title: Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design.
abstract: BACKGROUND
  Repeat abortion is a public health concern favored by many obstetric and social factors. The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion.
  
  
  METHODS
  We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC). Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women's demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3-4 weeks following pregnancy termination.
  
  
  RESULTS
  Of the 500 interviewed women, 211 (42.2 %; CI95% [37.88 - 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion. CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %).
  
  
  CONCLUSIONS
  Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.
authors.affiliation: Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia. sanaelmhamdi@gmail.com.
authors.forename: Sana
authors.initials: S
authors.lastname: El Mhamdi
authors.affiliation: Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia. bensalah.arwa@yahoo.fr.
authors.forename: Arwa
authors.initials: A
authors.lastname: Ben Salah
authors.affiliation: Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia. bouaneneines@gmail.com.
authors.forename: Ines
authors.initials: I
authors.lastname: Bouanene
authors.affiliation: Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia. imenhlaiem@hotmail.fr.
authors.forename: Imen
authors.initials: I
authors.lastname: Hlaiem
authors.affiliation: Reproductive Health Center of Monastir, Monastir, Tunisia. saloua.hadhri@gmail.com.
authors.forename: Saloua
authors.initials: S
authors.lastname: Hadhri
authors.affiliation: Reproductive Health Center of Monastir, Monastir, Tunisia. onfp.monastir@rns.tn.
authors.forename: Wahiba
authors.initials: W
authors.lastname: Maatouk
authors.affiliation: Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia. mohamed.soltani@rns.tn.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Soltani
mesh_terms: D000023:Abortion Applicants / Q000523:psychology / Q000706:statistics & numerical data; D000028:Abortion, Induced / Q000523:psychology / Q000706:statistics & numerical data; D000328:Adult; D003267:Contraception; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D000066511:Intimate Partner Violence / Q000517:prevention & control / Q000523:psychology / Q000639:trends; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D020380:Needs Assessment; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012747:Sexual Partners / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014416:Tunisia / Q000453:epidemiology