Saturday, 14 June 2014

Research reveals more than half of young women who have abortions were using contraception when they fell pregnant

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Research reveals more than half of young women who have abortions were using contraception when they fell pregnant

Reproductive health charity Marie Stopes UK has launched the findings of the first research in the UK into the contraceptive use of women aged 16-24 having one or more abortions. It found that more than half (57%) of women were using contraception when they became pregnant, with short-term methods like the pill or condoms the most commonly used instead of the more reliable long acting methods.

Researchers analysed five years of the charity's patient data, surveying 430 women - 121 of whom had previously had an abortion - to gain an insight into how post-abortion contraception services can be strengthened and reduce the numbers of women seeking subsequent abortions. Although the total number of abortions in England and Wales has gradually declined in recent years, the number of women seeking abortion who had one or more previous abortions is increasing[i].

Key findings include:

The majority were using short-term methods, such as the pill (54%) or condoms (40%) Only 12% of women had used emergency contraception 28% of women had had one or more previous abortions, and the older a women is, the more likely she is to have more than one abortion Uptake of contraception at four weeks post-abortion was extremely high at 86%, but 67% used their chosen method for less than a year. Reasons for stopping included menstrual irregularities for long-acting reversible contraception (LARCs) and not renewing supply in time for pills and injections 63% of all young women received a post-abortion LARC from Marie Stopes (compared to 30% in England as a whole). Women are more likely to choose a LARC method if they've had a previous abortion, or had a surgical rather than a medical abortion.

Genevieve Edwards, Director of Policy at Marie Stopes UK said:
"Women have three fertile decades to manage, but too many women are being let down by a lack of on-going support in choosing and using the most effective method of contraception.

"If we tackled the lack of sex and relationships education in schools, invested in contraceptive training for health professionals and bridged the gap between abortion, contraception and sexual health services, we'd see the rates of unwanted pregnancies plummet."

Not all methods provide the same protection. With typical use, around 9 in 100 women will become pregnant each year on the pill, while condoms have a failure rate of 18%, compared to less than 1% for long-acting methods like intrauterine contraceptives and implants[ii].

Genevieve added: "We have got to get better at talking about contraception and abortion. One in three women will have an abortion and one in four of them will go on to have another. Our research shows there is no particular demographic group who are more likely to have abortions - it can happen to any of us. But for the majority of women, it was more often the short-term methods that failed them.

"Getting this right is also good for the public purse. Fitting a coil costs about £40 and lasts ten years - that's less than 8p a week and it repays the NHS many times over in abortion or maternity costs[iii]."

The research also found that while uptake of contraception post-abortion was very high[iv], what suits women at one time, may not always be the best option, making an ongoing conversation so important.

Genevieve added: "We are particularly concerned about low awareness of emergency contraception. Family planning doesn't start and stop with condoms or the pill and much more needs to be done to support women on choosing and using the contraception that suits their lifestyle and stage of life."

[i] The Department of Health statistics show that in 2012, 37% of women of all ages undergoing abortions had one or more previous abortions. It continues an increasing trend of 31% in 2001, 32% in 2005 and 34% in 2010.

[ii] J Trussell, Contraceptive Failure in the United States: Contraception 83 (2011) 397-404

[iii] Based on Marie Stopes costings

[iv] 86% of women started to use contraception following their previous abortion - the majority short-term methods but they did not stay on this method for very long, with 21% for three months and 66.7% for less than one year.

Marie Stopes International UK

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Friday, 13 June 2014

Canada lags in access to "gold standard" medical abortions

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Canada lags in access to "gold standard" medical abortions

Canada lags in providing access to the internationally recognized gold standard for medical abortion - abortion induced with drugs rather than through surgical means, states a commentary in CMAJ (Canadian Medical Association Journal).

Many countries use mifepristone, combined with misoprostol, which provides a safe, effective nonsurgical method for early abortion. Canada, however, has not approved the drug and instead uses a drug regimen not recommended by the World Health Organization. In 2009, The Society of Obstetricians and Gynaecologists of Canada asked Health Canada to make mifepristone available to women in Canada.

The authors suggest that the small size of the Canadian market may be a deterrent for pharmaceutical companies to submit the drug for approval. As well, Health Canada may be biased against reproductive health drugs because the time lag to approve contraceptives is longer than for other drugs.

"It is time that Canadian women had the ability to choose the best regimen for medical abortion," writes Dr. Sheila Dunn, Women's College Hospital, with Rebecca Cook, Faculty of Law, University of Toronto, Toronto, Ontario, Canada. "Availability of mifepristone with the attendant probability of reduced demand and therefore shortened wait lists for surgical abortions, could improve the capacity of the health care system to provide abortions earlier, when they are safest."

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8 Jan. 2014.

