de las mejores prácticas que ayude a los gerentes de proyectos a identificar las intervenciones adecuadas para fortalecer los programas de atención postaborto. (extracto)

Site web : http://www.advanceafrica.org/publications_and_presentations/Technical_Papers/TP_Mini-Compendium_PAC.pdf

Article de périodique

Cook, C. T.

The effects of skilled health attendants on reducing maternal deaths in developing countries: testing the medical model
2002, Evaluation and Program Planning, N°25, 2, p. 107-116

Mots clés : avortement

Résumé :
-


Rapport

Fetters, T.; Jolayemi, T.

The hidden emergency: A facility-based assessment of postabortion care services in public health sector facilities in northern Nigeria
2002, Chapel Hill, North Carolina, Ipas, p. 24

Mots clés : soins post avortement
Pays : Nigeria

Résumé : To develop a clearer understanding of postabortion care in Northern Nigeria, Ipas collaborated with the State Ministries of Health on a baseline assessment with two main objectives: Determine the current provision of postabortion care (PAC) services in a variety of service-delivery settings common within selected states in Northern Nigeria. Determine training needs of various cadres of service providers in the area of PAC. The findings of this assessment will inform Ipas activities, as well as activities of other program managers and policymakers working in Northern Nigeria.

Site web : http://www.ipas.org/publications/en/hidden_emergency_nigeria_report.pdf

Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Chikovore, J.; Lindmark, G.; Nystrom, L.; Mbizvo, M. T.; Ahlberg, B. M.

The hide-and-seek game: men's perspectives on abortion and contraceptive use within marriage in a rural community in Zimbabwe
2002, Journal of Biosocial Science, N°34, 3, p. 317-32

Mots clés : avortement provoqué, homme; célibataire; collecte; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; Entretien; facteur démographique; homme; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; méthodologie; nuptialité; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Zimbabwe

Résumé : This paper is based on a study aimed at understanding the perceptions of men to induced abortion and contraceptive use within marriage in rural Zimbabwe. Two qualitative methods were combined. Men were found to view abortion not as a reproductive health problem for women. Instead, they described abortion as a sign of illicit sexual activity and contraceptive use as a strategy married women use to conceal their involvement in extramarital sexual activity. Men felt anxious and vulnerable for lack of control over women. In the absence of verbal communication on sexual matters, women and men resort to what are called here 'hide-and-seek' strategies, where women acquire and use contraceptives secretly while men search for evidence of such use. It is concluded that promoting women's sexual and reproductive health requires both short- and long-term strategies. The short-term strategy would entail providing women with reproductive technology they can use without risking violence. The long-term strategy would entail understanding men's concerns and the way these are manifested. In turn this requires the use of methodologies that encourage dialogue with research participants, in order to capture their deep meanings and experiences. (© 2002 Cambridge University Press)


Reproduced with the permission of Journal of Biosocial Science: http://www.cambridge.org/uk/journals/journal_catalogue.asp?historylinks=ALPHA mnemonic=JBS

Article de périodique

Ahiadeke, C.

The Incidence of Self Induced Abortion in Ghana: What are the Facts?
2002, Institute of African Studies : Research Review, N°18, 1, p. 33-42

Mots clés : avortement provoqué
Pays : Ghana

Résumé : In Ghana, despite the growing number of studies, induced abortion remains a relatively unknown aspect of the national demographics. Interest in abortion research is, however, reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to the high level of maternal mortality. A recent prospective study in Southern Ghana indicates that abortion rates in Ghana could range between 22 and 28 abortions per 1,000 women of reproductive age. Most of the abortion patients studied were young, some married and others unmarried. Results of logistic regression models suggest that those who work outside their homes, the self-employed, urban dwellers, single persons, women who have had a previous abortion, women with levels of education beyond Middle/JSS and Christians rather than Muslims are the ones likely to have an abortion. Because official statistics on illegal abortion do not exist and the numbers of such procedures must be estimated, the data presented here are the best available estimate; but they are not definitive.

Site web : http://www.ajol.info/journal_index.php?jid=133 ab=iasrr

Article de périodique

Johnson-Hanks, J.

The lesser shame: abortion among educated women in southern Cameroon
2002, Social Science Medicine, N°55, 8, p. 1337-1349

Mots clés : attitude; avortement; célibataire; collecte; comportements; contraception d'urgence/ contraception postcoitale; Dynamique démographique; enquête; enquête CAP; enquête démographique et de santé/EDS; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; état matrimonial; facteur démographique; femme; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; méthodologie; nuptialité; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; santé; santé de la reproduction
Pays : Afrique; Afrique subsaharienne; Cameroun

Résumé : Educated women in southern Cameroon both condemn abortion and practice it with some regularity. This apparent paradox arises because educated Cameroonian women use abortion as one of a set of strategies to manage the timing and social context of entry into motherhood. This paper is based on a body of research which included a demographic life history survey (= 184), open-ended narrative interviews (= 37), and participant observation over 10 months. The survey data included 61 reported abortions, giving a lower-bound estimate of the crude abortion rate of 19 per thousand woman-years of life. In southern Cameroon, sexual activity is socially tolerated in a wide variety of non-marital relationships, while childbearing is not. Thus, most of my informants, including those who reported having aborted, say that abortion is shameful; however, they view its moral and social consequences as less grave than those of a severely mistimed entry into socially recognized motherhood. That is, abortion persists in southern Cameroon because it is the lesser shame. (author's)

Site web : http://authors.elsevier.com/JournalDetail.html?PubID=315 Precis=DESC

Article de périodique

van Bogaert, L. J.

The limits of conscientious objection to abortion in the developing world
2002, Developing World Bioethics, N°2, 2, p. 131-143

Mots clés : complication grossesse; femme; grossesse
Pays : Afrique du Sud

Résumé : The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more 'technically illegal' abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker's life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

Site web : http://www.blackwell-synergy.com/loi/dewb;jsessionid=cLOs8bZxsa38dptmEL?open=2002

Article de périodique

Chakraborty, R.; Pulver, A.; Pulver, L. S.; Musoke, R.; Palakudy, T.

The post-mortem pathology of HIV-1-infected African children
2002, Annals of Tropical Paediatrics, N°22, p. 125-131

Mots clés : âge; avortement; biologie; cancer; cancer du sein; cancer utérin / cancer; complication grossesse; complications postavortement; contraception d'urgence/ contraception postcoitale; enfant /enfance; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; grossesse; infection VIH; infection/complication; intervention chirurgicale; jeune/adolescent; maladie; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; traitement/soin
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : A retrospective review of autopsy findings and medical records in 33 HIV-infected children living in a Kenyan orphanage is described. Their ages ranged from 1 month to 18 years and median age at death was 71 months (range 7-156). Respiratory disorders were probably the primary cause of death in 21 (64%), in 19 (90%) of whom pyogenic parenchymal lung disease was detected. A presumptive clinical diagnosis of pulmonary tuberculosis had been made in 14 (67%); these children also had a history of recurrent acute lower respiratory tract infections (more than four infections/year). At autopsy, however, only one case of tuberculosis was identified (disseminated disease). Pneumocystis carinii pneumonia was not identified. Primary bacterial meningitis was detected in 33%. The associated findings included disseminated Kaposi sarcoma in two children and cryptococcal meningitis in one child. It is concluded that pyogenic infections are common causes of morbidity and mortality in HIV-1-infected African children. Management should include prompt treatment and, if indicated, prophylaxis for recurrent bacterial infections, and early evaluation and treatment of pulmonary tuberculosis. (author's)


Congrès

Guengant, J.-P.

The proximate determinants during fertility transition
2002 - in Population Division;United Nations, Expert group meeting on completing, the fertility transition, New York, p. 22

Mots clés : avortement provoqué; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; fécondité

Article de périodique

Nelson, D.; Corbett, M. R.; Githiori, F.; Mason, R. F.; Muhuhu, P.

The right provider for the right place: private nurse-midwives offering primary-level postabortion care in Kenya
2002, PRIME II Dispatch, 4, p. 1-11

Mots clés : clinique/service de santé; counseling; éducation; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; programme; programme d'activités; Programme de formation; programme planification familiale; programme post-abortum; programme post-abortum, coût; santé; service de santé; service de santé communautaire/offre/service de santé; soin de santé primaire; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : In an effort to reduce maternal mortality or morbidity and decrease the chances of repeat abortion among clients, the PRIME-assisted program for private nurse-midwives emphasizes a comprehensive approach to primary-level PAC services. In addition to providing treatment for potentially life-threatening complications, the nurse-midwives counsel clients about family planning and contraceptive options and provide or refer for methods to help clients prevent future unwanted pregnancies and practice birth spacing. The nurse-midwives also offer selected reproductive and other health services either at their clinics or via referral to another facility accessible to the client. While some clients may be too traumatized in the aftermath of an unsafe abortion to receive or respond to counseling for family planning and other services, taking advantage of a postabortion visit as an opportunity to improve women's overall reproductive health is critical, especially in light of the estimated 14% rate of HIV/AIDS infection among Kenyans aged 15 to 49.3. (excerpt)

Site web : http://www.prime2.org

Article de périodique

Badawi, Z.

The role of the church in developing the law: an Islamic response
2002, J Med Ethics, N°28, 4, p. 223; discussion 229-31

Mots clés : avortement légal; avortement provoqué, religion; chrétien/religion; islam; jurisprudence; législation; religion
Pays : Egypte

Résumé : The concept of Hisba in Muslim law has been used by members of certain Islamic groups to impose, through the courts, limitations on freedom of expression. In so doing they sought to circumvent the right of parliament to legislate on matters of personal freedom. This device is now restricted by the Egyptian authorities.

Site web : http://jme.bmjjournals.com/

Article de périodique

Garenne, M.; Joseph, V.

The Timing of the Fertility Transition in Sub-Saharan Africa
2002, World Development, N°30, 10, p. 1835-1843

Mots clés : déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête démographique et de santé/EDS; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude de cas; étude/études; facteur démographique; fécondité; méthodologie; population; rapport de recherche; transition démographique; ville/résidence; zone rurale; zone urbaine
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : If demographic and health surveys have underlined declining fertility trends in many countries of sub-Saharan Africa, little is known on the precise timing and the speed of the fertility transition in the continent. This study attempts to fill this gap, by using an innovative approach to the analysis of Demographic and Health Survey data and other relevant surveys. The method utilizes fine tuning of fertility trends year by year, for urban and rural areas separately. The paper starts by a case study of the fertility transition in Kenya. The same method is later applied to more than 20 countries. Results indicate that in many countries, fertility started to decline in the late 1960s and 1970s in urban areas, and about 10 years later in rural areas, much earlier than usually thought. Placing a time frame at the onset of the fertility transition allows one to develop further analysis of the key determinants of the fertility transition. Emphasis is on the role of family planning programs, as well as on emerging independent individual behavior such as delayed marriage and induced abortions. Comparison is made with the situations of other developing countries, and with the possible role of mass media, in particular television. (author's)


Article de périodique

Ahman, E.; Shah, I. H.

Unsafe Abortion: Worldwide Estimates for 2000
2002, Reproductive Health Matters, N°10, 19, p. 13-17

Mots clés : avortement à risque; méthodologie; taux d'avortement à risque

Résumé : Unsafe abortion is preventable and yet remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the last decade, the World Health Organization has developed a systematic approach to estimate the regional and global incidence of unsafe abortion. Estimates based on figures around the year 2000 indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies ended in an unsafe abortion, giving a ratio of one unsafe abortion to about seven live births. Almost all unsafe abortions take place in the developing world. In Latin America and the Caribbean, 3.7 million unsafe abortions are estimated to take place each year, with an abortion rate of 26 per 1000 women of reproductive age, almost one unsafe abortion to every three live births. Asia has the lowest unsafe abortion rate at 11 per 1000 women of reproductive age, but 10.5 million unsafe abortions take place there each year, almost one unsafe abortion to every seven live births. However, excluding East Asia, where most abortions are safe and accessible, the ratio for the rest of Asia is one unsafe abortion to five live births. In Africa, 4.2 million abortions are estimated to take place per year, with an unsafe abortion rate of 22 per 1000 women, or one unsafe abortion per seven live births. In contrast, there is one unsafe abortion per 25 live births in developed countries.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Raufu, A.

Unsafe abortions cause 20 000 deaths a year in Nigeria
2002, BMJ. British Medical Journal, N°325, 7371, p. 988

Mots clés : avortement; avortement provoqué, mortalité; complication grossesse; épidémiologie; femme; grossesse; morbidité et mortalité maternelle; mortalité; mortalité maternelle
Pays : Nigeria
Site web : http://bmj.com

Article de périodique

Teklehaimanot, K. I.

Using the Right to Life to Confront Unsafe Abortion in Africa
2002, Reproductive Health Matters, N°10, 19, p. 143-150

Mots clés : avortement à risque; croyance; droit de l'homme; normes; taux d'avortement à risque
Pays : Afrique

Résumé : Unsafe abortion is one of the leading causes of maternal mortality in Africa. In international human rights law, there are two possible approaches to tackling the problem of unsafe abortion. One is to advocate the right of privacy, which means states must refrain from interfering in women's abortion decisions; the other is to advocate the right to life of women, which stresses the duty of states to take affirmative measures to minimise the consequences of unsafe abortion. African societies are communal and duty is the central element in them. The African Charter on Human and Peoples' Rights reflects communal values by stressing the duty of individuals to help their communities. Unlike other human rights documents, it does not have a right of privacy provision. This paper focuses mainly on the right to life and discusses the interpretation of this right for women, as applied to unsafe abortion, under the International Covenant on Civil and Political Rights. Advocating states' duties in ensuring women's right to life, to minimise the consequences of unsafe abortion, is more consistent with duty-based African communal values than the right of privacy.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Granja, A. C.; Zacarias, E.; Bergström, S.

Violent deaths: the hidden face of maternal mortality
2002, BJOG : An International Journal Of Obstetrics And Gynaecology, N°109, 1, p. 5-8

Mots clés : avortement provoqué, mortalité; crime; décès accidentel; décès violent; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; grossesse; homicide; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; problème social; rapport de recherche; suicide
Pays : Afrique; Afrique subsaharienne; Mozambique

Résumé : This study aims to review pregnancy-related deaths due to injuries, to identify the characteristics of these women and to compare the magnitude of injury- related maternal deaths to that of other causes of maternal death. It is a retrospective study performed during a 5-year period (1991-95), covering deaths from injuries, including suicide, homicide and accidents in Maputo, Mozambique. Its target population is the pregnant or recently pregnant (post-abortion and postpartum) population of Maputo City, the national capital of Mozambique. 27 cases of pregnancy-related deaths caused by injuries were identified. The proportion of deaths due to homicide, suicide, and accidents in pregnant women or within 42 days after termination of pregnancy, were the main outcome measures. 10 cases were due to alleged homicide, nine to alleged suicide and six to alleged accident. 59% (16/27) of women suffering an injury-related maternal death were younger than 25 years of age. 85% of pregnancies were <28 weeks of gestational age. The magnitude of the problem of violence-related maternal deaths compares with the magnitude of pregnancy-induced hypertension as the fourth cause of maternal death at Maputo Central Hospital. The contribution of violence-related deaths to maternal mortality is significant and must not be neglected. (author's, modified)


Reproduced with the permission of the review (© RCOG BJOG: An International Journal Of Obstetrics And Gynaecology) http://www.rcog.org.uk/index.asp?PageID=554

Article de périodique

Wulf, D.; Donovan, P.

Women and societies benefit when childbearing is planned
2002, Issues in Brief, N°3, p. 4

Mots clés : adulte/âge; adultère; âge; aspects socio-économiques; avortement; avortement provoqué, mortalité; complication grossesse; comportement reproductif; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; facteurs économiques; facteurs socio-économiques; famille; fécondité; femme; grossesse; grossesse adolescente; grossesse adolescente/grossesse; infection VIH; maladie; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; programme planification familiale; reproduction; santé; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; statistique; Statut de la femme; système de santé; taille famille
Pays : Afrique; Amérique latine

Résumé : This Issues in Brief presents the most recent information on the pregnancy-related health risks faced by women in developing countries and documents the potentially beneficial impact of family planning on women's lives. (excerpt) SA: Esta publicación resumida presenta la información más reciente sobre los riesgos de salud asociados al embarazo que enfrentan las mujeres de países en desarrollo y documenta el impacto potencialmente beneficioso de la planificación familiar en la vida de las mujeres. (extracto)

Site web : http://www.agi-usa.org/pubs/ib_3-02.html

Rapport

United Nations; Population Division

World population monitoring 2002. Reproductive rights and reproductive health: selected aspects
2002, New York, United Nations, p. 191

Mots clés : Dynamique démographique; évaluation; facteur démographique; méthodologie; Organisation et Administration; politique de développement; population; technique d'estimation

Rapport

Govindasamy, P.; Kidanu, A.; Bantayerga, H.

Youth reproductive health in Ethiopia
2002, Calverton, Maryland, ORC Macro, MEASURE DHS+, p. 99

Mots clés : âge; avortement; avortement provoqué, mortalité; célibataire; communication; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; éducation; éducation pour la santé; emploi; enquête; enquête démographique et de santé/EDS; excision/ mutilation génitale féminine; facteur culturel; facteur démographique; facteur économique; facteurs économiques; fécondité; grossesse adolescente; grossesse adolescente/grossesse; infection VIH; infection/complication; Infections génitales/IST/MST; jeune/adolescent; maladie; maladie sexuellement transmissible/MST/IST; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; media; média; méthodologie; mortalité; mortalité infantile; nuptialité; planning familial; planning familial, acceptante; population; rapport de recherche; santé; santé de la reproduction; santé de l'enfant; santé maternelle; sida; statistique; Syndrome d'immunodéficience acquise/sida
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : It is within this context that the Foundation has funded this in-depth analysis of the 2000 Ethiopia Demographic and Health Survey (DHS) data relating to adolescents and young adults. The objective of this analysis is to develop a comprehensive report on the fertility, family planning, and health behavior of adolescent and young adults in Ethiopia. We believe that this study will provide valuable information on what kinds of services are needed and where, so that appropriate programs can be developed to respond to these needs. (author's)


Article de périodique

Mashamba, A.; Robson, E.

Youth reproductive health services in Bulawayo, Zimbabwe
2002, Health Place, N°8, 4, p. 273-283

Mots clés : âge; analyse; collecte; comportement reproductif; comportements; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; étude/études; facteur démographique; fécondité; focus group/enquête; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; méthodologie; Organisation et Administration; population; programme; Programme d'évaluation; psychologie/facteur psychologique; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Zimbabwe

Résumé : This study examines young people's access to reproductive healthcare services via an urban youth advisory centre in Bulawayo, Zimbabwe. The aim is to explain why teenagers do not always use existing health services. Data from exit questionnaires with users and focus groups with non-users are analysed to evaluate service accessibility. Analysis suggests that even where clinics are spatially accessible, barriers to access include temporal factors, lack of factual knowledge and stigmatisation. The paper concludes that spatial accessibility is not the only factor necessary to ensure equal access to health services. Recommendations are made towards tackling young people's unmet needs for reproductive healthcare services.


  2001   
Article de périodique

Rutgers, S.

Abortion admissions in rural Matebeleland north province
2001, Central African Journal of Medicine, N°47, 9-10, p. 214-20

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; avortement provoqué, mortalité; complication; contraction utérine/complication; méthode d'avortement, effets secondaires; mortalité
Pays : Zimbabwe

Résumé : The study describes the characteristics, clinical features and management of women admitted with an abortion in rural Zimbabwe. in four government and two mission hospitals in rural Matebeleland North province. The Hospital records of 355 consecutive women admitted with the diagnosis abortion from May to October 2000, and delivery registers covering the same six month period were analysed . Abortion patients tended to be older and of higher parity than women who delivered in the same period. Fifteen percent were teenagers, 81.2% were married and 2% nullipara. Mean period of gestation was 11.3 weeks. About half of the women had been referred and 74.4% lived within a 50 km radius from the hospital. Forty two percent had never used contraception. Of the users, 38.6% had discontinued in order to conceive and 19.3% had fallen pregnant on the method. Thirty one percent of the women wanted no more children. One third of the abortion patients had a temperature above 37.6 degrees C; 25.9% offensive vaginal discharge and 7% a haemoglobin of less than 6 g/dl. Eighty percent were given antibiotics and 4.2% received a blood transfusion; 73.2% had an evacuation of the uterus for incomplete abortion, with a mean delay between admission and evacuation of 32.5 hours. Only 17.5% of the women had on record that they were given a contraceptive method on discharge. Mean length of hospital stay was 3.1 days. The case fatality rate was more than 1%. An estimated 43.4% of the women had a possibly unsafe induced abortion prior to admission. CONCLUSION: As evidenced by the high morbidity and mortality, abortions are a serious public health problem in rural Matebeleland North. Taking into account that only a minority of the women with both unsafe and spontaneous abortions present to a hospital, it is imperative that the reproductive needs of the women who do come are addressed. No opportunity should be missed to offer contraceptives to a group of women whose use of contraception is lower than average. Clinical management of abortion patients could improve by earlier evacuation of the uterus in cases of incomplete abortion, use of local or no anaesthesia and by increased availability of suction cannulas in district level hospitals, which would also reduce length of hospital stay.

Site web : http://212.241.193.254/journal_index.php?jid=52 ab=cajm

Article de périodique

Yusuf, L.; Zein, Z. A.

Abortion at Gondar College Hospital, Ethiopia
2001, East African Medical Journal, N°78, 5, p. 265-8

Mots clés : avortement incomplet/complication; avortement provoqué, complication; célibataire; complication; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; état matrimonial; femme; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; méthode d'avortement, effets secondaires; nuptialité; planning familial; planning familial, acceptante; rapport de recherche; taux d'avortement / taux
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : This descriptive cross-sectional situational study reviewed the pattern and magnitude of abortion to establish baseline facts and data for future studies. Analysis of the clinical picture of abortion was conducted at the Gondar College of Medical Sciences Hospital among 1191 patients, mostly married housewives originating from Gondar. The abortion rate and the ratio per 100 pregnancies and deliveries were 11.5 and 16.4, respectively. Patients who admitted to a history of interference with pregnancy were only 13.4%, in which cases data were obtained from 10.6%. The mean gestational ages for septic and nonseptic cases were 14.6 and 15.2 weeks, respectively, even though pregnancies of <12 weeks from the last normal menstrual period accounted for 50.5%. The commonly diagnosed clinical type was incomplete abortion, followed by inevitable and threatened abortion. The vast majority of the clinical conditions were nonseptic (85.1%) and spontaneous (85.6%), while the most common complications were anemia, genital tract infection, shock of various causes, and soft tissue injury.

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Aberra, Y.

Abortion in Ethiopia letter
2001, Africa Health, N°23, 3, p. 2

Mots clés : avortement; Avortement illégal; avortement légal; contraception d'urgence/ contraception postcoitale; planning familial; planning familial, acceptante; politique/programme
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : As I am a General Practitioner working in a rural part of the country, I cannot get even Gutenburg's typewriter (and forget a Personal Computer!), but I have managed to write to you anyway--by hand! Ethiopia is one of the poorest countries in the world, with a population of 60 million. The fertility rate per woman is 7.7 children, and the maternal mortality rate is 500-600 per 100,000 live births. Primary health care facilities are still very meager, and health education is rare. Worse is the situation when we come to the delivery of sex education and family planning services. Unwanted pregnancy is common, and abortion is illegal. Even though abortion is not a good method of family planning, we must choose the lesser evil: to do legal, safe abortions, or to continue watching the bitter consequences of unwanted pregnancy. Abortion is of course an issue of religion, morality, and attitude. But there are already some nongovernmental organization health institutions which do safe abortions in big towns in Ethiopia under cover of names like "menstrual regulation". But a good number of females, especially in their teens, go to the back-street abortionists, who operate unsafely. So should we legalize safe abortion in Ethiopia in the hands of the skilled and help these unfortunate females, or should we sit indifferently and keep on watching our teen sisters die of sepsis and bleeding due to unsafe abortions? (full text)


Ouvrage

United Nations; Population Division

Abortion Policies. A global review - vol I Afghanistan to France
2001, New York, United Nations, N°I, III, p. 183

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; législation; planning familial; planning familial, acceptante; politique/programme

Résumé : The country reports of national policies concerning induced abortion presented in Volume I of "Abortion Policies: A Global Review", covers abortion policies from Afghanistan to France. This document aims to provide objective information on the nature of abortion laws and policies at the end of the 20th century which include information on the social and political settings, ways in which they have been formulated, and their evolution over time. Chapter 1 presents major dimensions of abortion policies with a discussion on challenges in the practical and conceptual context, as well as on the conformity of written law or policies with practices. Chapter 2 outlines the description of the variables identified in each country profile, namely: grounds on which abortion is permitted; reproductive health indicator, and abortion policies and their national context. The third chapter details country profiles, which are arranged alphabetically.


Ouvrage

United Nations; Population Division

Abortion Policies. A global review - vol II Gabon to Norway
2001, New York, United Nations, N°II, III, p. 209

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; législation; planning familial; planning familial, acceptante; politique/programme

Résumé : This is the second of three planned volumes presenting a country-by-country examination of national policies concerning abortion. Information in this volume is provided in alphabetical order from Gabon to Norway, and concerns each country's abortion policy, the fertility and mortality context in which abortion policy has been developed, and statistics on induced abortion. (ANNOTATION)


Article de périodique

Jali, M. N.

Abortion--a philosophical perspective
2001, Curationis, N°24, 4, p. 25-31

Mots clés : avortement; complication grossesse; éthique; grossesse
Pays : Afrique du Sud

Article de périodique

Silberschmidt, M.; Rasch, V.

Adolescent girls, illegal abortions and "sugar-daddies" in Dar es Salaam: vulnerable victims and active social agents
2001, Social Science Medicine, N°52, 12, p. 1815-26

Mots clés : adolescent; âge; avortement; Avortement illégal; comportement à risque; comportement sexuel; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; facteur démographique; jeune/adolescent; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; rôle des hommes
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : Adolescent girls' early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in sub-Saharan Africa. Efforts, though, to understand their sexual behavior and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy prey of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing prey and active social agents engaging in high-risk sexual behavior. In order to get material benefits they expose themselves to serious health risks, including induced abortion -- without realizing their own vulnerability. In the author's study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, the authors' study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a license to practice illicit sex -- but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health. (author's)

Site web : http://authors.elsevier.com/JournalDetail.html?PubID=315 Precis=DESC

Article de périodique

Granja, A. C.; Machungo, F.; Gomes, A.; Bergström, S.

