Ba Djibril M, Zhang Yue, Pasha-Razzak Omrana, Khunsriraksakul Chachrit, Maiga Mamoudou, Chinchilli Vernon M, Ssentongo Paddy
Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America.
Department of Medicine, Division of Hospital Medicine, Penn State Health Medical Center, Hershey, Pennsylvania, United States of America.
PLOS Glob Public Health. 2023 Feb 28;3(2):e0001509. doi: 10.1371/journal.pgph.0001509. eCollection 2023.
Lack of access to safe, affordable, timely and adequate pregnancy termination care, and the stigma associated with abortion in low-middle income countries (LMICs), pose a serious risk to women's physical and mental well-being throughout the lifespan. Factors associated with pregnancy termination and their heterogeneity across countries in LMICs previously have not been thoroughly investigated. We aim to determine the relative significance of factors associated with pregnancy termination in LMICs and its variation across countries. Analysis of cross-sectional nationally representative household surveys carried out in 36 LMICs from 2010 through 2018. The weighted population-based sample consisted of 1,236,330 women of childbearing aged 15-49 years from the Demographic and Health Surveys. The outcome of interest was self-report of having ever had a pregnancy terminated. We used multivariable logistic regression models to identify factors associated with pregnancy termination. The average pooled weighted prevalence of pregnancy termination in the present study was 13.3% (95% CI: 13.2%-13.4%), ranging from a low of 7.8 (95% CI: 7.2, 8.4%) in Namibia to 33.4% (95% CI: 32.0, 34.7%) in Pakistan. Being married showed the strongest association with pregnancy termination (adjusted OR, 2.94; 95% CI, 2.84-3.05; P < 0.001) compared to unmarried women. Women who had more than four children had higher odds of pregnancy termination (adjusted OR, 2.45; 95% CI, 2.33-2.56; P < 0.001). Moreover, increased age and having primary and secondary levels of education were associated with higher odds of pregnancy termination compared to no education. In this study, married women, having one or more living children, those of older age, and those with at least primary level of education were associated with pregnancy termination in these 36 LMICs. The findings highlighted the need of targeted public health intervention to reduce unintended pregnancies and unsafe abortions.
在低收入和中等收入国家（LMICs），缺乏安全、可负担、及时且充分的终止妊娠护理，以及与堕胎相关的污名，对女性一生的身心健康构成严重风险。此前，低收入和中等收入国家中与终止妊娠相关的因素及其在不同国家的异质性尚未得到充分研究。我们旨在确定低收入和中等收入国家中与终止妊娠相关因素的相对重要性及其在不同国家的差异。对2010年至2018年在36个低收入和中等收入国家进行的具有全国代表性的横断面家庭调查进行分析。基于人口的加权样本包括来自人口与健康调查的1236330名15 - 49岁育龄妇女。感兴趣的结果是曾经终止妊娠的自我报告。我们使用多变量逻辑回归模型来确定与终止妊娠相关的因素。本研究中终止妊娠的平均合并加权患病率为13.3%（95%置信区间：13.2% - 13.4%），范围从纳米比亚的低至7.8（95%置信区间：7.2，8.4%）到巴基斯坦的33.4%（95%置信区间：32.0，34.7%）。与未婚女性相比，已婚与终止妊娠的关联最强（调整后的比值比，2.94；95%置信区间，2.84 - 3.05；P < 0.001）。有四个以上孩子的女性终止妊娠的几率更高（调整后的比值比，2.45；95%置信区间，2.33 - 2.56；P < 0.001）。此外，与未接受教育相比，年龄增长以及接受小学和中学教育与终止妊娠的几率更高相关。在这项研究中，在这36个低收入和中等收入国家，已婚女性、有一个或多个在世子女、年龄较大以及至少接受小学教育的女性与终止妊娠有关。研究结果强调了有针对性的公共卫生干预措施对于减少意外怀孕和不安全堕胎的必要性。
