Substance Abuse

Thomas W. Strahan Memorial Library
Index
Standard of Care for Abortion
Abortion Decision-Making
Psychological Effects of Abortion
Social Effects and Implications
Physical Effects of Abortion
Abortion and Maternal Mortality
Adolescents and Abortion
Definition of Terms
Women's Health After Abortion
Material Yet to be Cataloged
Strahan Summary Articles

Sub-Index
Psychological Effects
Validity of Studies
Reviews
Risk Factors
PTSD
Grief and Loss
Guilt
Ambivalence or Inner Conflict
Anxiety
Intrusion / Avoidance / Nightmares
Denial
Dissociation
Narcissism
Self-Image
Self Punishment
Depression
Psychiatric Treatment
Self-Destructive Behavior
Substance Abuse
Long-Terms Effects of Abortion
Replacement Pregnancies
Sterilization
Impact of Abortion On Others
Violence
Rape, Incest, Sexual Assault
After Late Term Abortion

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General Background Studies (Substance Abuse)

"Substance abuse and post-traumatic stress disorder comorbidity," P.J. Brown, J. Wolfe, Drug and Alcohol Dependence 35: 51-59,1994

Reviews the existing literature on the subject. In the relatively few studies which have assessed post-traumatic stress disorder, there is a common-co-occurring diagnosis among substance abusers.

"Fragmantation of the Personality Associated with Post-Abortion Trauma," Joel O Brende, Association for Interdisciplinary Research in Values and Social Change Newsletter8(3):1-8, Jul/August 1995.

Victims of post-traumatic self-fragmentation often use alcohol, tranquilizers, and other substances.

"Sharp rise reported in fetal alcohol syndrome," Minneapolis Star Tribune, April 7,1995, p. 7A

According to a study by the Centers for Disease Control, the rate of babies born with health problems caused by fetal alcohol syndrome increased from 1 per 10,000 births in 1979 to 6.7 per 10,000 births in 1993. Despite growing awareness that avoiding liquor prevents the syndrome, about one-fifth of women continued to drink even after they learned they were pregnant.

"The Spectrum of Fetal Abuse," J.T. Condon, J. Nervous and Mental Disease174(9): 509- 516, Sept, 1986

The fetus is a (potential) recipient par excellence for projection and displacement. Strategies aimed at reducing fetal abuse could more profitably focus on the determinants of the dysfunctional maternal-fetal relationship rather than "education" although clearly necessary but which may be insufficient for a major impact.

"A Study of Alcoholism in Women," James H. Wall, American Journal of Psychiatry93:943,952(1937).

In women excessive drinking is more highly individual and is more intimately associated with a definite life situation. Both sexes have in common a narcissistic type of personality with increasing inability to adjust to reality and adult responsibility.

"Women and Alcohol: A Review," Sheila B. Blume, Journal of the American Medical Association 256(11): 1469, September 19,1986.

Review of the literature.

"Some Backgrounds and Types of Alcoholism Among Women," T. Fort and A.L. Porterfield, Journal Health and Social Behavior 2:282-292(1961).

Thirty-four women members of Alcoholics Anonymous were interviewed; 47% evidenced a sudden onset of alcoholism immediately following a specific stressful event.

"Life Issues as Social Determinants for the Meaning of Being a Woman," Alcoholic- A Theory of Loss, Gloria Ann Gelfand, Ph.D thesis, Columbia University Teachers College, 1985.

"Suicide and Alcoholism-Interpersonal Loss Confirmed as a Predictor, G," E. Murphy, J. Armstrong, S. Hermele, J. Fischer and W. Clendenin, Archives of General Psychiatry36:65-69, January 1979.

"Drinking During Pregnancy and Spontaneous Abortion," J. Kline, P. Shrout, Z. Stein, The Lancet, July 26,1980, pp. 176-180.

Even moderate consumption of alcohol during pregnancy is a risk factor for, and may be a cause of spontaneous abortion. More than one-quarter of pregnant women drinking twice a week or more are likely to abort, compared with 14 percent of women who drink less often. Heavy drinking has been associated with fetal alcohol syndrome, minor and major malformations, stillbirths, prematurity, low birth weight, placental weight, and birth length.

"Alcohol. Smoking, and Incidence of Spontaneous Abortions in the First and Second Trimester," S. Harlap and P.H. Shiono, The Lancet, July 26,1980, pp. 173-176.

Increased risk of second-trimester miscarriage was noted in drinkers. Drinking and smoking were found to be independent risk factors for spontaneous abortion. The effect of drinking was greater than that of smoking.

"Alcohol Abuse During Pregnancy: An Epidemiologic Study," R. J. Sokol, S. Miller and G. Reed, Alcoholism: Clinical and Experimental Research 4(2): 135-145, April 1980.

A study of 12,127 pregnancies at a single institution found complications by maternal alcohol abuse of 1.7 percent. Patients tended to be older multigravidas who were not currently married. Their obstetric histories were marked by an excessive incidence of previous spontaneous abortions, low birth weights and fetal anomalies. They were more likely to smoke and abuse drugs. The risk of intrauterine growth retardation was estimated to be increased 2.4-fold in association with alcohol abuse alone, 1.8-fold with smoking alone, and 3.9-fold with combined smoking/alcohol use.

"The Effects of Moderate Alcohol Consumption During Pregnancy on Fetal Growth and Morphogensis," Hanson, et al.. Journal of Pediatrics 92(3), 457-460 (March 1978).

Data from this study of 163 selected offspring of mothers at a Seattle hospital suggested that the risk of having a newborn child with Fetal Alcohol Syndrome (FAS) increases proportionately with the average daily alcohol intake. If average maternal ingestion is less than one ounce of absolute alcohol per day/the apparent risk for abnormalities appears to be low. In the range of one to two ounces of absolute alcohol per day, the risk may approach 10 percent. Among women who drank an average of two or more ounces of ethanol daily, 19 percent had infants who were considered abnormal.

