Women’s Awareness and Knowledge of Abortion Laws: A Systematic Review

Background

Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women’s access to safe, legal abortion services.

Objective

To provide a synthesis of evidence of women’s awareness and knowledge of the legal status of abortion in their country, and the accuracy of women’s knowledge on specific legal grounds and restrictions outlined in a country’s abortion law.

Methods

A systematic search was carried for articles published between 1980–2015. Quantitative, mixed-method data collection, and objectives related to women’s awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis.

Results

Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women’s correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3% - 68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8% – 98%, while in the case of incest, ranged from 9.8% - 64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7% - 94% and 0% - 89.5% respectively.

Conclusion

This systematic review synthesizes literature on women’s awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary.

Full article at:   http://goo.gl/GN3ps1

By:  Anisa R. Assifi,1,* Blair Berger,2 Özge Tunçalp,1 Rajat Khosla,1 and Bela Ganatra1

¹WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

2

²Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America

1WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

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Contraception Usage and Timing of Pregnancy among Pregnant Teenagers in Cape Town, South Africa

OBJECTIVE:

To evaluate knowledge and use of contraception among pregnant teenagers in the Cape Town metropolitan area.

METHODS:

A cross-sectional study enrolled women aged 16 to 19 years who were pregnant and attending prenatal clinics, and prenatal and labor wards at regional hospitals and midwife-run obstetric clinics in the Cape Town area between March 1, 2011 and September 30, 2011. Data were collected using an administered questionnaire.

RESULTS:

The study enrolled 314 participants. Of the participants, 240 (76.4%) felt their pregnancies had occurred at the "wrong time" but only 38 (12.1%) were using contraception at the time of conception. The form of contraception that participants most commonly had knowledge of was injectable hormonal contraception (274 [87.3%]). Contraception use was low, with 126 (40.1%) participants having never used contraception. The forms of contraception used most commonly were the male condom (106 [33.8%]) and injectable contraception (98 [31.2%]). The majority of participants found it easy to get contraception (192 [61.1%]) and felt that information regarding contraception was readily available (233 [74.2%]).

CONCLUSION:

Contraception use is suboptimal but this may not simply be a reflection of ineffective family-planning services. Further research is needed to fully explain the lack of contraceptive use in this population.

Purchase full article at:   http://goo.gl/aX3TR4

By:  Vollmer LR1, van der Spuy ZM2.

• 1Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. Electronic address: lindivollmer@hotmail.com.
• 2Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00039-4. doi: 10.1016/j.ijgo.2015.10.011. 

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The Prevalence of Sexually Transmitted Infections on Teen Pregnancies & Their Association to Adverse Pregnancy Outcomes

INTRODUCTION:

Based on our population data, the teen pregnancy rate and the prevalence of sexually transmitted infections (STIs) reported during pregnancy are worrisome. STIs appear to pose a threat to pregnancy outcomes including preterm birth (PTB), neonatal low birth weight (NLBW) and premature rupture of membranes (PROM). The objective of this study is to determine the prevalence of STIs in pregnant teens and the association of this variable to adverse pregnancy outcomes.

METHODS:

We performed a cross sectional study to assess the prevalence of STIs among pregnant teens during a 4-year period at our institution. Birth outcomes such as gestational age at delivery, PROM and NLBW were analyzed and compared with adults.

RESULTS:

In the four years of our study, teen pregnancy rate fluctuated from 21.7% in 2010 to 16.8% in 2013. The rate of STIs for adult and teen pregnancies was similar, 21% and 23%, respectively. Chlamydia was the most common STI (67.3%) for both groups. PTB was more prevalent among adults affected with STIs than teens, 13.8% and 11.5%, respectively. NLBW was similar among teens and adults with STIs. PROM complicated 9.1% of teen pregnancies with STIs, compared to 6.7% in adults.

CONCLUSION:

There was no significant correlation between the STIs and adverse pregnancy outcomes on teen pregnancies for our population, except for PROM. This age group is associated with a high-risk sexual behavior and poor adherence to treatment. They would benefit from efforts to prevent unintended pregnancies and infectious diseases.

Full (PDF) article at:   http://goo.gl/vRh1qd

By:  Rodriguez Gonzalez ZM, Leavitt K, Martin J, Benabe E, Romaguera J, Negrón I.