Adolescent maternal mortality in Mozambique
2001, Journal of Adolescent Health, N°28, 4, p. 303-6

Mots clés : adolescent; âge; avortement; avortement provoqué, mortalité; Cause de décès; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; grossesse; Hypertension/HTA; jeune/adolescent; maladie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; paludisme; planning familial; planning familial, acceptante; population; rapport de recherche; taux d'avortement / taux
Pays : Afrique; Afrique subsaharienne; Mozambique

Résumé : This study aimed to demonstrate the adolescent maternal mortality in Maputo Central Hospital (HCM) by using an audit approach and by analyzing the avoidability of maternal deaths in adolescents. A total of 239 maternal deaths were analyzed according to circumstances of death, antenatal care, and care in other health centers and in the HCM. Analysis was carried out to detect any avoidable factor attributable to the patient, to the care provided at peripheral units, or to the care provided at HCM. Overall, results show a 30% higher institutional maternal mortality ratio in adolescents than in non-adolescents. Similar results regarding higher obstetric risk of death in adolescents were found in other institutional and community-based maternal mortality studies. The main causes of adolescent deaths include malaria, pregnancy-induced hypertension, puerperal sepsis, and septic abortion. The audit classified 75% of all maternal deaths as avoidable. To this effect, adequate strategies addressing the special needs of adolescents are required to prevent high levels of maternal mortality in this age group.


Article de périodique

Dickson-Tetteh, K.

Adolescent reproductive health in Africa: a problem or a priority? editorial
2001, African Journal of Reproductive Health / Revue Africaine de la Sante, N°5, 3, p. 11-2

Mots clés : adolescent; âge; avortement; contraception d'urgence/ contraception postcoitale; facteur démographique; genre; infection VIH; jeune/adolescent; maladie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; santé; santé de la reproduction; sida; Syndrome d'immunodéficience acquise/sida
Pays : Afrique; Afrique subsaharienne

Résumé : Adolescents are generally thought to be healthy, yet many of them die prematurely. The four major causes of death among them are road traffic accidents, suicide, tobacco use, and sexual and reproductive disorders. Focusing on adolescent reproductive health, it is noted that in many African countries, HIV prevalence levels are high among young people. It is projected that half of the 15-year-olds in South Africa and Zimbabwe will eventually die of AIDS, as will least one-third of this population in another 16 sub-Saharan countries where HIV prevalence is 10% or higher. Levels of unintended pregnancies among teenagers are also high, with more than one-fifth of recent births reported as unintended. Moreover, up to 4.4 million women aged 15-19 years undergo unsafe abortions annually, most often carried out illicitly by unqualified practitioners, and which result in complications. However, a substantial number of young people have indicated that they need information on matters such as pregnancy, sexually transmitted infections, sexual intercourse and relationships. To this effect, the WHO and its partners advocate a comprehensive approach to enable adolescents to develop their full potential to be healthy. The common agenda advocates creating a safe and supportive environment, providing information and rebuilding skills, and expanding access to health services. Special efforts should be made to develop gender sensitive programs.


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Alubo, O.

Adolescent reproductive health practices in Nigeria
2001, African Journal of Reproductive Health, N°5, 3, p. 109-19

Mots clés : adolescent; âge; collecte; culture; déterminant culturel; éducation; Entretien; étudiant; étudiant/scolarisation; facteur culturel; facteur démographique; focus group/enquête; genre; jeune/adolescent; méthodologie; population; rapport de recherche; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Adolescents have become a focal point of discussions of sexuality and reproductive health (RH) matters because they belong to a most active segment of the population and because of practical concerns in resolving problems such as unintended pregnancy and sexually transmitted diseases (STDs), including HIV/AIDS. Employing in-depth interviews and focus group discussion techniques, this study of 2510 respondents from four tertiary educational institutions in Nigeria examined various forms of RH practices, their origins, RH services available in the institutions, and the role of gender relations in RH concerns. The findings show that respondents engage in a wide range of folk practices and do-it-yourself procedures to maintain personal hygiene, prevent and treat STDs, as well as prevent and terminate unwanted pregnancies. These practices, which involve the use of every day commodities such as lime, antacid, and other drugs in particular ways, are learned from and passed on through peers. The practices are considered more confidential and are preferred to the RH services in the institutions' clinics. There are obvious implications for avoidable complications, morbidity and mortality, all of which need to be redressed through intervention. (author's) .


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Congrès

Ngondo a Pitshandenge, S.

Amitiés, sexualité et avortement en milieu scolaire. Le cas de la ville de kikwit (République Démocratique du Congo)
49103
2001, Les transitions démographiques des pays du Sud, Journées Scientifiques du Réseau Démographique de l'Agence Universitaire de la Francophonie, Rabat, Maroc, Estem, p. 241-250

Mots clés : adolescent; avortement; comportement sexuel; état matrimonial; nuptialité

Résumé : Les comportements adoptés par les jeunes en matière de nuptialité, de sexualité et d'avortement au cours d'une époque peuvent augurer des changements dans le domaine de la croissance démographique. A défaut d'un déclin de la mortalité, en effet, ces comportements peuvent conduire, pour leur impact sur la fécondité à une transition démographique provoquées uniquement par le déclin de la fécondité. C'est cette présomption que nous voulons défendre à travers cette propension aux amitiés et aux fiançailles, la forte intensité de la sexualité et le recours à l'avortement que nous avons noté lors d'une étude en milieux scolaires dans la ville de Kikwit. L'étude a porté sur un échantillon probabiliste de 802 filles scolarisées, prélevé dans 25 classes de 5ème et 6ème des Humanités de 13 écoles de la place; Ces classes n'ont renfermé que les filles célibataires, âgées de 15 - 21 ans. A l'analyse, il est ressorti que 635 de ces étudiantes, soit 79% de l'ensemble étaient impliquées dans les liens des fiançailles ou de "copinage". Pour des raisons aussi bien affectives qu'économiques, quelques-unes de ces étudiantes vivaient en "relations polyandriques" cumulant fiancé et copain. Sous couvert de ces relations, les étudiantes fiancées ou ayant un copain surtout menaient une vie sexuelle relativement intense.Calculs faits, les avortements provoqués enregistrés ces les étudiantes sous étude, conséquences d'une sexualité non protégée, parviennent à réguler une fécondité des jeunes scolarisées dont le niveau est égal à celui de filles de leur âge régulièrement mariées et gardant leur grossesse (Résumé d'auteur)


Chapitre d'ouvrage

Barrère, M.

Avortement
2001 - in DGSEE, FNUAP, ORC Macro, Enquête Démographique et de santé Gabon 2000, Calverton, Maryland, USA, p. 86-98

Mots clés : âge; avortement; complication grossesse; déterminant fécondité; fécondité; grossesse; première naissance; stérilité; tendance de la fécondité
Pays : Gabon

Chapitre d'ouvrage

Unité de Recherche Démographique URD (Université du Bénin); Direction Générale de la Statistique et de la Comptabilité Nationale

Avortement au Togo
2001, Famille, migration et urbanisation au Togo. Résultats de l'enquête quantitative., Lomé, Togo, URDDGSCN, p. 13

Mots clés : avortement
Pays : Togo

Article de périodique

Ramonate, N.; Hiemstra, L. A.; de Coning, E. C.; Nel, M.

Bio-social profile and survey of women seeking termination of pregnancy at Pelonomi and national hospitals, Bloemfontein
2001, South African Medical Journal, N°91, 6, p. 500

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; hôpital; hôpital publique; hôpital universitaire; Interruption volontaire de grossesse / IVG
Pays : Afrique du Sud

Résumé : Reports on a study conducted to determine the personal characteristics of women seeking termination of pregnancy, level of contraceptive knowledge and use, past obstetric experience, and reasons for termination of pregnancy at Pelonomi and national hospitals in Bloemfontein

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Elul, B.; Hajri, S.; Nguyen thi Nhu, N.; Ellertson, C.; Ben Slama, C.; Pearlman, E.; Winikoff, B.

Can women in less-developed countries use a simplified medical abortion regimen?
2001, Lancet, N°357, 9266, p. 1402-5

Mots clés : avortement médical; méthode d'avortement; méthode d'avortement,; méthodes

Résumé : Mifepristone-misoprostol abortion, consisting of oral pills, is potentially simple and safe enough for use in less-developed countries. But the labor-intensive, costly, clinic-based European protocols are not affordable or feasible in most less-developed countries. The authors prospectively tested two simplifications to the French mifepristone-misoprostol regimen in Vietnam and Tunisia. Women (n = 315) with amenorrhea of 8 weeks or less since their last menstrual period received 200 mg mifepristone in the clinic and then chose whether to take 400 mcg oral misoprostol 2 days later either at home or in the clinic. Despite a two-thirds reduction in the mifepristone dose, success rates were high: Vietnam 93%, Tunisia 91%. About 88% of participants chose home administration of misoprostol. Most Vietnamese and Tunisian women were satisfied with their abortions, but efficacy and satisfaction rates were higher among those who used misoprostol at home. A simplified medical abortion regimen of 200 mg mifepristone, followed by the option of home administration of misoprostol, seems feasible. (author's)

Site web : http://www.thelancet.com/

Article de périodique

Fekadu, Z.

Casual sex-debuts among female adolescents in Addis Ababa, Ethiopia.
2001, Ethiopian Journal of Health Development, N° 15, 2, p. 109-16.

Mots clés : activité sexuelle / sexualité; adolescent; âge; coït/sexualité; comportement sexuel; comportements; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; femme; jeune/adolescent; méthodologie; population; psychologie/facteur psychologique; rapport de recherche; sexualité
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : Abstract: In the era of the HIV/AIDS epidemic, understanding the nature of sexual debut among female adolescents is critical in developing effective preventive strategies. The objectives of the study were to investigate the specific age at sexual debut, to identify the specific reasons for sexual debut, and to examine the self- restraining capability of female adolescents. A self-administered questionnaire survey was conducted among sexually active adolescent females in Addis Ababa. A total of 354 sexually active female adolescents (aged 15-19 years) completed the self- administered questionnaire, of which 29% had planned sex, while the remaining 71% reportedly had casual sex. Moreover, 22% reported ever use of condoms, while 24% admittedly had experienced abortion. With the average age at sex debut being 16.7 years (standard deviation = 1.7), the respondents initiated sex as early as 11 years. Some of the reasons for sexual debut were identified, with 'maintaining relation with male partner' (51%), 'for the sake of passionate love' (45.8%), and 'to overcome loneliness' (40%) being the three most important reasons given. Regarding self-restraining capacity, the majority of the respondents (75.4%) indicated that they had 'little or no control over' their sexuality in the face of sexual advances made by male partners. Efforts must be strengthened to empower young female adolescents to protect themselves from sexual exploitation. (author's, modified)


Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Article de périodique

Strickler, j.; Heimburger, A.; Rodriguez, K.

Clandestine abortion in Latin America: a clinic profile
2001, International Family Planning Perspectives, N°27, 1, p. 34-36

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires
Pays : Amérique latine

Résumé : Context: Most research on abortion in Latin America has focused on women who are hospitalized with abortion complications, but little is known about the characteristics of women who are able to obtain clandestine procedures performed by trained personnel working in sanitary conditions.
Methods: Analysis of medical records for 808 clients of an urban clandestine abortion service in South America was supplemented with observation of clinic operations for six weeks in 1995.
Results: Nearly nine in 10 clients had at least a secondary education, about three-quarters were younger than 30 and a similar proportion were unmarried. Fifty-four percent had never given birth, and 13% had had at least one prior abortion. Three-fifths of women had not been using a contraceptive method when they conceived; among users, three-fifths had been using a traditional method. Three percent experienced mild complications related to the procedure (e.g., heavy bleeding or pelvic pain), and another 2% reported serious complications (e.g., pelvic infection, hemorrhage or suspected uterine perforation).
Conclusions: To reduce the need for abortion, it is important for family planning programs to include women who are young, unmarried and highly educated in their outreach efforts.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Goyaux, N.; Alihonou, E.; Diadhiou, F.; Leke, R. J. I.; Thonneau, P. F.

Complications of induced abortion and miscarriage in three African countries: a hospital-based study among WHO collaborating centers
2001, Acta Obstetricia et Gynecologica Scandinavica, N°80, 6, p. 568-73

Mots clés : avortement incomplet/complication; avortement provoqué, complication; avortement spontané; avortement spontané/fausse couche; biologie; complication; complication grossesse; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; facteurs de risque; grossesse; issue grossesse; maladie; méthode d'avortement, effets secondaires; planning familial; planning familial, acceptante; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Bénin; Cameroun; Sénégal

Résumé : The aim of this study was to describe two of the outcomes of pregnancy, induced abortion and miscarriage, in three African countries. Major maternal risk factors were also evaluated. The study was prospective and based on the medical files of all 1957 women admitted to participating health care structures. Overall, 988 women were admitted for complications of miscarriage, and 969 for complications of induced abortion. Gestational age was lower in women with miscarriages (p < 0.002). The level of use of contraceptive methods (p < 0.003) and educational level (p < 0.005) were lower in women who had had an induced abortion. In the authors' study, 26 maternal deaths were recorded, 22 of which were associated with induced abortion. Infection was the most important risk factor for death (odds ratio = 4.8; 1.9-12.4). Maternal deaths related to abortion complications often occurred shortly after hospital admission and with signs of sepsis. This demonstrates the importance of effective emergency services. Unfortunately, hospital-based studies alone cannot assess all maternal death risk factors, especially those for maternal death related to induced abortion complications. It is therefore important to determine what happened to the woman before hospital admission and during her stay in hospital. Combinations of qualitative and quantitative methods could be used to increase the authors' understanding of this problem and to help them solve it. (author's)


Article de périodique

Chiesa-Moutandou, S.; Tiemeni Wantou, G.

Comportement contraceptif des gabonaises. Les méthodes modernes : faible taux d'utilisation et déficit d'information
2001, Médecine d'Afrique noire, N°48, 5, p. 191-198

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive
Pays : Gabon

Résumé : Les auteurs tentent d'apprécier le comportement des Gabonaises à l'égard de la contraception, à partir d'une
enquête portant sur 850 femmes.
Il ressort que les Gabonaises ont très fréquemment recours à une méthode contraceptive mais il s'agit le plus
souvent de méthodes naturelles peu efficaces. La contraception hormonale, orale ou injectable, et les DIU ne
représentent que 11,5 % des moyens utilisés. Les condoms ne sont utilisés que comme moyens d'appoint (en
phase présumée fécondante).
L'IVG clandestine est malheureusement encore très fréquemment pratiquée : 37,22 % des enquêtées
reconnaissent y avoir eu recours au moins une fois.
L'absence d'une bonne information sur les moyens contraceptifs modernes semble être un facteur important
limitant leur utilisation et la mise en place d'une régulation efficace des naissances.

Site web : http://www.santetropicale.com/resume/54802.pdf

Article de périodique

Dakun, J. T.

Consequences of adolescents sexual behaviour
2001, Grassroots Health News, N°2, 2, p. 5

Mots clés : activité sexuelle / sexualité; adolescent; âge; avortement incomplet/complication; avortement provoqué, complication; coït/sexualité; complication; comportement à risque; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; facteur démographique; jeune/adolescent; méthode d'avortement, effets secondaires; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; santé; sexualité
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : The consequences of misguided adolescent sexuality have been summarized by the Ghana Social Marketing Foundation into two main risks: health and social risks. The health risks include early or unwanted pregnancy, unsafe abortion, sexually transmitted diseases (STDs) and HIV/AIDS infections, while social risk includes school drop out, leading to social, economic, and intellectual underdevelopment for the individual, and health and manpower crisis for the nation. In Nigeria, many teenage girls who get pregnant often resort to criminal unsafe abortion. In the northern part of Nigeria, a study conducted on attitudes to abortion revealed that 58% of the abortion patients admitted having unsuccessfully tried to induce abortion. It is noted that lack of information on STDs/HIV also exposes Nigerian youth to STDs/HIV/AIDS infection. A study in Plateau and Bauchi States reveals that knowledge about the prevalence of disease that are transmitted sexually is high among the youth, but knowledge of specific STDs, of prevention is low and vary according to ages and location.


Congrès

Guillaume, A.

Contraception et avortement: deux modes de régulation de la fécondité à Abidjan (Côte d'Ivoire)
2001 - in IUSSP, ¨XXIV IUSSP General Conference, Salvador Brazil, p. 11 p.

Mots clés : déterminant fécondité; fécondité
Pays : Côte d'Ivoire

Résumé : En Côte d'ivoire, comme dans de nombreux pays d'Afrique de l'Ouest, l'avortement est illégal. Il représente une cause majeure de morbidité et de mortalité maternelles, car est pratiqué le plus souvent dans des conditions d'hygiène et de sécurité insuffisantes. Les données sur ce sujet sont rares, et émanent principalement d'enquêtes menées dans des structures hospitalières où les femmes se rendent pour des complications. Cependant quelques études récentes ont montré l'importance de cette pratique et sa croissance rapide ces dernières années : l'avortement intervient parfois comme mode de régulation de la fécondité et influe sur son niveau.
Les résultats présentés ici sont issus d'enquêtes menées auprès de consultants (hommes et femmes) dans des centres de santé de la ville d'Abidjan. Le choix de travailler auprès de consultants se justifie car - d'une part cette étude s'inscrivait dans le cadre d'un programme de recherche appliquée sur la planification familiale mené dans des structures sanitaires - et d'autre part car cet acte étant illégal, une étude approfondie en population générale, sur la pratique de l'avortement était difficile. Une enquête quantitative a été menée sur une population de 2400 femmes et 600 hommes venus en consultation. Le questionnaire de l'enquête qualitative comprenait un module sur la vie génésique complète des femmes, les connaissances et pratiques de la contraception et un module spécifique sur l'avortement : méthodes connues et utilisées, raisons de l'avortement, pratique de la contraception avant et après cet avortement, processus de décision et coût du recours à l'avortement, connaissance et opinion par rapport à la légalisation de l'avortement. Des entretiens ont été menés auprès de consultants et de personnels de santé.
Les données ont été analysées à l'aide de méthodes bivariées et multivariées (régressions logistiques) pour déterminer les relations entre les caractéristiques socio-démographiques des femmes, la pratique de la contraception et le recours à l'avortement.
Bien qu'illégal en Côte d'Ivoire, le recours à l'avortement provoqué est très fréquent à Abidjan et cette pratique est souvent " à répétition ". Les femmes recourent à l'avortement pour éviter des grossesses non désirées et ce recours s'est accentué récemment. L'avortement est utilisé comme " méthode de planification familiale " par des femmes qui veulent réguler leur fécondité en limitant leur descendance ou en espaçant leurs naissances, mais qui n'utilisent pas la contraception pour différentes raisons : soit elles n'ont pas accès aux services de planification familiale, soit elles ont une mauvaise opinion de ces méthodes ou elles ont déjà connu un échec avec ces méthodes. Malgré une bonne connaissance de la contraception, son utilisation reste modérée particulièrement pour les méthodes modernes et certaines femmes ont eu des grossesses non désirées qui se sont terminées par un avortement provoqué alors qu'elles utilisaient une méthode naturelle de contraception.
Des contraintes familiales, sociales ou économiques expliquent ce recours à l'avortement : il est particulièrement fréquent chez les jeunes femmes, non mariées, qui craignent à cause de cette grossesse un rejet social ou familial ou un abandon précoce de leur scolarité.
L'avortement a un impact non négligeable sur la fécondité puisqu'il explique une partie de la diminution du niveau enregistré ces dernières années, en l'absence d'une pratique généralisée de la planification familiale.
Bien que pratiqué majoritairement par des méthodes chirurgicales, l'avortement est fait le plus souvent pas du personnel médical non qualifié et expose les femmes à des problèmes de santé, d'autant plus que la prise en charge post-abortum est quasiment inexistante. L'avortement pose ainsi un large problème de santé publique.

Site web : http://www.iussp.org/Brazil2001/s20/S21_P08_Guillaume.pdf

Article de périodique

Hord, C. E.

Creating access to safe abortion: a practical guide for advocacy
2001, Lancet, N°358, 9283, p. 689-95.

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; facteur démographique; femme; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; santé; santé publique; Sécurité
Pays : Afrique; Egypte

Résumé : At the 1994 International Conference on Population and Development (ICPD) in Cairo, and at the follow-up meeting held at the United Nations in 1999 to review the progress of those commitments (ClPD+5), most of the governments undertook to guarantee that legal abortions would be safe and accessible. This guide is a tool for activists who want to ensure that this mandate is fulfilled in their countries. This manual assumes that the reader wants abortion services in his or her country to be offered at an affordable cost and to be available to the women who seek them, and it presents a general overview of the factors that must be addressed in order to achieve that goal. This manual is divided into four main sections. Section one: Have a vision of the changes you want to see in the abortion services in your country. Section two: Find allies to help you achieve your goals and plan your work. Section three: Raise awareness among different groups of people about the need for change. Section four: Help prepare the health system and related sectors to provide safe abortion services. (excerpt)
SA: En la Conferencia Internacional sobre la Población y el Desarrollo (CIPD) de 1994 en El Cairo, y en la reunión de seguimiento que se llevó a cabo en las Naciónes Unidas en 1999 para revisar el avance de esos compromisos (ClPD+5), la mayoría de los gobiernos se comprometieron a garantizar que los abortos legales fueran seguros y accesibles. Esta guía constituye una herramienta para encaminar a los activistas que quieran asegurar que este mandato se cumpla en sus paises. Este manual presupone que el lector desea que los serviciosde aborto de su pals se ofrezcan a un costo asequible y estén disponibles para las mujeres que los soliciten, y presenta un panorama general de los aspectos que deben tratarse para lograrlo. Este manual se divide en cuatro secciones principales. Sección uno: Tener una visión de los cambios que usted quiera ver en los servicios de aborto de su país. Sección dos: Encontrar aliados que le ayuden a lograr sus metas y planear su trabajo. Sección tres: Hacer conciencia entre distintos grupos de personas sobre la necesidad del cambio. Sección cuatro: Contribuir en la preparación del sistema de salud y sectores relaciónados para la provisión de servicios de aborto seguro. (extracto)

Site web : http://www.thelancet.com/

Rapport

Joseph, V.; Garenne, M.

Datation de la baisse de la fecondite en Afrique subsaharienne
2001, Dossiers du CEPED No. 66, Paris, France, Centre Francais sur la Population et le Developpement [CEPED], p. 64

Mots clés : avortement; célibataire; contraception d'urgence/ contraception postcoitale; déterminant de la fécondité; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; nuptialité; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme planification familiale; rapport de recherche; transition de la fécondité
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : The authors present the results of a study conducted to determine when fertility began to decline in sub-Saharan Africa. Such declines lay at the core of demographic transition processes in developing countries. While Demographic and Health Surveys (DHS) identified a trend toward declining fertility in some sub-Saharan African countries, the exact beginning of the trend and the rate of transition across the country remain unclear. The authors of this study used methodology exploiting urban and rural yearly fertility trends applied to DHS and other reliable data to learn more about the exact timing of fertility decline in the region. Identification of the initiation of fertility decline permits the in-depth analysis of the process's determinants. Following a review of fertility transition in Kenya, the method is applied to more than 20 other countries. Study results show that fertility began to decline in many countries during the late 1960s and 1970s in urban areas, compared to approximately 10 years later in rural areas, far earlier than previously thought. Focus is given to the role of family planning programs and individual behavior changes such as delayed marriage and abortion. Comparisons are made with other developing countries and the potential role of mass media.


Reproduced with the permission of Ceped : http://ceped.cirad.fr

Thèse

Ouanaim, E. H.

Determination of needs in complimentary technical training for primary care physicians in rural setting
2001, Rabat, Morocco, Institut National d'Administration Sanitaire [INAS], p. 32

Mots clés : avortement; collecte; contraception d'urgence/ contraception postcoitale; demande; demande d'avortement; éducation; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; Entretien; évaluation; focus group/enquête; intervention chirurgicale; médecin/personnel de santé; méthodologie; personnel de santé; planning familial; planning familial, acceptante; population; Programme de formation; Recommandations; santé; santé de l'enfant; service de santé; service de santé communautaire/offre/service de santé; soin de santé primaire; système de santé; traitement/soin; zone rurale
Pays : Afrique; Maroc

Résumé : Quick advancement in health sciences and techniques and attention paid to health costs have made on-going medical training an essential activity in the practitioner's quest for efficiency. Therefore, for on-going medical training to achieve its expected objectives, it has to be planned; identifying training needs is one of the most important functions of an on-going training system. This report by the National Institute of Health Administration fits into this program. Its objective is to determine the needs in additional technical training for primary care physicians in the rural El Kelaa des Sraghnas province in Morocco. The methodology used combines two approaches; one is inductive and uses exploratory qualitative methods aimed at a group of 12 rural general practitioners, a focus group and a list validation of the results obtained by those two processes; the other one is deductive and uses questionnaire interviews. Training needs among primary care physicians were identified thanks to those two approaches and the information collected turned out to be in sync with institutional and community needs. The ten needs identified by the general practitioners were: operational procedures for acute asphyxia (laryngeal foreign body), reduction of articular dislocation, how to handle placental retention, learn basic procedures for neonatal care, administer ophthalmoscopic examination, circumcise, excise cysts and nodules, administer first aid, aid polytraumatized persons and how to handle the vacuum extractor. Pedagogical, managerial and logistical recommendations were formulated to multiply this type of studies in the health care field such as training practitioners to identify on-going training needs, prepare a yearly intervention plan, allocate necessary funds at the local level and offer rural training in technical medical material.
Compte tenu des besoins croissants liés à l'évolution rapide des sciences et des techniques de santé et à l'évaluation générale des coûts de la santé, la Formation Médicale Continue (FMC) constitue une activité essentielle dans la recherche d'efficacité du praticien. Par conséquent, pour que cette FMC atteigne les objectifs escomptés, il faut qu'elle soit planifiée et la détermination des besoins en formation représente une des fonctions les plus importantes d'un système de formation continue. Ce mémoire de l'INAS (Institut National d'Administration Sanitaire) s'inscrit dans ce contexte, son objectif est de déterminer les besoins en formation complémentaire technique des médecins généralistes en milieu rural de la province d'El Kelaa des Sraghnas au Maroc en vue d'améliorer la prise en charge des patients. La méthodologie utilisée combine deux approches, l'une inductive utilisant des méthodes exploratoires qualitatives constituées d'une technique de groupe nominal auprès de 12 médecins généralistes du rural, d'un focus group et d'une validation de la liste des énoncés obtenus par ces deux procédés et l'autre déductive utilisant une enquête par questionnaire. L'exploitation de ces outils a permis de dégager les besoins en formation recueillis auprès des médecins généralistes et qui se sont révélés en adéquation avec les besoins communautaires et institutionnels. En effet, les dix besoins identifiés par ces médecins sont: connaître la conduite à tenir devant une asphyxie aiguë (corps étranger laryngé), réduire les luxations articulaires, prendre en charge les rétentions placentaires, connaître les gestes élémentaires de réanimation néonatale, pratiquer un fond d'oeil, l'acte de circoncision, l'excision des kystes et nodules dermiques, les premiers gestes de secourisme, les premiers gestes devant un polytraumatisé et la manipulation de la ventouse obstétricale. Des recommandations pédagogiques, gestionnaires et logistiques ont été émises pour multiplier ce genre d'étude dans le système de santé telles que former les médecins à identifier des besoins en formation continue, l'élaboration d'un plan d'action annuel de formation continue, l'octroi de crédits nécessaires et leur délégation locale et la dotation des formations sanitaires rurales en matériel médico-technique plus particulièrement..


