Subsequent Abortion Research Articles

Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy

Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion.Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January–May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014.Results: During the 21 months ([median], IQR 20–22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68–2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06–0.48). When adjusted for LARC initiation status, age <25 years was a risk factor for subsequent abortion (27 abortions/283 women, 9.5%) compared to women ≥25 years (27/383, 7.0%, HR1.95, 95% CI 1.04–3.67).Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.

The impact of combined oral contraceptives on ocular tissues: a review of ocular effects.

The aim of this manuscript is to review the action and adverse effects of combined oral contraceptives (COCs) on ocular tissues. The percentage of unwanted pregnancies and the subsequent abortions make contraception crucial worldwide. Over 100 million women around the world use common contraceptive methods, including intrauterine devices, combined estrogen and progestin oral contraceptives, as well as progestin only preparations (oral contraceptives, implants or injections). COCs are widely used for contraception, but they are also indicated in menorrhagia, endometriosis, acne and hirsutism, fibroid uterus and premenstrual syndrome. However, they have been associated with high rates of cardiovascular events, venous thromboembolic disease, ischemic strokes and breast cancer. The incidence of COCs-related ocular complications is estimated to be 1 in 230 000, including dry eye symptoms, corneal edema, lens opacities and retinal neuro-ophthalmologic or vascular complications. We may infer that the serious ocular complications of COCs can be prevented by eliminating the estrogen dosage and choosing third-generation progestins. In any case, doctors should take into consideration the systemic and ocular history of the patients before selecting any method of contraception.

Using automated voice messages linked to telephone counselling to increase post-menstrual regulation contraceptive uptake and continuation in Bangladesh: study protocol for a randomised controlled trial

BackgroundAdoption of modern contraceptive methods after menstrual regulation (MR) is thought to reduce subsequent unwanted pregnancy and abortion. Long-acting reversible contraceptives (LARCs) are highly effective at reducing unintended pregnancy, but uptake in Bangladesh is low. Providing information on the most effective methods of contraception increases uptake of more effective methods. This protocol describes a randomised controlled trial of an intervention delivered by mobile phone designed to support post-MR contraceptive use in Bangladesh.MethodsThis is a multi-site single blind individual randomised controlled trial. At least 960 women undergoing MR procedures at selected facilities will be recruited after their procedure by female research assistants. Women will be randomised into the control or intervention group with a 1:1 ratio.All participants will receive usual clinic care, including contraceptive counselling and the telephone number of a non-toll-free call centre which provides counselling on MR and contraception. During the 4 months after their MR procedure, intervention participants will be sent 11 recorded interactive voice messages to their mobile phone about contraception with a focus on their chosen method and LARCs. Each message allows the participant to connect directly to the call centre. The intervention is free to the user. The control group will receive no messages delivered by mobile phone. All participants will be asked to complete an in-person questionnaire at recruitment and follow-up questionnaires by telephone at 2 weeks, 4 months and 12 months after their MR. The primary outcome for the trial will be self-reported LARC use 4 months post-MR. Secondary outcomes include LARC use at 2 weeks and 12 months post-MR, use of any effective modern contraceptive method at 2 weeks, 4 months and 12 months post-MR, and contraceptive discontinuation, contraceptive method switching, pregnancy, subsequent MR and experience of violence during the 12 month study period.DiscussionMobile phones offer a low-cost mechanism for providing individualised support to women with contraception outside of the clinic setting. This study will provide information on the effects of such an intervention among MR clients in Bangladesh.Trial registrationTrial registered with clinicaltrials.gov Registration number: NCT02579785 Date of registration: 16th October 2015.

P050 The uptake of larc’s in addressing subsequent unplanned pregnancies in young women

IntroductionTo decrease the number of subsequent unplanned pregnancies in young women presenting to one regional public health service and to note the barriers to the overall uptake of contraceptive options.MethodsYoung...

