The overall aim of this thesis was to examine the adoption of emergency contraceptive pills (ECP) in Sweden. Two cross-sectional surveys and two quasi-experimental studies were used. Reasons for induced abortion, contraceptive practices and contraceptive failure were examined in a group of abortion applicants with a waiting-room questionnaire (I) and knowledge, use and practices of ECP were assessed with a postal questionnaire in a population-based sample of young women (II). One community-based information campaign was evaluated with a repeated postal questionnaire (III) and a school-based education intervention was evaluated with repeated class-room questionnaires (IV). Abortion applicants had inadequate contraceptive practices and a low use of ECP. One year after the deregulation of ECP women were highly aware of the method and preferred the pharmacy for the purchase of ECP. Correct knowledge and positive attitudes influenced the willingness to use ECP in the future. The information campaign was noticed by two-thirds of the women and there was an overall trend towards better knowledge, improved attitudes and increased use among all women at follow-up. The school-based intervention improved the students’ knowledge of, and attitudes to, ECP without jeopardizing condom use. The adoption of ECP in Sweden seems to have gone through the first stages of diffusion of an innovation, i.e., developement, dissemination, and adoption, and has reached the stage of implementation since the studies indicated a general awareness of more than 90%, an intention to use in case of need of more than 70%, and womens’ own experience of use of around 30%. The most cited information channels were media, friends and the local Youth Clinic. ECP is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, but must be considered as being only one of many tools in the prevention of unintended pregnancies.

Made available in DSpace on 2015-07-22T20:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-25 / Por ser uma prática criminosa, o aborto provocado acaba sendo realizado clandestinamente tornando-se um grave problema de Saúde Pública. O objetivo deste estudo foi o de estimar a prevalência de mulheres em idade fértil com histórico de aborto. O estudo é transversal, resultante de uma amostra aleatória de mulheres 15 a 49 anos-, residentes no subdistrito da Vila Mariana, 2006. Os dados foram coletados mediante aplicação de questionários. Foi considerada como variável dependente classificação da mulher quanto ao aborto: sem aborto, aborto espontâneo e aborto provocado; e independentes: idade, defasagem do número ideal de filhos, atividade remunerada, escolaridade, estado civil, uso de contraceptivos e opinião sobre o aborto provocado. Para análises foram utilizados testes de qui-quadrado e modelos de regressão logística multinomial policotômica. Dentre o total de mulheres entrevistadas (n=1121), 84,4% (n=946) são de mulheres sem histórico de aborto; 11,2% (n=126) são de mulheres com histórico de aborto espontâneo e, 4,4% (n=49) são de mulheres com histórico de aborto provocado. A razão de chances de ter realizado aborto provocado sobre a sem aborto é 6,33 vezes maior (p0,001) entre mulheres que aceitam esta prática; 4,58 vezes maior (p=0,002) entre as mulheres que possuem menos de 4 anos de estudo e ainda, as chances da mulher declarar um aborto provocado comparado às sem aborto é 7% maior a cada ano em que a mulher envelhece. Dentre as 1121 mulheres, 49,5% (n=555) declararam ter tido alguma gravidez. Para que engravidaram a prevalência de mulheres com aborto espontâneo foi de 22,7% (n=126) de aborto provocado 8,85 (n=49). A razão de chances de ter realizado aborto provocado sobre a sem aborto é 28,34 vezes maior (p0,001) entre as que não possuem nenhum filho nascido vivo; 6,42 vezes maior (p0,001) entre as que aceitam esta prática; 4,96 vezes maior (p=0,002) entre as que possuem menos de 4 anos de estudo; e as chances de declarar um aborto provocado comparado as sem aborto é 8% maior a cada ano a mais de vida. Por outra parte, este estudo revela ainda que entre o total de mulheres a razão de chances de ter tido aborto espontâneo sobre a sem aborto é 0,34 (p0,001) entre as mulheres que não possuem nenhum filho nascido vivo; e, as chances da mulher declarar um aborto espontâneo comparado às sem aborto é 4% maior a cada ano de idade da mulher. O comportamento reprodutivo das mulheres deste estudo é equiparável ao das residentes em países desenvolvidos. Ao ter acesso a métodos contraceptivos considerados eficazes o aborto provocado legalizado, não seria utilizado de forma irresponsável. / Induced abortions are illegal in Brazil, leading many women to seek out clandestine clinics and practitioners, resulting in a serious public health problem. The purpose of this study was to estimate the number of women in the general population of fertile age with a history of abortion. This is a retrospective transversal study, based on a random sample of women – 15 to 49 years old –, residing at the Vila Mariana neighborhood of São Paulo in 2006. Data was collected through