Subsequent Abortion Research Articles

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

IntroductionDespite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. We aimed to study the evolving...

Association between Abortion and Acceptance of Post abortion Contraception

Post-abortion contraceptive uptake is essential in reproductive health, as it helps to identify women’s contraceptive needs, reduce unintended pregnancies and prevent subsequent abortions. Integrating abortion services with family planning counselling at all levels of health facilities can enhance contraceptive acceptance. This study aimed to evaluate the acceptance of various family planning methods following different abortion services over one year period, at a family planning center, Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital. This study analyzed the women who participated in contraceptive counselling and accepted different types of contraceptives following different methods of first and second trimester abortions services. The study included women who received post-abortion contraceptive counselling and services, excluding those with termination beyond the second trimester or those seeking only postpartum contraceptive counselling or post-abortion care. It aimed to analyze the association between different methods of abortion and contraception acceptance post-abortion. Among 100 women who had spontaneous and induced abortions, 89% received post-abortion counselling and 75% accepted various types of contraception immediately after abortion. About one third of women were aged 25–29 years (30%), 99% were married, 40% were graduates and 48% were housewives. Abortion methods included medical abortion (62%), manual vacuum aspiration (MVA) (35%) and dilatation and evacuation (3%). Contraceptive acceptance rates were: short-acting reversible contraception (SARC) 60%, long-acting reversible contraception (LARC) 14%, and permanent methods 1%. Among medical abortion recipients, most chose SARC (43%) followed by LARC (4%). For those undergoing MVA, 16% chose SARC, and 9% chose LARC. Condoms were the most accepted SARC method (22%). The study demonstrated that post-abortion counseling significantly increases acceptance of various contraceptive methods, with SARC being the predominant choice, especially condoms among users.

Interpregnancy Interval After Healthy Live Birth and Subsequent Spontaneous Abortion

Many studies have reported that the interpregnancy interval (IPI) is a potential modifiable risk factor for adverse perinatal outcomes. However, the association between IPI after live birth and subsequent spontaneous abortion (SA) is unclear. To investigate the association of IPI after a healthy live birth and subsequent SA. This prospective cohort study used data from 180 921 women aged 20 to 49 years who had a single healthy live birth and planned for another pregnancy and who participated in the Chinese National Free Prepregnancy Checkups Project from January 1, 2010, to December 31, 2020. Statistical analysis was conducted from June 20 to October 5, 2023. Interpregnancy interval, defined as the interval between the delivery date and conception of the subsequent pregnancy, was categorized as follows: less than 18 months, 18 to 23 months, 24 to 35 months, 36 to 59 months, and 60 months or longer. The main outcome was SA. Multivariable-adjusted odds ratios (ORs) were calculated by logistic regression models to examine the association between IPI and the risk of SA. Dose-response associations were evaluated by restricted cubic splines. The analyses included 180 921 multiparous women (mean [SD] age at current pregnancy, 26.3 [2.8] years); 4380 SA events (2.4% of all participants) were recorded. A J-shaped association between IPI levels and SA was identified. In the fully adjusted model, compared with IPIs of 18 to 23 months, both short (<18 months) and long (≥36 months) IPIs showed an increased risk of SA (IPIs of <18 months: OR, 1.15 [95% CI, 1.04-1.27]; IPIs of 36-59 months: OR, 1.28 [95% CI, 1.15-1.43]; IPIs of ≥60 months: OR, 2.13 [95% CI, 1.78-2.56]). Results of the subgroup analysis by mode of previous delivery were consistent with the main analysis. This cohort study of multiparous women suggests that an IPI of shorter than 18 months or an IPI of 36 months or longer after a healthy live birth was associated with an increased risk of subsequent SA. The findings are valuable to make a rational prepregnancy plan and may facilitate the prevention of SA and improvement in neonatal outcomes.

Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial

BackgroundInternational guidelines recommend placement of intrauterine devices immediately after second trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. ObjectiveWe aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at two to four weeks after second trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at two to four weeks after the abortion, in terms of the proportion of intrauterine device use after six months, with maintained safety and acceptability. Study DesignIn this open-label, randomized, controlled, superiority trial, we recruited participants at eight abortion clinics in Sweden. Eligible participants were ≥18 years, requesting medical abortion with gestation ≥85 days and opting for use of a post abortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in non-normal continuous variables were analyzed with the Mann-Whitney U-test and differences in dichotomous variables with the chi square or Fisher’s exact tests. A P value <.05 was considered statistically significant. Group differences are presented by modified intention-to-treat and per protocol analyses. ResultsBetween January 2019, and June 2022, we enrolled 179 participants, of whom 90 were assigned to intervention and 89 to control. Enrolment was prematurely stopped after an interim analysis exceeded a predefined intrauterine device expulsion rate of 20%. By modified intention-to-treat, use of intrauterine device after 6 months was 50.7% (34/67) in the intervention group compared to 71.6% (48/67) in the control group (proportion difference 20.9%; 95% confidence interval 4.4%-35.9%; P=.02). The intrauterine device expulsion rate was 30.1% (22/73) in the intervention group versus 2.9% (2/70; P <.001) in the control group. Other adverse events were rare and patient acceptability was high in both groups. ConclusionIntrauterine device placement within 48 hours after second trimester medical abortion was non-superior in terms of the proportion of intrauterine device use after 6 months when compared with placement after 2 to 4 weeks. Placement within 48 hours after second trimester abortion can be used in selected individuals after counselling on expulsion risk.

KISS-1 knockdown inhibits cell growth, migration, and invasion in HTR-8/SVneo cells by regulating the GRP54-mediated PI3K/AKT signaling pathway

Recurrent spontaneous abortions (RSA) affect reproductive health and increase the risk of subsequent abortions. To investigate the role of KISS-1/GPR-54 signaling in RSA progression. Villus tissue was collected from RSA patients, and human trophoblastic HTR-8/SVneo cells were used. KISS-1 and GRP54 levels were detected using RT-qPCR and immunohistochemistry. Western blotting was performed to analyze ZO-1 and ZEB1 levels. Cell proliferation was determined via CCK-8 and cell clone formation assays. Transwell assays were performed to assess cell migration and invasion abilities. KISS-1 was down-regulated in the villus tissues of RSA patients. KISS-1 overexpression dramatically inhibited trophoblast proliferation, migration, and invasion. Mechanistically, ZEB1 expression was down-regulated, whereas ZO-1 expression was up-regulated, after KISS-1 overexpression. GPR54 silencing neutralized the effect of KISS-1 in HTR-8/SVneo cells. Additionally, KISS-1 overexpression inactivated the PI3K/AKT signaling pathway through GRP54. The KISS-1/GPR-54 signaling axis regulates RSA progression by regulating the PI3K/AKT signaling pathway.

Comparative floral development in Mimosa (Fabaceae: Caesalpinioideae) brings new insights into merism lability in the mimosoid clade.

The genus Mimosa L. (Leguminosae; Caesalpinioideae; mimosoid clade), comprising more than 500 species, is an intriguing genus because, like other members of the mimosoid clade, it presents an enormous variation in floral characteristics and high merism lability. Thus, this study aimed to elucidate the floral development and identify which ontogenetic pathways give rise to merism variation and andromonoecy in Mimosa caesalpiniifolia, M. pudica, M. bimucronata, and M. candollei. Floral buds at various stages of development and flowers were collected, fixed, and processed for surface analysis (SEM). The development of the buds is synchronous in the inflorescences. Sepals appear simultaneously as individualized primordia in M. caesalpiniifolia and in reversed unidirectional order in M. bimucronata, with union and formation of an early ring-like calyx. Petal primordia appear in unidirectional order, with a noticeably elliptical shape in M. caesalpiniifolia. The wide merism variation in Mimosa results from the absence of organs from inception in the perianth and androecium whorls: in dimerous, trimerous, or tetramerous flowers, the additional organs primordia to compose the expected pentamerous flowers are not initiated. The haplostemonous androecium of M. pudica results from the absence of antepetalous stamens from inception. In the case of intraspecific variations (instabilities), there is no initiation and subsequent abortion of organs in the events of reduction in merosity. In addition, extra primordia are initiated in supernumerary cases. On the other hand, staminate flowers originate from the abortion of the carpel. Mimosa proved to be an excellent model for studying merism variation. The lability is associated with actinomorphic and rather congested flowers in the inflorescences. Our data, in association with others of previous studies, suggest that the high lability in merism appeared in clades that diverged later in the mimosoid clade. Thus, phylogenetic reconstruction studies are needed for more robust evolutionary inferences. The present investigation of ontogenetic processes was relevant to expand our understanding of floral evolution in the genus Mimosa and shed light on the unstable merism in the mimosoid clade.

