中国部分城市流动人口未婚人工流产女青年生殖健康状况分析

目的了解城市流动人口未婚人工流产女青年生殖道感染的患病率、性暴力的发生率、性和生殖健康知识、态度/观念和行为。方法2002年10月至2003年2月期间,选择广东省深圳市、广西省南宁市、北京市、河南省郑州市的市级医院妇产科,对1 129名年龄≤24岁要求人工流产的未婚流动人口女青年进行妇科检查、实验室检查及自填式问卷调查。结果研究对象平均年龄(22.0±1.6)岁、发生首次性行为的平均年龄(20.3±1.8)岁;其中38.7%既往有人工流产史、17.5%从未使用过任何避孕药具;性暴力发生率15.6%、生殖道感染患病率56.1%、性传播疾病患病率9.7%。研究对象的生殖健康保健知识较低。结论流动人口未婚人工流产女青年存在较严重的生殖健康问题,应关注流动人口的生殖健康保健。     

未婚人工流产手术妇女术前焦虑抑郁与心理压力的关系研究

目的：探讨术前人工流产术妇女术前焦虑抑郁与心理压力的状况及其关系。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和中文版知觉心理压力量表（CPSS）对200例术前未婚人工流产术妇女进行术前调查,分析SAS 、SDS与CPSS之间的关系。结果术前人工流产术妇女CPSS评分总分为（27.52±6.39）分,HRS者检出率为39％;SAS、SDS评分分别为（56.38±13.25）分、（53.38±11.25）分,明显高于国内常模（37.23±12.58）分、（41.38±10.57）分（t=193.47、14.64,P＜0.01）。术前未婚人工流产术妇女焦虑抑郁与心理压力存在显著正相关（P＜0.01）。结论焦虑抑郁情绪会加重术前未婚人工流产术妇女的心理压力,消除焦虑抑郁情绪能够缓解心理压力。     

常熟市未婚男青年生殖健康现状及服务需求调查

目的 :了解常熟市未婚男青年的生殖健康教育、性心理行为、避孕与婚前妊娠、人流现状 ,探索如何引导、教育未婚男青年正确接受和对待婚前生殖健康教育、性与避孕等问题 ,为进一步宣传教育提供依据。　方法 :采用社会心理行为学方法 ,随机调查有婚前性生活史者 5 10人。　结果 :6 1.2 %的人认为性与避孕知识教育应在学校获得 ,而实际只有 15 3%的人获得 (P <0 .0 1)。现实中获得性与避孕知识多来源于书刊及宣传小册子的人占 87.6 %。与恋人发生性关系时以反正要结婚 (39.4 % )和出于好奇 (32 .7% )居多。同居现象达 86 .8%。知道避孕方法中以避孕套最多 (81.2 % ) ,但知道某种方法却不一定使用该方法。首次性交采用避孕措施比例较低 (34.8% ) ;只有 39.7%的人每次都采用避孕方法 ,结果有 2 7.1%的人使女方怀孕 ,导致部分未婚女青年 (2 2 .4 % )上环避孕。不采用避孕措施的主要原因是怕麻烦 (6 3.6 % ) ;避孕药具主要来源是在药店购买 (5 9.8% )。　结论 :常熟市婚前性行为发生率较高 ,导致婚前妊娠人流等现象较重。应采取多种方式 ,对未婚男青年进行生殖健康教育     

Sexual and reproductive health service needs of university/college students: updates from a survey in Shanghai, China

AIM: To promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. METHODS: From July 2004 to May 2006, 5 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections (STIs)/AIDS. RESULTS: Of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. CONCLUSION: The reproductive health service is lagging behind current attitudes and demands of university students. Although students' attitudes towards sexual matters are liberal, their knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people.     

苏州和嘉兴地区门诊就诊妇女人工流产现状及影响因素调查

目的　了解苏州和嘉兴地区育龄妇女的人工流产 (人流 )现状及其影响因素 ,为现有的生殖健康服务机构提供生殖健康服务与教育提供依据。　方法　分层抽取江苏省苏州市、浙江省嘉兴市的市、县 (区 )、乡三级不同类别的生殖健康服务机构 1 0 0所。对2 0 0 0年 4～ 9月间就诊的育龄妇女进行自填式问卷调查。　结果　本次共调查了 1 850名育龄妇女 ,自我报告 53 .80 %有人流史 ,人流次数最多的 5次 ,平均 ( 1 .3 6± 0 .65)次 ;2 5.0 0 %有婚前人流史 ,婚前人流次数最多达 5次 ,平均 ( 1 .2 7± 0 .52 )次。性病防治所就诊妇女的人流次数明显高于其他机构就诊的妇女。影响人流次数和婚前人流次数的危险因素分析发现 ,避孕失败、妇女结婚年龄和有阴道炎史是影响人流次数和婚前人流次数的共同因素 ,多性伴、初次性行为年龄小 ,有性病病史、生殖道感染相关知识少等是人流次数的危险因素。　结论　两地区不同类别的生殖健康服务机构就诊妇女中有较高的人流率 ,妇女年龄、避孕失败、生殖道感染史、初次性行为年龄小以及相关知识得分等是影响妇女人流的主要危险因素。     

