Adverse childhood experiences and repeat induced abortion

Years of education mediate the association between adverse childhood experiences and unintended pregnancy: A population-based study in Japan

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with unintended pregnancies, including mistimed pregnancies (MP) and unwanted pregnancies (UWP). However, it remains unknown which cluster of ACEs (i.e., child maltreatment/household dysfunction and deprivation/threat) are associated with MP/UWP and whether years of education mediate these associations.

OBJECTIVE

To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years.

PARTICIPANTS AND SETTING

A retrospective cohort study among 7652 postpartum women in Chiba, Japan.

METHODS

MP/UWP was defined by emotional responses to confirming pregnancy. Multinomial logistic regression analyses with multiple imputed datasets estimated the relative risk ratio (RRR) of MP/UWP by cumulative scores and each cluster of ACEs. Causal mediation analysis assessed the indirect effects of years of education.

RESULTS

Women with 4 or more ACEs were at a 2.4 times higher risk of MP (95 % confidence interval (CI): 1.6-3.8) and a 5.0 times higher risk of UWP (95 % CI: 3.1-8.2). Among ACE clusters, having 3 or more household dysfunction showed the strongest association with MP (RRR: 1.91, 95 % CI: 1.23-2.95), and having 3 or more deprivation showed the strongest association with UWP (RRR: 3.69, 95 % CI: 2.00-6.83). Education years mediated 16 % and 11 % of the association between total ACEs and MP/UWP, respectively, with a similar trend observed in each cluster.

CONCLUSIONS

Not only ACEs score but also each cluster of ACEs was associated with MP and UWP. The mediating effects of years of education were modest.

Prevalence and determinants of repeat induced abortion in Ethiopia: A systematic review and meta-analysis

Introduction

Repeat-induced abortion is the termination of pregnancy for more than one time using drugs or surgical intervention before the fetus reaches the age of viability. This study aimed to estimate the pooled prevalence of repeat-induced abortion and its determinants among women in Ethiopia.

Materials and methods

PubMed, HINARI and Google Scholar were systematically searched for eligible studies. A random effect model was used to estimate the pooled prevalence. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity between included studies.

Results

The estimated pooled prevalence of repeat-induced abortion was 30.89% (95% CI: 28.88-32.91). Alcohol consumption (POR = 3.60, 95%CI: 2.26-5.74), assuming the procedure painless (POR = 2.79, 95%CI: 1.77-4.39), no fertility awareness (POR = 3.45, 95% CI: 1.05-11.36), and women with multiple sexual partners (POR = 4.31, 95% CI: 3.36-5.53) were significantly associated with repeat-induced abortion.

Conclusion

The study revealed that about one in ten women who had a history of abortion experienced repeat-induced abortion. Alcohol consumption, no fertility awareness, assuming the procedure is painless, and having multiple sexual partners were significantly associated with repeat-induced abortion.

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

BACKGROUND

Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals' perspectives with the patients' to determine how sexual violence conversations should occur in these environments.

METHODS

Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 (n = 22) living in Indiana who sought community-based or private healthcare for women's reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization.

RESULTS

There were three resulting themes: (1) healthcare professionals' approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize.

CONCLUSIONS

Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women's reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

Assessing parental marital quality and divorce related to youth sexual experiences and adverse reproductive health outcomes among 50,000 Chinese college students

BACKGROUND

This study aimed to investigate the associations between parental marital quality, divorce, and sexual and reproductive health outcomes among Chinese young people.

METHODS

The study included 51,124 students from a large-scale cross-sectional study in China from 2019 to 2020. The exposures were parental marital quality and legal marital status reported by students. The dichotomous outcomes included sexual experiences, high-risk sexual behaviors, unintended health outcomes, and sexual abuse. Multivariate logistic regression models adjusting for socio-demographic factors were used to assess the relationship between parental marital quality, divorce, and sexual and reproductive health outcomes, stratified by sex.

RESULTS

A total of 10.72% of the surveyed students' parents had divorced. Participants from divorced family rated perceived parental marital quality less than half of the ratings on a 10-point scale of those from intact family (3.22 vs. 7.44). Parental divorce was associated with a higher likelihood of sexual abuse, high-risk sexual behaviors, and unintended health outcomes. A higher perceived parental marital quality was associated with a lower probability of adverse sexual and reproductive health experiences and outcomes, such as forced penetrative vaginal or anal intercourse (male: OR: 0.73, 95% CI: 0.64-0.83; female: OR:0.71, 95% CI: 0.65-0.77), casual sexual intercourse (male: OR: 0.78, 95% CI: 0.73-0.83; female: OR: 0.77, 95% CI: 0.72-0.83), and sexually transmitted infections (male: OR: 0.79, 95% CI: 0.70-0.89; female: OR: 0.82, 95% CI: 0.73-0.91).

