Even in countries where abortion is legal, obtaining the procedure early in pregnancy can be difficult, especially for young, unmarried women. India is a case in point. In a study conducted by Shveta Kalyanwala and colleagues in two northern states, 91% of 549 15–24-year-olds who obtained abortions at clinics run by the nongovernmental organization Janani said they had realized they were pregnant during the first trimester of pregnancy, but only 75% obtained an abortion before entering the second trimester [see article]. The risk of having a second-trimester abortion declined with increasing age and education. However, compared with other young women, those who lived in rural areas, those who did not receive both emotional and financial support from their partner and those whose pregnancy resulted from a forced sexual encounter were more likely to have a second-trimester abortion.
STIs, which can have long-lasting consequences for health and fertility, are common among youth in developing countries. In most cases, the severity of these consequences depends on how quickly the infection is diagnosed and treated, yet little is known about whether and how youth seek health care for STIs and whether their care- seeking behavior differs by sex. Of 538 Nigerian males and females aged 15–24 who participated in nationally representative reproductive health surveys in 2003 and 2005, males were more likely than females to have sought treatment for their STI symptoms (64% vs. 48%), according to a study by Kristen Mmari and colleagues [see article]. The majority of females had sought care from a formal source, usually a government clinic, while the majority of males had sought care from an informal source, generally a traditional healer. The authors note that if STI treatment among youth in Nigeria is to be increased, interventions must be designed differently for males and females.
Fertility has dropped sharply in Vietnam over the last three decades, to 1.6 children per woman overall, but varies widely across the country's 54 ethnic groups. Using data for the five years preceding the 2001 Vietnam National Health Survey, Bussarawan Teerawichitchainan and Sajeda Amin examine the extent to which ethnic groupings (broadly defined by measures of poverty, geography and assimilation) have relied on contraceptive use and abortion to control fertility, as well as the implications of this information for family planning policies and programs [see article]. Compared with women in the group comprising the Kinh majority and Chinese minority (total fertility rate, 1.5), minority women in the central highlands and the northern uplands, with TFRs of 2.8 and 2.6, respectively, were less likely to have used modern or traditional contraceptive methods (odds ratios, 0.4 and 0.7 for each geographic grouping) and less likely to have had an abortion (0.2 and 0.6, respectively). The odds of having an abortion were elevated among women who were older, were better educated, had 1–2 children and were part of socioeconomically advantaged ethnic groups. Abortion rates were higher among women who used traditional methods than among those who used modern methods. Noting that members of more privileged ethnic groups have achieved replacement level fertility by combining traditional method use with abortion as a backup—largely because of the limited range of modern methods available and lack of counseling on how to use them effectively—the authors suggest that improved family planning services will be needed to complete Vietnam's fertility transition.
Pelvic pain conditions are common among Mexican women, but have not been a high priority because they are not life-threatening. According to a population-based study conducted by Hilda García-Pérez and colleagues in Hermosillo, 40% of women reported menstrual pain, 12% pain with or following intercourse and 6% chronic pelvic pain [see article]. Of these women, 10–26% reported that pelvic pain interfered with their work and 9–24% said it interfered with their home and social activities. Nevertheless, due to the social taboo on discussing matters related to sexuality, only 25% of women with menstrual pain and 23% of those with intercourse-related pain had talked to a doctor about their condition in the year before the survey, compared with 40% of women with chronic pelvic pain. The researchers recommend a more proactive medical practice in the assessment of pelvic pain, particularly in the evaluation of pain with intercourse."
The abortion rate in the republic of Georgia is the highest documented in the world. Florina Serbanescu and colleagues used information from national household surveys in 1999 and 2005 to identify possible ways of preventing unintended pregnancy and abortion [see article]. According to data from the 60 months before each survey, contraceptive prevalence among married women rose by 23% and the abortion rate decreased by 15% between the surveys. Both analytic approaches showed that nonuse of any method of family planning was the main determinant of the high unintended pregnancy rate and that the recent increase in use of modern methods explained 54% of the recent drop in abortion. The authors note that Georgian women's high rates of unintended pregnancy reflect that use of traditional methods is almost as prevalent as use of modern methods, and that more than half of women use no method at all. "Efforts to prevent unintended pregnancies," they say, "must reduce inequities in family planning access, method cost and information availability."