P33 Menstrual regulation: Incidence, methods, and sources of this understudied reproductive practice in three countries

Bell, Suzanne O.; Shankar, Mridula; Guiella, Georges; Khanna, Anish; OlaOlorun, Funmilola; Ahmad, Danish; Omoluabi, Elizabeth

doi:10.1016/j.contraception.2020.07.052

Cited by 3 publications

(6 citation statements)

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“…2021; Bell et al. 2020b). The phrasings used to capture pregnancy removal or period regulation experiences emerged from pilot training in Nigeria during discussions with female data collectors about the language women use to discuss actions that could be classified as abortion.…”

Section: Methodsmentioning

confidence: 99%

“…Interviewers and respondents interpreted the phrasings of these different abortion experiences correctly (Bell et al. 2020b). In this analysis, experiences of removing a pregnancy and regulating a period were both classified as abortions.…”

Section: Methodsmentioning

confidence: 99%

“…Women were asked separately whether they had done something to "remove a pregnancy" or to bring back a late period at a time when the respondent thought she was pregnant (hereafter referred to as period regulation). Language for period regulation was included to capture the experiences of women who may have nuanced interpretations of a possible pregnancy termination, especially when their pregnancy status is ambiguous or has not been confirmed clinically or via pregnancy test (Bell and Fissell 2021;Sheehy et al 2021;Bell et al 2020b). The phrasings used to capture pregnancy removal or period regulation experiences emerged from pilot training in Nigeria during discussions with female data collectors about the language women use to discuss actions that could be classified as abortion.…”

Section: Study Overviewmentioning

confidence: 99%

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Contraceptive Use Before and After Abortion: A Cross‐Sectional Study from Nigeria and Côte d'Ivoire

Magalona

Byrne

OlaOlorun

et al. 2022

Studies in Family Planning

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Post-abortion contraception enables women to effectively manage their fertility to prevent unintended pregnancies. Using data from population-based surveys of women aged - in Nigeria and Côte d'Ivoire, we examined contraceptive dynamics immediately before and after an abortion and examined factors associated with these changes using multivariable logistic regressions. Covariates included sociodemographic characteristics, abortion source, post-abortion contraceptive communication (wanting to and actually talking to someone about contraception after abortion), and perceived contraceptive autonomy. We observed higher contraceptive use after abortion than before abortion. In Nigeria, wanting to talk to someone about contraception post-abortion was associated with increased adoption and decreased discontinuation, whereas talking to someone about contraception post-abortion was associated with increased adoption. Obtaining care from a clinical abortion source was associated with increased adoption and decreased discontinuation. Both post-abortion contraceptive communication variables were associated with post-abortion contraceptive use in both countries, whereas clinical source was only associated with post-abortion contraceptive use in Nigeria. Our findings suggest that ensuring that women have access to safe abortion as part of the formal health care system and receive comprehensive, high-quality post-abortion care services that include contraceptive counseling enables them to make informed decisions about their fertility that align with their reproductive goals.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Overviewmentioning

confidence: 99%

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Contraceptive Use Before and After Abortion: A Cross‐Sectional Study from Nigeria and Côte d'Ivoire

Magalona

Byrne

OlaOlorun

et al. 2022

Studies in Family Planning

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“…Ethnographic research among young women in rural Tanzania documented a practice referred to as “suspending a pregnancy” or “moving a pregnancy to the back”, such that a pregnancy was delayed using traditional medicines until a young girl or woman is ready to be pregnant; the practice was not considered to carry the stigma of an abortion [ 17 ]. In recent population-based survey research on induced abortion in Côte d’Ivoire and Nigeria, researchers found substantial levels of self-reported menstrual regulation (20.8 per 1000 in Côte d’Ivoire and 28.3 per 1000 in Nigeria) [ 18 ]. While there was overlap in the methods used for menstrual regulation and those used for pregnancy termination, menstrual regulations more often involved the use of pills and traditional methods, and interaction with non-clinical providers.…”

Section: Introductionmentioning

confidence: 99%

A mixed-methods study exploring women’s perceptions of terminology surrounding fertility and menstrual regulation in Côte d’Ivoire and Nigeria

et al. 2021

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Background Women use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences (specifically menstrual regulation and pregnancy removal), and the specific scenarios that these practices encompass among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and Côte d’Ivoire. Methods Our analysis draws upon surveys with women in Nigeria (n = 1114) and Cote d’Ivoire (n = 352). We also draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States in Nigeria, and Abidjan, Cote d’Ivoire (n = 30 in both countries). We examine survey and interview questions that explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis. Results We find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy. Conclusions Overall, menstrual regulation and pregnancy removal are seen as distinct experiences in both settings. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs.

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“…Performance Monitoring for Action (PMA) surveys now include this approach by asking participants about experiences of 'period regulation'. 23 Methods to reduce under-reporting in surveys through indirect questions have produced mixed results 4 18 24 and have a number of flaws that limit the utility of the data they produce. For example, random response methods [25][26][27] and list experiments [28][29][30][31][32][33] do not produce individual-level data, have limited precision, and do not permit follow-on questions about sources of abortion and their safety, the process of abortion-seeking or issues with access to abortion care.…”

Section: Introductionmentioning

confidence: 99%

Interviewer effects on abortion reporting: a multilevel analysis of household survey responses in Côte d’Ivoire, Nigeria and Rajasthan, India

Footman

2021

BMJ Open

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ObjectivesThe analysis aimed to assess the scale of interviewer effects on abortion survey responses, to compare interviewer effects between different question wordings and between direct and indirect approaches, and to identify interviewer and interview characteristics that explain interviewer effects on abortion reporting.Setting2018 Performance Monitoring for Action nationally representative household surveys from Côte d’Ivoire, Nigeria and Rajasthan, India.ParticipantsSurvey data from 20 016 interviews with reproductive age (15–49) women, selected using multistage stratified cluster sampling. Data from self-administered interviewer surveys and from a sample of health service delivery points that serve the female survey participants were also included.Primary outcome measuresOutcomes were the respondent’s own experience of ever ‘removing a pregnancy’, their closest confidante’s experience of pregnancy removal and the respondent’s own experience of period regulation.ResultsSubstantial interviewer effects were observed, ranging from 7% in Côte d’Ivoire to 24% in Nigeria for pregnancy removal. Interviewer effects for survey questions that were designed to ask about abortion in a less stigmatising way were either similar to (9%–26% for confidante-reporting) or higher than (17%–32% for a question about period regulation) the pregnancy removal question. Interviewer and interview characteristics associated with abortion reporting included respondent–interviewer familiarity, the language of interview and the interviewer’s comfort asking questions about abortion.ConclusionThis study highlights that questions designed to be less stigmatising may increase interviewer effects due to lower comprehension among respondents. Further work is needed to assess question wordings for different contexts. Selecting and training interviewers to ensure comfort asking questions about abortion is important for reproductive health surveys. Challenges for the use of ‘insider’ interviewers and the management of surveys in countries with high linguistic diversity are also identified.

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P33 Menstrual regulation: Incidence, methods, and sources of this understudied reproductive practice in three countries

Cited by 3 publications

References 0 publications

Contraceptive Use Before and After Abortion: A Cross‐Sectional Study from Nigeria and Côte d'Ivoire

Contraceptive Use Before and After Abortion: A Cross‐Sectional Study from Nigeria and Côte d'Ivoire

A mixed-methods study exploring women’s perceptions of terminology surrounding fertility and menstrual regulation in Côte d’Ivoire and Nigeria

Interviewer effects on abortion reporting: a multilevel analysis of household survey responses in Côte d’Ivoire, Nigeria and Rajasthan, India

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