More than one abortion.

©FFPRHC J Fam Plann Reprod Health Care 2007: 33(3) Introduction The terms ‘repeat abortion’ and ‘repeat aborter’ appear in the scientific literature from the early 1970s onwards. To begin with, the pejorative term ‘abortion recidivism’ was used by some.1 The initial concern appeared to be that women might be using abortion instead of contraception as a means of fertility control, with connotations of irresponsibility.2–7 There were also concerns about risk of morbidity and mortality for the woman from complications, possible psychiatric sequelae and possible cumulative adverse effects on future reproductive outcome.3,4,6 The latter concerns are not dealt with in this paper but are fully addressed elsewhere in an evidencebased guideline.8 Women have been regarded as less deserving when they present for abortion with a history of having had a previous abortion. Doctors have felt “that to agree to a second abortion would only encourage immorality or at least carelessness”.9 In a recent survey, service providers were found to have discriminatory policies in their written approval criteria. One provider stated that “consultants are reluctant to undertake repeated terminations” and another that “if a doctor perceives that the patient regards termination of pregnancy as a form of contraception by virtue of the number of previous procedures had” then abortion will not be offered within the service contract.10 In some countries doctors have threatened women with sterilisation if they attend for subsequent abortions.11,12 In countries that have good access to legal abortion women will use safe abortion as an adjunct to contraception. Some methods of contraception are highly effective; but even when these methods are used, failures during typical use are substantial (eg, for the combined pill).13 It has been estimated that a fecund, sexually active woman relying only on abortion for fertility control would need to have 35 abortions during her lifetime if she wanted no children.14 This review starts by illustrating the phenomenon of so-called repeat abortion with statistics from several countries and proceeds to outline the demographic factors affecting trends over time. The review then summarises evidence of any differences between women having subsequent abortions and those having their first abortion. Finally, evidence is presented of any differences in contraceptive behaviour between the two groups. A literature search was conducted for the years 1966 to 2006 using the term ‘repeat abortion’ as a text word in MEDLINE, POPLINE, CINAHL and PsycINFO. Statistics were obtained from the following government websites: www.stakes.fi; www.dh.gov.uk/publichealthstatistics; www.sos.se; www.stats.govt.nz. More than one abortion