Trends in teenage termination of pregnancy and its risk factors: A population-based study in Finland, 1987-2009

Abstract

STUDY QUESTION What are the current trends in teenage termination of pregnancy (TOP) and its risk factors? SUMMARY ANSWER The incidence of teenage TOP fluctuated substantially during the study period and the incidence of repeat TOP among adolescents increased markedly in the 2000s. WHAT IS KNOWN ALREADY Teenage pregnancy is associated with difficulties in psychological, sexual and overall health. The proportion of teenage pregnancies resulting in termination varies by country and time, but only few countries have reliable statistics on TOPs. STUDY DESIGN , SIZE, DURATION This nationwide retrospective register study included all the TOPs (n 52 968) and deliveries (n 58 882) in Finland between 1987 and 2009 among girls <20 years of age at the beginning of pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHODS The cohorts were divided into three subgroups; 1315- (n 6087), 1617- (n 18 826) and 1819- (n 28 055) year-olds. MAIN RESULTS AND THE ROLE OF CHANCE After an initial steady decline, the incidence of teenage TOP increased by 44 between 1993 (8.0/1000) and 2003 (11.5/1000), and thereafter declined by 16 until 2009 (9.7/1000). The incidence was higher in older adolescents, but the trends were alike in all age groups. Early TOPs (performed at <56 days of gestation) more than tripled from 11 to 36 during the study period. However, the proportion of second-trimester TOPs remained steady at ∼7. Young age [1315 years: odds ratio (OR) 1.75 (95 confidence interval (CI) 1.571.94), 1617 years: OR 1.13 (1.051.23), 1819 years: OR 1 (reference category)] and non-use of contraception [(OR 11.16 (10.1512.27)] were related to a higher risk of second-trimester TOP. The incidence of repeat TOP increased by 95 from 1.9/1000 to 3.7/1000 in 1819-year-olds and by 120 from 0.5/1000 to 1.1/1000 in 1617-year-olds between 1993 and 2009. Increasing age [1315 years: OR 0.16 (95 CI 0.140.19), 1617 years: OR 0.49 (0.450.52), 1819 years 1 (Ref)], living in an urban area [rural: OR 0.62 (0.560.67), urban: OR 1 (Ref)] and having undergone a second-trimester TOP [OR 1.46 (1.311.63)] were risk factors for repeat TOP. The planned use of intrauterine contraception for post-abortal contraception increased from 2.6 to 6.2 and among girls with repeat TOP from 10 to 19. LIMITATIONSThe retrospective nature of the study remains a limitation and the quality of the data is reliant on the accuracy of reporting. We were not able to link repeat TOPs of the same woman in our data set. However, the share of repeat abortions was moderate. WIDER IMPLICATIONS OF THE FINDINGS The rate of teenage TOP seems to rapidly reflect changes in national sexual and reproductive health services and policy. The rising rate of repeat TOP is alarming and may represent a sign of marginalization among these girls. All efforts to maintain a low rate of teenage pregnancy are welcomed. © The Author 2012.