Abortion surveillance--United States, 1995

CONDITION: Since 1990 (i.e., the year in which the number of abortions was highest), the annual number of abortions in the United States has decreased by 15%. REPORTING PERIOD COVERED: This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1995. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City. RESULTS: In 1995, a total of 1,210,883 legal abortions were reported to CDC, representing a 4.5% decrease from the number reported for 1994. The abortion ratio was 311 legal induced abortions per 1,000 live births, and the abortion rate was 20 per 1,000 women aged 15-44 years, the lowest ratio and rate recorded since 1975. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most were obtaining an abortion for the first time. Approximately half of all abortions (54%) were performed at < or =8 weeks of gestation, and approximately 88% were performed before 13 weeks. Approximately 16% of abortions were performed at the earliest weeks of gestation (< or =6 weeks), approximately 17% at 7 weeks of gestation, and approximately 21% at 8 weeks of gestation. Few abortions were provided after 15 weeks of gestation -- approximately 4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained at > or =21 weeks. Younger women (i.e., women aged < or =24 years) were more likely to obtain abortions later in pregnancy than were older women. INTERPRETATION: Since 1990, the number of abortions has declined each year. Since 1987, the abortion-to-live-birth ratio has declined; in 1995, it was the lowest recorded since 1975. This decrease in the abortion ratio reflects a trend that a lower proportion of pregnant women obtain induced abortion. ACTIONS TAKEN: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed, efforts to prevent unintended pregnancy can be evaluated, and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.     

Suicides after pregnancy in Finland, 1987-94: register linkage study

OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100,000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy. CONCLUSIONS: The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.     

Neonatal death after induced abortion

An obstetrical practice based at a university hospital in Jerusalem has studied the offspring of 9,894 women who were pregnant at least once during the years 1966 through 1968, and discovered that the neonatal mortality rate was 2 to 3 times higher in infants born to women who reported a previous induced abortion. Among the women studied, 7.2% reported at least 1 previous abortion; immigrants from South Africa tended to have the highest rate of abortion, whereas the lowest rate was observed in the Arab population. An inverse relationship was detected between a history of induced abortion and the following: the degree of religious observance; maternal age at the time of marriage; and maternal age at the time of past deliveries. A positive correlation was observed between a history of induced abortion and the present age of the mother; smoking; Caesarian section; bleeding during pregnancy; vomiting during pregnancy; and the use of medications during the 1st trimester of the present pregnancy. The women in this study delivered a total of 11,057 infants between 1966 and 1968; infants born to mothers who reported a previous induced abortion experienced a higher neonatal mortality rate and were more likely to be low birth-weight infants, when compared to the group of infants whose mothers did not report a previous induced abortion.     

Sequence analysis of the terminal protein precursor coding regions from bovine adenovirus serotypes 2 and 3

The acceptability of medical abortion (mifepristone and misoprostol) among US women was investigated in a 1995 survey of 262 women seeking this method of pregnancy termination at 3 clinics in Oregon, Washington, and Vermont. The abortion patients' mean age was 27 years; mean gestational age was 49.5 days. 51.1% of respondents had experienced at least one prior abortion. Women completed a questionnaire at their initial clinic visit and again two weeks after the procedure. Participants chose medical abortion to avoid surgery (62.8%) or because they perceived it to be less invasive (56.3%), more natural (40.5%), and associated with a lesser risk of infection or damage to the uterus (35.1%) than vacuum aspiration, and could be performed earlier in pregnancy (27.2%). 49.8% indicated they preferred to wait for abortion to occur with a partner, friend, or family member, while 30.6% preferred to be alone; only 17.6% wanted to wait with other women undergoing the same procedure. Comparison of pre- and post-abortion questionnaires indicated women expected significantly more discomfort than they actually experienced and underestimated the number of days of bleeding. 72.8% of respondents were very satisfied with their medical abortion and 15.5% were somewhat satisfied. Women in the somewhat satisfied group had experienced significantly more abortion-related discomfort and anxiety than those who were very satisfied. Prior abortion experience and demographic characteristics did not influence satisfaction. 94% stated they would recommend medical abortion to a friend and 87% would select medical abortion if they had to terminate another pregnancy. Medical abortion has the potential to increase access to abortion among underserved groups of US women. Appropriate educational materials should be developed to help women choose between abortion methods.     

