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Item Maternal near-miss due to unsafe abortion and associated short-term health and socio-economic consequences in Nigeria(2015) Prada, E.; Bankole, A.; Oladapo, O. T.; Awolude, O. A.; Adewole, I. F.; Adewole, I. F.; Onda, T.Little is known about maternal near-miss (MNM) due to unsafe abortion in Nigeria. We used the WHO criteria to identify near-miss events and the proportion due to unsafe abortion among women of childbearing age in eight large secondary and tertiary hospitals across the six geo-political zones. We also explored the characteristics of women with these events, delays in seeking care and the short-term socioeconomic and health impacts on women and their families. Between July 2011 and January 2012, 137 MNM cases were identified of which 13 or 9.5% were due to unsafe abortions. Severe bleeding, pain and fever were the most common immediate abortion complications. On average, treatment of MNM due to abortion costs six times more than induced abortion procedures. Unsafe abortion and delays in care seeking are important contributors to MNM. Programs to prevent unsafe abortion and delays in seeking postabortion care are urgently needed to reduce abortion related MNM in Nigeria.Item The incidence of abortion in Nigeria(2015-12) Bankole, A.; Adewole, I. F.; Hussain, R.; Awolude, O.; Singh, S.; Akinyemi, J. O.CONTEXT—Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS—A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS—An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15–49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION—Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.Item Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia(Routledge, 2015) Moore, A. M.; Bankole, A.; Awolude, O.; Audam, S.; Oladokun, A.; Adewole, I.Fertility decisions among people living with HIV/AIDS (PLWHA) are complicated by disease progression, the health of their existing children and possible antiretroviral therapy (ART) use, among other factors. Using a sample of HIV-positive women (n = 353) and men (n = 299) from Nigeria and Zambia and their healthcare providers (n = 179), we examined attitudes towards childbearing and abortion by HIV-positive women. To measure childbearing and abortion attitudes, we used individual indicators and a composite measure (an index). Support for an HIV-positive woman to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already had an HIV-positive child. Such support was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than reported support from their healthcare providers. There was wider variation in support for abortion depending on the measure than there was for support for childbearing. Half of all respondents indicated no or low support for abortion on the index measure while between 2 and 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion indicate that most respondents did not see HIV as a medical condition which justifies abortion. Respondents in Nigeria and those who live in urban areas were more likely to support HIV-positive women’s childbearing. About a fifth of HIV-positive respondents reported being counselled to end childbearing after their diagnosis. In summary, respondents from both Nigeria and Zambia demonstrate tempered support of (continued) childbearing among HIV-positive women while anti-abortion attitudes remain strong. Access to ART did not impart a strong effect on these attitudes. Therefore, pronatalist attitudes remain in place in the face of HIV infection.Item Does knowledge about anti- retroviral therapy and mother-to- child transmission affect the relationship between HIV status and fertility preference and contraceptive use?(Cambridge University Press, 2014) Bankole, A.; Biddlecom, A. E.; Dzekedzeke, K.; Akinyemi, J. O.; Awolude, O.; Adewole, I. F.The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women’s knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women’s HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.Item Differences in unintended pregnancy, contraceptive use and abortion by HIV status among women in Nigeria and Zambia(2014) Bankole, A.; Keogh, S.; Akinyemi, J. O.; Dzekedzeke, K.; Awolude, O. A.; Adewole, I. F.CONTEXT: Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV status and pregnancy decision making may benefit strategies to reduce unintended pregnancy. METHODS: In 2009–2010, household-based surveys of 1,256 women in Nigeria and 1,280 women in Zambia collected information on social and demographic characteristics, unintended pregnancy, contraceptive use, abortion and self-reported HIV status. Multivariate models were used to examine the association of reported HIV status with nintended pregnancy and abortion in the five years preceding the survey and with contraceptive use at the time of conception. RESULTS: HIV-positive and HIV-negative women did not differ in their odds of unintended pregnancy or of having an abortion. However, HIV-positive women were more likely than HIV-negative women to have been using a contraceptive at the time their unintended pregnancy was conceived (odds ratio, 3.2). Women who did not know their HIV status were less likely than HIV-negative women to report an unintended pregnancy (0.6). However, they were also less likely than HIV-negative women to have been using a contraceptive at the time of conception (0.5). CONCLUSION: HIV-positive women may be making greater efforts than HIV-negative women to prevent unintended pregnancy, but with less success. Efforts should be made to improve access to effective contraceptive methods and counseling for all women, and for HIV-positive women in particular.Item Unwanted Pregnancy and induced abortion in Nigeria: causes and consequences.(2006) Bankole, A.; Oye-Adeniran, B. A.; Singh, S.; Adewole, I. F.; Wulf, D.; Sedgh, G.; Hussain, R.