Access to Adequate Reproductive Care in Florida’s Women’s Prisons and Jails

Mass incarceration is a pervasive issue in the United States, with women, particularly women of color, becoming the fastest growing population in prisons. Despite this, many carceral institutions lack the infrastructure to provide incarcerated women with adequate reproductive healthcare, and states often lack policy providing for adequate reproductive care. This paper examines the women’s prisons and jails of Florida, serving as both an analysis of the care offered to prisoners and the policies that have been passed in the state legislature. Additionally, it examines the potential impacts of the Supreme Court’s 2022 decision to overturn Roe v. Wade, and Florida’s subsequent legislation restricting abortion access. Through this analysis, this paper finds that more protections are needed at both the state and the institutional level for reproductive healthcare in Florida’s women’s prisons and jails, particularly after the overturning of Roe v. Wade.

One-year follow up of contraceptive use and pregnancy rates after early medical abortion: Secondary outcomes from a randomized controlled trial of immediate post-abortion placement of intrauterine devices.

Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after early medical abortion. We present secondary outcome data of continuation rates, factors associated with continuation and discontinuation, choice of IUD type, women's satisfaction with IUD, and IUD expulsions, subsequent pregnancies, and abortions within 1 year post-abortion in a randomized, controlled, multicenter trial on IUD placement within 48 hours compared with placement 2-4 weeks after medical abortion up to 63 days' gestation (ClinicalTrials.gov NCT03603145). Of the 240 women studied, 112/120 (93.3%) in the intervention group vs 113/120 (94.2%) in the control group completed the 12-month follow-up. The rate of IUD use at 12 months was 84/112 (75%) in the intervention group vs 75/113 (66.4%) in the control group (P = 0.19). Attendance at the IUD placement visit was the only predictor of long-term IUD use (relative risk [RR] = 5.7, 95% confidence interval [CI] 2.03-16.0; P = 0.001). The main reason for choosing an IUD was high contraceptive effectiveness. The most common reasons for IUD discontinuation were bleeding problems and abdominal pain. IUD expulsion was rare and did not differ between groups. Satisfaction among IUD users at 1 year was high (>94%) and the majority of all participants would recommend IUD to a friend (65.8%). Use of no contraception and experience of unprotected intercourse were less common in the intervention group (11/112 [9.8%] vs 25/113 [22.1%], P = 0.02 and 17/112 [15.2%] vs 32/113 [28.3%], P = 0.02, respectively). There was no difference in the rate of subsequent pregnancies and abortions (pregnancies 14/112, 12.5% in the intervention group vs 8/113, 7.1% in the control group, P = 0.19; abortions 5/112, 4.5% vs 3/113, 2.7%, P = 0.5). IUD placement after medical abortion led to high continuation and satisfaction rates with no difference between groups. We found no difference in IUD expulsions after immediate compared with later placement. Unprotected intercourse was significantly less common in the immediate group. In clinical practice, immediate placement of IUDs available free of charge at the abortion clinic is likely to increase attendance to the placement visit and continued use of IUDs after abortion.

A comparative analysis of the sexual culture and behavior of nursing students from the Medical University of Plovdiv in the period 2009-2019.

Population reproduction and family planning are highly dependent on sexual culture and sexual behavior. In this study, we seek to determine whether, over a ten-year period from 2009 to 2019, there have been any changes in the sexual culture of nursing students in relation to the knowledge of risk factors for unintended pregnancies and subsequent abortions.

The morning after: Prescription-free access to emergency contraceptive pills

We analyze the introduction of prescription-free access to morning-after pills—emergency contraceptives that aim to prevent unintended pregnancy and subsequent abortion after unprotected sexual intercourse. Exploiting a staggered difference-in-differences setting for Europe combined with randomization inference, we find sharp increases in sales and manufacturers’ revenues of more than 90%. However, whilst not reducing abortions significantly, the policy triggers an unexpected increase in fertility of 4%, particularly among women aged 25–34. We elaborate on mechanisms by looking at within-country evidence from several EU countries, which suggests that fertility is driven by decreasing use of birth control pills in response to easier access to morning-after pills.

