Abortion Rates Stop Falling Globally

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A study from the World Health Organization (WHO) and Guttmacher Institute reveals that worldwide, the long-term substantial decline in abortion rates has stalled. According to the study entitled "Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008" by Glida Sedgh et al., the overall number of terminations per 1,000 women, between the age of 15 to 44 years, has decreased from 35 per 1,000 to 29 per 1,000, between 1995 and 2003, and 28 per 1,000 in 2008. The study was published online by The Lancet.

According to the United Nations, the stall in abortion rates coincides with a decline in contraceptive uptake, which has been observed particularly in developing nations.

Furthermore, the study discovered that almost half of all terminations carried out across the world are unsafe, with the majority of unsafe terminations occurring in the developing world.

In 2003 and 2008, the termination rate in the developing world was 29 per 1,000, after dropping from 34 per 1,000 between 1995 and 2003. In the developed world, rates fell slightly from 20 per 1,000 in 1995, excluding Eastern Europe where rates were considerably lower - 17 per 1,000.

Gilda Sedgh, senior researcher at the Guttmacher Institute and lead author of the investigation, explained:

"The declining abortion trend we had seen globally has stalled, and we are also seeing a growing proportion of abortions occurring in developing countries, where the procedure is often clandestine and unsafe. This is cause for concern.

This plateau coincides with a slowdown in contraceptive uptake. Without greater investment in quality family planning services, we can expect this trend to persist."

An estimated 13% of all maternal deaths worldwide in 2008, nearly all of which occurred in developing nations, are due to complications from unsafe abortions. Worldwide in 2008, 220 women died per 100,000 procedures as a result of unsafe termination, 350 times the rate associated with legal induced abortions in the U.S. (0.6 per 100,000).

In addition, around 8.5 million women in developing nations each year suffer serious complications from abortion that require medical attention, out of which 3 million do not receive the care they need.

Iqbal H. Shah, of the WHO and a coauthor of the investigation, said:

"Deaths and disability related to unsafe abortion are entirely preventable, and some progress has been made in developing regions. Africa is the exception, accounting for 17% of the developing world's population of women of childbearing age but half of all unsafe abortion-related deaths.

Within developing countries, risks are greatest for the poorest women. They have the least access to family planning services, and are the most likely to suffer the negative consequences of an unsafe procedure. Poor women also have the least access to postabortion care, when they need treatment for complications."

Study results also showed additional evidence that restrictive abortion laws are not linked to lower rates or termination. For example, In Western Europe abortion is typically allowed on broad grounds, with a abortion rate of 12 per 1,000 women of childbearing age, while the 2008 abortion rate in Africa was 29 per 1,000, and 32 per 1,000 in Latin America, regions where abortion is highly restricted in nearly all nations.

The lowest rate of abortion in Africa (15 per 1,000 women) is in the Southern Africa subregion, where almost 90% of women live under South Africa's liberal abortion law. The researchers found rates were also low in Western Europe (12 per 1,000) and Northern Europe (17 per 1,000), where women have easy access to both abortion and contraception for free or at a considerably low price.

In Eastern Europe, abortion rates are almost 4 times more than in Western Europe, due to low levels of modern contraceptive use and low prevalence of effective birth control methods, such as the IUD and the pill. Although Eastern Europe saw a significant decline in abortion rates between 1995 and 2003, from 90 to 44 per 1,000 women, rates remained virtually unchanged between 2003 and 2008.

Richard Horton, editor of The Lancet, explained: "These latest figures are deeply disturbing. The progress made in the 1990s is now in reverse. Promoting and implementing policies to reduce the number of abortions is now an urgent priority for all countries and for global health agencies, such as WHO. Condemning, stigmatizing, and criminalizing abortion are cruel and failed strategies. It's time for a public health approach that emphasizes reducing harm - and that means more liberal abortion laws."

