Multiple abortions despite use of contraceptives

January 4, 2016 - 06:11

Many of the women in Norway who have abortions more than once say they conceived even though they used contraceptives. Researchers advice women to switch to securer methods of birth control.

Some 40 percent of all who seek abortions say that they had been using a contraceptive at the time they got pregnant. The most common methods were birth-control pills or condoms. (Photo: David Parry, Medicimag)

An annual tally is made of abortions performed in Norway, but little has been known about the number of women who have had abortions repeatedly.

How many of the roughly 15,000 women in Norway, with a population of 5 million, who have abortions annually have a history of them? What characterises these women?

This is something that a group of researchers at Akershus University Hospital’s Women’s Clinic wished to find out. 

The researchers got their data from the Norwegian Register of Pregnancy Termination. Their study covered all the requests for abortions in Norway in the period 2007–2011.

Nearly 37 percent came for the second time

All in all there were 80,346 requests for abortions within the end of the twelfth week of pregnancy during this five-year period. Self-determined abortions are fully legal in Norway but given no special medical or other circumstances they are only carried out within the first twelve weeks of pregnancy.

It turned out that nearly 37 percent of the women who asked for an abortion during these five years had undergone a previous abortion.

Almost 12 percent have had two or more abortions.

Need facts about risk factors

“Society seeks to prevent unwanted pregnancies as well as abortions. To succeed in this we need facts about risk factors for unwanted pregnancies. That’s why we initiated this study,” explains Ellen Marie Strøm-Roum. She led the work on the study, which was recently published in Acta Obstetricia et Gynecologica Scandinavica.

The Norwegian Register of Pregnancy Termination has not been utilised much in research to date. This is the first time it was used for a study on repeated abortions by women in Norway. 

Not teenagers

The average age of all the women applying for abortions was 27.6 years. Among those who previously had taken one or more abortions and were applying for another, 68 percent were over the age of 25.

From left: Ragnhild Justad-Berg, Anne Eksild and Ellen Marie Strøm-Roum have used data from the Norwegian Register of Pregnancy Termination to investigate how many women in Norway have more than one abortion. (Photo: Ahus)

“The relatively high age of these women caught us unawares. We were rather surprised that so many of those applying for a repeated abortion were over 25 years old,” says Ellen Marie Strøm-Roum.

Older women have had sex for a longer time, and this increases their chances of getting pregnant. This should partly explain the findings.

This is why Britt-Ingjerd Nesheim, a professor emerita in obstetrics and female diseases at the University of Oslo, is not particularly surprised that women who request abortions more than once are more than 25 years old.

What intrigues her most are the researchers’ findings about the use of birth control methods.

Many say they have used birth control

About 40 percent of all abortion applicants claim to have used some form of contraception when they conceived. Most of these women had used birth control pills or their partner had used a condom.

The researchers studied the information that was given by the women when they applied for an abortion.

“Women who accidentally get pregnant are usually quite embarrassed. It’s feasible that some who have claimed to have used contraceptives didn’t actually do so.”

She also knows from her experience as a gynaecologist that there are considerable risks of using birth control pills wrongly, particularly as women have to remember to take them every day.

Not always negligence

Even when they follow all directions, the risk of conceiving while using birth control pills is 0.3 pregnancies per 100 users per year. Added to that, Strøm-Roum thinks it rather easy to err in the use of the pill.

“Certain studies have shown that 9 out of every 100 users of the pill get pregnant per year. Wrong use doesn’t have to mean forgetfulness or negligence. Only a slight deviation from proper use is all that is needed for things to go wrong.”

Britt-Ingjerd Nesheim would like to see more women switching from birth control pills to coils or subdermal birth control implants. (Photo: University of Oslo)

Gynaecologist Nesheim recommends a shift focus away from birth control pills toward long-acting reversible contraception (LARC). That means a switch to non-hormonal copper IUDs, hormonal IUDs and subdermal contraceptive implants. The latter is a small flexible rod placed under the skin of the upper arm which releases the hormone progestogen and works for three years.

Diversity in fertility

The study shows that many of those who request an abortion have already given birth to one or more children. The researchers suggest that this, and the high share of women who claim to have used birth control, can indicate that those who repeatedly request abortions are simply more fertile than the average woman.

“We know there are considerable individual differences among women when it comes to fertility. Some women get pregnant the first time they have sex, whereas others struggle to get pregnant. Some also have to find the right partner to get pregnant.”

Regional differences

The researchers found that women with more college educations run lower risks of having to request abortions repeatedly than women with only elementary education. 

Women residing in Oslo and in North Norway are a bit more likely to request abortions twice or more than women elsewhere in Norway.

This tendency has been seen in earlier studies of regional differences regarding abortions.

Women who have had abortions are more likely to return to hospitals to request one again. So the researchers think these women should be offered a secure LARC which is hard to use wrongly. Those who decidedly wish for no more children might opt for sterilisation.

“It’s paradoxical that the termination of a pregnancy is nearly free of cost but patients wishing to be sterilised have to pay the Norwegian equivalent of about EUR 650,” asserts Strøm-Roum.

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Read this article in Norwegian at forskning.no

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Translated by
Glenn Ostling

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