OBJECTIVE: Given Iran\'s recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends.
METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records.
RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes.
CONCLUSIONS: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

To examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021.
Population-based study.
Republic of Malta PARTICIPANTS: Between 1 January 2017 and 31 December 2021, 1090 women and pregnant people requested at-home medical abortion through one online telemedicine provider (Women on Web). Mifepristone and misoprostol were shipped to 658 women (60.4% of requests).
The numbers and demographics of persons to which abortion pills were shipped, their reasons for accessing abortion, and reasons for requesting medical abortion via telemedicine between January 2017 and December 2021 were analysed. Selected data were compared across different groups.
The number of people in Malta to whom medical abortion pills were shipped increased significantly in the 5 years analysed. Women and pregnant people requesting medical abortion were diverse with respect to age, pregnancy circumstances and reasons for seeking an abortion. More than half had existing children and over 90% reached out to Women on Web at <7 weeks. Among those completing a medical abortion, 63% did not use contraception, and in 30% there was contraception failure. The most common reasons for ordering medical abortion pills online were difficulty accessing abortion because of legal restrictions (73%) and abortion pills not being available (45%) in the country.
Despite a complete ban on abortion, the number of women and pregnant people residing in Malta completing at-home medical abortions is considerable and has been steadily increasing.

We argue that, in certain circumstances, doctors might be professionally justified to provide abortions even in those jurisdictions where abortion is illegal. That it is at least professionally permissible does not mean that they have an all-things-considered ethical justification or obligation to provide illegal abortions or that professional obligations or professional permissibility trump legal obligations. It rather means that professional organisations should respect and indeed protect doctors\' positive claims of conscience to provide abortions if they plausibly track what is in the best medical interests of their patients. It is the responsibility of state authorities to enforce the law, but it is the responsibility of professional organisations to uphold the highest standards of medical ethics, even when they conflict with the law. Whatever the legal sanctions in place, healthcare professionals should not be sanctioned by the professional bodies for providing abortions according to professional standards, even if illegally. Indeed, professional organisation should lobby to offer protection to such professionals. Our arguments have practical implications for what healthcare professionals and healthcare professional organisations may or should do in those jurisdictions that legally prohibit abortion, such as some US States after the reversal of Roe v Wade.

The present paper is a case-based review on rare complications of illegal abortion, i.e., necrotizing fasciitis missed early by the treating gynecologists which landed up into a negligence tort against the physicians. The common complications of the abortion like incomplete abortion, haemorrhage, sepsis, etc. are usually handled successfully by the gynecologists; however, early detection often missed when a rare complication like necrotising fasciitis occurs. Eventually leading to litigations in case of death of the patient. The newer techniques have reduced the complications in medically terminated pregnancies (MTP); however, the deaths due to illegal abortions carried out by the clandestine abortion practitioners (CAP) poses a challenge, especially in rural areas. A 30-year-old woman went for an illegal abortion from a CAP to avoid social stigma. She developed sepsis & necrotising fasciitis (NF) of right lower limb due to intra-vaginal use of abortifacient herbs prescribed by the CAP. She was succumbed to the complications of necrotising fasciitis allegedly due to delayed diagnosis by the gynecologists. This led to a negligence tort filed by her family members against the treating gynecologists. The prudent medicolegal and medical steps are discussed here, that could have prevented such sequel.

Despite the implementation of the Choice on Termination of Pregnancy (CTOP) Act, many women continue to procure illegal abortions in South Africa. A lack of knowledge of the CTOP Act and poor access to legal abortion in public health facilities is a big challenge. In the scope of the CTOP Act, the termination of pregnancy is a time-restricted health service, and women presented to a health care facility in the second trimester have encounter more obstacles to access the services.

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We examine the impact of progressive and regressive abortion legislation on women\'s health in Mexico. Following a 2007 reform in the Federal District of Mexico which decriminalised and subsidised early-term elective abortion, multiple other Mexican states increased sanctions on illegal abortion. We observe that the original legalisation resulted in a sharp decline in maternal morbidity, particularly morbidity due to haemorrhage early in pregnancy. We observe small or null impacts on women\'s health from increasing sanctions on illegal abortion. These results quantify the considerable improvements in non-mortal health outcomes flowing from legal access to abortion.

In 2019, a total of 25 abortion bans were signed into law by states in the Southeast and Midwest. As of May 2019, 33 states have passed laws restricting or limiting abortion services, including \"trigger laws\" that make abortion illegal in the event that Roe v. Wade is overturned. In addition, 9 states have passed extreme abortion laws, such as making abortion illegal early in gestation (as early as 6-8 weeks\' gestation), which are all currently enjoined and not in effect. The Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and Society of Family Planning agree that access to abortion is essential to women\'s health and oppose legislation that directly affects the patient-physician relationship. It is time for maternal-fetal medicine physicians to play a more active role in the fight for abortion access. A 2012 study of maternal-fetal medicine physicians found only 31% of respondents performed dilation and evacuation for termination of pregnancies, predominantly based on whether the provider was trained in dilation and evacuation procedures during fellowship. We performed a 2018 survey of all maternal-fetal medicine fellows and program directors and found that more than two-thirds (62 of 90 [68.9%]) of fellows desire dilation and evacuation training; however, only 9 of 39 (23.1%) program directors believe dilation and evacuation training should be required. The maternal-fetal medicine community is well positioned to improve access to abortion services in the United States by prioritizing dilation and evacuation training for fellows and actively participating in reproductive health advocacy.

UNASSIGNED: clandestine abortions increase maternal morbi-mortality in sub-Saharan Africa and are closely linked to restrictive legislation and low contraceptive prevalence. In Brazzaville street drugs are commonly used to induce abortion. The purpose of this study is to determine street drug prevalence and socio-demographic characteristics of these patients.
UNASSIGNED: we conducted a longitudinal study of 67 patients with induced abortion complications admitted to the Talangaï Hospital from July to December 2018. (i) Socio-demographic (ii) and obstetrical (iii) characteristics as well as abortion features (procedure, Manganguiste involvement, abortion rank and cost) were collected and analyzed using EPI info 7 software. We compared the means using student\'s test, proportions with CHI-2, p value was set to < 0.05.
UNASSIGNED: the average age of patients was 25 years ± 6.6; 59.7% of them were attending college, 53.8% had no income-generating activity, 38.8% lived alone and in 15% of cases biological father had denied paternity. Street drugs had been used in 74.5% of cases, mean abortion cost was 3500 CFA (US$7) and 29500CFA (US$59) when it had been performed by health-care professionals. High school respondents were more likely (73.69%) to know at least contraceptive methods (p<0.05). Greater numbers of singles (p=0.000) and of those who knew a contraceptive method (p=0.003) expressed the intention to use contraception. Conclusion: combatting the use of street drugs and securing the right to safe voluntary abortion are necessary to limit complications due to clandestine abortions.

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