A study of the costs of postabortion care and legal abortion in Colombia by Elena Prada and colleagues reports that the country’s health system could greatly reduce its expenditures on these services without sacrificing quality of care by performing them at primary-level facilities rather than at the secondary or tertiary facilities where most such services are now provided [page 114]. For example, the average cost of a legal abortion at secondary and tertiary facilities in 2012 was US$200, compared with $45 in primary-level private clinics. According to the authors, medical providers at higher-level facilities routinely use dilation and curettage (D&C)—which is costly because it is time-consuming, requires general anesthesia and, in Colombia, often an overnight stay after an abortion. In contrast, the cost at primary-level private clinics, which provide outpatient services only and routinely use manual vacuum aspiration and medication abortion, was only $45.
Seasonal migration is common among men in many former Soviet republics, but little research has examined contraceptive use and abortion among women in such low-fertility, high-migration settings. According to a study conducted in rural Armenia by Arusyak Sevoyan and Victor Agadjanian, the odds of a woman’s pregnancy ending in abortion are associated with her household’s economic well-being, but not with her husband’s migration status [page 124]. Using data from two surveys among married women aged 18–45 in rural areas—one conducted in 2005 and another in 2007—the authors found that with increased household wealth, modern contraceptive use rose among women with a nonmigrant husband, but decreased slightly among women with a migrant husband. The researchers comment that there is a great need for programs that promote the benefits of using modern contraceptives rather than abortion for fertility control.
Can unmet need be reduced more effectively by making modern contraceptives available to women who have never used them, despite not wanting to become pregnant, or by supporting current users and encouraging women who have discontinued to resume use? Using data collected from married women in Demographic and Health Surveys conducted in 34 developing countries between 2005 and 2010, Anrudh K. Jain and colleagues examined the contribution of discontinuation of modern methods to unmet need at the time of the survey and in the future [page 133]. According to their calculations, women who had stopped use of a modern method, but said at the time of the survey that they did not want to have a child for at least two years, accounted for 38% of unmet need. These past users made up 19% of women who had ever used a modern method, suggesting that nearly one in five current and new users will eventually discontinue and have unmet need. The authors believe unmet need can best be reduced by addressing women’s reasons for stopping modern method use, such as side effects and the lack of a method appropriate for their situation and reproductive goals. They recommend increasing the range of methods available and improving quality of care and client-provider interactions.
A study by Sushanta K. Banerjee and colleagues finds that women in rural areas of Bihar and Jharkhand where public awareness campaigns had been conducted were significantly more likely to know that abortion is legal and where to obtain safe abortion services than women in areas without such an intervention [page 142]. On the basis of data from household surveys administered to rural, married women aged 15–49 in 2008 and in 2010, the study also found a greater increase in women’s confidence in their ability to make decisions and take action regarding family planning and abortion in areas where interventions had been conducted. The authors recommend using multiple messages, in different formats, when trying to improve knowledge and perceptions about stigmatized health issues such as abortion.
In a study by Kristin N. Mmari and colleagues, young Ugandan women who had not lived with both parents at age 11 or 12 were more likely than those who had to have had sex before age 15 and to have undergone sexual coercion at first sex. Using data on sexually experienced females aged 15–24 from an ongoing community cohort study in Rakai, the researchers also found that among those who had not been coerced at first sex, young women whose mother had some secondary education and whose female caregiver did not consume alcohol were more likely to have used a condom at first sex. The authors recommend that reproductive health interventions to delay the start of adolescent sexual activity, prevent sexual coercion and encourage condom use target both adolescents and their parents. —The Editors