CONCLUSIONS

Parental marital quality and status are associated with poorer sexual and reproductive health outcomes among young adults, suggesting that specific intervention programs should be implemented for children from unharmonious families or divorced families to prevent adverse sexual and reproductive health outcomes.

Working with or against the system: Nurses' and midwives' process of providing abortion care in the context of gender-based violence in Australia

AIMS

The aim of this study was to explain the process through which Australian nurses and midwives provide abortion care to people affected by gender-based violence (GBV).

DESIGN

A constructivist grounded theory study.

METHODS

This study took place between 2019 and 2021. The lead author conducted semi-structured interviews with 18 Australian nurses and midwives who provided abortion care. Participants were recruited through pro-abortion, nursing and midwifery networks using a snowballing technique. Data collection and analysis proceeded using purposive and theoretical sampling until we reached data saturation.

FINDINGS

Participants revealed they underwent a process of working with or against the system contingent on the degree to which the system (the interconnected networks through which a pregnant person, victimized by trauma, travels) was woman centred. When participants encountered barriers to person-centred abortion care, they bent or broke the law, local policy and cultural norms to facilitate timely holistic care. Though many participants felt professionally compromised, their resolve to continue working against the system continued.

CONCLUSION

Conservative abortion law, policies and clinical mores did not prevent participants from providing abortion care. The professional obligation to provide person-centred care was a higher priority than following the official or unofficial rules of the organizations.

IMPACT

This study addresses the clinical care of people accessing abortions in the context of GBV. Nurses and midwives may act out against the law, organizational policies and norms if prevented from providing person-centred care. This research is relevant for any location that restricts abortion through stigma, pro-life influences or politics.

Associations between distinct dimensions of early life adversity and accelerated reproductive strategy among middle-aged women in China

BACKGROUND

Life history theory argues that unpredictable and harsh conditions such as early life adversity tends to produce a fast life history strategy, characterized by early sexual maturation and less parenting of offspring. It remains unclear whether all forms of early life adversity are associated with accelerated reproductive strategy, and most previous studies predominantly focused on single form of reproductive strategy indicators.

OBJECTIVE

To examine the associations between 2 distinct dimensions of early life adversity (ie, threat and deprivation) and reproductive strategies across global metrics.

STUDY DESIGN

We used data from 9674 middle-aged women of the China Health and Retirement Longitudinal Study. The experiences of threat and deprivation were assessed using the Life History Survey Questionnaire in 2014. Reproductive strategy information was assessed via self-report from the follow-up of 2013, 2015 and 2018, including age at menarche, age at natural menopause, age at first birth, total number of children, and number of abortions. Multivariate linear regression analyses were performed to assess the associations between distinct dimensions of early life adversity and multiple reproductive strategy indicators, adjusting for age, Hukou location, family socioeconomic status in adulthood and body mass index.

RESULTS

Of the 9674 women (mean [standard deviation] age at baseline, 55.89 [10.23] years), 4084 (42.20%) reported exposure to threat-related early life adversity and 7332 (75.79%) reported exposure to deprivation-related early life adversity. Early life adversity characterized by threat was associated with accelerated reproductive strategy. Compared with women who have no experiences of threat-related early life adversity, ≥3 threat-related early life adversity was associated with 3.7-month earlier age at menarche (β=-0.31, 95% confidence interval, -0.53 to -0.08; P=.007), 8.6-month earlier age at natural menopause (β=-0.72, 95% confidence interval, -1.29 to -0.15; P=.013), >1-year earlier age at first birth (β=-1.14, 95% confidence interval, -1.58 to -0.71; P<.0001), and an increased total number of children (β=0.25, 95% confidence interval, 0.10-0.41; P=.002). In contrast, experiences of deprivation were associated with delayed age at natural menopause (β=.50, 95% confidence interval, 0.06-0.94; P=.025) and increased number of abortions (β=.17, 95% confidence interval, 0.01-0.34, P=.037), in models adjusting for co-occurring threat exposures.

CONCLUSION

This study suggests that early life adversity characterized by threat was associated with accelerated reproductive strategy, whereas deprivation was associated with slower reproduction strategy. Future research should clarify the biological pathways between different dimensions of early life adversity and reproductive strategies and further determine whether accelerated reproduction is an adaptive response to early life adversity in humans.

