title: Why prevention of repeat abortion is so challenging: psychosocial characteristics of women at risk.
abstract: OBJECTIVE
  Abortion rates have declined in recent decades; however, the rate of repeat abortion remains high. In order to identify keys to making efficient interventions against repeat abortion, our objectives were: to assess the percentage of repeat abortions in women opting for termination of pregnancy over a period of 1 year; to identify the risk factors for repeat abortion; and to assess the characteristics of women who opted for a further pregnancy termination despite having received standard post-abortion care.
  
  
  METHODS
  A retrospective cross-sectional survey was carried out among 362 women who underwent pregnancy termination during a 1-year period. Women with and without repeat abortion were compared with regard to age, nationality, marital status, parity and use of contraception. In a subsample of 160 women who were available for follow-up over 4 years, those who underwent a further pregnancy termination during the observation period were also analysed qualitatively.
  
  
  RESULTS
  The rate of repeat abortion was 30.1% in the survey population. Age and immigrant status were identified as risk factors. The use of long-acting reversible contraception (LARC) was significantly higher after repeat abortion than after a first termination of pregnancy. Among women with repeat abortion in the follow-up group, those with psychological problems tended to discontinue contraception and those with partnership conflicts were prone to using unreliable contraceptive methods.
  
  
  CONCLUSIONS
  Aside from promoting LARC methods, strategies to reduce repeat abortion should consider the psychosocial risk factors and characteristics of women at risk identified in this study. An interdisciplinary approach including social care and counselling would be the most appropriate means to enable this.
authors.affiliation: a Clinic for Reproductive Endocrinology , University Hospital of Zürich , Zürich , Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Leeners
authors.affiliation: b Faculty of Medicine, University of Basel , Basel , Switzerland.
authors.forename: Simone
authors.initials: S
authors.lastname: Bieli
authors.affiliation: c Division of Social Medicine and Psychosomatics, Department of Obstetrics and Gynaecology , University Hospital of Basel , Basel , Switzerland.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Huang
authors.affiliation: c Division of Social Medicine and Psychosomatics, Department of Obstetrics and Gynaecology , University Hospital of Basel , Basel , Switzerland.
authors.forename: Sibil
authors.initials: S
authors.lastname: Tschudin
mesh_terms: D000028:Abortion, Induced / Q000523:psychology* / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D003267:Contraception / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017533:Marital Status; D010298:Parity; D011247:Pregnancy; D036301:Qualitative Research; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Contraception; immigrants; repeat abortion; risk factors; termination of pregnancy