Partner involvement in abortion trajectories and subsequent abortion safety in Nigeria and Côte d’Ivoire

BackgroundUnsafe abortions contribute to maternal mortality and morbidity worldwide, with disproportionate impacts in lower-income countries. Identifying factors associated with an elevated risk of experiencing an abortion under the most unsafe conditions is an important component of addressing this burden. The partner’s role in obtaining a safe or unsafe abortion is not well understood. This study provides a quantitative assessment of the relationship between partner involvement and subsequent abortion safety.MethodsThe data are drawn from the PMA2020 female surveys and abortion follow-up surveys, fielded in Nigeria and Côte d’Ivoire between 2018 and 2020. The sample includes 1144 women in Nigeria and 347 women in Côte d’Ivoire who reported having ever experienced an abortion. We assess partner involvement in discussing the abortion decision and/or in selecting the method or source and evaluate the relationship between partner involvement and most unsafe abortion (using non-recommended methods from a non-clinical source) versus safe or less safe abortion, adjusting for sociodemographic characteristics.ResultsWe find a strong association between experiencing any partner involvement and decreased odds of experiencing a most unsafe abortion (Nigeria: aOR = 0.34, 95% CI 0.26–0.45; Côte d’Ivoire: aOR = 0.27, 95% CI 0.16–0.47). Analyzing the two types of partner involvement separately, we find that partner involvement in the decision is associated with lower odds of most unsafe abortion in both countries (Nigeria: aOR = 0.48, 95% CI 0.39–0.72; Côte d’Ivoire: aOR = 0.34, 95% CI 0.19–0.60); partner involvement in selecting the method and/or source was only significantly associated with lower odds of most unsafe abortion in Nigeria (Nigeria: aOR = 0.53, 95% CI 0.39–0.72; Côte d’Ivoire: aOR = 0.65, 95% CI 0.32–1.32).ConclusionIn Nigeria and in Côte d’Ivoire, respondents whose partners were involved in their abortion trajectory experienced safer abortions than those whose partners were not involved. These findings suggest the potential importance of including men in education on safe abortion care and persistent need to make safe abortion accessible to all, regardless of partner support.

Associations between contraceptive availability and rate ofsubsequent legal abortions in Colombia: A historical cohortanalysis.

To describe factors associated with subsequent abortions in Colombia and evaluate whether high-efficacy contraceptive availability (IUD) post-index abortion was associated with higher efficacy contraceptive initiation and fewer subsequent abortions within 2 years. The study population comprised patients aged 15-44 years who underwent index abortion in 2017 at four clinics in Bogotá, Colombia. Using charts, we conducted a retrospective cohort study with 2-year follow-up (2017-2019) after the index abortion for outcomes of contraceptive initiation and subsequent abortion. We evaluated associations between demographic or clinical characteristics and outcomes using Pearson chi-square and multivariate logistic regression. Of 9175 patients with index abortion, 3409 (37.2%) initiated an intrauterine device (IUD) and 467 (5.1%) had a subsequent abortion within the study period (2017-2019). IUD availability (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.39-1.93) and insurance use (aOR, 5.03; 95% CI, 4.37-5.78) were associated with high-efficacy contraceptive initiation; medication abortion was inversely associated (aOR, 0.24; 95% CI, 0.22-0.27). Initiation of no (aOR, 4.94; 95% CI, 3.59-6.80) or moderate-efficacy (injection: aOR, 4.21 [95% CI, 3.14-5.62]; oral contraceptive pill: aOR, 4.60 [95% CI, 3.21-6.59]) methods were associated with subsequent abortion. Subsequent abortion is inversely associated with initiated postabortion contraceptive efficacy, which is modifiable on a systems level by improving access to effective postabortion contraception.

Effectiveness and safety of a direct-to-patient telehealth service providing medication abortion targeted at rural and remote populations: Cross-sectional findings from Marie Stopes Australia

ObjectivesWe assessed the safety and effectiveness of direct-to-patient telehealth provision of medication abortion in Australia. Study designWe included all medication abortions (January 2017–December 2018) from Marie Stopes Australia's patient management and adverse event reporting systems. We defined effectiveness as whether the patient had a continuing pregnancy, incomplete abortion, and/or subsequent vacuum aspiration or procedural abortion and safety as whether the patient experienced any adverse event. ResultsDirect-to-patient telehealth was more effective than in-clinic provision (97.2% vs 95.4%). The proportion of adverse events did not differ between groups. ConclusionsThis direct-to-patient telehealth service is safe and effective.

The Role of Atypical Chemokine Receptor D6 (ACKR2) in Physiological and Pathological Conditions; Friend, Foe, or Both?

Chemokines exert crucial roles in inducing immune responses through ligation to their canonical receptors. Besides these receptors, there are other atypical chemokine receptors (ACKR1–4) that can bind to a wide range of chemokines and carry out various functions in the body. ACKR2, due to its ability to bind various CC chemokines, has attracted much attention during the past few years. ACKR2 has been shown to be expressed in different cells, including trophoblasts, myeloid cells, and especially lymphoid endothelial cells. In terms of molecular functions, ACKR2 scavenges various inflammatory chemokines and affects inflammatory microenvironments. In the period of pregnancy and fetal development, ACKR2 plays a pivotal role in maintaining the fetus from inflammatory reactions and inhibiting subsequent abortion. In adults, ACKR2 is thought to be a resolving agent in the body because it scavenges chemokines. This leads to the alleviation of inflammation in different situations, including cardiovascular diseases, autoimmune diseases, neurological disorders, and infections. In cancer, ACKR2 exerts conflicting roles, either tumor-promoting or tumor-suppressing. On the one hand, ACKR2 inhibits the recruitment of tumor-promoting cells and suppresses tumor-promoting inflammation to blockade inflammatory responses that are favorable for tumor growth. In contrast, scavenging chemokines in the tumor microenvironment might lead to disruption in NK cell recruitment to the tumor microenvironment. Other than its involvement in diseases, analyzing the expression of ACKR2 in body fluids and tissues can be used as a biomarker for diseases. In conclusion, this review study has tried to shed more light on the various effects of ACKR2 on different inflammatory conditions.

Provision of long-acting reversible contraception at surgical abortion-A cross-sectional nationwide register study.

Provision of long-acting reversible contraception (LARC) at surgical abortion is safe, practical, and leads to higher user rates than does delayed provision. The aim of this study was to explore whether provision of LARC at surgical abortion is associated with known risk factors for subsequent abortions and inconsistent use of contraception, including sociodemographic factors and psychiatric disorders. This was a register-based cross-sectional study of 6251 women having a surgical abortion in Sweden. Data were collected from National health and population registers. Women with procedure codes for surgical abortion were identified in the National Patient Register from October 2016 to December 2018. Information from Statistics Sweden, the National Patient Register, and the Swedish prescribed drug register on sociodemographic factors, psychiatric disorders, and dispensed LARC was added and linked on an individual level. Associations of sociodemographic factors and psychiatric disorders with LARC provision were explored with generalized logit mixed models and presented as crude and adjusted odds ratios with 95% confidence intervals (CIs). The overall rate of LARC provision at the time of the abortion was 2515/6251 (40.2%). Younger age and lower level of education were associated with an increased likelihood of LARC provision. In the study population, 2624/6251 (42.0%) patients had a pre- or post-abortion psychiatric disorder, a factor associated with an increased likelihood of LARC provision compared with women with no such disorders (adjusted odds ratio 1.21; 95% CI 1.08-1.34). The highest rates and odds were seen among women with personality, substance use, and/or neurodevelopmental disorders and among women with multiple psychiatric disorders. Sociodemographic risk factors and psychiatric disorders were associated with increased LARC provision at surgical abortion, indicating that women at high risk of unwanted pregnancies are provided with effective contraception. Still, less than half of all women undergoing surgical abortion were provided with LARC, suggesting that contraceptive access and counseling prior to a surgical abortion can be improved.

Choriocarcinoma in Cesarean Scar Site: A Case Report

Background & aim: Cesarean scar pregnancy is an ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar and is the rarest kind of ectopic pregnancy. The present study present a case of choriocarcinoma (CC) in the cesarean scar. The clinical course, findings, and treatment plan are discussed. Case report: A 41-years old multi-gravid woman with a history of one previous cesarean section and three subsequent abortions was admitted to the hospital. She suffered from an unknown abnormal vaginal bleeding for two months. Β-HCG titer was 1,000 IU/L and the report of sonography showed no gestational sac. Accordingly, the patient was diagnosed with ectopic pregnancy in the cesarean scar site and, therefore, weekly usage of methotrexate was prescribed for her. Since she did not respond to the treatment, she was referred to our department in the Faculty of Medicine. The evaluation showed mass invasion through the entire uterine wall. The uterus preservation was not possible, therefore, total hysterectomy was performed. The pathology report confirmed CC in the cesarean scar. Conclusion: Based on previous studies, as the number of cesarean sections increases, the possibility of complications rises, as well. Cesarean scars implantation of CC is one of the rare complications of caesarean section. The probability of a gestational trophoblastic disease should be considered in any woman during her pregnancy. Early detection and proper management of the complications can result in a decrease in morbidity and mortality.

