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Makenzius, Marlene
Publications (10 of 11) Show all publications
Makenzius, M., Oguttu, M., Klingberg-Allvin, M., Gemzell-Danielsson, K., Odero, T. M. A. & Faxelid, E. (2017). Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya. BMJ Open, 7(10), Article ID e016157.
Open this publication in new window or tab >>Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 10, article id e016157Article in journal (Refereed) Published
Abstract [en]

Objective To assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians. Design A multicentre randomised controlled equivalence trial. The study was not masked. Settings Gynaecological departments in two hospitals in a low-resource setting, Kenya. Population Women (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis. Interventions 600 mu g misoprostol orally, and contraceptive counselling by a physician or midwife. Main outcome measures Complete abortion not needing surgical intervention within 7-10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was -4% to 4%. Secondary outcomes were analysed descriptively. Results The proportion of complete abortion was 94.8% (768/810): 390 (95.4%) in the midwife group and 378 (94.3%) in the physician group. The proportion of incomplete abortion was 5.2% (42/810), similarly distributed between midwives and physicians. The model-based risk difference for midwives versus physicians was 1.0% (-4.1 to 2.2). Most women felt safe (97%; 779/799), and 93% (748/801) perceived the treatment as expected/easier than expected. After contraceptive counselling the uptake of a contraceptive method after 7-10 days occurred in 76% (613/810). No serious adverse events were recorded. Conclusions Treatment of incomplete abortion with misoprostol provided by midwives is equally effective, safe and accepted by women as when administered by physicians in a low-resource setting. Systematically provided contraceptive counselling in PAC is effective to mitigate unmet need for contraception.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-342094 (URN)10.1136/bmjopen-2017-016157 (DOI)000422617500060 ()
Available from: 2018-03-01 Created: 2018-03-01 Last updated: 2018-03-01Bibliographically approved
Makenzius, M. & Wamala, S. (2015). Swedish public health policy: Impact on regional and local public health practice and priorities. Journal of Public Health Policy, 36(3), 335-349
Open this publication in new window or tab >>Swedish public health policy: Impact on regional and local public health practice and priorities
2015 (English)In: Journal of Public Health Policy, ISSN 0197-5897, E-ISSN 1745-655X, Vol. 36, no 3, p. 335-349Article in journal (Refereed) Published
Abstract [en]

We evaluated the Swedish National Public Health Policy to determine its impact on public health priorities and practice at regional and local levels between 2004 and 2013. We conducted a survey by questionnaire in February 2013 among Swedish county councils/regions (n = 19/21), and municipalities (n = 219/290). The National Public Health Policy facilitated systematic public health practice, particularly for planning, for high priority concerns, including conditions during childhood and adolescence, physical activity, and tobacco prevention. Respondents expressed need for a comprehensive monitoring system with comparable indicators nationwide and explicit measurable objectives. To ensure effective monitoring and follow-up, the measurable outcomes need direct relevance to decision making and high-priority public health issues addressing Sweden's "overarching public health goal" - to create societal conditions for good health on equal terms for the entire population.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-261255 (URN)10.1057/jphp.2015.3 (DOI)000359095000008 ()25789926 (PubMedID)
Available from: 2015-09-01 Created: 2015-08-31 Last updated: 2017-12-04Bibliographically approved
Makenzius, M., Tydén, T., Darj, E. & Larsson, M. (2013). Autonomy and dependence: experiences of home abortion, contraception and prevention. Scandinavian Journal of Caring Sciences, 27(3), 569-579
Open this publication in new window or tab >>Autonomy and dependence: experiences of home abortion, contraception and prevention
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 569-579Article in journal (Refereed) Published
Abstract [en]

Background:  Few studies have explored experiences and needs in relation to an induced medical abortion with the final treatment at home.

Objective:  To explore women’s and men’s experiences and needs related to care in the context of a home abortion as well as to elicit their views on contraception and prevention of unwanted pregnancies.

Method:  Qualitative interviews were carried out with 24 women and 13 men who had experienced a home abortion; they took place in Sweden during 2009/10.