Contraception and voluntary termination of pregnancy. Survey of a sample of 500 women

In order to better evaluate the link between contraceptive attitudes and induced abortion, 500 women who underwent voluntary termination of pregnancy (VTP) at the First Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza" were interviewed. They were young (median age 28 years), medium to high educated (61%), non married (52.4%), nulliparous (59.2%) women. Forty-two percent of them had the first sexual intercourse before 18 years of age and 72.6% at least five years before. Ninety-five women (19%) admitted a previous voluntary termination of pregnancy. Withdrawal (305 women), oral contraceptives (246 women) and condom (223 women) were the most widely used methods of fertility regulation, but the pill had been taken only for short periods of time, never exceeding one year. Withdrawal resulted to be the most utilized method during the cycle in which conception occurred (49.4%); no method had been employed by 34.8% of the women. The diffusion of modern methods of fertility regulation greatly influences the number of induced abortions in Italy, as clearly indicated by the progressive reduction of VIP starting from 1982 paralleled by a constant increase in OCs diffusion. Our data, although limited in number, confirm that induced abortion is the consequence of an insufficient use of modern methods of fertility regulation.     

Demographic factors and pregnancy--who chooses abortion?

The number of pregnancies terminated as induced abortions has been analysed from data recorded in the Norwegian Birth Registry and the Norwegian Abortion File at the Central Bureau of Statistics. During the time period 1 January 1979 to 31 December 1991, 871,439 pregnant women were registered. Among single women the proportion of pregnancies terminated as induced abortions varied between 40 and 75% throughout the study period. Cohabitant women chose abortion significantly more often than married women. Among married women the proportion of pregnancies interrupted varied with the woman's age and the number of children. Among women 20-34 years of age with one or no child, more than 97% of the pregnancies proceeded to term. Women undergoing abortion comprise a heterogeneous group, judged by demographic factors. Future studies must focus on social factors as well as demographic factors, in order to uncover the complexity of the reasons for choosing abortion.     

Methodological aspects of the immunostaining of proliferating cell nuclear antigen (PCNA) in cytospin preparations of MCF-7 cell line

For the purpose of analysing the association between selected current socio-demographic characteristics and the history of induced abortion, 138 students of a Brazilian university, who had been pregnant at least once, were studied. These students were identified from among the 937 who returned, by mail, a self-administered, anonymous questionnaire distributed to all the female undergraduates. The subjects were divided into two groups, those who had and those who did not have a history of induced abortion. It was found that the largest percentage of women who had already had an induced abortion were of less than 24 years of age, were not living in marital union, had no religious affiliation and no living children at the time of the study. Analysis by logistic regression showed that having no living children was the only current characteristic associated with having had an induced abortion.     

Induced abortion in a Swiss canton from 1990 to 1993: implications for epidemiological surveillance

BACKGROUND: To describe abortion utilization in the Canton of Vaud (Switzerland) and to identify desirable changes in the data collection system to improve the epidemiologic monitoring METHODS: Retrospective survey of the 5600 abortion requests to the Canton Health Authority for resident women between 1990 and 1993. RESULTS: Nine women out of 1000 residents requested an abortion, but the abortion rate was higher among women of foreign origin compared to Swiss women (17/1000 vs. 6/1000, p < 0.0001). The proportion of terminated recognized conceptions was 127/1000, and the ratio of IVG to livebirths was 0.18. The abortion rate was lower during adolescence (6/1000) or after 40 years of age (1.8/1000), whereas the proportion of terminated conceptions was highest at these ages (527/1000 and 312/1000). Abortion utilization in Canton of Vaud is among the lowest. CONCLUSIONS: Although these indicators do reflect a satisfactory accessibility and use of family planning services, improvements could be made. A better knowledge of the causes (motives, contraceptive method, reproductive history) and of the consequences of abortion (psycho-social implications, medical complications) would allow to design more focused prevention strategies and to fit health services to current needs. Updating the 1942 Swiss legislation is also desirable.     

Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon

PURPOSE: We wished to determine the effects of seizure type, age at onset, and family history of epilepsy on risk of spontaneous abortion in the pregnancies of adults with idiopathic/cryptogenic epilepsy. METHODS: We examined pregnancy outcomes in 812 adults with idiopathic/cryptogenic epilepsy who had ever had or fathered a pregnancy and 250 of their same sex siblings who had ever had or fathered a pregnancy. We compared the likelihood of spontaneous abortion before and after onset of epilepsy with the likelihood of spontaneous abortion among same sex siblings. RESULTS: Risk of spontaneous abortion was not increased before onset of epilepsy. After onset of epilepsy, risk of spontaneous abortion was significantly increased in the pregnancies of wives of men who had localization-related epilepsy with age at onset <10 years or who did not have a family history of epilepsy. In women after onset of epilepsy, risk of spontaneous abortion was significantly increased for pregnancies of women with localization-related epilepsy with age at onset < or =20 years and for those of women with or without a family history of epilepsy. Risk of spontaneous abortion was greatest in the pregnancies of women with a positive family history of epilepsy odds ratio, (OR = 2.12, p < 0.05). CONCLUSIONS: Risk of spontaneous abortion in the pregnancies of men and women with idiopathic/cryptogenic epilepsy varied with the clinical characteristics of their epilepsy. The increased risk of spontaneous abortion in women with a family history of epilepsy may influence the observed risk of epilepsy in their live-born offspring.     

Abortion patients in 1994-1995: characteristics and contraceptive use

Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than +15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.     

Fracture of the ossified Achilles tendon

OBJECTIVE: To analyse the relation between induced abortion and risk of subsequent miscarriage. DESIGN: Case-control study conducted between February 1990 and May 1995. PARTICIPANTS: Case group included 782 women (median age 32 years, range 14-46) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14-45) were interviewed. RESULTS: A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8-1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4-1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage. CONCLUSIONS: This study did not find any strong association between induced and spontaneous abortion.     

The use of clomiphene citrate

Two hundred and fifty-five women received clomiphene citrate during a 10-year period. Fifty-six were treated diagnostically and one hundred and ninty-nine therapeutically for infertility. It is concluded that clomiphene may aid in confirming the diagnosis and establishing a prognosis in patients with primary or secondary amenorrhea. The success of clomiphene therapy in patients with anovulatory infertility is related to the etiologic factor responsible for the anovulation, but results can be improved by adjustment of the therapeutic regimen used. In the present series, 48% of the patients who ovulated became pregnant, and 25.3% of the pregnancies were miscarried. Those patients who ovulated spontaneously and became pregnant after having discontinued clomiphene therapy showed only a 10% abortion rate. A review of the results indicates that both the ovulation rate and the pregnancy rate can be improved if adjustments are made in therapy to ensure normal follicular maturation and corpus luteum function.     

Comparative study of the cytoplasmic domain of band 3 from human and rabbit erythrocyte membranes

OBJECTIVE: To identify sociodemographic characteristics associated with induced abortion of the first pregnancy and quantify the strength of association between them. MATERIAL AND METHODS: Data were gathered from a survey conducted in the district of Diez de Octubre, Havana, Cuba throughout 1991 and the beginning of 1992. The study population was divided into two comparable groups: one group of women whose first pregnancy terminated in induced abortion and a second group of women whose pregnancy terminated in childbirth. For the variables with statistically significant differences, both the crude and adjusted odds ratio were obtained for the one potentially confounding factor:age. Multivariate logistic regression analysis was employed in the final stage. RESULTS: The sociodemographic characteristic identified as risk factor for induced abortion during the first pregnancy is being younger than 24 years of age, a risk which increased with women who were less than 20 years old, whether single or in union. CONCLUSIONS: Recurrence risk of induced abortion during the first pregnancy is higher in younger women who have not achieved their professional, working or marrying expectations. This situation seem to be incompatible with maternity in the studied group.     

