Roy G. Smith

The effects of induced abortion on subsequent reproductive function and pregnancy outcome: Hawaii.

Abstract Early malnutritional status has been associated with reduced cognitive ability in childhood. However, there are almost no studies on the effect of malnutrition on positive social behavior, and no tests of possible mediating mechanisms. This study tests the hypothesis that poor nutritional status is associated with impaired social functioning in childhood, and that neurocognitive ability mediates this relationship. We assessed 1553 male and female 3‐year‐olds from a birth cohort on measures of malnutrition, social behavior and verbal and spatial neurocognitive functions. Children with indicators of malnutrition showed impaired social behavior (p < .0001) as compared with children in the control group with adequate nutritional status. These associations even persisted after controlling for social adversity and parental education. Findings were not moderated by gender or ethnicity, and there was no interaction effect with parental education. A dose–response relationship was observed between degree of malnutrition and degree of social behavior, with increased malnutrition associated with more impaired social behavior. Neurocognitive ability was found to mediate the nutrition–social behavior relationship. The mediation effect of neurocognitive functioning suggests that poor nutrition negatively impacts brain areas that play important roles in developing positive social behavior. Findings suggest that reducing poor nutrition, alternatively promoting good nutrition, may help promote positive social behavior in early childhood during a critical period for social and neurocognitive development, with implications for improving positive health in adulthood.

Women who obtain repeat abortions: a study based on record linkage.

The proportion of induced abortions in a year that are repeat procedures rises over time, but this rate is as low as can be expected given the shortcomings of currently available contraceptives. There is no evidence that women substitute abortion for contraception. Teenagers and poor women have greater difficulty avoiding unwanted pregnancies.

Induced abortion and spontaneous fetal loss in subsequent pregnancies.

The effect of induced abortion on spontaneous pregnancy loss in subsequent pregnancies was studied based on 3,416 pairs of matched data in a follow-up investigation. Pregnancy outcome was examined also in relation to abortion procedure, gestation length at time of abortion, and number of previous abortions. In general there was no significant association between prior induced abortion and risks of pregnancy loss with the relative risks of 1.10, 0.88, and 0.81 for the first to third trimester respectively. A slight increase of first-trimester spontaneous loss was noted with the D&C/Suction procedure and early induced abortion (less than 9 weeks). The D&C procedure was associated with non-significant increase of second-trimester loss with the relative risk of 1.59.

Abortion in Hawaii: the first 124 days.

During the first 4 months of new abortion law in the state of Hawaii 1192 abortions were performed. The incidence of complications was 4.1% with no mortalities. The geographic distribution of patients and the number of M.D.s performing abortions did not follow the population distribution within the state. The religious distribution of patients generally paralleled that of the population. A disproportionately high percentage of caucasian patients were represented with an under-represented of Hawaiians. There is a relationship between length of gestation complications and costs.

The Effect of Induced Abortion on the Incidence of Down's Syndrome in Hawaii

There was a decrease in the recorded number of cases and in the incidence rate of Downs syndrome in Hawaii between 1963-1969 and 1971-1977. Independent of all other factors, induced abortion accounted for 43 percent of the decline in the number of cases, based on the assumption that a substantial number of clandestine abortions were being performed in Hawaii before the 1970 legalization of abortion. However, if we assume that very few illegal abortions were performed prior to 1970, there would have been an actual 3.5 percent increase in the number of cases of Downs syndrome in the absence of legal abortion. Declining pregnancy rates and decreasing age-specific incidence rates of Downs syndrome also contributed to the drop in the number of cases between 1963-1969 and 1971-1977.

Abortion in Hawaii.

Abortion experience in Hawaii, which was the first state to legalize induce abortion (in March 1970), at the request of the patient, is reviewed after its first year in terms of the number of abortions performed, the demographic and social characteristics of women seeking abortion, implementation of the law, and medical and legal complications. 3643 abortions were performed in 15 hospitals during the first year of legalized abortion. The ratio of abortions to live births was 1:45. Of the patients, 42.9% had been born and lived in Hawaii, 19.8% had lived in the state for less than 1 year, and the 90-day residency requirement was unfulfilled by 13.0%. Comparisons of women seeking abortions in Hawaii are similar to the statistics for the U.S. as a whole as reported by the Joint Program for the Study of Abortion. 20% were teenagers, 51% had no prior pregnancies, and 54% had never been married although 71% indicated involvement in a continuing relationship. Ethnic distribution showed 47% Caucasians, 21% Japanese, 10% Hawaiian or part-Hawaiian, 8.4% Filipino and 5.0% Chinese. Marital status by ethnic origin at the time of conception suggested that Filipin o women are more likely to use abortion to limit family size (69% were married) than the others. The abortion patients were considerably better educated than the states population of women of childbearing age although 66.5% of the women reported lack of contraceptive use as the reason for having to seek abortion to terminate their pregnancies. This figure suggests a group of women in need of contraceptive information and services. Most frequent complications were cervical laceration (22.5% of all complications), hemorrhage (19.5%), and infection (16%). Hawaiis law stipulates that abortion must be performed in hospitals by licensed physicians prior to viability of the fetus (undefined but generally regarded as after the twentieth week of gestation). Women under 18 experienced the most frequent frustration in delay, largely because of the required parental consent. Legal and financial barriers appeared to be the greatest cause of delays with most other patients. Average abortion costs were about

The utilization of conception cohorts for the evaluation of family planning programs

350, and 57.5% of the abortions were paid for by personal funds or loans obtained by the patients. Recommendations based on the years experience suggest greater assistance to the patient through state and private agencies in covering abortion costs either through subsidies or low-interest loans with minim al delay. Improved procedures to provide lowest cost service while maintaining standards of good health and increased efforts in disseminating information on family planning, contraception and sex education are also necessary.

INDUCED ABORTION AND ECTOPIC PREGNANCY IN SUBSEQUENT PREGNANCIES

Abstract Data were collected from women who conceived during specified period from 1971 through June 1973 in order to determine: (a) the rates of planned and unplanned conception throughout the state, over time and by clinic service area; and (b) the characteristics which are known to influence fertility behavior (age, marital status, and ethnic group) of those women who failed to plan their conceptions. These data were compared with the characteristics of women served by the family planning clinics in various areas to determine whether services were being extended to high risk groups. Evaluation of the groups in need of service in each clinic area, and comparison of these findings with the characteristics of women actually served by the clinic, identified areas where services were not being directed to groups in need. These area differences provided examples of situations potentially amenable to application of evaluation results in order to give direction to family planning services.