Repeat Abortion Research Articles

Long-acting reversible contraception and repeat abortion: Rose et al

See related article, page 37 Unintended pregnancies and repeat abortion are pressing issues around he world. Recent figures suggest that n the United States, over 1 million uninended pregnancies per year end in aborion. For the patient, abortion can be a ource of emotional distress, and the surical procedure is associated with small isks for bleeding and infection. Overall, nintended pregnancies and abortion repesent a major public health issue. Therefore, attention has recently turned to the safety, efficacy, and patient acceptability of long-acting reversible contraceptive (LARC) methods. These methods include injectable, implantable, and intrauterine devices. This month, Journal Club participants discussed a prospective follow-up study from New Zealand that underscores the value of LARC methods in reducing the rate of repeat abortions. In the original 2008 study, which took place over a 10week period, women were offered free long-acting contraception after abortion— either the levonorgestrel intrauterine system (LNG-IUS), depot medroxyprogesterone acetate (DMPA), or the copper multiload Cu375 IUD (Cu-IUD). Implantable devices were not offered. Patients also received intense education and patient counseling about these methods. They were then contacted by phone at 6 weeks and 6 months to assess continuation rates. At the 6-month mark, investigators reached 78% of the women and learned that 81% with a LNG-IUS and 74% with a Cu-IUD had retained them; 71% of DMPA users were continuing use. For the new study, the rate of repeat abortion was ascertained at 24 months by matching National Health Index numbers (a unique identifier for

Discussion: ‘Long-acting reversible contraception and repeat abortion’ by Rose et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Rose SB, Lawton BA. Impact of long-acting reversible contraception on return for repeat abortion. Am J Obstet Gynecol 2012;206:37.e1-6.

A need to expand our thinking about “repeat” abortions

BackgroundWomen who have more than one abortion are often the “targets” for social and clinical interventions geared at preventing “repeat abortions.” Such an approach ignores the unique circumstances that may surround each abortion. Study DesignWe qualitatively analyzed the history of 10 women who have had more than one abortion who were participating in a larger study of women's emotional experiences following abortion. Women were recruited following their initial contact with a postabortion support talk line and from a previously completed study. ResultsOverall, women in the sample reported that each abortion was different and some abortions were more emotionally difficult than others, suggesting that the phrase “repeat” can be a misnomer and discounts the unique circumstances surrounding each abortion. ConclusionRather than use the term “repeat abortions,” we advocate for the use of the less loaded term “multiple abortions,” in which each abortion is understood as a unique experience.

Recent developments in the clinical use of the levonorgestrel‐releasing intrauterine system

This overview focuses on recent developments in the clinical use of the levonorgestrel- releasing intrauterine system (LNG-IUS) on established indications. Recent studies confirm that the LNG-IUS is safe and equally effective for all age groups of women. All available studies showed that intrauterine contraception is more effective when compared to non-intrauterine contraceptive methods to prevent repeat abortions. Furthermore, insertion in young nulliparous women is acceptable in the majority of women and associated with high continuation rates. The effectivity of LNG-IUS appears to be similar in women with chronic medical conditions, including HIV infection or coagulation disorders, and healthy women. More and most importantly, it has no adverse effect on the underlying condition. We also discuss effects of LNG-IUS on bone mineral density, vaginal flora, cardiovascular risk factors and breast cancer. In treatment of heavy menstrual bleeding, the LNG-IUS appears to be one of the most effective and cost-effective methods.

Experiences and Opinions of Health‐Care Professionals Regarding Legal Abortion in Mexico City: A Qualitative Study

This study examines the experiences and opinions of health-care professionals after the legalization of abortion in Mexico City in 2007. Sixty-four semistructured interviews were conducted between 1 December 2007 and 16 July 2008 with staff affiliated with abortion programs in 12 hospitals and 1 health center, including obstetricians/gynecologists, nurses, social workers, key decisionmakers at the Ministry of Health, and others. Findings suggest that program implementation was difficult because of the lack of personnel, space, and resources; a great number of conscientious objectors; and the enormous influx of women seeking services, which resulted in a work overload for participating professionals. The professionals interviewed indicate that the program improved significantly over time. They generally agree that legal abortion should be offered, despite serious concerns about repeat abortions. They recommend improving family planning campaigns and post-procedure contraceptive use, and they encourage the opening of primary health-care facilities dedicated to providing abortion services.

