Abstract

PIP: A study was conducted in the maternal and child health centers in 2 small towns in the Cap Bon peninsula (northeast Tunisia) in an attempt to determine the incidence of induced abortions. The birth rate in this area was 38.8/1000 in 1973 and 23.8/1000 in 1977. The family planning program and the liberalization of the abortion law might have contributed to the birth rate decline. A total of 502 induced abortions were performed over the September 1976 to December 1978 period. Each woman desiring an abortion was examined by the midwife for pregnancy confirmation. Any woman with a pregnancy of more than 2 1/2 months was referred to the nearby regional hospital. The abortion was performed by the gynecologist using vacuum aspiration under local anesthesia. Immediately after aspiration, an IUD is inserted or the oral contraceptive is given and its use explained. Each woman is kept under observation for 1-2 hours. Seven characteristics of the abortion patients were analyzed: age; number of living children and parity; age of last living child at time of conception; breastfeeding; domicle; use of contraception prior to induced abortion; and contraception in immediate postabortion period. 89% of the women were aged 20-39 years; 43% were under 30 years old. 40% had 1-3 living children and 58% had more than 3 children. Women aged under 30 had a mean of 2.49 living children and a mean parity of 2.78; for those over 30 the corresponding figures were 5.23 and 6.44. 60% had a child under 2 years old; 28% had their last living child aged 2-5 years; and 12% had a school age child. Of 463 women, 154 were breastfeeding at the time of conception. 71% of the women lived in the town where the center is located, and 29% came from the rural neighboring areas. A small number of women became pregnant due to the failure of their contraceptive method (IUD and technically failed tubal ligation). 1/3 of 492 women had used a contraceptive method since their last delivery, but most had stopped it after a time or had used it erratically. 3/4 accepted the IUD as an immediate postabortion method; 21.3% accepted oral contraception, and 2.6% accepted tubal ligation. The following factors have improved the acceptance of contraception and induced abortion by the women: there is no need for husband's consent or for approval of a medical panel; contraception and abortion are free of charge; decentralization of family planning and abortion; and the requirement of only a short stay for postintervention observation.