Abortion and sex-related conditions in substance-dependent Brazilian patients

Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Keywords:
Abortion; Sexual and Reproductive Health; Drug Users; Substance-related Disorders; Public Policies

	History of induced abortion						p-value
	Total (n = 616; 100.0%)		Yes (n = 165; 26.8%)		No (n = 451; 73.2%)
	n	%	n	%	n	%
Gender
Male	508	82.5	121	23.8	387	76.2	< 0.001 *
Female	108	17.5	44	40.7	64	59.3
Marital status
Unmarried	478	77.6	118	24.7	360	75.3	0.020 *
Married/Stable union	138	22.4	47	34.1	91	65.9
Ethnicity/Skin color/Race
White	336	54.5	101	30.1	235	69.9	0.027 *
Non-white	280	45.4	64	22.9	216	77.1
Religion
Catholic	325	52.7	73	22.5	252	77.5
Evangelical	130	21.2	43	33.1	87	66.9	0.070
Spiritualist/Umbanda/Candomblé/Other	81	13.2	26	32.1	55	67.9
Atheist/No religion	80	12.9	23	28.7	57	71.3
Educational level
Illiterate	72	11.7	69	95.8	3	4.2
Elementary school	219	35.5	156	71.2	63	28.8	< 0.001
Secondary school	223	36.2	161	72.2	62	27.8
Higher education/Graduate education	102	16.5	65	63.7	37	36.3
Occupational status
Retired	16	2.6	7	43.8	9	56.3
Registered employee	171	27.8	45	26.3	126	73.7	0.014
Non-registered employee/Liberal profession	356	57.8	95	26.7	262	73.3
Fully unemployed	62	10.1	11	17.7	51	82.3
Housewife	11	1.8	7	63.6	4	36.4
Income (minimum wage **)
≤ 1	225	36.1	45	20.0	180	80.0
2-3	215	34.9	63	29.3	152	70.7	0.022
4-5	98	15.9	27	27.6	71	72.4
6-7	28	4.5	11	39.3	17	60.7
≥7	50	8.1	19	38.0	31	62.0

	History of induced abortion						p-value
	Total (n = 616; 100.0%)		Yes (n = 165; 26.8%)		No (n = 451; 73.2%)
	n	%	n	%	n	%
Drug of choice
Alcohol	187	30.4	60	32.1	127	67.9	0.032 *
Cocaine (inhaled and smoked)	429	69.6	105	24.5	324	75.5
SAAD
Mild dependence	78	12.6	24	30.8	54	69.2	0.004
Moderate dependence	121	19.6	33	27.3	88	72.7
Severe dependence	175	28.4	61	34.9	114	65.1
Does not use alcohol	242	24.2	47	19.4	195	80.6
DAST
No problem/Low/Moderate	178	28.9	23	12.9	155	87.1	< 0.001
substantial/Severe	336	54.6	111	33.0	225	67.0
No illicit drug use	102	16.5	31	30.4	71	69.6
Tobacco
Yes	367	59.6	118	32.2	249	67.8	< 0.001 *
No	249	40.4	47	18.9	202	81.1
FTND
Very low/Low/Moderate	245	39.8	82	33.5	163	66.5	< 0.001
high/Very high	163	26.5	48	29.4	115	70.6
Non-smoker	208	33.7	35	16.8	173	83.2

	History of induced abortion						p-value
	Total (n = 616; 100.0%)		Yes (n = 165; 26.8%)		No (n = 451; 73.2%)
	n	%	n	%	n	%
Sexual activity in the past 12 months
Yes	440	71.4	141	32.0	299	68.0	< 0.001 *
No	176	28.6	24	13.6	152	86.4
Homosexual experience
Never	482	78.2	118	24.5	364	75.5	0.026
At least once	36	5.9	15	41.7	21	58.3
More than once	97	15.9	32	33.0	65	67.0
Sexual orientation
Heterosexual	573	93.0	156	94.5	417	92.5	0.239 *
Homosexual	43	7.0	9	5.5	34	7.5
Homosexual experience in exchange for drugs
Yes	66	10.7	25	37.9	41	62.1	0.025 *
No	550	89.3	140	25.5	410	74.5
Sex with sex workers
Yes	308	50.0	89	28.9	219	71.1	0.137 *
No	308	50.0	76	24.7	232	75.3
Condom use
No use	215	34.9	71	33.0	144	67.0	< 0.001
Sometimes	135	21.9	49	36.3	86	63.7
Always	266	43.1	45	16.9	221	83.1
History of STIs
Yes	145	23.5	58	40.0	87	60.0	0.530 *
No	471	76.5	107	22.7	364	77.3
HIV testing
Yes	401	65.0	133	33.2	268	66.8	< 0.001 *
No	215	35.0	32	14.9	183	85.1
Use of the morning-after pill
Yes	34	5.5	19	55.9	15	44.1	< 0.001 *
No	582	94.5	146	25.1	436	74.9
Number of sexual partners in the last 12 months
Up to 2	413	67.0	100	24.2	313	75.8	0.026
3 or more	203	33.0	65	32.0	138	68.0

	OR unadjusted (95%CI)	OR adjusted (95%CI)	p-value
Gender
Female	3.1 (1.42-3.89)	2.9 (1.75-4.76)	0.001
Male	1.00	1.00
Marital status
Unmarried	2.6 (1.04-2.37)	1.8 (1.13-3.12)	0.014
Married	1.00	1.00
Occupational status
Unemployed	2.8 (1.38-2.99)	2.4 (1.46-3.82)	0.001
Employed/others	1.00	1.00
Tobacco
Yes	2.0 (1.38-2.99)	1.6 (1.03-2.49)	0.037
No	1.00	1.00
Sexual activity in the last 12 months
Yes	2.9 (1.85-4.80)	2.0 (1.17-3.69)	0.013
No	1.00	1.00
Condom use
No use/Never use or sometimes	2.5 (1.73-3.78)	1.7 (1.09-2.75)	0.018
Always	1.00	1.00
History of STIs
Yes	2.2 (1.52-3.37)	2.0 (1.35-3.23)	0.001
No	1.00	1.0.
HIV testing
Yes	2.8 (1.84-3.37)	2.2 (1.32-3.53)	0.002
No	1.00	1.00
Use of the morning-after pill
Yes	3.7 (1.87-7.63)	3.2 (1.29-5.73)	0.003
No	1.00	1.00

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[1] * Correspondence A. Diehl Unidade de Pesquisa em Álcool e Drogas, Universidade Federal de São Paulo. Rua Botucatu 394, São Paulo, SP 04038-001, Brazil. alediehl@terra.com.br