Patient Characteristics and Service Trends Following Abortion Legalization in Mexico City, 2007–10

Legal abortion services have been available in public and private health facilities in Mexico City since April 2007 for pregnancies of up to 12 weeks gestation. As of January 2011, more than 50,000 procedures have been performed by Ministry of Health hospitals and clinics. We researched trends in service users' characteristics, types of procedures performed, post-procedure complications, repeat abortions, and postabortion uptake of contraception in 15 designated hospitals from April 2007 to March 2010. The trend in procedures has been toward more medication and manual vacuum aspiration abortions and fewer done through dilation and curettage. Percentages of post-procedure complications and repeat abortions remain low (2.3 and 0.9 percent, respectively). Uptake of postabortion contraception has increased over time; 85 percent of women selected a method in 2009-10, compared with 73 percent in 2007-08. Our findings indicate that the Ministry of Health's program provides safe services that contribute to the prevention of repeat unintended pregnancies.

One-year continuation of etonorgestrel contraceptive implant in women with postabortal vs. interval placement

Women undergoing abortion have a demonstrated need for safe, effective birth control. Postabortal use of the etonorgestrel contraceptive implant has potential to decrease unintended pregnancy and repeat abortion; however, there is no information on discontinuation rates of the implant in this population. The aim of this study was to determine whether women having the implant placed in the immediate postabortal period have similar discontinuation rates to women with interval placement.

Repeat induced abortion – a matter of individual behaviour or societal factors? A cross-sectional study among Swedish women

ABSTRACTBackground Almost 40% of all induced abortions in Sweden are repeat abortions; little is known about the risk factors.Objective To investigate differences between women who had a first-time abortion and those with repeat abortion, and to identify factors associated with repeat abortion.Methods A questionnaire was answered by 798 abortion-seeking women in Sweden during 2009. A regression model was used to assess risk factors for repeat abortions.Results In the age range 20–49 years, 41% of women had experienced at least one previous abortion. Risk factors for repeat abortion were parity (OR 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Some women (n = 55) considered economic support and work opportunities could have enabled them to continue the pregnancy. Increased Sex and Relationship Education (SRE), easy access to high-quality contraception and counselling, were suggested (n = 86) as interventions for preventing unintended pregnancies.Conclusions Even in a country with long established SRE and a public health policy to enhance sexual and reproductive health over a third of women requesting abortion have experienced one previously and the rate is maintained. Some specific factors are identified but, overall, a picture of vulnerability among women seeking repeat abortion stands out that needs to be considered in the prevention of unintended pregnancies.

Preventing repeat abortion in Canada: is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions?

Background In 2005, 97,254 abortions were performed in Canada, of which 38% were repeat abortions. The objective of this research was to determine if provision of free intrauterine devices (IUDs) postabortion is associated with a reduction in health-care costs and repeat abortions in a Canadian population compared with provision of oral contraceptives (OCPs) or depo-medroxyprogesterone acetate (DMPA). Study Design A retrospective cohort study was conducted by intention-to-treat chart review in a facility providing the majority of abortions in a Canadian health region. All ( n=1782) residents of this region who underwent abortion in 2003, 2004 and 2008 were included. One- and 5-year rates of repeat abortion were calculated, and a cost-effectiveness analysis was conducted to compare health-care system costs of providing patients with IUDs, OCPs or DMPA and subsequent repeat abortions. Results In 2003 and 2004, 1101 index abortions occurred. The main contraceptive cohorts were immediate IUD insertion ( n=117, 10.6%), immediate OCP ( n=413, 37.5%) and immediate DMPA administration ( n=357, 32.4%). After 5 years repeat abortion rates in the respective cohorts were: IUD, 9.4%, OCP, 17.4%, DMPA, 16.2% (p=.05). One-year rates of repeat abortion were not significantly different. Costs of providing contraception and subsequent abortions over 5 years were $142.63 (IUD), $385.61 (OCP) and $384.81 (DMPA) per user. Conclusion The immediate insertion of IUDs postabortion is associated with a lower 5-year rate of repeat abortion than provision of OCPs or DMPA. A cost reduction to the health-care system occurs when providing IUDs postabortion vs. alternate contraception of equivalent duration.

