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Women requesting a second or subsequent abortion should be screened for abuse

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.560-c (Published 10 March 2005) Cite this as: BMJ 2005;330:560
  1. David Spurgeon
  1. Quebec

    Women undergoing an abortion for a second or subsequent time were much more likely than woman undergoing a first abortion to have experienced physical abuse by a male partner, sexual abuse, or coercion, a study in the journal of the Canadian Medical Association shows. The researchers say that these findings show that women presenting for a second or subsequent abortion should be screened for such a history (CMAJ 2005;172:637-41).

    Of 1127 women presenting to a regional centre in southwestern Ontario between August 1998 and May 1999 for a termination of pregnancy, 769 (68.2%) were undergoing a first abortion, 260 (23.1%) a second abortion, and 98 (8.7%) a third or subsequent abortion. The participants were young (mean (SD) age 23.7 (6.4) years), mostly white (971 (86%)) and mostly born in Canada (962 (85%)).

    Of the women presenting for a first abortion, 181 (24%) reported a major conflict and fights with the man involved in the pregnancy; the corresponding figures were 73 (30%) for women having a second abortion and 34 (36%) for women having a third or subsequent abortion (P value for linear trend <0.01). Similarly significant trends were found for the proportions of women reporting a history of physical or sexual abuse or violence by a male partner.

    Most of the participants (1013 (90%)) had used contraception at some point in the past, and at the time of the current conception 60% were using condoms and 40% were using an oral contraceptive. However, nearly one in five said they sometimes could not afford to buy birth control products.

    Women undergoing a second or subsequent abortion were older than women seeking a first abortion and were more likely to have given birth and to have had a sexually transmitted disease in the past. They had more limited personal and financial resources and were more likely to have been victimised at some time in their lives. They also were more likely to have been born outside Canada and to be black or of Middle Eastern ethnicity.

    The authors wrote, “These results emphasize the need for screening for a current or past history of physical or sexual abuse at the time of presentation for abortion. Such screening could result in offers of referral and counselling that might prove helpful to the woman in dealing with a history of physical or sexual abuse and could potentially help avert a future abortion.”

    In an accompanying commentary Dr Susan Phillips, from the Department of Family Medicine at Queen's University, Kingston, Ontario, said the study reinforces the consistent findings of two decades of international research. A recently published British survey found that 35.1% of women seeking an abortion had experienced intimate abuse from a partner at some time and 6.6% lived in fear. Data from the United States show that 40% of women who seek abortions report abuse and are likely to cite relationship problems as the reason for asking for pregnancy termination.

    This study and others show little evidence that women seeking abortion for a second or subsequent time are using pregnancy termination as a method of birth control or that they are psychologically maladjusted. However, many have difficult or disrupted family circumstances.

    “Given the prevalence of victimization among women in general,” wrote Dr Phillips, “ I would suggest that physicians, particularly those in family practice, emergency medicine and obstetrics and gynaecology, screen all women [seeking an abortion] for what could be defined as an epidemic [of abuse].”

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