Article de périodique

Kaye, D.

Domestic violence among women seeking post-abortion care
2001, International Journal of Gynecology and Obstetrics, N°75, 3, p. 323-25

Mots clés : avortement; collecte; contraception d'urgence/ contraception postcoitale; crime; enquête; Entretien; étude/études; méthodologie; planning familial; planning familial, acceptante; problème social; violence domestique
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : A cross-sectional study was conducted among 311 women admitted with abortions in the gynecological emergency ward of the national referral hospital, Mulago in Uganda. The aim was to determine the prevalence, severity and factors associated with domestic violence, which included physical, sexual and psychological abuse. The subjects were selected by systematic sampling between January 5, 2000 and April 30, 2000 and were interviewed using a structured questionnaire. The results showed that 174 women (57.0%) reported domestic violence in the first pregnancy. Also, most (112) of the women had witnessed abuse of a close relative in their childhood. Also, 170 women reported prior domestic abuse, where 4.9% was physical only, 31.9% emotional only, and 47.8% both physical and emotional. In addition, among 70 women who reported induced abortion, 28 gave domestic violence-related issues as the main reason for abortion. In this regard, prior abuse was noted as the main predictor of induced abortion.


Article de périodique

Kaye, D.

Domestic violence and induced-abortion: report of three cases
2001, East African Medical Journal, N°78, 10, p. 555-6

Mots clés : avortement; collecte; comportement reproductif; contraception d'urgence/ contraception postcoitale; crime; déterminant fécondité; droit de l'homme; Dynamique démographique; enquête; Entretien; étude de cas; étude/études; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; méthodologie; planning familial; planning familial, acceptante; population; problème social; violence domestique
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : Domestic violence not only violates women's rights, but is also associated with diverse consequences ranging from physical injury to psychological morbidity. Several studies have associated domestic violence with risk of having an induced-abortion. The following three cases indicate that domestic violence may not cause unwanted pregnancy, but may be the reason that leads victims to resort to abortion. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=53

Thèse

Anoh, A.

Émergence de la planification familiale en Côte d'Ivoire
2001, Démographie, Nanterre, Paris X, p. 244

Mots clés : avortement; régulation des naissances; santé de la reproduction; système de santé
Pays : Côte d'Ivoire

Ouvrage

Ould Isselmou, A.; Barrère, B.; Salem Ould Moujtaba, M. L.; Housni, E. H.; Ould Ekeibed, M. A.; Barrère, M.; Mboup, G.; Office National de la Statistique (Mauritanie); ORC Macro

Enquête démographique et de santé Mauritanie 2000-2001
49407
2001, Calverton (US), ONSORC Macro, p. 385 p.

Mots clés : allaitement; avortement; déterminant fécondité; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; fécondité; méthodologie; mortalité infantile; nuptialité; régulation des naissances; service de santé; service de santé communautaire/offre/service de santé; sida; Syndrome d'immunodéficience acquise/sida; VIH
Pays : Mauritanie

Article de périodique

Letaief, M.; Bchir, A.; Belghith, Z.; Ben Salem, K.; Soltani, M. S.

Epidemiological aspects of induced abortion in Monastir, Tunisia
Aspects epidemiologiques de l'interruption volontaire de grossesse a Monastir, Tunisie

2001, Archives of Public Health, N°59, 2, p. 101-110

Mots clés : avortement; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête personnel de santé; enquête/enquête rétrospective; étude prospective; étude/études; facteur démographique; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; programme planification familiale; rapport de recherche; santé; santé de la reproduction
Pays : Afrique; Tunisie

Résumé : In Tunisia, a family planning (FP) program has been launched since 1966 and contributed to the improvement of sociodemographic indicators. However, induced abortion remains frequent. The authors' study aims to present sociodemographic characteristics, obstetrical profile, contraceptive use and mode of recourse to abortion among 597 women attending a FP center. A prospective study was carried out during the first semester 1998 in Monastir, Tunisia. Information was collected by interviewers using a questionnaire. The mean age of the study population was 32 years confidence interval (CI) 95% [31.5-32.5], 75% were below 36 years and have been married for a mean period of 10 years CI 95% [9.5-10.5]. 42.9% experienced one (30.0%) or more (12.9%) previous induced abortion. Contraceptive use 1 month before the conception showed that 61% of women had used several traditional contraceptive methods i.e. rhythm by 43.4% CI 95% [35.1-51.7], withdrawal method by 12.1% CI 95% [9.4-14.9] and breastfeeding by 5.1% CI [3.3-6.9]. About 25% of women had used modern contraceptive methods: 11.1% CI 95% [8.65-13.6] a contraceptive pill, IUD in 5.8% of cases CI 95% [3.9-7.7], only 5.3% CI 95% [3.5-7.1] reported use of condoms and other methods including spermicide and injectable contraceptive were used in 3.0% of cases. 14% declared not using any method. The most frequent reasons cited for not using any modern contraceptive methods were: fear of side effects (42.0%), careless (19.0%), refuse (17.0%) and lack of information (12.0%). These results showed that many efforts should be deployed in knowledge about contraceptive use, couple involvement and on health service integration to improve the quality of care in reproductive health. (author's)


Article de périodique

Munjanja, S. P.

Ethics in reproductive health: clinical issues in Zimbabwe
2001, Central African Journal of Medicine, N°47, p. 159-163

Mots clés : Anesthésie; aspects légaux; avortement; avortement pour viol; complication grossesse; confidentialité; éthique; grossesse; intervention chirurgicale; maladie; maladie sexuellement transmissible/MST/IST; planning familial; planning familial, acceptante; santé de la reproduction; VIH; viol; violence; violence contre les femmes
Pays : Zimbabwe

Résumé : Reproductive health can present health practitioners with ethical problems because of the complex interaction between cultural practices, the laws of the country and individual personal preferences. In particular, the problems of pregnancy, sexually transmitted infections, family planning, sexual violence, and domestic abuse require a good knowledge of the laws of the country and the culture in which they operate. The practitioner should at all times respect the patient's autonomy and serve their best interests, whilst keeping in mind the legitimate interest of their partners, spouses, parents or guardians.

Site web : http://212.241.193.254/journal_index.php?jid=52 ab=cajm

Article de périodique

Moussa, A.

Evaluation of postabortion IUD insertion in Egyptian women
2001, Contraception, N°63, 6, p. 315-7

Mots clés : adolescent; adulte/âge; adultère; avortement spontané; avortement spontané/fausse couche; complication grossesse; femme; grossesse; soin post-abortum; soin post-avortement; soins post avortement
Pays : Egypte

Résumé : This study was carried out at Alhussein University Hospital and Elmonera General Hospital to assess the safety and efficacy of intrauterine device (IUD) insertion immediately after spontaneous abortion compared with insertion 2 weeks after abortion. One hundred women between ages 18 and 40 years were recruited from those admitted via the emergency room with first trimester spontaneous abortion. All women were counseled about a method of contraception, particularly copper T-380, and divided into two groups: Group I, which included 69 women who preferred immediate IUD insertion, and Group II, which included 31 women who asked for late IUD insertion 2 weeks after an abortion. All women were followed at 2, 6, and 10 weeks after insertion of IUDs. Bleeding patterns were comparable in both groups. Mild bleeding occurred in 9.2% and 16% in Groups I and II, respectively; moderate bleeding occurred in 80% and 64%, respectively, and severe bleeding was observed in 10.8% and 20%, respectively. This was not significant. Expulsion rate was 4.5% and 3.4% in Groups I and II, respectively, which was also not significant. There were no cases of perforation or pelvic infections. This study showed that insertion of an IUD immediately after a spontaneous abortion is safe and could be offered to those who have had an abortion and who ask for a method of contraception.

Site web : http://www.contraceptionjournal.org/

Article de périodique

Youssef, H.; Hassan, E. O.; Nawar, L.

Expanding improved postabortion care in Egypt
2001, Egyptian Society of Obstetrics and Gynecology, N°27, 4-6, p. 237-51

Mots clés : Evaluation des services de santé; Organisation et Administration; planning familial; planning familial, acceptante; programme; programme post-abortum; programme post-abortum, coût; rapport de recherche
Pays : Afrique; Egypte

Résumé : This paper describes some considerations in expanding improved postabortion care services based on a pilot study conducted in 1995. It aimed at institutionalizing improved postabortion medical services and counseling procedures in selected Egyptian hospitals, including increased utilization of family planning services by postabortion patients. A pre-test/post-test no comparison group design was used to measure the impact of intervention activities on improved quality of care for postabortion patients. The study utilized three data collection tools, namely medical records, patient exit interviews and physician's interviews. Study results yielded a total of 1036 medical records, 1005 patient exit interviews, and 501 physician interviews both in the pre- and post-test surveys. Overall, the pre- and post-test samples of patients did not show any significant differences in terms of their socio-demographic characteristics. WHO guidelines for classifying postabortion hospitalization were used in this study and about 55% can be classified as spontaneous abortion. Improvement in technical knowledge of physicians was reported by physicians' themselves as well as from knowledge exchanged between patients and providers as shown from the exit interviews. The study had a positive effect on postabortion patients' intention to begin using a contraceptive method, (one-third in pre-test increased to half in post-test). Postabortion patients indeed need help and support through high quality postabortion care. (author's)


Article de périodique

McKay, H. E.; Rogo, K. O.; Dixon, D. B.

FIGO society survey: acceptance and use of new ethical guidelines regarding induced abortion for non-medical reasons
2001, International Journal of Gynecology Obstetrics, N°75, 3, p. 327-336

Mots clés : avortement; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; méthodologie

Résumé : Objective: FIGO's Ethical guidelines regarding induced abortion for non-medical reasons offer guidance concerning women's right to safe abortion services and the medical community's attendant responsibilities. Ipas surveyed FIGO constituent societies to determine their agreement with the Guidelines' recommendations and their readiness to use them to improve and expand services. Method: Ten months after the Guidelines publication in IJGO, a ten-item questionnaire was mailed to 283 Officers of the 101 FIGO societies, with follow-up prompts to non-respondents. Results: Officers of 59 societies responded, divided evenly between those in countries whose laws permit induced abortion on non-medical grounds and those in countries prohibiting it. In 'permitting' countries all responding societies supported the recommendations, and 85% said they should adopt them or had already done so. Two-thirds in 'prohibiting' countries supported the recommendations, but less than half believed their FIGO society, or their government, should adopt them. However, 20% in the 'prohibiting' countries had adopted or formally considered the recommendations and 23% had already brought them to the attention of their governments. Conclusion: The FIGO constituent societies showed overall strong support for the recommendations, but efforts need to be made to encourage those in 'prohibiting' countries to promote implementation of the recommendations.


Article de périodique

Round up: Service delivery

Half of abortions in Uganda to adolescent girls
2001, Reproductive Health Matters, N°9, 17, p. 225

Mots clés : adolescent; âge; avortement; comportement reproductif; déterminant fécondité; Dynamique démographique; épidémiologie; état matrimonial; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; mesure; méthodologie; nuptialité; planning familial; planning familial, acceptante; population; prévalence; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : In some 97 health units, 30 hospitals and 67 lower health units, data were collected over a one-year period to assess the status of safe motherhood in Uganda. Overall, 335,682 deliveries, 302 maternal deaths and 2,978 abortions were documented with a computed abortion ratio of 8,346 per 100,000 live births and a maternal mortality ratio of 846 per 100,000 live births. Over half of the abortions (55%) occurred among girls aged 17-20 and about 53 per cent of those having abortions were unmarried. One quarter (23 per cent) of abortion cases resulted in complications while the capacity to manage these was found to be limited. (author's)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Tadesse, E.; Yoseph, S.; Gossa, A.; Muletta, E.; Pogharian, D.

Illegal abortions in Addis Ababa, Ethiopia
2001, East African Medical Journal, N°78, 1, p. 25-9

Mots clés : avortement; Avortement illégal; contraception d'urgence/ contraception postcoitale; demande d'avortement; planning familial; planning familial, acceptante; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : Unsafe abortion is one of the greatest neglected problems of health care in developing countries and is a major medical and public health problem in Ethiopia. In this perspective, a cross-sectional hospital-based multi-center study was undertaken to identify the primary abortionist while the patient is in the hospital. Also, the study aims to determine the type of materials used to terminate the pregnancy, the number of attempts made to terminate the index pregnancy and to characterize the women with induced abortions at 5 hospitals in the city of Addis Ababa. A total of 2275 cases of abortion had been admitted to the study hospitals with obstetric and gynecologic services. The study demonstrated that 984 (43.3%) were spontaneous abortions. Of the 1290 illicit or unsafe abortions, 455 (35.3%) were performed by health assistants, 366 (28.4%) self-induced and 306 (23.7%) by non-medical people (cleaners). High doses of ampicillin per OS (32.3%) and inserting plastic tubes per vagina (32.1%) were identified as the most commonly used methods for inducing abortion. The study provides evidence that unsafe abortion carries a high risk of complications, permanent damage and even death where abortion is illegal or not readily available.

Site web : http://www.ajol.info/journal_index.php?jid=53

Congrès

Guengant, J.-P.; May, J. F.

Impact of the proximate determinants on the future course of fertility in sub-Saharan Africa
2001 - in Population Division;United Nations, Prospects for Fertility Decline in High Fertility Countries, New York, p. 24

Mots clés : avortement provoqué; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; fécondité

Article de périodique

Ahiadeke, C.

Incidence of induced abortion in southern Ghana
2001, International Family Planning Perspectives, N°27, 2, p. 96-101, 108

Mots clés : aspects socio-économiques; avortement; Avortement illégal; contraception d'urgence/ contraception postcoitale; demande d'avortement; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; facteurs économiques; facteurs socio-économiques; méthodologie; planning familial; planning familial, acceptante; rapport de recherche; Statut socio-économique; taux d'avortement / taux
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : In countries such as Ghana, where the law restricts elective induced abortion, data to quantify the incidence of abortion are scarce. Existing data on induced abortions in Ghana come mainly from hospital records, which are unreliable because record-keeping is poor and induced abortions often are classified inaccurately. A multistage random sampling design was used to identify 18,301 women aged 15-49 from eight communities in four of the 10 regions in Ghana between January and March 1997. Of the identified women, 1689 were pregnant. From March 1997 to March 1998, fieldworkers living in the pregnant women's communities monitored their health and pregnancy outcomes, including self-induced abortions. During the study period, the rate of abortion in the study areas was 17 induced abortions per 1000 women of childbearing age. There were 19 abortions per 100 pregnancies (or 27 abortions for every 100 live births). The majority (60%) of women who had an abortion were younger than 30, and 36% were nulliparous. 45% had obtained their abortions before the 7th week of gestation, and 90% had done so before the 10th week. Only 12% of the women said they had obtained their abortion from a physician. Muslim women had decreased odds of obtaining abortion. Women who lived in urban areas, who were educated, or who had four or more children had increased odds of obtaining an abortion. Women who were self-employed had greater odds of obtaining an abortion than those who were employed by someone else. Ghana's abortion law does nothing to prevent many induced abortions from occurring. However, few Ghanaian women who seek abortions obtain them from physicians, and most appear to induce abortions themselves, often in collaboration with pharmacists. (author's)


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Douvier, S.; Lordier-Huynh-Ba, C.; Rousseau, T.; Reynaud, I.

Interruption volontaire de grossesse: etude comparative entre 1982 et 1996 sur le principal centre de Cote d'Or. Analyse des femmes ayant des interruptions volontaires de grossesse iterative
[Induced abortion: comparative study from 1982 to 1996 in the main Cote d'Or center. Analysis of women who have had repeat abortions]
2001, GYNECOLOGIE, OBSTETRIQUE, FERTILITE, N°29, 3, p. 200-10

Mots clés : aspects socio-économiques; avortement; comportements; contraception d'urgence/ contraception postcoitale; facteurs économiques; Facteurs psycho-sociaux; facteurs socio-économiques; Pays développé; planning familial; planning familial, acceptante; rapport de recherche
Pays : Europe; France

Résumé : Since the egal use of induced abortion (1975), all the studies have shown a relative stability of the abortion rate related to delivery. Otherwise since 1985 we have noted an increase of repeat abortions. OBJECTIVE: We compared in same center two populations of aborters with a fifteen year's interval. Then we analysed the psyco-social conditions of patients who had more than one abortion (R). METHODS: It was a comparative study between 1982 and 1996 in the main center of Cote d'Or (France). A representative sample of patients coming for abortion was retrospectively compared, (348 for 1982 and 343 for 1996). RESULTS: There were more not married patients (p = 0.0003), more nulliparous women (p = 0.0017) and more nulligestities' one (p = 0.03) in 1996 than 1982. The interval between the previous pregnancy and in 1996 (p = 0.03). Repeat abortions (R) represented 15.8% in 1982 and 21.6% in 1996. Women who have had two or more abortions had increased significantly between 1982 (1.4%) and 1996 (5.2%) (p = 0.013). The R patients had more living children than patients who accessed for the first time at abortion (noR) in the two periods (p = 0.0003) and there were more women less thirty years old in the R group in 1996 than in 1992 (p < 0.05). The R mean age for the first abortion and for the first pregnancy were lower than the noR group in 1996: respectively 23.7 years versus 27.4% years (p = 0.00009) and 20.8 years versus 23.7 years (p = 0.0001). There were no significant difference between R and noR groups with regards of contraceptive failing, the reasons of abortion and the socio-professional categories. CONCLUSIONS: There were no difference in the number of abortion between 1982 and 1996. However we noted an increase of repeat abortion. This group was characterised by great socio-economic problems, unstable couples and ambivalence with wish of pregnancy and no wish of children. It seemed exist a real psycho-social precariousness. Actually, this population was perfectly aware of contraceptive methods.
Depuis la libéralisation légale de la pratique de l'interruption volontaire de grossesse (IVG) en 1975, toutes les études ont montré une relative stabilité du taux d'IVG rapporté au nombre d'accouchements, alors que les pouvoirs publiques s'attendaient à voir une nette diminution de ce taux. Depuis 1985, on note une augmentation du nombre des IVG itératives. Les auteurs ont comparé de façon épidémiologique deux populations de demandeuses d'IVG d'un même centre sur un intervalle de quinze ans. Ensuite, ils ont analysé les données psychosociales propres aux patientes recourant à des IVG répétées. L'étude rétrospective de 691 patientes conduite au centre d'orthogénie du Centre Hospitalier Universitaire de Dijon a comparé un échantillon représentatif de 348 demandeuses d'IVG en 1982 contre 343 demandeuses en 1996. Il y avait plus de femmes non mariées, nullipares, et nulligestes en 1996 qu'en 1982, l'intervalle de temps entre la précédente grossesse et l'IVG est plus court en 1996, et cette gestité est plus souvent une IVG en 1996. Des IVG répétées comprennaient 15,8% des cas en 1982 comparé à 21,6% des cas en 1996, avec un taux de femmes ayant au moins deux IVG passant de 1,4% à 5,2% au cours de la période. Les femmes chez lesquelles on voit les IVG répétées ont plus d'enfants que les femmes ayant recours pour leur première IVG et il y a plus de femmes de moins de trente ans chez les IVG répétées en 1996 qu'en 1982. Les femmes chez lesquelles on voit les IVG répétées et surtout plus de deux IVG se démarquent de la population générale de demandeuses par ses problèmes socioéconomiques, son instabilité conjugale, et son ambivalence entre le désir de grossesse et non d'enfant. Il existe chez ces femmes une véritable précarité psychosociale dont il faudra tenir compte.


Thèse

Jossaume, C.

Introduction à la santé publique. Etude des indicateurs de santé de la reproduction en Afrique subsaharienne; cas particulier du Bénin. .
2001, s.l, p. 93

Mots clés : avortement; comportement sexuel; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; femme; nuptialité; santé de la reproduction; sida; Syndrome d'immunodéficience acquise/sida; système de santé
Pays : Afrique subsaharienne; Bénin

Article de périodique

Capo-chichi, V.; Juarez, F.

Is fertility declining in Benin?
2001, Studies in Family Planning, N°32, 1, p. 25-40

Mots clés : aspects socio-économiques; déterminant de la fécondité; déterminant fécondité; Dynamique démographique; éducation; facteur démographique; facteurs socio-économiques; fécondité; femme; intervalle naissance; limitation naissance; planning familial; planning familial, acceptante; population; rapport de recherche; Statut socio-économique; taux de fécondité; taux natalité; transition de la fécondité
Pays : Afrique; Afrique subsaharienne; Bénin

Résumé : This study analyzes reproductive changes in Benin, a West African country with high fertility and low prevalence of use of modern contraceptive methods, using a combination of quantitative and qualitative approaches. Findings indicate that an irreversible fertility transition has started as the result of an emerging pattern of birth limitation and continued desire for the traditional long birth intervals. The data suggest that changes in childhood mortality in combination with an increase in women's education, although modest, have created a demand for fertility control among women; that induced abortion may be one of the means through which such demand is being met, particularly in urban areas; and that the economic crisis of the 1980s was the main catalyst that precipitated the onset of transition. Changes in reproductive preferences and practice suggest a diffusion process, from urban and more educated women to rural and less-educated ones. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Congrès

Rossier, C.; Pictet, G.; Ouedraogo, C.

Is modern contraception the same as induced abortion? Discourses on different forms of birth control and visions of reproduction in rural Burkina Faso?
2001, IUSSP seminar on The Production and Circulation of Population Knowledge,  Brown University Population Studies and Training Center, Providence, RI, p. 38

Mots clés : avortement
Pays : Afrique; Burkina Faso

Résumé : This paper examines why modern contraception and induced abortion hold a similar place in the traditional Mossi (rural Burkina Faso) view of reproduction, and how this is changing. Using qualitative data, this paper first assesses the diversity of opinions on the two methods of birth control in the population under study. Qualitative analysis led us to distinguih two main groups of respondents. First, the "traditionalists" either condemn or accept both contraception and abortion together. For them, abortion, as contraception, has an ambivalent meaning: these practices are condemned as the marker of dishonorable sexual conduct, but tolerated as a means of avoiding the shame of unappropriate pregnancies. "Innovators", on the other hand approve of contraception but condemn abortion. Innovators adopt the classifications promoted by international family planning discourses; in this instance, global and local visions of birth control are linked. Further analysis found that three main factors underlie the observed diversity: value attributed to early life, belief in reproductive predestination, and attitude towards abstinence. Opinions on abortion and contraception are embedded in representations of human personhood, individuality and sexuality.


Rapport

Blyth, K.; Nelson, D.; Yumkella, F.

Kenya: postabortion care (PAC), adolescent reproductive health. PAC on the primary level: successfully scaling up quality PAC services. Results review
2001, p. 2

Mots clés : avortement provoqué, mortalité; Dynamique démographique; éducation; facteur démographique; maladie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; personnel de santé; population; Programme de formation; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : An analysis of client tracking forms over three months shows that women seeking services from PAC-trained nurse-midwives are receiving appropriate treatment and care, contributing to improved health outcomes. The analysis found that 78% of patients received counseling for FP and about half accepted a short- or long-term FP method of their choice. As a result of PRIME's supplemental training, FP choices include Norplant® at 21 of the facilities. Community outreach is being conducted at 70 of the facilities to raise awareness about contraceptive methods and prevention of unplanned pregnancies. The analysis also shows the providers meeting other RH needs of PAC clients. Over half of all PAC patients received counseling for prevention of HIV/STIs, and 19 women were referred to hospitals for other RH services. At the 94 facilities analyzed, 690 women who presented with complications of spontaneous or induced abortion needed uterine evacuation and were successfully treated by a nurse-midwife using MVA. Young women between the ages of 15 and 25 made up more than half of the clients seeking emergency PAC services. No one was denied access because of age, and in fact 22% of the PAC patients who were managed using MVA were teenagers. (excerpt)

Site web : http://www.prime2.org/prime2/pdf/1ESA_300.pdf

Article de périodique

Siringi, S.

Kenyan government admits to high maternal death rates
2001, Lancet, N°358, 9292, p. 1523

Mots clés : avortement; avortement provoqué, mortalité; complication grossesse; contraception d'urgence/ contraception postcoitale; décès; Dynamique démographique; facteur démographique; facteur politique; femme; gouvernement; grossesse; législation; maladie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Government figures that were released on October 24 indicate that at least 700 women in Kenya die annually from pregnancy-related complications. The Chairman of the Parliamentary Committee on Health, Newton Kulundu, claimed that more than half the deaths resulted from complications during or after abortion, which is illegal in Kenya. It is in this context that Kulundu wants the government to introduce a policy legalizing abortion and stating where, by whom, and under what conditions abortion can be performed. Moreover, Abdullah Wako, the Medical Services Assistant Minister of Kenya, urged Parliamentary Committee members to act independently and bring a motion to the House to amend the law against abortion. On the other hand, the government plans to conduct a national health services conference to discuss the proposal on legalizing abortion although it has been rejected by churches.

Site web : http://www.thelancet.com/

Ouvrage

Ouedraogo, C.; Pictet, G.

La pilule est-elle une alternative à l'avortement en milieu rural africain ?
48415
2001, Ouagadougou (BF), UERD, 10, p. 55 p.

Mots clés : avortement; déterminant fécondité; fécondité; santé
Pays : Burkina Faso

Résumé : Les femmes du Bazèga, province rurale du Burkina Faso, préfèrent-elles l'avortement à l'utilisation des méthodes contraceptives comme moyen de contrôle des naissances ? De leur point de vue, il y a plus d'avantages à avorter qu'à recourir aux contraceptifs modernes. La pilule est même utilisée comme une méthode d'avortement. Les représentations relatives à la reproduction humaine ainsi que les perceptions des méthodes contraceptives modernes concourent à cette préférence. Néanmoins, des signes de changement sont perceptibles dans les comportements en matière de fécondité. Ces changements laissent présager une plus grande autonomie des couples et facilitent l'innovation dans le contrôle des naissances, qui, à terme, favorisent l'utilisation de la pilule (Résumé d'auteur)


Chapitre d'ouvrage

Ayad, M.; Jemai, H.

