Abstract
Abortion rates in Russia, particularly repeat abortions, are among the highest in the world, and abortion complications make a substantial contribution to the country's high maternal mortality rate. Russia also has a very high rate of hazardous alcohol use. However, the association between alcohol use and abortion in Russia remains unexplored. We investigated the longitudinal predictors of first and repeat abortion, focussing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16–44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994–2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62–3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994–2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts.
Highlights
Despite substantial reductions in the post-Soviet period, Russia’s induced abortion rate remains the highest of all Eastern European countries [1], and is more than twice as high as in the UK [2,3]
High abortion rates in Russia contribute to high rates of maternal mortality
Our findings show that the determinants of first and repeat abortion in Russia over the period 1994–2009 were different
Summary
Despite substantial reductions in the post-Soviet period, Russia’s induced abortion rate remains the highest of all Eastern European countries [1], and is more than twice as high as in the UK [2,3]. In the last 20 years Russian induced abortion rates (hereafter ‘induced abortion’ is referred to as ‘abortion’) have declined to a much lesser extent than in neighbouring countries Ukraine and Belarus [4]. The reason for this is unclear, but could be due to high contraceptive failure rates or only modest increases in the use of modern contraception [5], which are in turn driven by poor governmental support for family planning programmes [4]. In 2009 10% of maternal deaths in Russia were related to abortion [8], which is approximately twice as high as countries in Western Europe [9]
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