Managing unplanned pregnancies in five countries: Perspectives on contraception and abortion decisions

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries – the United States, Nigeria, Pakistan, Peru and Mexico – to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

Impact of long-acting reversible contraception on return for repeat abortion

The objective of the study was to determine the rate of return for repeat abortion in relation to postabortion contraceptive method choice 24 months onward from an intervention study. This was a prospective cohort study involving a hospital note search for 510 women 24 months after an abortion. Women using long-acting reversible contraceptive (LARC) methods (intrauterine device [IUD] and depot medroxyprogesterone acetate) had significantly lower return rates for repeat abortion (6.45%; 95% confidence interval [CI], 4.0-9.8) than non-LARC users, of whom 14.5% returned (95% CI, 9.9-20.2). A Cox proportional hazard analysis showed that the postabortion method choice was significantly related to the likelihood of returning for a repeat abortion (P = .002), controlling for major demographic factors and previous pregnancy history. Using the pill as a reference group for risk of repeat abortion, the IUD hazard ratio (HR) was 0.36 (95% CI, 0.17-0.77), the depot medroxyprogesterone acetate HR was 0.55 (95% CI, 0.21-1.45), and the HR for all other methods was 1.8 (95% CI, 0.83-3.92). This study provides strong support for the promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion.

Who presents more than once? Repeat abortion among women in Britain

Background and methodologyAround one in three sexually active women in Britain will have an abortion during their lifetime and a third of those women will experience more than one. Using...

Do women and men consider abortion as an alternative to contraception in the United States? An exploratory study

The USA, a country with widespread access to the full range of modern methods of contraception, continues to have one of the highest abortion rates among developed countries. Forty-nine per cent of women reported ever experiencing an unintended pregnancy in 2001; 48% of these conceptions occurred during a month that contraception was used. We explored the extent to which people use contraception and abortion interchangeably to achieve their fertility goals via focus groups (n=4) and semi-structured in-depth interviews (IDIs) (n=18) with men and women between the ages of 18 and 35 in New York City in 2006. While there was a consensus that abortion cannot replace contraceptive use, poor couple communication, lack of planning, lack of acceptable contraceptive methods and the pleasures that people associate with having unprotected sex result in the perception that some individuals rely on abortion over contraception to prevent unintended births. Men and women both identified women as solely in charge of avoiding an unwanted pregnancy and resolving it should one occur. No one supported repeat abortions for themselves or others, and many respondents perceived multiple abortions to lead to infertility, which strengthens their position that substituting abortion for contraception is unacceptable.

Teenage pregnancies that end in abortion: what can they tell us about contraceptive risk-taking?

Background and methodologyIn 1999, the Government set the ambitious target of halving the number of under-18 conceptions by 2010. It is now clear that this target will not be met....

L'évolution démographique récente en France : les adultes vivent moins souvent en couple

Résumé Au 1 er janvier 2010, la France métropolitaine compte 62,8 millions d’habitants. L’accroissement (5,2 ‰) est un peu plus faible qu’en 2008 car le solde naturel diminue un peu. Après trois années de baisse, le nombre d’étrangers admis à séjourner a légèrement augmenté en 2008. Les immigrés nés en Algérie et au Maroc sont désormais plus nombreux que ceux originaires du Portugal. L’indicateur conjoncturel de fécondité s’est légèrement replié en 2009, mais demeure très proche de 2 enfants par femme ; l’âge moyen à la maternité atteint 30 ans. L’indicateur conjoncturel des interruptions volontaires de grossesse (IVG) reste élevé en 2007 (0,53 IVG par femme). L’âge à la première IVG tend à diminuer, et la fréquence des IVG répétées à augmenter. L’augmentation du nombre de pacs se poursuit en 2009 et, malgré la baisse du nombre de mariages, le nombre d’unions officialisées tend à augmenter. La probabilité de mariage des célibataires continue à se réduire. Les divorces diminuent encore légèrement en 2009, mais l’indicateur conjoncturel demeure proche de 45 %. En raison de l’augmentation des ruptures d’union, hommes et femmes adultes vivent un peu moins souvent en couple en 2006 qu’en 1999 ; ils vivent plus souvent seuls dans leur logement ou en famille monoparentale. La progression de l’espérance de vie à la naissance a repris en 2009, après une pause pour les femmes en 2008 : elle est estimée à 77,8 ans pour les hommes et 84,5 ans pour les femmes.

Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses

While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff's views and experiences of working in abortion services. To elucidate gynaecologists' and midwives'/nurses' experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman's home. An additional aim was to illustrate gynaecologists', midwives' and nurses' visions of their future professional roles within the abortion services. Three focus group discussions within each profession were carried out in 1-hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals. The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late-term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other's skills. In order to promote women's health, gynaecologists' and midwives'/nurses' need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand

Adverse childhood experiences and repeat induced abortion

The objective of the study was to characterize the backgrounds of women who have repeat abortions. In a cross-sectional study of 259 women (mean age, 35.2 ± 5.6 years), the relation between adverse experiences in childhood and risk of having 2 or more abortions vs 0 or 1 abortion was examined. Self-reported adverse events occurring between the ages of 0 and 12 years were summed. Independent of confounding factors, women who experienced more abuse, personal safety, and total adverse events in childhood were more likely to have 2 or more abortions vs 0 abortions (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.15-5.71; OR, 2.74; 95% CI, 1.29-5.82; and OR, 1.59; 95% CI, 1.21-2.09, respectively) and vs 1 abortion (OR, 5.83; 95% CI, 1.71-19.89; OR, 2.23; 95% CI, 1.03-4.81; and OR, 1.37; 95% CI, 1.04-1.81, respectively). Women who experienced more family disruption events in childhood were more likely to have 2 or more abortions vs 0 abortions (OR, 1.75; 95% CI, 1.14-2.69) but not vs 1 abortion (OR, 1.16; 95% CI, 0.79-1.70). Women who have repeat abortions are more likely to have experienced childhood adversity than those having 0 or 1 abortion.

ABH secretor status and reproductive success in couples with primary recurrent spontaneous abortion

FUT2 is an autosomal gene that controls the secretion of the ABH blood group antigens in organic fluids. The secretor gene plays an important role during intrauterine life. The aim of this study is to investigate a possible association between the ABH system and reproductive success in couples with primary repeated spontaneous abortion (RSA). Sixty-six couples with primary repeated spontaneous abortion and 356 consecutive healthy puerperae with their newborn infants from the white population of Rome were studied. All couples were seen at the Center for Reproductive Disorders of the Institute of Obstetrics and Gynecology of the University of Rome, La Sapienza. Secretor phenotype was determined by saliva in all subjects by laboratory standard procedures. In couples with primary RSA, the frequency of non-secretor phenotype of both husbands and wives (37.9%) were significantly higher than those of newborns from other couples (21.4% for male newborns and 29.4% for female newborns). In husbands, but not in wives, of the couples with primary RSA succeeding in having at least a live born infant after 5 years of follow up, the frequency of non-secretor phenotype was significantly lower than those without a liveborn infant (22.8% vs 54.8%). The presence of joint secretor phenotype in both husband and wife was positively associated with having a liveborn infant after 5 years of follow up (odds ratio = 4.57, 95% C.I.1.39-15.6). Secretor phenotype of couples with RSA, especially of the husband, could facilitate 'reproductive success'.

Guiding change: provider voices in youth pre-abortion counselling in urban Vietnam

Pre-abortion counselling has a role in promoting safe sex practices and in preventing repeated unplanned pregnancies and repeated abortions among abortion-seeking women. Such counselling is essential in Vietnam, especially given the common use of abortion. Arguably, in Ho Chi Minh City, Vietnam, the delivery of pre-abortion counselling is more urgent for young women, who have historically been ignored by State reproductive health initiatives and are increasingly exposed to transmission of sexually transmitted infections (STIs), unplanned pregnancies and abortion. This paper charts urban Vietnamese service providers' discourses in pre-abortion counselling specific for reducing risks of additional unwanted pregnancies, repeat abortion and STI/HIV transmission among young Vietnamese women. Thirteen providers working in counselling delivery, management and programme-planning at the Reproductive Health Care Centre of Ho Chi Minh City participated in this study. Through qualitative interviews, this paper elicits a range of provider attitudes, considerations and approaches in pre-abortion counselling and presents these discourses using participant anecdotes. Demonstrated among participant responses were five key pre-abortion counselling phases for promoting effective family planning among young women. Topics covered in these counselling phases included abortion complications, post-abortion fertility return, contraception, behaviour change and STI/HIV prevention and sexual and reproductive health basics (SRH). The service provider discourses gleaned from this study are foundational for further research and development of best practice guidelines in pre-abortion counselling.