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International perspectives on the implementation of reproductive carrier screening

Delatycki MB, Alkuraya F, Archibald A, Castellani C, Cornel M, Grody WW, et al.

Prenat Diagn, 2020 02;40(3):301-310.
PMID: 31774570 DOI: 10.1002/pd.5611

Reproductive carrier screening started in some countries in the 1970s for hemoglobinopathies and Tay-Sachs disease. Cystic fibrosis carrier screening became possible in the late 1980s and with technical advances, screening of an ever increasing number of genes has become possible. The goal of carrier screening is to inform people about their risk of having children with autosomal recessive and X-linked recessive disorders, to allow for informed decision making about reproductive options. The consequence may be a decrease in the birth prevalence of these conditions, which has occurred in several countries for some conditions. Different programs target different groups (high school, premarital, couples before conception, couples attending fertility clinics, and pregnant women) as does the governance structure (public health initiative and user pays). Ancestry-based offers of screening are being replaced by expanded carrier screening panels with multiple genes that is independent of ancestry. This review describes screening in Australia, Cyprus, Israel, Italy, Malaysia, the Netherlands, Saudi Arabia, the United Kingdom, and the United States. It provides an insight into the enormous variability in how reproductive carrier screening is offered across the globe. This largely relates to geographical variation in carrier frequencies of genetic conditions and local health care, financial, cultural, and religious factors.

Matched MeSH terms: Abortion, Induced/statistics & numerical data
Counseling for prenatal diagnosis and termination of pregnancy due to thalassemia major: a survey of health care workers' practices in Malaysia

Ngim CF, Lai NM, Ibrahim H

Prenat Diagn, 2013 Dec;33(13):1226-32.
PMID: 24014379 DOI: 10.1002/pd.4233

OBJECTIVE: Genetic counseling for thalassemia carriers is conducted by nongeneticist health care workers (HCWs) in many countries. The aim of the study was to assess Malaysian HCWs' genetic counseling practices with regards to discussing prenatal diagnosis (PND) and termination of pregnancy (TOP) when counseling thalassemia carriers.
METHOD: A total of 118 Malaysian HCWs (52 doctors and 66 nurses) completed a structured questionnaire that enquired if they would discuss PND and TOP when counseling couples with thalassemia traits, and reasons for their responses were explored.
RESULTS: All the nurses and 50 (96.1%) doctors were in favor of discussing PND. Only 29 (58%) doctors and 33 (50%) nurses were agreeable to discuss about the option of TOP. Main reasons given for declining to discuss TOP were views that "the condition was not serious enough" (54.9%), TOP is not permissible by their religion (17.6%) and abortion for this indication was illegal (13.7%).
CONCLUSION: The results showed that HCWs in Malaysia lacked the comprehensive information and necessary skills required when counseling thalassemia carriers. When nongeneticist HCWs are tasked with such responsibilities, their practices and attitudes should be regularly evaluated so that areas of deficiencies could be identified and addressed.

Matched MeSH terms: Abortion, Induced/psychology
The Global Gag Rule: The death trap for comprehensive sexual and reproductive healthcare and way to overcome the US gag rule

Murshid ME, Haque M

J Popul Ther Clin Pharmacol, 2020 06 11;27(2):e87-e99.
PMID: 32621461 DOI: 10.15586/jptcp.v27i2.677

The United States of America (USA) is one of the largest bilateral donors in the field of global health assistance. There are beneficiaries in 70 countries around the world. In 2015, the USA released US$638 million for the improvement of global health status by promoting family planning services. Unfortunately, in 2017, Trump administration reinstated Mexico City Policy/Global Gag Rule (GGR). This policy prevents non-US nongovernmental organizations (NGOs) from receiving US health financial assistance if they have any relationship with abortion-related services. This restriction pushed millions of lives into great danger due to the lack of comprehensive family planning services, especially lack of abortion-related services. This article has attempted to let the readers know about the impacts of GGR around the world and how global leaders are trying to overcome the harmful effects of this rule. Finally, it proposes some solutions to the impacts of the extension of Mexico City Policy.

Matched MeSH terms: Abortion, Induced/legislation & jurisprudence*
The effects of life cycle and family formation variables on pregnancy outcome

Arshat H, Tan Boon Ann, Tey Nai Peng

Malays J Reprod Health, 1985 Dec;3(2):115-25.
PMID: 12314738
Matched MeSH terms: Abortion, Induced*
Reflections on the maternal mortality millennium goal

Lawson GW, Keirse MJ

Birth, 2013 Jun;40(2):96-102.
PMID: 24635463 DOI: 10.1111/birt.12041

Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth. Every such death is an overwhelming catastrophe for everyone confronted with it. Most deaths occur in developing countries, especially in Africa and southern Asia, but a significant number also occur in the developed world.

