Risks of Repeated Abortion

How many abortions are considered safe? I have had five already and I think I am pregnant again. I feel I am not ready financially, emotionally and physically to have a baby. Can I physically afford to have one more abortion? My body is healthy and strong. Will I be able to have children in the future?

--Aisha

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There is no easy, absolute answer to this question. The more times the cervix undergoes stress -- be it from D&Cs (for abortions or for abnormal bleeding) or from a LEEP or conization treatment after an abnormal pap smear -- the more likely it may be injured. Such injury includes scarring of the cervix, or cervical stenosis, which can prevent menstrual blood from getting out and sperm from getting in; this leads to higher chances of endometriosis or infertility. Another possible complication is cervical incompetence, in which the cervix is weakened and opens up inappropriately during pregnancy, leading to miscarriage or premature delivery.

Repeated abortions may also cause scarring inside the uterus. We call this Asherman's syndrome, and it can lead to infertility and miscarriage. If an abortion is complicated by an infection, then blockage of the fallopian tubes is another possibility. This may result in infertility, chronic pelvic pain or increased chance of an ectopic (tubal) pregnancy.

This is not to say that abortion is inherently a highly dangerous procedure. For many women, the potential damage from an abortion is far less than the physical and personal complications posed by an unplanned pregnancy. Still, like any surgical procedure, abortion carries risks -- and the more often you undergo the procedure, the more likely you are to suffer one of those risks. The result may be that you are unable to have a child when you want one.

That means that abortion should not be used as a substitute for contraception. In addition to the complications I have mentioned, another obvious concern is that exposure to pregnancy may go hand in hand with exposure to sexually transmitted diseases, including HIV. I strongly suggest you see a gynecologist to talk about contraceptive options appropriate for you.

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