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Wednesday, 11 June 2014

Intimate partner violence and termination of pregnancy linked

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Intimate partner violence and termination of pregnancy linked

Intimate partner violence in women (sometimes referred to as domestic violence) is linked to termination of pregnancy, according to a study by UK researchers published in this week's PLOS Medicine. The study, led by Susan Bewley from Kings College London, also found that intimate partner violence was linked to a women's partner not knowing about the termination of pregnancy.

The authors reached these conclusions by reviewing 74 published studies that provided information about experiences of intimate partner violence (which could be physical, sexual, or emotional/ psychological) among women who had had a termination. From the information in these studies, the authors found that worldwide, intimate partner violence rates among women undergoing termination of pregnancy ranged from 2.5% to 30% in the preceding year and from 14% to 40% over their lifetime. When combining relevant information from a selection of appropriate studies, the authors found that in women seeking a termination of pregnancy, the lifetime rate of intimate partner violence was 25%. Furthermore, the authors found some evidence that intimate partner violence was associated with single and repeat termination of pregnancy.

The authors also found that women undergoing terminations of pregnancy welcomed the opportunity to disclose their experiences of intimate partner violence and to be offered help, suggesting that termination services may represent an appropriate setting in which to test interventions designed to reduce intimate partner violence.

Among factors that may limit the conclusiveness of these finding are variability among the included studies, the likelihood of under-reporting of both intimate partner violence and termination of pregnancy in the included studies, and the lack of validation of reports of violence through, for example, police reports.

The authors conclude: "Intimate partner violence is associated with pregnancy termination. Novel public health approaches are required to address violence against women and repeat termination. Termination services provide an opportune health-based setting in which to design and test interventions at the individual level."

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7 Jun. 2014.

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Tuesday, 10 June 2014

New DNA test offers miscarriage clues

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New DNA test offers miscarriage clues

New research shows an alternative DNA test offers clinically relevant genetic information to identify why a miscarriage may have occurred years earlier. Researchers were able to identify chromosomal variants and abnormalities in nearly 50 percent of the samples. This first-of-its-kind study was conducted by researchers from Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University. The results were published in the March issue of Reproductive Biology and Endocrinology.

The technique used in this study, called rescue karyotyping, allows physicians to obtain important genetic information from tissue that had not been tested at the time of the miscarriage. As part of standard hospital protocol, tissue from miscarriages is embedded in paraffin for archival use and the karyotyping test is performed on DNA extracted from this tissue.

In this retrospective study of 20 samples from 17 women, genetic testing was successfully performed on 16 samples that had been archived for as long as four years. Of those samples, eight showed chromosomal variants and abnormalities. This is an important alternative when conventional karyotyping is not available or cannot be used for a specific sample.

"Given the ease of obtaining results, even if a delay in testing occurs, this new test may provide a useful technique to gain a better understanding as to why miscarriage occurs in some women," said Zev Williams, M.D., Ph.D., director, Program for Early and Recurrent Pregnancy Loss (PEARL), Montefiore and Einstein, assistant professor of obstetrics & gynecology and women's health and of genetics at Einstein, and corresponding author of the study. "I have seen women in tears because testing was not done at the time of the miscarriage and they feared they would never learn why it happened. Now we are able to go back and often get the answers we need."

One in five pregnancies ends in miscarriage, with the vast majority occurring in the first trimester. Recurrent miscarriage, which is defined as two or more miscarriages, occurs in up to 5 percent of couples attempting to conceive. Led by Dr. Williams, PEARL is comprised of a team of expert physicians, scientists, genetic counselors, nurses, technicians and staff members who work together to help these women maintain their pregnancies.

"Montefiore and Einstein have worked together to develop an innovative model based on research, which allows us to create novel diagnostic and treatment options and, in parallel, to quickly bring new advances to the clinic," said Dr. Williams. "This represents a new and emerging model in medicine - where the lab and clinic are brought closer in order to speed the pace of discovery and treatment."

"Most miscarriages are caused by an abnormal number of chromosomes in the embryo, accounting for up to 75 percent of first trimester losses," continued Dr. Williams. "This new test can help guide future treatment options but, more importantly, can also help alleviate some of the guilt and self-blame often associated with unexplained miscarriage and can close a door on a painful chapter in a woman's and couple's life."

Dr. Williams is a board certified obstetrician gynecologist with specialty training in reproductive endocrinology and infertility. He received his M.D. and Ph.D. degrees from the Mount Sinai School of Medicine and trained in Obstetrics and Gynecology at Harvard Medical School's Brigham and Women's Hospital and the Massachusetts General Hospital. Dr. Williams completed a fellowship in Reproductive Endocrinology and Infertility at Weill-Cornell Medical Center.

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7 Jun. 2014.

