UCSF

Factors Associated with Multiple Unintended Pregnancies in Fertile Women

E. Angel Aztlan-James

University of California, San Francisco, 2015

Abstract

Background: Fifty-one percent of pregnancies in the United States (U.S.) are unintended and 40% of these unintended pregnancies end in abortion. Seventeen percent of all U.S. women report more than one unintended pregnancy in their lifetime. While there is much literature on unintended pregnancy, less is known about factors associated with multiple unintended pregnancies. The extant literature presents mixed findings on the association between abortion and multiple unintended pregnancies.

Objectives: Specific aims of this dissertation were 1) to systematically assess the rate of abortion-related complications in the literature; 2) to cull from the literature a systematic view of the epidemiology of multiple unintended pregnancies for U.S. women; and 3) to investigate the association between abortion, and other factors, on the risk of multiple unintended pregnancies.

Methods: Empirical studies were chosen from research databases for the systematic literature reviews and meta-analysis. Secondary analysis of data from a prospective study of U.S. women, who requested abortion, was performed using survival analysis.

Results: A pooled abortion complication rate of 1.79% (95% CI 1.21 to 2.65) was estimated. Increasing age, being Black or Hispanic, non-voluntary first intercourse at a young age, and sex trade were associated with multiple unintended pregnancies. Analysis demonstrated neither receiving nor being denied a requested abortion were associated with an increased risk of subsequent unintended pregnancy. Women aged 35-46 years were less likely than women aged 20-24 years to have a subsequent unintended pregnancy (AHR=0.31, 95% CI=0.15-0.62). Latina women were at increased risk compared to white women (AHR=1.46, 95% CI=1.01-2.10), as were those who had two or more children at baseline compared to those who had none (AHR=1.58, 95% CI=1.06-2.34). When compared to women who did not report intimate partner violence in the past year, women who did (AHR=1.38, 95% CI=1.01-1.88) or who had a diagnosis of depression or anxiety when compared to women who did not (AHR=1.43, 95% CI=1.11, 1.85) were at increased risk.

Conclusions: First-trimester aspiration abortion is a safe procedure when performed legally. Abortion does not increase risk for multiple unintended pregnancies. Prevention strategies aimed at multiple unintended pregnancies should focus on factors other than abortion.