"Women's Drinking and Drinking Problems: Patterns from a 1981 National Survey," Richard Wilsnack, S. Wilsnack and A. Klassen, American Journal of Public Health 74(11):1231- 1238, November 1984

Adverse drinking consequences and episodes of extreme drinking were most common among women aged 21-34. Women with extremely high consumption levels were more likely to have histories of obstetrical and gynecological problems. (Some 17% of all women drinkers, 27% of moderate, 45% heavier drove a car while feeling drunk or high at least once during the past year.

"Alcohol-Related Relative Risk of Fatal Driver Injuries in Relation to Driver Age and Sex," P.L. Zador, Journal of Studies on Alcohol, 52(4): 302 ,1991.

A study based on driver fatalities in single-vehicle crashes, it was estimated at each 0.02 percentage increase in the blood alcohol content (BAC) of a driver with a non-zero BAC nearly double the risk of being in a fatal crash. At a BAC in the 0.05-0.09% range the likelihood of a crash was at least 9 times greater than at zero BAC for all age groups. Females had a higher relative risk than males. See also "Trends in Alcohol-Related Traffic Fatalities, by Sex-United States." Centers For Disease Control, JAMA 268(3): 313, July 15,1992. Citing various studies.

"Effects of Maternal Marijuana and Cocaine Use on Fetal Growth, B," Zuckerman, D. Frank, R. Hingson, H. Amaro, New England J. Med. 320:762-768, March 23,1989.

Cocaine or marijuana use increases risk of shorter gestation, low birth weight and spontaneous abortion. Some 80% of marijuana users and 80% of cocaine users also smoked. Alcohol use also was higher in drug users than non-users. Cocaine users had 22% incidence of sexually transmitted disease vs. 12-13% for other groups.

"Surgeon General's Advisory on Alcohol and Pregnancy," FDA Bulletin 11(2) (1981)

In a recent report to the president and Congress, it was stated that alcohol consumption during pregnancy can harm the fetus especially in the early months. Decreased birth weights have been noted in some women who average only one ounce of absolute alcohol per day during pregnancy. Sizable and significant increases of spontaneous abortions at reported alcohol consumption as low as one ounce of absolute alcohol twice per week. A woman who consumes alcohol at amounts consistent with a diagnosis of alcoholism risks bearing a child with fetal alcohol syndrome. (Fetal alcohol syndrome is frequently associated with mental retardation, central nervous system disorders, growth deficiencies, facial abnormalities, and other malformations.)

Substance Abuse and Induced Abortion

Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. Sullins DP. SAGE Open Medicine 2016 vol: 4 (0) pp: 2050312116665997

Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion.

Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models.

Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p < 0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p < 0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3) of the prevalence of mental disorders examined over the period were attributable to abortion.

Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model. Steinberg JR, Finer LB. Soc Sci Med. 2011 Jan;72(1):72-82. doi: 10.1016/j.socscimed.2010.10.006. Epub 2010 Oct 23.

After controlling for numerous factors, women who had a history of abortion were significantly more likely to be diagnosed with a substance abuse disorder.

Social and Emotional Adjustment Following Early Pregnancy in Young Australian Women: A Comparison of Those Who Terminate, Miscarry, or Complete Pregnancy. Olsson CA et al.J Adolesc Health. 2014 Jan 15. pii: S1054-139X(13)00738-6. doi: 10.1016/j.jadohealth.2013.10.203.

Women with a history of abortion are at higher risk of smoking and alcohol use as well as nicotine and alcohol dependence. Compared to never pregnant women of the same age, those with a history of abortion had adjusted higher 4.1 times higher risk of smoking (CI, 1.9-8.8), 4.5 times higher risk of nicotine dependence (OR 4.5; CI, 2.1-9.6), 2.5 times the risk of binge drinking (CI, 1.1-6.1), and 2.7 times the risk of alcohol dependence(CI, 1.2-5.9). Women who carried to term were generally at lower risk than never pregnant women and far below the risks associated with women who had abortions.

Abortion and mental health: findings from the national comorbidity survey-replication. Steinberg JR, McCulloch CE, Adler NE. Obstet Gynecol. 2014 Feb;123(2 Pt 1):263-70.

After controlling for numerous factors, women with a history of abortion were 2.3 times more likely to experience subsequent substance use disorders (CI 1.35-3.92).

Note: The authors of this study are vocal advocates of abortion on request and made study design decisions which tended to minimize their own findings. See: Steinberg

History of induced abortion in relation to substance abuse during subsequent pregnancies carried to term, PK Coleman et al, Am J Obstet Gynecol 187: 1673-1678, 2002.

A nationally representative sample of women using data from the National Pregnancy and Health Survey found that, compared to women who had given birth, women who had had an induced abortion were significantly more likely to use marijuana (OR 10.29,95%CI, 3.47-30.56) , various illicit drugs (OR 5.60, 95%CI, 2.39-13.10) , and alcohol (OR 2.22,95%CI, 1.31-3.76) during their next pregnancy. An average of 5 years had elapsed since a prior abortion; an average of 3.42 years had elapsed since a prior birth.

Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. Coleman P., Reardon D., Cougle J. Br J Health Psychol 2005; 10: 255–68.

Abstract

OBJECTIVE: The primary objectives of this study were to explore maternal history of perinatal loss and pregnancy wantedness as correlates of substance use during pregnancy.

METHOD: The research design involved interviewing women who gave birth in Washington DC hospitals during 1992. Interview data included pregnancy history (prior births, induced abortions, miscarriages, and stillbirths), desire for the pregnancy (wanted, not wanted, mistimed), socio-demographic information, timing of onset of prenatal care, and substance use (cigarettes, alcohol, and drugs) during pregnancy.

RESULTS: A history of induced abortion was associated with elevated risk for maternal substance use of various forms; whereas other forms of perinatal loss (miscarriage and stillbirth) were not related to substance use. Unwanted pregnancy was associated with cigarette smoking during pregnancy, but not with any other forms of substance use.

