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Repeat abortion: is it a problem?

As the number of Canadian women who have had induced abortions increases with each succeeding year, the number at risk--and the actual incidence--of repeat abortion also increases. Some researchers have argued that women who have more than one induced abortion are less well adjusted, others that they are less willing to use contraceptives, perhaps because of anxiety about sexuality. Still others have suggested that repeat abortion is unrelated to the psychology or attitudes of individual women, but rather is an inevitable result of imperfect contraceptives, imperfect contraceptive practice and the availability of legal abortion for the termination of unwanted pregnancies. A group of 580 women seeking abortions were interviewed at the Montreal General Hospital and given a number of psychological tests. About one in five of these women were having repeat abortions. The women having repeat abortions were older, less likely to be married and more tolerant of legal abortion than were women having their first abortions. They also had intercourse more frequently than the first-abortion patients. Women obtaining a repeat abortion were slightly more likely to have been using contraceptives at the time they became pregnant, but they did not differ from first-abortion patients in the types of methods that they used. On no other social or demographic characteristics, measures of psychological adjustment or attitudes about sexuality were there any important differences between the groups. A more complex statistical analysis reveals that the two most important factors differentiating first-abortion and repeat-abortion patients are age and coital frequency--both of which are variables that reflect added exposure to the risk of unintended pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗

Black teenage pregnancy: an obstetrician's viewpoint.

The Black pregnant teen is a microcosm of the impact of society on the most vulnerable. Who is the pregnant adolescent? What racial and ethnic connotations are implied? What is the quality of her progeny? What health risks and mortality attend Black pregnant adolescents? What measures are indicated to address teen pregnancy? Health providers must more intensively address the essentials of the socio-medical phenomenon of Black teenage pregnancy. The United States leads other developed countries of the world by substantial margins in births to teenagers, ranging from 3/1,000 in Japan to 52/1,000 in the United States. In 1983 in New York City, 40,000 teenagers became pregnant resulting in 14,000 births, 20,000 abortions, and 6,000 miscarriages. Sixty-six percent of the births occurred in areas with large concentrations of residents of lower socio-economic status. Special attention, then, needs to be focused on both pregnancy prevention and early prenatal care in these high risk areas. Most teenagers do not intend to become pregnant. There are suggested racial differences regarding both the intention of becoming pregnant and teen births. Twenty percent of pregnant teenagers conceive during the first sexual exposure and fifty percent become pregnant within the first six months. The younger the age at initiation of intercourse, the greater the likelihood of pregnancy. The desire to terminate a teen pregnancy is more closely associated with socio-economic status than ethnicity. The course of pregnancy in teenagers is more likely to be complicated by a variety of clinical problems than in adults. Further, the maternal mortality rate in pregnant black teenagers is significantly higher than in white teenagers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

The risk of premarital first pregnancy among metropolitan-area teenagers: 1976 and 1979.

Among sexually active teenage women living in metropolitan areas of the United States, the risk of premarital pregnancy within two years of first sexual intercourse rose from 32 percent in 1976 to 36 percent in 1979. As of 1979, 33 percent of unmarried white teenagers, and 43 percent of unmarried black teenagers, had conceived within 24 months of becoming sexually active. The increase in pregnancy risk between 1976 and 1979 was relatively greater for whites than for blacks at three, six and 12 months after first intercourse. The reverse was true at later intervals. The risk of pregnancy is disproportionately concentrated in the early months of sexual activity. Forty-five percent of all premarital pregnancies among those interviewed in 1979 had been conceived within the first six months of sexual activity, and 36 percent had been conceived within three months. In 1976, 27 percent of teenagers who had become sexually active before the age of 15 were premaritally pregnant within two years. By 1979, this proportion had risen to 41 percent--a 52 percent increase in the risk that accounts for almost all of the total three-year increase in premarital pregnancies among sexually active teenagers. The most pronounced increase in risk of pregnancy was registered among whites who became sexually active when they were younger than 15. Their 24-month probability of conception rose from 20 percent in 1976 to 39 percent by 1979. Levels of risk for unwed teenagers who initiated intercourse at ages 15-19 increased relatively little.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Cognitive development and adolescent contraception: integrating theory and practice.

The cognitive skills that develop during adolescence are crucial to successful contraceptive practice because most birth control methods require at least a minimal ability to plan for, acquire, and utilize them at the appropriate time. Consequently, we must understand the special developmental setting in which adolescent sexual growth and experimentation occurs in order to have an impact on their contraceptive use. To provide optimal service to adolescents, the developmental and medical aspects should be taken into account in order to determine the best choice for each patient. This article demonstrates how mental health and medical providers can work together to better serve the adolescent population.

Adolescent↗

HIV infection and associated risk factors in female prostitutes in Kinshasa, Zaire.

In Africa, female prostitutes represent a high risk group for HIV infection. In Kinshasa, Zaire, 101 (27%) out of 377 prostitutes were seropositive to HIV by ELISA and Western blot determination. Seropositivity was significantly associated with the number of lifetime partners with a median number of 600 partners, four seropositives and 338 for seronegative individuals (P = 0.02). Seropositivity was also significantly associated with a history of taking oral medications for the prevention of sexually transmitted diseases and/or pregnancy (odds ratio = 2.21, confidence interval = 1.2-4.2), and with the introduction of any product into the vagina for hygiene or other purposes (odds ratio = 2.3, confidence interval = 1.1-4.7). In addition, among 85 prostitutes reporting condom use by their sexual partners during the previous year, the use of condoms by 50% or more of partners was associated with a reduced risk of HIV seropositivity (P = 0.046). An increased risk of HIV seropositivity was not associated with fellatio, anal intercourse, or with any type of kissing. Twenty-nine per cent of prostitutes reported at least one symptom suggestive of HIV infection, and seropositivity was associated with weight loss, either with or without chronic diarrhea or pruritic dermatitis. These data confirm that African prostitutes are at high risk for HIV infection and that the number of lifetime sexual partners, and factors which interfere with the integrity of the vaginal or cervical mucosa, may be associated with an increased risk of HIV infection acquired through heterosexual contact.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