Les déterminants de la fécondité
2001 - in Vallin Jacques Locoh, Therese ., Population et developpement en Tunisie: la metamorphose,, Tunis, (UNFPA Project No. TUN/94/POA), p. 171-201

Mots clés : aspects socio-économiques; déterminant de la fécondité; déterminant fécondité; Dynamique démographique; facteur démographique; facteurs socio-économiques; fécondité; population; rapport de recherche; Statut socio-économique; transition de la fécondité
Pays : Afrique; Tunisie

Résumé : Tunisia is one of the first developing countries to have recognized from its first years of independence the importance of demographic equilibrium in development. As such, the country waged a structured and long-term campaign to reduce population growth through a fertility control program. That effort consisted of a combination of political, legal, institutional, health, and demographic measures conducted to progressively manage population growth. Between 1964, the year Tunisia's national family planning program was launched, and 1995, the year in which the most recent national maternal- child health survey was conducted, Tunisia's overall fertility level declined from over 7 children per woman to only 3 children/woman, an almost 60% reduction over 30 years. Such steep fertility decline is unparalleled in Africa and the Middle East, with the exception of Mauritius. The authors analyze the determinants of fertility decline in Tunisia in the following sections: the framework and social factors supporting fertility transition in Tunisia, fertility levels and trends, proximate fertility determinants, and the explanatory analysis of fertility variations. Social and legal reforms played a strong role in the success of this fertility transition. They provided the key framework to realizing birth control program target objectives. Among those measures, rising educational status and improving women's status were the most important factors in ultimately reducing fertility.
French Abstract: La Tunisie est un des premiers pays en développement à avoir compris dès les premières années de son indépendance de l'importance de l'équilibre démographique dans le processus de développement. C'est ainsi qu'elle s'est engagée dans une campagne structurée et de longue durée visant à réduire l'accroissement démographique à travers un programme de régulation de la fécondité. Cet effort comprend un ensemble de mesures politiques, juridiques, institutionnelles, sanitaires, et démographiques qui ont conduit à la maîtrise progressive du croît démographique. Entre 1964, l'année du lancement du programme national de planification familiale au pays, et 1995, l'année dans laquelle la dernière enquête nationale sur la santé de la mère et de l'enfant a été conduite, le niveau de la fécondité en Tunisie est passé de plus de sept enfants par femme à trois enfants par femme, une réduction de près de 60% en l'espace de trente ans. L'intensité de cette baisse ne connaît aucun égal ni en Afrique ni au Moyen Orient, à l'exception de l'Ile Maurice. Les auteurs analysent les déterminants de la baisse de fécondité en Tunisie dans les sections de document suivantes : le cadre et les facteurs sociétaux de la transition de la fécondité en Tunisie, les niveaux et les tendances de la fécondité, les déterminants proches de la fécondité, et l'analyse explicative des variations de la fécondité. Des réformes sociales et législatives ont joué un fort rôle dans le succès de cette transformation en fécondité. En effet, elles ont fourni le cadre clé à la réalisation des objectifs visés par le programme de limitation des naissances. Parmi ces mesures, l'élévation des niveaux d'instruction et l'amélioration du statut des femmes ont été les facteurs les plus importants dans la réalisation de la baisse de la fécondité.


Article de périodique

Mahjoub, S.; Mahbouli, S.; Masmoudi, A.; Ben hmid, R.; Bra, A.; Karoui, G.; Lebbi, I.; Gaigi, S. S.; Zouari, F.

Les interruptions médicales de grossesses. Indications, techniques and complications. A propos de 55 cas
Medical termination of pregnancy. Indications, techniques and complications. Report of 55 cases
2001, Tunisie Médicale, N°79, 2, p. 116-22

Mots clés : avortement; avortement médical
Pays : Tunisie

Rapport

Hord, C. E.

Making safe abortion accessible: a practical guide for advocates
2001, Chapel Hill, North Carolina, Ipas, p. 68

Mots clés : avortement; avortement légal; contraception d'urgence/ contraception postcoitale; médicament; Organisation et Administration; planning familial; planning familial, acceptante; programme; Programme d'évaluation; rapport
Pays : Afrique; Egypte

Résumé : At the International Conference on Population and Development (ICPD) in Cairo and a follow-up UN meeting held in 1999 to review progress toward the commitments made in Cairo ("ICPD+5"), a majority of the world's governments pledged to ensure that abortions permitted by law are safe and accessible. This guide offers direction to activists who want to ensure that this mandate is realized in their countries. It presupposes that the reader wants to make abortion services in her/his country safe, affordable, and available to women who seek them, and it provides an overview of the issues that must be addressed to do so. The guide is broken into four primary sections: Section 1-envisioning how you want to see abortion services change in your country; Section 2-finding partners to help your goals, and planning your work; Section 3-spreading awareness of the need for change among a variety of audiences; and Section 4- helping prepare the health system and related sectors to offer safe abortion services. (excerpt)


Reproduced with the permission of IPAS: http://www.ipas.org

Article de périodique

Getahun, H.

Marriage through abduction ('Telefa') in rural north west Ethiopia
2001, Ethiopian Medical Journal, N°39, 2, p. 105-12

Mots clés : adolescent; avortement légal; avortement pour viol; célibataire; droit des femmes; enfant /enfance; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; femme; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; méthodologie; population rurale; prévention; rural/résidence; viol; violence/abus sexuel
Pays : Ethiopie

Chapitre d'ouvrage

Thonneau, P. F.

Maternal mortality and unsafe abortion: a heavy burden for developing countries
2001 - in De Brouwere, Vincent;Van Lerberghe, Wim, Safe motherhood strategies: a review of the evidence, Antwerp, Belgium, ITG Press, N°Studies in Health Services Organisation and Policy No. 17, p. 149-170

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; Cause de décès; contraception; contraception d'urgence; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; Dynamique démographique; facteur démographique; famille; femme/mère; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maternité sans risque; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; revue littérature; santé; santé maternelle; taux d'avortement / taux

Résumé : More than ten years after the launch of the Safe Motherhood Initiative in 1987, abortion is certainly the 'poor relation' in the debate concerning ways to reduce the number of deaths from maternity-related causes, even though abortion complications account for about 15% of all maternal deaths, and up to 30% in some countries. Worldwide, 46 million pregnancies (20% to 25% of all pregnancies) each year end in abortion, 36 million of these abortions occur in developing countries and 10 million in developed countries. The WHO estimates that, worldwide, almost 20 million unsafe abortions take place each year, with 95% of these (19 million) performed in developing countries. The risk of death from unsafe abortion is about 1 in 150 procedures in Africa, and 1 in 150,000 in the USA and Europe. The number of maternal deaths is estimated to be about 80,000; this accounts for about 13% of all maternal deaths in the world, one in eight pregnancy-related deaths. In this review, we then analyze the several major concerns accounting for abortion being such a huge maternal mortality risk factor in developing countries: abortion laws and regulations, abortion techniques, unplanned pregnancy and family planning. In conclusion, the gap between between developing and developed countries in the risk of death from unsafe abortion have never been so high: 1/150 000 in developing countries versus 1/150 in developed countries. According to that enormous disparity, the international community and organizations from within the United Nations system must play a key role encouraging governments to modify their abortion legislation' and to improve their health system to take more account of women's health rights.


Article de périodique

Olatunji, A. O.; Sule-Odu, A. O.

Maternal mortality at Sagamu, Nigeria--a ten year review (1988 - 1997)
2001, Niger Postgrad Med J, N°8, 1, p. 12-5

Mots clés : avortement; avortement provoqué, mortalité; Cause de décès; causes de décès /décès; décès; mortalité
Pays : Nigeria

Résumé : A review of maternal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria over a 10 year period is presented. During the period, there were 92 maternal deaths, those from abortion and ectopic pregnancy inclusive. The total deliveries were 5423 giving a maternal mortality ratio of 1700 per 100,000. Ruptured uterus was the most common cause followed by eclampsia, postpartum haemorrhage and complications of abortion in that order. Unbooked patients constituted about one third of the total (29. 1 %). Primipara and grandmultipara were the most at risk of maternal death and the risk of dying following operative delivery was six times that of vaginal delivery. Easy access to affordable antenatal care, good blood transfusion services, more widespread use of contraceptives and training of traditional birth attendants would help reduce the risk of maternal death.


Article de périodique

Rogo, K. O.; Aloo-Obunga, C.; Ombaka, C.; Oguttu, M.; Orero, S.; Oyoo, C.; Odera, J.

Maternal mortality in Kenya: the state of health facilities in a rural district
2001, East African Medical Journal, N°78, 9, p. 468-72

Mots clés : avortement provoqué, mortalité; Dynamique démographique; évaluation; Evaluation des services de santé; facteur démographique; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Organisation et Administration; population; population rurale; programme; Programme d'évaluation; qualité des soins; rural/résidence; santé; service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : A study was conducted in Siaya District in Kenya to assess the existing state of health facilities, their level of function, and factors influencing their utilization. The Prevention of Maternal Mortality Network study design was used in this study. Qualitative data were obtained from focus group discussions of health service providers and managers from 30 health facilities. Findings revealed the inadequacy of the health facilities in offering quality maternal care, inaccessibility of the main referral system, and poor quality of most services offered. Moreover, geographical distribution, accessibility of emergency obstetric care facilities, and proportion of women with complications who are treated in the health facilities are among the factors noted to influence health services utilization. Overall, both quality of care and record keeping are noted to be well below the acceptable standards. These results indicate the need to address the widening gap in the provision of basic service to reduce maternal mortality.

Site web : http://www.ajol.info/journal_index.php?jid=53

Congrès

Lara, D.; Ellerston, C.; Diaz, C.; Stickler, j.

Measuring the prevalence of induced abortion in Mexico city: comparison of four methodologies
2001 - in IUSSP, ¨XXIV IUSSP General Conference, Salvador Brazil

Mots clés : avortement provoqué
Pays : Mexique

Résumé : Objectives : We compare four methods of collecting information on abortion through survey research to measure the levels of induced abortion in Mexico.
Methods : We tested four methods for collecting data on abortion attempts: face-to-face interview (FTF), Audio Computer-Assisted Self-Interview (ACASI), self-administered questionnaire (SAQ), and a random response technique (RRT). We tested all methods in three samples: 1) hospital patients in Mexico City; 2) rural women in Chiapas; and 3) women randomly chosen as part of a house-to- house survey in Mexico City
Results : In each of the three samples, RR T found the highest rate of attempted induced abortion (21.7% in hospital sample, 36.1 % in rural sample and 17.9% in household sample), followed by the SAQ (19.3% (hospital), 10.1 % (rural) and 10.8% (household". The ACASI and FTF interviews yielded fewer reported abortion attempts.
Conclusion :The RRT seems the most promising methodology to measure the levels of induced abortion. With SAQ, we obtained detailed information and the reported frequency rates were slightly lower than the RRT rates in urban areas.


Article de périodique

Brown, B.

Medical abortion at home
2001, International Family Planning Perspectives, N°27, 3, p. 110

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; hormones; médicament; Misoprostol, dosage; planning familial; planning familial, acceptante; population; prostaglandins/hormones; RU 486, dosage; taux de fécondité; taux grossesse
Pays : Afrique; Tunisie; Viêt Nam

Résumé : A simplified medical abortion regimen is effective, safe and acceptable to women in less-developed countries. Women seeking termination of an early pregnancy were given 200 mg of mifepristone, rather than the standard 600 mg dose, and the option to administer misoprostol themselves at home. Of the 120 Vietnamese and 195 Tunisian women who participated in the study, 93% and 91%, respectively, had successful abortions. Nearly 90% of women chose home administration. In both countries, women who chose clinic administration were more likely to have had unsuccessful abortions than were women who chose home administration (20% vs. 4% in Vietnam and 12% vs. 7% in Tunisia). According to the researchers, side effects, including heavy bleeding, pain and cramps and nausea and vomiting, were not severe. Overall, 78% of women who administered misoprostol at home said they were very satisfied or somewhat satisfied with the method, compared with 14% of women who chose clinic administration. Regardless of administration location, only 2% of women said they were unsatisfied with the method. Women who chose home administration said it was more compatible with their home or work life, that they were more comfortable at home and that returning to the clinic was inconvenient. The researchers conclude that "home administration of misoprostol offers women more choice, control and privacy in managing their abortions". (full text)


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Remez, L.

Medical abortion regimen with reduced mifepristone dose, home misoprostol use is feasible and effective
2001, International Family Planning Perspectives, N°27, 4, p. 210-1

Pays : Tunisie; Viêt Nam

Résumé : This document reports on a prospective study conducted among Vietnamese and Tunisian women seeking abortion. Data were collected from a sample of 120 pregnant women seeking surgical terminations in a clinic in Ho Chi Minh City, Vietnam, and 195 women in Tunis, Tunisia, from December 1997 through December 1998. While all participants received mifepristone from a clinic provider, they were given the choice of returning to the clinic 2 days later for their oral tablet of misoprostol or taking it on their own at home after the same time interval. At both study sites, procedure failure accounted for a greater proportion of unsuccessful terminations than did user or provider failure. The failure rate was much higher among women who received misoprostol at a clinic than among those who took it at home. The study results indicate that a regimen of medical abortion involving one- third the usual dose of mifepristone and fewer clinic visits appears to be successful and acceptable as the standard mifespristone-misoprostol regimen.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Congrès

Oguttu, M.; Odongo, P.

Midlevel providers' role in abortion care. Kenya country report
2001, Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care, South Africa, p. 14

Mots clés : avortement; avortement sélectif/foeticide; contraception d'urgence/ contraception postcoitale; foeticide; personnel de santé; planning familial; planning familial, acceptante; politique/programme; programme de santé; programme planification familiale; programme post-abortum; programme post-abortum, coût; régulation menstruelle; santé; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Having nurse/midwives provide post abortion care (PAC) services has been found to be beneficial on many fronts. Many private nurse/midwives facilities are located in the communities that they serve, providing easy access for clients. Having emergency PAC services available within the community can be life saving and reduces the burden on referral sites. Additionally, the providers often have positive interpersonal relationships with their clients. The PAC services provided by nurse/midwives in primary level clinics are of high quality and reasonably priced. (excerpt)

Site web : http://www.ipasihcar.net

Congrès

van der Westhuizen, C.

Midwifes' roles in expanding access to and the management of safe abortion care. South African country report.
2001, "Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care,", Kwa Maritane Lodge, Pilanesberg National Park, South Africa,, unpublished, p. 17

Mots clés : Evaluation des services de santé; Organisation et Administration; personnel de santé; politique/programme; programme; programme de santé; Programme d'évaluation; qualité des soins; sage-femme/personnel de santé; santé; santé de la reproduction; santé maternelle; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : This report draws upon the work of researchers from the Women's Health Project, the Reproductive Research Unit and Ipas, summarising the main activities undertaken in the Midwifery Abortion Care Training Programme (1998-2000), the first programme in South Africa to train midwives to provide abortion services as part of the National Abortion Care Programme. Their paper also outlines major findings of an evaluation of the quality of midwives' practices and presents recommendations for continuing and strengthening training and supervision of midwives in abortion care throughout South Africa. The focus of this report is on advancing the role of the registered midwife in the rendering of safe elective abortion care in South Africa. (excerpt)


Congrès

Mtonga, V.; Ndhlovu, M.

Midwives' role in management of elective abortion and post-abortion
2001, "Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care", South Africa, p. 20

Mots clés : adolescent; âge; attitude; avortement; comportements; connaissance; contraception d'urgence/ contraception postcoitale; étude/études; études statistiques; facteur démographique; jeune/adolescent; législation; méthodologie; perception; personnel de santé; planning familial; planning familial, acceptante; politique/programme; population; programme de santé; psychologie/facteur psychologique; rapport; sage-femme/personnel de santé; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé
Pays : Afrique; Afrique subsaharienne; Zambie

Résumé : Zambian midwives can participate in the provision of quality abortion services in many different ways even if the law is restrictive. They can offer counselling and family planning services. Now that the 1997 Nurses Act has been passed they can save lives of women who come in with complication of abortions by providing the full PAC package which includes performing MVA. (excerpt)

Site web : http://www.ipasihcar.net

Article de périodique

Baulieu, E.; Seidman, D. S.; Hajri, S.

Mifepristone (RU486) and voluntary termination of pregnancy: enigmatic variations or anecdotal religion-based attitudes? letter
2001, Human Reproduction, N°16, 10, p. 2243-2247

Mots clés : attitude; avortement; avortement provoqué, religion; biologie; chrétien/religion; comportements; contraception d'urgence/ contraception postcoitale; facteurs religieux; hormones; législation; Pays développé; planning familial; planning familial, acceptante; psychologie/facteur psychologique; religion; RU 486
Pays : Afrique; Allemagne; Europe; Israël; Tunisie

Résumé : Mifepristone (RU486), the first clinically efficient antiprogesterone (Hemmann et al., 1982; Baulieu, 1989), has made the concept of medical abortion a reality (Ulmann et al., (1992). Here we only refer to the voluntary termination of early pregnancy, which sustains so much controversy in the vast and evolving domain of women's reproductive health (Van Look, 2000). Legally on the market for years in France, Britain and Sweden and massively produced and used in China, the compound has become available to women in need in Israel, Tunisia and Germany, where what might be called religion-based attitudes have been observed. Of course the biology of pregnancy is quasi-identical for women all over the world, and its termination with an antagonist to the hormone of pregnancy, progesterone, should also be the same everywhere. But the use of this antagonist, mifepristone (RU486), does not mean the same thing to everybody everywhere. (excerpt)


Congrès

Libombo, A.; Usta, M. B.

Mozambique abortion situation. Country report
2001, Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care, South Africa, p. 7

Mots clés : adulte/âge; adultère; âge; avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; femme; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; politique/programme; population; programme de santé; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Mozambique

Résumé : The success of midlevel providers offering post abortion care services may provide an opportunity to expand low cost service provision to safe abortion services when legal limitations are removed. The impact of safe abortion services on maternal mortality and morbidity could be significant. (excerpt)

Site web : http://www.ipasihcar.net

Article de périodique

Touko, A.; Kemmegne, J.; Nissack, F.; Schmidt-Ehry, B.; Kamta, C.

Planning familial chez les adolescentes mères d'enfants dans un centre urbain au Cameroun
Family planning among adolescent mothers in an urban center of Cameroon

2001, African Journal of Reproductive Health, N°5, 2, p. 105-115

Mots clés : adolescent; âge; attitude; comportements; facteur démographique; famille; femme; femme/mère; jeune/adolescent; population; psychologie/facteur psychologique; rapport de recherche; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Cameroun

Résumé : This study was carried out in Yaounde (Cameroon) in 1995 to determine the knowledge, attitude and behavior to teenage mothers towards family planning (FP). The study was based on a questionnaire administered at household level drawn from previously determined clusters. It was accomplished by recruiting 462 teenage mothers with ages ranging from 14-19 years and who had 1-3 children. On the whole, 93.9% had heard of FP, 72.5% had heard of FP centers, but only 43% had been to one of these centers at least once. With regards to contraceptive prevalence, 62.1% affirmed the use of a contraceptive method at the time of the study with periodic abstinence being the most widely used (35.9%). Besides the common methods, some teenage mothers made use of herbal concoctions and vaginal douching, sometimes with permanganate or the taking of tablets. 19% of respondents had had between 1 and 4 episodes of induced abortion. According to these teenagers, the ideal average age for first delivery is 19.7 +or- 2.5 years, whereas that of nubility is 22.8 +or- 3.3 years, a difference of 3 years. This suggests that on the whole, teenage mothers believe that first delivery must precede marriage. (author's)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Noumi, E.; Tchakonang, N. Y.

Plants used as abortifacients in the Sangmelima region of Southern Cameroon
2001, J Ethnopharmacol, N°76, 3, p. 263-8

Mots clés : avortement; effets secondaires; méthode d'avortement; méthode d'avortement,; méthodes
Pays : Cameroun

Résumé : Differents polants are use to to induce abortion. Their pharmacological effects and their side effects are analysed in a South Province of Cameroon


Rapport

Academy for Educational Development [AED]; Support for Analysis and Research in Africa [SARA]

Postabortion care advocacy in East and Southern Africa
2001, Reproductive Health BriefUSAID, Washington, D.C., AED, SARA, p. 2

Mots clés : communication; organisation; Organisation et Administration; Pays développé; plaidoyer; programme; rapport; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; USAID
Pays : Afrique; Afrique subsaharienne; Etats-Unis

Résumé : A study conducted in 1995-96 showed that between 15 and 30% of maternal mortality in east, southern, and Central Africa was due to unsafe abortion. In response, the Bureau for Africa, a division of the US Agency for International Development (USAID), aimed to sensitize USAID missions and national governments to the reproductive health problems associated with unsafe abortions and to increase both financial and technical support for postabortion care. Hence, the postabortion care (PAC) initiative, with the support of the PAC Working Group for East and southern Africa (ESA), assisted the Policy Project to develop an educational brochure that was widely disseminated. USAID's Regional Office for ESA and Policy Project staff visited six USAID missions to sensitize them on PAC issues. Finally, the PAC initiative has helped to publicize existing findings on the magnitude and issues of unsafe abortion as a public health concern in the region.


Article de périodique

Ralisata, L. R.; Rabenjamina, F. R.; Razafintsalama, D. L.; Rakotonandrianina, E.; Randrianjafisamindraokotroka, N. S.

Postabortion peritonitis and pelvi-peritonitis at the Androva Mahajanga University Hospital: 28 cases
Les peritonites et pelvi-peritonites post-abortum au CHU d'Androva Mahajanga: a propos de 28 cas

2001, Journal De Gynecologie, Obstetrique et Biologie De La Reproduction, N°30, 3, p. 282-7

Mots clés : avortement provoqué, mortalité; mortalité

Résumé : In many underdeveloped countries, illegal abortion can lead to death or sequelae. Pregnancy termination is illegal in Madagascar except for medical reasons. The authors report 23 cases observed between April 1990 and December 1994 at the Androva Mahajanga University Hospital. Postabortion infectious complications ranked 19th for hospital admissions. Peritonitis was the most frequent (70%) and most serious complication. The women were young (mean age, 24 years; 44% under age 20). 30% were primigravidas and had poor living conditions (74% were homemakers and 13% were students; 44% were single). Clinical signs were malodorous loss and abdominal pain. A surgical procedure was performed in 74% of the cases: 3 salpingo-oophorectomies, 2 hysterectomies, and 10 uterine sutures. Mortality was high (13%). Illegal abortion must be prevented with better information on contraception and better health education programs. The question of the usefulness of current legislation is discussed. (author's)


Article de périodique

Mturi, A. J.; Moerane, W.

Premarital childbearing among adolescents in Lesotho
2001, Journal of Southern African Studies, N°27, 2, p. 259-275

Mots clés : adolescent; âge; avortement; comportement reproductif; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; étude comparée; étude/études; facteur culturel; facteur démographique; fécondité; grossesse; grossesse adolescente; grossesse adolescente/grossesse; grossesse prémaritale; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; taux de fécondité; taux natalité
Pays : Afrique; Afrique subsaharienne; Botswana; Lesotho

Résumé : The issue of premarital childbearing has been a concern of many analysts in southern Africa. This paper looks at the situation of premarital childbearing in Lesotho in comparative context with the neighbouring countries. The total fertility rate (TFR) estimated from the 1996 population census of Lesotho for all women combined was 4.1 births, a decline from a TFR of 5.5 in the mid-1970s. Only a small proportion of births in Lesotho are born out-of-wedlock. The Lesotho Safe Motherhood Initiative Survey data of 1995 found that only 3 per cent of never married Basotho women aged 15-19 had given birth a very much lower rate than in Botswana where the rate was 21 per cent. There are a number of factors that influence the relatively low incidence of premarital, adolescent childbearing in Lesotho. It is argued that one factor is that, despite significant social change, Sesotho culture is still generally opposed to such pregnancies. Local derogatory names are given to children born out-of-wedlock, and their mothers are still referred to as 'spoilt' or 'destroyed' in order to discourage such behaviour. The strength of such stigmatisation appears to be much less, or negligible, in neighbouring countries. There is a growing tendency to separate motherhood from marriage in many societies in the region and in some cases having a child can increase the chance of marriage. In Lesotho, the culture against premarital sex is changing as well, and a substantial number of adolescent females conceive before marriage. It appears that a significant proportion resort to illegal, unsafe abortions and the government needs to be aware of these changes in the behaviour of adolescents and their needs. (author's)


Article de périodique

Anochie, I. C.; Ikpeme, E. E.

Prevalence of sexual activity and outcome among female secondary school students in Port Harcourt, Nigeria
2001, African Journal of Reproductive Health, N°5, 2, p. 63-7

Mots clés : activité sexuelle / sexualité; adolescent; âge; coït/sexualité; comportements; éducation; enfant /enfance; étudiant; étudiant/scolarisation; facteur démographique; femme; jeune/adolescent; mesure; méthodologie; population; prévalence; rapport de recherche; sexualité
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Sexual activity among 534 Nigerian female secondary school students was studied using self-administered questionnaire. Prevalence of sexual intercourse was 25.7%. There was no significant difference between the junior (48.2%) and senior (51.8%) students (p > 0.05). 17 (12.4%) students had initiated sexual intercourse before 11 years. The frequency of sexual exposure was high, with 34.3% of the students having intercourse more than once in a week. Pregnancy rate among sexually active females was 27.0%, with 24.8% rate of induced abortion. Early sexual health education starting from primary school would be helpful in influencing the reproductive decisions and sexual behavior of the students, including contraceptive acceptance and usage, to avoid teenage pregnancy. Education of parents is also recommended in order to overcome the cultural barriers that discourage parents from providing sex education to their children at home. (author's)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Jenkins, T. L.; Moellendorf, D.; Schuklenk, U.

Privacy, abortion, resource allocation and other ethical issues: the Thandi case (1)
2001, Developing World Bioethics, N°1, 1, p. 70-82

Mots clés : adolescent; âge; avortement; comportement reproductif; comportements; déterminant fécondité; éthique; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; infection/complication; Infections génitales/IST/MST; jeune/adolescent; maladie; maladie sexuellement transmissible/MST/IST; planning familial; planning familial, acceptante; population; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : Many developing countries have two-tier healthcare systems: the component provided by the state is often inadequate, with primary healthcare clinics seeing most of the patients. These clinics are extremely busy, often understaffed and under-resourced; medicines are scarce and laboratory facilities inadequate. Secondary and tertiary hospitals are usually short of adequately trained staff, both nursing and medical. Private sector healthcare is of a generally higher standard but is expensive and beyond the reach of the vast majority of the population. A small proportion of the adult population is employed by firms large enough to provide healthcare insurance for their employees. Thandi is a 15 year old teenager. Although Thandi's family has no private health cover, her mother has by-passed the state's clinic and has taken Thandi directly to a doctor in private practice, Dr Smith - a radiologist. Given Thandi's lower abdominal pain her mother's choice of a radiologist as a primary healthcare provider may be inappropriate, but Dr Smith is a good, caring doctor and does not strictly confine his practice to radiology. (excerpt)


Congrès

Bozon, M.; Hertrich, V.

Rapports de genre et initiation sexuelle en Afrique et en Amérique Latine Une comparaison de 20 enquêtes EDS
2001 - in ENSEA, Colloque International "Genre population et développement en Afrique", Abidjan, p. 28 p

Mots clés : genre
Pays : Afrique

Résumé :
-


Article de périodique

Uygur, D.; Erkaya, S.

Reasons why women have induced abortion in developing countries
2001, European Journal of Gynecology Obstetrics and reproductive Biology, London, Elsevier, N°96, p. 211-214

Mots clés : âge; avortement provoqué; éducation

Résumé : The immediate explanation that women often give for seeking induced abortion is that the pregnancy was unplanned or unwanted. However, the myriad social, economic and health circumstances that underlie such explanations have not yet been fully explored. We wanted to evaluate these factors that lead one to have an abortion. This prospective study was performed on 588 women applied to our family planning unit to obtain an abortion.