山东省农村已婚育龄妇女人工流产决定因素与对策的研究

本研究试图从人群角度探讨农村妇女人工流产的决定因素和制定相应对策。研究设计采用现况调查方法，通过两阶段等比例抽样方法从山东省高密、平邑、茬平三县的２９９个自然村共抽取４４５０７名已婚育龄妇女作为随机样本，总抽样比为１０％。调查率达９９％。调查结果显示，三县的总和人工流产率依次分别为１．３８、１．２６和１．２７。表明调查地区农村呈高人工流产水平。多重分类分析（ＭＣＡ）显示，调查地区农村妇女因宫内节育器失败和未采用避孕措施者发生非意愿妊娠而导致人工流产的概率最高。Ｌｏｇｉｓｔｉｃ回归分析结果表明，以采用节育措施者为参照变量，未采用节育措施者的ＯＲ值为１２８．７４。在采用节育措施者中，以绝育者为参照变量，宫内节育器使用者的ＯＲ值为３５．９６；避孕药具使用者为６６．９５。在人口学因素方面，以２０岁以下年龄组农村已婚育龄妇女为参照变量，２０～２９岁年龄组的ＯＲ值为６．６９；３０～３９岁年龄组为４．８５。以３孩及以上妇女为参照变量，一孩和二孩妇女的ＯＲ值分别为１．４３和１．７５。研究结果表明，山东省农村现有一孩和二孩的２０～３９岁年龄组的已婚育龄妇女是发生人工流产的高危人群。因此，建议该省在预防对策方面，应以该年龄组已?     

基层计划生育服务站就诊妇女生殖道感染现状及危险因素的研究

为了解基层计划生育服务站就诊妇女生殖道感染现状及其危险因素 ,应用分层抽样的方法 ,选取市、区、县和乡级计划生育服务站为研究现场 ,对研究期间来现场就诊或寻求计划生育服务的育龄妇女进行问卷调查、妇科检查和实验室检查。结果 :基层计划生育服务站就诊妇女盆腔炎、附件炎、宫颈炎和阴道炎的病史报告率分别为 5.1%、17.0 %、15.5%和 2 0 .1% ;检出率分别为附件炎 10 .5%、宫颈炎 38.3%、滴虫性阴道炎7.3%、念珠菌性阴道炎 7.6 %。单因素 Logistic回归模型分析发现 ,年龄、受教育年数、结婚年限、人工流产 (人流 )次数、经期有性生活、性病知识得分以及使用避孕套等是就诊妇女生殖道感染的主要危险因素。多因素 Logistic回归模型分析发现 ,影响生殖道感染的危险因素主要有就诊地点、艾滋病知识得分、年龄、人流次数以及丈夫年龄和职业等。结果表明 ,基层计划生育就诊妇女有较高的生殖道感染率 ,并存在多种危险因素。     

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations.

OBJECTIVE: To establish the relationship between HIV infection and cervical dysplasia in young women in rural South Africa. METHODS: This cross-sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu- Natal. Standardised questionnaires were used to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap smears were done using standard methods. Pap smear data were linked to HIV serostatus. RESULTS: Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 - 55 years), and 80% were younger than 30 years. The HIV prevalence rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9 - 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithe lial lesions). The association between HIV seropositivity and abnormal Pap results was statistically significant (p < 0.05). CONCLUSION: There is a need for more data on cervical changes in HIV co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and where access to antiretroviral treatment remains limited.     