Associations between adverse childhood experiences and contraceptive use among young adults in Honduras

OBJECTIVE

Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men.

METHODS

We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use.

FINDINGS

Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22).

CONCLUSION

The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.

Repeat abortion and associated factors among women seeking abortion services in northwestern China: a cross-sectional study

Background

Repeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners.

Methods

This cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi’an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson’s chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed.

Results

Of 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08–1.73 for 31–35 years; 1.82, 1.29–2.57 for ≥36 years), received a low-level education (1.86, 1.42–2.43 for ≤senior high school; 1.46, 1.17–1.83 for junior college), were jobless (2.46, 1.18–5.13), had one child (1.54, 1.10–2.17), had a general (1.60, 1.28–1.98) or no (2.51, 2.02–3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09–1.61), withdrawal (1.43, 1.12–1.84), and emergency measures (1.48, 1.09–1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06–1.68 for 31–35 years; 2.13, 1.56–2.91 for ≥36 years), attained a low-level education (1.66, 1.28–2.15 for ≤senior high school; 1.38, 1.10–1.74 for junior college), received a high-level monthly income (1.34, 1.08–1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42–19.33) were more likely to have a repeat abortion.

Conclusions

The study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11653-4.

Prevalence and risk factors for repeat induced abortion among Chinese women: a systematic review and meta-analysis

OBJECTIVES

Repeat induced abortion is a significant public health problem in China. International knowledge about repeat induced abortion and its associated risk factors in Chinese women is scarce, and existing studies are hard to access for international scholars because most are published in Chinese. A systematic review was conducted to analyse the prevalence of repeat induced abortion among Chinese women and determine correlated risk factors.

METHODS

Seven electronic databases were systematically searched. Data on the prevalence of repeat induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach.

RESULTS

Of 2458 articles retrieved from seven databases, 21 were included in the study. The overall pooled prevalence of repeat induced abortion was 43.1% (95% confidence interval 36.7%, 49.5%). Of 25 exposures extracted, 15 factors were significantly correlated with repeat induced abortion, comprising seven individual demographic factors (i.e., age, education, employment, migrant status, parity, unhealthy lifestyle habits and region of residence), four reproductive health- and contraception-related factors (i.e., age at sexual debut, history of sexual activity, contraceptive knowledge and having a regular sexual life) and four sexual partner-related factors (i.e., multiple sexual partners, age of sexual partner, educational level of sexual partner and cohabitation with sexual partner).

CONCLUSION

The study findings highlight the problem of repeat induced abortion in China and suggest the need for government and civil society to increase efforts to reduce the alarming risks of repeat induced abortion in Chinese women and make them and their sexual partners more aware and protective of their sexual and reproductive health.

Repeat Induced Abortion among Chinese Women Seeking Abortion: Two Cross Sectional Studies

Background: In China, there were about 9.76 million induced abortions in 2019, 50% of which were repeat abortions. Understanding the tendency of repeat induced abortion and identifying its related factors is needed to develop prevention strategies. Methods: Two hospital-based cross-sectional surveys were conducted from 2005–2007 and 2013–2016 in 24 and 90 hospitals, respectively. The survey included women who sought an induced abortion within 12 weeks of pregnancy. The proportion of repeat induced abortions by adjusting the covariates through propensity score matching was compared between the two surveys, and the zero-inflated negative binomial regression model was established to identify independent factors of repeat induced abortion. Results: Adjusting the age, occupation, education, marital status and number of children, the proportion of repeat induced abortions in the second survey was found to be low (60.28% vs. 11.11%), however the unadjusted proportion was high in the second survey (44.97% vs. 51.54%). The risk of repeat induced abortion was higher among married women and women with children [OR_adj and 95% CI: 0.31 (0.20, 0.49) and 0.08 (0.05, 0.13)]; the risk among service industry staff was higher when compared with unemployed women [OR_adj and 95% CI: 0.19 (0.07, 0.54)]; women with a lower education level were at a higher risk of a repeat induced abortion (OR_adj < 1). Compared with women under the age of 20, women in other higher age groups had a higher frequency of repeat induced abortions (IR_adj: 1.78, 2.55, 3.27, 4.01, and 3.93, separately); the frequency of women with lower education levels was higher than those with a university or higher education level (IR_adj > 1); the repeat induced abortion frequency of married women was 0.93 (0.90, 0.98) when compared to the frequency of unmarried women, while the frequency of women with children was 1.17 (1.10, 1.25) of childless women; the induced abortion frequency of working women was about 60–95% with that of unemployed women. Conclusions: The repeat induced abortion proportion was lower than 10 years ago. Induced abortion seekers who were married, aged 20 to 30 years and with a lower education level were more likely to repeat induced abortions.

