Repeat abortion and associated factors among women seeking abortion services in northwestern China: a cross-sectional study

Repeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners. This cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi'an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson's chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed. Of 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08-1.73 for 31-35 years; 1.82, 1.29-2.57 for ≥36 years), received a low-level education (1.86, 1.42-2.43 for ≤senior high school; 1.46, 1.17-1.83 for junior college), were jobless (2.46, 1.18-5.13), had one child (1.54, 1.10-2.17), had a general (1.60, 1.28-1.98) or no (2.51, 2.02-3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09-1.61), withdrawal (1.43, 1.12-1.84), and emergency measures (1.48, 1.09-1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06-1.68 for 31-35 years; 2.13, 1.56-2.91 for ≥36 years), attained a low-level education (1.66, 1.28-2.15 for ≤senior high school; 1.38, 1.10-1.74 for junior college), received a high-level monthly income (1.34, 1.08-1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42-19.33) were more likely to have a repeat abortion. The study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practic