Article de périodique

Akande, E., O,

Reducing Morbidity and Mortality from Unsafe Abortion in Nigeria
2001, Archives of Ibadan Medicine, N°2, 1, p. 11-13

Mots clés : avortement à risque; avortement provoqué, mortalité; morbidité; mortalité; taux d'avortement à risque
Pays : Nigeria
Site web : http://212.241.193.254/journal_index.php?jid=244 tran=0 ab=aim

Ouvrage

Van de Walle, E.; Renne, E. P.

Regulating menstruation : beliefs, practices, interpretations
2001, Chicago ; London, University of Chicago Press, p. 292

Mots clés : anthropologie; avortement; avortement provoqué, histoire; contraception orale; histoire; menstruation

Résumé : Menstruation, seen alternately as something negative--a "curse" or a failed conception--or as a positive part of the reproductive process to be celebrated as evidence of fertility, has long been a universal concern. How women interpret and react to menstruation and its absence reflects their individual needs both historically as well as in the contemporary cultural, social, economic, and political context in which they live. This unique volume considers what is known of women's options and practices used to regulate menstruation--practices used to control the periodicity, quantity, color, and even consistency of menses--in different places and times, while revealing the ambiguity that those practices present.
Originating from an Internet conference held in February 1998, this volume contains fourteen papers that have been revised and updated to cover everything from the impact of the birth control pill to contemporary views on reproduction to the pharmacological properties of various herbal substances, reflecting the historical, contemporary, and anthropological perspectives of this timely and complex issue.


Article de périodique

Jewkes, R. K.; Vundule, C.; Maforah, N. F.; Jordaan, E.

Relationship dynamics and teenage pregnancy in South Africa
2001, Social Science Medicine, N°52, 5, p. 733-744

Mots clés : grossesse adolescente; santé sexuelle; violence; violence contre les femmes
Pays : Afrique du Sud

Résumé : Teenage pregnancy is extremely common in South Africa. Whilst its `problematic' nature is a subject of debate, it reflects a pattern of sexual activity which puts teenagers at risk of HIV. Currently one in five pregnant teenagers is infected with the virus. This creates a new imperative to understand teenage pregnancy and the pattern of high risk sexual activity of which it is one consequence. This was an exploratory study undertaken to investigate factors associated with teenage pregnancy amongst sexually active adolescents in an urban and peri-urban context. The study used a matched case control design, with 191 cases and 353 school or neighbourhood, age-matched controls. Subjects were under 19 years and recruited from township areas of Cape Town. A structured questionnaire was used to obtain information on socio-economic factors, contraceptive knowledge and use, and sexual behaviour. Conditional logistic regression was used to analyse the relationship between teenage pregnancy and the factors investigated. The results presented focus on relationship dynamics and their association with the risk of pregnancy. Both groups of teenagers had been dating for a mean of two and a half years and about half were still with their first sexual partner. The partners of the pregnant teenagers were significantly older, less likely to be in school and less likely to have other girlfriends. The pregnant teenagers were significantly more likely to have experienced forced sexual initiation and were beaten more often. They were much less likely to have confronted their boyfriend when they discovered he had other girlfriends. Multiple modelling shows that both forced sexual initiation and unwillingness to confront an unfaithful partner are strongly associated with pregnancy and also related to each other. We argue that the associations are mediated through unequal power relations within the relationship which are reinforced by violence. We further discuss indicators of greater intimacy within relationships of the pregnant teenagers which may suggest that more of the pregnancies were wanted than was suggested. Both of these conclusions pose critical challenges for health promoters.


Article de périodique

Dickens, B. M.

Reproductive health services and the law and ethics of conscientious objection
2001, Medicine And Law, N°20, 2, p. 283-293

Mots clés : contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; génétique; ligature des trompes / stérilisation; loi; reproduction; stérilisation/contraception
Pays : Afrique du Sud

Résumé : Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation, in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians' conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses' claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health-related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right. [Journal Article, Review, Review, Tutorial; 17 Refs; In English; South Africa]Specialty IndexingSource ID: KIE - 106870KIE Keywords: Genetics and Reproduction; Legal ApproachGeneral Note: KIE Bib: abortion/legal aspects; contraception; sterilization


Rapport

Anonymous

Research to stimulate policy dialogue on unsafe abortion in East and Southern Africa
2001

Mots clés : avortement; Avortement illégal; contraception d'urgence/ contraception postcoitale; organisation; Organisation et Administration; planning familial; planning familial, acceptante; politique de développement; rapport; santé; service de santé; service de santé communautaire/offre/service de santé; soin post-abortum; soin post-avortement; soins post avortement; système de santé; USAID
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : The US Agency for International Development's Bureau for Africa/Office of Sustainable Development asked the Commonwealth Regional Health Community Secretariat (CRHCS) to review regional literature and conduct a study of hospitals in Malawi, Uganda, and Zambia on the extent, cost, and quality of services for postabortion care. This brief paper highlights key findings of the CRHCS research on: 1) magnitude of unsafe abortion; 2) cost; 3) contraception and abortion; and 4) abortion laws. The research findings provided the first systematic, comprehensive description of abortion-related problems, clinical issues, contraception and abortion, male perspectives, and legal aspects. This activity also affirmed that working with a regional institution improved the chances of affecting policy changes.


Congrès

Guengant, J.-P.; May, J. F.

Revisiting the African fertility exception
2001, Annual meeting of the Population Association of America : session 76 : the future of fertility in the next 50 years, USA, p. 25

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; enquête démographique et de santé/EDS; fécondité; transition démographique; VIH
Pays : Afrique du Sud; Afrique subsaharienne

Article de périodique

Streatfield, P. K.

Role of abortion in fertility control
2001, Journal of Health, Population and Nutrition., N°19, 4, p. 265-7

Mots clés : avortement; comportement reproductif; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; méthodologie; planning familial; planning familial, acceptante; population
Pays : Bangladesh

Résumé : Abstract: The subject of this commentary concerns the interrelationship between abortion and contraceptive use in the control of fertility. There is sufficient historical evidence to conclude that no societies have achieved low fertility without recourse to use of some form of contraception together with abortion. In the historical experience, it is noted that as contraception becomes more efficient and attains a substantial level in many societies, abortion rates begin to decline, provided access to contraception is unimpeded. However, some societies have continued to rely primarily on abortion to control fertility, usually with negative consequences in terms of maternal morbidity and mortality. In Matlab, Bangladesh, where high quality contraception services are available, abortion still accounts for about 2% of pregnancies. Furthermore, a study in the area revealed that almost half of the women seeking an abortion over a period of 4 months in 1995 were not using any contraception at all prior to pregnancy. It is concluded that pregnancy-prevention services alone are not enough, but facilities offering safe abortion will continue to be needed.


Article de périodique

Anonymous

Sexual and reproductive rights in Nigeria from legal and socio-cultural context
2001, Empowerment, N°9, 7, p. 20-22

Mots clés : aspects socio-économiques; avortement; avortement provoqué, loi; constitution; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; discrimination sociale; droit de l'homme; droits reproductifs; espacement naissance; évaluation; facteur culturel; facteurs économiques; facteurs socio-économiques; famille; genre; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; problème social; Recommandations; Statut de la femme; taille famille
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Reproductive rights are human rights that are inalienable and inseparable from other basic rights such as right to life, right to non-discrimination, right to privacy, right to food, shelter, health, security, livelihood, education and political empowerment. It is the basic right of all couples and individual to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes the right to make decisions concerning reproduction free of discrimination, coercion and violence. (ICPD Program of Action, paragraph 7.3, International Conference on Population and Development, Cairo, Egypt, 1994). Maternal health issues are increasingly being recognized as human rights issues as the indivisibility of health and rights becomes clearly articulated. The ICPD supports strongly an integrated approach to health and rights in the area of promoting women's rights. However, entrenched cultural biases and practices as well as inequitable gender systems enshrined in, and institutionalised through law often stand in the way. This assertion is true of Nigeria where the systemic contrivance of legal norms (derived from secular, customary and religious laws) and socio-cultural practices result in massive violation of women's human rights, especially their reproductive rights. (excerpt)


Rapport

Brown, A.

Sexual relations among young people in developing countries: evidence from WHO case studies
2001, Geneva, Switzerland, World Health Organization [WHO], Special Programme of Research, Development and Research Training in Human Reproduction, p. 66

Mots clés : adolescent; âge; avortement; comportement à risque; comportement reproductif; comportement sexuel; comportements; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; enquête; étude de cas; étude/études; facteur culturel; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; jeune/adolescent; méthodologie; Nations Unies; OMS; organisation; perception; population; psychologie/facteur psychologique; rapport; rapport sexuel; Recommandations; reproduction

Résumé : Since the late 1980s, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction ("the Programme")has supported a number of social science research initiatives on under-investigated areas of sexual and reproductive health care. Four of these initiatives,on the dynamics of contraceptive use, the determinants and consequences of induced abortion, sexual behaviour, and the role of men, also covered the needs and perceptions of young people. These four initiatives comprised 146 research projects and, of these, 34 studies in 20 countries in Africa, Asia, and Latin America addressed young people, including adolescents (aged 10-19 years) and youth (aged 15-24 years). Fieldwork for these case studies was conducted chiefly between 1992 and 1996. A summary review of the studies is now available from the Programme. The studies cover a variety of sociocultural settings. In some, premarital sexual activity is taboo, using contraception is forbidden among unmarried youth, and abortion is viewed as the only solution to premarital pregnancy among adolescents. In others, premarital pregnancy may be condoned and childbearing among unmarried women is not unknown. Most studies focus on unmarried youth. However, some focus on special groups such as pregnant young women or those who have terminated a pregnancy, young reproductive health seekers in general, or young clients of services for sexually transmitted infections (STIs). Many common themes emerge from these studies. In every setting, sexual activity begins during adolescence among many young people. Much of this activity is risky, contraceptive use is often erratic, and unwanted pregnancy and unsafe abortions are observed in many settings. Sexual relations may be forced. There are wide gender-based differences in sexual conduct, and in the ability to negotiate sexual activity and contraceptive use. Despite this, relatively few young people think they are at risk of disease or unwanted pregnancy. Awareness of safe sex practices seems to be superficial, and misinformation regarding the risks and consequences of unsafe sex is wide- spread. This paper reviews these and other findings, discusses their implications for policies and programmes, and highlights research gaps. For the sake of consistency, the term, youth,is used to refer to young people of all ages between 10 and 24. A number of recommendations are offered on the basis of the summary review of these case studies. These include programmatic recommendations to build negotiation skills, dispel misconceptions, counter sexual violence, involve young people in programme design, tailor fertility regulation services to meet young people's needs, and communicate the message that every unprotected sexual act risks disease and unwanted pregnancy. The review suggests a need for more in-depth behavioural research on the perspectives and experiences of youth in different settings. It points to the need to study positive outcomes, in addition to risk assessment, and stresses that research should explore the ways in which gender roles and power imbalances affect life skills among youth and how social constraints make young women particularly vulnerable and unlikely to exercise choices relating to their sexual and reproductive lives. Research is also needed to document how young women can exercise greater autonomy.


Thèse

Kimanuka, F.

Stratégies de prise en charge des femmes victimes de violences au Rwanda "leçons et perspectives"
2001, Institut de Médecine Tropicale Prince-Léopold, Antwerpen, p. 51

Mots clés : avortement; avortement pour viol; counseling; femme; viol; violence; violence contre les femmes
Pays : Rwanda

Congrès

Rossier, C.

Testing four methods to estimate the rate of induced abortion in rural Burkina Faso
2001, Population Association of America Annual Meeting,,  Washington D. C., p. 37

Mots clés : enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; méthodologie
Pays : Afrique

Résumé : This paper presents the results of the test of four different methods to estimate the rate of clandestine induced abortion in one health district (9 villages, Bazega province) in rural Burkina Faso. The first method is a variation of Bongaart's formula. The second estimate is obtained through women self-reporting their abortions. The third counts cases of abortion that the respondents know about by hearsay. These three first estimates are calculated with survey data (sample = 1000 women). Extensive qualitative work preceded the survey design. The fourth estimate is based on the same information as the third, but collected using ethnographic methods (extensive stay in one village, key informants). Based upon the spread of the four estimates, conclusions will be drawn on the value of each method; possible biases is discussed. An estimation of the rate of induced abortion for the study area in rural Burkina Faso is presented (12 abortion per 1000 women aged 15-44).


Chapitre d'ouvrage

Chékir, H.

Textes juridiques choisis et commentés sur la politique de population en Tunisie.
2001 - in Vallin, Jacques;Locoh, Therese, Population et développement en Tunisie. La métamorphose., Tunis, Tunisia, Ceres Editions, p. 601-617

Mots clés : droit de l'homme; droits reproductifs; famille; femme; législation; politique de population; politique/programme
Pays : Afrique; Tunisie

Résumé : Many different government texts govern population policies. Both international and domestic instruments are among these texts. International legal guidelines include international accords adopted by the UN General Assembly and resolutions upon plans, programs of action, and declarations adopted during recent UN international conferences upon human rights, population and development, and women. National legal texts consist of a body of laws, decrees, and circulars defining the population field from independence and especially those governing families, women, and reproductive and sexual health. Some of these texts, adopted since 1956, remain in force despite various modifications effected over the years. Others arose following the government of Tunisia's adoption of a population policy and address particular aspects of policy. In Tunisia's case, the author describes the legal organization of family life and women's rights within the family regarding marital consent and the rights of married women. Regarding rights associated with the organization and protection of human life, the text explores individual civil status, contraception and abortion rights, and socioprofessional rights of pregnant women and young mothers.
French Abstract: Il existe de nombreux textes juridiques diversifiés qui régissent les politiques de population. Parmi ces textes, il y a des instruments internationaux et nationaux. Les instruments juridiques internationaux consistent en des conventions internationales adoptées par l'Assemblée générale des Nations unies et des résolutions sur les plans, les programmes d'action, et les déclarations adoptés au cours des dernières conférences internationales des Nations unies sur les droits de l'homme, la population et le développement, et les femmes. Les textes juridiques nationaux sont constitués d'un ensemble de lois, décrets, et circulaires qui organisent le domaine de la population depuis le début de l'Indépendance et surtout ceux qui régissent la famille, les femmes, et la santé reproductive et sexuelle. Certains de ces textes, adoptés depuis 1956, restent toujours en vigueur malgré leurs différentes modifications au cours des années. D'autres sont apparus avec l'adoption par l'Etat tunisien d'une politique de population et touchent des aspects particuliers de la politique. Pour le cas de la Tunisie, l'auteur décrit l'organisation juridique de la vie familiale et les droits des femmes dans la famille dans les domaines du consentement au mariage et les droits de la femme mariée. Quant aux droits liés à l'organisation et à la protection de la vie de la personne, le texte traite les sujets de l'état civil de la personne, le droit à la contraception et à l'avortement, et les droits socioprofessionnels de la femme enceinte et de la jeune mère.
Il existe de nombreux textes juridiques diversifiés qui régissent les politiques de population. Parmi ces textes, il y a des instruments internationaux et nationaux. Les instruments juridiques internationaux consistent en des conventions internationales adoptées par l'Assemblée générale des Nations unies et des résolutions sur les plans, les programmes d'action, et les déclarations adoptés au cours des dernières conférences internationales des Nations unies sur les droits de l'homme, la population et le développement, et les femmes. Les textes juridiques nationaux sont constitués d'un ensemble de lois, décrets, et circulaires qui organisent le domaine de la population depuis le début de l'Indépendance et surtout ceux qui régissent la famille, les femmes, et la santé reproductive et sexuelle. Certains de ces textes, adoptés depuis 1956, restent toujours en vigueur malgré leurs différentes modifications au cours des années. D'autres sont apparus avec l'adoption par l'Etat tunisien d'une politique de population et touchent des aspects particuliers de la politique. Pour le cas de la Tunisie, l'auteur décrit l'organisation juridique de la vie familiale et les droits des femmes dans la famille dans les domaines du consentement au mariage et les droits de la femme mariée. Quant aux droits liés à l'organisation et à la protection de la vie de la personne, le texte traite les sujets de l'état civil de la personne, le droit à la contraception et à l'avortement, et les droits socioprofessionnels de la femme enceinte et de la jeune mère.


Article de périodique

Donohue, J. J.; Steven D., l.

The impact of legalized abortion on crime
2001, Quarterly Journal of economics, N°CXVI, 2 - May 2001, p. 379-420

Mots clés : avortement; avortement légal; avortement provoqué; avortement provoqué, loi; communication; contraception d'urgence/ contraception postcoitale; crime; jurisprudence; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Pays développé; planning familial; planning familial, acceptante; problème social; revue littérature
Pays : Etats-Unis

Résumé : We offer evidence that legalized abortion has contributed significantly to recent crime reductions. Crime began to fall roughly eighteen years after abortion legalization. The five states that allowed abortion in 1970 experienced declines earlier than the rest of the nation, which legalized in 1973 with Roe v. Wade. States with high abortion rates in the 1970s and 1980s experienced greater crime reductions in the 1990s. In high abortion states, only arrests of those born after abortion legalization fall relative to low abortion states. Legalized abortion appears to account for as much as 50 percent of the recent drop in crime. (author's)


Article de périodique

Senlet, P.; Sian l., C.; Jill, M.; Hans, R.

The role of changes in contraceptive use in the decline of induced abortion in Turkey
2001, Studies in Family Planning, N°32, 1, p. 41-52

Mots clés : avortement; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; fécondité; maîtrise de la fécondité; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; taux d'avortement / taux
Pays : Turquie

Résumé : The induced abortion rate in Turkey declined from a peak of 4.5 abortions per 100 women in 1988 to 2.4 in 1998. This study examines the extent to which the decline in abortion in Turkey can be attributed to increased use of modern contraceptives. Trends in induced abortion rates and in contraceptive use are examined among Turkish women together with fertility preferences, changes in the contraceptive behavior associated with abortion, and changes in the propensity to abort unwanted pregnancies. The analysis includes a number of simulations that examine what abortion levels might be in different contraceptive-use scenarios. Results indicate that the decline in abortion is due to a decrease in the number of abortions associated with traditional method failure. This decrease is related to three factors: a shift from traditional method use to modern method use, a decline in the traditional method failure rate, and a decline in the proportion of pregnancies resulting from traditional method failures that are aborted. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Article de périodique

Munthali, J.; Moodley, J.

The use of misoprostol for mid-trimester therapeutic termination of pregnancy
2001, Tropical Doctor, N°31, 3, p. 157-161

Mots clés : avortement; Cytotec/Misoprostol; Mifepristone /RU486; Rupture utérine/complication
Pays : Afrique du Sud

Résumé : Extra-amniotic prostaglandin F(2)alpha (PC F(2)alpha) is probably the most widely used medical method for mid-trimester termination of pregnancy. The method is highly effective but is financially costly, particularly for poor countries faced with restricted health budgets. The aim of this study was to establish whether misoprostol administered vaginally is as effective as PC F(2)alpha. Sixty-one patients were prospectively randomized to receive either misoprostol (n=30) vaginally, or PG F(2)alpha (n=31) extra-amniotically. The overall success rate was 83.6%. The success rates in the misoprostol and PC F(2)alpha groups were 83.3% and 83.8% respectively. There was no statistical difference in the groups in relation to side effects. In this carefully selected group of patients, misoprostol was as safe and effective as PC F(2)alpha in mid-trimester termination of pregnancy. In these days of financial constraints, misoprostol is the preferred method for mid-trimester termination of pregnancy.

Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

Rutgers, S.

Two years maternal mortality in Matebeleland North province, Zimbabwe
2001, Central African Journal of Medicine, N°47, 2, p. 39-43

Mots clés : avortement; avortement provoqué, mortalité; complication; complication grossesse; contraception d'urgence/ contraception postcoitale; Dynamique démographique; éclampsie; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; femme; grossesse; maladie; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; paludisme; planning familial; planning familial, acceptante; population; rapport de recherche; taux d'avortement / taux
Pays : Afrique; Afrique subsaharienne; Zimbabwe

Résumé : The aim was to describe timeliness and completeness of maternal mortality notifications after the introduction of a revised national notification form in 1998, as well as sociodemographic and obstetric variables and causes of maternal deaths. A retrospective descriptive study was conducted in seven districts in Matebeleland North province using 95 maternal death notifications from 1 August 1998 to 31 July 2000. Main outcome measures were delay in submission and completeness of reports, age, marital status, religion, reproductive history, booking and referral status, duration and outcome of pregnancy, place of death, cause of death. 92/95 notifications were true maternal deaths, 86% were notified within 48 hours and 79% were complete, 74% of the deaths took place in a health facility. Mean age of the women was 27.8 years, mean parity 3.0. 60% had booked. The five main causes of death were obstetric hemorrhage (26%), malaria (24%), immune deficiency syndrome (13%), abortion (11%) and eclampsia (8%). The maternal mortality ratio per 100,000 reported home and institutional live births ranged from 155 to 532 per district. There is under reporting of maternal mortality in some districts, although from 1997 to 2000 a 200% increase in reporting was seen. Timeliness and completeness of reporting was satisfactory. With the exception of a high contribution from malaria the causes of maternal mortality in Matebeleland North province are similar to those reported elsewhere in Zimbabwe. (author's)

Site web : http://212.241.193.254/journal_index.php?jid=52 ab=cajm

Article de périodique

Olukoya, A. A.; Kaya, A.; Ferguson, B. J.; AbouZahr, C.

Unsafe abortion in adolescent
2001, International Journal of Gynecology Obstetrics, London, Elsevier, N°75, p. 137-147

Mots clés : avortement provoqué, loi; avortement provoqué, mortalité; complication; complication grossesse; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; grossesse; incidence; législation; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maladie; mesure; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population
Pays : Singapour

Résumé : This paper on the influence of abortion legislation on maternal mortality opens by noting that 585,000 women die from pregnancy- and childbirth-related causes each year and that all but about 250 of the 150,000 annual abortion-related deaths are preventable. The next section reviews the incidence of induced abortion (36-51 million each year, with 26-31 million being legal) and provides a table and a figure that reveal that the global incidence of unsafe abortion is approximately 20 million/year, resulting in approximately 70,000 deaths with many more women suffering serious complications that require treatment from seriously strained health care systems. Section 3 categorizes abortion laws as very strict (50 countries), rather strict (44 countries), rather broad (13 countries), and on request (22 countries). The most populous countries tend to have liberal laws, so only 25% of women worldwide have no access to legal abortion and 40% of women can decide for themselves. The next section discusses the fact that liberalizing abortion legislation leads to a tremendous decrease in maternal mortality rates because legalization allows abortion to be performed by trained providers using proper facilities and equipment and because accessibility and information dissemination allows women to seek abortions earlier in pregnancies. Section 5 notes the contrary effect of restrictive abortion legislation on maternal mortality, and section 6 reviews Singapore's experience in liberalizing abortion legislation. The article concludes that safe abortion services will always be needed and should be available worldwide.


Article de périodique

Gulmezoglu, A. M.; Villar, J.; Ngoc, N. T. N.; Piaggio, G.; Carroli, G.; Adetoro, L.; Abdel-Aleem, H.; Cheng, L. N.; Hofmeyr, G. J.; Lumbiganon, P.; Unger, C.; Prendiville, W.; Pinol, A.; Elbourne, D.; El-Refaey, H.; Schulz, K. F.

WHO multicentre randomised trial of misoprostol in the management of the third stage of labour
2001, Lancet, N°358, 9283, p. 689-695

Mots clés : biologie; complication; hormones; maladie; Misoprostol/méthode/cytotec; Nations Unies; OMS; organisation; oxytocin; Pays développé; prostaglandins/hormones; rapport de recherche; reproduction; traitement/soin
Pays : Afrique; Afrique du Sud; Afrique subsaharienne; Amérique latine; Argentine; Chine; Egypte; Europe; Irlande; Nigeria; Suisse; Thaïlande; Viêt Nam

Résumé : Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality. Active management of the third stage of labour, including use of a uterotonic agent, has been shown to reduce blood loss. Misoprostol (a prostaglandin Ell. analogue) has been suggested for this purpose because it has strong uterotonic effects, can be given orally, is inexpensive, and does not need refrigeration for storage. We did a multicentre, double-blind, randomised controlled trial to determine whether oral misoprostol is as effective as oxytocin during the third stage of labour. Methods In hospitals in Argentina, China, Egypt, Ireland, Nigeria, South Africa, Switzerland, Thailand, and Vietnam, we randomly assigned women about to deliver vaginally to receive 600 mug misoprostol orally or 10 IU oxytocin intravenously or intramuscularly, according to routine practice, plus corresponding identical placebos. The medications were administered immediately after delivery as part of the active management of the third stage of labour. The primary outcomes were measured postpartum blood loss of 1000 mL or more, and the use of additional uterotonics without an unacceptable level of side-effects. We chose an upper limit of a 35% increase in the risk of blood loss of 1000 mL or more as the margin of clinical equivalence, which was assessed by the confidence interval of the relative risk. Analysis was by intention to treat. Findings 9264 women were assigned misoprostol and 9266 oxytocin. 37 women in the misoprostol group and 34 in the oxytocin group had emergency caesarean sections and were excluded. 366 (4%) of women on misoprostol, had a measured blood loss of 1000 mL or more, compared with 263 (3%) of those on oxytocin (relative risk 1.39 [95% CI 1.19-1.63], p<0.0001). 1398 (15%) women in the misoprostol group and 1002 (11%) in the oxytocin group required additional uterotonics (1.40 [1.29-1.51], p<0.0001). Misoprostol use was also associated with a significantly higher incidence of shivering (3.48 [3.15-3.84]) and raised body temperature (7.17 [5.67-9.07]) in the first hour after delivery. Interpretation 10 IU oxytocin (intravenous or intramuscular) is preferable to 600 mug oral misoprostol in the active management of the third stage of labour in hospital settings where active management is the norm.

Site web : http://www.thelancet.com/

Article de périodique

Otoide, V. O.; Oronsaye, F.; Okonofua, F. E.

