A new study investigates the risk factors involved in multiple abortions.
Although the number of abortion procedures in America is on the decline, in 2012, there were 699,202 abortions reported to the Centers for Disease Control and Prevention (CDC).
At peak volumes, in the late 80s and early 90s, more than 1.3 million abortions were carried out per year.
Abortions are a relatively safe procedure, but they are ethically complicated and can be emotionally distressing.
Additionally, abortions can sometimes lead to preterm labor in future pregnancies. The current study looks at a number of factors that have the potential to influence repeat abortions.
One of these factors that predicted repeat abortions was the use of long-acting reversible contraception (LARC); these include subdermal implants and are often preferentially given to women undergoing an abortion.
Long-acting reversible contraception
The recent study, published in the Journal of Family Planning and Reproductive Health Care, found that women who used contraceptive implants and injections after their first abortion were more likely to go back for repeat procedures.
LARC - implants and injections - are regularly offered to women undergoing an abortion. The two primary reasons are that they offer a method of contraception that does not rely on patient compliance, and secondly, they are very cost effective. LARC methods certainly are effective, but, as the authors comment, "discontinuation rates are high, and, therefore, make terminations more likely."
Associated side effects of LARC methods can include irregular bleeding, weight gain, headaches and nausea; these effects may prompt some people to cease using them. The necessity of periodic replacement also presents challenges; some women may forget or simply not have the time or inclination to book into the local clinic.
Risk factors for additional abortions
In general, avoiding unnecessary medical procedures is advisable. The authors of the current study, from the University of Aberdeen and NHS Grampian in the UK, say:
"From a public health perspective, there is a need to identify women who are more likely to have repeat terminations and put in place targeted interventions to prevent unplanned pregnancies."
The team used data from the Termination of Pregnancy Database in the NHS Grampian region in Scotland from 1997-2003. The study, in total, captured the details of 13,621 women who had an abortion between those years.
Of the women who had a first abortion, 23.4% later went on to have a second.
The results elucidated a number of factors that impacted on whether a woman would go on to have further abortions:
- Women under the age of 20 at the time of their abortion were 5.59 times more likely to have a second
- Individuals from the lowest socioeconomic group were 1.23 times more likely to have a repeat abortion when compared with those in the highest socioeconomic group
- Women with two live births at the time of their first abortion were 1.51 times more likely to have a second abortion
- Women who had two or more miscarriages before their first abortion were 1.4 times more likely to have further procedures
- Women who were fitted with a contraceptive implant after their first termination were 1.78 times more likely to have a second procedure, compared with those who had no known method of contraception.
As for the future, the authors recommend that:
"Downloadable mobile phone applications may play an important role in the future in reminding women that their contraceptive implant is due for renewal."
The authors also remind us that the study is observational and, therefore, no cause and effect conclusions can be drawn. Abortions have already been found to be linked to a variety of other factors, including the number of previous pregnancies, socioeconomic groupings, poor relationships and more. It is a complex web to untangle. As ever, further study is needed.
Medical News Today recently covered a study reporting that 95% of people who had an abortion did not regret their decision.