Written By Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Dropping Planned Parenthood Is Not Political, Says Susan G. Komen For The Cure

Editor's Choice
Main Category: Breast Cancer
Also Included In: Women's Health / Gynecology;  Abortion
Article Date: 02 Feb 2012 - 9:00 PST

Has Komen Shot Itself In The Foot?

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Main Category: Sexual Health / STDs
Also Included In: Abortion;  Breast Cancer
Article Date: 05 Feb 2012 - 14:00 PST

Potential Solution To Melanoma's Resistance To Vemurafenib

Researchers at Moffitt Cancer Center in Tampa, Fla., and colleagues in California have found that the XL888 inhibitor can prevent resistance to the chemotherapy drug vemurafenib, commonly used for treating patients with melanoma.

Vemurafenib resistance is characterized by a diminished apoptosis (programmed cancer cell death) response. According to the researchers, the balance between apoptosis and cell survival is regulated by a family of proteins. The survival of melanoma cells is controlled, in part, by an anti-apoptotic protein (Mcl-1) that is regulated by a particular kind of inhibitor.

Their current findings, tested in six different models of vemurafenib resistance and in both test tube studies and in melanoma patients, demonstrated an induced apoptosis response and tumor regression when the XL888 inhibitor restored the effectiveness of vemurafenib.

The study appeared in a recent issue of Clinical Cancer Research, a publication of the American Association for Cancer Research.

"The impressive clinical response of melanoma patients to vemurafenib has been limited by drug resistance, a considerable challenge for which no management strategies previously existed," said study co-author Keiran S. M. Smalley, Ph.D., of Moffitt's departments of Molecular Oncology and Cutaneous Oncology. "However, we have demonstrated for the first time that the heat shock protein-90 (HSP90) inhibitor XL888 overcomes resistance through a number of mechanisms."

The diversity of resistance mechanism has been expected to complicate the design of future clinical trials to prevent or treat resistance to inhibitors such as vemurafenib.

"That expectation led us to hypothesize that inhibitor resistance might best be managed through broadly targeted strategies that inhibit multiple pathways simultaneously," explained Smalley.

The HSP90 family was known to maintain cancer cells by regulating cancer cells, making it a good target for treatment. According to the authors, the combination of vemurafenib and XL888 overcame vemurafenib resistance by targeting HSP90 through multiple signaling pathways.

There was already evidence that HSP90 inhibitors could overcome multiple drug chemotherapy resistance mechanisms in a number of cancers, including non-small lung cancer and breast cancer. Because XL888 is a novel, orally available inhibitor of HSP90, the researchers hoped that it would arrest the cancer cell cycle in melanoma cell lines.

In their study, the inhibition of HSP90 led to the degradation of the anti-apoptopiuc Mcl-1 protein. The responses to XL888 were characterized as "highly durable with no resistant colonies emerging following four weeks of continuous drug treatment." In other studies not using XL888, resistant colonies "emerged in every case," they reported.

"We have shown for the first time that all of the signaling proteins implicated in vemurafenib resistance are 'clients' of HSP90 and that inhibition of HSP90 can restore sensitivity to vemurafenib," concluded Smalley and his colleagues. "Our study provides the rationale for the dual targeting of HSP90 with XL888 and vemurafenib in treating melanoma patients in order to limit or prevent chemotherapy resistance."

Misoprostol Lowers Risk Of Complications In Abortions

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Article opinions: 3 posts
A new study, published Online First in The Lancet , reports that major complications during early surgical abortions are reduced by nearly a third in comparison with placebo, if the cervix is prepared with misoprostol.

Misoprostol is widely used for cervical preparation before surgical abortion (vacuum aspiration), given that the drug is effective, easy to use, cheap and widely available. However, there have been no studies, until now, that were sufficiently large to evaluate if misoprostol causes immediate or delayed serious complications from surgical abortion.

In a multinational, randomized study, Eduardo Bergel from WHO in Geneva, Switzerland, and his team compared complications rates of vacuum aspirations in terms of incomplete abortion, cervical tear, pelvic inflammatory disease, uterine perforation, or other serious events.