Why Nigerian adolescents seek abortion rather than contraception: evidence from focus-group discussions
2001, International Family Planning Perspectives, N°27, 2, p. 77-81

Mots clés : adolescent; âge; avortement; communication; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; désinformation; facteur démographique; jeune/adolescent; perception; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Nigerian adolescents generally have low levels of contraceptive use, but their reliance on unsafe abortion is high and results in many abortion-related complications. To determine why, it is important to investigate adolescents' perceptions concerning the risks of contraceptive use versus those of induced abortion. Data were collected through focus-group discussions held with adolescents of diverse educational and socioeconomic backgrounds. All were asked what they knew about abortion and contraception, and each method of contraception was discussed in detail. In particular, youths were asked about contraceptive availability, perceived advantages of method use, side effects and young people's reasons for using or not using contraceptives. Fear of future infertility was an overriding factor in adolescents' decisions to rely on induced abortion rather than contraception. Many focus-group participants perceived the adverse effects of modern contraceptives on fertility to be continuous and prolonged, while they saw abortion as an immediate solution to an unplanned pregnancy -- and, therefore, one that would have a limited negative impact on future fertility. This appears to be the major reason why adolescents prefer to seek induced abortion rather than practice effective contraception. The need to educate adolescents about the mechanism of action of contraceptive agents and about their side effects in relation to unsafe abortion is paramount if contraceptive use is to be improved among Nigerian adolescents. (author's)


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Rapport

center for reproductive laws and policy

Women of the World: Laws and Policies Affecting Their Reproductive Lives Anglophone Africa
2001, p. 175

Mots clés : adolescent; avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; droits reproductifs; loi / législation; planning familial; planning familial, acceptante; santé de la reproduction
Pays : Afrique du Sud; Ethiopie; Ghana; Kenya; Nigeria; Tanzanie; Zimbabwe

Résumé : Reproductive rights are internationally recognized as critical both to advancing women's human rights and to promoting development. Governments from all over the world have, in recent years, both acknowledged and pledged to advance reproductive rights to an unprecedented degree. But for governments, non-governmental organizations (NGOs), and concerned advocates to work towards reforming laws and policies so as to implement the mandates of these international conferences, they must be informed about the current state of national level formal laws and policies affecting reproductive rights.
This book on Anglophone Africa is the product of a unique series of collaborative reports between the U.S.-based Center for Reproductive Law and Policy and national-level NGOs around the world.
The Center for Reproductive Rights and NGOs in Africa have surveyed laws and policies in Ethiopia, Ghana, Kenya, Nigeria, South Africa, Tanzania, and Zimbabwe with respect to the following issues:
Governmental health and population policies with an emphasis on general issues relating to women's status;
Laws and policies regarding contraception, abortion, sterilization, FGM, HIV/AIDS, and other sexually-transmitted diseases;
Women's status as it relates to: marriage (including divorce and custody), property rights, labor rights, credit, education, and the right to physical integrity;
Reproductive health and rights of adolescents, including segments on female genital mutilation, marriage, sex education, and sexual offenses against minors;
Customary and religious laws regarding women's status.

Site web : http://www.crlp.org/pub_bo_wowafrica.html#online

  2000   
Article de périodique

Teri, E.

A presentation of the work of pathfinder international -- The use of emercency contraception to mitigate the problem of unwanted pregnancies and abortions in Africa
2000, International Journal of Gynecology and Obstetrics, N°70, Supplement 2, p. B116

Mots clés : avortement à risque; contraception d'urgence; contraception d'urgence/ contraception postcoitale; grossesse non prévue; morbidité et mortalité maternelle; mortalité maternelle; taux d'avortement à risque
Pays : Afrique

Résumé : Objectives: Studies conducted in the Africa Region show that the burden of unwanted pregnancies and unsafe abortions is enormous. Hospital figures show that the maternal mortality rate (MMR) due to abortion accounts for 20.30% of all maternal deaths in sub-Sahara Africa. In Kenya studies reveal that:
- 1. 90% of unwanted pregnancies end in abortions - 2. 2550% of abortion cases occur among young teenage women -3. 13.51% of gynecological admissions are die to incomplete abortions - 4. 60% of emergency gynecological admission at the main National Hospital re due to ab ortion. Emergency contraceptives (EC) are the only method couples can use to prevent pregnancy after they have had unprotected sexual intercourse or a contraceptive accident. EC is not much know or used in Africa. By making EC more widely available, FP providers can help reduce unplanned pregnancies, many of which result in unsafe abortion and take a large toll on women's health. The paper presents the work of Pathfinder International - Africa Region Office (PI/ARO) in enhancing the use emergency contraception in Kenya to mitigate the problem of unwanted pregnancies and abortions. It shares experience and lessons learnt in the introduction of EC into national reproductive health program in Kenya and the lessons learned. It further highlights t he need to identify a "product for special use as ECP", roles played by stakeholders and partner organizations, and the need for the role of national task forces for EC services and promotion. It also shares practical example that can provide learning experience for those working in similar projects in other developing countries
especially in Africa.


Article de périodique

Sarkin, J.

A review of health and human rights after five years of democracy in South Africa
2000, Medicine And Law, N°19, 2, p. 287-307

Mots clés : aspects socio-économiques; avortement légal; démocratie; facteurs socio-économiques; loi et jurisprudence; prévention; sida; Syndrome d'immunodéficience acquise/sida
Pays : Afrique du Sud

Résumé : South Africa became a democratic state with a supreme Constitution and Bill of Rights in 1994. Between 1994 and 1996 South Africans drafted a new constitution which came into force in 1997. While, the right to health, as well as socio-economic rights is provided for, the health care system in post-apartheid South Africa still mirrors that which existed during the apartheid years. There are still two health care systems. The poorly funded public sector services the majority, while the well-funded private sector services the privileged few. A lack of resources is blamed by the state for its inability to provide better and more widespread health services. This article examines, from a human rights perspective, the successes and challenges in developing the right to health between 1994 to 1999, and provides an overview of the present state of health in South Africa. This article further examines the constitutional provisions on health, and discusses recent constitutional court decisions relevant to the right to health. New and controversial health laws and regulations, affecting health care professionals, medical aid schemes and the availability of pharmaceuticals, are critiqued. The move to devolving health care to the provinces is described. Also discussed are the controversial steps taken by the Department of Health to restructure health structures and services. Progress on key health issues such as HIV/Aids, tobacco, tuberculosis, polio, measles, hepatitis, malaria and abortion are also described. Attention is focused on the role of the Truth and Reconciliation Commission's health hearings in bringing to light violations of human rights in health during apartheid as well as the recommendations made to address these problems.


Article de périodique

Gaym, A.

A review of maternal mortality at Jimma Hospital, Southwestern Ethiopia
2000, Ethiopian Journal of Health Development, N°14, 2, p. 215-23

Mots clés : avortement provoqué, mortalité; Cause de décès; complication grossesse; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; femme; grossesse; hôpital; hôpital publique; hôpital universitaire; maladie; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; rapport de recherche; santé; service de santé; système de santé; taux de mortalité; taux mortalité/décès
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : A retrospective review of hospital maternal deaths at Jimma Hospital, southwestern Ethiopia, covering the period from September 1990-May 1999 was conducted with the objectives of determining the overall maternal mortality rate, observing trend of maternal mortality during the period, and identifying major causes of maternal mortality. The overall maternal mortality rate for the period was 1965 maternal deaths per 100,000 live births, ranging from 1636 to 2332 deaths per 100,000 live births, with an overall trend showing no decrease. Ruptured uterus (33.2%) was the major cause of death, with unsafe abortion responsible for 26.8% of all cases. Overall, hemorrhagic complications of pregnancy, sepsis and hypertensive disorders were responsible for 94.9% of all maternal deaths. Analysis of trends of major causes showed deaths due to ruptured uterus to be increasing over the years. Obstructed labor was found to be directly or indirectly responsible for 45.53% of all maternal deaths, mainly affecting primigravid and grand multiparous (44.9%) women. Concentrating on the provision of peripartum care to this subgroup of mothers is suggested as one possible strategy to effect rapid reduction in overall maternal mortality within the foreseeable future. (author's, modified)


Reproduced with the permission of the Ethiopian Journal of Health Developpement : http://212.241.193.254/contact.php?jid=56 tran=0 ab=ejhd

Article de périodique

Kebede, S.; Jira, C.; Mariam, D.

A survey of illegal abortion in Jimma Hospital, south western Ethiopia
2000, Ethiopian Medical Journal, N°38, 1, p. 35-42

Mots clés : adolescent; adulte/âge; adultère; aspects socio-économiques; avortement; facteurs socio-économiques; planning familial; planning familial, acceptante
Pays : Ethiopie

Résumé : A cross-sectional descriptive study of induced abortion was conducted in Jimma Hospital, South-western Ethiopia to determine socio-economic factors and associated problems during February 25-May 5, 1996. There were a total of 80 patients with a diagnosis of induced abortion were enrolled of which 50 (62.5%) cases were admitted for bleeding and infections. Thirty six (45%) of all cases were primigravidae. Students accounted for 28 (35%) of the cases. Seventy (87.5%) of the cases could read and write and only 31 (38.8%) were married. Seventy (87.5%) knew presence of family planning methods, and 40 (50%) used at least once previously. Eighteen (22.5%) gave economic problems as reason for abortion, and 76 (95%) of them used either rubber tubes or roots of plants to induce the abortion. Of the total 42 (52.5%) believed that the right of abortion concerns mainly themselves


Article de périodique

Getahun, H.; Berhane, Y.

Abortion among rural women in north Ethiopia
2000, International Journal of Gynecology and Obstetrics, N°71, 3, p. 265-6

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; facteur démographique; femme; planning familial; planning familial, acceptante; population; rapport
Pays : Afrique; Afrique subsaharienne; Ethiopie

Résumé : This study describes the magnitude of abortion in the rural district of South Gonder in north Ethiopia. A total of 1158 women of reproductive age (15-49 years) and who were currently married participated in the study. Lifetime history of abortion was reported by 241 of the women. Of the reported abortions, the majority (91.4%) was spontaneous. Moreover, induced abortion was mainly related to avoidance of pregnancy and poverty. Self-introduction of hard material into the vagina and chloroquine over-dosage were the main methods used for inducing abortion. A history of sexually transmitted disease (P < 0.01) and more than one lifetime marriage (P < 0.01) were associated with an increased risk of abortion. The study indicates that with the rapid growth of population and a decline in agricultural land size per capita in Ethiopia, the rate of induced abortion in rural communities may have a remarkable increase in the near future.


Article de périodique

Bennett, T.

Abortion and human rights in sub-Saharan Africa
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 1-3

Mots clés : aspects socio-économiques; avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; facteurs économiques; facteurs socio-économiques; femme; inégalités; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante
Pays : Afrique; Afrique subsaharienne

Résumé : This issue of Initiatives focuses on the generally restrictive abortion laws in sub-Saharan Africa. It is noted that African women account for at least 34,000 of the total number of female deaths caused by unsafe abortion globally each year. These restrictive abortion laws violate women's rights and, by targeting women uniquely, legal limitations on abortion constitute a form of gender discrimination. The interplay between human and reproductive rights and abortion realities can be seen in the context of the African case studies presented in this issue. These case studies highlight the damaging cycle of women's inequality, in which low social status leads to lack of contraceptive and other preventive health services for women, resulting in unintended pregnancies and utilization of unsafe abortion. Just as human rights are a prerequisite for reproductive freedom and abortion rights for women, the availability of safe abortion services is necessary for full implementation of other rights. Sub-Saharan African women are asserting their reproductive rights to the full extent and sometimes beyond the extent of the law. To support this endeavor, the international community must help to free resources for building the economic and social infrastructures that will make possible the exercise of human rights in the developing world.


Article de périodique

Guillaume, A.

Abortion in Africa: a birth control method and a public health issue
2000, Ceped News, 8, p. 1-4

Mots clés : adolescent; âge; avortement; avortement provoqué, mortalité; biologie; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; Dynamique démographique; facteur démographique; facteurs de risque; femme; jeune/adolescent; maladie; morbidité; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; santé
Pays : Afrique

Résumé : Induced abortion is an important factor of maternal morbidity and mortality in Africa. Despite often restrictive law systems and very poor sanitary conditions for operations, abortion seems to be on the rise, particularly among the younger generations of women who are either educated or wish to go on with their studies, and in urban environments. An in-depth study conducted in Ivory Coast among women in four health centers in Abidjan, affords greater insight into reasons and methods used for abortion. The survey shows the competition between contraception and abortion, two birth control methods that do not involve the same risks for the health of women. (author's)


Reproduced with the permission of Ceped : http://ceped.cirad.fr

Article de périodique

Kasolo, J.

Abortion in Uganda
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 9-10

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; comportements; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; droit de l'homme; femme; méthode d'avortement, effets secondaires; planning familial; planning familial, acceptante; santé; santé maternelle
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : In Uganda, health care for women is not considered a basic right by society or by women themselves. A woman's worth and prestige are measured by her ability to feed the family; her health is not a priority. They are not allowed to use contraception or any family planning services. Because of their low status and barriers to contraception, many resulted in unwanted pregnancies and unsafe abortion. It is noted that women seek abortion for various reasons, primarily to continue their education, to maintain a job if the man has denied responsibility, or to avoid producing a child outside wedlock or before marriage. The negative societal attitudes about abortion often result in clandestine abortion. It is evident that unsafe abortion causes 20% of maternal deaths. Unless the Ugandan society experiences a shift in attitudes, women's reproductive rights can never be realized. It is suggested that advocacy, greater acceptance of single motherhood, accessible family planning services, and reproductive health policies can decrease the demand for abortion.


Article de périodique

Mbonye, A.

Abortion in Uganda: magnitude and implications
2000, African journal of Reproductive Health, N°4, 2, p. 104-108

Mots clés : analyse; avortement provoqué, mortalité; biologie; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; études statistiques; facteur démographique; facteurs de risque; méthodologie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; rapport de recherche; santé; service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : This study was conducted to assess the magnitude of maternal deaths in health units in Uganda, and the risk factors associated with such deaths. A retrospective study of maternal deaths in 20 hospitals and 54 randomly selected health centers was conducted in 12 randomly selected districts of Uganda. The reference period for documenting maternal deaths was September 1992-September 1993. The International Classification of Diseases 10 was used to define a maternal death. Data on maternal deaths and associated risk factors was obtained from admission and patient case notes. Statistical Package for the Social Sciences/PC was used to carry out advanced statistical analysis. Log linear analysis was used to rank risk factors for maternal deaths. A total of 418 maternal deaths and 75,000 live births were recorded, giving a maternal mortality ratio of 557/100,000 live births. 360 (86.1%) mothers died within 1 hour of admission. The risk factors identified were inadequate antibiotic supply, intravenous drug fluids, and blood for transfusion in health units; non- use of family planning; use of traditional medicine; mothers aged 15-19 and 30- 50 years. Others included those who had a history of two or more abortions and stillbirths; parity of five and above; and living within a distance of more than 10 km to the nearest health unit. The authors conclude that the focus on risk factors for maternal deaths have policy implications. (author's)


Reproduced with the permission of African Journal of Reproductive Health http://www.ajol.info/journal_index.php?jid=49 ab=ajrh

Article de périodique

Cohen, S.

Abortion Politics and U.S. Population Aid: Coping with a Complex New law
2000, International Family Planning Perspectives, N°26, 3, p. 137-145

Mots clés : avortement; loi / législation

Résumé :
-


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Stevens, M.

Abortion reform in South Africa
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 4-6

Mots clés : avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Organisation et Administration; planning familial; planning familial, acceptante; programme; Programme d'évaluation
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : In South Africa, the election of a new government in 1994 formalized a growing emphasis on human rights and equality for all. In conjunction with the dismantling of apartheid, the country developed a number of initiatives that supported a rights-based approach to reproductive health care and personal autonomy and laid the foundation for the passage of a liberalized abortion law in 1996. It is noted that the process leading to abortion law reform was complex and multi-faceted. Researchers, activists, community groups, political representatives and religious leaders all contributed to the change. However, despite the improvements in the model human rights framework in which the South African abortion law was created, implementation of legal abortion services is slow and needs careful vigilance to ensure that the needs of ordinary women are met in the South African context. To this effect, health planners and managers need to observe and listen to women's strategies for negotiating their multiple roles and the daily challenges they face. The health sector must also ensure that women know their rights, have access to services, and receive satisfaction and support from their health care.


Article de périodique

Varkey, S. J.

Abortion services in South Africa: available yet not accessible to all
2000, International Family Planning Perspectives, N°26, 2, p. 87-8

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); Organisation et Administration; planning familial; planning familial, acceptante; programme; Programme d'évaluation; santé; service d'avortement; service de santé; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : In 1994, the political regime in South Africa ushered in the government's commitment to women's health as indicated in key documents which recognized the woman's right to choose and addressed the problem of clandestine, unsafe abortion. Within this enabling environment, the Choice on Termination of Pregnancy Act was passed in 1996. Since then, research and monitoring initiatives have documented the increased availability of abortion services. However, the question of how accessible these services are remains to be answered. This article evaluates accessibility of services to assess the implementation of three provisions of the Act that were intended to ensure access for all. These provisions include training midwives to perform first-trimester abortions so that services can be provided in primary health care facilities; placing no restrictions on access to services besides individual choice; and ensuring that women have the sole right to consent to an abortion. Overall, the information gathered from various research and monitoring efforts indicates that although the Act has increased availability, the right to abortion remains elusive for certain groups, especially women from peripheral areas and younger women. Concerted effort is recommended to maintain the rights guaranteed by the Act; the right to self-determination and the right to equal access.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Cameron, N.

Abortion--ethical obligations
2000, South African Medical Journal, N°90, 3, p. 206, 208

Mots clés : avortement; éthique
Pays : Afrique du Sud
Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Bateman, C.

Abortion: damned if you do or you don't
2000, South African Medical Journal, N°90, 8, p. 750-751

Mots clés : avortement légal; connaissances, attitudes, pratiques; loi et jurisprudence; personnel de santé; Statistique
Pays : Afrique du Sud
Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Rasch, V.; Silberschmidt, M.; McHumvu, Y.; Mmary, V.

Adolescent girls with illegally induced abortion in Dar es Salaam: the discrepancy between sexual behaviour and lack of access to contraception
2000, Reproductive Health Matters, N°8, 15, p. 52-62

Mots clés : adolescent; âge; avortement; Avortement illégal; comportement reproductif; comportement sexuel; comportements; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; jeune/adolescent; Organisation et Administration; planning familial; planning familial, acceptante; population; programme; Programme d'évaluation; programme planification familiale; rapport de recherche
Pays : Afrique; Afrique subsaharienne; Tanzanie

Résumé : This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14-19) were asked for socioeconomic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationship with their partners, sexual behavior, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most girls were in love with and enjoyed sex with partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of sexually transmitted diseases and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning (FP) services and in practice these services are not being provided. There is a need for youth-friendly FP services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls. (author's)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Ouvrage

Kaufman, C. E.; Wet, T. d.; Stadler, J.

Adolescent pregnancy and parenthood in South Africa
46861
2000, New York (US), Population Council, 136, p. 41 p.

Mots clés : adolescent; âge; aspects socio-économiques; célibataire; comportement reproductif; culture; déterminant culturel; déterminant fécondité; Dynamique démographique; éducation; facteur culturel; facteur démographique; facteurs économiques; facteurs socio-économiques; fécondité; grossesse adolescente; grossesse adolescente/grossesse; grossesse prémaritale; jeune/adolescent; mariage; mariage/état matrimonial; mariage/polygamie; mariage/polygynie; nuptialité; population; rapport de recherche; Statut socio-économique
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : South Africa's total fertility rate is estimated to be one of the lowest in sub-Saharan Africa, less than 3.0 births per woman nationally and declining. At the same time, adolescent childbearing levels remain high; more than 30% of 19-year-old girls are reported to have given birth at least once. Using evidence from focus groups conducted in urban and rural areas in South Africa with young Black women and men, and with the parents of teenage mothers, the authors consider the experience of early parenthood. Specifically, the analysis explores four aspects of teenage childbearing as it relates to key transitions into adulthood: the advent of a pregnancy and the decision to terminate or carry the pregnancy to term; the conditions under which "damages" (a fine for the boy's behavior that also effectively assigns paternity even if no marriage follows) are denied, paid, or refused; the impact of early childbearing on school, work, and marriage; and consequences of premarital childbearing on future relationships, including subsequent fertility. The authors find that in South Africa, in contrast to many other settings, teenage mothers may return to school once they have given birth and that this opportunity is strongly related to a long delay before the birth of a second child. Education is also strongly associated with the valuation of brideprice: girls who are better educated bring a higher price, which may encourage parents to support their daughters' schooling, and perhaps also their return to school following early pregnancy and childbirth. Babies born to teenage parents are extremely vulnerable. Because the baby is usually born premaritally and subsequent marriage between mother and father is uncommon, the support and maintenance of the child are subject to paternal recognition and commitment. The presence of a baby also generally means a lower brideprice for a future marriage; first-born children are sometimes kept secret from prospective grooms to maintain higher brideprice. (author's)


Reproduced with the permission of Population Council : http://www.popcouncil.org/

Congrès

Noël, M.-F.

Approche anthropologique de quelques concepts et conceptions populaires relatifs à la santé maternelle. Représentations et pratiques de la grossesse, de l'accouchement et du post-partum en milieu touareg
46443
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan, Cote d'Ivoire, 1, p. 47-60

Mots clés : allaitement; avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; femme; médecine traditionnelle; stérilité
Pays : Mali

Article de périodique

Takongmo, S.; Binam, F.; Simeu, C.; Ngassa, P.; Kouam, L.; Malonga, E.

Aspects thérapeutiques des péritonites génitales au CHU de Yaoundé (Cameroun)
2000, Médecine d'Afrique Noire, N°47, 1, p. 19-21

Mots clés : avortement; avortement provoqué; complication/ péritonite; laparotomie
Pays : Cameroun

Résumé : In this study the evaluation of the surgical treatment of peritonitis of genital origin has revealed a mortality of 7 dead (23,3 %) out of 30 cases. This high mortality was due peritonitis complicating ab o rtions and presenting as localized abscesses, therefore drained by colpotomy. The study recommends laparotomy as the best route of treatment in all types of peritonitis caused by abortion in our country.
Cette étude avait pour but d'évaluer les méthodes de traitement chirurgical des péritonites génitales au CHU de Yaoundé. Elle reposait sur une analyse rétrospective de 30 patientes opérées en 10 ans. La mortalité de 7 cas (23,3 %) restait élevée ; elle était le fait des péritonites compliquant une interruption volontaire de grossesse et le fait des malades opérées secondairement par laparotomie après échec d'un traitement par colpotom ie - drainage. L'étude recommande la laparotomie d'emblée devant ces péritonites même dans leurs formes localisées.

Site web : http://www.santetropicale.com/resume/14704.pdf

Article de périodique

Webb, D.

Attitudes to "Kaponya Mafumo": the terminators of pregnancy in urban Zambia
2000, Health Policy and Planning, N°15, 2, p. 186-93

Mots clés : adolescent; âge; attitude; avortement; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; grossesse non prévue/grossesse non désirée; jeune/adolescent; perception; planning familial; planning familial, acceptante; population; population urbaine; psychologie/facteur psychologique; rapport de recherche; santé; santé de la reproduction; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Zambie

Résumé : As part of a larger study of adolescent sexual and reproductive health in urban Zambia, the issue of unwanted pregnancy and abortion was considered through the examination of the perceptions of both adolescents and adults. Young people rank sexual health as their primary health issue, and sexual behavior is integrally linked into other aspects of their lives. Pregnancies were deemed to be a common occurrence amongst the adolescents, with an estimated two-thirds of unwanted pregnancies ending in unsafe abortion. The decision to abort is primarily determined by the reaction of the boyfriend and his willingness to accept paternity and the associated financial implications. Other crucial influences are the desire to stay in school and the stigma attached to unwanted pregnancy. The decision-making process regarding the abortion itself is related to the perceived advantages and disadvantages of various service providers. Around 40% of the respondents stated that in the event of an abortion being carried out, it would be performed either by the girl herself or with the assistance of other non-medical personnel. Less popular but still significant are traditional healers and private doctors. Formal health services tend to be rejected due to their poor perception by young people, centered on the lack of privacy and confidentiality, and the de facto illegal nature of abortion itself. The services of nurses are sought, but outside of the clinic setting. The most popular method of self-induced abortion is overdosing on chloroquine. Other methods involve the use of traditional medicines such as various types of roots, as well as more modern methods such as ingesting washing powder. Recommendations for policy-makers concentrate on the improvement of formal, "youth friendly" health services and the development of appropriate outreach education methods which address specific concerns widely held by young people. (author's)


Article de périodique

Attitudes to abortion among adolescents in urban Zambia
2000, Reproductive Health Matters, N°8, 16, p. 191

Mots clés : adolescent; âge; attitude; avortement; comportements; contraception d'urgence/ contraception postcoitale; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; étude/études; facteur démographique; jeune/adolescent; méthodologie; planning familial; planning familial, acceptante; population; population urbaine; psychologie/facteur psychologique; ville/résidence; zone urbaine
Pays : Afrique; Afrique subsaharienne; Zambie

Résumé : A study in urban Zambia explored attitudes to abortion among adolescents using qualitative data collected in some 100 focus group discussions in five urban districts, and quantitative data from a narrative questionnaire completed by 1100 school children. About 12% of boys aged 10-19 thought they had made a girl pregnant, while 9% of girls aged 10-19 had been pregnant. The main reasons for a girl to decide to abort included the reaction of her boyfriend and his unwillingness to accept paternity, the desire to stay in school and the stigma attached to schoolgirl pregnancy. Traditional healers are the most likely to assist in carrying out abortions, because they are seen to keep confidentiality, not ask probing questions and play the role of spiritually cleansing the girl afterwards. Girls who abort are known as kaponya mafumo (terminators of pregnancies) and there is a belief that they can infect others, one of the main causes of the stigma associated with girls who abort. Private doctors are considered to be "clean" and confidential, but expensive. Self-induced abortion is also common; large dosages of chloroquine is the most frequently mentioned method. These findings show the need for improving youth-friendly health services and developing appropriate and effective outreach methods, including destigmatization of teenage pregnancy. (full text)


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Article de périodique

Harrison, A.; Montgomery, E. T.; Lurie, M.; Wilkinson, D.

Barriers to implementing South Africa'a Termination of Pregnancy Act in rural KwaZulu Natal
2000, Health Policy and Planning, N°15, 4, p. 424-31

Mots clés : attitude; avortement provoqué, loi; comportements; connaissance; contraception d'urgence/ contraception postcoitale; croyance; culture; déterminant culturel; facteur culturel; facteur démographique; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); obstacles; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; santé; service de santé; service de santé communautaire/offre/service de santé; soin de santé primaire; système de santé
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18% and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape of incest, or if the continued pregnancy would endanger a woman's health (61% and 56%, respectively), few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability. (author's)


Article de périodique

Ntia, I. O.; Ekele, B. A.

Bowel prolapse through perforated uterus following induced abortion
2000, West African Journal of Medicine, N°19, 3, p. 209-211

Mots clés : avortement; biologie; Clients; contraception d'urgence/ contraception postcoitale; facteur démographique; femme; intervention chirurgicale; maladie; méthodologie; Organisation et Administration; perforation utérine/complication; perforation/complication; planning familial; planning familial, acceptante; population; programme; programme d'activités; rapport de recherche; traitement/soin
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Between 1991 and 1998, there were nine cases of uterine perforation following induced abortion with prolapse of the bowel out of the introitus, managed at Usmanu Danfodiyo University Teaching Hospital, Sokoto. Non-physicians caused the injury in six cases. Interval between instrumentation and presentation ranged from 5 to 14 days. In all the cases, there was already necrosis of the involved bowel. The ileum was the most commonly involved bowel (6 cases; 67%) while the uterine injury was on the fundus most of the time (7 cases; 78%). Resection and anastomosis with uterine repair was the surgical procedure in all the cases. There were 3 cases of anastomotic leakage but no mortality. We do encounter major complications of induced abortion in our center. Apart from preventive measures against unwanted pregnancies, access to safe abortions by trained personnel might minimize this type of complication. (author's)

Site web : http://www.ajol.info/journal_index.php?jid=177 tran=0 ab=0

Rapport

Anonymous

Burkina Faso: postabortion care. Upgrading postabortion care benefits patients and providers
2000

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires; soins post avortement
Pays : Burkina Faso

Résumé : During 1996-98, the Reproductive Health Research Network conducted a study to introduce emergency care for women with complications from miscarriage and abortions. Within this project, physicians, nurses, and midwives at two large hospitals in Ouagadougou and Bobo-Dioulasso were trained to provide postabortion care (PAC), including manual vacuum aspiration (MVA), family planning methods, infection prevention, and communication with patients. Changes in knowledge and behavior were measured through an interview with 330 patients with abortion complications and 78 providers before the intervention, and 456 patients and 41 providers after the intervention. Overall, the study demonstrated that the improved emergency medical care for women with miscarriages and unsafe abortions leads to better patient care, shorter hospital stays, lower costs, and increased contraceptive use. However, when performing MVA, verbal assurance alone from the training staff is inadequate for pain control, but rather local anesthesia is essential. The study also revealed that providers switched to MVA as their preferred treatment for PAC, since MVA lowered costs for both hospital and patients due to shorter hospital stays, less anesthesia, and less staff time.


Article de périodique

Kafé, H.; Brouard, N.

Comment ont évolué les grossesses chez les adolescentes depuis 20 ans?
2000, Population et sociétés, N°361, p. 4

Mots clés : avortement; avortement provoqué, loi; comportement reproductif; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; incidence; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); mesure; méthodes barrières/contraception; méthodologie; Pays développé; planning familial; planning familial, acceptante; population; préservatif/ condom; prévalence
Pays : Europe; France

Résumé : 25 ans après le vote de la loi Veil du 17 janvier 1975, on discute de nouveau l'interruption volontaire de grossesse (IVG). Parmi les modifications envisagées de la loi figurent l'augmentation du délai légal de recours à l'IVG et l'assouplissement de l'autorisation parentale pour les mineures. Le nombre de grossesses de mineures a diminué de 36% en 17 ans, passant de 20.710 en 1980 à 13.192 en 1997. Cette baisse s'est traduite par une diminution de 60% du nombre des naissances vivantes, mais le nombre annuel d'IVG déclarées chez les mineures a stagné entre 4,9% et 5,9% du nombre total d'IVG. Environ la moitié des naissances et des avortements survenant chez les mineures sont le fait d'adolescentes de 17 ans. La période des années 1960 à 1980 a vu la fin du baby-boom et l'entrée en vigueur de la loi Neuwirth libéralisant la contraception. Globalement, l'évolution de la fécondité des personnes âgées de 12 à 17 ans a connu deux phases. Durant la première phase, au cours des années 1980, la proportion d'adolescentes entamant une grossesse a connu une forte diminution, de 5,4% par an, qui s'est traduite par une baisse de la fréquence des naissances vivantes et de celle des IVG. Ensuite, depuis 1989 et au cours des années 1990, les conceptions sont stabilisées, mais la fréquence des IVG remonte de 2,8% par an, tandis que celle des naissances continue à baisser. L'âge médian des femmes au premier rapport sexuel est resté stable à une valeur de 17 à 18 ans depuis plusieurs années. 51% des femmes qui ont commencé leur vie sexuelle en 1970 n'avaient pas utilisé de contraception au premier rapport sexuel, contre 30% en 1988 et 16% en 1993. 8% des femmes qui ont commencé leur vie sexuelle en 1987 ont utilisé un préservatif, comparé à preès de 90% de telles femmes vers la fin des années 1990. Les auteurs discutent le recours à l'IVG, l'efficacité de la contraception, et le nombre de grossesses chez les adolescentes.
Keywords:

Site web : http://www.ined.fr/publications/index.html

Article de périodique

Baird, T. L.; Billings, D. L.; Demuyakor, B.

Community education efforts enhance postabortion care program in Ghana
2000, American Journal of Public Health, N°90, 4, p. 631-2

Mots clés : communauté; éducation; éducation pour la santé; planning familial; planning familial, acceptante; population; programme planification familiale; programme post-abortum; programme post-abortum, coût; résidence
Pays : Afrique; Afrique subsaharienne; Ghana

Résumé : As in most countries in the developing world, unsafe abortion devastates the health and lives of women in Ghana. It is the highest single contributor to its maternal mortality ratio of 740 deaths per 100,000 live births. Although complications of abortion are treatable, delays in prompt treatment increase the risk of morbidity and death. To address the problem of unsafe abortion and delays in seeking care for women, a comprehensive operations research project aimed at improving women's access to postabortion services was implemented in Ghana. Community education was an integral component of the postabortion care project, implemented under the US Agency for International Development's MotherCare contract. The experiences and lessons that were learned from incorporating community education into the program are presented in the paper. Through this strategy, women, men, adolescents, community leaders, and the community at large were made aware of the risks and signs of unsafe abortions and its complications and the availability of services by trained midwives. This approach, in being both strategic and sustainable, directly complements the national Safe Motherhood health education program of Ghana and could be easily integrated into other reproductive health programs in various settings.


Rapport

Rogo, K. O.; Bohmer, L.; Ombaka, C.

Community level dynamics of unsafe abortion in western Kenya and opportunities for prevention. Summary of findings and recommendations from pre-intervention research
2000, Los Angeles, California, Pacific Institute for Women's Health, p. 19

Mots clés : âge; avortement; avortement provoqué, homme; avortement provoqué, mortalité; collecte; comportement reproductif; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; Entretien; facteur démographique; fécondité; femme; focus group/enquête; grossesse non prévue/grossesse non désirée; homme; jeune/adolescent; maladie; méthodologie; morbidité; morbidité et mortalité maternelle; mortalité; mortalité maternelle; personnel de santé; planning familial; planning familial, acceptante; population; rapport; santé; santé publique; Sécurité; service de santé; service de santé communautaire/offre/service de santé; soin de santé primaire; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Unsafe abortion is a public health problem of enormous consequence and remains a leading cause of maternal morbidity and mortality in the East, Central and Southern Africa region. According to recent estimates approximately 20-50% of pregnancy related mortality in this region is due to unsafe abortion. Postabortion care has been a successful approach to reducing morbidity and mortality by improving the care of women with abortion complications with: emergency treatment for complications of abortion; postabortion family planning and services; and links between emergency treatment and other reproductive health services. Programs to improve abortion care have almost exclusively focused on secondary prevention at the hospital level, although efforts to decentralize treatment for abortion complications are underway in the region. (excerpt)

Site web : http://www.piwh.org/pdfs/kenya_report.pdf

Article de périodique

Diallo Diabaté, F. S.; Traoré, M.; Diakité, S.; Perrotin, F.; Dembélé, F.; Diarra, I.; Dolo, A.

Complications des avortements provoqués illégaux à Bamako (Mali) de décembre 1997 à novembre 1998
2000, Cahiers d'études et de recherches francophones /santé, N°10, 4, p. 243-247

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires; morbidité et mortalité maternelle; mortalité maternelle
Pays : Mali

Résumé : Dans une étude rétrospective descriptive, menée pendant une période de un an dans le service de référence de gynécologie-obstétrique de l'hôpital Gabriel-Touré à Bamako, nous avons analysé 1 081 dossiers de patientes qui se sont présentées dans le service à la suite d'une complication d'avortements spontanés ou provoqués. Nous avons isolé et étudié 189 cas d'avortements provoqués illégaux. Les patientes étaient jeunes (avec un âge moyen de 21,8 ans), d'un bas niveau socio-économique, et n'avaient pour la plupart (71,4 %) aucun enfant vivant. Pour 19,5 % d'entre elles l'âge gestationnel était inférieur à 12 semaines et compris entre 13 et 16 pour 47,6 %. Les manoeuvres abortives ont été pratiquées par des tradipraticiens (3,7 %), des médecins généralistes (9 %), des infirmiers du premier cycle (10,5 %) et des infirmiers d'États et sages-femmes (57,1 %). Dans plus de la moitié des cas (71,4 %) l'avortement a eu lieu au domicile du praticien. Plusieurs méthodes abortives ont été utilisées (curetage, sondage utérin, etc.). Dans 44,4 % des cas, les femmes ont gardé un mutisme complet sur le motif de l'avortement. Les autres ont évoqué des raisons scolaires dans 20,63 % des cas et la crainte des parents dans 13,22 %. Les métrorragies (51,3 %), les hyperthermies (35,4 %) les douleurs (9,52 %) et les troubles neurologiques (3,1 %) ont été les principaux motifs de consultation. Trois types de complications ont été identifiés : les hémorragies (47 %), les complications infectieuses (33,3 %), les intoxications médicamenteuses (4,2 %). La mortalité maternelle a été de 10 %. La prise en charge des patientes a nécessité des traitements chirurgicaux (allant du curetage à l'hystérectomie) et médicaux avec une durée moyenne d'hospitalisation de 10 jours

Site web : http://www.john-libbey-eurotext.fr/fr/revues/sante_pub/san/e-docs/00/03/5B/94/resume.md

Congrès

Moumouni, A.

Conceptions et pratique de l'avortement en pays Songhay-Zarma
46450
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan, 1, p. 105-110

Mots clés : avortement
Pays : Niger

Article de périodique

Ujah, I. A. O.

Contraceptive intentions of women seeking induced abortion in the city of Jos, Nigeria
2000, Journal of Obstetrics and Gynaecology (Abingdon), N°20, 2, p. 162-166

Mots clés : avortement; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; naissance non prévue
Pays : Nigeria

Résumé : This is a prospective study involving 120 women who requested abortion for an unplanned and unwanted pregnancy. We sought to determine their contraceptive intentions and use. The characteristics of these women revealed that the majority were young, single schoolgirls with 68.5% of them being nulliparous. Over 90% had had their first sexual experience before the age of 20 years. Although, 113 (94%) were aware of the availability of contraceptive services only 70 (62%) of these had ever used a method and the majority of the contraceptive methods selected were ineffective. Although 97 (80.8%) had a positive intention towards post-abortion family planning, only 18 (18.5%) eventually agreed and were offered a method after the termination of pregnancy. The study revealed a high risk group of unplanned and unwanted pregnancy in Jos but low contraceptive use despite the high positive intentions expressed by this cohort of patients. Effective post-abortion contraception counselling should be incoporated into family planning in Nigeria in order that clients who express positive intentions to the use of family planning actually use the method thereby reducing the incidence of repeated induced abortions and its social and medical consequences.


Article de périodique

Kyamureku, P. T.

Contradictions in human rights and social attitudes: case studies of abortion in Uganda
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 8

Mots clés : avortement incomplet/complication; avortement provoqué, complication; complication; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; déterminant fécondité; droit de l'homme; Dynamique démographique; facteur démographique; fécondité; femme; grossesse adolescente; grossesse adolescente/grossesse; méthode d'avortement, effets secondaires; planning familial; planning familial, acceptante; politique/programme; population
Pays : Afrique; Afrique subsaharienne; Ouganda

Résumé : In Africa and in many developing countries, there are many unwritten rules that apply to women. These unwritten rules and regulations, though referred to as culture or tradition, keep women in bondage and in a subservient status to men. Moreover, these regulations limit women's right, health, and development and determine women's access to abortion and other health care. In contrast to these traditional views, many countries, including Uganda, have written constitutions with sections that provide the "Protection and Promotion of Fundamental and Other Human Rights and Freedoms". In this article, two case studies are presented that highlight contradictions between culture and written law and explore questions of human rights as they confront social attitudes in Uganda. Both stories relate the sufferings of two teenagers who became pregnant out of wedlock. It is noted that Ugandan women seeking abortion face severe punishments, which are more often the result of traditions and culture than a requirement of the law. Society and women in particular do not know or understand legal codes and women's rights, thus they act out of ignorance and fear of how society might judge them. Given the increasing effects of these structural adjustments policies in Africa, safe and legal abortion should be an issue of immediate concern.


Article de périodique

Dyer, M.

Correcting the record on ARAG's philosophy letter
2000, International Family Planning Perspectives, N°26, 1, p. 43

Mots clés : avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; droits reproductifs; facteur démographique; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); organisation; planning familial; planning familial, acceptante; population
Pays : Afrique; Afrique du Sud; Afrique subsaharienne

Résumé : This article presents a commentary on a paper entitled "Abortion Reform in South Africa: A Case Study of the 1996 Choice on Termination of Pregnancy Act." The author reacts to the statement found in the paper's footnote area, which makes an offensive suggestion about the Abortion Rights Action Group (ARAG). The author makes clear that, since its inception, ARAG has been a nonracial organization opposing all government policies that are unjust. Furthermore, the ideals and beliefs of ARAG cannot be likened to that of the National Party, because the organization believes that, while women themselves should be the arbiters of when or whether they will have children, they are persuaded to choose to have no more than two, for their own and their children's welfare. Lastly, the organization will strive to achieve more positive demographic trends in Africa.


Reproduced with the permission of The Alan Guttmacher Institute : http://www.agi-usa.org

Article de périodique

Botes, A.

Critical thinking by nurses on ethical issues like the termination of pregnancies
2000, Curationis, N°23, 3, p. 26-31

Mots clés : avortement légal; connaissances, attitudes, pratiques; demande; demande d'avortement; droit des femmes; Entretien; femme; focus group/enquête; hôpital; hôpital publique; hôpital universitaire; jurisprudence; législation; personnel de santé; psychologie/facteur psychologique; santé
Pays : Afrique du Sud

Résumé : This research forms part of a larger interdisciplinary research project on the termination of pregnancies. The focus of this part of the project is on the ethical issues related to termination of pregnancies. The practice of the professional nurse is confronted with ethical dilemmas and disputes. Whether the nurse chooses to participate in the termination of pregnancies or not, the core function of the nurse is that of counseling and ethical decision-making. Effective counseling requires empathy, respect for human rights and unconditional acceptance of a person. Making ethical decisions implies making critical decisions. It is self-evident, therefore, that such decisions should be based on sound arguments and logical reasoning. It is of vital importance that ethical decisions can be justified on rational ground. Decision-making is a critical thinking approach process for choosing the best action to meet a desired goal. The research question that is relevant for this paper is: Are nurses thinking critically about ethical issues like the termination of pregnancies? To answer the research question a qualitative, exploratory, descriptive design was used (Mouton, 1996:103-169). Registered nurses were selected purposively (Creswell, 1994:15). 1200 registered nurses completed the open-ended questionnaires. Focus group interviews were conducted with 22 registered nurses from a public hospital for women and child health services. Data analysis, using secondary data from open-ended questionnaires and transcribed focus group interviews, were based on the approach of Morse and Field (1994:25-34) and Strauss and Corbin (1990). The themes and categories from open coding were compared, conceptualized and linked with theories on critical thinking (Paul, 1994; Watson Glaser, 1991 and the American Philosophical Association, 1990). The measures of Lincoln and Guba (1985) and Morse (1994) related to secondary data analysis were employed to ensure trustworthiness. Based on these findings the researcher concluded that nurses are not thinking critically when making ethical decisions concerning the termination of pregnancies. Recommendations are made as a possible solution for this problem.


Article de périodique

Taylor, R.; Richards, G. A.

Critically ill obstetric and gynaecological patients in the intensive care unit
2000, South African Medical Journal, N°90, 11, p. 1140-1144

Mots clés : adolescent; adulte/âge; adultère; avortement incomplet/complication; avortement provoqué, complication; complication; complication grossesse; contraction utérine/complication; décès hospitalier; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; femme; grossesse; issue grossesse; méthode d'avortement, effets secondaires; méthodologie; patient

Résumé : OBJECTIVES: To document mortality among critically ill obstetric and gynaecological patients requiring intensive care unit (ICU) admission and to investigate whether any poor prognostic features could allow for earlier and more aggressive intervention. STUDY DESIGN: A retrospective study of all obstetric and gynaecological patients admitted to the ICU of Johannesburg Hospital between 1985 and 1996. Sixty-one patients were analysed both as a group and as two subgroups--those with incomplete abortions and those with other pregnancy-related diagnoses. RESULTS: Derangements in platelet counts, serum creatinine levels and prothrombin international normalised ratio (INR) were present in all patients on the day of admission to hospital. In the group with incomplete abortions absolute levels of these parameters may be used to identify those patients with a worse outcome. The mortality rate was 38%. CONCLUSION: Early ICU admission and aggressive surgical intervention are strongly recommended in patients with septic incomplete abortions presenting with more than a single organ dysfunction. [Journal Article; In English; South Africa]

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Glynn, J. R.; Buve, A.; Carael, M.; Kahindo, M.; Macauley, I. B.; Musonda, R. M.; Jungmann, E.; Tembo, F.; Zekeng, L.

Decreased fertility among HIV-1-infected women attending antenatal clinics in three African cities
2000, Jaids. Journal of Acquired Immune Deficiency Syndromes, N°25, 4, p. 345-52

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; femme; infection VIH; intervalle naissance; maladie; méthodologie; planning familial; planning familial, acceptante; population; rapport de recherche; taux de fécondité; transition de la fécondité
Pays : Afrique; Afrique subsaharienne; Cameroun; Kenya; Zambie

Résumé : Population HIV prevalence estimates rely heavily on sentinel surveillance in antenatal clinics (ANCs), but because HIV reduces fertility, these estimates are biased. To aid interpretation of such data, the authors estimated HIV-associated fertility reduction among pregnant women in ANCs in Yaounde (Cameroon), Kisumu (Kenya), and Ndola (Zambia). Data collection followed existing HIV sentinel surveillance procedures as far as possible. HIV prevalence among the women was 5.5% in Yaounde, 30.6% in Kisumu, and 27.3% in Ndola. The birth interval was prolonged in HIV-positive multiparous women compared with HIV-negative multiparous women in all three sites: adjusted hazard ratios of pregnancy were 0.84 (95% CI: 0.62-1.1) in Yaounde, 0.82 (95% CI: 0.70-0.96) in Kisumu, and 0.74 (95% CI: 0.61-0.90) in Ndola, implying estimated reductions in the risk of pregnancy in HIV-positive women of between 16% and 26%. For primiparous women, the interval between sexual debut and birth was longer in HIV-positive women than in HIV-negative women in all sites, although the association was lost in Ndola after adjusting for age and other factors. Consistent results in different study sites help in the development of standard methods for improving ANC-based surveillance estimates of HIV prevalence. These may be easier to devise for multiparous women than for primiparous women. (author's)


Article de périodique

Benagiano, G.; Pera, A.

Decreasing the need for abortion: challenges and constraints
2000, International Journal of Gynecology Obstetrics, London, Elsevier, N°70, p. 35-48

Mots clés : avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); revue littérature; taux d'avortement / taux

Résumé : Voluntary abortion is the most controversial act in the entire field of medical practice, although today it is a practice that, under different conditions, has been legalized in more than 100 countries, mostly in the developed world. The UN has agreed that in no case should abortion be promoted as a method of family planning and, therefore, it should be utilized only when contraception has failed. Overall, 61% of humanity lives in countries where abortion is legal and widely available; 14% in countries where termination is allowed to protect a woman's health--physical, mental, or both; 21% in countries where it can be performed only to save the mother's life; and 4% in countries where abortion is not permitted at all. Restrictive legislation, per se, does not represent a valid deterrent to prevent abortion, while it may contribute to an increase in morbidity and mortality associated with pregnancy. In addition, because abortion is outlawed, nothing is done to actively reduce the reasons leading to it. Indeed, the countries with the lowest abortion rates are those where, on the one hand, pregnancy termination is legal and, on the other, sex education and contraceptive knowledge are widely spread. (author's)


Article de périodique

Solo, J.

Easing the pain: Pain management in the treatment of in complete abortion
2000, Reproductive Health Matters, N°8, 15, p.  45-51

Mots clés : aspiration manuelle; douleur/complication; soins post avortement
Pays : Kenya

Résumé : Although there have been significant improvements in post-abortion care programmes around the world, improvingpain managementhas remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generallybeen vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea thatpain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.


Reproduced with the permission of Reproductive Health Matters : http://www.rhmjournal.org.uk/

Rapport

Anonymous

Egypt: postabortion care. Expand access to postabortion care
2000

Mots clés : étude/études; Evaluation des services de santé; médecin/personnel de santé; méthodologie; Organisation et Administration; personnel de santé; planning familial; planning familial, acceptante; programme; Programme d'évaluation; programme planification familiale; programme post-abortum; programme post-abortum, coût; projet pilote; qualité des soins; santé; service d'avortement; service de santé; système de santé
Pays : Afrique; Egypte

Résumé : A 1997 pilot study sought to institutionalize improved postabortion medical care and counseling procedures in 10 hospitals in Egypt. Conducted by the Egyptian Fertility Care Society, a 5-day training course in manual vacuum aspiration (MVA), infection control, and family planning (FP) counseling was administered to five senior physicians from each hospital. The physicians then supervised 4 months of on-the-job training of doctors and nurses, and introduced a case management protocol. Researchers measured the resulting changes in knowledge and practice by administering surveys before and after the intervention. Overall, findings reveal that after the training, physicians had significant gains in knowledge about short-term complications, adverse health impacts, and the immediate return of fertility following postabortion treatment. There was also a shift from use of dilatation and curettage to use of MVA among physicians. Consequently, a shift from general anesthesia to local anesthesia was noted. Moreover, there was an increase in the proportion of PAC patients stating that the service they received at the hospital was excellent. Several policy implications are cited based on the results.


Article de périodique

Berer, M.

Eliminer les risques liés à l'avortement : le devoir d'une bonne politique de santé publique
2000, Bulletin of the World Health Organization, N°78, 5, p. 580-592

Mots clés : accès aux soins; information; législation; morbidité et mortalité maternelle; mortalité maternelle

Résumé : La mortalité liée aux avortements représente au moins 13%de la mortalité maternelle dans le monde. Des méthodes dangereuses, l'absence de formation des personnes qui pratiquent l'avortement et une législation restrictive vont généralement de pair avec des taux é levé s de morbidité et de mortalité. La prévention de la morbidité et de la mortalité dues aux avortements dans les pays ou` elles restent é levé es relève de la santé publique et fait partie des initiatives pour une maternité sans risque. Le pré sent article, qui s'appuie sur de nombreux documents publiés et non publiés, examine les changements a` apporter a` la politique générale et a` la prestation des services de santé pour éliminer les risques liés aux avortements. Pour être efficaces, les mesures de santé publique doivent tenir compte des raisons pour lesquelles les femmes avortent, du type de services requis et a` quel stade de la grossesse, de la catégorie voulue de dispensateurs de soins, et des aspects relatifs a` la formation, au coût et au conseil. Il y a trois impératifs pour éliminer les risques liés à l'avortement : des changements au niveau de la politique nationale ; la formation du personnel appelé a` pratiquer les avortements et la prestation des services au premier niveau approprié des services de santé ; l'utilisation de ces services par les femmes au lieu de ceux que peuvent fournir des praticiens non qualifié s. Il est indispensable également que le public soit informé de l'existence des services pratiquant les avortements, en particulier les adolescentes et les femmes célibataires, qui ont moins accès aux services de santé génésique en général.

Site web : http://whqlibdoc.who.int/recueil_articles/2000/RA_2000_3_117-128_fre.pdf

Thèse

Dikamba, M.

Etude multicentrique des déterminants et des complications des avortements provoqués à Kinshasa
2000, Kinshasa, University: Université-de-Kinshasa-Faculté-de-Médecine-Kinshasa-XI

Mots clés : avortement; complications postavortement; gynécologie

Rapport

Yumkella, F.; Githiori, F.

Expanding opportunities for postabortion care at the community level through private nurse-midwives in Kenya. Final report
2000, Technical Report 21, Chapel Hill, North Carolina, USA, USAID;PRIME project / Intrah, p. 74

Mots clés : étude/études; facteur économique; facteurs économiques; méthodologie; personnel de santé; projet pilote; rapport; reproduction; santé; service de santé; service de santé communautaire/offre/service de santé; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : This report documents the Primary Providers Training in Reproductive Health project postabortion care (PAC) pilot initiative in Kenya. It focuses on the design, processes of implementation, results and experiences in strengthening private nurse-midwives' capacity to provide high quality PAC services. It is noted that the pilot initiative had six components, including pre-intervention components and intervention components. The activities implemented were needs assessment, advocacy activities for policy support, strengthening the capacity of public health nurses to support and supervise private nurse-midwives, training of private nurse-midwives, systematic follow-ups for trained private nurse-midwives, and a seminar to disseminate results. Overall, the initiative demonstrated that trained nurse-midwives could successfully provide safe, quality PAC services using manual vacuum aspiration at the community level. Moreover, it highlighted several factors relevant to the continued expansion of PAC services through private nurse-midwives.

Site web : http://pdf.dec.org/pdf_docs/PNACJ874.pdf

Thèse

Mosoko, J. J.

Factors associated with induced abortion among women attending antenatal clinics in Yaounde, Cameroon
2000, p. 43

Mots clés : avortement; gynécologie
Pays : Cameroun

Congrès

Yaogo, M.

Fécondité, contraception et accouchement : quelques matériaux en zone linguistique Moore
46445
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan, 1, p. 67-74

Mots clés : allaitement; avortement; complication grossesse; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; femme; grossesse; menstruation; relation sexuelle
Pays : Burkina Faso

Rapport

Koster-Oyekan, W.

Fertility regulation among the Yoruba: an applied participatory research project in Lagos state. Report
2000, Lagos, Nigeria, Women's Health and Action Research Centre, p. 63

Mots clés : avortement; collecte; contraception; contraception d'urgence/ contraception postcoitale; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; déterminant fécondité; Dynamique démographique; enquête; Entretien; étude/études; facteur démographique; fécondité; fécondité naturelle; focus group/enquête; méthodologie; planning familial; planning familial, acceptante; population; reproduction; stérilité; traitement/soin
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Fertility regulation means all methods and measures intended to influence the natural fertility of a woman. Such methods and measures include infertility treatments, contraception and induced abortion. This paper presents the procedures, experiences, major findings, and recommendations of an applied research project in fertility regulation practices among the Yoruba of Lagos State, Nigeria, from 1997-99. Outlined into eight chapters, chapter 1 is the introduction and gives the rationale for the study and the study objectives. Chapter 2 explains the study methodology and focuses on some of the major activities. Chapter 3 introduces the Yoruba traditional midwives, whose services are highly used in both rural and urban areas. Chapter 4 presents the study findings on the perceptions and treatments of infertility. Chapter 5 deals with prevention of pregnancy and reasons why women are not using any prevention. Chapter 6 tackles the problems related to induced abortion. The discussion and findings on youths are presented in chapter 7. Finally, chapter 8 displays the recommendations for addressing the identified problems. It is hoped that this study will provide more insight into the problems related to fertility regulation and increase the motivation to take action and tackle the problems in an objective, practical way, without prejudices.


