{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T12:39:03Z","timestamp":1794227943623,"version":"4.9.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States Agency for International Development Madagascar","award":["AID-687-G-13-00003"],"award-info":[{"award-number":["AID-687-G-13-00003"]}]},{"DOI":"10.13039\/100002271","name":"Pasteur Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002271","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Madagascar has restrictive abortion laws with no explicit exception to preserve the woman\u2019s life. This study aimed to estimate the incidence of abortion in the country and examine the methods, consequences, and risk factors of these abortions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We interviewed 3179 women between September 2015 and April 2016. Women were selected from rural and urban areas of ten districts via a multistage, stratified cluster sampling survey and asked about any induced abortions within the previous 10\u2009years. Analyses used survey weighted estimation procedures. Quasi-Poisson regression was used to estimate the incidence rate of abortions. Logistic regression models with random effects to account for the clustered sampling design were used to estimate the risk of abortion complications by abortion method, provider, and month of pregnancy, and to describe risk factors of induced abortion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For 2005\u20132016, we estimated an incidence rate of 18.2 abortions (95% CI 14.4\u201323.0) per 1000 person-years among sexually active women (aged 18\u201349 at the time of interview). Applying a multiplier of two as used by the World Health Organization for abortion surveys suggests a true rate of 36.4 per 1000 person-year of exposure. The majority of abortions involved invasive methods such as manual or sharp curettage or insertion of objects into the genital tract. Signs of potential infection followed 29.1% (21.8\u201337.7%) of abortions. However, the odds of potential infection and of seeking care after abortion did not differ significantly between women who used misoprostol alone and those who used other methods. The odds of experiencing abortion were significantly higher among women who had ever used contraceptive methods compared to those who had not. However, the proportion of women with a history of abortion was significantly lower in rural districts where contraception was available from community health workers than where it was not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incidence estimates from Madagascar are lower than those from other African settings, but similar to continent-wide estimates when accounting for underreporting. The finding that the majority of abortions involved invasive procedures suggests a need for strengthening information, education and communications programs on preventing or managing unintended pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12905-020-00962-2","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T14:03:55Z","timestamp":1588773835000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Frequency, risk factors, and complications of induced abortion in ten districts of Madagascar: results from a cross-sectional household survey"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3867-6343","authenticated-orcid":false,"given":"Rila","family":"Ratovoson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Kunkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Pierre","family":"Rakotovao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Pourette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiarella","family":"Mattern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyne","family":"Andriamiadana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina","family":"Harimanana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Piola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,6]]},"reference":[{"key":"962_CR1","volume-title":"Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008","author":"World Health Organization Department of Reproductive Health and Research","year":"2011","unstructured":"World Health Organization Department of Reproductive Health and Research. 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At the household level, the fieldworkers explained in the local language that they were conducting a survey on maternal health that would contain sensitive questions about past pregnancies, abortions, and use of family planning. Verbal consent was obtained from the head of the household (or his wife \/ her husband). At this point, the fieldworkers asked about whether any women in the target age range were present in the home. Any eligible women were given a more detailed explanation of the study as well as information about confidentiality, privacy and the right to refuse to participate or withdraw before conducting any interview. Interviews only occurred if the woman agreed to participate and signed an informed consent form. In rare cases, if the woman requested it, other household members were allowed to remain for the portion of the interview related to household composition and socioeconomic status, but questions about pregnancy history and use of family planning began only when the interviewer was alone with the woman.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"We declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"96"}}