Comment on ‘Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data’: authors’ response
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* Stephen J McCall
* Gillian Flett
* Emmanuel Okpo
* Sohinee Bhattacharya

*   abortion

We thank Rowlands *et al*.1 for their interest in our article and for raising the important issue of terminology with regard to more than one abortion. We would like to reiterate that the purpose of our article was to establish any underlying risk factors associated with women who had more than one abortion in Aberdeen, UK.2 Our study wished to characterise these women, so that future specialised care can be targeted at demographics that have an elevated likelihood of a further unplanned or mistimed pregnancy.

A recent review has shown that enhanced counselling at the time of abortion does not reduce the likelihood of a subsequent abortion.3 However, the use of implants and intrauterine devices after an initial abortion has been shown to decrease the incidence of subsequent abortions.4 Interestingly, our study showed that women who left with the implant at the first abortion were more likely to return for a subsequent abortion. On examination of the inter-termination period, implants were very good in terms of preventing repeat abortions in the 2-year time period, but thereafter became a risk factor for a subsequent abortion. This suggests that targeted care through the provision of a contraception recall system may help to encourage and support effective contraceptive coverage throughout the reproductive life course.

## Footnotes

*   Competing interests None declared.

## References

1.   Rowlands S , Hoggart L , Belfield T , et al . Comment on ‘Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data’. J Fam Plann Reprod Health Care 2016;42:157. [doi:10.1136/jfprhc-2016-101457](http://dx.doi.org/10.1136/jfprhc-2016-101457) 
    
    [FREE Full Text](http://jfprhc.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImZhbWlseXBsYW5uaW5nIjtzOjU6InJlc2lkIjtzOjg6IjQyLzIvMTU3IjtzOjQ6ImF0b20iO3M6MzE6Ii9mYW1pbHlwbGFubmluZy80Mi8yLzE1Ny4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.   McCall SJ , Flett G , Okpo E , et al . Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data. J Fam Plann Reprod Health Care 2016;42:133–42.[doi:10.1136/jfprhc-2014-101059](http://dx.doi.org/10.1136/jfprhc-2014-101059)
    
    [Abstract/FREE Full Text](http://jfprhc.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImZhbWlseXBsYW5uaW5nIjtzOjU6InJlc2lkIjtzOjg6IjQyLzIvMTMzIjtzOjQ6ImF0b20iO3M6MzE6Ii9mYW1pbHlwbGFubmluZy80Mi8yLzE1Ny4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.   Stewart H , McCall SJ , McPherson C , et al . Effectiveness of peri-abortion counselling in preventing subsequent unplanned pregnancy: a systematic review of randomised controlled trials. J Fam Plann Reprod Health Care 2016;42:59–67. [doi:10.1136/jfprhc-2014-101096](http://dx.doi.org/10.1136/jfprhc-2014-101096) 
    
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4.   Cameron ST , Glasier A , Chen ZE , et al . Effect of contraception provided at termination of pregnancy and incidence of subsequent termination of pregnancy. BJOG 2012;119:1074–1080. [doi:10.1111/j.1471-0528.2012.03407.x](http://dx.doi.org/10.1111/j.1471-0528.2012.03407.x) 
    
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