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      Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design

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          Abstract

          Background

          Repeat abortion is a public health concern favored by many obstetric and social factors.

          The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion.

          Methods

          We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC).

          Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women’s demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3–4 weeks following pregnancy termination.

          Results

          Of the 500 interviewed women, 211 (42.2 %; CI 95% [37.88 – 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion.

          CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %).

          Conclusion

          Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

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          Most cited references26

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          Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009.

          Samantha K. Coleman (2011)
          Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians. To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome. After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios. Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour. This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.
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            Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion.

            Satu Suhonen, Oskari Heikinheimo, Mika Gissler (2008)
            The rate of repeat induced abortion varies from 30% to 38% in northern Europe. Thus, repeat abortion is an important public health issue. However, risk factors as regards repeat abortion are poorly understood. We characterized risk factors related to sociodemographic characteristics, history of abortion and post-abortal contraception. A prospective cohort study of 1269 women undergoing medical abortion between August 2000 and December 2002 was conducted. The subjects were followed via the Finnish Registry of Induced Abortions until December 2005, the follow-up time (mean+/-SD) being 49.2+/-8.0 months. Altogether, 179 (14.1%) of the subjects requested repeat abortion within the follow-up time. In univariate analysis, a history of prior abortion, being parous, young age, smoking and failure to attend the follow-up visit were associated with repeat abortion. Immediate--in contrast to postponed--initiation of any contraceptive method was linked to a lower risk of repeat abortion. In comparison with combined oral contraceptives, use of intrauterine contraception was most efficacious in reducing the risk of another pregnancy termination. In multivariate analysis, the effects of young age, being parous, smoking, a history of prior abortion and type of contraception on the risk of another abortion persisted. An increased focus on young women, parous women and those with a history of abortion may be efficacious in decreasing repeat abortion. Contraceptive choices made at the time of abortion have an important effect on the rate of repeat abortion. Use of intrauterine contraceptives for post-abortal contraception was associated with decreased risk of repeat abortion.
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              Increased risk for postpartum psychiatric disorders among women with past pregnancy loss.

              Stephanie Giannandrea, Catherine Cerulli, Elizabeth Anson … (2013)
              Scant literature exists on whether prior pregnancy loss (miscarriage, stillbirth, and/or induced abortion) increases the risk of postpartum psychiatric disorders-specifically depression and anxiety-after subsequent births. This study compares: (1) risk factors for depression and/or anxiety disorders in the postpartum year among women with and without prior pregnancy loss; and (2) rates of these disorders in women with one versus multiple pregnancy losses.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sana El Mhamdi: sanaelmhamdi@gmail.com
                Arwa Ben Salah: bensalah.arwa@yahoo.fr
                Ines Bouanene: bouaneneines@gmail.com
                Imen Hlaiem: imenhlaiem@hotmail.fr
                Saloua Hadhri: saloua.hadhri@gmail.com
                Wahiba Maatouk: onfp.monastir@rns.tn
                Mohamed Soltani: mohamed.soltani@rns.tn
                Journal
                Journal ID (nlm-ta): BMC Womens Health
                Journal ID (iso-abbrev): BMC Womens Health
                Title: BMC Women's Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6874
                Publication date (Electronic): 10 May 2015
                Publication date PMC-release: 10 May 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 40
                Affiliations
                [ ]Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
                [ ]Reproductive Health Center of Monastir, Monastir, Tunisia
                Article
                Publisher ID: 198
                DOI: 10.1186/s12905-015-0198-x
                PMC ID: 4433016
                PubMed ID: 25956507
                SO-VID: ef23acef-d582-4f1c-8e0b-0697bbb9373d
                Copyright © © El Mhamdi et al.; licensee BioMed Central. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 2 January 2015
                Date accepted : 5 May 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: abortion, induced,aged,contraception,health knowledge, attitudes, practice,violence,mental disorders
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: abortion, induced, aged, contraception, health knowledge, attitudes, practice, violence, mental disorders

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