Adverse Childhood Experiences are Associated with Miscarriage in Adulthood: The GROWH Study

OBJECTIVES

To investigate whether adverse childhood experiences are associated with miscarriage.

METHODS

The Gulf Resilience on Women's Health Consortium recruited from clinics and community organizations in Southern Louisiana, 2011-2016. Data from 1511 reproductive-aged women with at least one pregnancy were analyzed. Adverse childhood experiences including abuse, neglect, and family dysfunction, as a child (< age 12), and as an adolescent (12-17), were assessed. Outcome measures were self-reported miscarriage at first pregnancy and at any pregnancy, analyzed with logistic regression with adjustment for maternal age at pregnancy, race, BMI, education, marital and smoking status.

RESULTS

Women reporting four or more adversities as a child and as a teen had higher odds of experiencing miscarriage at first pregnancy (AOR_child 1.71, 95% CI 1.00-2.90; AOR_teen 1.73, 95% CI 1.05-2.87) and miscarriage at any pregnancy (AOR_child 1.74, 95% CI 1.16-2.62; OR_teen 1.65, 95% CI 1.10-2.45) compared to those with no adverse childhood experiences. Similar patterns of association were seen for other ACE sub-categories.

CONCLUSIONS

Childhood adversities were associated with miscarriage. Further research is needed on the pathways which created this association, including psychological, behavioral, and physiological mechanisms and factors which can mitigate the effects of these outcomes.

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

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.

Sexual health of women with schizophrenia: A review

Women with schizophrenia experience low rates of sexual satisfaction and high rates of sexual dysfunction. They are at high risk for adverse sexual health outcomes including unplanned pregnancies, induced abortions, and human immunodeficiency virus (HIV), and face higher rates of sexual violence and various forms of intimate partner violence. This review explores the complex and intersecting biopsychosocial risk factors that explain these outcomes among women with schizophrenia, including factors related to the illness itself, antipsychotic medications, medical and psychiatric comorbidities, stigma, childhood trauma, and social determinants of health including poverty and housing instability. Sexual health interventions designed to help women with schizophrenia achieve pleasurable and safe sexual experiences, free of coercion, discrimination and violence are few and far between, suggesting opportunities for future development in this area.

Adverse childhood experiences and electronic cigarette use among young Australian women

Researchers have identified positive relationships between childhood adversities and smoking, problem drinking and illicit drug abuse. Nonetheless, to our knowledge, in no studies has there been an examination of the association between adverse childhood experiences (ACEs) and e-cigarette use. This study aimed to investigate the association between ACEs and e-cigarette use. Data from the Australian Longitudinal Study on Women's Health were used. Study respondents (N = 8915) from the 1989-95 cohort (third wave) aged 19-26 years completed an online survey in 2015. Multivariate logistic regression analysis was used to examine the association between ACEs and e-cigarette use, adjusted for socio-demographic variables and smoking status. Participants who reported past year e-cigarette use were more likely to report childhood psychological abuse (Adjusted odds ratio (AOR) = 1.45, 99%CI: 1.11, 1.90), physical abuse (AOR = 1.30, 99%CI, 1.03, 1.82), or sexual abuse (AOR = 1.41, 99%CI, 1.02, 1.95), All abuse types associated with past year e-cigarette use were also associated with ever e-cigarette use. Ever e-cigarette use was also associated with household substance abuse (AOR = 1.35, 99%CI, 1.08, 1.68), witnessing domestic violence (AOR = 1.28, 99%CI, 1.01, 1.69), or having a mentally ill household member (AOR = 1.28, 99%CI, 1.05, 1.58) compared with those who were not. A positive dose-response relationship was observed between the number of ACEs and the odds of e-cigarette use. This study identified an association between ACEs and e-cigarette use. Improvements in supportive parenting skills and the provision of counselling services for those exposed to ACEs may help avert health-harming behaviours, including e-cigarette use.

Association of adverse childhood experiences and health risk behaviors among young adults visiting a regional primary healthcare center, Federation of Bosnia and Herzegovina

Background

Many studies have linked adverse childhood experiences (ACEs) to long-term health outcomes, as well as health risk behaviors. In the post-war period in Bosnia and Herzegovina, many young people grew up in an environment of deteriorated living standards due to high unemployment and economic insecurity. The objectives of the study were to: 1) describe the health risk behaviors of young adults accessing primary healthcare; and 2) examine associations of these risk factors with adverse childhood experiences in this context.