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Monday, 9 June 2014

Risk of miscarriages not increased by NSAIDs

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Risk of miscarriages not increased by NSAIDs

Women who take nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy are not at increased risk of miscarriages, confirms a new study published in CMAJ (Canadian Medical Association Journal).

NSAIDs, which include ibuprofen, naproxen, diclofenac and others, are increasingly used by pregnant women in the first trimester to combat pain, fever and inflammation. However, it is unclear whether they increase the risk of pregnancy loss because previous studies have shown inconsistent results.

To determine whether there is an association between the use of NSAIDs in pregnancy and miscarriage (spontaneous abortion), researchers looked at data on 65 457 women aged 15 to 45 years who were admitted to Soroka Medical Center in Beer-Sheva, Israel, between January 2003 and December 2009 to give birth (90% of women) or for a miscarriage (10%). Of the total group, 4495 (6.9%) of women took NSAIDs during the first trimester of pregnancy. Women who took NSAIDs were older, were more likely to smoke and had more inflammatory diseases. As well, more pregnant women in the exposed group had undergone in-vitro fertilization (IVF) than in those who did not take NSAIDs.

About 8.2% of women in the group exposed to NSAIDs - general anti-inflammatories - had miscarriages compared with 10% of women in the group that did not take NSAIDs. In the group of women who took COX-2 selective inhibitors, which target specific inflammation, 17% had a miscarriage, although this group was small and the question needs further research.

"We found no important associations between exposure to NSAIDs, either by group or for most specific NSAID drugs, and risk of spontaneous abortion," write Dr. Sharon Daniel and Prof. Amalia Levy, Department of Public Health, Ben-Gurion University of the Negev and Soroka Medical Center, with coauthors. "However, we found an increased risk of spontaneous abortion following exposure to indomethacin."

The authors believe that this may be due to "reverse causation bias" because indomethacin was dispensed at the end of pregnancy, likely to treat preterm labour, an indication different than that for other NSAIDS.

"The fact that the study was based on large proportion of the district population, was adjusted to nearly all known risk factors for miscarriages (tobacco use, obesity, IVF, uterine malformations, hypercoagulable conditions, intrauterine contraceptive device etc.) and used advanced statistical methods strengthens the validity of the results," states the principal investigator, epidemiologist Prof. Levy.

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7 Jun. 2014.

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Saturday, 7 June 2014

Research shows women trying hard to avoid unwanted pregnancy

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Research shows women trying hard to avoid unwanted pregnancy

Most women experiencing unwanted pregnancy report they used a contraceptive at the time they conceived, data released by the British Pregnancy Advisory Service (bpas) shows. Older women undergoing abortion were less likely to have used contraception than women under 30, which may reflect their belief they are no longer fertile.

bpas looked at contraceptive use of more than 150,000 women aged 15 and over receiving care at its clinics over the past 3 years. The analysis showed:

Two thirds (66%) of women having an abortion at bpas reported using a form of contraception when they conceived. 40% of these say they were using the contraceptive pill, the most popular prescribed contraceptive in the UK. Contraceptive pills have a 'perfect use' failure rate of just 1% when used exactly as instructed, but with 'typical use' around 9 in 100 women will become pregnant a year. Reasons for failure may include missed pills, stomach upsets, or taking other medications.Just over a third of women (35%) having an abortion at bpas became pregnant while using condoms, which are used by 1 in 4 people in the UK. With perfect use, 2 in every 100 women using condoms will experience an unintended pregnancy each year. With typical use - in which the condom is sometimes not put on or taken off properly - that increases to 12 in every 100.A third of all women having an abortion at bpas reported not using contraception when they conceived. The proportions of women reporting not using contraception when they conceived are lowest among younger women undergoing abortion, with 31% of women aged 15-24 reporting no use, rising to over 42% of women over 40.The reasons for not using contraception are diverse: sex may be unplanned and women are not prepared. A small group of women will be ending a planned pregnancy, and there will also be instances of coercion into unprotected sex.

But many do not use contraception because they under-estimate their fertility and the risk of pregnancy. For older women this may be linked to public health messaging about the difficulties their age group faces conceiving wanted pregnancies. For younger women, the belief that a previous diagnosis of chlamydia may have permanently damaged their fertility is not uncommon, or if they have had unprotected sex and did not become pregnant they assume they are infertile.

An increasing number of women across all age groups report being unhappy with the side-effects of some hormonal contraception, or believe they are not having sex frequently enough to warrant long-term contraception. Some then switch to fertility awareness and/or withdrawal which requires a lot of attention, commitment and control.

Ann Furedi, chief executive of the British Pregnancy Advisory Service, said:

"Contraception fails and sometimes we fail to use it properly. In our experience women are trying hard to avoid unwanted pregnancy, or sometimes vastly underestimate their own fertility.