北京市石景山区1006例男性泌尿生殖健康调查

目的:了解30～60岁男性泌尿生殖健康状况,为提高男性泌尿生殖健康水平提供依据。方法:按照分层、随机抽样原则,于2008年10月至2009年2月在北京市石景山区抽取年龄30～60岁男性无业人员、出租车司机、机关干部共1 006例提供泌尿生殖健康调查。结果:有效调查1 006例。身体质量指数(BMI)≥24 kg/m2者占72.7%;高血压者占40.0%;国际前列腺症状评分异常者占85.5%;慢性前列腺炎症状评分异常者占75.6%;国际勃起功能指数异常者占66.3%;男性更年期问卷(AMS)量表异常者占10.7%;处于焦虑状态者占17.1%,处于抑郁状态者占25.1%。空腹血糖>6.1 mmol/L占34.9%;总胆固醇>5.07 mmol/L占44.3%;甘油三脂>1.71 mmol/L占46.6%;总睾酮(17.9±7.2)nmol/L,<12 nmol/L者占21.3%,<8 nmol/L者占3.4%;游离睾酮水平(36.5±15.1)pmol/L。结论:北京市石景山区30～60岁男性生殖健康状况令人担忧。     

上海绝经女性生殖健康状况调查

目的通过对上海地区绝经女性生殖健康状况的调查,探讨对绝经女性的健康保健措施。方法 2012年9月至2013年1月,采用随机抽样的方法对来自全市多个社区企事业的员工并在上海交通大学附属第六人民医院健康体检的绝经妇女,以问卷方式调查绝经女性的人口学特征、自然绝经年龄及其相关影响因素,并采用改良Kupperman评分对绝经相关症状进行评估。资料采用SPSS20.0软件进行统计分析。结果 1 065例绝经妇女纳入研究,平均绝经年龄为50.76岁,平均生育年限为35.71年。60岁、60~65岁和65岁3个年龄组的平均绝经年龄分别为(51.17±3.26)岁、(51.02±3.55)岁及(50.54±2.98)岁。初潮年龄早、未生育、患慢性疾病者的自然绝经年龄较早(P0.05)。绝经相关症状发生频率最高的前5位依次为疲乏(71.50%)、骨关节痛(64.75%)、失眠(55.84%)、潮热出汗(48.79%)、以及易激动(43.96%),早期主要以潮热、失眠为主,晚期主要以骨关节痛、泌尿生殖道症状为主。结论上海地区妇女平均绝经年龄呈逐渐推迟趋势,且初潮年龄早、未生育、患有慢性疾病与绝经年龄提前相关。但尚需进一步验证。绝经早晚期主要症状不同,临床治疗方法应有所差异。     

Risk markers of severe psychological violence against women: a WorldSAFE multi-country study

This study was an attempt to determine the prevalence and significant risk factors associated with severe psychological violence in 6 WorldSAFE sites. The respondents were 3975 women aged 15-49 years and residing in selected urban areas in Chile, Egypt, the Philippines and India. Using a standard instrument translated locally, psychological violence was measured using items indicating the following domains: verbal abuse, fear and separation. A woman who had experienced severe psychological violence had admitted that she had experienced any of the above-mentioned behaviors '3 or more times' in her lifetime (lifetime prevalence) or with her current partner during the past 12 months (current prevalence). The results showed a lifetime prevalence of severe psychological violence ranging from 10.5% of women in Egypt to about 50% in Chile and Trivandrum, India. Verbal abuse was most common among the different behavioral indicators. A woman's mental health status and partner alcohol use were found to be the common significant risk factors. Recommendations were made to facilitate efforts to address severe psychological violence in developing countries.     

Male reproductive health research needs and research agenda: Asian and Chinese perspective

Research that addresses male reproductive health should assist in the development of reproductive health programmes and policy; identify and test new leads in male contraceptive technology; establish effective male involvement initiatives which are likely to have a positive impact on the reproductive health of men and women; guide the allocation of health care resources to ensure cost-effectiveness of interventions; generate new knowledge, develop diagnostic technology in reproductive health and offer optimal treatment/care regimens. In considering the needs and demands of male reproductive health research in Asia and the Pacific, the following six research topics are recommended as the priority research areas: male contraceptive technology; male reproductive health behaviour and male adolescent reproductive health; male reproductive aging including male menopause and other diseases; male RTIs, STDs, HIV/AIDS; prevalence, management and prevention of male infertility; environment and semen quality and other male reproductive problems. One of the major challenges now facing us is the elaboration of a comprehensive, yet realistic male reproductive health research agenda that reflect the needs and demands of Asian developing countries. To this end, to make use of an interdisciplinary approach is of strategic importance. The most creative insights and productive leads are likely to emerge from a research team that is interdisciplinary especially in the field of reproductive health.     