Results:  Two overarching themes were identified: Autonomy– the decision to undergo an abortion and the choice of method were well considered by the woman, supported by the partner. The home environment increased their privacy and control, which helped them freely express and share their emotions. They were motivated to avoid a subsequent abortion and considered it an individual responsibility; however, contraceptive follow-up visits were rare. Dependence– a desire to be treated with empathy and respect by care providers and to receive adequate information. In the prevention of unwanted pregnancies, financial resources, improved communication/education and subsidized contraceptives were considered important.

Conclusion:  Home abortion increases autonomy, and women and partners demonstrate self-care ability. This autonomy, however, is related to dependence: a desire to be treated with empathy and respect on equal terms and to receive adequate information tailored to their self-care needs. Routines in abortion care should be continuously evaluated to ensure care satisfaction, safety and security as well as contraceptive adherence.

Keywords
induced abortion, home abortion, abortion care, abortion methods, decision-making, care satisfaction, prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-179808 (URN)10.1111/j.1471-6712.2012.01068.x (DOI)000321625800010 ()
Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2017-12-07Bibliographically approved
Makenzius, M., Tydén, T., Darj, E. & Larsson, M. (2013). Sverige har Nordens höögsta aborttal: Oönskade graviditeter bör ses i helhetsperspektiv - individer, vård, samhålle. Läkartidningen, 110(38), 1658-1661
Open this publication in new window or tab >>Sverige har Nordens höögsta aborttal: Oönskade graviditeter bör ses i helhetsperspektiv - individer, vård, samhålle
2013 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 38, p. 1658-1661Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-208292 (URN)
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved
Makenzius, M. & Larsson, M. (2012). Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation. Scandinavian Journal of Primary Health Care, 27(1), 20-26
Open this publication in new window or tab >>Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation
2012 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 27, no 1, p. 20-26Article in journal (Refereed) Published
Abstract [en]

Background: In public health efforts, knowledge about risk-groups is important for creating societal conditions to ensure good health on equal terms.

Aim: To investigate differences in lifestyle and perceived health among 15-year-old teenagers with experience of sexual intercourse (self-defined) and same-aged teenagers without experience of sexual intercourse.

Methods: A two-cluster questionnaire study among 15-year-old Swedish students (n = 2170) in 2009/10. Chi-squared test was used to identify differences between three groups: teenagers who had not had sexual intercourse; teenagers who had had sexual intercourse at age of 14 or younger; and teenagers who had had intercourse at an age of 15.

Results: Thirty-two per cent (n = 334) of girls and 31% (n = 324) of boys had had sexual intercourse. Teenagers with experience of sexual intercourse at 15 years or younger used more tobacco, alcohol and illicit drugs than same-aged teenagers without intercourse experience did. Furthermore, teenagers with experience of intercourse, especially those with a debut at 14 year or younger, had less positive school experiences, more involvement in injuries and physical violence, were less (girls) and more (boys) physically active, and perceived a poorer health than teenagers without intercourse experience.

Conclusion: Sexual intercourse at the age of 15 or younger is an indicator for a hazardous lifestyle and problematic life situation.

Keywords
teenager, adolescents, sexual behaviour, risk taking, onset sexual intercourse
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-179247 (URN)10.1111/j.1471-6712.2012.00989.x (DOI)000314819900004 ()22462801 (PubMedID)
Available from: 2012-08-23 Created: 2012-08-10 Last updated: 2017-12-07Bibliographically approved
Liljas Stålhandske, M., Makenzius, M., Tydén, T. & Larsson, M. (2012). Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation. Journal of Psychosomatic Obstetrics and Gynaecology, 33(2), 53-61
Open this publication in new window or tab >>Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation
2012 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 33, no 2, p. 53-61Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the prevalence of existential experiences and needs among women involved in induced abortion.

Methods: A questionnaire was used to collect information from 499 women requesting an induced abortion. A principle component analysis resulted in three components of existential experiences and needs, labelled: existential thoughts, existential practices, and humanisation of foetus. These components were analysed in relation to background data and other data from the questionnaire.

Results: Existential experiences and needs were common. Existential thoughts about life and death, meaning and morality were related to abortion experience for 61% of women. Almost 50% of women, reported a need for special acts in relation to the abortion; and, 67% of women considered the pregnancy in terms of a child. A higher degree of existential components correlated to difficulty in making the abortion decision and poor psychological wellbeing after the abortion.