Bol Asoc Med P R. 2015 Jul-Sep;107(3):89-94.

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Socio-Cultural & Economic Factors Influencing Adolescents’ Resilience Against the Threat of Teenage Pregnancy: Accra, Ghana

Background

Adolescent pregnancy exposes female adolescents to medical, social and economic risks. In Ghana, adolescent mothers are more likely to experience complications during pregnancy and delivery as compared to older mothers. This study examined the competencies of adolescent girls to either proactively prevent teenage pregnancy or reactively cope effectively with it.

Methods

A cross-sectional survey approach was used to interview 820 adolescent girls aged 15–19 years in Accra, Ghana. The main focus of the study was to examine how social capital (various kinds of valued relations with significant others), economic capital (command over economic resources, mainly cash and assets), cultural capital (personal dispositions and habits; knowledge and tradition stored in material forms and institutionalized) and symbolic capital (honour, recognition and prestige) contribute to the development of competencies of adolescents to deal with the threat of teenage pregnancy and childbirth.

Results

Out of 820 adolescents interviewed, 128 (16 %) were pregnant or mothers. Adolescents in both groups (62 % never pregnant girls and 68 % pregnant/young mothers) have access to social support, especially from their parents. Parents are taking the place of aunts and grandmothers in providing sexual education to their adolescent girls due to changing social structures where extended families no longer reside together in most cases. More (79 %) pregnant girls and young mothers compared to never pregnant girls (38 %) have access to economic support (P = <0.001). Access to social, economic and cultural capitals was associated with high competence to either prevent or deal with pregnancy among adolescent girls.

Conclusion

Findings showed that adolescent girls, especially those that get pregnant should not be viewed as weak and vulnerable because many of them have developed competencies to cope with pregnancy and childbirth effectively. Thus, focusing on developing the competencies of girls to access social, economic and cultural capitals may be an effective way of tackling the threat of teenage pregnancy than focusing only on their vulnerability and associated risks.

Below:  Reproductive Resilience framework (modified Multi-layered Social Resilience framework by Obrist et al., 2010). The frame work illustrates how a threat of teenage pregnancy could be influenced by the capacity- personal disposition and life skills; Capitals- social, economic, cultural and symbolic and Socio-demographic context which could enhance proactive actions or becomes constraining factors. As indicated by the arrows, these factors interact with each other to produce competence levels of adolescents to develop resilience against teenage pregnancy of cope well with it when it occurs

Below:  Reproductive Resilience framework

Full article at:   http://goo.gl/lDTVUs

By:   Collins K Ahorlu^1*, Constanze Pfeiffer²³ and Brigit Obrist²³⁴

¹Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana

²Swiss Tropical and Public Health Institute, Basel, Switzerland

³University of Basel, Basel, Switzerland

⁴Institute of Social Anthropology, University of Basel, Basel, Switzerland

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Child Maltreatment and Sexual Risk Behavior: Maltreatment Types and Gender Differences

To compare sexual risk behaviors in maltreated male and female sexually active adolescents with a comparison population and examine whether specific maltreatment experiences were associated with sexual risk behaviors and teen pregnancy.

Data came from the fourth assessment (M = 7.2 years after baseline) of an ongoing longitudinal study with case-control design. The sample was restricted to only the sexually active adolescents, leaving a sample of 251 (n = 82 comparison, n = 169 maltreated, mean age = 18.49 years, SD = 1.46). Maltreatment type was coded from case records, and sexual behaviors were assessed via computerized questionnaire.

• Maltreated youth were significantly younger at first consensual intercourse than comparison youth, and males were younger than females. 
• Maltreated males reported significantly higher number of lifetime sexual partners than maltreated females. 
• Neglected, sexually abused, and physically abused youth were more likely to have had a one-night stand than comparison youth. 
• Sexually abused females were at higher risk of having sex under the influence than other maltreated females. 
• Neglected females were more likely to have ever been pregnant than females with other maltreatment types or comparison females. 
• A higher number of maltreatment victimizations predicted a younger age at first pregnancy involvement for both sexes.

