Sexual activity and pregnancy are rare among the youngest adolescents, whose behavior represents a different public health concern than the broader issue of pregnancies to older teens. Health professionals can improve outcomes for teenagers by recognizing the higher likelihood of nonconsensual sex among younger teens and by teaching and making contraceptive methods available to teen patients before they become sexually active.

Background Key sexual and reproductive health milestones typically mark changing life stages with different fertility intentions and family planning needs. Knowing the typical ages at such events contributes to our understanding of changes in family formation and transition to adulthood and helps inform needs for reproductive health services. Methods We used data from the 1982–2010 National Surveys of Family Growth and the 1995 National Survey of Adolescent Males and event history methods to examine trends over time for women and men in the median ages at several reproductive and demographic events. Findings Women’s reports indicate that age at menarche has changed little since 1951. Women’s and men’s median ages at first sex declined through the 1978 birth cohort, but increased slightly since then, to 17.8 for women and 18.1 for men. The interval from first sex to first contraceptive use has narrowed, although Hispanic women have a longer interval. Age at first union (defined as the earlier of first marriage and first cohabiting relationship) has remained relatively stable, but the time between median age at first sex and median age at first birth has increased to 9.2 years for women and 11.4 for men. For some women and men born in the late 1970s, median age at first birth is earlier than median age at first marriage for the first time in at least the past several decades. Conclusion The large majority of the reproductive years are spent sexually active. Thus, women have a lengthy period during which they require effective methods. In particular, the period between first sex and first childbearing has lengthened, but long-acting method use, although increasing, has not kept up with this shift. Moving the contraceptive method mix toward underutilized but highly effective contraceptive methods has the potential to reduce the unintended pregnancy rate.

BackgroundTanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence.ObjectivesTo provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar).MethodsA nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology.ResultsIn Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15–49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone.ConclusionsThe abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies.

This report represents the first comprehensive compilation of information about abortion in Sub-Saharan Africa and its four subregions. It offers a panorama of this hard-to-measure practice by assembling data on the incidence and safety of abortion, the extent to which the region’s laws restrict abortion, and how these laws have changed between 2000 and 2019. Many countries in this region have incrementally broadened the legal grounds for abortion, improved the safety of abortions, and increased the quality and reach of postabortion care. There is still much progress to be made, however, including enabling the region’s women to avoid unintended pregnancies and unsafe abortions. The report concludes with recommendations for a broad range of actors to improve the sexual and reproductive health and autonomy of the region’s 255 million women of reproductive age.

CONTEXT-National and state-level information about abortion incidence can help inform policies and programs intended to reduce levels of unintended pregnancy.METHODS-In 2015-2016, all U.S. facilities known or expected to have provided abortion services in 2013 or 2014 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. The number of abortionproviding facilities and changes since a similar 2011 survey were also assessed. The number and type of new abortion restrictions were examined in the states that had experienced the largest proportionate changes in clinics providing abortion services.RESULTS-In 2014, an estimated 926,200 abortions were performed in the United States, 12% fewer than in 2011; the 2014 abortion rate was 14.6 abortions per 1,000 women aged 15-44, representing a 14% decline over this period. The number of clinics providing abortions declined 6% between 2011 and 2014, and declines were steepest in the Midwest (22%) and the South (13%). Early medication abortions accounted for 31% of nonhospital abortions, up from 24% in 2011. Most states that experienced the largest proportionate declines in the number of clinics providing abortions had enacted one or more new restrictions during the study period, but reductions were not always associated with declines in abortion incidence. CONCLUSIONS-The relationship between abortion access, as measured by the number of clinics, and abortion rates is not straightforward. Further research is needed to understand the decline in abortion incidence.Information about abortion incidence in the United States is necessary to estimate accurate pregnancy rates and to determine rates of unintended pregnancy. 1 In 2011, there were 1.06 million abortions, and 21% of pregnancies were terminated. 2 These figures reveal that abortion is not uncommon. Abortion incidence in 2011 was remarkable for several reasons. Between 1990 and 2008, the abortion rate declined an average of 2% per year, 3 but between 2008 and 2011, it dropped 13%.

BackgroundIn Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates.MethodsWe conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology.ResultsWe estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures.ConclusionsThe estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

BackgroundIn the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion.ObjectivesOur study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa.MethodsWe applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility.ResultsIn 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49.ConclusionsIncreasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

Objective While several clinical studies have compared the prophylactic efficacy of oxytocin and misoprostol for prevention of postpartum hemorrhage (PPH), no studies have examined these interventions at the community level. This cost-effectiveness analysis is the first to do so. Methods This cost-effectiveness study accompanied a randomized trial comparing the prophylactic effectiveness of misoprostol with that of oxytocin conducted in rural Senegal from June to September 2013 of consenting women delivering in maternity huts. We compared the two interventions, with PPH referrals to a higher level facility being the outcome measure. We calculated costs and effects for two hypothetical cohorts of women delivering during a one-year period, each receiving one of the interventions. A third cohort simulated current standard of care (SOC). A sensitivity analysis was performed to estimate the impact of variation in model assumptions. Results The incremental cost-effectiveness ratios (ICER) for the misoprostol intervention was USD 40 per PPH case averted and USD 120 for oxytocin. In all scenarios, the misoprostol intervention dominated except in the worst-case scenario, where the oxytocin intervention was slightly more cost-effective. Conclusion Our findings suggest that use of misoprostol for PPH prevention would be cost-effective in countries with inadequate maternal health care.