Methods

This was a cross-sectional survey, conducted from April to October 2014. Participants were recruited from the Primary Healthcare Center Zenica. Patients between the ages of 18 and 24 were eligible for inclusion. The informed consent and self-administered questionnaire were offered to patients during clinic intake. The questionnaire contained questions on sexual and reproductive health, use of alcohol and drugs, dating violence, and adverse childhood experiences.

Results

During the study period 520 questionnaires were distributed, and 400 complete surveys were returned, for a response rate of 76.9%. Among the 400 respondents, 166 were males (41.5%) and 234 were females (58.5%). Our study showed that 48.7% of respondents had experienced some form of childhood adversity. Emotional neglect was the most common type of adverse childhood experience (25.6%) and was significantly more prevalent among females. Our study indicated that more than 15% of respondents had witnessed domestic violence. Overall, ACEs were associated with increased odds of early sex initiation, alcohol use, drug use, and dating violence, although some of these associations did not reach statistical significance. Emotional neglect was the exception, and reporting emotional neglect was associated with a significantly elevated odds ratio for all four of the health risk behaviors. Emotional abuse was associated with an increased odds of drug abuse (OR = 2.78; 95% CI = 1.31–5.90) and dating violence (OR = 2.31; 95% CI = 1.10–4.89). Sexual abuse was marginally associated with increased early sex initiation (OR = 3.2; 95% CI 0.93–10.8). Parental divorce was significantly associated with alcohol abuse.

Conclusion

The results of this study demonstrated associations between adverse experiences in childhood and the probability of engaging in health risk behavior which has implications for health outcomes in the long-term.

Differential Associations of Adverse Childhood Experience on Maternal Health

INTRODUCTION

The current study examined whether three distinct antecedent factors related to maternal adverse childhood experiences were differentially associated with maternal health and psychosocial outcomes in the antepartum period. It was hypothesized that all three adverse childhood experience factors would be positively associated with poor health prior to pregnancy, poor reproductive health history, and health complications and psychosocial difficulties during pregnancy.

METHODS

Data from 1,994 women (mean age=30.87 years) and their infants were collected from a prospective longitudinal cohort from 2008 to 2011. Pregnant women completed self-report questionnaires and a healthcare professional assessed the mothers' health prior to pregnancy, reproductive history, and pregnancy complications.

RESULTS

Data analyses were conducted from December 2016 to March 2017. Path analysis demonstrated that women who had experience with physical/emotional abuse in childhood were significantly more likely to enter pregnancy with a chronic health condition (AOR=1.25, 95% CI=1.02, 1.54) and to have psychosocial difficulties in their pregnancy (AOR=1.60, 95% CI=1.34, 1.89). Women who were exposed to household dysfunction in childhood were also significantly more likely to experience psychosocial difficulties during pregnancy (AOR=2.33, 95% CI=1.49, 3.65). There was no association between exposure to sexual abuse and maternal health or mental health outcomes.

CONCLUSIONS

Adverse childhood experience categories differentially predicted maternal health and psychosocial outcomes prior to and during pregnancy. The overall variance accounted for by adverse childhood experiences was small (3%-19%), suggesting that factors other than childhood adversity likely contribute to maternal health.

Women's experiences of more than one termination of pregnancy within two years: a mixed-methods study

OBJECTIVE

To examine the experiences of women seeking more than one termination of pregnancy (TOP) within 2 years.

DESIGN

Mixed methods study.

SETTING

Six TOP services across Scotland.

SAMPLE

Women presenting for TOP between July and December 2015.

METHODS

Descriptive and inferential analysis of quantitative survey data, thematic analysis of qualitative interview data and integrative analysis. In quantitative analysis, multinomial logistic regression was used to compare three groups: previous TOP within 2 years, previous TOP beyond 2 years and no previous TOP.

MAIN OUTCOME MEASURES

Characteristics and experiences of women seeking TOP.

