The impact of abortions on women’s health
Dolgushina N.V., Ermakova D.M., Sheshko E.L.
The objective of the review was to systematize the literature data on the impact of abortions on women’s health. The paper provides the conclusions that abortions have many negative effects; they cause both early and long-term complications, increasing the risks of gynecological and somatic diseases, obstetric and perinatal complications in subsequent pregnancies. Early pregnancy complications include bleeding, uterine perforation, amniotic fluid embolism, thromboembolic, infectious and inflammatory complications. The long-term consequences of abortions refer to gynecological diseases, infertility, obstetric complications in subsequent pregnancies (gestational diabetes, placenta previa, cervical incompetence, premature birth, bleeding, low birth weight), oncological and cardiovascular diseases, and mental health disorders. Measures aimed at preventing abortions and supporting women in their reproductive choices are important steps to protect women’s general and reproductive health, and as a result, improve the demographic situation.
Conclusion: In recent years, a large number of measures have been taken in the Russian Federation to reduce the number of induced abortions. Clinical guidelines and standards have been approved, and interactive educational modules on psychological pre-abortion counseling have been implemented. Speech modules for communicating with women in situations of reproductive choice have also been introduced into the work of medical organizations. Motivational surveys are conducted as part of a program to provide individual recommendations and support measures for women in such situations.
Authors’ contributions: Dolgushina N.V., Ermakova D.M., Sheshko E.L. – developing the concept and design of the study, collecting and processing the material, writing the text, editing.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Dolgushina N.V., Ermakova D.M., Sheshko E.L. The impact of abortions on women’s health.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (7): 5-11 (in Russian)
https://dx.doi.org/10.18565/aig.2025.129
Keywords
References
- Bearak J., Popinchalk A., Ganatra B., Moller A.-B., Tunçalp Ö., Beavin C. et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob. Heal. 2020; 8(9): e1152-61. https://dx.doi.org/10.1016/S2214-109X(20)30315-6
- Bridwell R.E., Long B., Montrief T., Gottlieb M. Post-abortion complications: a narrative review for emergency clinicians. West. J. Emerg. Med. 2022; 23(6): 919-25. https://dx.doi.org/10.5811/westjem.2022.8.57929
- Kerns J.L., Brown K., Nippita S., Steinauer J. Society of Family Planning Clinical Recommendation: Management of hemorrhage at the time of abortion. Contraception. 2024; 129: 110292. https://dx.doi.org/10.1016/j.contraception.2023.110292
- Choudhary N., Saha S.C., Gopalan S. Abortion procedures in a tertiary care institution in India. Int. J. Gynaecol. Obstet. 2005; 91(1): 81-6. https://dx.doi.org/10.1016/j.ijgo.2005.06.012
- Frick A.C., Drey E.A., Diedrich J.T., Steinauer J.E. Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications. Obstet. Gynecol. 2010; 115(4): 760-4. https://dx.doi.org/10.1097/AOG.0b013e3181d43f42
- ACOG Practice Bulletin No. 135: Second-Trimester Abortion. Obstet. Gynecol. 2013; 121(6): 1394-1406. https://dx.doi.org/10.1097/01.AOG.0000431056.79334.cc
- Ashok P.W., Templeton A., Wagaarachchi P.T., Flett G.M.M. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004; 69(1): 51-8. https://dx.doi.org/10.1016/j.contraception.2003.09.006
- Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet. Gynecol. 2009; 113(5): 1117-23. https://dx.doi.org/10.1097/AOG.0b013e31819dbfe2
- White K., Carroll E., Grossman D. Complications from first-trimester aspiration abortion: a systematic review of the literature. Contraception. 2015; 92(5): 422-38. https://dx.doi.org/10.1016/j.contraception.2015.07.013
- Premkumar A., Huysman B., Cheng C., Einerson B.D., Moayedi G. Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care. Am. J. Obstet. Gynecol. 2025; 232(1): 92-101. https://dx.doi.org/10.1016/j.ajog.2024.07.045
- Benson M.D. Amniotic fluid embolism mortality rate. J. Obstet. Gynaecol. Res. 2017; 43(11): 1714-8. https://dx.doi.org/10.1111/jog.13445
- Creanga A.A., Syverson C., Seed K., Callaghan W.M. Pregnancy-related mortality in the United States, 2011–2013. Obstet. Gynecol. 2017; 130(2): 366-73. https://dx.doi.org/10.1097/AOG.0000000000002114
- Niinimäki M., Pouta A., Bloigu A., Gissler M., Hemminki E., Suhonen S., Heikinheimo O. Immediate complications after medical compared with surgical termination of pregnancy. Obstet. Gynecol. 2009; 114(4): 795-804. https://dx.doi.org/10.1097/AOG.0b013e3181b5ccf9
- World Health Organization. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 6th ed. 2011. 57 p.
