2019-2021 baseline status, trends of and risk factors of repeat induced abortion among women seeking abortion in the Prospective Cohort of Induced Abortion and Future Pregnancy Outcomes

BackgroundAbortion is legally restricted in Liberia with few exceptions. The country also has among the highest maternal mortality ratios in the world, with an estimated 742 deaths per 100,000 live births. The contributions of unsafe abortion to maternal mortality have been investigated in Liberia, but less is known about the magnitude of and circumstances around abortions occurring in the second trimester. We aimed to assess the prevalence and factors associated with second trimester induced abortions among women seeking post-abortion care in Liberia.MethodsWe conducted a secondary analysis of data from a Prospective Morbidity Survey conducted at health facilities across Liberia from October to December 2021. We analyzed data from women seeking post-abortion care (PAC) for induced abortions to calculate the proportion occurring in the second trimester and to identify factors associated with second-trimester termination.ResultsAmong women seeking PAC after induced abortion, 35 out of 185, or 19.0% (95% CI: 14.0%, 25.3%), had induced abortions during the second trimester. This represented just over 8% (95% CI: 5.9%, 11.0%) of all women seeking PAC. The distribution of women across age, employment status, religious affiliation, and relationship status was largely similar between those who induced abortion in the second trimester and those who terminated their pregnancies in the first trimester. They also had similar reproductive histories, with no differences in history of spontaneous or induced abortion or in the number of living children. About 68% of women who ultimately terminated their pregnancies in the second trimester reported previous attempts at inducing abortion for the same pregnancy. Compared to women with secondary or tertiary level education, women with no formal education or primary school education had 3.1 times the odds of second-trimester abortion (OR = 3.1, 95% CI: 1.4-7.0, P = 0.006). Likewise, women who reported that their pregnancies were intended had 2.2 times the odds of a second-trimester abortion compared to women reporting unintended pregnancies (OR = 2.2, 95% CI: 1.0-4.8, P = 0.045). The direct effects of these factors exhibited some degree of mediation by having made one or more previous attempts at termination and/or by making the decision to terminate later in the pregnancy.ConclusionsSecond-trimester abortion constitutes nearly one-fifth of induced abortions for which PAC is being sought in Liberia. The high prevalence of repeat abortion attempts for the same pregnancy points to limitations in access to safe and effective abortion methods. Similarly, the high rates of unintended pregnancy in the study sample despite reported use of family planning suggests gaps in the quality of family planning services and commodities accessible to women. More comprehensive sexual and reproductive health education is warranted.

Aims: This study aimed to determine the sociological characteristics of abortion seekers according to marital status and previous induced abortions in a major regional hospital in Nanjing, China. Methods: A cross-sectional survey was conducted through face-to-face interviews using a structured questionnaire in women seeking abortion at Nanjing Maternal and Child Health Care Hospital in China in 2003. Results: The average age of the participants was 26.0 ± 4.5 years. Of the 462 abortion seekers, 95.9% had one previous induced abortion. The majority (49.6%) of the ever-married women were in the age group of 25–29 while the majority (76.9%) of the unmarried women were aged 20–24 years. Unprotected intercourse (53.6%) and contraception failure (43.9%) were the primary reasons given for the current induced abortion for ever-married women. Unmarried women terminated their current pregnancies mainly because they did not want children (62.1%). Of the 182 unmarried subjects, 86.8% had psychological problems in their premarital pregnancy. Conclusions: Education and communication about sexual morality, contraception and reproductive health, as well as post-abortion counseling and services, especially for young women, are needed to reduce the rate of induced abortions.

