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PubMedDate not supplied

The accessibility of abortion services in the United States.

Abortion services are provided in hospitals, doctors' offices and various types of clinics, but about two-thirds of procedures are performed in specialized abortion clinics. While this system appears to work well for most women, some women seeking abortion face obstacles related to distance, cost, harassment and special medical conditions. Nine percent of nonhospital abortion patients must travel more than 100 miles and 18 percent travel 50 to 100 miles for services. The average woman having a first-trimester nonhospital abortion paid $251 in 1989. Fees were higher in facilities with small abortion caseloads. An abortion at 10 weeks' gestation in a hospital cost an average of $1,757. Charges for abortions at 16 weeks averaged $509 in abortion clinics, compared with $1,539 in hospitals for curettage and $2,246 for instillation procedures. Some women face other barriers: Only 43 percent of all abortion facilities offer services past 12 weeks, and 27-37 percent of nonhospital facilities say they do not treat patients who test positive for the human immunodeficiency virus (HIV), the virus that causes AIDS. Women who need special services such as an administration of Rh immunoglobulin, general anesthesia or HIV testing usually pay extra for these services. In addition, 85 percent of nonhospital facilities that serve 400 or more abortion patients a year reported some form of antiabortion harassment in 1988, most commonly picketing; there was virtually no change in this proportion between 1985 and 1988.

Abortion, Legal↗
PubMed1991

Indicators of accessibility to primary health care coverage in rural Odukpani, Nigeria.

Indicators of accessibility were investigated in Odukpani Local Government Area using a structured questionnaire administered to mothers or heads of households in the study area. The indicators considered included proportion of births attended by trained health personnel, proportion of children with diarrhea treated with oral rehydration therapy (ORT), distance from home to regular immunization site, and acceptability of primary health care services to the target population. Sociodemographic data revealed a typical developing country population profile and surprisingly high literacy rate (57.8%) relative to the national rate, an observation which may account for the appreciable level of awareness.

Female↗
PubMedDate not supplied

Fertility and contraceptive use among young adults in Harare, Zimbabwe.

In 1986, a survey of young adults aged 14-24 in Harare, Zimbabwe obtained information about their knowledge, attitudes, and sexual behavior. Most adolescent childbearing took place within marriage, although sexual intercourse was generally initiated before marriage. Knowledge of family planning was high, but contraceptive use lagged behind knowledge. Fewer than half of the respondents had talked to an elder about family planning, sex, or pregnancy. Fourteen percent of young women who were unmarried at the time of first intercourse used contraceptives, compared to 18 percent of young unmarried men. Current contraceptive use among sexually active unmarried youths was 36 percent among women and 29 percent among men. One consequence of low contraceptive use was a high number of unwanted premarital pregnancies. Twenty-nine percent of the women had been pregnant; those not married at the time they got pregnant generally got married soon after. Of the girls who got pregnant while in school, 90 percent had to drop out of school. A second consequence of low contraceptive use is an increased risk of transmission of STDs and AIDS among the youth of Harare.

Adolescent↗
PubMed1989

Risk groups and risk areas.

The risk approach to health management usually relates to groups of people. An alternative method is to concentrate on the areas at risk, which may sometimes be more useful in decision-making.

Health Planning↗
PubMed1993

Factors related to the utilization of prenatal care in Vietnam.

Data from the 1988 Vietnam Demographic and Health Survey and 1990 Vietnam Accessibility of Contraceptives Survey were used in this analysis of the influence of selected individual and community characteristics on the utilization of prenatal care in Vietnam. Specific analysis of the impact of availability of health services and other development characteristics of the community on utilization of prenatal care was done in a rural subsample. The woman's educational level and total number of living children were the most significant predictors of prenatal care utilization. Age independent of parity did not significantly affect the use of prenatal care. Rural women and women living in provinces with the highest infant mortality rates were significantly less likely to use prenatal services than their counterparts in the urban areas and provinces with low infant mortality rates. Non-physician health care providers were the main sources of prenatal care for women in both rural and urban areas.

Adolescent↗
PubMed1992

Functioning and utilization of rural water supplies in Sarawak, Malaysia.

A cross-sectional survey of 976 households in 41 villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the state of functioning and utilization of rural water supplies. The survey was carried out by inspection and interview. About one-third of the systems were functioning well, one-third imperfectly, and the remainder were no longer functioning. The coverage of households by water supply varied with the type of water supply, the overall coverage being 81.3%. Usage varied with the type of water supply and access, the overall figure being 87.1%, and the overall utilization was 70.8%. The study showed that it is important to account for water supply usage in impact evaluation because not all households have access and not all those with access use the water supply. It is also important to define water use, depending on whether the health outcome is a reduction in diseases that are water-borne or related to washing with water, because the percentage of households using the water for drinking is different from those using it for bathing.