- Patel A., Talmont E., Morfesis J., Pelta M., Gatter M., Momtaz M.R. et al. Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy. Contraception. 2006; 73(4): 420-30. https://dx.doi.org/10.1016/j.contraception.2005.10.004
- Parazzini F., Mais V., Cipriani S., Busacca M., Venturini P. Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 143(2): 103-6. https://dx.doi.org/10.1016/j.ejogrb.2008.12.010
- Pun S. Induced abortion: a risk factor for adenomyosis. J. Nepal Health Res. Counc. 2023; 20(4): 913-5. https://dx.doi.org/10.33314/jnhrc.v20i4.4649
- Shrestha A. Risk factors for adenomyosis. J. Nepal Health Res. Counc. 2012; 10(22): 229-33.
- Genc M., Genc B., Cengiz H. Adenomyosis and accompanying gynecological pathologies. Arch. Gynecol. Obstet. 2015; 291(4): 877-81. https://dx.doi.org/10.1007/s00404-014-3498-8
- Kobayashi H., Matsubara S., Imanaka S. Clinicopathological features of different subtypes in adenomyosis: focus on early lesions. PLOS One. 2021; 16(7): e0254147. https://dx.doi.org/10.1371/journal.pone.0254147
- Grimes D.A., Benson J., Singh S., Romero M., Ganatra B., Okonofua F.E., Shah I.H. Unsafe abortion: the preventable pandemic. Lancet. 2006; 368(9550): 1908-19. https://dx.doi.org/10.1016/S0140-6736(06)69481-6
- Чучалина Л.Ю. Роль искусственного прерывания беременности в первом триместре в формировании вторичного бесплодия. Акушерство и гинекология. 2016; 11: 113-6. [Chuchalina L.Yu. The role of induced abortion in the first trimester of pregnancy in the development of secondary infertility. Obstetrics and Gynecology. 2016; (11): 113-6 (in Russian)]. https://dx.doi.org/10.18565/aig.2016.11.113-6
- Wang H., Guo X., Song Q., Su W., Meng M., Sun C. et al. Association between the history of abortion and gestational diabetes mellitus: a meta-analysis. Endocrine. 2023; 80(1): 29-39. https://dx.doi.org/10.1007/s12020-022-03246-x
- Zhang J., Savitz D.A. Maternal age and placenta previa: a population-based, case-control study. Am. J. Obstet. Gynecol. 1993; 168(2): 641-5. https://dx.doi.org/10.1016/0002-9378(93)90511-G
- Faiz A.S., Ananth C.V. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J. Matern. Fetal Neonatal. Med. 2003; 13(3): 175-90. https://dx.doi.org/10.1080/jmf.13.3.175.190
- Hung T.H., Hsieh C.C., Hsu J.J., Chiu T.H., Lo L.M., Hsieh T.T. Risk factors for placenta previa in an Asian population. Int. J. Gynaecol. Obstet 2007; 97(1): 26-30. https://dx.doi.org/10.1016/j.ijgo.2006.12.006
- Johnson L.G., Mueller B.A., Daling J.R. The relationship of placenta previa and history of induced abortion. Int. J. Gynaecol. Obstet. 2003; 81(2): 191-8. https://dx.doi.org/10.1016/s0020-7292(03)00004-3
- Zhu Q.X., Gao E.S., Chen A.M., Luo L., Cheng Y.M., Yuan W. Mifepristone-induced abortion and placental complications in subsequent pregnancy. Hum. Reprod. 2009; 24(2): 315-9. https://dx.doi.org/10.1093/humrep/den426
- Koifman A., Levy A., Zaulan Y., Harlev A., Mazor M., Wiznitzer A., Sheiner E. The clinical significance of bleeding during the second trimester of pregnancy. Arch. Gynecol. Obstet. 2008; 278(1): 47-51. https://dx.doi.org/10.1007/s00404-007-0530-2
- Lowit A., Bhattacharya S., Bhattacharya S. Obstetric performance following an induced abortion. Best. Pract. Res. Clin. Obstet. Gynaecol. 2010; 24(5): 667-82. https://dx.doi.org/10.1016/j.bpobgyn.2010.02.015
- Shah P.S., Zao J. Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analyses. BJOG. 2009; 116(11): 1425-42. https://dx.doi.org/10.1111/j.1471-0528.2009.02278.x
- Saccone G., Perriera L., Berghella V. Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2016; 214(5): 572-91. https://dx.doi.org/10.1016/j.ajog.2015.12.044