questionnaires. As the dependent variable we used different abortion categories, reflecting different types of experiences with abortion, which included: no abortion, spontaneous abortion and induced abortion. As independent variables we used: age, the difference between number of children and ideal number of children, employment and marital status, level of education, use of contraceptives, and personal opinion about induced abortion. Analyses were carried out using chi-square tests and polytomous multinomial logistic regressions. Furthermore, 84,4% (n=946) had no history of abortion; 11,2% (n=126) indicated having had a spontaneous abortion; and 4.4% (n=49) indicated having had an induced abortion. We found that it is 6,33 times more likely (p0,001) to have had an induced abortion versus no abortion among women who are pro-choice; 4,58 times more likely (p=0,002) among women who have less than 4 years of formal education; and the chances of a woman admitting an induced abortion compared to no abortion are 7% higher for each additional year of age. We surveyed a total of 1121 women, among which 49.5% (n=555) indicated that they had been pregnant at least once. Among the latter, 22,7% (n=126) indicated having at least one spontaneous abortion and 8,85% (n=49) indicated having at least one induced abortion. Our results show that among women with no live birth pregnancies it is 28,34 times more likely that they have undergone induced abortion versus no abortion (p0,005); among those that are pro-choice it is 6,42 times more likely (p0,001); among those who have less than 4 years of formal education it is 4,96 times more likely (p=0,002); and the chances of admitting to an induced abortion versus no abortion increases by 8% higher for each additional year of age. Finally, this study reveals that women with no live births are 0,34 more likely (p0,001) to have had an spontaneous abortion versus no abortion; and the chances of a woman admitting spontaneous abortion compared to no abortion is 4% higher for each additional year of age. In conclusion, the reproductive behavior of women in this study is comparable to the behavior of women who live in developed countries. With broad access to effective contraceptive methods, legalized induced abortion would not be carried out irresponsibly. / TEDE

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-12-02T19:07:26Z No. of bitstreams: 1 DISS ACADEM. Monique França. 2012.pdf: 1239594 bytes, checksum: 57756f108456b3592bb7c9162cdee0b9 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-12-02T19:11:05Z (GMT) No. of bitstreams: 1 DISS ACADEM. Monique França. 2012.pdf: 1239594 bytes, checksum: 57756f108456b3592bb7c9162cdee0b9 (MD5) / Made available in DSpace on 2015-12-02T19:11:05Z (GMT). No. of bitstreams: 1 DISS ACADEM. Monique França. 2012.pdf: 1239594 bytes, checksum: 57756f108456b3592bb7c9162cdee0b9 (MD5) / O trabalho teve por objetivo compreender os significados da experiência de mulheres na internação por aborto, a partir das suas trajetórias nas diferentes etapas da atenção nas maternidades, da interação com profissionais de saúde e outras mulheres internadas e da percepção sobre a assistência recebida. Este artigo teve origem de uma pesquisa etnográfica que combinou entrevistas semiestruturadas e observação participante, durante nove meses entre 2008 e 2009. Foram analisadas 19 entrevistas com mulheres que declararam ter abortado em três maternidades públicas de Salvador, Bahia, Brasil. Para a interpretação qualitativa dos dados, utilizou-se a técnica da análise de conteúdo. Os relatos indicaram a preponderância das experiências anteriores de aborto e também partos, sejam delas próprias ou de mulheres conhecidas, na significação da experiência corporal e emocional em cada etapa da internação. A hospitalização foi marcada, sobretudo, por sentimentos negativos (medo, solidão, culpa e arrependimento) além de dor física e emocional, mas também pelo alívio com o fim da gravidez e dos sintomas físicos. Sofrimento adicional foi condicionado pela organização (inadequada) da assistência. A falta de apoio emocional e de informação, a convivência com a dor, a sensação de abandono pela equipe e um cuidado visivelmente tecnicista – com pouco acolhimento às demandas das mulheres – evidenciaram o não cuidado às mulheres, com o descumprimento das normas de atenção humanizada. Algumas delas consideraram estes aspectos a forma pela qual se manifestava a discriminação por terem abortado. Paradoxalmente, as mulheres tenderam a avaliar positivamente a assistência, sendo discutidos sete elementos que contribuíram para esta percepção. A relação com as outras mulheres cumpriu papel positivo, na qual a troca de experiências e o apoio mútuo tornaram a hospitalização mais suportável. Por fim, o trabalho demonstra que profissionais, gestores e governos devem garantir esforços para promover o atendimento humanizado e de qualidade às mulheres com abortamento, buscando alternativas que levem em consideração as experiências das mulheres no ajustamento das atuais condutas, além da revisão das leis que criminalizam o aborto.

