A seminar and presentations by Dr. Iqbal Shah, Harvard School of Public Health

On 6 October 2016 Dr. Iqbal Shah, Principal Research Scientist with the Harvard University T. H. Chan School of Public Health, gave a seminar at our graduate school entitled "Abortion and Contraception following Liberalization of Abortion Laws".
The presentation briefly covered the known world history of abortion, key concepts regarding abortion, data sources and their limitations, levels and trends in induced abortion, contraception and births, and then turned the focus to the main theme indicated in the title, surveying data and previous studies.
Dr. Shah pointed out that abortion and contraception are two alternative means of regulating fertility, and that past research indicates that although the abortion rates do rise initially after the legalization of abortion, they also tend to decline over time as the use of modern contraceptives increases. So far, evidence suggests that the prevalence of modern contraceptive methods continues to rise or stays constant at high levels after the legalization of abortion.
At the end of his presentation Dr.Shah called for further study of abortions after legalization and deeper examination of the interactions between contraceptive and abortion rates under different conditions and at different levels. He also suggested the need for additional studies to better understand causal pathways leading to the decline of abortion rates after liberalization of abortion laws. 
In addition, Dr. Shah gave a lecture on postpartum family planning that illustrates the content of work in the project he leads at Harvard University: "Postpartum Family Planning in Low- and Middle-income Countries". Based on a review of literature supplemented by an analysis of Demographic and Health Survey data (DHS) for 16 countries, Dr. Shah covered terms and definitions, measurement of the unmet need for family planning and addressed the following four key points: (1) is the postpartum unmet need for family planning particularly high or higher than at other times; (2) do women await for the return of menses before initiating contraception: 3) is breastfeeding a deterrent to using modern contraceptive methods; and 4) what are the program implications.
The data Dr. Shah presented suggest that: 1) the unmet need in postpartum is not higher than at other times once amenorrhea and abstinence is taken into account, but that health consequences of pregnancy are greater; 2) the return of menses is a powerful signal for contraceptive adoption, but appreciable minorities adopt contraceptives before the return of menses, particularly sterilization in some countries; and 3) among menstruating women breastfeeding has little influence on the use or method choice, except on oral contraceptives in some countries. In terms of policy implications, promoting early uptake of contraception in countries where lactational protection lasts for three or four months is recommended. In countries where lactational amenorrhea typically extends throughout the first 12 months after birth, as in sub-Saharan African countries and India, promoting early uptake of long-acting reversible methods or giving advice on using a modern method of contraception at six months postpartum is recommended.
Dr. Shah pointed out the importance of learning women's perspectives on the timing of initiating contraceptive use, on the link between the return of menses and the risk of pregnancy as well as on the contraceptive protective effect of breastfeeding.He concluded his presentation by indicating that postpartum contraception is important in rich countries as well.  
Furthermore, on the same day Dr.Shah delivered a third presentation entitled: "Changing Profile of Reproductive Health in Europe", in which he provided an overview of trends in reproductive health in countries of North,West,East and South Europe.
In Europe fertility transition to low levels preceded the advent of modern methods of contraception. With few exceptions, the total fertility rate in European countries in 2014 was lower than in 1980. A trend in terms of increased childlessness, increased divorce rates, and increased number of births outside marriage was noted. Marriage rates in Europe have fallen and the age at first birth has increased. Dr. Shah pointed out that factors influencing these patterns are contextually determined and needed to be better studied to make informed policy decisions and interventions.