Matched MeSH terms: Abortion, Induced/mortality
Fulltext Knowledge and practice on Toxoplasma infection in pregnant women from Malaysia, Philippines, and Thailand

Andiappan H, Nissapatorn V, Sawangjaroen N, Khaing SL, Salibay CC, Cheung MM, et al.

Front Microbiol, 2014;5:291.
PMID: 24966855 DOI: 10.3389/fmicb.2014.00291

Toxoplasma gondii, is one of the infectious agents of congenital TORCH infections, causes severe clinical outcomes in fetus and newborns. Nevertheless this life-threatening parasitic disease is preventable by simple preventive measures related to lifestyle during pregnancy. We aim to study on the knowledge about toxoplasmosis and practices that prevents this infection among the pregnant women. Total of 2598 pregnant women from Malaysia, Philippines, and Thailand were randomly surveyed to determine the knowledge and their practices on Toxoplasma infection. The questionnaire covered respondents' general information and knowledge on plausible risks factors, symptoms, timing of infection, prevention knowledge, and preventive behavior regarding Toxoplasma infection. Majority of these pregnant women were in their age group of 20-29 years (50.9%), completed secondary level of education (51.7%), in their second trimester of pregnancies (38.1%), non-parous (36.6%), and had no history of abortion (90.4%). Based on this survey, only 11% of these pregnant women had read, heard, or seen information regarding toxoplasmosis and 3.5% of them were aware of being tested for the infection. A small percentage of these pregnant women knew that T. gondii were shed in the feces of infected cats (19.4%) and sometimes found in the raw or undercooked meat (11.0%). There was 16.1% of responding women knew that toxoplasmosis is caused by an infection. Demographic profiles such as age group, level of education, pregnancy term, and number of children of the pregnant women showed significant association with their responses toward prevention knowledge and preventive behavior related questions (P < 0.05). Thus, it is suggested that health education on toxoplasmosis and primary behavioral practices should be consistently offered to reproductive age women in general and pregnant women in particular. This information could help to reduce vertical transmission of Toxoplasma infection during pregnancy.

Matched MeSH terms: Abortion, Induced
Child marriage and its association with adverse reproductive outcomes for women in Bangladesh

Kamal SM, Hassan CH

Asia Pac J Public Health, 2015 Mar;27(2):NP1492-506.
PMID: 24097938 DOI: 10.1177/1010539513503868

This study examines the prevalence of child marriage and its effect on reproductive outcomes among women in Bangladesh using the most recent 2011 Bangladesh Demographic and Health Survey data. Both bivariate and multivariate statistical techniques used in the study yielded quantitatively important and reliable estimates of child marriage and its impact on adverse reproductive and health outcomes. Overall, 77% of the marriages among women aged 20 to 49 years old took place before the age of 18 years. Women's education is the most single significant determinant of child marriage. Findings revealed that after being adjusted for sociodemographic factors, child marriage significantly (P < .001) increases the likelihood of stillbirth/miscarriage (odds ratio [OR] = 1.80; 95% confidence interval [CI] = 1.45-2.24) and pregnancy termination (OR = 1.24; 95% CI = 1.12-1.38). Programs should aim to retain girls in school for longer periods not only to raise the age at first marriage but also for sound reproductive health and overall social development of Bangladesh.

Matched MeSH terms: Abortion, Induced
Public Prosecutor v. Dr. Nadason Kanagalingam, 9 June 1984

Malaysia. High Court

Annu Rev Popul Law, 1987;14:39.
PMID: 12346715

The defendant, an obstetrician and gynaecologist, was accused of voluntarily causing a woman to miscarry, such miscarriage having been performed without good faith and an intention to save the woman's life. The Court upheld the conviction of the defendant, rejecting his argument, supported by an expert witness, that he had performed the abortion in order to avoid the possibility of pulmonary embolism, which might result because the woman had enlarged varicose veins. It held that the argument was not reasonable under the current law and that procuring an abortion was a serious matter to be done only as a last resort to save the life of a woman or to save her from becoming a mental "wreck."