Made available in DSpace on 2015-05-14T13:16:33Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 817356 bytes, checksum: 3d92ee05ca1ae8120a03a662176e093b (MD5) Previous issue date: 2008-08-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / For appearing in a question of public health, the induced abortion has been the subject of the social debate. Nevertheless, the discussion is around the speeches that evaluate this behavior not only as a morally inacceptable fact, but also as an action passive of punishment inside the Brazilian legislation. From this reflection, this work analyzed the social perception of induced abortion and its relationship with a whole series of psychosocial factors that make this perception possible. The perception is understood inside three evaluative dimensions: community (how much the action of induced abortion is common), justice (how much the action of induced abortion is fair) and punishment (how much the action of induced abortion must be punished). They were presented stories of abortion in the conditions allowed by law (normalized) and in the not allowed conditions (non-normalized), and also participants who were requested to evaluate them as fair, ordinary and passive of punishment behavior. The considered psychosocial factors were social beliefs that support the social position facing the induced abortion, essentialist beliefs in the differences among men and women, religiosity and familiarity with the induced abortion. For this, it was realized a study correlated to the application of a questionnaire to 614 university students from both male and female sexes from a public university in Paraíba. The results found indicated, for the studied sample, that the induced abortion is perceived as a common behavior, for both situations, normalized (allowed by law) and non-normalized (illegal abortion). The normalized abortion was considered as fairer and less passive of punishment, while the participants considered the non-normalized abortion as less fair and more passive of punishment. As to the position, there was an adhesion to the arguments against the abortion practice, except the arguments linked to the autonomy and individual freedom of the woman to decide about her own body. The sample admitted a small familiarity with the phenomenon of abortion. In the perception of the abortion community (normalized and non-normalized), the explained variations were the position and the familiarity. But for the perception of the justice (normalized and nonnormalized) and the perception of the normalized punishment, the explained variations were the position and the religiosity. And for the perception of the non-normalized punishment, only the position appeared as an explained variation. It was observed that the essentialism does not appear as an explained variation of any perception. The results point to the fact that the more familiarity with the phenomenon of abortion the more is the attribution of the community, it is, there is the recognition of the raised occurrence of abortions for those who admit some type of proximity with the question. It makes sense then to strengthen the institutional role as promotional of the visibility of the abortion, to go beyond the perspective of the morality, but for the social problematic that it is involved with, while behavior daily practiced to the default of the moral judgments made by it. / Por configurar-se numa questão de saúde pública, o aborto provocado tem sido pauta do debate social. No entanto, a discussão se faz atravessada dos discursos que avaliam esse comportamento como um ato tanto moralmente inaceitável, como também passível de punição dentro da legislação brasileira. Partindo dessa reflexão, o presente trabalho analisou a percepção social do aborto provocado e sua relação com uma série de fatores psicossociais que fundamentariam essa percepção. A percepção é entendida dentro de três dimensões avaliativas: comunidade (o quanto a prática do aborto provocado é comum), justiça (o quanto a prática do aborto provocado é justa) e punição (o quanto a prática do aborto provocado deve ser punida). Foram apresentadas historias de abortamento dentro das condições permitidas em lei (normatizadas) e das condições não permitidas (não-normatizadas) e os participantes solicitados a avaliá-las como comportamento comum, justo e passível de punição. Os fatores psicossociais considerados foram crenças sociais que fundamentam o posicionamento social frente ao aborto provocado, crenças essencialistas nas diferenças entre homens e mulheres, religiosidade e familiaridade com o aborto provocado. Para tanto, realizou-se um estudo correlacional com a aplicação de questionário a 614 estudantes universitários de ambos os sexos de uma universidade pública da Paraíba. Os resultados encontrados indicaram que, para a amostra estudada, o aborto provocado é percebido como um comportamento comum, tanto nas situações normatizadas (permitidas em lei) e não-normatizadas (aborto ilegal). O aborto normatizado foi percebido como mais justo e menos passível de punição, enquanto que os participantes perceberam o aborto não-normatizado como menos justo e mais passível de punição. Quanto ao posicionamento houve uma adesão aos argumentos contrários á prática do aborto, com exceção dos argumentos que vinculam-se a autonomia e liberdade individual da mulher para decidir sobre o próprio corpo. A amostra admitiu uma baixa familiaridade com o fenômeno do abortamento. Na percepção da comunidade do aborto (normatizado e não-normatizado), as variáveis explicativas foram o posicionamento e a familiaridade. Já para a percepção da justiça (normatizado e não-normatizado) e a percepção da punição normatizada, as variáveis explicativas foram o posicionamento e a religiosidade. E para a percepção da punição não-normatizada, apenas o posicionamento apareceu como variável explicativa. Observou-se que o essencialismo não aparece como variável explicativa de nenhuma das percepções. Os resultados encontrados apontam para o fato de que quanto mais familiaridade com o fenômeno do abortamento maior é atribuição de comunidade, ou seja, há o reconhecimento da elevada ocorrência de abortos por aqueles que admitem algum tipo de proximidade com a questão. Faz sentido então reforçar o papel institucional como promotor da visibilidade do abortamento, para além da perspectiva da moralidade, mas sim da problemática social que o envolve, enquanto comportamento cotidianamente praticado à revelia dos julgamentos morais a ele feito.

