Objective
The objective of the study was to characterize the backgrounds of women who have repeat abortions.
Study Design
In a cross-sectional study of 259 women (mean age, 35.2 ± 5.6 years), the relation between adverse experiences in childhood and risk of having 2 or more abortions vs 0 or 1 abortion was examined. Self-reported adverse events occurring between the ages of 0 and 12 years were summed.
Results
Independent of confounding factors, women who experienced more abuse, personal safety, and total adverse events in childhood were more likely to have 2 or more abortions vs 0 abortions (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.15–5.71; OR, 2.74; 95% CI, 1.29–5.82; and OR, 1.59; 95% CI, 1.21–2.09, respectively) and vs 1 abortion (OR, 5.83; 95% CI, 1.71–19.89; OR, 2.23; 95% CI, 1.03–4.81; and OR, 1.37; 95% CI, 1.04–1.81, respectively). Women who experienced more family disruption events in childhood were more likely to have 2 or more abortions vs 0 abortions (OR, 1.75; 95% CI, 1.14–2.69) but not vs 1 abortion (OR, 1.16; 95% CI, 0.79–1.70).
Conclusion
Women who have repeat abortions are more likely to have experienced childhood adversity than those having 0 or 1 abortion.
More abortions are performed in the United States than in any other Western nation. Among American women, unintended pregnancies represent almost 50% of all pregnancies, and approximately 40% of all unintended pregnancies end in abortion. Repeat abortions are also common in the United States; 47% of women who have an abortion have had 1 or more previous abortions. In comparison, in Canada and the United Kingdom, rates of repeat abortions are 35.5% and 32%, respectively.
The experience of having an initial abortion provides a powerful opportunity to intervene in preventing subsequent unintended pregnancies. Intervention efforts in this population, however, have met with limited success. For example, in one study of 613 women presenting for an induced abortion, an intervention using specialized contraceptive counseling and provision compared with usual care showed no long-term impact on reducing the occurrence of having a subsequent abortion over the next 2 years. Additionally, although the overall number of abortions in the United States has declined, rates of repeat abortions remain steady, suggesting that women who are susceptible to recurrent unintended pregnancies require new intervention approaches.
Interventions to reduce repeat abortions will need to target risk factors for subsequent unintended pregnancies with particular emphasis on those factors that are linked to repeat abortions. Previous research shows that, in addition to the identification of several sociodemographic characteristics of women who have repeat abortions (eg, increased age, nonwhite ethnicity) experiences of abuse, including intimate partner violence and history of sexual abuse, distinguish women undergoing a repeat vs first abortion. Abuse history has also been linked to other deleterious reproductive health outcomes, including unplanned pregnancy, sexual risk-taking behaviors, poor adherence to contraception, and having a sexually transmitted infection.
The present study builds on the existing literature by evaluating whether abuse in childhood relates to the probability of having repeat abortions in adolescence and adulthood. Previously reported associations between abuse and repeat abortions examined lifetime history of abuse only, allowing for possible confounding by experiences of current abuse. Additionally, given the increased prevalence of nonabuse compared with abuse events, the present study also evaluated whether nonabuse adverse events, such as family difficulties (eg, death of a parent) and issues of personal safety (eg, home robbery) may increase the likelihood of having repeat abortions or whether any associations are limited to abuse-related exposures.
The current sample included 259 reproductive-aged women who provided by interview and questionnaire-based methods information regarding their exposures to adverse events in childhood as well as their lifetime reproductive medical history. We hypothesized that increased exposures to abuse as well as nonabuse adverse events in childhood would increase the likelihood of a woman having repeat abortions (ie, ≥2) in adolescence and adulthood compared with never having had an abortion or having only 1 abortion.
Materials and Methods
Participants
The current sample was derived from an ongoing population-based study of ovarian aging (the OVA Study), which includes women belonging to a large integrated health care delivery system serving a wide and generally representative population in northern California. Selection criteria for the OVA Study require that participants be between the ages of 25-45 years, have regular menses, and have their uterus and both ovaries intact.
All participants self-identify as being of 1 of 5 different ethnicities: Caucasian, African American, Latino, Chinese, or Filipino and speak/read English, Spanish, or Cantonese. Participants are excluded if they report a major medical illness, are on medications affecting the menstrual cycle within the 3 months prior to study participation, or are pregnant or breastfeeding.
As a part of the OVA Study protocol, women participate in an in-person interview, undergo a transvaginal ultrasound, and have their blood drawn. Additionally, beginning 4 months after the initiation of the OVA Study, participants began to also complete a questionnaire packet of self-report measures, including the measure of stressful life events used in the present analysis.