Many maltreated youth continue to be at high risk for engaging in behaviors that may initiate a trajectory of problematic sexual behaviors. The findings highlight maltreated males and neglected females as vulnerable groups that should be targeted in prevention efforts to curtail sexual risk behaviors and prevent teenage pregnancy.

Via: http://ht.ly/SxNgv Purchase full article at: http://goo.gl/SnkgaX

By: Negriff S1, Schneiderman JU, Trickett PK.

• 1School of Social Work, University of Southern California, Los Angeles, CA.
• 
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Using a Checklist to Assess Pregnancy in Teenagers and Young Women

OBJECTIVE

Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women.

RESULTS

Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results.

CONCLUSION

The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population

Table 1

Criteria and Related Questions Used in the Checklist to Assess Pregnancy Among Female Teenagers and Young Women Seeking Care in a Family Planning Clinic

WHO and CDC Criteria to Be Reasonably Certain a Woman Is Not Pregnant	Question in Study Checklist and Determination of Pregnancy Status*
Is 7 d or less after the start of normal menses Has not had sexual intercourse since the start of last normal menses Has been correctly and consistently using a reliable method of contraception Is 7 d or less after spontaneous or induced abortion Is within 4 wk postpartum Is fully or nearly breastfeeding, amenorrheic, and 6 mo or less postpartum	Did your last menstrual period start within the last 7 d? Have you had sex since your last menstrual period started? Have you been using a reliable birth control method consistently and correctly since your last menstrual period started? Did you have a miscarriage or abortion in the last 7 d? Did you have a baby in the last 4 wk? Did you have a baby in the last 6 mo? Are you breastfeeding now? Are your periods still gone since you had the baby?	Yes: Pregnancy unlikely No: Pregnancy unlikely Yes: Pregnancy unlikely Yes: Pregnancy unlikely Yes: Pregnancy unlikely Yes to all: pregnancy unlikely

WHO, World Health Organization; CDC, Centers for Disease Control and Prevention.

*Pregnancy was considered to be unlikely if the participant fulfilled any of these criteria: answered “yes” to questions 1, 3, 4, or 5; answered “no” to question 2; or answered “yes” to questions 6, 6A, and 6B.

Via:  http://ht.ly/RUk8x

By: Maura K. Whiteman, PhD, Naomi K. Tepper, MD, MPH, Melissa Kottke, MD, MPH, MBA, Kathryn M. Curtis, PhD,Peggy Goedken, MPH, Michele G. Mandel, and Polly A. Marchbanks, PhD

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia

Vulnerability Factors and Pathways Leading to Underage Entry into Sex Work in Two Mexican-US Border Cities

"...[C]onsequences of early sexual and physical abuse led to running away from home, dropping out of school, and homelessness. The homelessness and lack of social support rendered them vulnerable to underage entry or in some instances to being coerced or forced into sex work. These findings complement prior research conducted in other regions indicating experiences young exposure to sexual and physical abuse and running away as an adolescent are primary risks for the commercial sexual exploitation of children.49–51 Furthermore, it is important to mention that not one of the participants received mental health services or professional services of any kind for the abuse they endured. For many this study was their first time disclosing to someone the abuse they had experienced and many participants expressed relief in doing so. These findings suggest the need in Mexico for more effective child protective service programs to identify and assist children who have been victims of sexual or physical abuse in a timely way given their potential implications.

Economic need is often connected to entry into sex work; evidence indicates that when women lack viable alternatives, they are more likely to perceive sex work as a feasible option for income.52 In our study, teen pregnancy was the common denominator that gave rise to economic need such as child caring needs (i.e., shelter, food, etc.). Because these women were underage at the time of pregnancy, had low levels of education and were poorly skilled, they had limited employment opportunities. These findings complement prior work indicating the role of limited opportunities for women as drivers of entry to sex work and trafficking.53, 54 The Mexican government has gone to great efforts to improve the educational opportunities, and thus the employment opportunities, of young women and girls from lower socioeconomic status with programs such as Prospera (previously referred to as Oportunidades).55 However, these findings indicate that there are other needs that must be addressed (i.e., family issues, sexual and physical abuse) in order to reach these girls or expand their program to target high-risk girls who are suffering from these vulnerabilities as our study revealed." [bold added]

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