No previous studies have analyzed the connection between total hip replacement and induced abortion. We evaluated the nationwide induced abortion rates among women with and without total hip replacement. Data for this cohort study were gathered from national registers from 1987 to 2007. All fertile-aged (15-44 years old) females who had undergone primary total hip replacement in Finland were selected. The total hip replacement patient group comprised 1713 women and the reference group 5148 women. Information on all pregnancies for both groups before and after total hip replacement/index date was gathered from the medical birth register and the register of induced abortion. Logistic regression model was used to analyze the adjusted odds ratio for induced abortion. Adjustment was made for age at induced abortion, parity, previous induced abortions, previous deliveries, and marital status. Women had higher induced abortion proportions after total hip replacement (17.9%) compared with women before total hip replacement (14.1%) and the referents (13.9%), but the differences were not statistically significant. Women in the total hip replacement patient group had significantly more induced abortions after total hip replacement due to maternal health issues (14.7%) compared with the referents (2.7%), p = 0.003. Patients in the total hip replacement group were not more likely to have their pregnancy ending in induced abortion than the women in the reference group (odds ratio 1.32, 95% confidence interval 0.89-1.96, p = 0.17). However, in the adjusted analysis, there was a trend for higher risk for pregnancy to end in induced abortion in the total hip replacement group in relation to the reference group (adjusted odds ratio 1.50 (confidence interval 0.99-2.28, p = 0.05). The total hip replacement patient group had higher, but statistically insignificant, induced abortion proportions compared with the reference group before and after the operation. After total hip replacement, the patients were not more likely to have a pregnancy ending in induced abortion. This finding remained statistically insignificant after adjusting with possible confounders.

Complications following early induced abortion by vacuum aspiration were examined in a controlled study. Data were collected on healthy women 7--12 weeks pregnant at the time of abortion. No association was found between complication rates and age, marital status, or parity. However, women in their first pregnancies and those who had experienced an induced or spontaneous abortion in their previous pregnancy had a higher rate of complications following the current induced abortion.

Unintended pregnancy: Consequences and solutions for a worldwide problem

BackgroundInduced abortion is a common undergo in many societies of the world. Every year, around 20 million unsafe abortions are done worldwide. From fragmented studies conducted in Ethiopia, the prevalence of induced abortion and its adverse effects are increasing over time. The aim of this study was to assess factors associated with induced abortion among female preparatory school students in Guraghe zone.MethodsA cross-sectional study was conducted among female students of preparatory schools in April 2017. Systematic random sampling technique was employed to select 404 students from the total of 3960 female preparatory school students in the study area. Data was collected through self-administered questionnaires. Descriptive summary, binary and multivariate analyses were underwent to identify factors associated with induced abortion. The study was ethically approved by institutional review board of Wolkite University.ResultsThe response rate of this study was 98.3%. The lifetime prevalence of induced abortion among young preparatory schools students whose age range from 15 to 22 years was 13.6% [95% CI (10.4, 17.1)]. The odds of induced abortion undergo was 2.3 times more likely in rural family residents [AOR = 2.3, 95% CI (1.1, 4.8)] as compared to that of urban family residents. Students without sexual health education were 6.4 times more likely to undergo induced abortion as compared to those who got sexual health education at sc0000hool [AOR = 6.4, 95% CI (3.1, 13.1)]. Furthermore, students who drank alcohol often were 4 times [AOR = 4.0, 95% CI (1.1, 14.2)] more likely to undergo induced abortion and students who consumed alcohol sometimes had 3.3 times [AOR: 3.3, 95%CI (1.4, 8.1)] the risk of induced abortion compared with girls with no history of alcohol consumption.ConclusionA high lifetime prevalence of induced abortion among young adolescent was observed. Being rural residence, not having reproductive health education, and alcohol consumption were found to be independent predictors of induced abortion undergo. Therefore, IEC/BCC programs with special emphasis on youth friendly sexual and reproductive health services should be strengthened to reduce induced abortion.

