Abortion Incidence and Unintended Pregnancy in Nepal

Puri, Mahesh; Singh, Susheela; Sundaram, Aparna; Hussain, Rubina; Tamang, Anand; Crowell, Marjorie

doi:10.1363/42e2116

Cited by 63 publications

(102 citation statements)

References 15 publications

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“…At 47·0 abortions per 1000 women aged 15–49 years, the abortion rate in India is within the range of reported estimates of abortion incidence in three other south Asian countries (figure 3). 21,22,29 Additionally, our estimate of 3·4 million facility-based abortions in 2015 is nearly five times the number that was reported 4 to government sources in 2014–15 (701 415 abortions). The difference was expected because official data on abortion are known to be highly underreported.…”

Section: Discussionmentioning

confidence: 64%

“…First, for-profit sales were increased by 5% to account for IMS Health’s incomplete data coverage. Second, total medication abortions (for-profit and non-profit) were reduced: (1) by 10% to account for wastage on the basis of available data of drug wastage in general (data on medication abortion drug wastage are unavailable); 18,19 (2) by 5% of all facility-based abortions to avoid double counting women who attempted a medication abortion outside of a facility but eventually received a successful abortion within a facility, where they are already counted in the HFS; 20 and (3) by 72 000 medication abortions in states that have borders with Nepal (Puri M, Center for Research on Environment Health and Population Activities, personal communication) 21 and by 21 000 medication abortions in states that have borders with Bangladesh (A Hossain, Bangladesh Association for Prevention of Septic Abortion, personal communication) 22 to account for cross-border exports of medication abortion drugs to these countries.…”

Section: Methodsmentioning

confidence: 99%

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The incidence of abortion and unintended pregnancy in India, 2015

Singh

Shekhar

Acharya

et al. 2018

The Lancet Global Health

232

229

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Summary Background Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015. Methods National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015–16 National Family Health Survey-4. Findings We estimate that 15·6 million abortions (14·1 million–17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2–52·1) per 1000 women aged 15–49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15–49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15–49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended. Interpretation Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous suppl...

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Section: Discussionmentioning

confidence: 64%

Section: Methodsmentioning

confidence: 99%

The incidence of abortion and unintended pregnancy in India, 2015

Singh

Shekhar

Acharya

et al. 2018

The Lancet Global Health

232

229

View full text Add to dashboard Cite

show abstract

“…) and Nepal (Puri et al. )). Indirect methods which ask women to report on others in their network, such as the best‐friend approach and anonymous third‐party reporting are also being explored with mixed results (Scott et al.…”

Section: Discussionmentioning

confidence: 99%

Effect of ACASI on Reporting of Abortion and Other Pregnancy Outcomes in the US National Survey of Family Growth

Lindberg¹,

Scott²

2018

Studies in Family Planning

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Abortion is a behavior that is stigmatized and difficult to measure. To improve reporting of abortion and other sensitive behaviors in the United States, the National Survey of Family Growth (NSFG) supplements the interviewer administered face-to-face (FTF) interview with audio computer-assisted selfinterviewing (ACASI). This paper estimates differential reporting of abortion and other pregnancy outcomes (miscarriage, live birth) in the NSFG (2002, 2006–2010, 2011–2015) between women’s ACASI and FTF interviews. Examining reporting of less stigmatized pregnancy outcomes can help understand the relative contributions of stigma and survey-level factors in reporting of abortions. More women reported abortions, miscarriages and births in the ACASI than the FTF interview. Differences in reporting were moderated by the length of recall. The ACASI elicited relatively more reporting of abortions and miscarriages among non-white and low-income women. Reporting ratios increased over time. ACASI is a tool that may work differently across time, for different measures, and with varying survey contexts.

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“…Sources Health Professional Surveys, in each country, based on opinions of key informants. See Bankole et al (2015), Basinga et al (2012), Keogh et al (2015), Mohamed et al (2015), Moore et al (2016), Polis et al (2017), Prada et al (2016), Puri et al (2016), Sathar et al (2014), Sedgh et al (2011Sedgh et al ( , 2015 and Singh et al (2017) Country treated for complications with official statistics or with results from other data collection approaches such as a Prospective Morbidity Survey (PMS); comparison of a multiplier based on the HPS with multipliers from population-based surveys; and AICM estimates of abortion incidence with estimates obtained through different methodologies, such as the secret ballot or sealed envelope approach.…”

Section: Additional External Validation Of Aicm Resultsmentioning

confidence: 99%

“…The HFS needed to be expanded to obtain counts of legal abortions and PAC caseload, and the HPS needed to obtain additional information on the proportion obtaining abortions from approved or legal providers separately from the proportion obtaining abortions from non-approved or illegal providers. Researchers have used this adaptation to estimate the incidence of abortions in Nepal, Ethiopia and Bangladesh (Puri et al 2016;Moore et al 2016;Singh et al 2017). Estimating Abortion Incidence: Assessment of a Widely Used……”

Section: Mixed Legal Settingsmentioning

confidence: 99%

Estimating Abortion Incidence: Assessment of a Widely Used Indirect Method

Singh

Juárez

Prada³

et al. 2019

Popul Res Policy Rev

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Induced abortion is a reproductive behavior that remains difficult to measure in countries where the procedure is highly restricted by law. Additionally, in some countries where abortion is broadly legal, a high proportion of abortions are carried out by illegal and untrained providers. In these contexts, official statistics are non-existent or highly incomplete. Measurement of the incidence of induced abortion is essential to inform sexual and reproductive health policies and programs. Researchers have developed diverse methodologies over the years. Direct methods, such as population-based surveys that ask women about their abortion experience, generally are subject to high levels of underreporting. A range of indirect methods have been developed to obtain more accurate estimates. Created in the early 1990s, the Abortion Incidence Complications Method (AICM) is a widely applied indirect method that has produced robust estimates of abortion incidence in a range of contexts. This paper presents the original AICM methodology used in countries where abortion is highly restricted. It also highlights modifications made for two situations, one of which is newly emerging. First, the methodology has been adapted recently for countries where, despite the restrictive abortion laws, a new, relatively safe method-medication abortion (mainly misoprostol alone)-is increasingly used. Second, it has been adapted for countries where abortion is broadly legal but unsafe abortion remains common. The paper also assesses performance of the methodology to the extent available data permit. The paper provides guidance to researchers who want to conduct abortion incidence studies using the AICM and to further advance the measurement of abortion incidence.

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Abortion Incidence and Unintended Pregnancy in Nepal

Cited by 63 publications

References 15 publications

The incidence of abortion and unintended pregnancy in India, 2015

The incidence of abortion and unintended pregnancy in India, 2015

Effect of ACASI on Reporting of Abortion and Other Pregnancy Outcomes in the US National Survey of Family Growth

Estimating Abortion Incidence: Assessment of a Widely Used Indirect Method

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