Male reproductive health research needs and research agenda:Asian and Chinese perspective

Research that addresses male reproductive health should assist in the development of reproductive healthprogrammes and policy; identify and test new leads in male contraceptive technology; establish effective maleinvolvement initiatives which are likely to have a positive impact on the reproductive health of men and women; guidethe allocation of health care resources to ensure cost-effectiveness of interventions; generate new knowledge, developdiagnostic technology in reproductive health and offer optimal treatment/care regimens. In considering the needs and demands of male reproductive health research in Asia and the Pacific, the followingsix research topics are recommended as the priority research areas: male contraceptive technology; male reproductivehealth behaviour and male adolescent reproductive health; male reproductive aging including male menopause and otherdiseases; male RTIs, STDs, HIV/AIDS; prevalence, management and prevention of male infertility; environment andsemen quality and other mal     

Declining trends in conception rates in recent birth cohorts of native Danish women: a possible role of deteriorating male reproductive health

Recent findings of poor semen quality among at least 20% of normal young men in Denmark prompted us to use unique Danish registers on births and induced abortions to evaluate a possible effect of the poor male fecundity on pregnancy rates among their presumed partners--the younger cohorts of women. We have analysed data from the Danish birth and abortion registries as well as the Danish registry for assisted reproduction (ART) and defined a total natural conception rate (TNCR), which is equal to fertility rate plus induced abortion rate minus ART conception rate. A unique personal identification number allowed the linkage of these databases. Our database included 706,270 native Danish women born between 1960 and 1980. We used projections to estimate the fertility of the later cohorts of women who had not yet finished their reproduction. We found that younger cohorts had progressively lower TNCR and that in terms of their total fertility rate, the declining TNCR is compensated by an increasing use of ART. Our hypothesis of an ongoing birth cohort-related decline in fecundity was also supported by our finding of increasing and substantial use of ART in the management of infertility of relatively young couples in the later cohorts. Furthermore, the lower rates of induced abortion among the younger birth cohorts, often viewed as a success of health education programs, may not be fully explained by improved use of contraception. It seems more likely that decreased fecundity because of widespread poor semen quality among younger cohorts of otherwise normal men may explain some of the observed decline in conception rates. This may imply increasing reproductive health problems and lower fertility in the future, which is difficult to reverse in the short term. The current and projected widespread use of ART in Denmark may be a sign of such an emerging public health problem.     

Nocturia in the Dutch adult population

OBJECTIVE: To estimate the prevalence of nocturia in the Dutch adult population, its association with sociodemographic and health characteristics, and to assess problems experienced by persons with nocturia. SUBJECTS AND METHODS: In spring 2001 a telephone survey was conducted among a representative sample of 4721 Dutch respondents (response 53%). Using questions from the Bristol Lower Urinary Tract Symptoms questionnaire respondents were asked about having nocturia and the problems they experienced. In addition, questions were asked about sociodemographic and health characteristics. RESULTS: The prevalence of nocturia (a mean of twice or more/night) among Dutch men and women over 18 years old was 13%, standardized for age and sex. Women had nocturia more often than men (16% vs 9%) and the prevalence was positively associated with age, poor health status and use of medication. CONCLUSION: The prevalence of nocturia in Dutch men and women differs more than reported in earlier studies. The prevalence in the Netherlands seems slightly higher than in other Western countries, but Dutch persons with nocturia report fewer problems. Nocturia does not occur in isolation and is associated with sleep disturbances. It is worthwhile for general practitioners to routinely check whether patients who contact them for lower urinary tract symptoms or sleeping disorders have nocturia.     

合肥地区中老年男性更年期综合征样症状初步调查

目的:了解合肥地区中老年男性更年期综合征样症状发生率及其影响因素。方法:共入选健康体检门诊1 026例45岁以上接受检查的男性,调查采用个人信息、整体健康状况、中老年男性症状问卷(AMS量表)进行自我评估。结果:合肥地区中老年男性更年期综合征样症状总发生率为64.7%,AMS评分为(31.2±6.8)分,其中轻度58.1%,中度30.9%,重度11.0%,与年龄具有明显相关性(P<0.05)。评分分量中的精神心理症状、躯体症状及性功能症状评分分别为(8.3±2.1)分、(12.4±4.8)分、(9.3±4.5)分,精神心理症状及躯体症状评分与年龄无明显相关性(P>0.05)。各个年龄组性功能症状评分随年龄增加而明显增加(P<0.05)。统计分析显示,年龄、吸烟、糖尿病、心血管疾病、肥胖是影响男性更年期综合征样症状的重要危险因子,而体育锻炼是男性更年期综合征样症状的重要保护因子。结论:随着年龄的增长,男性更年期综合征样症状的发生率逐渐增高,性功能出现下降,但精神心理及躯体评分并不受年龄的影响。年龄、整体健康状况及生活方式是影响男性更年期综合征样症状的重要因素。     

