Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design

Abstract

Background: Repeat abortion is a public health concern favored by many obstetric and social factors. The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion. Methods: We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC). Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women's demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3-4 weeks following pregnancy termination. Results: Of the 500 interviewed women, 211 (42.2 %; CI 95% [37.88 -46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion. CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %). Conclusion: Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

Repeat induced abortion and associated factors among women seeking abortion care services at Debre Markos town health institutions, Amhara regional state, Ethiopia, 2017

“…Finally, those who had a history of physical violence by a male partner had a 2.6 times higher risk of having a RIA than those who did not have a history of physical violence. This result is consistent with the studies done in Tunisia [15]. This could be due to fear of telling her male partner about the pregnancy and tend to protect herself by having an induced abortion.…”

“…Our study has identified that participants who had no education and had an educational level of primary and secondary were more likely to undergo a RIA than those who had an educational level of more than secondary. The finding is in consistent with the study in Ethiopia, Kenya, Tunisia, Georgia, and Russia [1,8,15,18,19]. Unplanned pregnancy secondary to poor contraceptive knowledge and use among those with a lower educational level might be the possible reason.…”

“…This might be due to the liberalized abortion law in Ethiopia may encourage women to seek for abortion care in a health institution. On the contrary, this study has smaller magnitude compared to the study done in Tunisia (42.2%) [15]. This may be due to the long time history of the liberalization of abortion law in Tunisia.…”

Women’s education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region

“…There has been an increasing number of studies that investigated factors associated with health-seeking behaviors of mothers and children [13]. Similar findings across these studies suggested that maternal health care is generally affected by various personal, sociocultural and environmental factors, including individual perceptions of health, self-efficacy, motivation, social values and belief systems [14][15][16]. Access to SBA services are found to be associated with various sociodemographic factors, for example education of women/mothers, religion, residency (urban/rural) and household financial capabilities are important predictors for women's access to maternal health services [17][18][19][20].…”

Factors associated with male involvement in reproductive care in Bangladesh

“…Research evidence from other South Asian countries suggests that men’s involvement in women’s reproductive care has a crucial role to play to increase the uptake of maternal health services and reduce maternal and infant mortality [12–14]. Reproductive health seeking behaviour of an individual has shown to be a psychological construct affected by various proximal/individual (perception of health, self-efficacy, motivation) [12, 14, 15] and distal/social influences (social norms and values, belief systems, degree of openness about personal matters) [16, 17]. There is also lot to accomplish especially in the areas of universal access to reproductive health services, increasing the rate of institutional delivery and adoption of family planning which have shown to be more effective in active presence of male counterparts [15, 18].…”