Multiple induced abortions – implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden

Abstract

Objectives

To investigate factors associated with multiple induced abortions.

Materials and methods

A multi-centre cross-sectional survey among abortion-seeking women (n = 623;14-47y) in Sweden, 2021. ‘Multiple abortions’ was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions.

Results

67.4% (n = 420) reported previous experience of 0-1 abortion, and 25.8% (n = 161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n = 109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n = 27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n = 65/161), compared to those with 0-1 abortion (n = 131/420), p=.034.

Conclusion

Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence.

SHORT CONDENSATION

Seeking multiple abortions is common in Sweden, and is associated with parity, low education, tobacco use, and exposure to violence. Although Sweden provides high quality and accessible comprehensive abortion care, counselling must be adaptable and address specific needs in vulnerable groups.

摘要

目的：探讨多次人工流产的相关因素。

材料和方法：2021年在瑞典对寻求堕胎的妇女(623人；14-47岁)进行的一项多中心横断面调查。“多次流产”被定义为接受过至少两次人工流产。这一组与以前有过0-1次人工流产经历的女性进行了比较。进行回归分析以确定与多次流产相关的独立因素。

结果：67.4%(420例)有过0-1流产史, 25.8%(161例)有过至少2次流产(42例选择不予回应)。有几个因素与多次流产有关, 并且在调整回归模型后, 以下因素仍然存在：产次≥1(OR = 2.96, 95%CI[1.63, 5.39])、低教育程度(OR = 2.40, 95%CI[1.40, 4.09])、吸烟(OR = 2.50, 95%CI[1.54, 4.07])和过去一年暴露于暴力事件中(OR = 2.37, 95%CI[1.06, 5.29])。与至少流产过2次的妇女(27/161)相比, 接受0-1次流产的妇女(109/420)认为自己在受孕时不能怀孕的人数更多, p= .038。情绪波动, 是避孕药的一种副作用, 与有过0-1次流产的妇女 (131/420)相比, 在至少流产过2次的妇女中更常见(65/161), p= .034。

结论：多胎流产与脆弱性有关。瑞典提供高质量和可获得的全面堕胎护理；然而, 咨询必须得到改进, 以实现避孕措施的遵守, 并查明和解决家庭暴力问题。

Keywords:

• Comprehensive abortion care
• multiple abortion
• repeat abortion

Author contributions

TT, ML, MER, ISP and MM contributed to the design of the study and data collection. Statistical analysis was performed by MM and CO, and drafting of the paper was conducted by CO and MM, with constructive feedback from all authors. All authors have read and approved the final manuscript.

Acknowledgements

Foremost, the authors thank all the women who participated in this study who shared their valuable views. Our deepest gratitude to all engaged midwives, physicians and secretaries who enabled the data collection. Special thanks goes to Annika Lindqvist, Ninni Berg, Ann-Sofi Kullman-Östlund, Marianne Lindholm, Ulrika Nilsson, Magdalena Hoveklint, Ulrica Stråhlman, Cecilia Svedung and Kaj Wedenberg. The authors acknowledge that people with uteruses choose to identify with genders other than ‘woman’, and for brevity’s sake in this paper, ‘women’ and ‘she’ are used as broad terms to refer to those who have uteruses and who may need to induce an abortion.

Disclosure statement

KG-D has received consulting fees and/or payment or honoraria from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, MedinCell, Cirqle, Natural Cycles, Exelgyn, Campus Pharma and HRA-Pharma. KG-D has been involved in advisory boards of Gedeon Richter, Organon, and Bayer. KG-D is a member of the FIGO council, a former member of STAG, and current Director of a collaborating centre, WHO HRP/SRH, Geneva. KG-D is emeritus member of the ICCR, Population council, past president of the European Society for Contraception and Reproductive Health, and FIAPAC, and is an honorary Fellow of FSRH/RCOG (UK) honorary professor at HKU. IS-P has served occasionally on advisory boards or acted as an invited speaker at scientific meetings for Asarina Pharma, Bayer Health Care, Gedeon Richter, Peptonics, Shire/Takeda and Sandoz. No conflicts of interest are reported by any other authors.