CONCLUSIONS: Reproductive history information may offer insight to professionals pertaining to the likelihood of women using substances in a later pregnancy.

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study Kaeleen Dingle, Rosa Alati, Alexandra Clavarino, Jake M. Najman, and Gail M. Williams BJP 2008 193: 455-460.

Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0–6.7) and miscarriage OR=2.6 (95% CI 1.2–5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3–3.5) and 12-month depression (OR=1.9, 95% CI 1.1–3.1).

Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Pedersen, W. (2007), Addiction, 102: 1971–1978.

ABSTRACT

Aims: To investigate the possible linkages between deliveries, abortions and subsequent nicotine dependence, alcohol problems and use of cannabis and other illegal drugs from the ages of 15–27 years.

Methods: Data were gathered as part of the Young in Norway Longitudinal Study, an 11-year follow-up of a representative sample of Norwegian adolescents and young adults.

Design, setting and participants: Information was obtained on (i) the history of childbirths and induced abortions for the participants between the ages of 15–27 years; (ii) measures of nicotine dependence, alcohol problems and use of cannabis and other illegal drugs; and (iii) socio-demographic, family and individual confounding factors.

Results: Those who had had an abortion had elevated rates of substance use and problems. Those who gave birth to a child had reduced rates of alcohol problems and cannabis use. These associations persisted after control for confounders. However, those women who still lived with the father of the aborted fetus were not at increased risk.

Conclusions: Abortion in women may, under some circumstances, be associated with increased risk of nicotine dependence, alcohol problems and use of cannabis and other illegal drugs. The birth of a child may reduce the use of some substances.

Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model. Steinberg JR, Finer LB. Social Science & Medicine 2010

Women with a history of multiple abortions are significantly more likely to have mood disorders and substance abuse problems than women with no history of abortion and for women with a history of only one abortion. Also, "Women who were younger at the time of their first abortion or pregnancy if they had had no abortions, those with violence in their lives, or those with prior mental health disorders were more likely to have mental health disorders at the time of the interview." And "Women who reported having had multiple abortions were 4.0 times as likely to have substance use disorders compared to women who had had no abortions, p < 0.05. In addition, women who had multiple abortions were 2.8 times more likely to have substance use disorders compared to women who had had only one abortion, p < 0.05."

When increased exposure to an event, such as abortion, is associated with an increased risk of negative reactions, the increased exposure-risk rate increases the likelihood that the association is causal.

Personal resilience, cognitive appraisals, and coping: An integrative model of adjustment to abortion. Major B, Richards C, Cooper ML et al. J Person Soc Psychol, 1998; 74: 735-752

527 women completed a survey one month following their abortions in which they indicated how much they "did each of the behaviors listed to help deal with [their] abortion." 23% reported using smoking, 18% drinking, and 9% using drugs from "a little bit" to "a great deal" in order to deal with their abortions.

Associations Between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample. Mota NP, Burnett M, Sareen J. The Canadian Journal of Psychiatry, Vol 55, No 4, April 2010

Methods: Data came from the National Comorbidity Survey Replication (n = 3310 women, aged 18 years and older). The World Health Organization–Composite International Diagnostic Interview was used to assess mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and lifetime abortion in women. Multiple logistic regression analyses were employed to examine associations between abortion and lifetime mood, anxiety, substance use, eating, and disruptive behaviour disorders, as well as suicidal ideation and suicide attempts. We calculated the percentage of respondents whose mental disorder came after the first abortion. The role of violence was also explored. Population attributable fractions were calculated for significant associations between abortion and mental disorders.

Results: After adjusting for sociodemographics, abortion was associated with an increased likelihood of several mental disorders—mood disorders (adjusted odds ratio [AOR] ranging from 1.75 to 1.91), anxiety disorders (AOR ranging from 1.87 to 1.91), substance use disorders (AOR ranging from 3.14 to 4.99), as well as suicidal ideation and suicide attempts (AOR ranging from 1.97 to 2.18). Adjusting for violence weakened some of these associations. For all disorders examined, less than one-half of women reported that their mental disorder had begun after the first abortion. Population attributable fractions ranged from 5.8% (suicidal ideation) to 24.7% (drug abuse).

Conclusions: Our study confirms a strong association between abortion and mental disorders. Possible mechanisms of this relation are discussed.

"Fetal Alcohol Syndrome (FAS) Primary Prevention Through FAS Diagnosis: II. A Comprehensive Profile of Birth Mothers of Children with FAS," SJ Astley et al, Alcohol & Alcoholism35(5): 509-519, 2000.

In a study of birth mothers of children with fetal alcohol syndrome, 31.3 % reported having used abortion as birth control.

"Substance Abuse in Pregnant Women: Recent Experience at the Perinatal Center for Chemical Dependence of Northwestern Memorial Hospital," L.G. Keith et al, Obstet. Gynecol. 73: 715,1989

In a study of pregnant women who used drugs, cocaine users averaged 1.8 abortions, opiate users averaged 1.0 abortions, cocaine plus opiate users averaged 1.9 abortions, and non-drugs using controls averaged 0.6 abortions.

"Drug Use as a Risk Factor for Premarital Teen Pregnancy and Abortion in a National Sample of Young White Women," B. Mensch, D.B. Kandel, Demography 29(3): 409, August, 1992.

In the National Longitudinal Survey of Youth, illicit drug use among adolescents increased the likelihood of an abortion fivefold.

"Prevalence of Illicit Drugs Detected in the Urine of Women of Childbearing Age in Alabama Public Health Clinics," Public Health Reports 109(4): 530, July/Aug. 1994

In a 1991 Alabama study of women attending maternity, family planning and obstetrical clinics throughout the state, the prevalence of positive findings for any drug, marijuana or cocaine significantly increased with an increasing number of abortions.

"The Incidence and Effects of Alcohol and Drug Abuse in Women Following Induced Abortion," Thomas W. Strahan, Association for Interdisciplinary Research Newsletter3(2): 1-8 Summer, 1990

Summary of the literature

"Alcoholism in Women: Social and Psychological Concomitants," E.S. Lisansky, Quarterly Journal of Studies in Alcohol 18:588,609(1957). (Prior abortion listed as one of the reasons for drinking.

