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The `Problem' of Repeat Abortions

1974; Guttmacher Institute; Volume: 6; Issue: 3 Linguagem: Inglês

10.2307/2134124

2325-5617

Christopher Tietze,

Assisted Reproductive Technology and Twin Pregnancy

Along with increasing acceptance and utilization of legal abortion to terminate unwanted pregnancy, has arisen an often vague and generalized anxiety on the part of some health and social welfare professionals about the 'problem' of repeat abortions. One author, physician, points to the great concern and considerable dismay expressed by his colleagues at large New York health institution when less than 12 months patients who previously had been aborted at this institution, and [received] family planning indoctrination, began to return for repeat abortion. . ..' Another author, psychologist, suggests that repeated abortion-seeking behavior may indicate that a significant number of women will come to rely on abortion as preferred method of family planning. He calls for major efforts in psychosocial research to learn how to avert such situation.2 A report from Scotland suggests that doctors understandably may be irritated with someone [especially if she is not married] who appears to be taking the availability of abortion for granted. They mayfeel that to agree to second abortion would only encourage immorality or at least carelessness.3 Even physicians who recognize, in principle, woman's right to control her own fertility may become frustrated when patient returns for second or third abortion. Reliable information on the frequency of repeat legal abortions, based on record linkage, is not yet available for any area in the United States. Nor has there yet been published any estimate, based on known use-failure rates of contraception in the United States, of what proportion of women seeking abortions might be expected to be abortion repeaters in any given year. It is usually assumed that any rate of repeat abortions is unacceptably high, and that errors in the delivery of health care, as one author puts it, should be identified and corrected.4 In this article, we attempt to predict the likelihood of repeat abortion, based on published experience about the effectiveness of contraceptive practice in contemporary U.S. populations. As empirical data concerning the actual incidence of repeat abortions are collected and published they can be evaluated against such estimates. The inset, Selected Measures of Repeat Abortion Frequency (p. 150), shows the formulae used to predict repeat abortion frequency. Table 1 shows the proportions of women who may be expected to have at least one repeat abortion within stated periods ranging from one to 10 years after first legal abortion. It is assumed here that the circumstances which led to the first abortion continue during the period under consideration and, therefore, that all subsequent pregnancies would also be terminated by abortion. The proportions of repeaters in any given year would be reduced, depending on the proportion in any year who chose to carry subsequent pregnancies to term. * In the United States, where 70 percent of legal abortions in 1972 involved unmarried women (including an estimated 55 percent who were never married),5 this could lead to substantial reductions from the model for the 10-year estimates, but would not be likely to affect very much the estimates for the first few years following the first legal abortion. Two assumptions are made regarding Table 1. Percent of women expected to have at least one repeat abortion each year after having first legal abortion, according to effectiveness of contraception in reducing unwanted pregnancy*