Which Abortion Patients Have Had a Prior Abortion? Findings from the 2014 U.S. Abortion Patient Survey
Rachel Jones, PhD, Jenna Jerman, MPH, and Meghan Ingerick, BA
Background: Updated information about abortion patients who have had a prior abortion could inform patient- centered practices that help women avoid unintended pregnancies in the future.
Materials and Methods: Data come from a national sample of 8,380 nonhospital U.S. abortion patients accessing services at 87 facilities. The dependent variable was a self-reported measure of prior abortion. Bivariate and multivariable analyses were used to assess associations between a range of demographic and circumstantial characteristics and reports of obtaining a prior abortion.
Results: We found that 45% of patients reported having one or more prior abortions. Age was most strongly associated with this outcome, and patients aged 30 and older had more than two times the odds of having had a prior abortion compared with those aged 20–24. Other characteristics associated with an increased likelihood of prior abortion included having one or more children, being black, relying on insurance or financial assistance to pay for the procedure, and exposure to disruptive events in the last 12 months. Characteristics associated with a decreased likelihood of having a prior abortion included having a college degree and living 25 or more miles from the facility where the current abortion was obtained.
Conclusions: Age is the biggest risk factor for having had a prior abortion; the longer a woman has been alive, the longer she is at risk of unintended pregnancy. Some characteristics associated with prior abortion were beyond the control of the individuals experiencing them.
Lesley Hoggart, Victoria Louise Newton, Louise Bury
Background: In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women’s abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women’s post- abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants’ own narratives.
Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/ unwanted pregnancy (n=15).
Results: The qualitative research findings demonstrate the complexity of women’s contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame.
Conclusions: This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion. of the studies.
Dr. Catriona Melville
Conclusions & Recommendations
• Women’s circumstances and reasons for seeking more than one abortion are not dissimilar to those of any women seeking abortion.
• Women undergoing abortion more than once in 2 years are not treating abortion ‘like contraception’.
• Contraception was an issue, but by no means the only one.
• For all women, there was consideration of whether they could cope with a pregnancy and having a child: financially, practically, and emotionally.
• Complex and overlapping issues demonstrate a range of potential vulnerabilities (including intimate partner violence) among women seeking more than one abortion.
• The consequences of abortion stigma for women having more than one abortion were clearly evident.
• A disproportionate focus on ‘repeat’ abortion exacerbates stigmatisation.
• It distracts from a more productive focus on improving abortion provision.
• Current framings of ‘repeat’ abortion may contribute to constraining women’s reproductive decision-making.
• Rather than a policy focus on trying to reduce ‘repeat’ abortions, we should shift the focus to preventing unintended conceptions and supporting those who need subsequent abortions.
• Encourage use of the most effective contraceptives methods, and greater provision for women who present for abortion.
• This should go hand in hand with attempts to challenge the prevailing negative social attitudes to abortion that currently exist — including health professionals.
• Abortion provision should be considered as essential in enabling women to have the kinds of families and life outcomes that they want.
• Encouraging and promoting a more positive view of women accessing abortion more than once to situate it as essential healthcare provision, rather than something exceptional and stigmatising.
• This will represent a step toward situating abortion more clearly as an issue of gender equality and social justice.