"Stressful Life Events and Alcohol Problems Among Women Seen at a Detoxification Center," E.R. Morrissey and M.A. Schuckit, Journal of Studies on Alcohol 39(9): 1559-1576, 1978

Eighty-nine percent of 262 women had experienced a prior gynecological event; 18% had prior abortions. Problem drinkers and secondary alcoholics were likely to have experienced alcohol-related problems subsequent to abortion. Problem drinkers and secondary alcoholics had a wide variety of health and social problems.

The Psycho-Social Aspects of Stress Following Abortion, Anne Catherine Speckhard, (Sheed and Ward: Kansas City, 1987)

Sixty percent of 30 women experiencing psychosocial stress following abortion reported increased alcohol use. A majority reported their first heavy use of drugs or alcohol in conjunction with stress related to abortion.

"Post-Abortion Trauma, 9 Steps To Recovery," Jeanette Vought (Grand Rapids: Zondervan, 1991) p. 111-112.

In a 1990 study of 68 religiously oriented women (primarily Evangelical and Lutheran) 10- 15 years post-abortion, 37% of the women reported they frequently used alcohol and 21% frequently used drugs. Of the women who used alcohol, 48% began drinking after their abortion experience. Of the women who used drugs, 42.9% started using them after their abortion experience.

"Physical and psychological Injury in Women Following Abortion: Akron Pregnancy Services Survey," L.H. Gsellman, Association for Interdisciplinary Research Newsletter 5(4):1-8, Sept/Oct 1993.

In a survey of 344 postabortion women receiving a variety of services Akron Pregnancy Services, Akron, Ohio during 1988-1993 ,17% reported alcohol/drug abuse as a psychological problem following abortion. In a sub-sample of African-American women, 6% reported alcohol/drug abuse as a psychological problem following abortion.

"Patterns of Alcohol and Cigarette Use in Pregnancy," J. Kuzma and D. Kissinger, Neurobehavioral Toxicology and Teratology 3:211-221(1981).

In a California study of more than 12,000 women during 1975-1977, of those having a history of two or more abortions, virtually all (98.5%) consumed alcohol throughout the entire 9 months of a subsequent pregnancy and at higher levels than any of the other categories studied (up to 3 oz. per day) Overall, 51% of the women drank and 35% smoked during the pregnancy.

"Sexual Experience and Drinking Among Women in a U.S. National Survey," A. Klassen and S. Wilsnack, Archives of Sexual Behavior 15(5): 363-392 (1986)

In a 1981 random survey of 917 women in the U.S., 4% of the abstainers had a prior reported non-spontaneous abortion compared to 5% for light drinkers (under 0.22 oz. absolute alcohol per day), 13% for moderate drinkers ( 0.22-0.99 oz. absolute alcohol per day) , and 13% for heavy drinkers (at least 1 oz. absolute alcohol per day) compared to 6% for all ever pregnant women. Moderate and heavy drinkers combined exceeded lighter drinkers in abortion experience to a statistically significant degree.

"Characteristics of pregnant women who engage in binge alcohol consumption," J Gladstone et al, Can Med Assoc J 156 (6): 789-808, 1997

Women who were binge drinkers during their pregnancy had a significantly higher rate of previous therapeutic abortions.

"Overdose and termination of pregnancy: an important association?," H. Houston, L. Jacobson, Br. J. General Practice 46: 737-738, Dec. 1996

A significant association was found between a recorded and treated drug overdose either before or after an induced abortion with a majority of such events occurring within two years of each other.

Aborted Women: Silent No More, David C. Reardon (Chicago: Loyola Univ. Press, 1987).

According to anecdotal reports substance abuse occurred in women following induced abortion to overcome nightmares or insomnia, as an attempt to reduce grief reactions, and to repress the abortion experience itself.

"Therapeutic Abortion on Psychiatric Grounds," S.A. Drower and E.S. Nash, South Africa Medical Journal 54(2): 604-608 Oct 7/1978.

Increased use of alcohol, tobacco, drugs and tranquilizers was found in women who aborted compared to women who were refused abortion and had a variety of pregnancy outcomes where each group had presented for abortion for psychiatric reasons at a Capetown, South Africa hospital.

Women, Drinking and Pregnancy, Moria Plant, (London: Tavistock Publications, 1985)

In a Scottish study of 1,008 women, those with a history of induced abortion had significantly higher self-reported levels of alcohol consumption in pregnancy than those with a history of stillbirth, spontaneous abortion, or having had a mentally or physically handicapped child.

"Drug Use Among Adolescent Mothers: Profile of Risk," H. Amaro, B. Zuckerman and H. Cabral, Pediatrics 84:144-150, July 1989.

In a study of inner-city adolescent mothers, those with a history of induced abortion were twice as likely to be involved in alcohol, marijuana or cocaine compared with non-using controls.

"Drug Use and Other Determinants of Premarital Pregnancy and Its Outcome: A Dynamic Analysis of Competing Life Events," K Yamaguchi and DB Kandel, Journal of Marriage and the Family 49:257, 1987

A study of young women in the state of New York found that the current use of illicit drugs (other than marijuana) was 6.1 times higher if there was a history of a prior abortion. In contrast, women with postmarital births were much less likely (0.14) to report current use of illicit drugs.

"Abortion and Subsequent Substance Abuse," DC Reardon, PG Ney, Am J Drug Alcohol Abuse 26(1): 61-75, 2000

Women who aborted a first pregnancy were five times more likely to report subsequent substance abuse compared to women who carried to term.

"Characteristics of pregnant women exposed to cocaine in Toronto between 1985 and 1990," K Graham and G Koren, Can Med Assoc J 144(5): 563, 1991

In a Toronto study of pregnant women, cocaine users had a higher mean average of elective abortions compared to non-users of drugs.

"Health issues associated with increasing use of "crack" cocaine among female sex workers in London," H Ward et al, Sex Transm Infect 76(4): 292-293, 2000

34% of female sex workers in London reported using " crack" cocaine in 1995-1996. Crack use was associated with abortion and with hepatitis C infection.

"Cocaine Use During Pregnancy: Prevalence and Correlates," D.A. Frank, B. Zuckerman, H. Amaro, K. Aboagye, Pediatrics 82(6):888-895, December 1988.

In a study of drug abuse among Boston inner-city women during pregnancy/those using cocaine were twice as likely to have a history of two elective abortions (19% vs. 9%) and three times more likely to have had three or more elective abortions (9% vs. 3%) than non-cocaine using controls. Cocaine users were more likely to drink alcohol, use cigarettes, marijuana, opiates and other illicit drugs compared to cocaine non-users.

"Direct and Indirect Interactions of Cocaine with Childbirth Outcomes," L Singer et al, Arch Pediatr Adolesc Med 148: 959-964, 1994

A retrospective review of hospital charts over a one year period compared women who tested positive for cocaine during pregnancy compared with matched controls who did not use cocaine found that cocaine use was the best predictor of increased incidence of abortions.

"Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates," A.S. Oro and S.D. Dixon, Journal of Pediatrics 111:571-578(1987).

In a San Diego study of drug use, women who used cocaine and/or methamphetamine averaged 1.7 abortions compared with 1.2 abortions for non-drug using controls. Women who used heroin or methadone were more likely to have had abortions (2.4 vs. 1.2) than non-drug using controls. Infants exposed to both heroin and either cocaine or methamphetamine had mothers with the highest number of pregnancies (5) and abortions (2.7). These infants had the highest percentage of no prenatal care, prematurity/poorer growth, small birth weight and fetal distress.

"Psychosocial Characteristics of Psychiatric Inpatients with Reproductive Losses," T Thomas et al, Journal of Health Care for the Poor and Underserved 7(1): 15, 1996

Women hospitalized for major psychiatric disorders with a history of abortion were significantly more likely to have received the diagnosis of psychoactive substance abuse (DSM-IIIR criteria) and significantly more likely to report substance abuse, alcohol abuse and cocaine abuse compared to women with no live birth.

"Abortion in Adolescence," Nancy B. Campbell/ K. Franco and S. Jurs, Adolescence23(92):813-823, Winter 1988.

A study at the Medical College of Ohio compared differences in 35 women who had their abortions as teenagers with 36 women who had their abortions after the age of 20. Antisocial and paranoid disorders as well as drug abuse and psychotic delusions were found to be significantly higher in the group who aborted as teenagers. Adolescents were more likely to retreat into sexual activity or drug and alcohol abuse.

Related Research

Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: a register-based case-control follow-up study of 524 women. Kahila H1, Gissler M, Sarkola T, Autti-Rämö I, Halmesmäki E. Drug Alcohol Depend. 2010 Oct 1;111(3):215-21. doi: 10.1016/j.drugalcdep.2010.04.014. Epub 2010 Jun 3.

BACKGROUND: A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy.

METHODS: Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007.

RESULTS: 7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p<0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5).

CONCLUSIONS: These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.

EDITOR's NOTE: In light of the studies indicating a increased risk of substance use during pregnancy among women with a history of abortion, it seems likely these results reflect another risk associated with abortion.

Alcohol

See above

Women's risk of repeat abortions is strongly associated with alcohol consumption: a longitudinal analysis of a Russian national panel study, 1994-2009. Keenan K, Grundy E, Kenward MG, Leon DA. PLoS One. 2014 Mar 26;9(3):e90356. doi: 10.1371/journal.pone.0090356. eCollection 2014.

We investigated the longitudinal predictors of first and repeat abortion, focusing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16-44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994-2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62-3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994-2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts.

Smoking

Active smoking and the risk of estrogen receptor-positive and triple-negative breast cancer among women ages 20 to 44 years. Kawai M, Malone KE, Tang MT, Li CI. Cancer. 2014 Feb 10. doi: 10.1002/cncr.28402.

Increased Smoking Rates In Women Following Induced Abortion, by Thomas Strahan

Social and Emotional Adjustment Following Early Pregnancy in Young Australian Women: A Comparison of Those Who Terminate, Miscarry, or Complete Pregnancy. Olsson CA et al.J Adolesc Health. 2014 Jan 15. pii: S1054-139X(13)00738-6. doi: 10.1016/j.jadohealth.2013.10.203.

Women with a history of abortion are at higher risk of smoking and alcohol use as well as nicotine and alcohol dependence. Compared to never pregnant women of the same age, those with a history of abortion had adjusted higher 4.1 times higher risk of smoking (CI, 1.9-8.8), 4.5 times higher risk of nicotine dependence (OR 4.5; CI, 2.1-9.6), 2.5 times the risk of binge drinking (CI, 1.1-6.1), and 2.7 times the risk of alcohol dependence(CI, 1.2-5.9). Women who carried to term were generally at lower risk than never pregnant women and far below the risks associated with women who had abortions.

Smoking, traumatic event exposure, and post-traumatic stress: a critical review of the empirical literature. Feldner MT, Babson KA, Zvolensky MJ. Clin Psychol Rev. 2007 Jan;27(1):14-45. Epub 2006 Oct 10.

Exposure to trauma, and particularly PTSD, is associated with higher rates of smoking.

Nicotine Dependence and Major Depression, N Breslau et al, Arch Gen Psychiatry 50:31-35, 1993.

A history of major depression increased the risk for progression to nicotine dependence or more severe levels of dependence (OR 2.06,95%CI, 1.21-3.49). Persons with a history of nicotine dependence had a higher rate of first instance major depression during a 14 month follow-up period than persons with no history of nicotine dependence (7.5% v. 3.2% ; (OR 2.45,95%CI, 1.17-5.15). see also, Smoking and Major Depression, KS Kendler et al, Arch Gen Psychiatry 50:36-43, 1993 (average levels of cigarette consumption were strongly related with the lifetime prevalence rate for major depression.)

Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Pedersen, W. (2007), Addiction, 102: 1971–1978.

Women with a history of abortion were 5 times more likely to smoke.

Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal pregnancy survey, L Henriet, M Kaminski, Br J Obstet Gynaecol 108:1036-1042, 2001

A 1995 French national survey of women who delivered a singleton birth found that 23.6% of the women smoked during the third trimester of pregnancy where there was no induced abortion history compared to 34.5% for women with a history of one induced abortion, and 42% of women with a history of two or more induced abortions. Women with abortion history were also more likely to be heavier smokers compared to women with no abortion history.

"Morbidity and Mortality in Children Associated With the Use of Tobacco Products by Other People," J.R. DiFranza, R.A. Lew, Pediatrics 97(4): 560 April, 1996

Based on meta-analysis it was concluded that the use of tobacco products by adults has an enormous adverse impact on the health of children.

"The Relationship Between Idiopathic Mental Retardation and Maternal Smoking During Pregnancy," C.D. Drews et. al. Pediatrics 97(4): 547, April, 1996

A study by researchers at Emory University suggested that maternal smoking may be a preventable cause of mental retardation in children.

Personal resilience, cognitive appraisals, and coping: An integrative model of adjustment to abortion. Major B, Richards C, Cooper ML et al. J Person Soc Psychol, 1998; 74: 735-752"

527 women completed a survey one month following their abortions in which they indicated how much they "did each of the behaviors listed to help deal with [their] abortion." 23% reported using smoking, 18% drinking, and 9% using drugs from "a little bit" to "a great deal" in order to deal with their abortions.

"Characteristics of Women by Smoking Status in the San Francisco Bay Area," E.A. Holly et al.. Cancer Epidemiology, Biomarkers & Prevention: 1: 491-497, Sept/Oct 1992

Women smokers were more likely than non-smokers to consume larger quantities of coffee, soft drinks, liquor and beer; more likely to have had first sexual intercourse before age 16; had a greater number of lifetime sexual partners; were more likely to have been pregnant and report a history of chlamydia, gonorrhea and/or pelvic inflammatory disease.

"Pregnancy Decision Making as a Significant Life Event: A Commitment Approach," J Lydon et al, J. of Personality & Social Psychology 71(1): 141-151, July, 1996.

57 women from either Los Angeles or Montreal were interviewed during a clinic visit for a pregnancy test, and subsequently received positive test results. They were interviewed a second time two days later. A third interview took place a month after the women had undergone an induced abortion or carried to term Those women continuing the pregnancy reported smoking fewer cigarettes at the third interview compared to the first interview, while those who had abortions did not report a change in smoking behavior. see Changes in Smoking and Drinking During Pregnancy, CA Hilton, JT Condon, Aust NZ Obstet Gynaecol 29:18, 1989 ( An Australian study found that the primary reason influencing smoking and drinking behavior during pregnancy was that doing so might harm the baby.).

"Psychological responses following medical abortion (using mifepristone and gemepost) and surgical aspiration," R Henshaw et al, Acta Obstet Gynecol Scand 73:812, 1994.

A study of Scottish women who had an induced abortion by use of either mifepristone and gemepost or vacuum aspiration found that at 16 days postabortion, anxiety scores correlated with the number of cigarettes smoked, with the most anxious women having the heaviest smoking habits.

"Increased Smoking Rates in Women Following Induced Abortion," Thomas W. Strahan, Association for Interdisciplinary Research Newsletter 2(2):5-8, Spring, 1989

Review of the literature.

"Pregnancy and Patterns of Tobacco Use: Shifts and Directions," in Forbes, Frecker, Nostbakken, ed. Proceeding of the Fifth World Conference on Smoking and Health, Vol. 1 (Winnipeg, Canada: Ottawa Council on Smoking and Health, 1983) 117-120.

Data on tobacco use before, during and after pregnancy showed that 80 percent of the women surveyed were aware of smoking's adverse effects. The proportion of smokers declined from 49 percent before pregnancy to 35 percent during pregnancy. The major reasons cited for not smoking were less desire to smoke and concern for the infant. After pregnancy/however, smoking increased again to before pregnancy frequency.

"An Overview: Maternal Nicotine and Caffeine Consumption and Offspring Outcome," J.C. Martin, Neurobehavioral Toxicology and Teratology 4(4): 421-27, July-August 1982.

Smoking during pregnancy generally results in a 150-200 mg. reduction in weight, a 20 percent increase in neonatal death for those smoking a pack per day/and a 35 percent greater chance of neonatal death for those smoking a pack per day. There is also a possible increase in congenital anomalies, decrease in growth rate, and a compromise in cognitive function in early and middle childhood. Only 12-13 percent of smoking women curtail their habit during pregnancy, and it has been estimated that 4,600 of the 87,000 infant deaths in the U.S. during the prenatal period would have been prevented if their mothers had not smoked.

"Smoking and Women. Tragedy of the Majority," J. F. Fielding, New England Journal of Medicine, 317(21), November 19/1987, pp. 1343-1345.

Since the release of the first Surgeon General's report on smoking and health in 1964, the prevalence of female smokers had declined at a considerably slower rate than that of male smokers. The decline in adult male smokers has been 21.4 percent, as compared with only 5.8 percent in women. Currently, 25.7 percent of adult women smoke as compared with 31.5 percent of men. Smoking reduces fertility, increases the rate of spontaneous abortion of chromosomally normal fetuses/and increases the incidence of abruptio placenta, placenta previa, bleeding during pregnancy and premature rupture of the membranes. Because of these effects, smoking results in many thousands of preventable fetal and neonatal deaths. Pregnant women must understand that giving their unborn child the best chance of being normal at birth and surviving the perinatal period requires that they stop smoking. Organizations that have been actively working for women's rights might consider devoting some attention to helping women wean themselves from a habit that is usually unwanted and known to be self-destructive.