Why are abortions the answer? Prevalence, knowledge and attitude towards induced abortions among women attending a secondary level health care facility in Tamil Nadu, Southern India

Background: In India, from 2010 to 2011, government statistics on family welfare recorded 620,472 abortions in government-approved institutions. On the downside, a study conducted by the Indian Council of Medical Research (ICMR) in rural areas, found that abortions by uncertified health care personnel/in unapproved institutions were twice as many as in the approved ones (13.5 v 6.1 per 1000 pregnancies).This could be attributed to low levels of modern contraceptive use, being only 48% in 2007-08 (DLHS-3). The aim was to assess prevalence, knowledge and attitude towards induced abortions among women who attend a secondary health center, in Tamil Nadu, IndiaMethods: The study was a hospital-based cross-sectional study, done in the Out-patient department of a secondary level health care facility in Vellore, in September 2015. The women attending the secondary level health care facility; who were then pregnant or just post-delivery and those who had greater than two years of inter-pregnancy interval; were eligible to be enrolled in the study.Results: Only 27 out of the 175 women (15.4%) used any form of contraception. We found a rate of 72.69 abortions per 1000 married woman years in our study. Out of the 175 women, 29 (16.5%), 95% CI (10.9%, 22.1%), reported to have had at least one induced abortion; the main reason was unwanted pregnancy 22 (75.86%). Most women 116 (66.3%) had poor knowledge and attitude on induced abortions.Conclusions: We conclude that contraceptive use should be strongly advocated to women for birth planning and prevention of unwanted pregnancy and subsequent induced abortions.

Domestic Violence and Abortion Among Rural Women in Four Indian States.

The prevalence of domestic violence and abortion in India is high, yet little is known about the relationship between these experiences. Data from two linked data sets, India's 1998-1999 National Family Health Survey (NFHS-2) and a follow-up survey in 2002-2003, were analyzed. The analysis examines how the experience of physical violence affects the subsequent uptake of abortion, and how the experience of abortion affects subsequent experience of physical, sexual, and verbal violence. Women who experienced physical violence have significantly higher odds of reporting a subsequent induced abortion, whereas women who had an induced abortion have significantly higher odds of reporting subsequent sexual and verbal violence. There was no significant relationship between domestic violence and spontaneous abortion.

Early pregnancy angiogenic markers and spontaneous abortion: an Odense Child Cohort study

Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. We investigated the association between maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week <22 (median 83 days of gestation, interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum <22+0 gestational weeks, and the prevalence was 3.52% (59 cases). The time-dependent effect of maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor on subsequent late first-trimester or second-trimester spontaneous abortion (n= 59) was evaluated using a Cox proportional hazards regression model, adjusting for body mass index, parity, season of blood sampling, and age. Furthermore, receiver operating characteristics were employed to identify predictive values and optimal cut-off values. In the adjusted Cox regression analysis, increasing continuous concentrations of both soluble Fms-like kinase 1 and placental growth factor were significantly associated with a decreased hazard ratiofor spontaneous abortion: soluble Fms-like kinase 1, 0.996 (95% confidence interval, 0.995-0.997), and placental growth factor, 0.89 (95% confidence interval, 0.86-0.93). When analyzed by receiver operating characteristic cut-offs, women with soluble Fms-like kinase 1 <742 pg/mL had an odds ratio for spontaneous abortion of 12.1 (95% confidence interval, 6.64-22.2), positive predictive value of 11.70%, negative predictive value of 98.90%, positive likelihood ratio of 3.64 (3.07-4.32), and negative likelihood ratio of 0.30 (0.19-0.48). For placental growth factor <19.7 pg/mL, odds ratio was 13.2 (7.09-24.4), positive predictive value was 11.80%, negative predictive value was 99.0%, positive likelihood ratio was 3.68 (3.12-4.34), and negative likelihood ratio was 0.28 (0.17-0.45). In the sensitivity analysis of 54 spontaneous abortions matched 1:4 to controls on gestational age at blood sampling, the highest area under the curve was seen for soluble Fms-like kinase 1 in prediction of first-trimester spontaneous abortion, 0.898 (0.834-0.962), and at the optimum cut-off of 725 pg/mL, negative predictive value was 51.4%, positive predictive value was 94.6%, positive likelihood ratio was 4.04 (2.57-6.35), and negative likelihood ratio was 0.22 (0.09-0.54). A strong, novel prospective association was identified between lower concentrations of soluble Fms-like kinase 1 and placental growth factor measured in early pregnancy and spontaneous abortion. A soluble Fms-like kinase 1 cut-off <742 pg/mL in maternal serum was optimal to stratify women at high vs low risk of spontaneous abortion. The cause and effect of angiogenic factor alterations in spontaneous abortions remain to be elucidated.

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis.

BackgroundUnsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12–24 years seeking abortion-related care in Kenya.MethodsWe used data on 1,378 young women aged 12–24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form.ResultsNine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %).ConclusionsOur study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.