Bakgrund: Barnmorskor och sjuksköterskor världen över möter och vårdar kvinnor som av olika skäl genomför en inducerad abort. Det kan vara en utmaning som kräver både kunskap och stöd för dem som arbetar inom abortvården. Syfte: Syftet med studien var att belysa barnmorskors och sjuksköterskors erfarenheter av att vårda kvinnor i samband med inducerad abort. Ordet erfarenheter innefattar upplevelser och åsikter baserat på erfarenheter. Metod: Studien genomfördes som en kvalitativ metasyntes med metaetnografi som analysmetod. Tjugosju (27) artiklar inkluderades i resultatet. Resultat: Tre huvudkategorier och tio mönster belyser barnmorskors och sjuksköterskors erfarenheter av att vårda kvinnor i samband med inducerad abort. Dessa var att göra ett bra arbete genom att vara ett stöd, att åsidosätta egna värderingar och att skapa goda upplevelser för kvinnan. Barriärer för kvalitativ abortvård i form av negativa attityder från omgivningen, brister i verksamheten, bristande preventivmedelsanvändning, egna känslor och ta emot fostret. Behov hos vårdgivarna i form av stöd och kunskap. Slutsats: Den abortsökande kvinnan är i behov av stöd och icke dömande attityder från vårdgivare. Barnmorskor och sjuksköterskor behöver ha kunskap och få stöd i arbetet med abortvård. Brist på stöd och kunskap hos barnmorskor och sjuksköterskor kan påverka attityder om kvinnors rätt till inducerad abort inom kollegiet på en arbetsplats, vilket i sin tur kan ha en inverkan på den abortsökande kvinnans omvårdnad. / Background : Midwives and nurses all over the world meet with and care for women who, for various reasons, are undergoing induced abortion. It may be a challenge that requires both knowledge and support for those working in abortion care.Objective: To describe midwives and nurses’ experiences of caring for women who undergo induced abortion. The word experience includes perceptions based on experiences. Method: The study was conducted as a qualitative metasynthesis using meta-ethnography as analysis of data. Twenty-seven (27) peer-reviewed scientific articles were included in the result. Result: Three main categories and ten different patterns highlighted the midwives and nurses' experiences of caring for women undergoing an induced abortion. These were doing a good job by being supportive, putting own values aside and with the goal to create good experiences for the woman. Barriers to qualitative abortion care included negative attitudes from the surroundings, own feelings, receiving the fetus and various issues at the abortion care clinics. The third category was the caregivers’ needs which included support and knowledge. Conclusion: The abortion-seeking woman is in need of support and non-judgmental attitudes from caregivers. Midwives and nurses need knowledge and support in the work of abortion care. Lack of support and knowledge can affect midwives and nurses’ attitudes towards induced abortion as a woman’s right, which in turn can affect the women in need of abortion care.