Antiprogestin drugs: ethical issues

Ethical issues of RU-486 in the US are the same as those of any new medical technology, but the politics of abortion can tempt us to believe that antiprogestins pose new ethical hazards. Good facts are needed to have good ethics. Risk-benefit assessments reveal medical facts and begin with clinical trials, evaluating RU-486's effectiveness and the degree and likelihood it causes harm, discomfort, and side effects. They should also consider social and psychological risks and benefits. Clinical trails in Los Angeles show that women who had previously undergone a surgical abortion method found RU-486 to be a less violent abortion method. Antiabortion proponents misconstrue this benefit to be a disadvantage, because they believe women undergoing abortion should suffer from pain and suffering. Even though an international convention ensures reproductive freedom for women, women must be informed about and have access to all family planning services in order to exercise this right. Ethics and the law require voluntary, informed consent. Yet, the US prevents workers at federally-funded family planning programs from providing clients any information on abortion, thereby violating this ethical requirement. Ethical precepts are also violated by denying women their right to privacy and by the punitive actions taken against women undergoing abortion by physicians, other health workers, and antiabortion proponents. Ru-486 allows women to undergo an abortion in private. Abortion opponents consider this privacy a disadvantage, because they lose targets for picketing, harassment, and violence. They believe that the improved access to abortion awarded by RU-486 would make abortion emotionally easier for women, leading to an increase in the number of abortions. Yet, there is no empirical evidence to support this. Again they see a benefit (decreased psychological stress) as a disadvantage. Ethical arguments show that RU-486 provides women greater health benefits, fosters their right to reproductive freedom, and improves the prospects for expanded social justice.     

Single and repeated elective abortions in Japan: a psychosocial study

Despite its social, legal and medical importance, termination of pregnancy (TOP) (induced abortion) has rarely been the focus of psychosocial research. Of a total of 1329 women who consecutively attended the antenatal clinic of a general hospital in Japan, 635 were expecting their first baby. Of these 635 women, 103 (16.2%) had experienced TOP once previously (first aborters), while 47 (7.4%) had experienced TOP two or more times (repeated aborters). Discriminant function analysis was performed using psychosocial variables found to be significantly associated with either first abortion or repeated abortion in bivariate analyses. This revealed that both first and repeated aborters could be predicted by smoking habits and an unwanted current pregnancy while the repeated aborters appear to differ from first aborters in having a longer pre-marital dating period, non-arranged marriages, smoking habits, early maternal loss experience or a low level of maternal care during childhood. These findings suggest that both the frequency of abortion and its repetition have psychosocial origins.     

Breast cancer risk: protective effect of an early first full-term pregnancy versus increased risk of induced abortion

PURPOSE/OBJECTIVES: To examine the question of whether an early first full-term pregnancy (FFTP) protects against breast cancer and whether interruption of the pregnancy with an induced abortion increases breast cancer risk. DATA SOURCES: Published medical and epidemiology journal articles, books, scientific reports, news interviews of researchers, scientific journals. DATA SYNTHESIS: Continually increasing breast cancer rates cannot be explained by the American Cancer Society risk factors, which account for only 25% of cases. Induced abortion is a newly recognized risk factor and has been prevalent in our society since it was legalized in 1973. CONCLUSIONS: Early FFTP confers protection, while induced abortion confers risk. Most specific and controlled variables studies indicate 150% risk for abortions performed on women younger than 18 years of age. Studies have yet to discover the full impact of induced abortion because women who underwent legalized abortion in 1973 are just reaching ages of highest breast cancer incidence. IMPLICATIONS FOR NURSES: Awareness of a controversial risk factor and its relevance to women allows nurses to include this information when educating and supporting patients. Specifically, nurses need to include questions on this reproductive risk when eliciting a patient's reproductive history. Nurses should further be aware of the emotional impact disclosure may have.     

Outcome of pregnancy after conization

The outcome of 635 pregnancies in 197 women before and after conization is reported. After conization a significant increase in premature deliveries occurred in young women (age 21-25), nulliparae representing the highest risk. The rate of premature deliveries in this age group was 4.4% before conization and 30.6% after conization. No such increase could be found in any other age group. Labor was notably short in non-parous women and in parous women it started with rupture of the membranes significantly more often after conization. In addition, a significant increase in the frequency of cervical stenosis was observed, but this was of clinical significance in only one case. Treatment in the form of prophylactic cerclage did not reduce the incidence of either premature delivery or of late spontaneous abortion.     