The participants considered for inclusion in the current sample were those women who enrolled in the study at the time the questionnaire packet was added to the study protocol. Over a 1 year period (June 2007 to May 2008), 295 women enrolled in the OVA Study. Of these, 259 (88%) completed the questionnaire packet and are included in the present analysis.
The study protocol was approved by the University of California, San Francisco, Committee on Human Research as well as the Kaiser Permanente of Northern California Institutional Review Board. Informed, written consent was obtained from all study participants.
Measures
Abortion history: information regarding abortion history was obtained from an in-person medical history interview. Participants underwent a structured interview administered by trained research associates in which a detailed medical history was obtained. As a part of this interview, women were asked to identify each pregnancy they experienced and the outcome of the pregnancy. In cases in which a pregnancy was terminated by abortion, other relevant details, including the age of the participant at the time of the abortion and whether the abortion was medically indicated, were ascertained. Women were classified as having no abortion, 1 abortion, or 2 or more abortions.
Stressful life events: the original Life Events Checklist was adapted to include 26 items pertaining both to conventional life events (eg, parental divorce) as well as traumatic life events (eg, sexual abuse). For each of 14 items relevant to childhood, participants were asked to indicate whether they experienced the event and their age(s) at the time the event occurred. Participants were assigned 1 point for each event they endorsed having experienced in childhood defined as occurring between the ages of 0 and 12. Items were summed to create a total score (score range, 0–14). In addition, 3 subscale scores were calculated reflecting abuse history, family disruption, and threats to personal safety.
Abuse history (score range, 0–2) consisted of 2 items pertaining to physical abuse and sexual abuse.
Family disruption (score range, 0–6) consisted of 6 items pertaining to the following: (1) death of a parent, (2) separation or divorce of parents, (3) witnessing physical fights between parents, (4) witnessing frequent arguments between parents, (5) living with a relative who has a serious drinking or drug problem, and (6) living with a relative who has a psychiatric illness.
Threats to personal safety (score range, 0–6) consisted of 6 items pertaining to the following: (1) being in a life-threatening accident, (2) suffering a serious illness or injury, (3) witnessing violence to another person, (4) experiencing a home robbery, (5) being in a natural disaster, and (6) being physically assaulted.
Statistical analysis
All participants had complete data on the variables of primary interest, including abortion history and stressful life events in childhood. Regarding covariates (age, race, childhood socioeconomic status, and number of pregnancies), 8 participants (3.1%) had missing data on mother’s education; a multiple linear regression procedure was used to estimate these 8 missing values from 3 predictor variables, including participant’s age (in years), race (1, Caucasian; 2, nonwhite), and education (in years).
Comparison of women with and without missing values on mother education showed missingness was unrelated to abortion history or stressful life events in childhood ( P > .05). Seven participants (2.7%) had missing data on father education and 12 participants (4.6%) indicated that they did not have a father or father-figure present in their lives. Values for missing data on father education were not imputed. Mother and father education were then standardized and summed to create an index of childhood socioeconomic status; in cases in which father education was missing, mother education only was used in the index of childhood socioeconomic status. Among the remaining covariates (age, race, and number of pregnancies), all participants had complete data.
To compare women who had 0 (n = 170), 1 (n = 46), and 2 or more (n = 43) abortions on sociodemographic factors, reproductive history, and exposures to stressful life events, analysis of variance (ANOVA) was used to examine continuous variables and χ 2 to examine dichotomous variables. For ANOVAs in which group differences reached statistical significance, post hoc multiple comparisons were computed.
Stepwise logistic multiple regression analyses were used to determine whether exposures to stressful life events in childhood relate to the probability of having repeat abortions in later life. In separate regression equations, the total number of stressful life events, the stressful life events composites (abuse history, family disruption, and threats to personal safety), and the individual physical and sexual abuse items were entered as independent variables in relation to 3 dichotomized abortion outcomes: having 1 abortion (n = 46) vs 0 abortions (n = 170); having 2 or more abortions (n = 43) vs 0 abortions (n = 170), and having 2 or more abortions (n = 43) vs 1 abortion (n = 46).
The following covariates were entered simultaneously on the first step of each regression equation: age (in years), race (1, Caucasian; 2, nonwhite), childhood socioeconomic status (indexed by summing the standardized values of mother and father education), and number of pregnancies.
The regression coefficient (B), significance value ( P ), odds ratio (OR), and 95% confidence interval (CI) were derived for each regression equation; statistical significance was set at P < .05. Statistical analyses were performed using version 17.0 of SPSS (SPSS Inc, Chicago, IL).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