RESULTS

Of 1662 questionnaire respondents, 14.6% (n = 242) and 19.8% (n = 329) reported previous TOP within and beyond 2 years, respectively. The previous TOP within 2 years group was significantly less likely to own their accommodation than the no previous TOP group (adjusted odds ratio [aOR] 0.34, 95% CI: 0.18-0.62) and previous TOP beyond 2 years group (aOR: 0.44, 95% CI: 0.23-0.85); and more likely to report inconsistent (aOR: 1.63, 95% CI: 1.04-2.57; aOR: 1.95, 95% CI: 1.16-3.28) and consistent (aOR: 2.13, 95% CI: 1.39-3.26; aOR: 1.71, 95% CI: 1.07-2.76) contraceptive use than the no previous TOP and previous TOP within 2 years groups, respectively. Twenty-three women from the previous TOP within 2 years group were interviewed. Qualitative and integrative analyses highlight issues relating to contraceptive challenges, intimate partner violence, life aspirations and socio-economic disadvantage.

CONCLUSIONS

Women undergoing more than one TOP within 2 years may experience particular challenges and vulnerabilities. Service provision should recognise this and move away from stigmatising discourses of 'repeat abortion'.

FUNDING

Scottish Government.

TWEETABLE ABSTRACT

Women having two or more terminations of pregnancy in 2 years may face key challenges/vulnerabilities including intimate partner violence and socio-economic disadvantage.

[Is there any relation between couple violence and repeated medical abortion?]

OBJECTIVES

Risk factors of repeated induced abortion remain unclear. One of them could be domestic violence. The aim of this study was to explore the association between repeated induced abortion and domestic violence, including violence during childhood.

MATERIALS AND METHODS

A cross-sectional questionnaire study was conducted in three hospitals in Alsace. All women between 18 and 50 years old were asked to complete an anonymous questionnaire during their hospitalization for induced abortion between 31th of November 2013 and 1st of December 2014. The questionnaire included questions about the current or past existence of domestic violence. They have also been questioned about the past existence of domestic violence between their parents and the fact that they had themselves been victims of violence and abuse during childhood.

RESULTS

Four hundred and eighty women answered to the questionnaire: 322 came for their first abortion while 158 were hospitalized for at least the second time for an induced abortion. The proportion of current or past violence was 53% in the "repeated induced abortions" group compared with 33% in the "first induced abortion" group (OR 2.1, CI 95% [1.4-3.1], P<0.01). Statistically significant differences were found between the two groups for all types of domestic violence.

CONCLUSION

In our sample of women, we found that experiencing domestic violence with current partner appeared to be a risk factor of repeated induced abortions.

Induced abortion in a Southern European region: examining inequalities between native and immigrant women

OBJECTIVES

To examine induced abortion (IA) inequalities between native and immigrant women in a Southern European region and whether these inequalities depend on a 2010 Law facilitating IA.

METHODS

We conducted two analyses: (1) prevalence of total IAs, repeat and second trimester IA, in native and immigrant women aged 12-49 years for years 2009-2013 according to country of origin; and (2) log-binomial regression was used to quantify the association of place of origin with repeat and second trimester IAs among women with IAs.

RESULTS

Immigrants were more likely to have an IA than Spanish women, with the highest probability in Sub-Saharan Africa (PR 8.32 95 % CI 3.66-18.92). Immigrant women with an IA from countries other than Maghreb and Asia have higher probabilities of a repeat IA than women from Spain. Women from Europe non-EU/Romania were 50 % (95 % CI 0.30-0.79) less likely to have a second trimester IA, while women from Central America/Caribbean were 45 % (95 % CI 1.11-1.89) more likely than Spanish women. The 2010 Law did not affect these associations.

CONCLUSIONS

There is a need for parenthood planning programs and more information and access to contraception methods especially in immigrant women to help decrease IAs.

Repeat abortions in New York City, 2010

This study aims to describe factors associated with the number of past abortions obtained by New York City (NYC) abortion patients in 2010. We calculated rates of first and repeat abortion by age, race/ethnicity, and neighborhood-level poverty and the mean number of self-reported past abortions by age, race/ethnicity, neighborhood-level poverty, number of living children, education, payment method, marital status, and nativity. We used negative binomial regression to predict number of past abortions by patient characteristics. Of the 76,614 abortions reported for NYC residents in 2010, 57% were repeat abortions. Repeat abortions comprised >50% of total abortions among the majority of sociodemographic groups we examined. Overall, mean number of past abortions was 1.3. Mean number of past abortions was higher for women aged 30-34 years (1.77), women with ≥5 children (2.50), and black non-Hispanic women (1.52). After multivariable regression, age, race/ethnicity, and number of children were the strongest predictors of number of past abortions. This analysis demonstrates that, although socioeconomic disparities exist, all abortion patients are at high risk for repeat unintended pregnancy and abortion.

