Repeat Induced Abortion among Chinese Women Seeking Abortion: Two Cross Sectional Studies

Abstract

Background: In China, there were about 9.76 million induced abortions in 2019, 50% of which were repeat abortions. Understanding the tendency of repeat induced abortion and identifying its related factors is needed to develop prevention strategies. Methods: Two hospital-based cross-sectional surveys were conducted from 2005–2007 and 2013–2016 in 24 and 90 hospitals, respectively. The survey included women who sought an induced abortion within 12 weeks of pregnancy. The proportion of repeat induced abortions by adjusting the covariates through propensity score matching was compared between the two surveys, and the zero-inflated negative binomial regression model was established to identify independent factors of repeat induced abortion. Results: Adjusting the age, occupation, education, marital status and number of children, the proportion of repeat induced abortions in the second survey was found to be low (60.28% vs. 11.11%), however the unadjusted proportion was high in the second survey (44.97% vs. 51.54%). The risk of repeat induced abortion was higher among married women and women with children [ORadj and 95% CI: 0.31 (0.20, 0.49) and 0.08 (0.05, 0.13)]; the risk among service industry staff was higher when compared with unemployed women [ORadj and 95% CI: 0.19 (0.07, 0.54)]; women with a lower education level were at a higher risk of a repeat induced abortion (ORadj < 1). Compared with women under the age of 20, women in other higher age groups had a higher frequency of repeat induced abortions (IRadj: 1.78, 2.55, 3.27, 4.01, and 3.93, separately); the frequency of women with lower education levels was higher than those with a university or higher education level (IRadj > 1); the repeat induced abortion frequency of married women was 0.93 (0.90, 0.98) when compared to the frequency of unmarried women, while the frequency of women with children was 1.17 (1.10, 1.25) of childless women; the induced abortion frequency of working women was about 60–95% with that of unemployed women. Conclusions: The repeat induced abortion proportion was lower than 10 years ago. Induced abortion seekers who were married, aged 20 to 30 years and with a lower education level were more likely to repeat induced abortions.

Recent trend and correlates of induced abortion in China: evidence from the 2017 China Fertility Survey

“…The finding from the regression analysis showing that age, residence, ethnicity, and education level are significantly associated with women’s induced abortion experiences confirms the findings of previous studies [ 9 , 12 , 14 , 52 , 53 ], and is consistent with our period and cohort results. The interaction terms in the regression results show that the profile of women who resort to abortion has shifted from well-educated urban women toward rural, less-educated women, contradicting Zheng et al [ 9 ], who found a shift among women resorting to abortion from less-educated rural women to well-educated urban women.…”

“…The number of births decreased and the proportion of induced abortions rebounded. Regarding age at induced abortion, the number of induced abortions experienced by each woman increases with age; repeat induced abortions occur mainly among women in the older group [ 12 , 17 ]. Although the minimum age at the time of induced abortion is declining [ 32 , 44 ], adolescents’ induced abortions still account for a relatively small proportion, contributing to the upward trend in the average age of women having induced abortions.…”

“…Previous research has shown that induced abortions are associated with individual characteristics and socio-economic factors [ 9 – 11 ]. First, age is an important factor: the average number of induced abortions increases with age [ 12 ], and high rates of repeat induced abortions are also associated with age [ 13 , 14 ]. Second, residence status is another factor associated with induced abortion.…”

“…Education level also affects women’s induced abortion behaviors in China [ 9 , 11 , 17 ], although research conclusions diverge in this area. Some studies have shown that less-educated women have less knowledge of reproductive health and contraception and are more likely to undergo induced abortion and repeat induced abortions [ 12 , 18 , 19 ]. However, other studies have shown that women with higher levels of education have higher abortion rates [ 9 ].…”

“…Women’s marital status and sex of existing children are also associated with induced abortion [ 14 , 15 ]. Married women and women with children are more likely to undergo repeat induced abortions in China [ 12 ]. In the past, induced abortions have generally occurred among married women constrained by the birth control policy.…”