Sex-Ratio Pattern in Maharashtra: Locating Epi Centress of Female Deficit

Population data from Census-2011 at district level, show an alarming decline in the female to male (f/m) ratios in the child population (0–6 years). The decline is considerably higher in the urban segments of the population than in the rural segments. Besides, it is particularly sharp in some of the prosperous states of north-western India. However, these ratios have shown a similar decline in some parts of Maharashtra, a front-ranking prosperous state in the country. Here too, the decline has been high in urban segments, but many rural areas have also shown a disturbing decline. The deterioration in the f/m ratios has been sharp in certain spatial clusters. Mapping helps us locate the ‘epicenter’ of such clusters in the urban and in rural areas. In addition, NSSO (National Sample Survey Organisation) data for the 43rd, 50th, 55th survey rounds reveal unusually masculine sex ratios among the prosperous segment of the society. Such pattern is a clear indication of the abuse of newly developed medical technology of sex selection and subsequent abortion of the female fetus. It raises important questions regarding the developmental model we are pursuing, since the technological advances, prosperity, urbanization and increased standard of living do seem to be aggravating the gender bias within the society. This should be a subject of worry to planers, researchers and activists.

Awareness and utilization of emergency contraception among female undergraduates in a Nigerian University

Background: Many women are not aware of emergency contraception, which limits its use. Because increased risk of unwanted pregnancy and subsequent unsafe abortion have been well-documented, research on the knowledge and usage of emergency contraception is appropriate. Materials and Methods: The present study was a descriptive cross-sectional study conducted among 450 female undergraduate students of a University in northeast Nigeria from November to December 2014. Results: The age range of the respondents was 19-30 years, with a mean age of 21.4 ± 2.1 years. Most of them, 308 (68.4), were between the ages of 20 and 24 years. Majority of the students, 321 (71.3%), were single. Overall, 295 (65.5%) students were aware of emergency contraception, and 211 (71.5%) had utilized them. Among those who had utilized them, 174 (82.4%) were singles. The most common source of initial information about emergency contraception was health personnel, 148 (50.1%), followed by friends, 107 (36.3%). School, 11 (3.7%), and parents, 4 (1.4%), were the least utilized sources of information. Information from health personnel, news media and schools were the major influences of emergency contraceptive utilization. Levonorgestrel only pills (Postinor-2 R ) and combined pills (Yuzpe) were the most commonly utilized emergency contraception by 91 (43.1%) and 85 (40.3%) of the respondents, respectively. Conclusion: There was good level of awareness and utilization of emergency contraception among female undergraduates. However, there is a need to educate the parents, students and staff or counselors at the family clinic section of the university health clinic on its importance to improve the awareness of the students.

Mitigation of pollen limitation in the lowbush blueberry agroecosystem: effect of augmenting natural pollinators

Growers of small fruit crops often supplement the natural pollinator community by introducing pollinators into commercial orchards and fields, but there are relatively few studies that test the extent to which such interventions increase fruit yield. To test whether plants are limited by pollen availability, inflorescences in 78 commercial lowbush blueberry fields during three years were hand‐pollinated either with supplemental outcross pollen, or marked and left as controls (open‐pollination). Maximum fruit set with supplemental pollination was in the range 50–65%, whereas with open‐pollination, it was slightly, but significantly lower, in the range of 47–57%, suggesting that pollen limitation can affect fruit set. In a two‐year experiment, we augmented native pollinators with introduced honey bees, bumble bees, and leaf cutter bees and all combinations in 48 fields. Stigmatic pollen loads were influenced by the total numbers of managed bees in a field in 2010 but not 2011. The presence of leaf cutter bees had a small but positive effect on seed set in 2010, and honey bees had a small but negative influence on seed set in 2011. There was a strong correlation between fruit set reproductive output of supplementally pollinated and open‐pollinated plants, suggesting that plant health or plant resources influence reproductive success. Temperature variation among regional groupings of fields was minimal and is unlikely to have accounted for differences among fields in fruit set. We propose several reasons why, despite pollen‐limitation of fruit and seed set of blueberry plants, augmentation of the pollinator community of lowbush blueberry did not significantly increase reproduction. These include pollinator‐mediated transfer of self‐pollen followed by subsequent fruit abortion due to inbreeding depression and resource limitation for fruit maturation. Management practices that focus on increasing outcross pollen receipt, or plant resources for fruit set may have greater overall benefit than pollinator augmentation alone.

Acceptance of family planning methods by induced abortion seekers: An observational study over five years

BackgroundPrior to legalization of abortion, induced abortions were performed in an illegal manner and that resulted in many complications hence abortion was legalized in India in 1971 and the number of induced abortions has been gradually increasing since then. One way of preventing abortions is to provide family planning services to these abortion seekers so that same is not repeated. The study was performed to find out the acceptance of contraception after abortion. MethodsA prospective study was performed over a period of five years from 2010 to 2014. The study group included all the cases reporting for abortion. A proforma was filled in detail to find out the type of contraception being used before pregnancy and acceptance of contraception after abortion. The existing facilities were also evaluated. Results1228 abortions were performed over a period of five years. 94.5% of abortions were during the first trimester. 39.9% had not used any contraceptive before, contraceptives used were natural and barrier which had high failure. The main indication for seeking abortion was failure of contraception and completion of family. 39.6% of patients accepted sterilization as a method of contraception. The existing post abortion family planning services are inadequate. ConclusionPost abortion period is one which is important to prevent subsequent abortions and family planning services after abortion need to be strengthened.

Induced abortion in 30 Chinese provinces in 2013: a cross-sectional survey

BackgroundGalloping economic growth and reform in China in the past 30 years has led to dramatic social changes. Attitudes towards sex and sexual behaviour have changed, and premarital sex has become more acceptable. The methods of contraception have changed, and the use of highly effective or long-acting contraceptive methods tends to be decreasing, especially in urban areas. Abortion is commonly used to end unintended pregnancy. The aim of this study was to survey the current situation of induced abortions in selected hospitals in 30 provinces in China. MethodsThis cross-sectional study was conducted in 295 randomly selected hospitals in 30 Chinese provinces between April and August, 2013. We collected data using a questionnaire filled by the abortion service providers for all women seeking abortion within 12 weeks of pregnancy during a period of two months. The information included self-reported demographic and economic characteristics, history of induced abortion, and use of contraception. The characteristics of women were summarised with counts (percentages) for categorical variables; mean (SD) and range for age of women. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium. Findings79 174 women participated in the study (mean age 28·9 years (SD 1·7; range 13–58), of whom 27 134 (35%) were undergoing a first induced abortion, 28 637 (37%) a second abortion, and 22 682 (29%) a third or subsequent abortion. About a third of participants (31%) were not married and more than half (61%) were not local residents. The primary reasons for the unintended pregnancy were contraception failure (50%) and non-use of contraception (44%). InterpretationThis is the first nationwide large-scale study in 30 provinces to show that repeated induced abortion is high in China. A family planning programme for young and unmarried people is urgently needed to improve their access to information, advice, and services about contraception and to reduce unintended pregnancies and repeated induced abortion. FundingThe European Commission (EC) under the Seventh Framework Programme (FP7), project number 282490.

Accuracy of surgical abortion data capture in Canadian Government Health Administration Databases

Objectives: Utilization of single-payer health administrative data to estimate clinical events in a population is limited by the potential for data entry and coding errors. Birth events are accurately captured in health administrative data, but the accuracy of such data on abortion events is unknown. We conducted a randomized controlled clinical trial at the time of an index surgical abortion and used health administrative data to follow subsequent events. If administrative data capture is accurate for surgical abortion, this resource can be used to detect subsequent abortion events among consenting women. For all enrolled participants, we confirmed an index clinical event via clinical records. Our objective was to use the clinical records of these events to assess the accuracy of data capture in the health administrative databases.

Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial.

