Multiple induced abortions : implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden

Objectives: To investigate factors associated with multiple induced abortions. Materials and methods: A multi-centre cross-sectional survey among abortion-seeking women (n?=?623;14-47y) in Sweden, 2021. ?Multiple abortions? was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions. Results: 67.4% (n?=?420) reported previous experience of 0-1 abortion, and 25.8% (n?=?161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n?=?109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n?=?27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n?=?65/161), compared to those with 0-1 abortion (n?=?131/420), p=.034. Conclusion: Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence