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Background:

- In the United States, one in four women experiences at least one abortion by the age of 45.

- About 926,200 abortions were performed in America in 2014.

- Repetitive, in 2010 repeat abortions accounted for 57% of the 74,347 abortions.

- Repeat abortions are strongly associated with poorer physical and mental health.

Gaps:

- Results have been inconsistent.

- Most of the extant literature mainly focuses on abortion rather than repeat abortions

- Few studies contain data on this topic from in the U.S.

Significance:

To address this gap in the current research

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Research Question:

What is the relationship between the included factors and repeat abortions.

Hypothesis:

Older age, black/African American ethnicity, have used contraception methods, no health insurance coverage and income below poverty line will increase the risk of having repeat abortions

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Methods

Data Source:

- Guttmacher Institute’s 2014 Abortion Patient Survey

Measures:

- Outcome: Repeat abortions(1=No and 2=Yes, recoded as 0=No and 1=Yes)

- Independent(exposures):

Demographic Factors: Age, Marital Status, Race and ethnicity, Education Level

Socioeconomic Factors: Insurance Coverage, Income(Below Poverty/Above Poverty)

Health-related behavior Factors: Contraception Use, Have you stopped contraception before pregnancy, Number of months used contraception methods, Partner physical abuse, Partner Forced Sex

Statistical Analysis:

- Frequency distributions & Chi-square test

- Univariable & Multivariable logistic regression models:

- Software: R version 4.1.2

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Result

-Bivariable Analysis:

· Older than 25 years old

· Divorced/widowed/seperated

· Black/Africian American

· Annual family income lower than the 2014 US poverty line

· Do not have any type of health insurance

· Having stopped all the contraception methods before this pregnancy

· Have experienced partner physical abuse

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Result�Multivariable Analysis

-Risk factors:

Older age

Divorced/separated/widowed marital status (OR=1.38)

Black/African ethnicity(OR=1.65)

Income below poverty line(OR=1.17)

Using contraception methods for less than 12 months(OR=1.28)

-Protective Factors:

Not living with partner during pregnant month(OR=0.70)

Having certain type of insurance

no physical abuse(OR=0.60)

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Conclusion

This study suggest that many factors plays a significant role in the association with repeat abortions among women in the United States.

Better insurance coverage, social support, and economic interventions are needed, especially for those women with older age, lower income, no insurance coverage and risky health-related behaviors.

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Limitations

- Causality:

cross-sectional study design, all the data are obtained simultaneously, which means the causality cannot be determined

- Recall Bias&Social desirability:

Given that this is a survey-based study, there may be bias in subjects' responses to the questionnaires

- Confounders:

Despite we have adjusted demographic, socioeconomic and health-related behavior characteristics, other potential covariates are not included in this study, such as different contraception methods, mental health status, family information background etc.

- Others: because of the small sample size, we grouped divorced, separated and widowed into one category, however, these three status have different impact on repeated abortions and it may influence the result.

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References

- Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and changes since 2008. Guttmacher Institute. https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014?TB_iframe=true&width=921.6&height=921.6. Published August 24, 2022. Accessed November 6, 2022.

- Population Group abortion rates and lifetime incidence of abortion: United States, 2008–2014. American Journal of Public Health. https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304042. Accessed November 6, 2022.

- Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2014. Perspectives on Sexual and Reproductive Health. https://onlinelibrary.wiley.com/doi/full/10.1363/psrh.12015. Accessed November 7, 2022.

- Characteristics of U.S. abortion patients, 2008. Guttmacher institute. https://www.guttmacher.org/sites/default/files/pdfs/pubs/US-Abortion-Patients.pdf. Accessed November 7, 2022.

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