Can the need of subsequent abortion be reduced by providing intrauterine contraception as a part of the abortion service? Provision of intrauterine devices (IUDs) in association with first trimester abortion more than halved the incidence of repeat abortion during the first year of follow-up. Following abortion, the incidence of subsequent abortion is high, up to 30-40%. In cohort studies, intrauterine contraception has reduced the need of repeat abortion by 60-70%. A randomized controlled trial. The main outcome measure was the incidence of subsequent induced abortions during the follow-up. Altogether 751 women seeking first trimester induced abortion were recruited and randomized into two groups. Randomization was accomplished by computer-assisted permuted-block randomization with random block sizes of four to six. The investigators did not participate in randomization, which was done before commencing the study. The participants were recruited between 18 October 2010 and 21 January 2013. The inclusion criteria were age ≥18 years, duration of pregnancy ≤12 weeks, accepting intrauterine contraception, residence in Helsinki and signing the informed consent form. Women with contraindications to intrauterine contraception, such as uterine anomaly, acute genital infection or pap-smear change requiring surgical treatment were ineligible to participate.This study was conducted in collaboration between the Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, and Centralized family planning of the City of Helsinki.The intervention group (n = 375) was provided with intrauterine contraception (either the levonorgestrel-releasing intrauterine system or copper-releasing intrauterine device) immediately following surgical abortion (18.1%) or at a follow-up 2-4 weeks after medical abortion (81.9%). Women in the control group were prescribed oral contraceptives and advised to contact their primary healthcare unit for a follow-up visit and further contraceptive services according to national guidelines. The women were followed-up to 28 February 2014 by using the Finnish National Abortion Registry, Helsinki University Hospital electronic database and clinical follow-up visit at 1 year. The median age of the whole study group was 27 years and 44% had a history of induced abortion(s). During the follow-up year the number of women requesting subsequent abortion was significantly lower in the intervention than in the control group (9/375 [2.4%] versus 20/373 [5.4%], difference -3.0 [95% CI -6.0 to -0.2] percentage points, P = 0.038, according to intention-to-treat analysis and 5/346 [1.4%] versus 20/357 [5.6%], difference -4.2(-7.2 to -1.4) percentage points, P = 0.003, according to per-protocol analysis, respectively). Provision of intrauterine contraception was safe with rate of infection and expulsion similar to those reported previously. The power calculation was calculated for a 5-year follow-up. However, significant differences between the two groups were already seen after 1 year. The present study was performed in a single clinic, where, ∼15% of all abortions in Finland are performed. In order to decrease the need of subsequent abortions, IUDs should be provided at the time of abortion. The study was registered at www.clinicaltrials.gov (NCT01223521). 18 October 2010. 18 October 2010.

The impact of psychiatric history on women's pre- and postabortion experiences

ObjectiveThe objective of this study is to investigate to what extent psychiatric history affects preabortion decision difficulty, experienced burden, and postabortion emotions and coping. Women with and without a history of mental disorders might respond differently to unwanted pregnancy and subsequent abortion. Study designWomen who had an abortion (n=325) were classified as either with or without a history of mental disorders, using the Composite International Diagnostic Interview version 3.0. The two groups were compared on preabortion doubt, postabortion decision uncertainty, experienced pressure, experienced burden of unwanted pregnancy and abortion, and postabortion emotions, self-efficacy and coping. The study was conducted in the Netherlands. Data were collected using structured face-to-face interviews and analyzed with regression analyses. ResultsCompared to women without prior mental disorders, women with a psychiatric history were more likely to report higher levels of doubt [odds ratio (OR)=2.30; confidence interval (CI)=1.29–4.09], more burden of the pregnancy (OR=2.23; CI=1.34–3.70) and the abortion (OR=1.93; CI=1.12–3.34) and more negative postabortion emotions (β=.16; CI=.05–.28). They also scored lower on abortion-specific self-efficacy (β=−.11; CI=−.22 to .00) and higher on emotion-oriented (β=.22; .11–.33) and avoidance-oriented coping (β=.12; CI=.01–.24). The two groups did not differ significantly in terms of experienced pressure, decision uncertainty and positive postabortion emotions. ConclusionsPsychiatric history strongly affects women's pre- and postabortion experiences. Women with a history of mental disorders experience a more stressful pre- and postabortion period in terms of preabortion doubt, burden of pregnancy and abortion, and postabortion emotions, self-efficacy and coping. ImplicationsNegative abortion experiences may, at least partially, stem from prior or underlying mental health problems.

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design.

BackgroundRepeat abortion is a public health concern favored by many obstetric and social factors.The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion.MethodsWe carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC).Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women’s demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3–4 weeks following pregnancy termination.ResultsOf the 500 interviewed women, 211 (42.2 %; CI95% [37.88 – 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion.CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %).ConclusionHealth facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

Gender in Classic ‘Social Realism’: Juan García Hortelano’s Nuevas amistades

Juan García Hortelano’s Nuevas amistades is regarded as a quintessential social realist novel which details the superficiality and apathy of the wealthy upper-classes of Madrid. However, despite the fact that the novel is centred on a pregnancy and subsequent abortion, gender issues have barely been addressed in relation to the novel. This article argues that social issues which disproportionately affected women, such as the hypocritical double standards of sexual morality, the rigid gender roles prescribed by the regime and women’s lack of control over their own reproductive rights, are in the foreground of García Hortelano’s novel. By depicting these issues in his novel, the author drew the reader’s attention to some of the consequences of Francoist Spain’s patriarchal social values. It also briefly discusses the way the novel, with the controversial theme of pregnancy outside of marriage and abortion at its heart, was received by the censor.

Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond

ObjectivesThe aims of this study were to compare immediate postabortion uptake of recently subsidized (no-cost) levonorgestrel-releasing implants with already available intrauterine and shorter-acting methods and to compare the incidence of subsequent pregnancies (ending in birth or abortion) within 2 years. Study designRetrospective chart review of 4698 women attending a New Zealand public hospital abortion clinic over 2 years (2010–2012) to describe postabortion contraceptive choice, with follow-up via clinic and national births records to assess subsequent pregnancies at 12, 24, 36, and 48 months. ResultsTwenty percent of the cohort (934/4698) received an implant, 26% an intrauterine method (927 copper intrauterine device, 301 levonorgestrel-releasing intrauterine system [LNG-IUS]), and 54% chose other shorter-acting methods (2536/4698). Method choice was significantly associated with age, ethnicity, and pregnancy history (p < .001). At 24 months, the unadjusted incidence of subsequent abortion for implant users was 3.8% (95% confidence interval [CI] = 2.5–5.0) and 11.6% (95% CI = 10.3–12.8) for those choosing other short-acting methods. By 48 months, 6.6% of implant users had a subsequent abortion (compared with 18.3% for short-acting methods). The incidence of continued pregnancy at 24 months was 6.3% (95% CI = 4.4–8.1) for implant users and 15.7% (95% CI = 14–17.2) for those choosing other short-acting methods. Adjusted hazard ratios (HRs) for subsequent abortion were lowest for women initiating an implant (HR = 0.26, 95% CI = 0.20–0.35) or LNG-IUS (HR = 0.26, 0.16–0.44, reference group: short-acting methods). ConclusionsImmediate postabortion insertion of an implant significantly reduced rates of subsequent pregnancy for at least 2 years. Abortion service providers should ensure women have barrier-free access to all long-acting reversible contraceptions to delay or prevent pregnancy. ImplicationsInitiation of an levonorgestrel implant immediately postabortion was associated with a 74% reduction in subsequent abortion over the next 4 years compared with use of short-acting methods. Implants were popular among adolescents—a group at high-risk of subsequent pregnancy, and who have not historically been considered appropriate candidates for intrauterine contraceptive methods.

Risk factors for unwanted pregnancy and subsequent abortion among women aged 16 to 25 years in Latvia

Objective To investigate the risk factors associated with unwanted pregnancy in 16- to 25-year-old women in Latvia.Methods Case-control study of 16- to 25-year-old, sexually active women who did not want to get pregnant: the cases were 144 women who underwent their first abortion whereas 278 nulliparous women served as controls. Data concerning them were obtained by using a semi-structured anonymous questionnaire that included questions about education, sexual life habits, contraceptive practice and a multiple-choice test to assess knowledge about contraception.Results Women who underwent an abortion had had more lifetime sexual partners, had more often not used any contraception, and were significantly less knowledgeable about the latter than controls. No strong correlation between knowledge and actual contraceptive practice was observed in the study groups. Logistic regression analysis showed that the most significant risk factors were non-use of contraception or use of less effective methods.Conclusions The risk of unwanted pregnancy was associated with the woman's behaviour; her knowledge of contraception was much less relevant. Sexual health programmes should focus more on intrapersonal and interpersonal factors to promote use of effective contraception among young women.Chinese 摘要:目的：探讨16-25岁拉脱维亚女性非意愿妊娠相关的危险因素。方法：采用病例对照研究，研究对象是16-25岁的不想怀孕的性活跃的女性，其中144名经历第一次流产的女性为研究对象，278名未妊娠的女性作为对照组。相关信息通过匿名的半结构式问卷获得，问卷包括以下问题：受教育程度、性生活习惯、避孕措施的实施以及关于避孕知识的多选题等。结果：和对照组相比，经历流产的女性总的性伴侣数较多，较经常不使用任何避孕措施，避孕知识明显不足。避孕知识和采取避孕措施之间的相关性不强。Logistic回归分析结果显示不采取避孕措施或采取效果较差的避孕方法是最显著的危险因素。结论：非意愿妊娠的风险和女性的行为有关，与她的避孕相关知识相关性不大。性健康计划应更多的关注女性内心及外界人际间的因素来促进年轻女性使用有效的避孕措施。