Survival and dispersal of brucella vaccine strain brucella abortus 19 in the body of vaccinated animals

In the general complex of antibrucellosis measures, specific prevention of the disease occupies an important place. The first experiments on vaccination of animals against brucellosis were carried out in the early 20th century. Experiments have shown that even a single subcutaneous vaccination with a live virulent culture 2 months before fertilization in 90% of cases protects animals from subsequent infection and abortion. Of all the brucellosis vaccines used in different countries, the most widespread is the vaccine from the B. abortus 19 strain, which is used to prevent brucellosis in all farm animals. When studying the dispersal and survival of brucella of the vaccine strain in the body of animals vaccinated with different doses of the vaccine, it proceeded similarly, without significant difference (P&gt;0,05). The infection index in heifers vaccinated with a small dose 1 month after vaccination was 60±2, and in heifers vaccinated with a full dose - 74±4. Two months after vaccination, the infection index was 44±16 and 44±4, respectively. 2 months after vaccination, the total number of isolated cultures was 21% less than in the study 1 month after vaccination. According to the total data, 38.5% of cultures were sown from the pharyngeal and prescapular lymph nodes of heifers vaccinated with a small dose 1 month after vaccination, and 20% after 2 months. In heifers vaccinated with a full dose, 28.1% and 26.9%, respectively. Thus, the results of the experiment showed that the dispersibility and survival rate of brucella vaccine strain B. abortus 19 in the body of heifers slightly depends on the dose of the vaccine, which is consistent with the data obtained by us in the experiment on guinea pigs, as well as with the data of other authors.

Exploring the physician's role in contraceptive counseling at the time of abortion in the US

ObjectiveWe explored how physicians conceptualize their role in contraceptive counseling at the time of abortion, including identifying clinician attitudes that may lead to patients’ perceptions of contraceptive coercion. Study designWe conducted individual semi-structured interviews using questions based on components of the Theory of Planned Behavior. We recruited physician abortion providers using purposeful sampling to attain diversity in practice setting and geographic practice region. We analyzed transcribed interviews using initial and values coding methods. ResultsWe interviewed 39 participants across the United States, who primarily self-reported as White female obstetrician gynecologists (OB/GYNs) aged 25 to 44. Over half of participants practiced in an academic setting. Participants perceived providing patient education and taking a patient-centered approach as part of their role in contraceptive counseling. Participants also believed it was their responsibility to prevent unintended pregnancies and subsequent abortions among their patients. External motivations behind this belief included wanting patients to avoid the challenges of obtaining another abortion, particularly in states with multiple abortion restrictions. Internal motivations included valuing professional goal attainment, discomfort with abortion, and abortion stigma. When physicians counseled about contraception, many expressed preferences toward methods of long-acting reversible contraception (LARC) and an emphasis on contraception provision for adolescents and women with prior abortions. ConclusionsPhysicians providing abortions strive to use a patient-centered approach to contraceptive counseling. However, many continue to be motivated by the goal of avoiding a subsequent abortion which patients may perceive as coercion towards contraceptive uptake. ImplicationsConsidering contraceptive counseling as a means to prevent subsequent abortion may lead to coercive practices, especially with specific patient populations. Moral codes and abortion stigma influence physicians’ counseling practices and physicians must examine their personal values and motivations behind recommending contraception after an abortion.

