Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series

Correia, Luciano Lima; Rocha, Hermano Alexandre Lima; Leite, Álvaro Jorge Madeiro; Campos, Jocileide Sales; Silva, Anamaria Cavalcante e; Machado, Márcia Maria Tavares; Rocha, Sabrina Gabriele Maia Oliveira; Gomes, Thales Nogueira; Cunha, Antônio José Ledo Alves da

doi:10.1590/1806-93042018000100006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 18 (1) • Jan-Mar 2018 • https://doi.org/10.1590/1806-93042018000100006 copy

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil.

Methods:

series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models.

Results:

a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 – 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 – 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 – 39.05) and not having any children (AOR= 3.43).

Conclusions:

rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Key words
Women health; Abortion rate; Prevalence study; Brazil; Epidemiologic determinants

	1994	2001	2007
Total number of abortions	158	100	93
Number of spontaneous abortions	117	69	86
Number of induced abortions	41	31	7
Percentage of induced abortions^* * Proportion of all abortion episodes;	25.9	31.0	7.5
Induced abortion ratio^ induce abortion per 100 spontaneous abortions.	35	45	8

	1994	2001	2007	p
% of pregnancies ending in abortions^* * An estimate of pregnancies in the previous 12 months, including births and abortions;
Spontaneous abortions	12.5	10.2	13.8
Induced abortions	4.4	4.6	1.1
All abortions	16.9	14.8	15.0
Abortion Ratios^ Abortions per 100 livebirths.
Spontaneous abortions	15.1	12.0	16.3	0.854
Induced abortions	5.3	5.4	1.3	0.375
All abortions	20.4	17.4	17.6	0.343

Factors	Sample proportion (%)	Prevalence of induced abortion (%)	Odds Ratio	CI95%	p
Literate women
Yes	88.4	0.2	1.31	0.51 - 3.34
No	11.6	0.3	1		0.568
Has companion
Yes	50.0	0.2	4.60	2.51 - 8.45
No	50.0	1.1	1		< 0.001^† † Included in model;
Women age (years)
10 to 19	20.9	1.5	2.,60	5.08 - 10.50
20 to 29	46.5	0.6	9.82	2.29 - 42.07	< 0.001^† † Included in model;
30 to 39	27.9	0.3	4.94	1.10 - 22.12
40 to 49	4.7	0.1	1
Years of schooling
Up to 4	2.3	0.2	0.50	0.46 - 5.60
5 to 8	74.4	0.5	1.29	0.31 - 5.42	0.432
9 to 12	18.6	0.3	0.73	0.15 - 3.43
13 to 16	4.7	0.4	1
Age of menarche (years)
Up to 10	7.0	1.0	3.08	0.31 - 29.77
11 to 12	37.2	0.5	1.39	0.18 - 10.57	0.688
13 to 14	41.9	0.4	1.25	0.16 - 9.44
15 to 16	11.6	0.3	0.89	0.10 - 7.64
19 and on	2.3	0.3	1
Age at first sexual intercourse(years)
Up to 13	18.6	1.6	7.10	0.88 - 5700
14 to 17	53.5	0.5	2.37	0.32 - 17.61	< 0.001^†† †† Not included in model for collinearity.
18 to 25	25.6	0.2	1.03	0.13 - 8.00
25 to 35	2.3	0.2	1
Use contraceptive methods
Yes	61.5	0.5	0.83	0.43 - 1.59
No	38.5	0.5	1		0.585
Had sexual intercourse the last 30 days?
Yes	59.5	0.3	0.56	0.30 - 1.05
No	40.5	0.6	1		0.073
Used condom in the last sexual intercourse
Yes	38.5	0.7	2.74	1.24 - 6.05
No	61.5	0.3	1		0.013^† † Included in model;
Knows the morning-after pill
Yes and used	7.0	0.8	1.79	0.54 - 5.89
Yes	23.3	0.3	0.66	0.32 - 1.36	0.280
Doesn't know	69.8	0.4	1
Number of pregnancies
One	26.2	0.4	1.18	0.46 - 3.07
2 to 4	57.1	0.4	1.12	0.48 - 2.62	0.938
5 or more	16.7	0,.	1
Age of first pregnancy (years)
Up to 14	23.3	1.9	1.82	0.23 - 14.38
15 to 17	34.9	0.6	0.54	0.07 - 4.14	< 0.001^† † Included in model;
18 to 25	34.9	0.2	0.23	0.03 - 1.75
26 to 35	4.7	0.2	0.14	0.01 - 1.65
36 or more	2.3	1.0	1
Age when had first child (years)
Up to 14	6.9	0.5	6.63	0.60 - 73.35
15 to 17	34.5	0.5	6.74	0.86 - 52.75	0.162
18 to 25	55.2	0.2	3.52	0.46 - 26.58
26 to 35	3.4	0.1	1
Number of children
None	3.6	3.5	1.12	4.29 - 40.09
One	25.6	0.4	1.40	0.44 - 4.40	< 0.001^† † Included in model;
2 to 4	32.6	0.2	0.86	0.28 - 2.3
5 or more	9.3	0.3	1
Wanted the child
Yes	35.5	0.2	0.50	0.24 - 1.04
No	64.5	0.4	1		0.066
How many more children intended
None	44.2	0.2	0.12	0.05 - 0.26
One	34.9	0.8	0.40	0.17 - 0.92	< 0.001^† † Included in model;
2 to 4	20.9	1.9	1
How many antenatalcare visits in last pregnancy
None	86.8	0.7	1.97	0.47 - 8.25
1 to 3	7.9	3.6	10.66	1.75 - 64.82	0.032^† † Included in model;
7 or more	5.3	0.4	1