Cross-Sectional Studies↗
PubMedDate not supplied

Abortion services in the United States, 1987 and 1988.

A 1989 survey by The Alan Guttmacher Institute shows that 1.6 million abortions were performed in the United States in 1988, a number that has remained relatively unchanged since 1980. More than 98 percent of abortions in 1987-1988 were performed in metropolitan areas. Although 51 percent of metropolitan counties have no provider of abortion services, 93 percent of nonmetropolitan counties are without a provider. The lack of abortion services in nonmetropolitan areas has been intensified by a 13 percent reduction since 1985 in the number of hospitals that offer abortion services. The number of nonhospital facilities providing abortion services increased by four percent, however, and specialized clinics provided 64 percent of all abortions performed in 1988.

Abortion, Legal↗
PubMed1990

Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population.

We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents.

Adolescent↗
PubMedDate not supplied

Barriers to prenatal care among low-income women in New York City.

Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.

Adolescent↗
PubMedDate not supplied

The availability of reproductive health services from U.S. private physicians.

Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed1991

Determinants of the evolution of the health situation of the population.

The objective of the present project is to evaluate the relative importance of different governmental social programmes for health development during the 1970's. National statistics available for the whole period and disaggregated to district level were analyzed with particular regard to three indicators of infant health status when the infant mortality rate was used, increased access to secondary care and improved socio-economic status were related to improvement in infant health status. When the percentage of neonatal deaths or the percentage of deceased live births per woman was used, neither the socio-economic improvement nor the assess to secondary did explain the improvement. Moreover, the primary health programme did not seem to be of importance in explaining the changes in the three indicators of infant health status. A second phase of the project, currently ongoing, is aimed at the evaluation of other factors such as the degree of efficiency of some of the health programmes. This study is based on directly collected information, quantitative as well as qualitative. Structured interviews have been used together with anthropological information from in-depth interviews with individuals and groups. The preliminary results of this second phase indicate that the contradictions observed in the first phase might be due to shortcomings in the national registers. In one of the study areas the coverage of PHC developed earlier than indicated by the official information. In other areas it was found that different obstacles as access problems, lack of health centers, socio-economical problems and lack of cultural knowledge reduced the effectiveness and impact of the primary health programmes.

Costa Rica↗
PubMedDate not supplied

Abortion in Europe, 1920-91: a public health perspective.

This article grew out of a keynote address prepared for the conference, "From Abortion to Contraception: Public Health Approaches to Reducing Unwanted Pregnancy and Abortion Through Improved Family Planning Services," held in Tbilisi, Georgia, USSR in October 1990. The article reviews the legal, religious, and medical situation of induced abortion in Europe in historical perspective, and considers access to abortion services, attitudes of health professionals, abortion incidence, morbidity and mortality, the new antiprogestins, the characteristics of abortion seekers, late abortions, postabortion psychological reactions, effects of denied abortion, and repeat abortion. Special attention is focused on the changes occurring in Romania, Albania, and the former Soviet Union, plus the effects of the new conservatism elsewhere in the formerly socialist countries of central and eastern Europe, particularly Poland. Abortion is a social reality that can no more be legislated out of existence than the controversy surrounding it can be stilled. No matter how effective family planning services and practices become, there will always be a need for access to safe abortion services.

Abortion, Induced↗
PubMed1993

Childspacing intervals and abortion among blacks and whites: a brief report.

Although physical, psychological, and social problems for children born to women denied abortion have been identified, little attention has been paid to the role that close childspacing might play in contributing to those problems. Small childspacing intervals (less than two years) have been linked to numerous physical, psychological, and social problems for mother and child. Using secondary analysis, this study examines the characteristics of 596 mothers who sought abortions in 1987 by race and age. Nearly 25% of these mothers had at least one child under two years of age. Abortion patients with such young children were more likely to be Black and have low incomes than abortion patients with older children. More than half of the mothers studied had more than two children. The findings suggest that a substantial number of children born to women denied access to abortion would be closely spaced, with the resulting adverse health consequences falling more heavily on subpopulations of abortion patients already at higher risk for negative perinatal and neonatal outcomes.

Abortion, Legal↗
PubMed1992

The untold story: how the health care systems in developing countries contribute to maternal mortality.

This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

Abortion, Legal↗
PubMed1992

Maternal mortality in the Thyolo District of southern Malawi.

The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.

Adolescent↗