Perdas fetais espontâneas e voluntárias no Brasil em 1999-2000: um estudo de fatores associados

Abstract

Despite its illegality in Brazil, about 31% of all pregnancies end in abortion. Most abortions are performed by unskilled personnel and under unsafe conditions, resulting in increased female mortality. This study used data from a cross-sectional representative sample of 3,047 puerperal women, in 1999-2000, part of a national multicenter study on the prevalence of syphilis in Brazil. Of these, 1,838 women with at least one previous pregnancy before the reference pregnancy were included in the analysis. The outcomes studied were voluntary prior fetal loss, spontaneous prior fetal loss, and no prior fetal loss. The analysis was carried out using multinomial logistic regression. The results indicated a high number of fetal losses per woman (up to six); and 31% of the losses were voluntary. The absence of prenatal care, history of STD in the reference pregnancy, and absence of living children were factors that increased the odds of fetal loss. For voluntary fetal loss, being non-white, having more than one partner in the previous year, and an early age at first sexual intercourse also increased the odds of fetal loss. These data confirm the public health relevance of abortion in Brazil. Characteristics related to women´s vulnerability should be considered in family planning programs in order to reduce the number of abortions and their consequences. Counseling must also be provided, targeting women with a previous abortion.

Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018

“…Twenty five articles presented data on abortion estimates (Table 1), eight of which had a national scope: two derived from the Brazilian National Survey of Demography and Health (PNDS, in Portuguese), from 1996 and 2006 10,11 ; two from the Brazilian National Abortion Survey (PNA, in Portuguese), conducted in 2010 and repeated in 2016 12,13 ; one from the National Alcohol and Drugs Inquiry (LENAD, in Portuguese) 14 ; two used secondary data from the SIH-SUS 15,16 ; and the remaining articles was a survey of maternity hospitals from 24 states 17 .…”

“…The ratio of unsafe aborions/100 live births was reduced from 35 to 30/100 live births, but rose in the Northern and Southern regions 16 . Lastly, a multi-centric, hospital-based study using a direct estimate based on interviews with women who had given birth in Brazilian maternity hospitals estimated 9.7% of induced abortions in previous pregnancies 17 .…”

“…Twenty-two studies addressed the characteristics of women who have abortions and/or factors associated with unsafe abortions 10,11,14,17,21,22,23,24,25,27,28,30,31,34,35,36,37,38,39,40,41,42 (Table 2).…”

“…Hospital studies in the public network described the characteristics of women admitted due to abortion, with samples varying between 104 and 1,838 users. A study at a maternity hospital that is an HIV reference center for the entire country found an association with young age at first sexual relation, non-white race/color, smaller number of children, sexually transmissible infections, absence of prenatal care for that pregnancy and greater number of partners 17 . Four studies 36,37,38,39 used criteria from the World Health Organization (WHO) to classify abortions 43 and considered most as certainly or probably induced.…”

Causas múltiplas de mortalidade materna relacionada ao aborto no Estado de Minas Gerais, Brasil, 2000-2011

“…Vale lembrar que, historicamente, as mulheres negras apresentam maior vulnerabilidade quando se analisa o acesso a serviços para o atendimento das suas necessidades no âmbito dos direitos sexuais e reprodutivos. Diante disso, não é inesperado o fato de que entre elas está a maior prevalência de gravidez indesejada, aumentando a probabilidade de estas realizarem abortos inseguros 37 .…”