AIM: The aim of this study was to analyse whether immigrant women request induced abortion more frequently than Swedish-born women and, if so, to study possible explanations, including contraceptive practices and attitudes. METHODS: All women who requested induced abortion during a period of one year were included in the study. The 1289 women, of whom 36% were born outside Sweden, were interviewed by a nurse-midwife who, using a structured protocol, gathered information on socioeconomic factors, reasons for abortion, experience of contraceptive methods, and family planning counselling. The proportion of women with non-Swedish origin in the study population was compared with the official demographic statistics of the corresponding area. RESULTS: The number of women born outside Sweden who requested induced abortion was larger than expected from their proportion in the population. The immigrant women originated from 77 countries and four continents, the largest subgroup, 11%, coming from Iran. Immigrant women had less experience of contraceptive use, more previous pregnancies and more induced abortions than women born in Sweden. In a multivariate analysis, immigrant status and educational level were found to be independent risk factors for repeat abortion. CONCLUSION: Immigrant status seems to be an independent risk factor for induced abortion. The immigrant women originated from a wide range of cultures. There is no reason to believe that the women in this heterogeneous group should have any cultural factor in common that could explain their higher proneness to seek induced abortion. The most probable cause is that immigrant status is associated more often with low education, weak social network, poverty, unemployment, and being outside common pathways to healthcare.
STUDY OBJECTIVE: To analyze if immigrant girls request early pregnancy termination more frequently than ethnic Swedish girls and, if so, study possible explanations, including contraceptive practices and attitudes. DESIGN AND PARTICIPANTS: All women under 19 years of age who attended a large abortion clinic during one year were interviewed. Out of 126 adolescents, 36% were born outside Sweden. The immigrant girls (37 born abroad and 23 with at least one parent born abroad) were compared to 66 ethnic Swedish girls regarding contraceptive habits, reasons for abortion and social factors. RESULTS: The proportion of adolescents born abroad was larger than expected: 38 (29%) were born outside Sweden, compared to 18% in corresponding areas of Stockholm. The ethnic Swedish girls had fewer previous pregnancies than first and second generation immigrants and had more experience of contraceptive counselling. The most common reason for abortion in both groups was the wish to finish education. Ethnical Swedish girls claimed young age as reason for abortion more often than immigrants; economic reasons and reasons related to partner relationship were also common. CONCLUSION: First generation immigrant girls are over-represented among adolescents who seek termination of pregnancy. This can be explained by the fact that the immigrant girls had less experience of contraceptive use and contraceptive counselling than ethnical Swedish girls.
This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.
Improvements in the clinical management of CDH have led to overall improved reported result from single institutions. However, population-based studies have highlighted a hidden mortality.
To explore the incidence in Sweden and to address the hidden mortality for CDH during a 27-year period in a population-based setting.
This is a population based cohort study that includes all patients diagnosed with CDH that were registered in the National Patient Register, the Medical Birth Register, the Register of Congenital Malformations and the Register for Causes of Death between 1987 and 2013. The mortality rates were calculated based on the number deaths divided by the number of live born cases. The hidden mortality was defined as the number of CDH cases that were not born (because of TOP or IUFD), cases of neonatal demise during birth or demise the same day of birth in patients who were in peripheral institutions and who never reached tertiary centers.
In total, 861 CDH patients were born in Sweden between 1987 and 2013, which corresponds to an incidence of 3.0 born CDH per 10,000 live births. When adding the cases of TOP and IUFD, the total incidence of CDH in Sweden was 3.5/10,000 live born. The mortality rate between 1987 and 2013 was 36%: 44% during the first time period 1987-1999 and 27% in the later period 2000-2013. The hidden mortality in the second period was 30%, resulting in a total mortality rate of 45%.
The incidence of CDH during a 27-year period remained unchanged in the population. However, we observed a decrease in the prevalence because of the increasing numbers of TOP. A significant hidden mortality exists, with overall mortality rate of 45% for CDH in this population.
To study changes in adolescent sexual behavior in periods of increase (1994-2000) and decrease (2001-2007) in the abortion rate.
School surveys with self-administered questionnaires were carried out annually among eighth graders (mean age 14.8 years) and ninth graders (mean age 15.8 years) (N=286,665) in 1996/1997 and 2006/2007. Schools participated biennially. The proportions of respondents reporting noncoital (kissing, light petting, heavy petting) and coital (ever had sexual intercourse, intercourse at least 10 times, at least three partners) sexual experience and nonuse of contraception were studied.
Among adolescents, both coital and noncoital sexual experiences and the proportion of those not using contraception increased between 1996-1997 and 2000-2001 (P for trend
In Sweden, society's attitudes towards teenage sexual relationships are liberal, and sexual and reproductive health issues are given high priority. Family and sex education has been taught in schools since the 1950s. The age of sexual consent is 15 years. Since 1975, abortion has been free on demand. Contraceptive counselling is free, easily available at family planning and youth health clinics. Screening for genital chlamydial infection is performed at these clinics, thus providing a "one stop shop" service. Condoms and oral contraception are available at low cost, emergency contraception is sold over the counter. Teenage childbearing is uncommon. However, sexual and reproductive health problems are on the increase among young people. During the 1990s, a period of economic stagnation in Sweden, schools have suffered budget cut backs. Sex education is taught less. Social segregation, school non-attendance, smoking, and drug use have increased. Teenage abortion rates have gone up, from 17/1000 in 1995 to 22.5/1000 in 2001. Genital chlamydial infections have increased from 14,000 cases in 1994 to 22,263 cases in 2001, 60% occurring among young people, and with the steepest increase among teenagers. Thus, a question of major concern is whether and how adolescent sexual behaviour has shifted towards more risky practices during the late 1990s.
According to official Swedish epidemiological figures, during 1996 the number of abortions increased for the first time in the 1990s, breaking a declining trend, especially among women under 24 years of age. In several European countries a similar increase was reported. The number of induced abortions declined by 16.1% during 1990-95, whereas it increased by 2.3% in 1996 compared to the previous year. The corresponding increase was 4.1% for teenagers and 2.5% for women in the 20-24 age group. In Norway, a 7.2% increase was reported in the first half of 1996 compared to the first half of 1995, although there, too, there had been a declining trend during the 1990s. Preliminary figures from Denmark indicate an increase of abortions to 18,022 for 1996 vs. 17,720 for 1995. Similarly, in Great Britain, in the first half of 1996, the figure increased by 10% compared with the same period in 1995. More than 90% of women in Sweden use or have used oral contraceptives (OCs); about 50% of women up to age 24 use them, and for women up to age 29 OCs also continue to be the most frequently used contraceptive. In October 1995, the World Health Organization published an extensive epidemiological study, which showed that low-dose OCs containing third-generation gestagens pose double the risk of deep venous thrombosis compared to low-dose OCs containing second-generation gestagens. Immediately after this alarming report the trend of declining abortions stopped and the users of OCs dropped from 440,000 before the report to 370,000 in 1996 in Sweden.