Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons

Pinho, Adriana de Araujo; Villela, Wilza Vieira; Barbosa, Regina Maria; Monteiro, Simone Souza

doi:10.1590/1806-93042019000400006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1806-93042019000400006 copy

Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

we investigated the lifetime prevalence of abortion and life contexts and reasons reported for first abortion among women living (WLHA) and not living with HIV/AIDS(WNLHA).

Methods:

representative samples of 975 users of public health care reference network for HIV/AIDS and of 1,003 users of the primary care public services in São Paulo municipality were selected by cluster-stratified sampling and answered an electronic socio-behavioral questionnaire.

Results:

the prevalence of abortion was 11.9% (CI95%9.8-13.9) among WLHA and 3.0% (CI95%2.4-5.7) for WNLHA.Most abortions (128) among WLHA occurred before diagnosis and 28 after diagnosis or during pregnancy when diagnosis was given. The majority of women did not use any contraception at the time of the first abortion. The use of misoprostol was the most reported method. Having HIV was very important in deciding to abort for half of the WLHA. Absence of marital life and the lack of desire to have children were the most reported reasons by both groups.

Conclusions:

the similarity in contexts and reasons to abort among WLHA and WNLHA suggests that they share experiences molded by gender and social inequalities that affect their ability to access sexual and reproductive health resources and services.

Key words
Abortion; HIV; Reproductive health

Variables	WLHA		WNLHA		WLHA with		WLHA with
	general sample		general sample		abortion reports		abortion reports
	n	%^* * % = weight-adjusted proportions derived from the sampling process,	n	%^* * % = weight-adjusted proportions derived from the sampling process,	n	%^* * % = weight-adjusted proportions derived from the sampling process,	n	%^* * % = weight-adjusted proportions derived from the sampling process,
Total (n)	916		1003		116		29
Age at the time of interview (years)
18-34	196	26.3	330	60.1	6	4.8	5	27.3
35-49	680	73.7	416	39.9	110	95.2	23	72.7
		p<0.001				p=0.005
Age at time of diagnosis (years)
Younger than 25	255	28.1	0	-	16	13.7	0	-
25-29	248	28.1	0	-	31	27.1	0	-
30-49	402	43.8	0	-	65	59.2	0	-
Color of skin
White	373	39.9	391	39.1	50	42.9	13	44.7
Black	158	17.9	107	10.7	20	17.6	3	10.0
Brown	368	40.2	473	47.1	42	36.3	10	35.3
Other	16	1.5	31	3.0	4	3.1	3	9.9
		p<0.001				p=0.334
Schooling
Incomplete elementary	247	27.0	204	20.2	36	31.2	8	26.4
Complete elementary	234	25.3	247	24.8	24	20.6	4	12.3
High school complete	294	31.9	435	43.3	33	28.1	12	44.4
Superior (complete and incomplete)	143	15.7	116	11.6	23	20.1	5	16.9
		p=0.001				p=0.505
Household per capita income (monthly)
Up to half minimum salary	255	27.8	302	29.9	33	26.9	6	18.7
From half to 1 MS	281	30.5	351	35.5	40	36.6	11	37.8
More than 1 MS	382	41.6	350	34.5	43	36.4	12	43.4
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/no information, p= p value, WLHA=Women living withHIV/AIDS, WNLHA= Women not living with HIV/AIDS, MS=Minimum-salary, GENIH=Gender and Infection by HIV.	80	9.3	79	7.8	8	7.0	2	7.5
		p=0.083				p=0.777
Number of partners in life
1-2 partners	141	15.7	463	46.0	2	1.5	3	8.5
3-5 partners	406	44.5	383	38.6	40	35.7	12	45.4
6 or more partners	299	33.2	138	14.1	58	51.0	12	39.5
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/no information, p= p value, WLHA=Women living withHIV/AIDS, WNLHA= Women not living with HIV/AIDS, MS=Minimum-salary, GENIH=Gender and Infection by HIV.	59	6.6	12	1.2	13	11.8	2	6.7
		p<0.001				p=0.069
Number of marriages
Was never married	72	7.8	154	15.8	7	5.7	3	10.0
Only once	415	45.8	622	61.2	40	35.4	12	38.8
Twice or more	224	46.4	425	23.0	68	58.9	14	51.5
		p<0.001				p=0.604
Number of pregnancies
Never got pregnant	101	10.8	157	15.6	-	-	-
Once	189	23.4	290	34.4	8	6.1	5	15.5
Twice	223	26.9	244	28.9	19	16.3	10	36.4
Three or more	405	49.6	312	36.7	89	77.6	14	48.0
		p<0.001				p=0.003
Number of living children
None	162	7.4	319	19.4	15	11.9	8	28.2
One	261	32.3	267	32.0	30	26.7	9	30.9
Two	247	30.3	233	27.3	27	23.5	5	21.2
Three or more	248	30.0	184	21.3	44	37.9	7	19.6
		p<0.001				p=0.084