Comparison of the contraceptive use and its related factors among women seeking repeat and first-time induced abortions in iran

Background:

Abortion in Iran, like other Islamic countries is severely restricted except in a few exceptions. However, some women who have an unwanted or mistimed pregnancy are seeking abortion.

Objectives:

This study aimed to compare the contraceptive use and its related factors among repeat and first- time induced abortion seekers in Iran.

Patients and Methods:

In this cross-sectional study, 417 married women (age range, 15-49 years) seeking abortion services at either a hospital or private office in Maku City, the northwest of Iran, were selected through convenience sampling between December 2010 and March 2011. All the subjects were asked about the contraceptive methods used during the three months before the current pregnancy and the use of any emergency contraception and forced sex. Women who mentioned reasons except than completing family size for their applying for abortion were excluded from the analysis. Characteristics of women were examined using chi-square and t test. T test and Mann-Whitney U test were used to compare contraceptive methods and the regularity of contraceptive use between repeat and first-time abortion seekers, respectively.

Results:

About 33.8% of the repeat abortion-seekers and 76.8% of first-time abortion seekers were using male methods (withdrawal and condom). Utilization of an intrauterine device for birth control was higher among women seeking repeat abortion than in first-time abortion seekers (P = 0.003). All of 31 pill users in the repeat abortion-seeking group missed three or more pills per month for three times during the three months before contraception. The repeat abortion seekers had used condom more regularly than those in the first-time abortion seekers. Forced sex was more prevalent in the abortion seekers who had used male method.

Conclusions:

Using male methods are prevalent in abortion-seeker women. An increased focus is needed on training the regular use of pills and using the emergency contraception for all of the couples who are first-time abortion-seekers. Moreover, information about the role of forced sex might be efficacious in decreasing illegally induced repeat abortion in couples who use condom or withdrawal methods.

Intimate partner violence and repeat induced abortion in Italy: A cross sectional study

OBJECTIVE

To investigate the impact of intimate partner violence (IPV) on the risk of repeat induced abortion (RIA), we compared IPV history among women with and without previous induced abortion (IA).

METHODS

All consecutive women aged 18 years or more requiring IA in 12 Italian abortion clinics were eligible for inclusion in the study. They were asked to fill in an anonymous, self-developed questionnaire assessing sociodemographic data and their history of different types of violence and related risk factors.

RESULTS

The analysis included 1030 women, 624 (60.6%) of whom reported a previous IA. Past or current IPV was reported by 19.3%: 7.0% reported sexual violence, 11.3% physical abuse and 12.1% psychological abuse. Past or current IPV was reported by 22.3% of women with RIA and 14.8% of those undergoing their first IA (adjusted odds ratio 1.57, 95% confidence interval 1.07-2.30; p = 0.02). When we considered sexual, psychological and physical abuse separately, we found that any kind of abuse was more frequent in women with RIA than in women with no previous IA.

CONCLUSION

This study underlines the impact of IPV on the risk of RIA and suggests the need for screening for IPV among women requiring abortion, in order to identify women at risk of RIA and to improve their general and reproductive health.

Abortion and mental health: findings from The National Comorbidity Survey-Replication

OBJECTIVE

To examine whether a first abortion increases risk of mental health disorders compared with a first childbirth with and without considering prepregnancy mental health and adverse exposures, childhood economic status, miscarriage history, age at first abortion or childbirth, and race or ethnicity.

METHODS

A cohort study compared rates of mental disorders (anxiety, mood, impulse-control, substance use, eating disorders, and suicidal ideation) among 259 women postabortion and 677 women postchildbirth aged 18-42 years at the time of interview from The National Comorbidity Survey-Replication.

RESULTS

The percentage of women with no, one, two, and three or more mental health disorders before their first abortion was 37.8%, 19.7%, 15.2%, and 27.3% and before their first childbirth was 57.9%, 19.6%, 9.2%, and 13.3%, respectively, indicating that women in the abortion group had more prior mental health disorders than women in the childbirth group (P<.001). Although in unadjusted Cox proportional hazard models, abortion compared with childbirth was associated with statistically significant higher hazards of postpregnancy mental health disorders, associations were reduced and became nonstatistically significant for five disorders after adjusting for the aforementioned factors. Hazard ratios and associated 95% confidence intervals dropped from 1.52 (1.08-2.15) to 1.12 (0.87-1.46) for anxiety disorders; from 1.56 (1.23-1.98) to 1.18 (0.88-1.56) for mood disorders; from 1.62 (1.02-2.57) to 1.10 (0.75-1.62) for impulse-control disorders; from 2.53 (1.09-5.86) to 1.82 (0.63-5.25) for eating disorders; and from 1.62 (1.09-2.40) to 1.25 (0.88-1.78) for suicidal ideation. Only the relationship between abortion and substance use disorders remained statistically significant, although the hazard ratio dropped from 3.05 (1.94-4.79) to 2.30 (1.35-3.92).

