Women's experiences of more than one termination of pregnancy within two years: a mixed-methods study

BJOG. 2017 Dec;124(13):1983-1992. doi: 10.1111/1471-0528.14940. Epub 2017 Oct 20.


Objective: To examine the experiences of women seeking more than one termination of pregnancy (TOP) within 2 years.

Design: Mixed methods study.

Setting: Six TOP services across Scotland.

Sample: Women presenting for TOP between July and December 2015.

Methods: Descriptive and inferential analysis of quantitative survey data, thematic analysis of qualitative interview data and integrative analysis. In quantitative analysis, multinomial logistic regression was used to compare three groups: previous TOP within 2 years, previous TOP beyond 2 years and no previous TOP.

Main outcome measures: Characteristics and experiences of women seeking TOP.

Results: Of 1662 questionnaire respondents, 14.6% (n = 242) and 19.8% (n = 329) reported previous TOP within and beyond 2 years, respectively. The previous TOP within 2 years group was significantly less likely to own their accommodation than the no previous TOP group (adjusted odds ratio [aOR] 0.34, 95% CI: 0.18-0.62) and previous TOP beyond 2 years group (aOR: 0.44, 95% CI: 0.23-0.85); and more likely to report inconsistent (aOR: 1.63, 95% CI: 1.04-2.57; aOR: 1.95, 95% CI: 1.16-3.28) and consistent (aOR: 2.13, 95% CI: 1.39-3.26; aOR: 1.71, 95% CI: 1.07-2.76) contraceptive use than the no previous TOP and previous TOP within 2 years groups, respectively. Twenty-three women from the previous TOP within 2 years group were interviewed. Qualitative and integrative analyses highlight issues relating to contraceptive challenges, intimate partner violence, life aspirations and socio-economic disadvantage.

Conclusions: Women undergoing more than one TOP within 2 years may experience particular challenges and vulnerabilities. Service provision should recognise this and move away from stigmatising discourses of 'repeat abortion'.

Funding: Scottish Government.

Tweetable abstract: Women having two or more terminations of pregnancy in 2 years may face key challenges/vulnerabilities including intimate partner violence and socio-economic disadvantage.

Keywords: Abortion stigma; health services; intimate partner violence; mixed methods; repeat abortion; termination of pregnancy.

MeSH terms

  • Abortion, Induced / economics
  • Abortion, Induced / psychology*
  • Abortion, Induced / statistics & numerical data*
  • Adult
  • Contraception Behavior / statistics & numerical data*
  • Family Planning Services
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Surveys
  • Humans
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pregnancy
  • Qualitative Research
  • Risk Factors
  • Scotland
  • Social Stigma
  • Socioeconomic Factors
  • Spouse Abuse / psychology
  • Spouse Abuse / statistics & numerical data*
  • Substance-Related Disorders / epidemiology
  • Young Adult