巴基斯坦的堕胎与意外怀孕：2023年的新证据及过去十年的趋势
Abortion and unintended pregnancy in Pakistan: new evidence for 2023 and trends over the past decade.
作者信息
Sathar Zeba, Singh Susheela, Shah Iqbal H, Niazi Muhammad Rehan, Parveen Tahira, Mulhern Octavia, Mir Ali Mohammad
机构信息
Population Council Pakistan Office, Islamabad, Pakistan.
Guttmacher Institute, New York, New York, USA
出版信息
BMJ Glob Health. 2025 Jan 30;10(1):e017239. doi: 10.1136/bmjgh-2024-017239.
BACKGROUND
Despite induced abortion being highly legally restricted in Pakistan, studies in 2002 and 2012 showed that many women rely on abortion when faced with an unintended pregnancy. Following the 2012 study, concerted efforts were made to improve contraceptive services and to strengthen postabortion care. The availability and use of misoprostol also expanded in the past decade. Our primary objective was to provide new evidence on the rates of unintended pregnancy, induced abortion and postabortion care in 2023 and to assess trends in these outcomes since 2012.
METHODS
This is a cross-sectional study based on a Health Professional Survey, and a nationally representative Health Facilities Survey, conducted in 2023. A widely applied methodology is used to estimate rates of abortion and unintended pregnancy. Data sources and methods are comparable across the 2012 and 2023 studies.
RESULTS
In 2023, an estimated six million unintended pregnancies occurred and 64% of them or 3.8 (95% CI 2.2 to 6.4) million resulted in induced abortions. This corresponds to an annual unintended pregnancy rate of 100 and an induced abortion rate of 66 (95% CI 38 to 111) per 1000 women aged 15-49. There was no significant change in the unintended pregnancy rate, but the abortion rate increased by 25% between 2012 and 2023. In 2023, 697 913 women were treated for postabortion complications, corresponding to an annual rate of 12.1 (95% CI 6.4 to 16.5) per 1000 women ages 15-49. This treatment rate declined by 16% between 2012 and 2023.
CONCLUSIONS
The unintended pregnancy rate has remained stable in the past decade. However, Pakistani women are increasingly relying on abortion to resolve unintended pregnancy. The treatment rate of postabortion complications has declined, owing largely to widespread access to misoprostol. This transformation of the abortion landscape calls for concerted efforts to increase contraceptive use and strengthen postabortion care.
背景
尽管在巴基斯坦人工流产受到严格法律限制，但2002年和2012年的研究表明，许多女性在面临意外怀孕时会选择人工流产。2012年的研究之后，人们齐心协力改善避孕服务并加强流产后护理。米索前列醇的可及性和使用在过去十年中也有所增加。我们的主要目标是提供2023年意外怀孕、人工流产和流产后护理发生率的新证据，并评估自2012年以来这些结果的趋势。
方法
这是一项基于2023年进行的卫生专业人员调查和具有全国代表性的卫生设施调查的横断面研究。采用广泛应用的方法来估计人工流产和意外怀孕的发生率。2012年和2023年研究的数据来源和方法具有可比性。
结果
2023年，估计发生了600万例意外怀孕，其中64%（即380万例，95%置信区间为220万例至640万例）导致了人工流产。这相当于15至49岁女性的年意外怀孕率为每1000人中有100例，人工流产率为每1000人中有66例（95%置信区间为38例至111例）。意外怀孕率没有显著变化，但2012年至2023年期间人工流产率上升了25%。2023年，有697913名女性接受了流产后并发症治疗，相当于15至49岁女性的年治疗率为每1000人中有12.1例（95%置信区间为6.4例至16.5例）。2012年至2023年期间，这一治疗率下降了16%。
结论
在过去十年中，意外怀孕率一直保持稳定。然而，巴基斯坦女性越来越依赖人工流产来解决意外怀孕问题。流产后并发症的治疗率有所下降，这在很大程度上归因于米索前列醇的广泛可及性。人工流产情况的这种转变需要共同努力来增加避孕措施的使用并加强流产后护理。
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