Conclusion: Women’s experiences of abortion can include existential thoughts about life, death, meaning and morality, feelings of connectedness to the foetus, and the need for symbolic expression. This presents a challenge for abortion personnel, as the situation involves complex aspects beyond medical procedures and routines.

Keywords
abortion, psychological wellbeing, women’s health, existential question, foetus
National Category
Social Sciences Interdisciplinary
Research subject
Psychology of Religion
Identifiers
urn:nbn:se:uu:diva-159166 (URN)10.3109/0167482X.2012.677877 (DOI)000303495100003 ()
Available from: 2011-09-23 Created: 2011-09-23 Last updated: 2018-01-12Bibliographically approved
Makenzius, M., Tydén, T., Darj, E. & Larsson, M. (2012). Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion. Scandinavian Journal of Public Health, 40(2), 211-216
Open this publication in new window or tab >>Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion
2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 211-216Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Prevention of unintended pregnancies is a public health objective; however, the profiles of male partners of women who choose to abort are relatively unexplored.

OBJECTIVE:

To investigate risk factors among men who have repeated experience of being the partner of a woman electing an induced abortion.

METHODS:

A questionnaire was used to collect information from 590 men recruited through their pregnant partner who applied for an abortion in Sweden during 2009. A binary logistic regression model assessed risk factors associated with repeated experience of abortion.

RESULTS:

One-third of the men had previous experience of a pregnant partner electing an induced abortion. Univariate analysis indicated these men were older, had a lower educational level and less emotional support, and were more often tobacco users than men for whom it was the first experience of a partner choosing to abort. Independent risk factors were being a victim of physical, psychological, or sexual violence or abuse over the past year (OR 2.62, 95% CI 1.36-5.08), unemployment or sick leave (OR 2.58, 95% CI 1.57-4.25), and having children (OR 2.00, 95% CI 1.22-3.28). The men suggested improved sex and relationship education in school and lower unemployment rates could prevent unintended pregnancies and abortions.

Conclusions:

Men with experience of repeat abortions present a picture of vulnerability that should be recognised in the prevention of unintended pregnancies. Increased work opportunities might be one important intervention to reduce the number of abortions.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-168811 (URN)10.1177/1403494811435496 (DOI)000301192100014 ()22307996 (PubMedID)
Available from: 2012-02-15 Created: 2012-02-15 Last updated: 2017-12-07Bibliographically approved
Makenzius, M. (2012). Unintended Pregnancy, Abortion and Prevention: Women and Men's Experiences and Needs. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Unintended Pregnancy, Abortion and Prevention: Women and Men's Experiences and Needs
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Women and men’s experiences and needs in relation to induced abortion, and their views on the prevention of unintended pregnancies were explored through questionnaire studies at 10 and13 Swedish women’s clinics (Papers I–IV). Among 798 women in age range 14 – 49, 35% had experience of at least one previous abortion, and in the age range 20 – 49, 41%. The risk factors for repeat abortion were having children (Odds Ratio [OR] = 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Among 590 men in age range 16 – 63, 32% had been involved in at least one previous abortion. The risk factors were, being a victim of violence or abuse (OR 2.62), unemployment or sick leave (OR 2.58), and having children (OR 2.0). Tobacco use was common, among both women (33%) and men (50%), and among those with repeat abortion 41% and 57%, respectively. Some considered societal efforts important for prevention, (Paper I–II).

Overall care-satisfaction (Paper III) was high (74% of women and 52% of men). For women, factors associated with high care-satisfaction were being well treated by the staff (OR 11.78), sufficient pain relief (OR 3.87), adequate information about the gynaecological examination (OR 2.25), suitable contraceptive counselling (OR 2.23), and accessibility to the clinic by phone (OR 1.91). For men, the factors were being well treated by the staff (OR 5.32) and adequate information about the abortion procedure (2.64).

Existential experiences and needs related to abortion were investigated among 499 women. Three components were identified (Paper IV): existential thoughts (61% of women), existential practices (48%), and humanisation of the foetus (67%). A higher presence of existential components correlated with difficulty in deciding to abort and poor psychological wellbeing after the abortion.