	Women with abortion			Women with abortion
	before HIV			after HIV			WNLHA
	n	%	CI95%^* * % = weight-adjusted proportions derived from the sampling process;	n	%	CI95%^* * % = weight-adjusted proportions derived from the sampling process;	n	%	CI95%^* * % = weight-adjusted proportions derived from the sampling process;
Total of women (n)	102			24			29
Frequency of abortions
Only one abortion	76	8.2	6.5-10.1	20	2.3	1.4-3.5	25	2.8	1.8-4.4
More than one abortion	26	2.9	1.9-4.2	4	0.4	0.2-1.1	4	0.4	0.2-1.1
Total abortions (n)	128			28			33
Mean age when first abortion occurred (amplitude)	21	12-32		28	22-42		22	12-34
Use of contraceptive method at the time of 1st abortion
yes	35	37.7	28.3-48.2	10	48.7	28.1-69.7	8	36.3	16.1-62.7
No	55	59.4	48.8-69.1	9	45.4	25.4-66.9	19	63.7	37.3-83.8
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	2	2.8	0.7-10.8	1	6.0	0.8-32.4	0	-	-
Used contraceptive method
Masculine/feminine condom	8	23.8	12.3-41.1	8	80.4	46.4-95.1	1	17.9	3.1-60.0
Reversible (pill / IUD / injectable/ combinations)	18	48.9	33.0-65.0	2	19.6	4.9-53.6	7	82.0	39.9-96.9
Coitus	6	15.7	7.0-31.4	0	-	-	0	-	-
Outher	3	8.1	2.6-22.4	0	-	-	0	-	-
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	1	3.4	0.5-20.7	0	-	-	0	-	-
Reason for not using contraceptive method¹ 1 ACM= anticonception method; CI95% = 95% confidence interval adjusted for weights derived from complex sampling process, HIV=Human Acquired Immunodeficiency syndrome Virus; WLHA=women living with HIV/AIDS; WNLHA=women not living with HIV/AIDS; GENIH=gender and infection by HIV.
Did not think would get pregnant/ did not worry about it	38	65.6	52.5-76.7	6	66.7	32.9-89.1	9	57,6	29.9-81.2
Getting pregnant would not be a problem	4	6.2	2.3-15.6	0	-	-	1	4,9	0.6-29.6
Had not planned sexual intercourse	4	5.1	1.8-13.1	2	20.5	5.1-55.6	4	19,8	6.3-47.9
Had interrupted the use of contraceptive method recently	2	3.5	0.8-13.1	0	-	-	3	14.0	4.4-36.8
Partner did not like she used contraceptive method	1	1.5	0.2-10.3	0	-	-	1	3.5	0.5-19.6
Other reasons	6	8.4	3.5-19.1	0	-	-	0	-	-
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	5	9.0	3.7-20.1	1	12.8	1.8-54.4	2	NC
Reason reported for pregnancy occurring during use of contraceptive method
Forgot/stopped using the pill (interruption)	6	15.3	6.9-30.3	0	-	-	4	50.8	25.3-75.9
Failure of method (condom broke, coitus interruptus failed)	21	57.3	40.8-72.3	7	68.1	35.3-89.3	3	31.2	5.4-78.2
Did not use condom in all intercourses	2	5.1	1.3-18.5	3	31.8	10.7-64.7	0	-	-
Other reason	4	10.5	3.9-25.0	0	-	-	1	17.9	3.1-60.1
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	4	11.8	4.4-28.0	0	-	-	0	-	-
Lived with partner of pregnancy which resulted in the 1st abortion
Yes	30	29.2	21.0-39.0	8	57.6	31.9-79.8	9	31.8	21.1-44.9
No	69	70.8	61.0-78.9	6	42.3	20.2-68.1	20	68.1	55.1-78.8
Relationship status with abortion partner
Was beginning	18	20.0	12.9-29.6	3	12.4	3.9-32.7	7	27.1	13.8-46.3
Was stable	57	58.9	48.4-68.6	11	53.3	32.4-73.1	14	47.0	23.1-72.5
Was unstable/ in a crisis	16	17.8	11.1-27.4	4	17.8	6.8-39.4	6	25.8	11.8-47.7
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	3	3.2	0.5-8.3	2	16.4	5.4-40.4	2	NC