Influence of a values clarification workshop on residents training at Catholic Hospital programs

ObjectivesTo evaluate if a values clarification workshop conducted at Catholic hospital training programs influenced obstetrics and gynecology residents' abortion attitudes. Study designBetween 2018 and 2019, we provided a values clarification workshop focused on abortion care to 47 obstetrics and gynecology residents at five Catholic programs that do not provide abortion training. Participants received a pre-survey eliciting participant characteristics, and training experiences. On pre- and post-surveys, we asked participants to respond to abortion scenarios using a five-point Likert scales (1 = strongly disagree, 2 = somewhat disagree 3 = neither agree nor disagree, 4 = somewhat agree, 5 = strongly agree). We calculated descriptive frequencies, report the proportions agreeing with the statements (Likert ≥4) before and after the workshop, and compared median Likert responses using Wilcoxon matched pair test. ResultsForty-one participants (87%) completed both surveys. Twelve (29%) reported Catholic religion, six (15%) reported their personal reproductive care views were in line with their institution, and five (12%) selected their program based on its religious affiliation. Three (9%) had experience with first-trimester abortion for nonmedical reasons, and 20 (49%) planned to provide such care after graduation. Both before and after the workshop, all participants could think of a justification why a patient with an undesired pregnancy would choose abortion. After the workshop, more residents were able to think of a justifiable reason for the following abortion-related scenarios: (1) patients declining post-abortal contraception (51% vs. 78%, p < 0.001), (2) patients presenting for subsequent abortion (93% vs 95%, p = 0.01), and (3) patients presenting for second-trimester abortion (93% vs. 100%, p = 0.001). Many participants increased their Likert score when asked about acceptability of patients declining post-abortal contraception (n = 24, 59%), patients seeking a subsequent abortion (n = 15, 37%), and patients obtaining a second trimester abortion contraception (n = 11, 27%). Emotional and professional reactions to these scenarios were unchanged. After the workshop, residents were more likely to consider either financial inability (73% vs. 83%, p < 0.01) or disruption to career or education (71% vs 80%, p < 0.01) as morally acceptable reasons for requesting an abortion. For abortion for a patient who is financially unable to support their child, 12 (29%) increased their Likert score, 1 (2%) had a lower score and the remaining 28 (68%) had no change. For abortion for a patient whose career or education would be disrupted 13 (32%) increased their Likert score, one (2%) had a lower score and the remaining 27 (66%) had no change. ConclusionOur values clarification workshop resulted in more residents at Catholic training programs endorsing accepting attitudes toward abortion patient scenarios. Values clarification exercises can be a useful tool for residents to discuss abortion care, especially when training is insufficient. ImplicationsMost obstetrics and gynecology residents at Catholic hospitals experience limited training in abortion care. A values clarification workshop conducted at such programs may result in increasing resident acceptance of abortion-related patient care scenarios and may help reduce abortion stigma.

The level and deriving factors of repeat-induced abortion in Ethiopia: A systematic review and meta-analysis

BackgroundDespite repeat induced abortion is a growing challenge for both developing as well as developed countries, abortion-related complications are found to be higher among women in developing countries. This systematic review and meta-analysis was intended to assess the level of repeat-induced abortion and its deriving factors in Ethiopia. MethodsDifferent data sources such as PubMed, EMBASE, Google Scholar, and University online data bases were used to identify candidate articles for this systematic review and meta-analysis. The article search was conducted from June 10 to 26, 2020. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the quality of the included studies. Data extraction was performed through a format prepared on Microsoft excel work book and exported to Stata 11 for analysis. The heterogeneity of the studies was tested using Cochran (Q test) and I2 test statistics. Publication bias was assessed by funnel plot and Egger's regression asymmetry test. Subgroup-analysis was conducted based on sample size and study Regions. ResultsFive studies with 2000 participants who visited health facilities for abortion services were included in this systematic review and meta-analysis. The pooled level of repeat-induced abortion was found to be 29.93% (95%, CI 23.15%, 36.71%). Urban residence (OR = 5.10, 95%, CI 2.51, 10.33), illiteracy (OR = 4.12, 95%, CI 2.40, 7.07), having multiple sexual partners (OR = 6.28, 95% CI 4.28, 9.22), and early sexual initiation (OR = 3.80, 95%, CI1.76, 8.19) were found to be the deriving factors for experiencing repeat induced abortion. However, there was no significant association between ever use of family planning and repeat induced abortion (OR = 1.03, 95%, CI 0.09, 11.59). ConclusionThe level of repeat-induced abortion was found to be high in Ethiopia. High risk of experiencing repeat-induced abortion was reported among participants who were urban residents, illiterate, who had multiple sexual partners, and early sexual initiation. However, a statistically significant association was not found between ever use of family planning and repeat-induced abortion. Health education shall be given about the risk of subsequent abortion and the relevance of avoiding unintended pregnancy, multiple sexual partners, and early sexual initiations through various mechanisms.