Interviews with 24 women and 13 men on their experiences and needs related to home abortion and views on the prevention of unwanted pregnancies revealed two overarching themes (Paper V). Home abortion increased autonomy: both women and men demonstrated self-care ability. However, autonomy was related to dependence: the desire to be treated with empathy and respect on equal terms and receive adequate information adapted to individual needs. They were motivated to avoid a subsequent abortion, but planned contraceptive follow-ups were rare.

Both individual and societal challenges were implied: women and men experiencing repeat abortion appeared more disadvantaged and abortion involved complex aspects beyond medical procedures and routines. Thus, abortion care should be continuously evaluated to ensure care satisfaction, safety, and contraceptive adherence. Preventive efforts would include work opportunities, sex and relationship education, and cheap and effective contraceptives. Minimising differences between socioeconomic groups is important, and both individuals and society should share the responsibility for these efforts.

Abstract [sv]

De senaste åren har kvinnor fått ökade möjligheter att välja mellan olika abortprocedurer, vilket medfört att andelen medicinska aborten har ökat och utgör 89% av alla inducerade aborter före utgången av graviditetsvecka 9. Den medicinska aborten kan avslutas i hemmet om kvinnan så önskar och inga hinder finns. Generellt finns begränsad kunskap om kvinnor och framför allt män som är involverade i en abort. Socialstyrelsens register ger endast information om; vilken vecka aborten avslutas i, abortmetod (medicinsk/ kirurgisk), kvinnans ålder, kommuntillhörighet, antal barn och tidigare aborter. Det innebär att det finns begränsad möjlighet att undersöka eventuella skillnader mellan olika grupper. En relativt hög andel (40%) av de abortsökande kvinnorna har erfarenhet av att ha gjort minst en tidigare abort, men kunskap om den gruppen är begränsad. Det övergripande syftet med den här avhandlingen var att undersöka kvinnors och mäns upplevelser och behov i samband med en abort och deras syn på förebyggande insatser.

Kvantitativa och kvalitativa metoder har använts i de olika delarbetena (I– V) samt teoretiska modeller som utgår från folkhälso- och omvårdnadsperspektiv. Samtliga studier är godkända av den regionala etikprövningsnämnden i Uppsala.

Delarbete I–IV bygger på resultat från en multicenter studie som genomfördes 2009, där 10 och 13 svenska kvinnokliniker deltagit. Syftet med delstudie I och II var att undersöka riskfaktorer för upprepad abort bland kvinnor och män. Två enkäter (kvinna/man) delades ut på kliniken i samband med att kvinnorna sökte för abort. Enkäten besvarades av 798 kvinnor efter genomgången abort. Männen som var involverade i graviditeten blev tillfrågade att delta i studien av kvinnorna och 590 män besvarade enkäten. Separata frankerade kuvert bifogades, vilket möjliggjorde att kvinnorna och männen kunde besvara enkäten oberoende av varandra.

Resultatet i delarbete I och II visade att 35% av 798 kvinnor i åldern 14 – 49 hade erfarenhet av minst en tidigare abort och den andelen var högre i åldern 20 – 49; 41%. Upprepad abort var associerat med; att ha barn (Odds Ratio [OR] = 2.57), brist på emotionellt stöd (OR 2.09), att vara arbetslös eller sjukskriven (OR 1.65), rökning/snusning (OR 1.56), och låg utbildningsnivå (OR 1.5). För de 590 männen i åldern 16 – 63 hade 32% erfarenhet av minst en tidigare abort. Upprepad abort var associerat med; att ha varit utsatt för våld eller tvång (OR 2.62), att vara arbetslös eller sjukskriven (OR 2.58), och att ha barn (OR 2.0). Daglig tobaksanvändning var vanligt förekommande bland både kvinnor (33%) och män (50%), men vanligare bland dem med erfarenhet av upprepad abort (41%/57%).

Konkreta åtgärder som kvinnor och män med aborterfarenhet efterfrågar i det förbyggande arbetet är fler arbetstillfällen, mer och bättre kvalitet på sexoch samlevnadsundervisningen i skolan, hög tillgänglighet till billiga och effektiva preventivmedel samt kvalificerad rådgivning.