- Lemmers M., Verschoor M.A.C., Hooker A.B., Opmeer B.C., Limpens J., Huirne J.A.F. et al. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum. Reprod. 2016; 31(1): 34-45. https://dx.doi.org/10.1093/humrep/dev274
- Freak-Poli R., Chan A., Tucker G., Street J. Previous abortion and risk of pre-term birth: a population study. J. Matern. Fetal Neonatal Med. 2009; 22(1): 1-7. https://dx.doi.org/10.1080/14767050802531813
- Mitrogiannis I., Evangelou E., Efthymiou A., Kanavos T., Birbas E., Makrydimas G. et al. Risk factors for preterm birth: an umbrella review of meta-analyses of observational studies. BMC Med. 2023; 21(1): 494. https://dx.doi.org/10.1186/s12916-023-03171-4
- Brittain J.J., Wahl S.E., Strauss J.F., Romero R., Wolf H.M., Murphy K. et al. Prior spontaneous or induced abortion is a risk factor for cervical dysfunction in pregnant women: a systematic review and meta-analysis. Reprod. Sci. 2023; 30(7): 2025-39. https://dx.doi.org/10.1007/s43032-023-01170-7
- Kyriacou H., Al-Mohammad A., Muehlschlegel C., Foster-Davies L., Bruco M.E.F., Legard C. et al. The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis. Eur. Hear. J. Open. 2022; 2(5): oeac065. https://dx.doi.org/10.1093/ehjopen/oeac065
- Brind J., Chinchilli V.M., Severs W.B., Summy-Long J. Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis. J. Epidemiol. Community Health. 1996; 50(5): 481-96. https://dx.doi.org/10.1136/jech.50.5.481
- Islam M.A., Sathi N.J., Abdullah H.M., Tabassum T.A. Meta-analysis of induced abortion, alcohol consumption, and smoking triggering breast cancer risk among women from developed and least developed countries. Int. J. Clin. Pract. 2022; 2022: 6700688. https://dx.doi.org/10.1155/2022/6700688
- Brind J., Condly S.J., Lanfranchi A., Rooney B. Induced abortion as an independent risk factor for breast cancer: a systematic review and meta-analysis of studies on south asian women. Issues Law Med. 2018; 33(1): 32-54.
- Cuenca D. Pregnancy loss: Consequences for mental health. Front. Glob. Womens Health. 2022; 3: 1032212. https://dx.doi.org/10.3389/fgwh.2022.1032212
- Mergl R., Quaatz S.M., Edeler L.M., Allgaier A.K. Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies. Eur. J. Psychotraumatol. 2022; 13(2): 2108578. https://dx.doi.org/10.1080/20008066.2022.2108578
- Bellieni C.V., Buonocore G. Abortion and subsequent mental health: Review of the literature. Psychiatry Clin. Neurosci. 2013; 67(5): 301-10. https://dx.doi.org/10.1111/pcn.12067
- Coleman P.K. Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009. Br. J. Psychiatry. 2011; 199(3): 180-6. https://dx.doi.org/10.1192/bjp.bp.110.077230
- Charles V.E., Polis C.B., Sridhara S.K., Blum R.W. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception. 2008; 78(6): 436-50. https://dx.doi.org/10.1016/j.contraception.2008.07.005
- Gissler M., Karalis E., Ulander V.M. Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987–2012. Scand. J. Public Health. 2015; 43(1): 99-101. https://dx.doi.org/10.1177/1403494814560844
Received 14.05.2025
Accepted 23.06.2025
About the Authors
Nataliya V. Dolgushina, Dr. Med. Sci., Professor, Deputy Director for Scientific Work, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia, n_dolgushina@oparina4.ru, https://orcid.org/0000-0003-1116-138Xhttps://orcid.org/0000-0003-1116-138X
Daria M. Ermakova, PhD, Researcher, obstetrician-gynecologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Oparina str., Moscow, 117997, Russia, +7(906)555-79-97, daria.ermakova.97@bk.ru, https://orcid.org/0000-0002-8558-4687
Elena L. Sheshko, PhD, Deputy Head, Federal Service for Surveillance in Healthcare of the Russian Federation, Moscow, Russia.