Adverse childhood experiences and repeat induced abortion
Maria E. Bleil, PhD; Nancy E. Adler, PhD; Lauri A. Pasch, PhD; Barbara Sternfeld, PhD;Renee A. Reijo-Pera, PhD; Marcelle I. Cedars, MD
The objective of the study was to characterize the back-grounds of women who have repeat abortions.
In a cross-sectional study of 259 women (mean age,35.2
5.6 years), the relation between adverse experiences in child-hood and risk of having 2 or more abortions vs 0 or 1 abortion was ex-amined. Self-reported adverse events occurring between the ages of 0and 12 years were summed.
Independent of confounding factors, women who experi-enced more abuse, personal safety, and total adverse events in child-hood were more likely to have 2 or more abortions vs 0 abortions (oddsratio [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). Womenwho experienced more family disruption events in childhood were morelikely 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).
Women who have repeat abortions are more likely tohaveexperiencedchildhoodadversitythanthosehaving0or1abortion.
contraception, early adversity, life events, repeatabortions
Cite this article as: Bleil ME, Adler NE, Pasch LA, et al. Adverse childhood experiences and repeat induced abortion. Am J Obstet Gynecol 2011;204:122.e1-6.
ore abortions are performed inthe United States than in any other Western nation.
Among Ameri-can women, unintended pregnanciesrepresent almost 50% of all pregnancies,and approximately 40% of all unin-tended pregnancies end in abortion.
RepeatabortionsarealsocommonintheUnited States; 47% of women who havean abortion have had 1 or more previousabortions.
Theexperienceofhavinganinitialabor-tion provides a powerful opportunity tointervene in preventing subsequent unin-tendedpregnancies.Interventioneffortsinthis population, however, have met withlimitedsuccess.Forexample,inonestudy of 613 women presenting for an inducedabortion,aninterventionusingspecializedcontraceptive counseling and provisioncomparedwithusualcareshowednolong-termimpactonreducingtheoccurrenceof havingasubsequentabortionoverthenext2years.
Additionally,althoughtheoverallnumber of abortions in the United Stateshasdeclined,
suggestingthatwomenwhoare susceptible to recurrent unintendedpregnancies require new interventionapproaches.Interventions to reduce repeat abor-tions will need to target risk factorsfor subsequent unintended pregnancieswith particular emphasis on those fac-tors that are linked to repeat abortions.Previousresearchshowsthat,inadditionto the identiﬁcation of several socio-demographic characteristics of womenwhohaverepeatabortions(eg,increasedage, nonwhite ethnicity)
experiencesofabuse,includingintimatepartnervio-lence and history of sexual abuse, distin-guishwomenundergoingarepeatvsﬁrstabortion.
Abuse history has also beenlinked to other deleterious reproductivehealth outcomes, including unplannedpregnancy, sexual risk-taking behaviors,pooradherencetocontraception,andhav-ingasexuallytransmittedinfection.
The present study builds on the exist-ing literature by evaluating whetherabuse in childhood relates to the proba-bility of having repeat abortions in ado-lescence and adulthood. Previously re-ported associations between abuse andrepeat abortions examined lifetime his-toryofabuseonly,
allowingforpossibleconfounding by experiences of currentabuse. Additionally, given the increasedprevalence of nonabuse compared withabuseevents,thepresentstudyalsoeval-uated whether nonabuse adverse events,such as family difﬁculties (eg, death of aparent) and issues of personal safety (eg,home robbery) may increase the likeli-hood of having repeat abortions orwhether any associations are limited toabuse-related exposures.The current sample included 259 re-productive-aged women who providedby interview and questionnaire-based
ReceivedApril15,2010;revisedJuly25,2010;acceptedSept.28,2010.Reprints:MariaE.Bleil,PhD,HealthPsychologyProgram,UniversityofCalifornia,SanFrancisco,3333CaliforniaSt.,Suite465,SanFrancisco,CA94143firstname.lastname@example.org. ThisstudywassupportedinpartbyNationalInstituteofChildHealthandHumanDevelopment/ NationalInstituteonAgingGrantR01HD044876,NationalInstituteofMentalHealthGrant T32MH019391,andRobertWoodJohnsonFoundationGrant045820.0002-9378/$36.00 • © 2011 Mosby, Inc. All rights reserved. • doi: 10.1016/j.ajog.2010.09.029
American Journal of Obstetrics