"Managing the Uncomplicated Pregnancy," J.M. Bengston, R. Petrie and J.C. Shank, Patient Care, December 15,1987, pp. 56-93.

Very detailed listing of items to consider during pregnancy. It states that risks to patient and baby associated with smoking include miscarriage, premature birth, stillbirth, abruptio placenta and placenta previa, low birth weight, sudden infant death syndrome, neurobehavioral deficits, and susceptibility to respiratory infections during infancy.

"Mixed Messages for Women: A Social History of Cigarette Smoking," Virginia L. Emster, New York State Journal of Medicine, 85(7): 335-34, July, 1985; also "Getting Women Hooked: Defending the Indefensible, Women and Children Last?" J.L. Stenfeld, N.Y. State J. Med. 83(13): 1257, Dec, 1983; "Precious Baby." Mary Ann Comer, N.Y. State J.Med. 83(13): 1292, Dec, 1983.

This valuable collection of articles written by the health profession should be read in connection with articles in the same journal in July 1985. The articles attack the feminist movement and urge the medical profession to become more active in the smoking and health field. For example, the article "Precious Baby" states, "Ms. Magazine [May 1983 issue] was devoted entirely to the topic of women's health without a clear emphasis on the leading cause of preventable disease and death in women-cigarettes. In its 13 year existence Ms. has never published an article on smoking but has carried hundreds of pages of cigarette advertising." Apparently many women in the feminist movement smoke themselves. See New York State Journal of Medicine, December 1983, p. 1258.

"Women's Smoking Trends and Awareness of Health Risk," R. Tagliacozzo and S. Vaughn, Preventive Medicine 9:384-387(1980).

Several studies have reported results indicating that in treatment programs designed to stop smoking, women are less successful than men in achieving and maintaining abstinence. Cites several studies.

United States Public Health Service. Adult Use of Tobacco, (Atlanta: U.S. Department of Health, Education and Welfare, Center for Disease Control, Bureau of Health Education, 1975).

Women are more likely to report that they use cigarettes to deal with emotional upset than men. Women are more likely than men to affirm, "When I feel blue or want to take my mind off troubles, I smoke cigarettes," and "I light up when I feel angry about something."

"Personality Variables Associated With Cigarette Smoking," Richard W. Coan, Journal of Personality and Social Psychology 26(1): 86-104(1973).

Valuable study on the differences between smokers and non-smokers. Male smokers had the greatest extroversion while female non-smokers had the greatest introversion. Smokers tended to experience more distress or disturbance than non-smokers. There is a tendency for men to be more liberal than women, and for smokers to be more liberal than non-smokers. Nonsmokers tend to attach greater importance to deliberate and planned action, while smokers favored spontaneity. Smokers tended toward uncontrolled complexity rather than organized simplicity in their preferences and thought processes. Smokers tended to manifest aesthetic rather than practical interests. Smokers tended to show more tolerance if not actual hunger for varied ideas/ emotional and perceptual effects, complexity and perhaps even confusion. Non-smokers had a greater need for control, order and simplicity. Women tend to be more psychologically sensitive than men- they are aware of a greater range of effects in their private experience. Smokers have a higher level of anxiety than non-smokers. Smokers manifest more psychomatic symptoms, more pretension, more guilt proneness, more ergic tension, a higher Taylor anxiety score, more unrealistic fantasy content, less self-control over internal processes, more nervous tension. Evidently smokers dwelled more on the past than non-smokers but future time perspective was highest in the male smokers and lowest in the female smokers. Future time perspective represents percentage measures based upon the subject's assignment of his recent topics of conversation to the categories of past, present and future.

"Smoking in Pregnancy: a study of psychosocial and reproductive risk factors," AW Morales et al, J Psychosom Obstet Gynaecol 18(4): 247, 1997

A British study found that women with a higher incidence of smoking in pregnancy were more likely to have previous miscarriages and terminations.

"The pregnant smoker: a preliminary investigation of the social and psychological influences," C Haslam et al, Journal of Public Health Medicine 19(2): 187-192, 1997

Pregnant smokers, when asked, ‘What in particular, causes you to have an urge to smoke?'; two-thirds gave an emotional state ( stress, boredom, feeling upset) for their answer.

"Characteristics of young female smokers in a Swedish primary health care area," J Liljestrand et al, Scand J Primary Health Care 11:157, 1993

A 1990 Swedish study found that women smokers were significantly more likely to have prior legal abortions (19%) compared to non-smokers (9%). There were no differences between smokers and non-smokers where there were prior miscarriages or live born children.

"Induced abortion is not a cause of subsequent pre-term delivery in teenage pregnancies," TT Lao and LF Ho, Human Reproduction 13(3): 758, 1998.

In a Hong Kong study, 39% of teenage mothers with a history of induced abortion who delivered were smokers compared to 14.4% of teenage mothers who delivered but had no induced abortion history.

"Relation between smoking in reproductive age women and disorders in reproduction," D Hrub'a and P Kachl'ik, Ceska Gynekol 62(4): 191-196, 1997.

A study of women teachers in the Czech Republic found that smokers significantly more often had abortions of unwanted pregnancies compared to non-smokers.

"Outcome of First Delivery After 2nd Trimester Two-Stage Induced Abortion. A Controlled Historical Cohort Study," O. Meirik and K.G. Nygren, Acta Obstetricia et Gynecological Scandinavica 63(1): 45-50(1984).

A positive correlation between maternal smoking and history of abortion was found in an historical cohort study of the outcome of the first birth after a legal second trimester two- stage abortion induced with saline or prostaglandin. It was concluded that low birth weight of infants born to aborters may be related as much to maternal smoking as to the previously induced abortion.

"Pregnancy Complications Following Legally Induced Abortion: An Analysis of the Population with Special Reference to Prematurity," E.B. Obel, Danish Medical Bulletin 26:192- 199(1979).