Background: ​Induced abortion involves intentionally terminating a pregnancy. This can be donemedically or surgically. Abortion is a common procedure around the world, where the globalspectrum of cultures and perceptions regarding abortion is very varied. Person-centered care,treatment and support are important aspects of the concepts of nursing-care. Aim: ​The purpose of this study is to investigate experiences and psycosocial needs of carerelated to induced abortion, independent of abortion method or length of pregnancy. Method: ​This is a general literature study where previous research has been used to answer thepurpose. The articles were quality reviewed and analyzed thematically. Results: ​Patients and partners experience strong emotions in connection with the abortionprocess, some of which are ambivalent. Experiences of being judged by the care staff also occur,at the same time as the care staff seem to have the opportunity to influence the experience withthe help of different nursing measures. Patients and partners value good treatment and support,while maintaining integrity and autonomy. These factors contributed to a good experience withinduced abortion. Conclusion: ​In an induced abortion situation, patients and partners may experience strongemotions, ambivalent emotions and fear of being convicted. Healthcare professionals play animportant role in ensuring that patients and partners have a good abortion experience. Furtherresearch on the subject is recommended. / Bakgrund: Inducerad abort innebär att avsiktligt avsluta en graviditet. Detta kan utföras medicinskt eller kirurgiskt. Abort är ett vanligt förekommande ingrepp världen över, där det globala spektrumet av kulturer och uppfattningar gällande abort är mycket varierad. Omvårdnadsbegreppen personcentrerad omvårdnad, bemötande och stöd är viktiga inom abortvården. Syfte: Det övergripande syftet med denna studie är att undersöka upplevelser och psykosocialt omvårdnadsbehov i samband med inducerad abort, oberoende av abortmetod eller graviditetslängd. Metod: Detta är en allmän litteraturstudie där tidigare forskning har använts för att besvara syftet. Artiklarna kvalitetsgranskades samt analyserades tematiskt.  Resultat: Patienter och partners upplever starka känslor i samband med abortprocessen, varav vissa är ambivalenta. Upplevelser av att bli dömd av vårdpersonalen förekommer också, samtidigt som vårdpersonalen tycks ha möjlighet att påverka upplevelsen med hjälp av omvårdnadsåtgärder. Patienter och partners värderar ett gott bemötande och stöd samt bibehållen integritet och autonomi. Dessa faktorer bidrog till en god upplevelse vid inducerad abort.  Slutsatser: I en inducerad abortsituation kan patienter och partners uppleva starka känslor, ambivalenta känslor och rädsla inför att bli dömd. Vårdpersonal har en viktig roll i om patienter och partners får en god abortupplevelse. Fortsatt forskning kring ämnet rekommenderas.

Bakgrund: Avbrytande av graviditet innebär att fostret utförskaffas ur livmodern innan graviditetsvecka 22, spontant eller genom induktion. En inducerad abort kan ske medicinskt eller kirurgiskt. Cirka 56 miljoner aborter sker årligen i ett globalt perspektiv. Barnmorskan ska stödja kvinnan i abortvården samt verka för att ge jämställd och rättvis vård baserad på vetenskap och beprövad erfarenhet utifrån ett socialt-, ekonomiskt- och kulturellt perspektiv. Barnmorskan utvecklas i sin yrkesroll genom kunskap och erfarenhet. Syfte: Syftet med studien är att belysa kvinnors erfarenheter av medicinsk- eller kirurgisk abort i ett globalt perspektiv. Metod: Studien genomfördes som en metasyntes med kvalitativ ansats. Femton (15) vetenskapliga artiklar utgör resultatet. Resultat: Fyra huvudkategorier identifierades otillgänglighet och konsekvenser för kvinnan, ekonomiska faktorer, stigma samt autonomi. Resultatet visar att kvinnorna upplever att restriktiv lagstiftning skapar en stor oro och kan ge desperation. Detta kan innebära att många kvinnor söker sig till osäkra alternativ om tillgången på säker abortvård inte finns tillgänglig. Aborten hade negativa ekonomiska konsekvenser för kvinnorna. Att få bestämma över sin egen kropp och känslan av kontroll var en viktig del i abortbeslutet för kvinnan. Slutsats: Brist på ekonomiska tillgångar och stigma gör att många kvinnor söker sig till osäkra abortalternativ. Den enskilda kvinnan bör få ta beslut som rör hennes egen kropp och själv besluta om när hon önskar skaffa barn vilket innebär att tillgängligheten på säker abortvård måste öka. Klinisk tillämpbarhet: Studien kan användas för att ge ökad kunskap om kvinnors upplevelser och erfarenheter vilket kan leda till en mer tillgänglig abortvård för kvinnor i ett globalt perspektiv. / Background: Termination of pregnancy is when a fetus is removed from the uterus before pregnancy week 22, spontaneously or through induction. An induced abortion can be performed either medical or surgical. In a global perspective, each year around 56 million abortions are performed. The role of the Midwife in abortion care is to support the woman aiming to offer equal and equitable care based on proven experience and with a social-, economical- and cultural perspective. The professional skills of the midwife is developing through knowledge and experience. Objective: The aim of the study was to identify womens experiences of medical- or surgical abortion in a global perspective. Method: The study was conducted as a qualitative metasynthesis. Fifteen (15) scientific articles were included in the result. Result: Four main categories were identified inaccessibility and consequences for the woman, economical factors, stigma and autonomy. The result shows that the women experience that restrictive legislations makes women anxious and instill feelings of desperation. Many women are considering unsafe alternatives when safe abortion care isn’t accessible. The abortion had negative financial consequences for the women. To decide about their own body and having a feeling of control was an important part in the decision of abortion for the woman. Conclusion: Lack of financial assets and stigma means that many women seek unsafe abortion options. The individual woman should be able to make decisions concerning her own body and decide for herself when she wants to have children, which means that access to safe abortion care must increase. Clinical applicability: The study can be used to provide increased knowledge about womens experiences which can lead to a more accessible abortion care for women in a global perspective.

