title: Is underage abortion associated with adverse outcomes in early adulthood? A longitudinal birth cohort study up to 25 years of age.
abstract: Is underage abortion associated with adverse socioeconomic and health outcomes in early adulthood when compared with underage delivery?
  
  
  
  Underage abortion was not found to be associated with mental health problems in early adulthood, and socioeconomic outcomes were better among those who experienced abortion compared with those who gave birth.
  
  
  
  Teenage motherhood has been linked with numerous adverse outcomes in later life, including low educational levels and poor physical and mental health. Whether abortion at a young age predisposes to similar consequences is not clear.
  
  
  
  This nationwide, retrospective cohort study from Finland, included all women born in 1987 (n = 29 041) and followed until 2012.
  
  
  
  We analysed socioeconomic, psychiatric and risk-taking-related health outcomes up to 25 years of age after underage (<18 years) abortion (n = 1041, 3.6%) and after childbirth (n = 394, 1.4%). Before and after conception analyses within the study groups were performed to further examine the association between abortion and adverse health outcomes. A group with no pregnancies up to 20 years of age (n = 25 312, 88.0%) served as an external reference group.
  
  
  
  We found no significant differences between the underage abortion and the childbirth group regarding risks of psychiatric disorders (adjusted odds ratio 0.96 [0.67-1.40]) or suffering from intentional or unintentional poisoning by medications or drugs (1.06 [0.57-1.98]). Compared with those who gave birth, girls who underwent abortion were less likely to achieve only a low educational level (0.41 [95% confidence interval 0.31-0.54]) or to be welfare-dependent (0.31 [0.22-0.45]), but more likely to suffer from injuries (1.51 [1.09-2.10]). Compared with the external control group, both pregnancy groups were disadvantaged already prior to the pregnancy. Psychiatric disorders and risk-taking-related health outcomes, including injury, were increased in the abortion group and in the childbirth group similarly on both sides of the pregnancy.
  
  
  
  The retrospective nature of the study remains a limitation. The identification of study subjects in order to collect additional data was not allowed for ethical reasons. Therefore further confounding factors, such as the intentionality of the pregnancy, could not be checked.
  
  
  
  Previous studies have found that abortion is not harmful to mental health in the majority of adult women. Our study adds to the current understanding in suggesting that this is also the case concerning underage girls. Furthermore, women with a history of underage abortion had better socioeconomic outcomes compared with those who gave birth. These findings can be generalized to settings of high-quality social and health-care services, where abortion is accessible and affordable to all citizens. Social and health-care professionals who care for and counsel underage girls facing unplanned pregnancy should acknowledge this information.
  
  
  
  This study was financially supported by the Finnish Cultural Foundation and the Päivikki and Sakari Sohlberg Foundation. The researchers are independent of funders and the funders had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. The authors have no competing interests.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, P.O. Box 610, 00029-HUS Helsinki, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Leppälahti
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, P.O. Box 610, 00029-HUS Helsinki, Finland oskari.heikinheimo@helsinki.fi.
authors.forename: Oskari
authors.initials: O
authors.lastname: Heikinheimo
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, P.O. Box 610, 00029-HUS Helsinki, Finland Department of Surgery & Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kalliala
authors.affiliation: THL, National Institute for Health and Welfare, P.O. BOX 30, 00271 Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Santalahti
authors.affiliation: THL, National Institute for Health and Welfare, P.O. BOX 30, 00271 Helsinki, Finland Research Centre for Child Psychiatry, University of Turku, Turku, Finland Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000293:Adolescent; D000367:Age Factors; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000209:etiology*; D008603:Mental Health; D011247:Pregnancy; D012189:Retrospective Studies; D012309:Risk-Taking; D055815:Young Adult
keywords: abortion; health outcomes; socioeconomic outcomes; teenage motherhood; teenage pregnancy