Repeat induced abortion: what are the risk factors? A systematic review

Abortion remains a sensitive and highly debated topic globally, with significant variations in legal frameworks between countries. Although abortion rates differ considerably between regions, repeat induced abortions (RIA) continue to represent a public health concern in many settings. This study aims to identify and analyse risk factors for RIA and their interconnections.

We conducted a systematic review of the literature, examining 34 articles from various regions around the world. Exclusions included studies focused on spontaneous abortion, induced abortion for medical reasons, and systematic reviews, meta-analyses, or non-conclusive studies. The selected articles encompassed data on 373,424 women. This review was registered in PROSPERO (CRD420251003863) and conducted according to PRISMA guidelines.

Across 34 studies including 373,424 women, the most frequently reported risk factors for repeat induced abortion (RIA) were older age, higher parity, lower educational attainment, urban residence, contraceptive failure or misuse, intimate partner violence, adverse childhood experiences, and substance use. Several studies also showed that early initiation of contraception after the first abortion-particularly with long-acting reversible contraceptives (LARCs)-reduced the likelihood of subsequent abortions.

Addressing these risk factors with comprehensive support can significantly improve women's reproductive health and reduce the occurrence of RIA.