"An unintended pregnancy is often a happy accident - and a large proportion of births in this country are unplanned. But for many women an unplanned pregnancy causes considerable distress, coming at a time in their lives when they are not in the position to start or expand their family. Ultimately women cannot control their fertility through contraception alone, and need accessible abortion services as a back-up for when their contraception lets them down."

"We need new contraceptive options. We are excited by research into a "pericoital" pill that women could take at the time of sex. This would be of great benefit to those women who don't feel they are having sex often enough to need an on going method, but who do not wish to rely solely on condoms."

Article adapted by Medical News Today from original press release. Source:

British Pregnancy Advisory Service (bpas)


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Sunday, 1 December 2013

Global Abortion Rates Remain Steady

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Main Category: Abortion
Also Included In: Sexual Health / STDs
Article Date: 19 Jan 2012 - 10:00 PST Current ratings for:
Global Abortion Rates Remain Steady
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New figures from the Guttmacher Institute and the World Health Organization (WHO) show that after a long period of decline, the global abortion rates have steadied. From 1995 to 2003, rates dropped from 35 per 1000 women of childbearing age to 29 per 1000, whereas the new study shows the 2008 rate is stable at 28 per 1000.

The United Nations says the slow down coincides with a plateau in the uptake of contraceptive use in developing countries, where there has been a big contraceptive drive in the last couple of decades, partly because of HIV and partly because of over population issues.

Sadly though, the report also makes a note of the fact that nearly half of all abortions in the developing world are unsafe and almost all unsafe abortions occur in developing countries around the world. The abortion rate is lower in the developed world, excluding Eastern Europe and comes in for 2008 at 17 per 1000 women of child bearing age, dropping slightly from 20 per 1000 in 1995.

Gilda Sedgh , lead author of the study and a senior researcher at the Guttmacher Institute says :

"The declining abortion trend we had seen globally has stalled, and we are also seeing a growing proportion of abortions occurring in developing countries, where the procedure is often clandestine and unsafe. This is cause for concern ... This plateau coincides with a slowdown in contraceptive uptake. Without greater investment in quality family planning services, we can expect this trend to persist."

Alarmingly, WHO figures state that 13% of all maternal deaths worldwide are caused by unsafe abortions, a tragedy considering the procedure is relatively simply and safely performed if the doctor and nurses are trained, have the correct facilities, cleanliness and medicines available to them. Unsafe abortion accounted for 220 deaths per 100,000 procedures in 2008, 350 times the rate associated with legal induced abortions in the United States (0.6 per 100,000). Unsafe abortion is also a significant cause of ill-health: Each year approximately 8.5 million women in developing countries experience abortion complications serious enough to require medical attention, and three million of them do not receive the needed care.

Iqbal H. Shah, of the WHO and a coauthor of the study said :

"Deaths and disability related to unsafe abortion are entirely preventable, and some progress has been made in developing regions. Africa is the exception, accounting for 17% of the developing world's population of women of childbearing age but half of all unsafe abortion related deaths ... Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to post abortion care, when they need treatment for complications."

The figures show conclusively that stricter abortion laws have no bearing upon number of abortions and in fact simply cause women to go through back street channels with unlicensed or unscrupulous practitioners. Whether you are for or against abortion or feel indifferent, it's impossible to argue against the numbers that demonstrate how too much regulation or prohibition simply creates an unsafe and over priced black market, much as prohibition of alcohol and drugs does. For example, the 2008 abortion rate was 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America, regions where abortion is highly restricted in almost all countries. In contrast, in Western Europe, where abortion is generally permitted on broad grounds, the rate is 12.

In contrast, the South African abortion laws are far more relaxed and the figures come in at only 15 per 1000, very close to European figures. Eastern Europe has a different scenario, with very high abortion rates coming in at 90 per 1000 in 1995 and falling to 44 per 1000 in 2003. There hasn't been much change in the rate since 2003, and it seems alarmingly high. Researchers put this down to low uptake of contraceptive methods such as the pill and IUD, while the population is generally more sexually liberated and less religious than in Africa and Latin America. Eastern Europe is also stereotyped for providing many prostitutes to West Europe, and this attitude towards sex may also increase the number of unwanted pregnancies.

Richard Horton, editor of The Lancet says :

"These latest figures are deeply disturbing. The progress made in the 1990s is now in reverse. Promoting and implementing policies to reduce the number of abortions is now an urgent priority for all countries and for global health agencies, such as WHO ... Condemning, stigmatizing, and criminalizing abortion are cruel and failed strategies. It's time for a public health approach that emphasizes reducing harm - and that means more liberal abortion laws."

Written By Rupert Shepherd
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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'Global Abortion Rates Remain Steady'

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