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Epidemiological Study of Abortions in Singapore1Limin Lim, 2Hungchew Wong 1Euleong Yong, 1Kuldip Singh

1Department of Obstetrics and Gynaecology, National University Health Systems; 2Yong Loo Lin School of Medicine, National University of Singapore

Introduction, Objectives and Methodology Results Conclusions and Recommendations

References

[1] Singh K, Prasad RN, Ratnam SS. Abortion trends in Singapore: a 25-year review. J Pediatr Adolesc Gynecol 1996; 9: 27-30.[2] Sykes P. Complications of termination of pregnancy: a retrospective study of admissions to Christchurch Women's Hospital 1989 and 1990. N Z Med J. 1993; 106: 83-5. [3] Banerjee B, Pandey G, Dutt D, Sengupta B, Mondal M, Deb S. Teenage pregnancy: a socially inflicted health hazard. Indian J Community Med 2009; 34: 227-31. [4] Phupong V, Suebnukarn K. Obstetric outcomes in nulliparous young adolescents. Southeast Asian J Trop Med Public Health 2007; 38: 141-5. [5] Singh K, Fong YF, Loh SY. Profile of women presenting for abortions in Singapore at the National University Hospital. Contraception 2002; 66: 41-6. [6] Daly JZ, Ziegler R, Goldstein DJ. Adolescent postabortion groups: risk reduction in a school-based health clinic. J Psychosoc Nurs Ment Health Serv 2004; 42: 48-54.

IntroductionAbortion has been legalized in Singapore by the Abortion Act

of 1970, resulting in a dramatic increase in the number of abortions beginning in 1974 and peaking in 1985, where 35% of all pregnancies were terminated [1].

Abortions may lead to undesirable complications, frequency of which increases with gestational age, particularly after 14 weeks [2]. Pregnancies in teenagers also have increased risk of complications such as anemia [3][4], stillbirths, preterm deliveries and low birth weights.

Objectives1) Characterise the profiles of teenage abortions and

compare them to the general population 2) Identify risk factors for second trimester terminations3) Make recommendations to curb the rising trend in

abortions

MethodologyThis retrospective study was approved by the National Health

Group Domain-Specific Review Board of the hospital and conducted on women who presented for abortions at the National University Hospital in Singapore from January 1, 2005 through December 31, 2009.

Sociodemographic and obstetric data including ethnic groups, educational level, activity status, marital status, parity, history of previous abortions, gestation period, contraceptive usage and reason for termination was collected from these women through an interview with the abortion counsellors.

Teenage pregnancies are defined as pregnancies occurring in females aged below 20 years of age, hence characteristics of women in the teenage age group (< 20 years) were compared to those ≥ 20 years to find out if there are any significant differences in their profiles. We also studied the risk factors associated with mid-trimester abortions up to 24 weeks gestation.

Analysis was carried out only on the group of women with single abortion throughout the study period so as to prevent erroneous multiple analysis of the profile of a single woman with multiple abortion records.

ConclusionsTrend of increasing abortions over last decade highlighted, increasing from 1370 (1996-2000) to 2230 (2005-2009) [5], with Malay teenagers identified as a high-risk populationTeenagers are more likely to present late for abortions and have no prior usage of contraceptionImportant risk factors for late abortions include: young age, Malay ethnicity, singlehood, nulliparity and no prior contraceptive usage

RecommendationsTo target the Malay teenagers, a high-risk group for abortions

Additional attention by school nurses in terms of education on abstinence if contraception not in line with religious beliefs

Support for families to prevent drop-outs in Malay teenagers

Teenage postabortion groups set up in school-based clinics to reduce risks of repeated pregnancies [6]

Results

OPTIONALLOGO HERE

OPTIONALLOGO HERE

Total(n = 1998)

<20 years(n = 182)

≥20 years(n = 1816)

P-value

Ethnicity

Chinese 663(33.2%) 62 (34.1%) 601 (33.1%) 1

Malay 727 (36.4%) 99 (54.4%) 628 (34.6%) < 0.001

Indian 514 (25.7%) 16 (8.8%) 498 (27.4%) < 0.001

Others 94 (4.7%) 5 (2.7%) 89 (4.9%) 0.764

Trimester of termination

First trimester 1637(81.9%)

110 (60.4%)

1527(84.1%)

< 0.001

Second trimester 361 (18.1%) 72 (39.6%) 289 (15.9%) < 0.001

Contraceptive usage

Practised up to time of pregnancy

1122(56.2%)

81 (44.5%)

1041(57.3%)

0.003

Discontinued after pregnancy

325 (16.2%) 8 (4.4%) 317 (17.5%) < 0.001

Never practised 551 (27.6%) 93 (51.1%) 458 (25.2%) < 0.001

Adjusted OR (95% CI) P-value

Age

< 20 years old 1.99 (1.33 to 2.97) 0.001

≥ 20 years old 1.00

Ethnicity

Malay vs Chinese 1.95 (1.44 to 2.64) < 0.001

Malay vs Indian 1.59 (1.14 to 2.22) 0.036

Marital status

Single or divorced 1.68 (1.19 to 2.38) 0.003

Married 1.00

Parity

0 1.78 (1.27 to 2.51) 0.001

1+ 1.00

Prior usage of contraception

No prior usage of contraception 2.71 (2.11 to 3.48) < 0.001

With prior usage of contraception

1.00

Education Level

Secondary Level and above 0.96 (0.57 to 1.63) 0.960

Primary Level 1.00

Table 2: Table depicting comparison between population of women below 20 years and above 20 years

Table 3: Specific risk factors for late (second-trimester) termination of pregnancy

14199 gravid women comprising deliveries and abortions were attended to at NUH between 2005-20092109 women underwent induced abortions

1998 (94.7%) women had only 1 record of abortion111 (5.3%) women had more than 1 record of abortions

Age: mean of 29.1 years90.9% ≥ 20 years, 9.1% < 20 years

Marital status66.4% married, 33.6% single

Parity67.1% multiparous, 32.9% nulliparous

Timing of abortions81.9% first trimester, 18.1% second trimester

Educational levels94.3% at least secondary education, 5.7% primary education

Contraceptive usage72.4% used contraception, 27.6% never used contraception

Reasons for termination of pregnancy86.8% socioeconomical reasons (single, enough children, financial issues, too close to last pregnancy, not ready to start another family)5.7% medical reasons or fetal anomalies2.0% advanced maternal age1.5% contraceptive failure4.1% others e.g. marital problems

Ethnicity

Race Gravid women (deliveries plus abortions)

N=14199

Women with 1 abortion (% of gravid women)

n=1998

Chinese 5531 663 (12.0%)

Malay 4966 727 (14.6%)

Indians 2922 514 (17.6%)

Others 780 94 (12.1%)

Table 1: Ethnic distribution of women undergoing abortions in NUH (2005-2009)