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限制性堕胎法对撒哈拉以南非洲地区现代避孕措施使用的影响。

The role of restrictive abortion laws on modern contraceptive use in Sub Saharan Africa.

作者信息

Kumbeni Maxwell Tii, Bovbjerg Marit L, Harvey S Marie, Chi Chunhuei, Luck Jeff

机构信息

School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, Oregon, United States of America.

Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana.

出版信息

PLOS Glob Public Health. 2025 Jul 10;5(7):e0004875. doi: 10.1371/journal.pgph.0004875. eCollection 2025.

Abstract

Previous evidence found that restrictive abortion laws were associated with high incidence of unsafe abortions and abortion-related complications. But few studies have assessed the association of restrictive abortion laws with contraceptive use patterns. Our study examined the role of restrictive abortion laws on contraceptive use among women in Sub Saharan Africa (SSA). We performed secondary data analysis using the most recent Demographic and Health Survey data along with the 2022 abortion law classification data from the Center for Reproductive Rights (CRR) for 31 countries in SSA. Based on CRR classification, abortion restriction was categorized into three, ordinal levels; broadly liberal, moderately restrictive, and highly-restrictive laws. We conducted multivariable, multilevel logistic regression analysis to estimate odds ratios (OR) and 95% confidence intervals (CI). The analysis also included multivariable imputation by chained equations to account for missing data. A weighted sample of 453,195 women of reproductive age (15-49 years) were included. Thirty-nine percent and 49% of women lived in countries with moderately-and highly-restrictive abortion laws, respectively. Women in countries with moderately-and highly-restrictive abortion laws were 0.62 (95% CI: 0.58, 0.65) and 0.88 (95% CI: 0.83, 0.93) times as likely to use modern contraceptives, respectively, compared to women in countries with broadly liberal abortion laws. However, in countries that had policies that supported adolescents to access contraceptives, women overall were more likely to use contraceptives. Liberalizing abortion laws and implementing policies that support women's autonomy in contraceptive decision-making could enhance contraceptive use among women in SSA.

摘要

先前的证据表明,限制性堕胎法律与不安全堕胎及堕胎相关并发症的高发生率有关。但很少有研究评估限制性堕胎法律与避孕使用模式之间的关联。我们的研究探讨了限制性堕胎法律在撒哈拉以南非洲(SSA)女性避孕使用方面所起的作用。我们使用最新的人口与健康调查数据以及生殖权利中心(CRR)提供的2022年31个撒哈拉以南非洲国家的堕胎法律分类数据进行了二次数据分析。根据CRR的分类,堕胎限制被分为三个有序级别:广泛宽松、适度限制和高度限制的法律。我们进行了多变量、多层次逻辑回归分析以估计比值比(OR)和95%置信区间(CI)。分析还包括通过链式方程进行多变量插补以处理缺失数据。纳入了453,195名育龄(15 - 49岁)女性的加权样本。分别有39%和49%的女性生活在堕胎法律为适度限制和高度限制的国家。与堕胎法律广泛宽松的国家的女性相比,堕胎法律为适度限制和高度限制的国家的女性使用现代避孕方法的可能性分别为其0.62倍(95% CI:0.58, 0.65)和0.88倍(95% CI:0.83, 0.93)。然而,在那些有支持青少年获取避孕措施政策的国家,女性总体上更有可能使用避孕措施。放宽堕胎法律并实施支持女性在避孕决策中自主权的政策可以提高撒哈拉以南非洲女性的避孕使用率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67cc/12244480/0c3dbe35c1d6/pgph.0004875.g001.jpg

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