Pregnancy in HIV-infected women. Counseling and care--12 years' experiences and results

BACKGROUND: A specialized antenatal care unit was set up for counseling and care of HIV-infected pregnant women. The team consisted of gynecologists, a midwife, a social worker and pediatricians. METHODS: The women were referred from departments of infectious diseases, venereology or institutions for drug addicts, antenatal care units and abortion clinics, or applied themselves. Women identified in the pregnancy HIV screening program were informed primarily by the team. The women were counseled along with their partners and cared for during abortion or the antenatal period, delivery and post partum. Contraceptive services were offered and psychosocial support was given. RESULTS: Between April 1985 and March 1997, 95 HIV-infected women with 122 pregnancies attended. Twenty-one per cent were or had been drug users, 2% had been infected by transfused blood and 77% were classified as having been sexually infected, two thirds of whom were Africans. The mean age was 27.8 years. In 54 of 93 pregnancies (58%) in which the woman could make an informed decision, she elected abortion -- in 37 cases for HIV related reasons. Significantly more women with an uninfected steady partner, compared to women without a steady partner, chose to continue the pregnancy, as did women in a relatively stable social situation. Of the partners, 68 were HIV-negative, 36 HIV-positive and 18 not tested. No severe HIV-related complications occurred during pregnancy. Seven of 40 (18%) children with a known infection status were infected. During the course of follow-up, nine mothers, two fathers and three children have died. Seventeen children were at risk of being orphaned, and another five were placed in foster care. CONCLUSION: Although it is possible to reduce mother-to-infant transmission by zidovudine therapy, the negative consequences of HIV and childbearing are still substantial. Therefore HIV screening during pregnancy and pre-pregnancy counseling are important issues for the health care system.     

Let''s clear the air of that nocturnal miasma. Cigar anyone?

A significant number of patients suffer psychological complications as a consequence of abortion, and 10-20% experience severe depression. The risk factors for such psychological complications originate with abortions performed under pressure, eugenic abortions, or late abortions, and with cultural or religious hostility against abortion. The response to abortion consists of four phases: phase 1 is short and comprises the immediate reaction and alleviation that the pregnancy is over; phase 2 can last for several weeks or months, with anxiety and even guilt being experienced by 20% of women 2 years after the abortion; phase 3 corresponds to a pathological phase, that is, when anxiety is transformed into disease in 10-20% of women (symptoms of this depressive disease include insomnia, crying, inability to concentrate, anxiety, and panic attacks); phase 4 consists of reactivated mourning. Treatment depends on the phase: for anxiety, counseling is indicated; for depression, anti-depression drugs; however, these are contraindicated in the first trimester if the patient becomes pregnant. For breast-feeding mothers, tricyclic antidepressants are indicated and during such treatment counseling should be suspended. Although the effects of such treatment methods have not been adequately assessed, it could be concluded that they do not cause any harm. The efficacy of treatment choices needs to be studied.     

Antiphospholipid antibodies and the outcome of pregnancy after the first in-vitro fertilization and embryo transfer cycle

Increased antiphospholipid antibody prevalence has been demonstrated by a number of recent studies in in-vitro fertilization (IVF) patients but the potential effects of antiphospholipid antibodies on the different components of the reproductive process and the consideration of whether to test IVF patients for antiphospholipid antibodies are controversial. The present study was undertaken to investigate the possible association between the presence of circulating antiphospholipid antibodies (namely the lupus anticoagulant and anticardiolipin antibodies), among a series of 21 consecutive IVF patients having a clinical spontaneous abortion after their first embryo transfer. As a control group (n=42), the nearest IVF cycle resulting in an ongoing pregnancy before and after each miscarried IVF cycle (i.e. the closest cycles in temporal relationship to the index cycle) was used. One patient (4.8%) in the study group and two women (4.8%) among controls were seropositive for antiphospholipid antibodies. These low and similar seropositivity rates found in the two groups studied lead us to conclude that antiphospholipid antibodies testing in IVF patients should be considered only in those women having repeated failures of implantation/clinical abortion after embryo transfer but not in an infertile general population reaching an IVF programme.