As 2015 approaches, concern is growing about whether many developing countries can attain the fifth Millennium Development Goal, which focuses on maternal health. Throughout the developing world, women still die in great numbers from complications of unsafe abortion, from lack of skilled obstetric care and other maternal health services and from limited access to services that would allow them to avoid unwanted and mistimed pregnancies. Pregnant adolescents—especially those who are HIV-positive—are particularly vulnerable when access to care is limited. The articles in this issue of International Perspectives on Sexual and Reproductive Health explore various facets of the circumstances that continue to expose women to these risks.
In the lead article, Elena Prada and colleagues estimate numbers and rates of abortion in Colombia for 2008 [see article]. Although abortion was made legal under limited circumstances in 2006, just 322 of the estimated 400,400 abortions performed in 2008 were legal. Noting that only one in nine of the Colombian health facilities sampled in the study offered legal abortion in 2009 and that the national family planning program has lost momentum in the last decade, the authors warn that unsafe abortion will continue to have a substantial impact on women's health until access to such services is increased.
The latest in a series of studies of family planning program effort conducted since 1972 indicates that on average, programs improved their effort levels slightly between 1999 and 2009 [see article]. Nevertheless, authors John Ross and Ellen Smith say, the average effort in 2009 was only about half of maximum, and neither scores for service nor those for access to contraceptives reached that level. According to the authors, countries have not yet ensured universal access to a wide range of long-term and short-term methods.
Abortion is severely restricted in Iran, and many women with an unwanted pregnancy resort to a clandestine, unsafe abortion. Using data from the 2009 Tehran Survey of Fertility, Amir Erfani estimates that about 11,500 abortions were performed in the city in the year before the survey and that 8.7 of every 100 known pregnancies ended in abortion [see article]. Fertility-related or socioeconomic reasons were cited by seven in 10 women who reported having an abortion. More than two-thirds of the pregnancies that were terminated resulted from method failure among women who reported using withdrawal, the pill or a condom.
Using data on 506 pregnancies among 393 HIV-infected adolescents aged 15–19 enrolled in HIV/AIDS programs in Kenya, Harriet Birungi and colleagues conducted analyses to identify variables associated with use of maternal health services—prenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, assistance during childbirth and other pregnancy outcomes, and postpartum and postabortion care—provided by health care professionals [see article]. The adolescents were more likely to obtain prenatal care than PMTCT services, but they received the recommended four prenatal visits for only 45% of their pregnancies. They were more likely to receive prenatal or PMTCT services when the man responsible for the pregnancy was their husband rather than someone else.
Also in This Issue
•In a Comment, Sara Seims discusses issues that limit the impact of reproductive health and rights funding provided by seven European donors, and suggests ways in which these issues can be ameliorated or resolved [see article].
•In "A Woman Cannot Die from a Pregnancy She Does Not Have"[see article], Nadia Diamond-Smith and Malcolm Potts argue that although improvements in obstetric care are greatly needed, such improvements will take time to implement widely and will be costly. In the meantime, they say, family planning programs can save many lives by preventing unsafe abortions of unwanted pregnancies, as well as pregnancies to women who are at high risk of obstetric complications.