Abstract
BackgroundThe study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia.MethodsData were retrieved from the Estonian Medical Birth and Abortion Registry and Statistics Estonia. Total induced abortion numbers, rates, ratios and age-specific rates are presented for 1996–2011. The percentage change in the number of repeat abortions within selected socio-demographic subgroups, contraception use and distribution of induced abortions among Estonians and non-Estonians for the first, second, third, fourth and subsequent abortions were calculated for the periods 1996–2003 and 2004–2011.ResultsObserved trends over the 16-year study period indicated a considerable decline in induced abortions with a reduction in abortion rate of 57.1%, which was mainly attributed to younger cohorts. The percentage of women undergoing repeat abortions fell steadily from 63.8% during 1996–2003 to 58.0% during 2004–2011. The percentage of women undergoing repeat abortions significantly decreased over the 16 years within all selected socio-demographic subgroups except among women with low educational attainment and students. Within each time period, a greater percentage of non-Estonians than Estonians underwent repeat abortions and obtained third and subsequent abortions. Most women did not use any contraceptive method prior to their first or subsequent abortion.ConclusionA high percentage of women obtaining repeat abortions reflects a high historical abortion rate. If current trends continue, a rapid decline in repeat abortions may be predicted. To decrease the burden of sexual ill health, routine contraceptive counselling, as standard care in the abortion process, should be seriously addressed with an emphasis on those groups - non-Estonians, women with lower educational attainment, students and women with children - vulnerable with respect to repeat abortion.
Highlights
The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia
Repeat abortions may be associated with adverse outcomes in future pregnancies such as preterm births and low birth weights [8,9] and are often preventable: access to sexuality education, effective contraceptive methods and good quality sexual health services are well known measures widely attributed to a decreased prevalence in unintended pregnancies [10,11]
Use of contraception Contraception non-use prior to abortion accounted for nearly two thirds of women having a repeat abortion; while the failed use of contraceptive pills and intrauterine contraception was low at the time of first, second, third or fourth or subsequent abortions (Table 2)
Summary
The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia. Repeat abortions may be associated with adverse outcomes in future pregnancies such as preterm births and low birth weights [8,9] and are often preventable: access to sexuality education, effective contraceptive methods and good quality sexual health services are well known measures widely attributed to a decreased prevalence in unintended pregnancies [10,11]. Affordable contraceptive methods are available: hormonal contraceptive methods are subsidized by Estonian Health Insurance Fund, which covers 50%; copper IUDs have reimbursement of 100% during one year after delivery.
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