CONCLUSIONS

After accounting for confounding factors, abortion was not a statistically significant predictor of subsequent anxiety, mood, impulse-control, and eating disorders or suicidal ideation. LEVEL OF EVEDIENCE: II.

The role of previous contraception education and moral judgment in contraceptive use

INTRODUCTION

The knowledge and attitudes that lead to nonuse of contraception are not well understood. The goal of this study was to determine whether an association exists between contraceptive use and specific knowledge and attitudinal factors.

METHODS

We conducted a secondary analysis of data from a nationally representative telephone survey of 897 unmarried women aged 18 to 29 years to examine the relationship between contraceptive use and comprehensive sex education, attitude toward pregnancy prevention, perceived infertility, distrust toward the health care system or contraception, and moral attitude toward contraception.

RESULTS

Both ever having made a visit to a physician or clinic for women's health care and ever having used any method of contraception to prevent pregnancy were significantly impacted by more comprehensive sex education and less likelihood to view contraception as morally wrong. Consistent with other research, we found no association between the desire to avoid pregnancy and contraceptive use. We found an association between health system distrust and contraceptive use, but health system distrust did not predict contraceptive use.

DISCUSSION

Our findings show that contraceptive use among a sample of young women is influenced by previous contraceptive education and moral attitudes toward contraception. Clinicians should be cognizant of these realities, which may need to be addressed in both clinical and nonclinical venues.

The impact of emotional, physical, and sexual abuse on contraceptive method selection and discontinuation

OBJECTIVES

We evaluated the impact of exposure to emotional, physical, or sexual abuse on contraceptive method selection and discontinuation.

METHODS

We performed a secondary analysis of 7170 women enrolled in the Contraceptive CHOICE Project in St. Louis, Missouri, a prospective cohort study in which 9256 women were provided their preferred method of contraception at no cost from 2007 to 2011. We defined contraceptive discontinuation as device removal or nonuse for at least 4 weeks within the first 12 months after initiation.

RESULTS

One third of women experienced some abuse in their lifetimes. Women with an abuse history were as likely as those without to select a long-acting reversible contraceptive method and more likely to choose a contraceptive injection, the patch, or the ring. When we compared women who were abused to those who were not, rates of discontinuation at 12 months were higher among women who selected long-acting reversible contraception (17% vs 14%; P = .04) and significantly higher among women who selected non-long-acting methods (56% vs 47%; P < .001). Type of abuse did not alter the association between abuse and contraceptive continuation.

CONCLUSIONS

Previous experiences of abuse are associated with both contraceptive method selection and continuation.

Childhood adversities and subsequent risk of one or multiple abortions

Although many studies have found an association between childhood adversities and mental health disorders, few have examined whether childhood adversities are linked to having abortions. This research investigates the association between a range of childhood adversities and risk of abortion in part to identify which adversities should be considered when examining the association between abortion and subsequent mental health. Using the U.S. National Comorbidity Survey-Replication (NCS-R), we tested the association between 10 childhood adversities and risk of 0, 1, or multiple abortions among 1511 women ages 18-41. We employed multinomial logistic regression to examine the independent association between each childhood adversity and number of subsequent abortions, controlling for sociodemographic factors, total number of pregnancies, and each adversity. Women who had experienced two or more personal safety threats, one parental mental illness, or two or more parental mental illnesses while growing up were more likely subsequently to have multiple versus no abortions [Relative Risk Ratio (RRR) = 9.87, 95% CI: 2.45-39.72; OR = 2.81, 95% CI: 1.27-6.21; RRR = 5.28, 95% CI: 1.60-17.38, respectively], and multiple versus one abortion [RRR = 13.33, 95% CI: 2.48-71.68; RRR = 2.17, 95% CI: 1.03-4.56; RRR = 3.67, 95% CI: 1.15-11.76, respectively]. Women who had experienced childhood physical abuse were more likely to have one compared to no abortions [RRR = 2.00; 1.19-3.34]. These results suggest that some childhood adversities may partially explain the association between abortion and mental health. Accordingly, they should be considered in future research examining the link between abortion and mental health.