Factors	Sample proportion (%)	Prevalence of induced abortion (%)	Odds Ratio	CI95%	p
Literate women
Yes	87.4	1.5	1.20	0.75 - 1.92	0.443
No	12.6	1.3	1
Has companion
Yes	80.5	1.5	1.10	0.74 - 1.64	0.611
No	19.5	1.6	1
Women age (years)
10 to 19	18.4	4.8	6.79	3.90 - 11.83	< 0.001^† † Included in model;
20 to 29	35.4	1.7	2.40	1.47 - 3.91
30 to 39	31.6	1.3	1.79	1.09 - 2.95
40 to 49	14.6	0.7	1
Years of schooling
Up to 4	4.4	1.3	0.78	0.29 - 2.12	0.194
5 to 8	55.1	1.3	0.78	0.39 - 1.55
9 to 12	34.8	1.9	1.12	0.55 - 2.29
13 to 16	5.7	1.7	1
Age at menarche (years)
Up to 10	5.0	2.6	2.76	0.72 - 10.52	0.008^† † Included in model;
11 to 12	45.3	2.0	2.11	0.66 - 6.75
13 to 14	35.8	1.3	1.33	0.41 - 4.27
15 to 16	11.3	1.0	1.06	0.31 - 3.65
17 to 18	0.6	0.3	0.33	0.03 - 3.19
19 and on	1.9	1.0	1
Age of first sexual intercourse (years)
Up to 13	5.9	1.7	0.98	0.37 - 2.57	0.024^† † Included in model;
14 to 17	5.9	1.9	1.05	0.50 - 2.19
18 to 25	34.9	1.1	0.61	0.29 - 1.30
25 to 35	5.3	1.8	1
Use contraceptive methods
Yes	65.3	1.8	1		0.072
No	34.7	1.3	0.70	0.48 - 1.03
Had sexual intercourse the last 30 days?
Yes	75.0	1.6	1.16	0.81 - 1.66	0.408
No	25.0	1.3	1
Used condom in the last sexual intercourse
Yes	22.0	1.9	1.23	0.80 - 1.89	0.340
No	78.0	1.5	1
Knows the morning-after pill
Yes and used	6.3	2.6	2.20	1.13 - 4.29	0.002^† † Included in model;
Yes	42.5	2.0	1.66	1.20 - 2.30
Doesn't know	51.2	1.2	1
Number of pregnancies
One	22.6	1.4	1.18	0.70 - 2.00	0.240
2 to 4	62.9	1.6	1.43	0.91 - 2.26
5 or more	14.5	1.1	1
Age at first pregnancy (years)
Up to 14 years	5.0	1.5	0.27	0.08 - 0.86	< 0.001^† † Included in model;
15 to 17	35.0	2.1	0.39	0.15 - 1.00
18 to 25	41.3	1.1	0.19	0.07 - 0.49
26 to 35	15.6	2.0	0.36	0.13 - 0.97
36 or more	3.1	5.2	1
Age when had first child (years)
Up to 14	13.1	4.2	2.65	1.41 - 4.96	< 0.001^† † Included in model;
15 to 17	24.1	1.6	0.96	0.56 - 1.64
18 to 25	46.0	1.0	0.59	0.37 - 0.96
26 to 35	16.8	1.6	1
Number of children
None	25.9	10.2	14.95	7.60 - 29.37	< 0.001^† † Included in model;
One	33.5	1.8	2.47	1.29 - 4.76
2 to 4	33.5	0.9	1.19	0.62 - 2.29
5 or more	7.0	0.8	1
Wanted the child
Yes	57.1	1.5	1.22	0.87 - 1.70	0.247
No	42.9	1.2	1
How many more children intended
None	37.5	0.7	0.11	0.07 - 0.17	< 0.001^† † Included in model;
One	43.8	3.5	0.55	0.35 - 0.86
2 to 4	18.8	6.2	1
How many antenatal care visits in last	pregnancy
None	88.2	1.4	1.33	0.57 - 3.09	0.481
1 to 3	1.3	1.2	1.14	0.13 - 9.66
4 to 6	2.6	0.5	0.47	0.09 - 2.35
7 or more	7.9	1.1	1

Variable	Adjusted OR	Adjusted CI	p
Induced abortion^* * Variables included in the model: Has companion; Used condom in the last sexual intercourse; How many more children want; Age at first offspring; Women age; Age of first sexual intercourse;
Doesn't have companion	3.79	2.50 - 5.75	< 0.001
Used condom in the last sexual intercourse	1.95	1.31 - 2.92	0.001
Wants one or more additional child	3.45	2.34 - 5.09	< 0.001
Age at first offspring up to 25 years-old	5.21	2.90 - 9.34	< 0.001
Women's age up to 19 years-old	2.54	1.65 - 3.91	< 0.001
Age at first sexual intercourse up to 13 years-old	5.88	3.29 - 10.51	< 0.001
Spotaneous abortion^ Variables included in the model: Years studied, Age of menarche, Knows the next day pill, used condom in the last sexual intercourse; How many more children want; Women age; Number of children.
Schooling up to 8 years	1.66	1.11 - 2.49	0.013
Knew and had already used morning-after pill	26.44	17.90 - 39.05	< 0.001
Want one or more other child	3.81	2.61 - 5.58	< 0.001
Women age up to 19 years-old	13.47	8.99 - 20.19	< 0.001
Doesn't have children	4.43	2.97 - 6.59	< 0.001

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[TFN1] ^*
Proportion of all abortion episodes;

[TFN2] ^**
induce abortion per 100 spontaneous abortions.