Urban women applying for induced abortion. Studies of epidemiology, attitudes and emotional reactions

In Sweden between 32-38,000 women annually elect to terminate pregnancy by means of induced abortion, though their reasons are still not well understood. The purpose of these studies, carried out at the Department of Obstetrics and gynecology and of Community Medicine at University Hospital, Malmö, was to elucidate the incidence of induced abortion in an urban population, with special emphasis on epidemiological and socio-demographic factors, the women's attitude to abortion, and the incidence and severity of post-abortion emotional reactions. Study of the 1,446 abortion applicants in Malmö in 1989 showed strong correlation to exist between abortion application and various socio-demographic factors, and an urban population with a high overall abortion rate to be characterized of substantial variation in prevalence between different residential areas. About 10% of the abortion applicants changed their minds before or after the mandatory visit before induced abortion, and wished to continue the pregnancy instead. This subgroup differed in socio-demographic profile from those who underwent abortion. Of the 1,285 abortees one third declined participation in a followup interview about a year later. The socio-demographic factors associated with refusal has in other studies been found to be associated with an increased morbidity and mortality. We found this subgroup to be characterized by a significantly higher pregnancy rate during the 1-2 years following the index abortion. Of the group who agreed to participate in the followup interview, 50-60% reported the occurrence of post-abdominal emotional distress, which was estimated as severe in 16% of cases. The identification of certain associated factors suggest that such post-abortion emotional reactions may be preventable. The prevalence of women who had undergone at least one previous abortion was 42% in the series as a whole, and as high as 57% in the >35-year-old age group; 34 (2.6%) of the women had undergone more than three previous abortions. Multiple abortees differed in a number of socio-demographic factors from first abortees, and had a higher incidence of repeat abortion within the following 1-2 years.60% reported not having used any contraceptives, and another 13% reported erratic use of otherwise safe contraceptives. Although the availablility of medically competent and caring management of unwanted pregnancies is a self-evident prerequisite in a country with claims to being concerned about women's health and fertility, and although a zero solution as goal in the question about induced abortion is neither realisitc nor a desirable goal, minimization of the unwanted preganancy rate, for instance by improved information, is nevertheless a worthwhile goal. It is important that the community as a whole and the health care system in particular are prepared to make the necessary resources availabe