Epidemiological Study of Abortions in Singapore

1. Epidemiological Study of Abortions in Singapore 1Limin Lim, 2Hungchew Wong 1Euleong Yong, 1Kuldip Singh1Department of Obstetrics and Gynaecology, National University Health Systems; 2Yong Loo Lin School of Medicine, National University of Singapore OPTIONALLOGO HERE OPTIONALLOGO HERE Introduction, Objectives and Methodology Results Results Conclusions and Recommendations • Introduction • Abortion 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. • Objectives • Characterise the profiles of teenage abortions and compare them to the general population • Identify risk factors for second trimester terminations • Make recommendations to curb the rising trend in abortions • Methodology • This 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. • Conclusions • Trend 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 population • Teenagers are more likely to present late for abortions and have no prior usage of contraception • Important risk factors for late abortions include: young age, Malay ethnicity, singlehood, nulliparity and no prior contraceptive usage Recommendations • To 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] • 14199 gravid women comprising deliveries and abortions were attended to at NUH between 2005-2009 • 2109 women underwent induced abortions • 1998 (94.7%) women had only 1 record of abortion • 111 (5.3%) women had more than 1 record of abortions • Age: mean of 29.1 years • 90.9% ≥ 20 years, 9.1% < 20 years • Marital status • 66.4% married, 33.6% single • Parity • 67.1% multiparous, 32.9% nulliparous • Timing of abortions • 81.9% first trimester, 18.1% second trimester • Educational levels • 94.3% at least secondary education, 5.7% primary education • Contraceptive usage • 72.4% used contraception, 27.6% never used contraception • Reasons for termination of pregnancy • 86.8% socioeconomical reasons (single, enough children, financial issues, too close to last pregnancy, not ready to start another family) • 5.7% medical reasons or fetal anomalies • 2.0% advanced maternal age • 1.5% contraceptive failure • 4.1% others e.g. marital problems • Ethnicity 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 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. Table 1: Ethnic distribution of women undergoing abortions in NUH (2005-2009)