Recourse to induced abortion in Spain: profiling of users and the influence of migrant populations

To study patterns of induced abortion versus childbirth related to education among Norwegian and Pakistani women. Population-based study in Oslo, Norway. All women 15-50 years of age of Norwegian (n=94,428) or Pakistani (n=5,390) descent living in Oslo. Induced abortion or child delivery. In Norwegian women with a university education, 15.3% delivered a child and 2.9% had an induced abortion between 2000 and 2002. In women with less than high school education, the figures were 5.3% and 4.3%. Pregnant women with less than high school education were twice as likely to have an induced abortion as women with a university education (odds ratio, 2.0; 95% confidence interval, 1.7-2.5), after adjustment for age, parity, marital status, and residential area. Among Pakistani women with a university education, 23.0% gave birth and 2.9% had an induced abortion. In Pakistani women with less than high school education, the figures were 20.8% and 2.8%. Among pregnant Pakistani women, those with less than high school education were less likely to have an induced abortion compared to women with a university education (odds ratio, 0.5; 95% confidence interval, 0.2-1.1). Childbirth was substantially more common in Pakistani than in Norwegian women living in Oslo. In Norwegian women, low education was associated with lower frequency of child delivery but higher frequency of induced abortion. In Pakistani women, child delivery was not related to education, but induced abortion tended to be more frequent in those with a university education.

We appreciate the comments by Basso (1) regarding our study of induced abortion and the risk of preeclampsia (2). Basso raised concerns that our estimated decrease in risk of preeclampsia in women with a prior induced abortion compared with those without induced abortion might represent an overall effect of gravidity because the comparison group was largely comprised of women with no prior pregnancy. This concern does have implications for understanding the respective roles of previous induced abortion, spontaneous abortion, and other pregnancy outcomes in the development of preeclampsia. It should be noted that in these data, the association between history of spontaneous abortion and preeclampsia was null, and indeed the crude odds ratio for comparison of induced abortion relative to spontaneous abortion for preeclampsia resulted in the same point estimate of 0.9, as did the comparison that we presented. A secondary aim of our study was to consider a possible role of endometrial injury in the development of preeclampsia by separately examining surgical and medical induced abortions. The issue of gravidity should remain less of a concern here because both point estimates would be equally affected by a bias and could still be compared to each other.

Determinantes del retraso de la interrupción voluntaria del embarazo

BACKGROUND In induced abortion, the method, the risk of complications and the economic cost of the abortion are determined by gestational age. The aim of this study was to describe the determinants of induced abortion delay until the second trimester of pregnancy in Barcelona. METHODS We performed a cross-sectional study of induced abortions due to the physical or mental health of the woman (Barcelona, 2004-2005; N=9,175). The city's induced abortion register provided data on gestational age at abortion (dependent variable), educational level, age, cohabitation with the partner, number of children previous abortions, and type of center. Adjusted prevalence ratios (aPR) were calculated with log-binomial regression models. RESULTS A total of 7.7% of induced abortions were second-trimester abortions and 99.3% were performed in private centers. Compared with women with a university education, those with primary education or less had an aPR of 1.8 (95% confidence interval [95%CI]: 1.4-2.2) of delaying the abortion until the second trimester. A higher proportion of second-trimester abortions were also recorded in women aged less than 18 years old (aPR=2.6; 95%CI: 2.0-3.4), women not cohabiting with their partners (aRP=1.4; 95% CI: 1.2-1.6) and in public centers (aPR=2.8; 95% CI: 2.2-3.7). No differences were found in induced abortion delay among women with previous abortions and those without. CONCLUSION Induced abortion delay until the second trimester of pregnancy was associated with low educational level, young ages, not cohabiting with a partner, and public centers. This study demonstrates the existence of socioeconomic inequalities in access conditions to abortion services.

To compare and analyze socioeconomic aspects and the emotional experience of women with spontaneous or induced abortion and in women living in the outskirts of São Paulo. A prospective case-control study carried out from July 2008 to March 2010, involving semi-structured interviews with women who presented a previous diagnosis of abortion and who had been admitted to two public hospitals in the outskirts of São Paulo. The study included 100 women with diagnosis of abortion and were hospitalized for curettage. Eleven women who reported induced abortion (11%) represented the case group. The control group (n=22) was selected at a 2:1 ratio according to the following procedure: for every case of induced abortion, the next two cases of spontaneous abortion at the same hospital. A semistructured interview was conducted with questions regarding emotional aspects and family, social and economic context. The women with induced abortion compared to the group with spontaneous abortion had lower educational level, with more frequent elementary level (82 versus 36%, p=0.04), lower income (median, R$ 1,000.00 versus R$ 1,400.00, p=0.04), lower personal income (median, R$ 200.00 versus R$ 333.00, p=0.04), higher frequency of negative feelings upon suspicion (82 versus 22%, p=0.004) and confirmation (72 versus 22%, p=0.03) of pregnancy. Among women looking for health care in hospitals in the outskirts of São Paulo, induced abortion is related to unfavorable socioeconomic conditions, which affects the emotional experiences of suspicion and confirmation of pregnancy.