Le sujet de l’avortement provoqué demeure encore tabou au Togo et la compréhension du phénomène reste incomplète. La présente étude vise à dresser un portrait complet de ses divers aspects dans la capitale togolaise, qui a connu une baisse importante de la fécondité au cours des dernières années. À partir des données des Enquêtes démographiques et de santé (EDS) de 1988 et 1998, et de celles de l’Enquête sur la planification familiale et l’avortement provoqué (EPAP) de 2002, l’étude montre que le recours à l’avortement est à la hausse à Lomé, bien que l’estimation de son ampleur dépende de la méthode utilisée. Plus de 32 % des femmes ayant déjà été enceintes ont déclaré avoir avorté au moins une fois. Toutefois, l’avortement est plus fréquent chez les jeunes, qui y ont recours de manière plus précoce et plus rapprochée que leurs aînées. En contribuant ainsi à la régulation des naissances, l’avortement réduit la fécondité de 10 à 12 %. En utilisant les données de l’EPAP, réalisée auprès de 4755 femmes âgées de 15-49 ans, nous avons aussi étudié le recours à l’avortement comme une séquence d’étapes débutant par l’exposition au risque de grossesse jusqu’au recours à l’avortement, en passant par une absence de pratique contraceptive et le fait qu’une grossesse qui survient soit déclarée « non désirée ». L’ethnie et la génération sont associées à certaines étapes de la séquence alors que la religion, la parité, le statut matrimonial et le niveau d’instruction sont associés aux quatre étapes. Ainsi, le risque élevé d’avorter chez les femmes instruites découle en fait de leur risque élevé à toutes les étapes. En étant moins à risque de grossesse, les femmes qui ont au moins deux enfants sont plus susceptibles que les nullipares, d’utiliser une contraception moderne, de déclarer une grossesse comme non désirée et d’avorter. Si plusieurs grossesses non désirées surviennent aux âges jeunes, c’est surtout le caractère « hors union » de la grossesse qui fait qu’elle est considérée comme « non désirée » et interrompue. En outre, les femmes qui ont déjà avorté ou utilisé une contraception sont plus enclines à recourir à un avortement. Les résultats montrent également que le partenaire soutient souvent la femme dans la décision d’avorter et s’acquitte des coûts dans la majorité des cas. Malgré le fait qu’ils soient illégaux, plus de 40 % des avortements sont pratiqués à Lomé dans des centres de santé, par un membre du personnel médical, et à l’aide du curetage ou de l’aspiration. Mais, la moitié de ces avortements (22 %) avait été tentée au préalable par des méthodes non médicales. Plusieurs avortements ont aussi lieu soit à domicile (36 %), soit chez des tradi-thérapeutes (24 %), grâce à des méthodes non médicales. Par ailleurs, près de 60 % des avortements ont entraîné des complications sanitaires, conduisant la majorité des femmes à une hospitalisation. Sur le plan psychologique et relationnel, nous avons montré que la plupart des avortements ont entraîné des regrets et remords, de même que des problèmes entre les femmes et leurs parents. Les parents soutiennent en fait peu les femmes dans la décision d’avorter et interviennent rarement dans le paiement des coûts. L’étude a enfin révélé que la loi sur l’avortement est peu connue. Cependant, être âgée de 25 ans ou plus, en union ou très instruite, connaître des méthodes contraceptives, le recours d’une parente ou amie à l’avortement sont associés, toutes choses égales par ailleurs, à une plus grande chance de connaître la loi. L’analyse, en appuyant des déclarations des professionnels de la santé et des femmes, montre que malgré sa forte prévalence à Lomé, le recours à l’avortement demeure largement stigmatisé. Les quelques professionnels et femmes qui se sont prononcés en faveur de sa légalisation pensent que celle-ci permettrait de « réduire les avortements clandestins et risqués ». En fait, ce sont les femmes les plus instruites, âgées de 25 ans ou plus, utilisant la contraception, ayant déjà avorté ou connaissant quelqu’un l’ayant fait, qui sont plus aptes à approuver la légalisation de l’avortement. Celles qui appartiennent aux églises de type « pentecôtiste », plus sévères quant aux relations sexuelles hors mariage, sont par contre moins susceptibles que les catholiques d’avoir une telle attitude positive. / Induced abortion remains a taboo topic in Togo and the understanding of the phenomenon is still incomplete. This study aims to provide more complete portrait of its various aspects in the Togolese capital city, Lomé, where an important decrease in fertility has occurred during recent years. Using data from the 1988 and 1998 Demographic and Health Surveys (DHS) and from the 2002 Survey on Family Planning and Induced Abortion (EPAP), results clearly show that induced abortion prevalence has increased in Lomé, although the estimate of its magnitude depends on the method