Multiple induced abortions - implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden

SHORT CONDENSATIONSeeking multiple abortions is common in Sweden, and is associated with parity, low education, tobacco use, and exposure to violence. Although Sweden provides high quality and accessible comprehensive abortion care, counselling must be adaptable and address specific needs in vulnerable groups. ObjectivesTo investigate factors associated with multiple induced abortions.Materials and methodsA multi-centre cross-sectional survey among abortion-seeking women (n = 623;14-47y) in Sweden, 2021. 'Multiple abortions' was defined as having had >= 2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions.Results67.4% (n = 420) reported previous experience of 0-1 abortion, and 25.8% (n = 161) >= 2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity >= 1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n = 109/420) believed they could not become pregnant at the time of conception, compared to women who had >= 2 abortions (n = 27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with >= 2 abortions (n = 65/161), compared to those with 0-1 abortion (n = 131/420), p=.034.ConclusionMultiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence.