Women's Risk of Repeat Abortions Is Strongly Associated with Alcohol Consumption: A Longitudinal Analysis of a Russian National Panel Study, 1994–2009

Abstract

Abortion rates in Russia, particularly repeat abortions, are among the highest in the world, and abortion complications make a substantial contribution to the country's high maternal mortality rate. Russia also has a very high rate of hazardous alcohol use. However, the association between alcohol use and abortion in Russia remains unexplored. We investigated the longitudinal predictors of first and repeat abortion, focussing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16–44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994–2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62–3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994–2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts.

Repeat induced abortion and associated factors among women seeking abortion care services at Debre Markos town health institutions, Amhara regional state, Ethiopia, 2017

“…Those who were consuming alcohol had a 2.7 times higher risk of having a RIA. This finding is consistent with the research done in San Francisco General Hospital, USA and with the study done in Russia [17,19]. This may be because of the impact of alcohol on logical thinking of women and might lead them to have unprotected sex.…”

“…Our study has identified that participants who had no education and had an educational level of primary and secondary were more likely to undergo a RIA than those who had an educational level of more than secondary. The finding is in consistent with the study in Ethiopia, Kenya, Tunisia, Georgia, and Russia [1,8,15,18,19]. Unplanned pregnancy secondary to poor contraceptive knowledge and use among those with a lower educational level might be the possible reason.…”

Higher alcohol consumption in early pregnancy or low‐to‐moderate drinking during pregnancy may affect children's behaviour and development at one year and six months

“…There were also group differences with respect to abortions. The mothers in group 2 reported significantly more spontaneous and legal abortions than the group 4 mothers who did not drink during pregnancy, which agrees with previous studies . It has been reported that women drinking at least four alcoholic drinks per week or binge drinking on three or more occasions during pregnancy were associated with an increased risk of infant mortality, especially during the postneonatal period .…”

Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women’s Health

“…We did not find alcohol to have an independent effect on abortion over time, in contrast to cross-sectional studies showing that abortion is correlated with alcohol and illicit drug use. 4,31 It may be that selfmedicating with alcohol and experiencing violence are closely correlated, and violence is the stronger factor. Illicit drug use and violence independently and cumulatively have an effect on a woman's ability to control her fertility.…”

“…Determinants are often culturally bound, through abortion's legal status and religious and social environments. In addition to associations with socioeconomic and demographic factors, [2][3][4][5][6] studies have examined knowledge about fertility, 7 knowledge and/or use of contraception, 3,5,[8][9][10] mental health, 11 alcohol or drug dependence, 4,11 and HIV/AIDS. 12 Many studies of socioeconomic and other determinants are from low-and middle-income countries.…”