Why prevention of repeat abortion is so challenging: psychosocial characteristics of women at risk

Abstract

Objectives: Abortion rates have declined in recent decades; however, the rate of repeat abortion remains high. In order to identify keys to making efficient interventions against repeat abortion, our objectives were: to assess the percentage of repeat abortions in women opting for termination of pregnancy over a period of 1 year; to identify the risk factors for repeat abortion; and to assess the characteristics of women who opted for a further pregnancy termination despite having received standard post-abortion care.

Methods: A retrospective cross-sectional survey was carried out among 362 women who underwent pregnancy termination during a 1-year period. Women with and without repeat abortion were compared with regard to age, nationality, marital status, parity and use of contraception. In a subsample of 160 women who were available for follow-up over 4 years, those who underwent a further pregnancy termination during the observation period were also analysed qualitatively.

Results: The rate of repeat abortion was 30.1% in the survey population. Age and immigrant status were identified as risk factors. The use of long-acting reversible contraception (LARC) was significantly higher after repeat abortion than after a first termination of pregnancy. Among women with repeat abortion in the follow-up group, those with psychological problems tended to discontinue contraception and those with partnership conflicts were prone to using unreliable contraceptive methods.

Conclusion: Aside from promoting LARC methods, strategies to reduce repeat abortion should consider the psychosocial risk factors and characteristics of women at risk identified in this study. An interdisciplinary approach including social care and counselling would be the most appropriate means to enable this.

Chinese abstract

目的：最近几十年流产率有所下降, 但反复流产率仍然很高。为了明确关键因素从而采取防止反复流产有效的干预措施, 我们的目的是评估1年内选择终止妊娠的妇女中反复流产发生率, 明确反复流产的危险因素并评估接受正规的流产后关爱护理仍选择再次终止妊娠妇女的特点。方法：对1年内接受终止妊娠的362名妇女进行回顾性横断面调查研究。在年龄, 国籍, 婚姻状况, 孕产次和避孕方式等方面比较是否发生反复流产。其中160名妇女随访4年以上, 随访期间选择了再次终止妊娠, 我们对此也进行了定性分析。结果：调查人群中反复流产率为30.1%。其中年龄和移民身份是危险因素。长效可逆避孕方法（LARC）的使用在反复流产后比在第一次终止妊娠后显著升高。在反复流产随访人群中, 有心理问题的妇女倾向于终止避孕, 而有伴侣关系冲突的妇女更倾向于使用不可靠的避孕方法。结论：除了提倡LARC的使用, 减少反复流产的策略中, 在研究中我们应该考虑到有发生反复流产危险的妇女其心理和社会等因素, 其中社会关怀和跨学科间咨询将是实现这一目标最适当的手段。

Keywords:

• Contraception
• immigrants
• repeat abortion
• risk factors
• termination of pregnancy

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.