Rapport

Anonymous

Guinea: adolescent sexuality in the administrative regions of Faranah, Kankan and N'Zerekore. Results of a narrative study
Guinee: la sexualite des adolescents dans les regions administratives de Faranah, Kankan et N'Zerekore. Resultats d'une recherche narrative

2000

Mots clés : activité sexuelle / sexualité; adolescent; âge; attitude; avortement; coït/sexualité; collecte; communication; comportement reproductif; comportement sexuel; comportements; contraception d'urgence/ contraception postcoitale; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; focus group/enquête; grossesse adolescente; grossesse adolescente/grossesse; jeune/adolescent; media; média; méthodologie; planning familial; planning familial, acceptante; population; psychologie/facteur psychologique; rapport de recherche; sexualité; sexualité prémaritale
Pays : Afrique; Afrique subsaharienne; Guinée

Résumé : A key component of PRISM, communication for behavioral change (CBC) encourages populations to adopt and maintain healthy behaviors. Therefore in its action plan, the organization conceived and launched narrative research together with discussion groups exploring the sexual behaviors of adolescents aged 14-19 years in Guinea's Faranah, Kankan, and N'Zérékoré administrative districts. The research's main goal was to identify, through drama, the most prevalent behavioral and sexual relational models among young people. Study data will help in message development and campaign implementation targeting youth. 8 groups of adolescents participated in each region, with each group comprised of 10-12 subjects. There were 4 urban groups and 4 rural groups per region. Study results are presented upon sexual negotiation, first sexual relations, managing pregnancy and abortions, adolescents' sexual behavior following first abortion, STD-related behavior, deciding to carry a second pregnancy to term, young mothers' advice, attitudes on health services and providers, information sources and young people's needs for reproductive health materials, young people's needs, and factors influencing young people's sexuality. Recommendations are offered.


Article de périodique

Merzouki, A.; Ed-derfoufi, F.; Molero Mesa, J.

Hemp (Cannabis sativa L.) and abortion
2000, Journal of Ethnopharmacology, N°73, 3, p. 501-503

Mots clés : médicament

Résumé : no abstract


Article de périodique

Otsea, K.

Improving reproductive health for refugee women through post-abortion care
2000, Sexual Health Exchange, 2, p. 7-9

Mots clés : avortement; contraception d'urgence/ contraception postcoitale; étude/études; facteur démographique; méthodologie; migration; planning familial; planning familial, acceptante; population; programme planification familiale; programme post-abortum; programme post-abortum, coût; projet pilote; réfugiés; santé; santé de la reproduction; service de santé; service de santé communautaire/offre/service de santé; service de santé maternelle; Service de santé maternelle et infantile; soin de santé primaire; système de santé
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : Globally, the WHO estimates that at least 80,000 maternal deaths each year are caused by unsafe abortions as those provided by unskilled persons or under unhygienic conditions, or self-induced. The UN Population Fund estimated that 25-50% of this rate is in refugee settings and thousands more women experience complications due to unsafe abortions and suffer crippling injuries, life-long chronic pain or infertility. It is noted that most of these deaths and complications are preventable if women have access to contraceptives and post-abortion care (PAC). In view of this, the Inter-Agency Working Group was created to strengthen reproductive health for refugees. Its recommendations have been implemented by the Kenya Refugee Project, carried out in two refugee camps. Overall, the Kenya Project demonstrated support for PAC services among clinicians, administrators and clients, and the feasibility of providing high-quality, low-technology, decentralized PAC services for women in refugee camps. Evaluation results also showed the effectiveness of offering these services at the health delivery sites where women normally seek care, resulting in the use of fewer resources and faster life-saving services.


Article de périodique

Yassin, K. M.

Incidence and socioeconomic determinants of abortion in rural Upper Egypt
2000, Public Health, N°114, 4, p. 269-72

Mots clés : aspects socio-économiques; avortement provoqué, déterminant; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; déterminant; Dynamique démographique; facteur démographique; facteurs économiques; facteurs socio-économiques; femme; maladie; mesure; méthodologie; morbidité; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; population rurale; prévalence; rapport de recherche; rural/résidence
Pays : Afrique; Egypte

Résumé : Because of a growing cultural and religious sensitivity and controversy over reproductive health issues, particularly abortion, this area remains relatively unexplored in Egypt. This study was conducted using a participatory approach to determine the morbidity and determinants of abortion in rural Upper Egypt. In all, 1025 women from 6 villages in Upper Egypt were included in the study. Information regarding the incidence of abortion, patterns of health care utilization and risk factors was obtained using a structured interview format. The local dialect was used in formulating questions and they were revised and amended by a panel of local leaders, interviewers and representatives of the study population. Interviewers were local educated (secondary or university level) female volunteers. Information about exposure to 17 risk factors was also collected and statistical analysis was done by estimating the odds ratio and applying a test of statistical significance. Then, a multivariate logistic regression model was applied to control for possible interactions and confounding effects. The results were that 40.6% (n = 416) had aborted at least once; of them, 24.6% (n = 252) had aborted more than once and were designated as recurrent aborters. The lifetime prevalence of recurrent abortion was estimated to be 25% and nearly 21% of pregnancies were aborted. The incidence of abortion was estimated to be 265 per 1000 live birth. Only 21.9% (n = 91) of women received medical care for the last abortion. The vast majority of women (92%, n = 299), who did not seek medical help received help from traditional and domestic sources. These sources are midwife (59.9%, n = 179), relative or neighbor (29.8%, n = 89), and traditional practitioner (10.4%, n = 31). The multivariate analysis revealed that the incidence of abortion is significantly associated with gravidity, consanguinity, and mother occupation, while recurrent abortion is associated with gravidity, consanguinity and woman's age at marriage. In conclusion, the morbidity of abortion is a serious public health problem in Egypt. Because the incidence rate is very high and because safe abortion is limited in Egypt, maternal mortality due to abortion is expected to be underestimated. Promotion of family planning is expected to have a significant impact on the incidence of abortion in Upper Egypt. (author's)


Congrès

Ouattara, F.

Interactions entre populations et personnels de santé lors des consultations prénatales dans une maternité rurale (Burkina Faso)
46451
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan, Cote d'Ivoire, 1, p. 111-125

Mots clés : avortement; complication grossesse; enquête; enquête CAP; enquête fécondité; enquête/ enquête double aveugle; enquête/ enquête en communauté; enquête/enquête rétrospective; grossesse; méthodologie; personnel de santé
Pays : Burkina Faso

Article de périodique

Kiragu, J.

Kenyan adolescents at risk
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 11-2

Mots clés : adolescent; âge; Avortement illégal; avortement incomplet/complication; avortement provoqué, complication; complication; comportement à risque; comportement reproductif; comportements; contraception d'urgence/ contraception postcoitale; contraction utérine/complication; déterminant fécondité; discrimination sociale; Dynamique démographique; facteur démographique; fécondité; grossesse adolescente; grossesse adolescente/grossesse; grossesse non prévue/grossesse non désirée; jeune/adolescent; méthode d'avortement, effets secondaires; planning familial; planning familial, acceptante; politique/programme; population; problème social
Pays : Afrique; Afrique subsaharienne; Kenya

Résumé : In Kenya, population policy is unclear regarding adolescent rights to sexual and reproductive health education and services. Consequently, many Kenyan adolescents who are sexually active, with little information or protection against unwanted pregnancies and sexually transmitted diseases, resort to unsafe abortion and suffer disproportionately from abortion-related mortality. It is also noted that the laws restricting abortion discriminate most against the young and the poor because they have the least access to safe abortion services. Hospital records of women seeking unsafe abortions show that abortion is mainly sought by women who are young, unmarried, either in school or unemployed, and not using any method of contraception. In view of this, it is suggested that access to safe abortion within the existing law regardless of age or social class should be enhanced to reduce the number of abortion-related deaths and the number of cases of incomplete abortion.


Chapitre d'ouvrage

Akhmisse, M.

L'accoucheuse traditionnelle
The traditional birth attendant
2000 - in Akhmisse, Mustapha, Médecine, magie et sorcellerie au Maroc ou l'art traditionnel de guérir., Casablanca, Morocco, Dar Kortoba, p. 89-98

Mots clés : avortement; complication grossesse; contraception d'urgence/ contraception postcoitale; culture; déterminant culturel; facteur culturel; facteur démographique; femme; grossesse; issue grossesse; personnel de santé; planning familial; planning familial, acceptante; population; reproduction; santé; système de santé
Pays : Afrique; Maroc

Résumé : In Morocco, the traditional birth attendant is called the Kabla. This is a woman, often elderly, who has performed several deliveries over several years. A pregnant woman calls on the Kabla when the first labor pains appear. The latter comes with her therapeutic arsenal which she immediately gives to the parturient mother to drink in order to relax the muscles while she performs abdominal massages. There are regions in Morocco which have the pregnant woman adopt the supine position at the time of delivery, while others engage in the half-sitting or standing position. After delivery, the placenta is expelled either by abdominal massage or by traction on the umbilical cord, then buried. The umbilical cord is generally cut with a knife and tied with woolen thread. The Kabla then gives the woman chicken soup to drink with poppy which causes her to sleep. The baby is cleaned and smeared with oil, and its eyes are smeared with kohl in order to prevent purulent ophthalmia. Then, in the crib with him are placed a mirror, a knife, and a talisman in order to protect him from malevolent genies. In addition to deliveries, the midwife also performs abortions either through ingestion of drugs such as kif, tobacco, and oleander which are at times quite dangerous or even deadly, or through their introduction vaginally as suppositories. She also knows many ways to combat sterility, hence she suggests consuming whey to which egg yolk and fenugreek have been added, or a mixture of approximately 13 plants called Ras El Hanout. The traditional physician is also interested in contraception, and unfortunately ineffective recipes are still used in the Moroccan setting such as introduction into the vagina of a mixture of honey and a plant called Alasfa ten minutes before sexual relations, or the act of dipping 5 figs in menstrual blood without looking at them and hiding them for as many years as the woman desires sterility.
Au Maroc, l'accoucheuse traditionnelle est appelée la "Kabla", c'est une femme souvent âgée qui a pratiqué plusieurs accouchements pendant plusieurs années. La femme enceinte fait appel à la Kabla aux premières douleurs de l'accouchement, cette dernière se présente avec son arsenal thérapeutique qu'elle fait tout de suite boire à la parturiente pour décontracter les muscles, elle lui pratique des massages abdominaux. On trouve des régions marocaines qui adoptent la position couchée au moment de l'accouchement, alors que d'autres pratiquent la position demi assise ou la position débout. Après l'accouchement, le placenta est expulsé soit par massages abdominaux soit par des tractions sur le cordon puis enterré. Le cordon est coupé généralement au couteau et lié par un fil de laine. La kabla fait alors boire à la femme un bouillon de poulet avec du pavot, pour la faire dormir. Le bébé est essuyé et enduit d'huile, et ses yeux sont enduits du "Koheul" en vue d'éviter les ophtalmies purulentes. On lui met dans le berceau un miroir, un couteau et un talisman afin de le protéger des génies malfaisants. La sage-femme pratique, en plus des accouchements, des avortements soit par l'ingestion de drogues comme le kif, le tabac et le laurier rose, qui sont parfois très dangereux voire mortels, soit par leur introduction sous forme d'ovules dans la voie vaginale. Elle connaît également plusieurs moyens de lutter contre la stérilité, c'est ainsi qu'elle conseille la consommation du petit lait additionné de jaune d'oeuf et de fenugrec, ou un mélange d'environ 13 plantes appelé "Ras El Hanout". La médecine traditionnelle s'intéresse aussi à la contraception, et les recettes inefficaces sont malheureusement encore en pratique dans le milieu marocain, telles que l'introduction dans le vagin d'un mélange de miel et d'une plante appelée "Alasfa" dix minutes avant le rapport sexuel, ou le fait de tremper dans le sang des règles 5 figues sans les regarder et les cacher autant d'années que la femme désire être stérile.


Congrès

Koné, M.

L'avortement : une pratique contraceptive "sure" en Côte d'Ivoire ?
46449
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan (CI) 1999/11/4-7, 1, p. p. 95-104

Mots clés : avortement; Cause de décès; stérilité
Pays : Côte d'Ivoire

Article de périodique

Guillaume, A.

L'avortement en Afrique: mode de controle des naissances et probleme de sante publique
2000, Chronique Du Ceped, 37, p. 1-4

Mots clés : avortement; avortement provoqué, loi; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); maladie; morbidité; morbidité et mortalité maternelle; mortalité; mortalité maternelle; planning familial; planning familial, acceptante; population; santé; santé publique
Pays : Afrique

Résumé : L'avortement provoqué est en Afrique une cause importante de morbidité et de mortalité maternelles. Pour le continent, le taux de mortalité maternelle est estimé à 680 décès pour 100.000 avortements. Les risques liés aux avortements provoqués en Afrique sont dus au caractère illégal de l'acte dans beaucoup de pays, aux problèmes d'accès aux services habilités, et au manque de prise en charge sanitaire et sociale des femmes après un avortement. Dans les trois centres hospitaliers universitaires d'Abidjan entre 1989 et 1992, 70% des décès maternels étaient consécutifs à des avortements provoqués survenus à domicile ou dans de mauvaises conditions. En dépit d'un cadre législatif et réglementaire souvent restrictif et malgré des conditions d'intervention médiocre au plan sanitaire, le recours à l'avortement semble se développer, surtout chez les jeunes et davantage parmi les jeunes femmes scolarisées ou souhaitant poursuivre leurs études. Les ratios d'avortement sont toujours plus élevés en zone urbaine qu'en milieu rural. Une étude a été conduite en Côte d'Ivoire auprès des consultantes de quatre centres de santé d'Abidjan afin de mieux cerner les motifs d'avortement et les méthodes employées. L'auteur explique l'importance du phénomène de l'avortement en Côte d'Ivoire, les méthodes abortives utilisées, les principaux motifs d'avortement, et la contraception et l'avortement. Le recours à l'avortement provoqué en Afrique est souvent une réponse aux besoins non satisfaits de planification familiale. Un meilleur accès à des programmes orientés surtout vers les adolescentes et les jeunes femmes réduirait l'incidence de l'avortement provoqué.


Reproduced with the permission of Ceped : http://ceped.cirad.fr

Article de périodique

Berer, M.

Making abortions safe : a matter of good public health policy and practise
2000, Bulletin of World Health Organisation, Geneva, World Health Organisation, N°78 (5), Special theme - reproductive health,, p. 580-592

Mots clés : avortement; avortement provoqué, mortalité; contraception d'urgence/ contraception postcoitale; Dynamique démographique; facteur démographique; maladie; morbidité et mortalité maternelle; mortalité; mortalité maternelle; Organisation et Administration; planning familial; planning familial, acceptante; politique de développement; population; revue littérature; santé; santé publique; Sécurité

Résumé : Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost, and counseling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. (author's)


Article de périodique

Sule-Odu, A. O.

Maternal deaths in Sagamu, Nigeria
2000, International Journal of Gynecology and Obstetrics, N°69, 1, p. 47-9

Mots clés : avortement provoqué, mortalité; biologie; Dynamique démographique; facteur démographique; facteurs de risque; morbidité et mortalité maternelle; mortalité; mortalité maternelle; population; santé; santé maternelle
Pays : Afrique; Afrique subsaharienne; Nigeria

Résumé : Worldwide maternal mortality review shows that over 500,000 women die yearly from complications of pregnancy, childbirth, puerperium, and clandestine abortion. Most of these deaths occur in developing countries, especially sub-Saharan African countries. In response, the Safe Motherhood initiative was launched to take care of factors responsible for the high maternal deaths so as to reduce it substantially, if not eliminate completely. 10 years later, the maternal mortality ratio continues to rise as evidenced by a survey conducted by the Ogun State University Teaching Hospital, Sagamu, in southwestern Nigeria. The 10-year survey (1988-97) showed that there were 103 maternal deaths recorded out of a total of 5320 deliveries. 89 (86.4%) of the deaths were due to obstetric causes, while 11 (10.7%) were attributable to septic-induced abortion. Other major causes of deaths were ruptured uteri (28.2%), eclampsia (12.6%), and puerperal sepsis (10.7%). Reduction of maternal deaths can easily be achieved if basic, simple, and necessary facilities like a good blood banking system, easy access to health care services, and a good communication system are ensured. Women should also be empowered educationally, economically, socially, and politically.


Article de périodique

Ghorab, M. N.

Misoprostol; intracervical versus intravaginal routes: a comparative study in induction of midtrimester abortion
2000, Egyptian Society of Obstetrics and Gynecology, N°26, 10-12, p. 959-65

Mots clés : avortement; biologie; contraception d'urgence/ contraception postcoitale; médicament; Misoprostol/méthode/cytotec; planning familial; planning familial, acceptante; prostaglandins/hormones; rapport de recherche; santé; santé publique; Sécurité
Pays : Afrique; Egypte

Résumé : The objective was to compare the efficacy and safety of intracervical misoprostol compared with intravaginal misoprostol in induction of mid-trimester abortion. The study was carried out at the Department of Obstetrics and Gynecology at El-Galaa Teaching Hospital. The sample included 54 pregnant women between 16 and 24 weeks of gestation with indicated therapeutic abortion. They were randomly assigned to receive either intravaginal (group I, n = 30) or intracervical (group II, n = 24) misoprostol. 200 mcg misoprostol was administered intravaginally in group II and 50 mcg was administered intracervically in group II. The dose was repeated every 6 hours according to the response, and results were compared. There was a significant difference between group I and II as regards the rate of successful abortion within 24 hours (100% in group II vs. 80% in group I). The median induction-to- delivery interval was significantly shorter in group II (9.6 hours) vs. group I (13.7 hours), with P < 0.05. The median dose of misoprostol was 400 mcg (range, 200-600 mcg) in group I, compared to 75 mcg in group II (range, 50-150 mcg). Also, this study showed a significant higher incidence of side effects in group I (35%) vs. group II (18%), with P < 0.05. The author concludes that intracervical administration of misoprostol is a safe and more effective alternative for termination of mid- trimester pregnancy. (author's, modified)


Article de périodique

Anonymous

New Women of the World publication features Francophone Africa
2000, Reproductive Freedom News, N°9, 6, p. 2

Mots clés : aspects socio-économiques; avortement; avortement provoqué, loi; contraception d'urgence/ contraception postcoitale; droit de l'homme; facteur politique; facteurs économiques; facteurs socio-économiques; femme; groupes de femme; loi; loi et programme; loi sur l'avortement; loi sur l'avortement (changement); loi sur l'avortement (histoire); planning familial; planning familial, acceptante; politique/programme; rapport; santé; santé de la reproduction, femme; Statut de la femme
Pays : Afrique

Résumé : This article presents the publication Women of the World--Francophone Africa: Laws and Policies Affecting their Reproductive Lives, by Codou Bop, a Senegalese women's rights activist. This book contains a comprehensive review of the reproductive health and rights of women in Benin, Burkina Faso, Cameroon, Cote d'Ivoire, Mali, Senegal, and Chad. It provides practical and legal guidelines for rights advocates and identifies problem issues in the region. Each country was examined in terms of its political framework, sources for governing laws, customary laws and health, population and family planning policies. Across the seven nations, similar problems in restrictive abortion laws, high maternal mortality rates, high HIV/AIDS prevalence rates, low contraceptive use and the continuation of harmful traditional practices were noted. Likewise, legal status of women in the context of their right to be free from discrimination and issues affecting adolescents were examined. During the launching of the book, representatives from the featured countries were able to discuss strategies for revising laws and adopting better policies to protect the rights and welfare of women.


Article de périodique

Ikpeze, O. C.

Pattern of morbidity and mortality following illegal termination of pregnancy at Nnewi, Nigeria
2000, Journal of Obstetrics and Gynaecology (Abingdon)., N°20, 1, p. 55-57

Mots clés : avortement; avortement incomplet/complication; avortement provoqué, complication; complication; contraction utérine/complication; méthode d'avortement, effets secondaires
Pays : Nigeria

Résumé : Seventeen women were treated for complications of illegal termination of pregnancy over a 2-year period, January 1996 to December 1997. Important characteristics of the women include a mean age of 21 years (mode 18 years) and being unmarried (100%, n=17), nulliparous (94%, n=16) and unemployed (76%, n=13). There was a tendency towards late termination as 50% of women had a termination after 13 weeks. Serious complications were cervical laceration, pelvic abscess/peritonitis, ruptured uterus, transection of the sigmoid colon and ileal/jejunal lacerations. The mortality rate was 6% (n=1). Most of the terminations were performed through instrumental cervical dilatation without prior medical or hydrophilic treatment. This study shows that illegal abortions are still commonly performed in Nigeria with an unacceptably high incidence of morbidity and mortality. Modemisation of abortion laws, wider contraceptive usage, adoption of modern methods of termination of pregnancy (RU 486 and prostaglandin E1 analogues) and prophylactic antibiotics are recommended in order to reduce the problems of unsafe abortion in Nigeria and other developing countries.


Article de périodique

Lema, V. M.; Mpanga, V.

Post-abortion contraceptive acceptability in Blantyre, Malawi
2000, East African Medical Journal, N°77, 9, p. 488-93

Mots clés : clinique/service de santé; contraception; contraception, choix méthode; contraception, utilisation par la femme; contraception, utilisation par l'homme; contraception/méthode contraceptive; counseling; femme; méthodologie; Organisation et Administration; planning familial; planning familial, acceptante; programme; programme d'activités; rapport de recherche; reproduction
Pays : Afrique; Afrique subsaharienne; Malawi

Résumé : This cross-sectional pilot study aimed to assess the acceptability of contraceptive counseling and services by 464 post-abortion patients being treated at the gynecological ward of the Queen Elizabeth Central Hospital in Blantyre, Malawi. The socio-demographic and reproductive profiles of the respondents were obtained, as well as information on previous contraceptive use, whether index pregnancy was wanted or not, and whether abortion was induced or not. Results showed that mean age and parity of the respondents were 24 (SD 6.1) and 1.5 (SD 1.9), respectively. Index pregnancy was reported as unintended by 45.3%, and 17.2% said they had an unsafe abortion; 373 (80.4%) accepted contraception; and the main contraceptive methods used were combined oral pills, injectables, and condoms. There was no relationship between acceptance and one's age, marital status, or parity. Overall, this study indicated that post-abortion contraception is acceptable with proper planning and will provide additional contraceptive service opportunity. It is recommended that post-abortion contraception be integrated into emergency post-abortion care..

Site web : http://www.ajol.info/journal_index.php?jid=53

Article de périodique

Salihu, H. M.; Kamdom-Moyo, J.

Primary ovarian pregnancy: a rare and often missed diagnosis
2000, Tropical Doctor, N°30, 1, p. 35-6

Mots clés : adolescent; complication grossesse; ethnology; grossesse; grossesse adolescente; grossesse adolescente/grossesse; grossesse extra-utérine
Pays : Cameroun
Site web : http://www.rsmpress.co.uk/td_gfa.htm

Article de périodique

de Jonge, E. T. M.; Jewkes, R. K.; Levin, J.; Rees, H.

Randomised controlled trial of the efficacy of misoprostol used as a cervical ripening agent prior to termination of pregnancy in the first trimester
2000, South African Medical Journal, N°90, 3, p. 256-262

Mots clés : avortement; Misoprostol/méthode/cytotec
Pays : Afrique du Sud

Résumé : BACKGROUND: Misoprostol is being used increasingly in clinical practice for cervical ripening in first-trimester abortions, but because of lack of good evidence of its effectiveness, administration consensus has not been reached on dosage, route of administration, time of administration pre-operatively and gestational age group. In this study we tested the hypothesis that self-administration of 600 micrograms vaginal misoprostol is feasible and when used 2-4 hours pre-operatively results in sufficient cervical dilatation to make suction curettage easier. METHODS: A double-blind, randomised, placebo-controlled trial was undertaken. Two hundred and seventy-eight women scheduled for termination of pregnancy of up to 12 weeks' duration by manual vacuum aspiration were assigned to receive either 600 micrograms misoprostol pre-operatively, or placebo. The achievement of 'satisfactory' (> or = 7 mm) baseline cervical dilatation after 2-4 hours was evaluated as the primary outcome. Secondary outcome measurements included ease and duration of the procedure. Side-effects such as pre-operative bleeding, gastro-intestinal complaints and pain as well as adverse events were noted in all cases. FINDINGS: Self-administration of vaginal misoprostol was successful in all women and 273 women were evaluated for main end-points. A significantly larger proportion of patients in the treatment group reached cervical dilatation of > or = 7 mm (67.3% v. 30.9%, P Africa]

Site web : http://www.samedical.org/journals.asp

Reproduce with the kind permission of the SAMJ

Article de périodique

Mukabideli, T.

Refugee health: the plight of Rwandan women
2000, Initiatives in Reproductive Health Policy, N°3, 2, p. 10-1

Mots clés : abus sexuel; agression sexuelle; avortement; avortement pour viol; comportement reproductif; contraception d'urgence/ contraception postcoitale; crime; déterminant fécondité; Dynamique démographique; facteur démographique; fécondité; femme; grossesse non prévue/grossesse non désirée; migration; planning familial; planning familial, acceptante; population; problème social; réfugiés; santé; santé de la reproduction; viol
Pays : Afrique; Afrique subsaharienne; République démocratique du Congo; Rwanda

Résumé : In Rwanda, wars have devastated the country, causing many deaths among the population and leading to widespread displaced persons and millions of refugees. In the refugee camps, sexual exploitation and rape were particularly widespread. These acts were assault on human integrity and freedom, and undermined the social status of many Rwandan women. Moreover, serious consequences ensued for women's health and fertility, including sexually transmitted diseases, unwanted pregnancies, and unsafe and sometimes fatal abortions. This situation was also attributed to a lack of efficient preventive measures, including comprehensive education programs. Moreover, girls and women who had been raped had difficulties speaking about the aggression they had suffered. Their silence can be explained by shame, fear of ridicule, respect for tradition, and the absence of structured and efficient help. In view of this, it is suggested that the protection of women, especially adolescents, unaccompanied girls, and single women must be improved in situations such as the crisis in Rwanda.


Congrès

Blé, M. Y.

Représentations populaires relatives à la grossesse et à l'avortement provoqué en milieu rural ivoirien : le cas des Bété de Guiberoua
46439
2000, Atelier : Grossesse, Contraception, Avortement, Accouchement en Afrique de l'Ouest, Abidjan (CI) 1999/11/4-7, 1, p. p. 27-34

Mots clés : avortement; complication grossesse; grossesse; morbidité et mortalité maternelle; mortalité maternelle; régulation des naissan