Can the need of subsequent abortion be reduced by providing intrauterine contraception as a part of the abortion service? Provision of intrauterine devices (IUDs) in association with first trimester abortion more than halved the incidence of repeat abortion during the first year of follow-up. Following abortion, the incidence of subsequent abortion is high, up to 30-40%. In cohort studies, intrauterine contraception has reduced the need of repeat abortion by 60-70%. A randomized controlled trial. The main outcome measure was the incidence of subsequent induced abortions during the follow-up. Altogether 751 women seeking first trimester induced abortion were recruited and randomized into two groups. Randomization was accomplished by computer-assisted permuted-block randomization with random block sizes of four to six. The investigators did not participate in randomization, which was done before commencing the study. The participants were recruited between 18 October 2010 and 21 January 2013. The inclusion criteria were age ≥18 years, duration of pregnancy ≤12 weeks, accepting intrauterine contraception, residence in Helsinki and signing the informed consent form. Women with contraindications to intrauterine contraception, such as uterine anomaly, acute genital infection or pap-smear change requiring surgical treatment were ineligible to participate.This study was conducted in collaboration between the Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, and Centralized family planning of the City of Helsinki.The intervention group (n = 375) was provided with intrauterine contraception (either the levonorgestrel-releasing intrauterine system or copper-releasing intrauterine device) immediately following surgical abortion (18.1%) or at a follow-up 2-4 weeks after medical abortion (81.9%). Women in the control group were prescribed oral contraceptives and advised to contact their primary healthcare unit for a follow-up visit and further contraceptive services according to national guidelines. The women were followed-up to 28 February 2014 by using the Finnish National Abortion Registry, Helsinki University Hospital electronic database and clinical follow-up visit at 1 year. The median age of the whole study group was 27 years and 44% had a history of induced abortion(s). During the follow-up year the number of women requesting subsequent abortion was significantly lower in the intervention than in the control group (9/375 [2.4%] versus 20/373 [5.4%], difference -3.0 [95% CI -6.0 to -0.2] percentage points, P = 0.038, according to intention-to-treat analysis and 5/346 [1.4%] versus 20/357 [5.6%], difference -4.2(-7.2 to -1.4) percentage points, P = 0.003, according to per-protocol analysis, respectively). Provision of intrauterine contraception was safe with rate of infection and expulsion similar to those reported previously. The power calculation was calculated for a 5-year follow-up. However, significant differences between the two groups were already seen after 1 year. The present study was performed in a single clinic, where, ∼15% of all abortions in Finland are performed. In order to decrease the need of subsequent abortions, IUDs should be provided at the time of abortion. The study was registered at www.clinicaltrials.gov (NCT01223521). 18 October 2010. 18 October 2010.

Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence

Spontaneous losses between the 5th and 27th weeks of pregnancy were measured in a prospective study of 32 123 women whose contraceptive history around the time of conception was known. Diaphragm use prior to conception was associated with a significant reduction in second-trimester losses, after taking into account the effects of age, parity, race, marital status, alcohol use, and previous spontaneous or induced abortions. Women who used oral contraceptives and stopped them more than one month prior to their LMP experienced a deficit of first-trimester losses but conceptions occurring immediately after stopping the pill were followed by a small but nonsignificant increase in spontaneous abortions. After oral contraceptive failures there was an increase in first-trimester losses, but no change in the incidence of second-trimester ones. IUD failures were followed by a significant two-fold increase in the risk of both first and second-trimester losses: no differences were detected between the different brands.