Matched MeSH terms: Abortion, Induced
Fulltext Islamic perspective on elective abortion of Zika virus infected pregnant women

Syazwani Hamdan, Mohd Rahman Omar, Mohammad Naqib Hamdan, Ummu Aiman Faisal

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):60-60.
MyJurnal

Introduction: Zika virus infection is caused by flavivirus virus and spread by Aedes mosquitoes. Since first report-ed in 1947, it spread to various countries especially in the equatorial region including Malaysia. The infection is non-fatal to an adult. However, the major risk of its infection is towards unborn baby when the mother is infected. The vertical transmission to the foetus possess various risks include the teratogenic effect that may lead to elective abortion. Thus, the objectives of this review are to discover about Zika virus and its effect on pregnant women and to evaluate Islamic perspective about elective abortion of Zika virus-infected women. Methods: This review was done through reviewing evidence from the journals, books and reports. The data were reviewed thematically according to the objectives. Results: Studies shown that Zika virus may cause miscarriage, preterm birth, microcephaly and other malformation known as Congenital Zika syndrome. This leads to a demand for elective abortion which raised Islamic ethical issue if it is permissible. In Islam, abortion is extremely prohibited once the foetus reached 120-day of con-ception unless it causes harm to the mother’s life. But, if the foetus age is less than 120-day, abortion is permissible when the pregnancy affects the mother’s health. Abortion due to foetal microcephaly and congenital malformation is prohibited. Conclusion: Effort must be taken to prevent the spread of Zika virus to reduce the need for an elective abortion through an education Muslim community regarding elective abortion.

Matched MeSH terms: Abortion, Induced
Fulltext Medical students' knowledge and perception toward family planning services: A preliminary intervention study

Htay MNN, Latt SS, Abas AL, Chuni N, Soe HHK, Moe S

J Educ Health Promot, 2018;7:137.
PMID: 30596109 DOI: 10.4103/jehp.jehp_104_18

INTRODUCTION: Family planning and contraception is the effective strategy to reduce maternal mortality, child mortality, abortion, and unwanted pregnancies. Since the medical students are the future doctors, it is important to have proper knowledge and training on family planning services. This study aimed to explore the effect of teaching-learning process at maternal and child health (MCH) clinics on the students' knowledge, perceptions toward contraception methods, and family planning counselling.
METHODS: This quasi-experimental study was conducted in the private medical institution in Malaysia. The same questionnaire was used to administer twice, before and after the posting. Moreover, a qualitative question on the issues related to family planning and contraception utilizations in Malaysia was added to the after posting survey. The quantitative data were analyzed using IBM SPSS (version 20) and qualitative data by RQDA software.
RESULTS: A total of 146 participants were recruited in this study. Knowledge on contraception method before posting was 5.11 (standard deviation [SD] ±1.36) and after posting was 6.35 (SD ± 1.38) (P < 0.001). Thematic analysis of the students' answer revealed four salient themes, which were as follows: (1) cultural barrier, (2) misconception, (3) inadequate knowledge, and (4) improvement for the health-care services.
CONCLUSIONS: The teaching-learning process at the MCH posting has an influence on their perception and upgraded their knowledge. It also reflects the role of primary health-care clinics on medical students' clinical exposure and training on family planning services during their postings.

Matched MeSH terms: Abortion, Induced
Availability, Utilization, and Health Providers' Attitudes Towards Safe Abortion Services in Public Health Facilities of a District in West Bengal, India

Pyne S, Ravindran TKS

Womens Health Rep (New Rochelle), 2020;1(1):80-88.
PMID: 33786477 DOI: 10.1089/whr.2019.0007

Background:
The provision of safe abortion services upholds the realization of justice in sexual and reproductive health. Many state-level studies in India have identified poor availability of abortion services in the public sector and negative attitudes toward abortion among health providers, as potential barriers to access.
Materials and Methods:
A cross-sectional study was done to document the availability and utilization of medical termination of pregnancy (MTP or abortion) services and to assess public sector health providers' attitudes towards safe abortion. It was carried out in a representative district of West Bengal, using a facility checklist and a validated attitude scale.
Results:
Only 11 of 42 public health facilities had both trained doctors and equipment to provide MTP services. Twelve facilities provided MTP services, of which only three urban-based secondary-level facilities provided second trimester MTPs. There were female providers in just 2 of the 12 MTP-providing facilities. Among the 64 health providers interviewed, 40% were trained to provide MTP. According to the attitude scale, 38% had a negative attitude toward the provision of safe abortion services. There was no statistically significant association between attitudes of health providers and provision of MTP. However, there appeared to be a subtle process of gatekeeping in operation, such as making MTP conditional on acceptance of contraception, requiring the husband's consent, and so on.
Conclusions:
The study shows the poor availability of abortion services in public sector facilities in a district of West Bengal, although all public health facilities from the primary health center level upwards are authorized to provide abortion services.

Matched MeSH terms: Abortion, Induced
Fulltext A retrospective review of 25 cases of lethal fetal anomalies

Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.

International Medical Journal Malaysia, 2016;15(1):19-23.
MyJurnal

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.

