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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
  1. Stephen J McCall, MSc
  1. Gillian Flett, FRCOG, FFSRH
  1. Emmanuel Okpo, MBBS, FFPH
  1. Sohinee Bhattacharya, MBBS, PhD
  1. Research Assistant, Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK and DPhil Student, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; stephen.mccall{at}
  2. Consultant in Sexual and Reproductive Health, Department of Sexual Health, NHS Grampian, Aberdeen, UK; gillian.flett{at}
  3. Consultant in Public Health Medicine, Department of Public Health, NHS Grampian, Aberdeen, UK; emmanuel.okpo{at}
  4. Senior Lecturer in Obstetric Epidemiology, Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK; sohinee.bhattacharya{at}

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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.


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  • Competing interests None declared.

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