used. Overall, more than 32 % of ever-pregnant women declare having had at least one abortion. However, abortion is more common among young women, who make use of it at an earlier age and more frequently than older women. The intensity of abortion should then reduce fertility by 10 to 12 %. Using data from EPAP, conducted among 4755 women aged 15-49, we approached the abortion as a sequence of stages beginning with exposure to a pregnancy, going through a lack of contraceptive use and a declaration of a pregnancy as “unwanted” by the woman, and ending with abortion. While ethnicity and generation influence certain stages leading to the abortion, women’s religion, marital status and age, educational attainment and parity have significant association with all four stages. Thus, the expected high risk of abortion among educated women results from their higher likelihood at all stages. Even if they are less at risk of a pregnancy, women who have at least two children are more likely to use modern contraception, to declare a pregnancy as unwanted and to end it through abortion, compared to childless women. Even if several unwanted pregnancies occur at younger ages, it is mainly the “out of wedlock” character of the pregnancy that leads it to be considered as unwanted and to be interrupted. In addition, women who had a previous abortion or who used contraception are more likely to resort to abortion. The study also shows that the partner often supports the woman in the abortion decision-making process, and, in most cases, he pays the related costs. Even though they are clandestine, more than 40 % of abortions in Lomé are performed in healthcare centers by medical staff, and by using curettage or aspiration. However, in half of these cases (22 %), abortions had been previously attempted using non-medical methods. Probably to keep the abortion secret, many abortions also take place either at home (36 %) or through traditional therapists (24 %) using non-medical abortion methods. Consequently, almost 60 % of abortions resulted in health complications, leading the majority of women to hospitalization. On the psychological and relational side, we find that most women who have had abortions express regrets and remorse, and also commonly speak of problems between themselves and their parents. In fact, parents are rarely involved in the abortion decision-making and almost never pay the abortion fees. Finally, this study shows that the abortion law is barely known in Lomé. However, being older than 24 years, in a relationship or highly educated, having knowledge of contraceptive methods, having a relative or a friend who had an abortion are associated, other factors being equal, to a better knowledge of the law. By supporting qualitative statements from health professionals and women, the analysis illustrated that, despite its high prevalence in Lomé, abortion remains widely stigmatized. The few professionals and women, who are in favour of its legalization, believe that this would “reduce illegal and unsafe abortions”. Opinion on the legalization of abortion, which remains a sensitive and little studied topic, is influenced by women’s characteristics, especially their religion. In fact, women attending “Pentecostal churches”, which are less tolerant of sexual relations outside marriage, are less likely than Catholics to approve the legalization of abortion. The most educated and older women, those who use contraception, who had an abortion or know someone who had an abortion, are also more likely to have such positive attitude.

Reproductive health and induced abortion in Latin America and the Caribbean Abstract The objective of this study is to give a comprehensive overview of the reproductive health of the population living in Latin America and the Caribbean, and to evaluate the level of induced abortion in the region at the same time. In the theoretical part of the study the term reproductive health is defined and indicators evaluating its level are described. As well the difference between safe and unsafe abortion is explained and the state of abortion law is expounded in this part. Next part is devoted to the promotion of family planning programs. In the analytical part Latin American and Caribbean countries are divided into four groups by using cluster analysis. Within each group one selected country is characterized in more detail. Indicators entering into the analysis show the level of reproductive health, the level of fertility and the economic performance of countries in the early 21st century. In the part related to the induced abortion rate in the region is discovered that despite the fact that in Latin America and the Caribbean there is one of the highest levels of contraceptive prevalence, there is also the highest level of induced abortion in the world. In the last part of the study the relationship between level of...

