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A population-based study of the frequency and predictors of induced abortion among women with schizophrenia

  • Hilary K. Brown (a1), Cindy-Lee Dennis (a2), Paul Kurdyak (a3) and Simone N. Vigod (a4)

Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia.


We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk.


In a population-based, repeated cross-sectional study (2011–2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15–44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion.


Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5–17.5 v. 12.8–13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16–1.54). They also had higher abortion ratios (592–736 v. 321–341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96–2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39–2.44), multiparity (aRR 2.17, 95% CI 1.66–2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34–3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47–2.34) were associated with increased abortion risk.


These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.

Declaration of interest


Corresponding author
Correspondence: Hilary K. Brown, Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada. Email:
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Previously presented as a poster at the Canadian National Perinatal Research Meeting in Banff, Alberta, Canada, on 14 February 2018.

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1Andreasen, NC. Symptoms, signs, and diagnosis of schizophrenia. Lancet 1995; 346: 477–81.
2Vigod, SN, Seeman, MV, Ray, JG, Anderson, GM, Dennis, CL, Grigoriadis, S, et al. Temporal trends in general and age-specific fertility rates among women with schizophrenia (1996–2009): a population-based study in Ontario. Canada. Schizophrenia Res 2012; 139: 169–75.
3Jatlaoui, TC, Shah, J, Mandel, MG, Krashin, JW, Suchdev, DB, Jamieson, DJ, et al. Abortion surveillance—United States, 2014. MMWR Surveill Summ 2017; 66: 148.
4Matevosyan, NR. Reproductive health in women with serious mental illnesses: a review. Sex Disabil 2009; 27: 109–18.
5Ozcan, NK, Boyacioglu, NE, Enginkaya, S, Dinc, H, Bilgin, H. Reproductive health in women with serious mental illnesses. J Clin Nurs 2014; 23: 1283–91.
6Simoila, L, Isometsa, E, Gissler, M, Suvisaari, J, Sailas, E, Halmesmaki, E, et al. Schizophrenia and induced abortions: a national register-based follow-up study among Finnish women born between 1965–1980 with schizophrenia and schizoaffective disorder. Schizophrenia Res 2018; 192: 142–7.
7Laursen, TM, Munk-Olsen, T. Reproductive patterns in psychotic patients. Schizophrenia Res 2010; 121: 234–40.
8World Health Organization (WHO). International statistical classification of diseases and related health problems. WHO, 1994.
9American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed. APA, 2000.
10Williams, JI, Young, WA. Summary of studies on the quality of health care administrative databases in Canada. In Patterns of Health Care in Ontario, The ICES Practice Atlas (eds Goel, V, Williams, JI, Anderson, GM, Blackstien-Hirsch, P, Fooks, C and Naylor, CD): 339–45. Canadian Medical Association, 1996.
11Kurdyak, P, Lin, E, Green, D, Vigod, S. Validation of a population-based algorithm to detect chronic psychotic illness. Can J Psychiatry 2015; 60: 362–8.
12Pope, MA, Joober, R, Malla, AK. Diagnostic stability of first-episode psychotic disorders and persistence of comorbid psychiatric disorders over 1 year. Can J Psychiatry 2013; 58: 588–94.
13Chamberlain, A, Rauh, J, Passer, A, McGrath, M, Burket, R. Issues in fertility control for mentally retarded female adolescents: I. Sexual activity, sexual abuse, and contraception. Pediatrics 1984; 73: 445–50.
14Urquia, ML, Moineddin, R, Jha, P, O'Campo, PJ, McKenzie, K, Glazier, RH, et al. Sex ratios at birth after induced abortion. CMAJ 2016; 188(9): E181–90.
15Canadian Institute for Health Information. Important Notes Regarding Coverage. Canadian Institute for Health Information, 2014 (
16Johns Hopkins Bloomberg School of Public Health. The Johns Hopkins ACG® System, version 9.0. Johns Hopkins University, Maryland, USA, 2009 (
17Jee, SH, Cabana, MD. Indices for continuity of care: a systematic review of the literature. Med Care Res Rev 2006; 63: 158–88.
18Zou, GY. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702–6.
19Pehlivanoglu, K, Tanriover, O, Tomruk, N, Karamustafalioglu, N, Oztekin, E and Alpay, N. Family planning needs and contraceptive use in female psychiatric outpatients. Turkish J Fam Med Primary Care 2007; 1: 32–5.
20Kelly, DL, Conley, RR. Sexuality and schizophrenia: a review. Schizophrenia Bull 2004; 30: 767–79.
21Chernomas, WM, Clarke, DE, Chisholm, FA. Perspectives of women living with schizophrenia. Psychiatr Serv 2000; 51: 1517–21.
22Copeland, LA, Zeber, JE, Wang, CP, Parchman, ML, Lawrence, VA, Valenstein, M, et al. Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization. BMC Health Serv Res 2009; 9: 127.
23Hugues, E, Edmondson, AJ, Onyekwe, I, Quinn, C, Nolan, F. Identifying and addressing sexual health in serious mental illness: views of mental health staff working in two National Health Service organizations in England. Int J Ment Health Nurs 2018; 27(3): 966–74.
24Quinn, C, Happell, B, Welch, A. The 5-As framework for including sexual concerns in mental health nursing practice. Issues Ment Health Nurs 2013; 34: 1724.
25Hayter, M. Reaching marginalized young people through sexual health nursing outreach clinics: evaluating service use and the views of service users. Nursing Open 2005; 22(4): 339–46.
26Wahabi, HA, Alzeidan, RA, Bawazeer, GA, Alansari, LA, Esmaeil, SA. Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2010; 10: 63.
27Vigod, SN, Gomes, T, Wilton, AS, Taylor, VH, Ray, JG. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population-based cohort study. BMJ 2015; 350: h2298.
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A population-based study of the frequency and predictors of induced abortion among women with schizophrenia

  • Hilary K. Brown (a1), Cindy-Lee Dennis (a2), Paul Kurdyak (a3) and Simone N. Vigod (a4)
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