Financial situation when discovered pregnancy
Good, reasonable	41	41.9	32.2-52.3	14	70.2	47.3-86.0	3	10.8	4.0-26.1
A little difficult	20	21.9	14.5-31.7	3	14.3	4.6-36.4	7	25.5	11.7-47.1
Very difficult	31	32.9	24.1-43.3	2	9.5	2.4-31.3	17	56.6	38.5-73.1
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	2	2.1	0.5-8.2	1	5.9	0.8-32.4	2	7.1	2.1-21.3
In the decision of interrupting pregnancy
She and her partner agreed	34	36.3	27.1-46.7	7	28.3	13.9-49.1	11	38.1	27.8-49.7
She wanted but he did not	13	13.8	8.1-22.7	2	10.2	2.6-32.5	6	17.2	7.9-33.4
He wanted but she did not	10	11.7	6.3-20.5	2	8.1	2.0-27.4	3	10.5	4.1-24.2
Partner allowed her to decide	9	8.7	4.5-15.9	3	13.2	4.3-34.2	2	7.5	1.8-25.7
Partner was not informed of pregnancy	26	27.4	19.2-37.4	4	16.3	6.2-36.5	5	20.1	9.4-37.7
Outher	1	1.1	0.1-7.1	3	12.9	4.2-33.8	1	3.1	0.4-19.8
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	1	1.1	0.1-7.1	1	10.9	2.7-34.5	1	3.5	0.4-23.7
How abortion was accomplished (multiple answer)
Use of misoprostol	63	64.1	54.0-73.1	19	70.2	49.6-84.9	12	46.8	22.4-73.0
By curettage	18	18.9	12.1-28.3	4	15.4	5.8-34.8	3	11.4	2.7-37.8
By aspiration (vacuum, suction)	5	5.8	2.4-13.2	2	8.2	2.0-27.9	0	-	-
With use of objects (needle, probe, catheter)	12	12.9	7.3-21.3	0	-	-	1	3.2	0.4-20.5
With teas, infusions and herbs	13	13.8	7.9-22.8	3	11.1	3.5-29.9	8	24.9	11.2-46.8
Outher form	12	12.9	7.5-21.4	3	11.7	3.8-30.9	2	5.9	1.4-21.4
Other medicines (except misoprostol)	2	1.6	0.4-6.5	1	3.8	0.5-22.0	2	7.6	1.7-28.0
Main reason that weighed on abortion decision
Was not married/did not life together/ was without partner	20	22.1	14.6-32.0	3	13.2	4.3-34.2	7	23.6	9.9-46.4
She and/or partner could not afford the child	12	13.2	7.5-21.9	0	-	-	4	15.1	3.7-45.5
Family and / or family members of partner would not accept pregnancy	16	18.1	11.3-27.7	4	17.1	6.5-37.9	4	14.0	3.0-46.2
She did not want a child at that moment	19	19.0	12.3-28.3	2	8.1	2.0-27.4	8	31.1	16.5-50.6
Partner did not want a child at that moment	8	8.6	4.3-16.7	2	8.1	2.0-27.5	2	6.8	2.6-16.5
She did not want (another) child from that partner	12	12.0	6.9-20.2	9	37.4	20.4-58.3	1	3.2	0.4-20.5
Suffered violence from partner	5	5.8	2.4-13.4	0	-	-	1	3.2	0.4-20.5
Outher reason	1	1.1	0.1-7.2	1	5.1	0.7-28.7	1	3.1	0.4-21.2
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	0	-	-	1	10.9	2.7-34.5	0	-	-
In the decision to abort, HIV:
Was very important	-	-	-	11	47.6	28.4-67.6	-	-	-
Was important	-	-	-	1	4.1	5.6-24.1	-	-	-
Was of little importance	-	-	-	3	12.2	3.9-31.9	-	-	-
Was not important	-	-	-	6	25.2	11.6-46.3	-	-	-
DK/DR/NI^ DK/DR/NI= doesn't know/doesn't remember/not informed; NC=not calculated;	-	-	-	1	10.9	2.7-34.5	-	-	-

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[1] Authors’ contribution

Pinho AA conceived the paper, analyzed and inter-preted data and wrote the first version of the manu-script. Villela WV contributed to the discussion and writing of the manuscript. Barbosa RM coordinated the GENIH study and participated in the manus-cript’s revision. Monteiro SS contributed to the discussion and revision of the manuscript. All of them approved the manuscript’s final version.