Repeat abortion and determinants of Chinese women: A systematic review and meta-analysis

Abstract

Background Repeat abortion is a public health problem globally and has adverse impacts on women's reproductive health. Risk factors associated with repeat abortion have been well-established in many studies; however, studies documenting the prevalence of repeat abortions and associated risk factors in China are hard to access, due to the language barrier, as they are mostly published in Chinese. Meanwhile, the two-child policy in China may increase the risk of repeat abortions among women in China, hence, the need to review and document existing evidence on repeat abortions in China. Methods For this systematic review, we searched through six electronic databases, including PubMed, EMBASE, Cochrane Library, China Academic Journal Network Publishing Database, China Science Period Database, and China Biology Medicine disc. The focus of the review was on original studies, with no restrictions on language or publication date. The last search was run on May 5, 2017. The studies, which presented data on repeat abortion and related risk factors of women in mainland China were selected for the review. Two reviewers reviewed all the articles and extracted relevant data from the selected full-text studies. Meta-analyses were performed using RevMan 5.3 and the odds ratios with 95% confidence intervals were calculated in fixed or random effects models based on the results of the Q test. The publication bias was quantitatively evaluated by Egger's linear regression analysis using Stata 13.0. A narrative approach was used to analyze exposures; for which a meta-analysis was not possible. We used descriptive statistics to assess whether the percentage of repeat abortion varied significantly among women in different groups of each exposure. Results Of 3015 records initially identified, 29 studies met our inclusion criteria, representing 36,879 individuals from China. Of 36,879 individuals in 28 cross-sectional studies, 43.0% (15854) had a repeat abortion. Of 48 exposures identified, 25 were significantly associated with repeat abortions of Chinese women. Meta-analyses indicated that women who were older (≥ 20 years, OR: 2.08, 95% CI: 1.72–2.50), multiparous (≥ 1 child, 4.99, 2.18–11.43), migrant (1.62, 1.34–1.96), unemployed (2.20, 1.65–2.93), tobacco/alcohol users (2.35, 1.66–3.32), with early sexual debut ( Conclusions Chinese women with a repeat abortion account for a large percentage of the total sample of women in the included studies. Despite significant heterogeneity of some risk factors, there is evidence that repeat abortions of women are associated with individual, sexual-partner's, and parental risk factors. More targeted strategies should be developed to reduce the high-risks of repeat abortions of women.