Abstract
OBJECTIVE: To explore time trends in abortion based on method used and characteristics associated with method type by uniquely linking social and behavioral data reported by a population-based cohort of young Australian women. METHODS: We analysed self-reported data from 16 993 women in the Australian Longitudinal Study on Women's Health 1989-95 cohort, aged 18-24 years at recruitment in 2013, linked to abortion data from three population-based administrative data sources. RESULTS: The incidence of medication abortion increased over time whereas surgical abortion decreased, with similar trends across the largest states. The adjusted odds ratio (AOR) of having a medication compared with a surgical abortion increased over time [by each 1-year increase in time, 1.33 (95% confidence interval 1.20, 1.48)]. Women who lived in outer regional/remote/very remote areas [AOR 3.51 (2.15, 5.74)] and inner regional areas [1.80 (1.21, 2.69)] had increased odds of a medication abortion compared with women who were living in major cities. Medication abortions were more common than surgical abortions in outer regional/remote/very remote areas from 2017 whereas, in major cities, surgical abortion remained the most common abortion method throughout the study period. CONCLUSION: Linkage of government-recorded health events with self-reports demonstrated a shift towards increasing use of medication abortion relative to surgical abortion, with greater increases in nonmetropolitan areas. The strong geographical disparities in abortion method suggest that, for those who are living in nonmetropolitan areas, there may be less opportunity to choose surgical abortion due to limited availability of services, with significant implications for women who present later in pregnancy.