上海市24小时生殖健康咨询热线的报告

目的 :为了解上海市民的生殖保健需求 ,对上海市首条 2 4h生殖健康咨询热线开通 9个月结果进行分析 ,以发现新的需求 ,提出改善措施。方法 :对热线开通 9个月的所有咨询记录输入计算机进行统计分析 ,并按春、夏、秋三季 ,随机抽取 40 0 0多个性问题进行深入分析。对不同性别、不同性质的问题 (性问题或其他问题 )进行对比分析。结果 :9个月共接听 44 2 1 6人次。咨询者包括各个年龄层次 ( 1 2～ 78岁 )、不同婚姻状况、来自上海及外地。咨询总体中男女比例相当。咨询内容囊括生殖健康各个方面 ,其中男女性问题和孕期优生保健及婴幼儿保健分别占 2 6.5%和 3 4% ;咨询性问题男性远多于女性 ,咨询孕期及婴幼儿保健女性多于男性。性问题及其他咨询内容在 2 4h各时刻均存在 ,但前者在夜间至凌晨明显增高。男性性问题在各时段均居前三位。结论 :上海市民对性保健、孕期和婴幼儿期保健知识的需求非常高 ,日常生活中出现问题或存在困惑时需要医务人员和专业人员的及时指导 ;上海应该建立相应的保健机构或门诊以满足育龄人群的生殖保健需求。     

Access to safe abortion: building choices for women living with HIV and AIDS

In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of all pregnancies worldwide in 2008, 41% were reported as unintended or unplanned, and approximately 50% of these ended in abortion. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long‐term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights. In this paper, we explore the existing evidence related to global and country‐specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non‐implementation of the law, and a rather liberal setting. Similarities and differences are discussed, and we further outline global and country‐specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.     

Marital status and risk of HIV infection in South Africa.

OBJECTIVE: Available evidence on the relationship between marital status and HIV is contradictory. The objective of this study was to determine HIV prevalence among married people and to identify potential risk factors for HIV infection related to marital status in South Africa. METHODS: A multistage probability sample involving 6 090 male and female respondents, aged 15 years or older was selected. The sample was representative of the South African population by age, race, province and type of living area, e.g. urban formal, urban informal, etc. Oral fluid specimens were collected to determine HIV status. A detailed questionnaire eliciting information on socio-demographic, sex behaviour and biomedical factors was administered through face-to-face interviews from May to September 2002. RESULTS: HIV prevalence among married people was 10.5% compared with 15.7% among unmarried people (p-value < 0.001). The risk of HIV infection did not differ significantly between married and unmarried people (odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.71 - 1.02) when age, sex, socio-economic status, race, type of locality, and diagnosis of a sexually transmitted infection (STI) were included in the logistical regression model. However, the risk of HIV infection remained significantly high among unmarried compared with married people when only sex behaviour factors were controlled for in the model (OR 0.55; 95% CI: 0.47 - 0.66). CONCLUSIONS: The relationship between marital status and HIV is complex. The risk depends on various demographic factors and sex behaviour practices. Increased prevention strategies that take socio-cultural context into account are needed for married people.     

The association between induced and spontaneous abortion and risk of breast cancer in Slovenian women aged 25-54

The risk of breast cancer may be increased by induced or spontaneous abortion. The evidence for this association was evaluated in a population based case-control study in Slovenia, where 624 women aged 25-54 years with breast cancer diagnosed during 1988-1990 were matched for age and site of residence with controls randomly selected from the Slovenian Population Registry. Odds ratios (OR) and 95% confidence intervals (CI) were obtained by conditional logistic regression analyses. Spontaneous abortion was not associated with a significantly increased risk of breast cancer (nulliparous women: OR=1.41, 95% CI 0.22-9.01; uniparous women: OR=0.98, 95% CI 0.50-1.91; women with parity 2 or more: OR=1.40, 95% CI 0.91-2.15). Induced abortion was not associated with a statistically significant elevated risk. The risk of breast cancer was higher in nulliparous women (OR=2.49, 95% Cl 0.68-9.09), and was less among women who had more deliveries. In uniparous women, the risk of breast cancer appeared higher when the induced abortion took place before a first full-term pregnancy (OR=1.94, 95% CI 0.70-5.39) rather than after a first full-term pregnancy (OR=1.22, 95% CI 0.71-2.10) but neither of these odds ratios reached significance. We found no significant association between spontaneous abortion or induced abortion and breast cancer risk. This study found an elevated, but not statistically significant, risk associated with induced abortion among nulliparous women and among parous women when the induced abortion was before the first full-term pregnancy.