Matched MeSH terms: Abortion, Induced
Fulltext A follow-up profile of women seeking pregnancy terminations in a clinic in urban Malaysia: 1998-2005

Siti Fathilah Kamaluddin

Jurnal Sains Kesihatan Malaysia, 2010;8(1):5-11.
MyJurnal

This is a follow-up study to assess the socio demographic profile of a sample of 28,605 women seeking pregnancy terminations at a private clinic in Penang over a seven year period as compared to an earlier study in 1995 of a sample of 23,986 women over a six and a half year period at the same clinic. This study was conducted using computerized patient medical records and paper reports generated from the computer data. The earlier 1995 study showed that the profile of a typical abortion client was a Chinese (60%), housewife (45%) in her late twenties (47%) with a monthly household income of less than RM1,200 (58%), having her first abortion (51%) and who had used contraception before (78%). For the seven year period from 1998-2005, the follow-up profile of a woman seeking an abortion in the same clinic in urban Malaysia was one with a monthly household income of less than RM2,000 (100%) in her late twenties (54%) who had used contraception in the past (85%). It is noted that the percentage of Malay respondents has increased (34%). The percentage of women who had a prior abortion at this clinic or elsewhere has also increased (68%), as compared to the preliminary study. Non-use of contraception remained an issue and traditional methods still outweighed the use of more effective contraceptive methods. In conclusion, fewer housewives and more Malay and Indonesian factory workers contributed to the clinic client profile over these seven years compared to that of the earlier study in 1995.

Matched MeSH terms: Abortion, Induced
East Asia review, 1976-7: Malaysia

Aziz NL

Stud Fam Plann, 1978 Sep;9(9):41-2.
PMID: 734714 DOI: 10.2307/1965636
Matched MeSH terms: Abortion, Induced
Low perinatal autopsy rate in Malaysia: time for a change

Tan GC, Hayati AR, Khong TY

Pediatr Dev Pathol, 2010 Sep-Oct;13(5):362-8.
PMID: 20367214 DOI: 10.2350/09-03-0623-OA.1

Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing.

Matched MeSH terms: Abortion, Induced
Feasibility, efficacy, safety, and acceptability of mifepristone-misoprostol for medical abortion in the Democratic People's Republic of Korea

Tran NT, Jang MC, Choe YS, Ko WS, Pyo HS, Kim OS

Int J Gynaecol Obstet, 2010 Jun;109(3):209-12.
PMID: 20206354 DOI: 10.1016/j.ijgo.2010.01.012

To examine the feasibility, efficacy, safety, and acceptability of medical abortion among rural and urban women up to 56 days of pregnancy in the Democratic People's Republic of Korea.

Matched MeSH terms: Abortion, Induced/methods*
The pattern of maternal mortality at maternity hospital Kuala Lumpur

Nafisah Adeeb

Malays J Reprod Health, 1983 Jan;1(1):34-9.
PMID: 12279887
Matched MeSH terms: Abortion, Induced
Effect of green and ripe Carica papaya epicarp extracts on wound healing and during pregnancy

Anuar NS, Zahari SS, Taib IA, Rahman MT

Food Chem Toxicol, 2008 Jul;46(7):2384-9.
PMID: 18468758 DOI: 10.1016/j.fct.2008.03.025

The traditional use of papaya to treat many diseases, especially skin conditions and its prohibition for consumption during pregnancy has prompted us to determine whether papaya extracts both from green and ripe fruits improve wound healing and also produce foetal toxicity. Aqueous extracts of green papaya epicarp (GPE) and ripe papaya epicarp (RPE) were applied on induced wounds on mice. GPE treatment induced complete healing in shorter periods (13 days) than that required while using RPE (17 days), sterile water (18 days) and Solcoseryl ointment (21 days). Extracts were administered orally (1 mg/g body weight/day) to pregnant mice from day 10 and onwards after conception. 3 (n=7) mice and 1 (n=6) mice given RPE and misoprostol, an abortive drug, respectively experienced embryonic resorption while this effect was observed in none of the mice given GPE (n=5) and water (n=5). The average body weight of live pups delivered by mice given GPE (1.12+/-0.04 g) was significantly lower than those delivered by mice given water (1.38+/-0.02 g). In SDS-PAGE, proteins were distributed in three bands (Mr range approximately 8-29 kDa). Band intensity at Mr approximately 28-29 kDa was higher in GPE than in RPE. In contrast, band intensity at low Mr (approximately 8 kDa) was found to be higher in RPE than in GPE. Notably, the band corresponding to Mr approximately 23-25 kDa was absent in RPE. These differences in composition may have contributed to the different wound healing and abortive effects of green and ripe papaya.

Matched MeSH terms: Abortion, Induced
Demographic and fertility characteristics of 4 squatter settlements

Yusof K, Zulkifli SN

Malays J Reprod Health, 1985;3(1):31-45.
PMID: 12268887
Matched MeSH terms: Abortion, Induced

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