A study of 7,327 pregnant women at two Copenhagen hospitals found 63 percent smokers where there was one or more prior induced abortions, 51 percent smokers where there was a history of one or more spontaneous abortions, 49 percent smokers where there was a previous live birth, and 55 percent smokers where there was no previous history of pregnancy. After 28 weeks gestation 43.1% still smoked during pregnancy if the last pregnancy was terminated by abortion compared to only 32.1 % if live birth or 30.2% for no previous pregnancy.

"Characteristics of Pregnant Women Reporting Previous Induced Abortions," S Harlap and A. Davies, Bulletin World Health Organization, 52:149(1975).

Smokers have twice the rate of reporting previous induced abortion than non-smokers i.e. 12 percent vs. 6 percent based upon standardized rates among Arab and Israeli women.

"Early Complications of Induced Abortion in Primigravidae," K. Dalaker, K. Sundfor, and J. Skuland Annales Chirurgiae et Gynaecologiae 70(6): 331-336(1981).

A statistically significant difference was found between the smoking habits of women under 19 years and those over 19. The incidence of pelvic inflammatory disease after the abortion was highest in the group of patients who, in addition to having a high frequency of smokers/ were characterized by a low age of menarche and a low rate of married or cohabit status. (Abstracted in Smoking and Health Bulletin, U.S. Department of Health and Human Services, Public Health Services [1982}, p. 396)

"Ectopic Pregnancy and Myoma Uteri: Tetragenic Effects and Maternal Characteristics," E. Matsunaga and E. Shiota, Teratology 21:61-69 (1980).

Ectopic pregnancy was found to be associated with lower parity, previous ectopic pregnancy and maternal smoking and drinking. The frequency of fetal malformations was 11.6 percent among 43 recovered from ectopic pregnancies, compared with 6.2 percent among 97 from myomatous pregnancies, and 3.3 percent among 3/1474 from normally implanted pregnancies not complicated by myomas. Incidence of smoking was 9.4 percent in the myomatous pregnancy group, 29.2 percent in the ectopic pregnancy group, and 15.1 percent in the prior induced abortion group. (Japanese study at National Institute of Genetics)

"Association of Induced Abortion with Subsequent Pregnancy Loss," A. Levin, S.C. Schoenbaum, R. Monson, P.G. Stubblefield and K. Ryan, Journal of the American Medical Association 243:2495-2499, June 27, 1980.

(Women patients of Boston Hospital had smoking rates of 31.7 percent with no prior induced abortion, 40.3 percent with one prior abortion and 51.7 percent with two or more prior abortions.

"Low Birth Weight In Relation To Multiple Induced Abortions," M.T. Mandelson, C.B. Maden, J.R. Daling, AmJ. Public Health, 82(3):391-394, March, 1992.

In a Washington State study of 6541 white women who delivered a child between 1984- 87, 41.6% of the women smoked during this pregnancy if they had a history of 4 or more induced abortions compared with 31.0% smokers (2 prior abortions), 28.1% smokers (1 prior abortion) or 18.0% smokers (no prior abortions).

"A study on the effects of induced abortion on subsequent pregnancy outcome," C. Madore, W.E. Hawes, F. Many, A.C. Hexter, Am. J. Obstet. Gynecol. 139: 516, 1981.

A California case-control study in 1976-78 of women with a history of one or more previous induced abortions compared to control subjects without a history of abortion found that 11.8% of women with an abortion history smoked 1 pack of cigarettes per day compared to 8.1% of controls which was statistically significant.

"A Prospective Study of Smoking and Pregnancy," S. Kullander and B. Kallen, Acta Obstet. Gynec. Scand. 50:83-94(1971).

A study of 6,363 Swedish women during 1963-64 found that 56.1% of the women smoked who had induced abortions compared with 43.3% smokers among women having given birth. Information on whether the pregnancy was wanted was obtained on 4,843 women. Among those reporting wanted pregnancies 41.5% were smokers vs. 52.4% among women who reported unwanted pregnancies (later carried to term). Some 18.9% of the women with wanted pregnancies smoked 10 or more cigarettes per day vs. 27.1% of women reporting unwanted pregnancies.

"Outcome of First Delivery After Second Trimester Two Staged Induced Abortion: A Controlled Historical Cohort Study," O. Meirik, K.G. Nygren, Acta Obstet. Gynecol. Scand. 63(1):45-50 (1984)

In a later study of 4,719 Swedish women during 1970-1978, 58.1% of those women with a history of abortion smoked (37.4% smoked 10 or more cigarettes per day) compared with 40.4% smokers among parity-matched controls (21.1% of parity-matched controls smoked 10 or more cigarettes per day) and all Swedish women generally in 1975 (37.8% smoked and 18.9% of all Swedish women smoked 10 or more cigarettes per day).

"Smoking During Pregnancy and Child Maltreatment: Is There An Association?," J. Chessare, J. Pascoe and E. Baugh, Int'l J. Biosocial Research 8(1): 37-42, (1986).

Women who smoked during pregnancy were three times more likely to be reported for maltreatment in the first 18 months after birth compared with non-smoking mothers. (22.6% vs. 7.6%)

Case-Control Study of Attention-Deficit Hyperactivity Disorder and Maternal Smoking, Alcohol Use and Drug Use During Pregnancy", E Mick et al, J Am Acad Child Adolesc. Psychiatry 41(4):378, April, 2002

Smoking during pregnancy was found to be a statistically significant increased risk factor for attention-deficit hyperactivity disorder in children.

Annual Smoking -Attributable Mortality, Years of Potential Life Lost, and Economic Costs- United States, 1995-1999. Centers for Disease Control, MMWR Vol. 51, No. 14:300-303, April 12, 2002.

During 1995-1999, smoking caused an annual average of 178,311 deaths of women in the U.S. Most smoking deaths were attributed to lung cancer, ischemic heart disease, and chronic airways obstruction. Each year, smoking-attributable mortality was responsible for an estimated 2,284,113 years of potential life lost for women. Adult females lost an average of 14.5 years of life because they smoked.