Original Report
Trends in Induced Abortions in Greece: A Cross-sectional Study

https://doi.org/10.1016/j.jpag.2019.11.006Get rights and content

Abstract

Study Objective

Teenage pregnancies and associated induced abortions represent an important public health issue. The aim of this study was to investigate the prevalence, the time trends, and associated factors of teenage induced abortions in Greece.

Design

A cross-sectional study was conducted between 2018 and 2019.

Setting

Third Academic Department of Obstetrics and Gynecology of the Aristotle University of Thessaloniki.

Participants

All pregnant women who underwent a second trimester anomaly scan were eligible for the study.

Interventions and Main Outcome Measures

Epidemiological characteristics were recorded and 5 age groups were created. Trends in the rates of teenage induced abortions were analyzed and we compared several parameters between women with and without history of abortions.

Results

Overall, 3370 women were eligible and agreed to participate in the study. The prevalence of women who reported a history of at least 1 abortion at 15-19 years was 9.7% (n = 328/3370). The abortion rates across the 5 age groups were: 20-24: 7.5%; 25-29: 8.4%; 30-34: 8.2%; 35-39: 12%; and 40 years and older: 13.9%. Moreover, a history of 1 or more teenage abortions was more common in multiparous women (58.2% vs 46.5%; P < .001; odds ratio, 1.605; 95% confidence interval, 1.274-2.022) and in current smokers (27.4% vs 11%; P < .001; odds ratio, 3.066; 95% confidence interval, 2.346-4.008).

Conclusion

A significant decline in the teenage induced abortion rates was identified in the study population. A history of teenage induced abortion was associated with smoking and multiparity. More efforts are needed to provide appropriate education on effective contraception and family planning.

Introduction

Most adolescent or teenage pregnancies, which occur from menarche and before 20 years of age, are unwanted as a result of ineffective contraception and often result in induced abortion over concerns regarding starting a family too early and the possible negative effect on personal career plans.1 Worldwide, more than 15 million women between the ages of 15 and 19 years give birth every year and approximately a third of them have an abortion.2 In Europe, there is an estimated prevalence of teenage induced abortions (TIAs) of 12.2%.3 Moreover, published data have shown that countries from northern Europe report the highest rates of TIA (United Kingdom and Sweden reported rates of 22.5%), whereas the lowest rates have been reported from southern and western Europe (in Malta abortions are prohibited so the reported rates are 0.0%).3 Moreover, in the United States the reported rate was 29.2%, whereas in Russia it was as high as 56.1%.4 In most high-income countries induced abortions mostly involve young, unmarried women who opt for a delay of a first birth, whereas in low-income countries abortions are more common in married multiparous women who have completed their families.5

Teenage sexual behavior is influenced by social environment and the promotion of the use of effective contraception through sexuality education seems to play a crucial role.6,7 The availability of effective family planning services and the legislation regarding abortions also affect the number of teenage pregnancies. Moreover, in Greece, family has a strong influence on decisions that affect its members, including sexuality and marriage.8 Unfortunately, most children and teenagers in Greece report that they rarely discuss sex behavior issues with their parents and prefer to ask their peers or watch television or refer to the Internet to get the relevant information.9 In fact, it is proven that poor sexuality education, which is not mandatory in Greece, including effective contraceptive methods is a major issue.9 Regarding baseline data on teen sexual activity in Greece, there is no official database to extract valid data.

In a recent study conducted in Greece, more than 40% of women hospitalized due to pregnancy complications reported their pregnancy as unplanned.10 Moreover, women who eventually decide to continue with an unwanted pregnancy might show increased rates of hypertensive disorders, abnormal bleeding, anemia, antenatal depression, postpartum hemorrhage, and need for blood transfusion.11,12

In Greece, induced abortions up to 12 gestational weeks became legal in 1986 and there is a strict legislation securing the safety of these procedures. However, there is no central registry of the procedures and there is a lack of valid statistics on the actual rates of induced abortions overall and in particular among teenagers. Thus, the aim of this study was to investigate: (1) the prevalence; (2) the trends of TIA for women reaching menarche after 1986 in Greece; and (3) identify possible associations of a history of TIA with specific current characteristics of the women. This study is not only helpful for the public health in Greece, but it is also useful for creating a broader picture for Europe and better comparisons of health policies.

Section snippets

Study Design

This cross-sectional study was conducted from February 2018 to February 2019 in the Third Academic Department of Obstetrics and Gynecology of the Aristotle University of Thessaloniki. This is a tertiary center that covers a population of more than 2 million in Northern Greece. All pregnant women who underwent the routine anomaly scan (between 20 and 24 gestational weeks) and were 20 years of age or older, were eligible to participate in the study. This point in pregnancy was chosen because the

Results

A total of 3560 women fulfilled the inclusion criteria and 3370 (94.7%) of them agreed to participate in the study. All of the participants reported first sexual activity after 15 years of age. The prevalence of women who reported at least 1 TIA at 15-19 years was 9.7% (n = 328/3370). Of these, 271 women (82.6%) reported history of 1 TIA, 45 (13.7%) reported history of 2, and 12 women (3.7%) reported a history of 3 or more TIAs. The 5 maternal age groups consisted of: 20-24, 214 (6.3%); 25-29,

Discussion

This study showed a significant decline in the rates of TIA in Greece in a sample of almost 3500 women. In this sample, approximately 1 of 10 women reported a history of at least 1 induced abortion at the age of 15-19 years (9.7%; n = 328), whereas the rates of TIA among the different age groups ranged from 7.5% to 14%. This proportion is lower compared with some European countries such as France (15.2%) but almost double than in others (eg, Germany, 5.9%).3

Additionally, a decline in the rates

References (18)

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Cited by (3)

  • The impact of COVID-19 on abortion access: Insights from the European Union and the United Kingdom

    2021, Health Policy
    Citation Excerpt :

    The Court of Hague rejected the case by publishing the judgment [116]in which it refused to allow access to EMAvia alternative methods and invited the plaintiffs to comply with the existing abortion regulations.Abortions in Greece are available on request until the 12th week of pregnancy. It has been reported that during the pandemic, many Greek women choose to see a private gynecologist to avoid delays that are common with the public system [117]. Difficulties for migrant woman in access are also highlighted [118].

The authors indicate no conflicts of interest.

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