PART 2

CHAPTER VI

FAMILY PLANNING AND ABORTION PRACTICE

2.6.1.   Family Planning Practice

This survey shows that among the sample of 1400 women of reproductive age, the majority (77%) ever used some methods of contraception. At the time of the survey-interview 57% of women were current family planning users, 21% stopped using contraception, and 22% have never used any method (Figure 2.6.1.).

In total, 799 women (57%) either stopped contraception or changed methods. The main reasons are described in the Table 2.6.1.

The most frequently mentioned reasons for stopping contraception or changing methods were desired or current pregnancy, or postpartum (52%). A significant proportion of couples (19%) found better methods or stopped contraception because of side effects/complications (8%), divorce/separation/death of partner (8%) or subsequent sub-fertility (7%). 

In the Tables 2.6.2. and 2.6.3. are given specific methods of contraception that were previously and currently used. The most popular methods were withdrawal, IUDs and condoms.

The most popular was coitus interrupts or withdrawal method, which was ever used by the majority of couples (68%) and currently by 57%. The second most popular method was IUD, which was ever used by more than 22% and currently – by 17% of women. The condoms have been ever used by more than 21% of respondents and currently – by about 15%. In comparison, data from the previous nation-wide Reproductive Health survey among married women of reproductive age, which was carried out in Armenian in 1997 (1) shows that 53% of respondents currently used withdrawal method, 17% used condom, 17% - the IUDs, and 1% - hormonal contraceptive pills.

2.6.2. Unwanted Pregnancy and Abortion Use

Frequency:

Results of this survey on reproductive health in Armenian women confirmed data from the previous nation-wide Reproductive Health survey, 1997 (1) and indicate that induced abortion is widely used all over the country as a method of birth control. According to the obtained information, 898 out of 1400 respondents of this survey (64.1%) reported at least one induced abortion during their lifetime. An average number of abortions for total survey sample was 2.7 (SD=4.03), and for the sample of 898 women who had an abortion ever was 4.2 (SD=4.35). Below is given a summary of the main statistics surrounding abortion use as reported by women:

The percentage distribution of women according to the number of abortions is given in Table 2.6.4.

Decision taking:

This survey supported findings from the survey in men that abortion practice in Armenia is based mainly on the willingness of both partners (Table 2.6.5.).

According to the women’s replies, male partners were in agreement with termination of pregnancy in most of the first and last abortion cases. However, in some cases the male partner did not know about the abortion, or it was performed in spite of his objection (Table 2.6.6.).

Background factors and common reasons:

The age of women at their first abortion varied from 16 up to 43, with an average 25.0 years of age (SD=4.14). The great majority of women (96%) already have had at least one child before they had first abortion (Mean±SD=1.9±0.74). However 32 women (4%) did not have children at that time. At the time of the last abortion the majority of women already had at least 2 children (Mean±SD=2.4±0.82).

The most common reason for the first abortion was willingness to postpone the birth of the next child  (43%), while the most common reason for the last abortion was completed family formation (64%). The lack of income and inappropriate housing, as well as the problems related to health and the fear of side effects were also important reasons for abortion use (Table 2.6.7.).

Results of this survey show that the lack of family planning is the main background factor for abortion. More than 42% of couples who had their first abortion did not use any methods of contraception to prevent unwanted pregnancy. However the remaining women (58%) tried to be protected from pregnancy, but it failed. The number of non-contraceptive users decreased to 34% among those who had their last abortion. The majority of them (65%) used some methods of birth control (Figure 2.6.2.).

In most of the cases, the unreliable withdrawal method was used prior to the first and the last (69%) abortion. However, there were also cases of unwanted pregnancy and induced abortion among those who used condom, pills and IUD, which, perhaps, were not properly used (Figure 2.6.3.).

Safety, complications and consequences:

In most of the abortion cases, termination of pregnancy was carried out at a maternity hospital or specialized health center (Table 2.6.8). However, in about 11% of cases it was performed in the facilities where the abortion procedure is restricted by governmental regulations.

Obstetrician-gynecologists mainly performed the abortion procedures (98% of the first abortion and 99% of the last one). The gestational age of terminated pregnancies varied from 5 up to 24 weeks and an average of about 11 weeks. However, in about 13% of cases of the first abortion and in 12% of the last abortion, the gestational age of pregnancy was more than 12 weeks. The frequency of immediate complications and late consequences of abortion were quite high (Table 2.6.9.).

In most of the cases, abortion was performed without anesthesia and was painful causing depression in a significant proportion of women (Table 2.6.10.).

Self-induced abortion:

This survey supported the observations from the survey in men; for termination of unwanted pregnancy some women rely on self-induced abortion practices in order to regulate their fertility. Thus, 165 women (12%) had tried to induce miscarriage using unsafe and often dangerous interventions. In total, there were 398 attempts per 165 women or 2.4 attempts per woman, on the average (SD=±3.11).

The majority of these attempts (272 attempts - 68%) were never successful, 98 (25%) were successful, and the remaining 28 attempts (7%) were complicated by heavy bleeding due to incomplete abortion  (Figure 2.6.4.). Seventy-two (44%) out of 165 women tried to induce miscarriage repeatedly, as a method for birth control (Table 2.6.11.).

Women reported successful self-induced abortion as miscarriage, therefore the frequency of spontaneous abortion was quite high. Thus, 336 women (24%) mentioned the history of at least one spontaneous abortion during their life span. In total, there were 539 spontaneous abortions and 126 out of these miscarriages (23%) were self-induced (Figure 2.6.5.).

Post-abortion family planning services:

The great majority of survey respondents did not receive adequate post-abortion family planning counseling or care (Table 2.6.12.).