Repeat induced abortion and adverse childhood experiences in Aquitaine, France: a cross-sectional survey

Abstract

Objective

The aim of the study was to analyse the relationship between adverse childhood experiences (ACEs) and repeat induced abortion, with regard to the potential effects of social deprivation and intimate partner violence.

Methods

An observational cross-sectional survey was conducted across each of the 25 abortion centres in Aquitaine, France, from 15 June to 15 September 2009. The sample comprised 806 women >18 years who had requested an induced abortion. Data were collected through a self-reported anonymous questionnaire on ACEs and experience of previous abortion. The main outcome measure was the percentage of repeat induced abortions.

Results

Among the participants, 473 (58.7%) were having their first induced abortion and 333 (41.3%) had already had a previous induced abortion. The abortion rank (first, second, third or more) was inversely related to the proportion of women with no ACE exposure (28%, 20% and 9%, respectively) and positively related to the proportion of women with a high ACE exposure (17%, 27% and 32%, respectively). Compared with women with no ACE exposure who were having a first induced abortion, in those with high ACE exposure, the odds of a third or more request for abortion was high: adjusted odds ratio 7.73 (95% confidence interval 3.56, 16.77).

Conclusion

We found a strong graded link between the extent of ACE exposure and the occurrence of repeat induced abortion.

摘要

目的：本研究的目的是分析不良童年经历(ACE)与反复人工流产的关系, 以及社会性剥夺和亲密伴侣暴力的潜在影响。方法：从2009年6月15日到9月15日, 对法国Aquitaine区的25个人工流产中心进行了一项观察性横断面调查。样本包括806名18岁以上要求人工流产的女性。数据是通过一份关于ACEs和既往人工流产经历的自报匿名问卷收集的。主要结果衡量标准是反复人工流产的百分比。结果：473例(58.7%)首次人工流产, 333例(41.3%)已有人工流产史。流产次数（第一次、第二次、第三次或更多)与未接触ACE的女性比例(分别为28%、20%和9%)呈负相关, 与高ACE暴露的女性比例(分别为17%、27%和32%)呈正相关。与没有ACE的女性相比, 在高ACE暴露的女性中, 第三次或以上要求人工流产的几率很高：调整后的优势比为7.73(95%可信区间为3.56, 16.77)。结论：我们发现ACE暴露的程度与重复人工流产的发生有很强的等级关联。

Keywords:

• Adverse childhood experiences
• care
• intimate partner violence
• repeat induced abortion
• social deprivation

Acknowledgements

The authors would like to thank the women who participated in this study; S. Maurice-Tizon (ISPED, Bordeaux University, Bordeaux, France), who assisted with the statistical analysis in 2009; B. A. Baratchart, C. Tauzin and C. Pelletier (Agence régionale de santé, Aquitaine, France), for their contributions in organising the survey and communicating the data from the Aquitaine regional health agency; the teams at the 25 induced abortion centres; the general practitioners who led the survey; P.-Y. Ancel and E. Azria (INSERM, UMR1153, EPOPé, Paris, France), for their helpful comments on this paper; and L. and S. Haddad (family members), for their help in translating the manuscript into English.

Disclosure statement

The authors declare that there is no conflict of interest associated with this article.

Authors contribution

SH was involved in the conception and planning of the study, the acquisition and analysis of the data and drafting the paper. ML was involved in the conception and design of the study and the acquisition of data and gave final approval for the article. LMM conducted quantitative and qualitative analysis in consultation with MJSC. MJSC was involved in revising the article critically for important intellectual content. SH, MJSC and LMM contributed to interpreting the data by commenting on successive drafts and approved the final version.