Slutsatserna i delarbete I och II är att kvinnor och män med erfarenhet av en abort löper hög risk för en upprepad abort. Personer med erfarenhet av upprepad abort är mer socioekonomiskt utsatta. Att minska skillnader mellan olika socioekonomiska grupper kan därför vara av betydelse i det förebyggande arbetet med oönskade graviditeter.

Delarbete III syftade till att undersöka hur nöjda kvinnor och män upplevt vården i samband med en inducerad abort samt att identifiera faktorer som har samband med en hög grad av tillfredsställelse med vården. De flesta var nöjda med vården, men en fjärdedel (26%) av kvinnorna och nästan hälften av männen (48%) var inte helt nöjda. Den viktigaste faktorn för hög tillfredsställelse med vården var att ha fått ett gott bemötande bland både kvinnor (OR 11.78) och män (OR 5.32). Andra faktorer av betydelse var för kvinnorna att ha fått tillfredsställande; smärtlindring (OR 3.87), information om den gynekologiska undersökningen (OR 2.25), och preventivmedelsrådgivning (OR 2.23), samt att det var lätt nå kliniken via telefon (OR 1.91). För männen var även information om abortproceduren en viktig faktor för deras totala tillfredsställelse med vården (2.64).

Slutsatserna i delarbete III är att en fjärdedel av kvinnorna och varannan man inte var helt nöjda, vilket indikerar att abortvården kan förbättras, speciellt avseende männen. Bland både kvinnor och män, är ett positivt bemötande från personalen den viktigaste faktorn för en tillfredsställande upplevelse av vården i samband med abort.

Delarbete IV syftade till att undersöka förekomsten av existentiella tankar, känslor och handlingar bland 499 kvinnor som gjort en abort. Genom faktoranalys identifierades olika existentiella komponenter relaterade till en inducerad abort. Resultatet visade att sex av tio kvinnor hade existentiella tankar om livet, döden, mening och moral. Nästan hälften av kvinnorna uppgav att de hade behov att genomföra en symbolisk handling i relation till aborten, och 67% tänkte på fostret i termer av ett barn. Högre grad av existentiella faktorer korrelerade med större svårighet att fatta beslut om abort, och ett sämre psykiskt välbefinnande efter aborten.

Slutsatserna i delarbete IV är att existentiella känslor, tankar och handlingar i samband med abort är vanligt förekommande. Detta är för vårdpersonalen en utmanande aspekt som inte självklart inkluderas i abortvården och dess styrdokument.

Syftet med delarbete V, som var en kvalitativ studie, var att undersöka kvinnors och mäns upplevelser och behov i samband med hemabort. Syftet var även att belysa deras syn på samhälleliga åtgärder för att förebygga oönskade graviditeter. Kvinnorna rekryterades från fem olika kvinnokliniker och männen tillfrågades om att delta i studien genom kvinnorna. Tjugofyra kvinnor och 13 män intervjuades via telefon.

Innehållsanalysen mynnande ut i två övergripande teman; autonomi som beskriver att beslutet om abort och valet av metod var väl genomtänkt av kvinnan, men oftast med stöd av partner. Hemmiljön ökade deras integritet och kontroll, vilket också underlättade deras möjligheter att fritt uttrycka och dela känslor; beroende som beskriver kvinnors och mäns önskan att bli behandlade med värdighet och respekt och att få tillfredsställande information som är individuellt anpassad för deras behov. Resultatet indikerar att hemabort ställer höga krav på vårdpersonalens kommunikationsförmåga. Kvinnor och män var motiverade att förebygga en ny oönskad graviditet men ett planerat återbesök var ovanligt. I det förebyggande arbetet av oönskade graviditeter ansågs fast arbete, förbättrad kommunikation/utbildning och subventionerade preventivmedel som viktigt.

Slutsatserna i delarbete V är att hemabort ökar kvinnors och mäns autonomi, men samtidigt finns ett uttalat beroende av att vårdpersonalen utformar vården individuellt och med respekt för olika livssituationer. Rutiner och uppföljning bör därför kontinuerligt utvärderas för att säkerställa både kvaliteten av abortvården men också följsamheten i användningen av preventivmedel.

