Academic journal article International Perspectives on Sexual and Reproductive Health

Contraception Matters: Two Approaches to Analyzing Evidence of the Abortion Decline in Georgia

Academic journal article International Perspectives on Sexual and Reproductive Health

Contraception Matters: Two Approaches to Analyzing Evidence of the Abortion Decline in Georgia

Article excerpt

CONTEXT: The abortion rate in the republic of Georgia is the highest documented in the world. Analyses using reliable data are needed to inform programs for preventing unintended pregnancy and abortion.

METHODS: Data from two large national household surveys conducted in 1999 and 2005 were used to assess the relationship between contraceptive use and abortion. Two analytic approaches were used. First, abortion rates were estimated for three subgroups: users of modern contraceptives, users of traditional contraceptives and nonusers of contraceptives. A decomposition method was then used to estimate the proportions of change in abortion rates that were due to changes in contraceptive use and to changes in use- and nonuse-specific abortion rates. Second, a methodology developed by Westoff was used to examine abortion rates among contraceptive users and among nonusers with differing risks of unintended pregnancy.

RESULTS: According to data from the 60 months before each survey contraceptive prevalence among married women increased by 23% (from 39% to 48%) and the marital abortion rate declined by 15% (from 203 to 172 abortions per 1,000 woman-years) between 1999 and 2005. Both approaches showed that nonuse of any method was the principal determinant of the high unintended pregnancy rate and that the increase in use of modern contraceptives was a significant contributor to the recent drop in abortion (explaining 54% of the decline, according to the decomposition analysis).

CONCLUSIONS: Efforts to increase availability and use of modern family planning methods in Georgia should lead to a direct and measurable decline in the abortion rate.

International Perspectives on Sexual and Reproductive Health, 2010, 36(2):99-110

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Most transition countries of Eastern Europe and the former Soviet Union have fertility rates lower than the typical rates in Western Europe and well below the replacement level of 2.1 births per woman. (1), (2) One of the principal proximate determinants of fertility decline in these countries has been the use of abortion on request during the first trimester of pregnancy.

In 1920, Russia became the first country to legalize abortion, doing so well before Western European countries. After the Socialist revolution, abortion on request was the main fertility control method in the Soviet Union. Even between 1936 and 1955, when abortion was legally available only to women with certain narrowly defined medical indications, medical providers and traditional practitioners performed many clandestine abortions. (3) The procedure became broadly legal again in the Soviet Union in 1955. Until recently, abortion was the principal fertility control method throughout the Soviet bloc countries, and it continues to be widely used.

Currently, the abortion rates in several Eastern European and Central Asian countries are among the highest in the world. (4), (5) A high proportion (42-66%) of pregnancies in these countries are unintended, and the great majority (82-93%) of unintended pregnancies end in elective abortion. (6) Although almost all abortions in these countries are performed in health facilities, they are not completely risk-free; approximately 5-16% of abortions in Eastern Europe result in complications requiring treatment and in long-term consequences. (5) Further, an estimated 26% of maternal deaths in the region are abortion-related, compared with 13% worldwide. (7)

The Republic of Georgia, formerly part of the Soviet Union, has for more than a decade had one of the highest abortion rates in the world. Data from Demographic and Health Surveys (DHS) and Reproductive Health Surveys (RHS) indicate that from 1996 to 1999, the reported total abortion rate in Georgia--3.7 abortions per woman--was the highest among 12 Eastern European and Central Asian countries.* (2), (6) During the same period, Georgia also had the lowest proportion of women using contraceptives (25%). …

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