Einleitung: Nach einer kontrovers diskutierten Einführung von Mifepriston im Jahre 1999 in Deutschland weisen die niedrigen Anwendungszahlen auf eine zögerliche Etablierung hin. Aufgrund der aktiven Einbeziehung der Frau in die Durchführung des Schwangerschaftsabbruches wird oft eine erschwerte emotionale Verarbeitung vermutet. Wir untersuchten die psychische Belastung vor und nach medikamentösem und chirurgischem Abbruch. Methoden: 147 Frauen mit gewähltem medikamentösen und 72 Frauen mit chirurgischem Abbruch wurden vor und vier Wochen nach dem Eingriff befragt. Neben demographischen Aspekten, Beweggründen, Kriterien der Methodenauswahl und medizinischen Details wurden die deutsche Fassung der Hospital Anxiety and Depression Scale (HADS) und der Impact of Event Scale (IES) verwendet. Ergebnisse: Die demographischen Angaben zeigten keine Unterschiede zwischen den Anwenderinnen beider Methoden. Bei einem Vergleich der Ergebnisse der HADS vor und vier Wochen nach dem Abbruch zeigte sich ein signifikanter Abfall der Werte für Angst und Depression bei beiden Methoden. Die Anwenderinnen von Mifepriston wiesen jedoch deutlich seltener erhöhte Angstwerte vor dem Schwangerschaftsabbruch auf. Vier Wochen später zeigten die Werte für Angst und Depression keine signifikanten Unterschiede zwischen beiden Verfahren mehr. Auf den Skalen der IES wurde ein geringeres Ausmaß von erlebter Intrusion und Vermeidungshaltung bei den Frauen der medikamentösen Methode gefunden. Im Vergleich deutlich stärker waren die erlebten Blutungen, Schmerzen und Nebenwirkungen bei der Anwendung von Mifepriston. Dieses hatte jedoch weder einen negativen Einfluss auf die psychische Verarbeitung des Ereignisses noch auf die hohe Akzeptanz der Methode. Eine überwältigende Mehrheit der Frauen beider Methoden schätzte es als außerordentlich wichtig ein, zwischen verschiedenen Methoden wählen zu können. In einer hypothetischen Zukunftssituation würden sich 80,3 % der Frauen nach medikamentöser Methode und 62,9 % der Frauen nach chirurgischer Methode wieder für die gleiche Methode entscheiden. Schlussfolgerung: Unsere Untersuchung belegt die in anderen Studien allgemein geteilte Auffassung, dass die Beendigung einer ungewollten Schwangerschaft unabhängig von der durch die Frau gewählten Methode eine positive erste Konfliktlösung bedeutet. Die positiven Ergebnisse der psychischen Verarbeitung und die hohe Zufriedenheit der Anwenderinnen unterstreicht die Notwendigkeit einer Aufrechterhaltung der Auswahlmöglichkeit zwischen verschiedenen Methoden zur Schwangerschaftsbeendigung und einer verbesserten Zugänglichkeit zur medikamentösen Methode mit Mifepriston in Deutschland. / Introduction: After a controversial introduction of medical abortion with mifepristone in 1999 this method is still not widely available in Germany. Because of the active participatory role of the women many doctors fear a higher rate of psychological sequelae after an abortion with mifepristone. In our study we compared the coping process of women who chose the medical procedure to terminate an unwanted pregnancy with others who opted for surgical abortion. Methodology: Women were asked before and four weeks after the procedure to complete a questionnaire covering demographic data, motivation, medical details and social support. Additionally, the women completed the German Version of the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). The following evaluation compares the data of 147 women who chose medical abortion with the results of 72 women who preferred a surgical abortion. Results: No significant differences were found for the demographic background of the women using the two different methods. Comparing data before and a month after the abortion, our study shows a significant decline of both anxiety and depression for both methods. Women using the abortion with mifepristone showed significantly lower entrance levels on the anxiety subscale than the surgical group. There were no significant differences in post-abortion anxiety and depression levels. For the IES, women choosing medical abortion scored significantly lower on the intrusion and avoidance subscales than the women opting for surgical abortion. Women using mifepristone experienced significantly more bleeding, pain and other side effects. However, these side effects did neither show a negative influence on the psychological coping nor on the high acceptability of mifepristone. An overwhelming majority of women in both groups evaluated choosing between different abortion methods as being highly important to them. 80,3 % of the women after medical abortion with mifepristone and 62,9 % of the women after surgical abortion would chose the same method again. Conclusions: Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.