Oönskade graviditeter och aborter är inte frågor som enbart berör kvinnor eller hälso- och sjukvården, det är större än så, ett delat ansvar som berör både individer och samhället.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 795
Keywords
Induced abortion, Risk factors, Unwanted pregnancy, Repeat abortion, Patient satisfaction, Prevention, Existential expression, Home abortion, Care
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-179250 (URN)978-91-554-8424-8 (ISBN)
Public defence
2012-09-21, Sal IX, Universitetshuset, Uppsala, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-08-30 Created: 2012-08-10 Last updated: 2013-01-22Bibliographically approved
Makenzius, M., Tydén, T., Darj, E. & Larsson, M. (2012). Women and men's satisfaction with care related to induced abortion. European journal of contraception & reproductive health care, 17(4), 260-269
Open this publication in new window or tab >>Women and men's satisfaction with care related to induced abortion
2012 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 4, p. 260-269Article in journal (Refereed) Published
Abstract [en]

Objectives To investigate satisfaction with abortion care among women and their male partners, and to identify factors associated with high overall contentment with the care received.

Methods A multi-centre cross-sectional questionnaire survey conducted in 2009 among 798 Swedish abortion-seeking women and 590 male partners was analysed with logistic regression.

Results Overall care satisfaction was rated high by two-thirds (74%) of the women and half (52%) of the men. For women, factors associated with high overall satisfaction with care were: to be well treated by the health care staff (Odds Ratio [OR] = 11.78), sufficient pain relief (OR = 3.87), adequate information about the gynaecological examination (OR = 2.25), suitable contraceptive counselling (OR = 2.23), and ease of access to the clinic by phone (OR = 1.91). For men, the factors were to be well treated by the health care staff (OR = 5.32), and adequate information about the abortion procedure (OR = 2.64).

Conclusion Most women and half of the men were pleased with the attention they had received, but one in four women and half the men were not, or not completely, suggesting improvement is needed, especially with regard to men. For both women and men the human aspect of the care, namely, the consideration showed by the attending staff, appears to be the most important factor associated with satisfaction regarding abortion care.

Keywords
Care satisfaction, Abortion care, Induced abortion, Decision making
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-179556 (URN)10.3109/13625187.2012.688149 (DOI)000306425400004 ()
Available from: 2012-08-20 Created: 2012-08-20 Last updated: 2017-12-07Bibliographically approved
Makenzius, M., Tydén, T., Darj, E. & Larsson, M. (2011). Repeat induced abortion - a matter of individual behaviour or societal factors?: A cross-sectional study among Swedish women. European journal of contraception & reproductive health care, 16(5), 369-377
Open this publication in new window or tab >>Repeat induced abortion - a matter of individual behaviour or societal factors?: A cross-sectional study among Swedish women
2011 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 16, no 5, p. 369-377Article in journal (Refereed) Published
Abstract [en]

Background: Almost 40% of all induced abortions in Sweden are repeat abortions; little is known about the risk factors.

Objective: To investigate differences between women who had a first-time abortion and those with repeat abortion, and to identify factors associated with repeat abortion.

Methods: A questionnaire was answered by 798 abortion-seeking women in Sweden during 2009. A regression model was used to assess risk factors for repeat abortions.

Results: In the age range 20-49 years, 41% of women had experienced at least one previous abortion. Risk factors for repeat abortion were parity (OR 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Some women (n = 55) considered economic support and work opportunities could have enabled them to continue the pregnancy. Increased Sex and Relationship Education (SRE), easy access to high-quality contraception and counselling, were suggested (n = 86) as interventions for preventing unintended pregnancies.

Conclusions: Even in a country with long established SRE and a public health policy to enhance sexual and reproductive health over a third of women requesting abortion have experienced one previously and the rate is maintained. Some specific factors are identified but, overall, a picture of vulnerability among women seeking repeat abortion stands out that needs to be considered in the prevention of unintended pregnancies.

Keywords
Women, Abortion, Repeat abortion, Risk factors, Socioeconomics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156545 (URN)10.3109/13625187.2011.595520 (DOI)000295004100007 ()21777046 (PubMedID)
Available from: 2011-08-02 Created: 2011-08-02 Last updated: 2017-12-08Bibliographically approved
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