The study recruited 4,972 women who requested an abortion before the 12th week of pregnancy, from 14 centers in nine countries. 2,485 women were randomly assigned for administration with vaginal misoprostol, whilst 2,487 women received placebo 3 hours before aspiration.

The results showed that the risk of experiencing one or more complications was almost a third lower for women in the misoprostol group than that of those who received placebo, whilst minor cervical tears and uterine perforations were also observed to be less frequent in the misoprostol group. They also found an almost three times increased risk of incomplete abortion in the placebo group compared with women in the misoprostol group.

The researchers also noted that women in the misoprostol group more frequently experienced abdominal pain, vaginal bleeding, and nausea after being treated with misoprostol during the 3 hours before surgery, however, no differences were observed between both groups with regard to incidences of pelvic inflammatory disease or other serious adverse events.

In a concluding statement the researchers state:

"Misoprostol reduced the overall incidence of complications, particularly incomplete abortions and unscheduled clinic visits and hospital admissions after abortion...Providers should be aware of the side-effects of the drug and inform women about these effects."

According to a linked comment made by Allan Templeton from the University of Aberdeen in Scotland:

"The important issue...is the balance between effectiveness of the procedure and the side-effects of misoprostol, which will include abdominal cramps and vaginal bleeding in most women, although not to the extent of needing medical intervention before surgery. Surely routine pharmaceutical dilation of the cervix should be recommended as an integral part of surgical abortion in all women."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

The Gap Between Policy And Practice In Maternal Health And Maternal Mortality

As the UN Special Rapporteur on maternal mortality in India points out there is a 'yawning gulf between ... commendable maternal mortality policies and their urgent, focused, sustained, systematic and effective implementation.' Reproductive Health Matters explores the causes and impact of this gap, but also highlights hopeful signs of progress.

Two papers from India included in the issue capture both the good and bad news that characterise the gap between rhetoric and reality in maternal health and maternal mortality. In India a range of provisions to support better maternal nutrition and access to subsidised health care are required by law, but there is a wide gap between policy and practice. Preventable deaths are caused by several factors including a shortfall in antenatal care, delays in emergency obstetric care and inappropriate referral. Detailed case studies of women who died point to lack of accountability, discrimination on the grounds of poverty and caste, and according to Subha Sri Balakrishnan, author of one of the papers, "In some cases...quality of care (that) was so poor that it may be considered negligent."

Both papers follow subsequent action taken to seek government accountability and justice. In one paper, author Jameen Kaur, reports on the way in which a women's family sought redress in the courts, supported by human rights lawyers. The second paper details an investigation lead by Subha Sri Balakrishnan into maternal deaths in response to a public protest about local maternal deaths in Madhya Pradesh. The researchers presented their findings to district and state level health officials which led to some improvements in care.

Examples of using law to promote accountability and good practice are described in a paper from Latin America reporting on landmark decisions by the UN Committee on the Elimination of Discrimination Against Women (CEDAW) calling for appropriate maternal health care (Brazil) and decriminalisation of abortion to safeguard women's health (Peru). These are promising examples of the application of human rights to demand government responsibility for maternal deaths and to assert the rights of women not to die in pregnancy, childbirth and unsafe abortion.

Furthermore a new emphasis on evidence-based practice is described in several papers, providing grounds for optimism. It suggests there is a real desire to improve outcomes and the hope that new initiatives may have a greater chance of success in saving women's lives. Without the political commitment to addressing equity, however, important initiatives will continue to fail the poorest and most marginalised women. As one author notes, "The death of a woman due to pregnancy complications is not just a biological fact it is also a political choice."

Multiple Abortions May Increase Risk Of Prematurity And Low Birth Weight In Future Pregnancies

Main Category: Pregnancy / Obstetrics
Also Included In: Abortion;  Pediatrics / Children's Health
Article Date: 31 Aug 2012 - 0:00 PDT