Contraception
Volume 78, Issue 2 , Pages 143-148, August 2008

Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion☆

  • Suzan Goodman

      Affiliations

    • University of California, San Francisco, San Francisco, CA 94110, USA
    • Corresponding Author InformationCorresponding author. University of California, San Francisco, San Francisco, CA 94110, USA. Tel.: +1 415 202 4679; fax: +1 415 206 8387.
    • ,
  • Sarah K. Hendlish

      Affiliations

    • Planned Parenthood Golden Gate, San Francisco, CA 94109, USA
    • ,
  • Matthew F. Reeves

      Affiliations

    • University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
    • Magee-Women's Research Institute, Pittsburgh, PA 15261, USA
    • ,
  • Anne Foster-Rosales

      Affiliations

    • University of California, San Francisco, San Francisco, CA 94110, USA
    • Planned Parenthood Golden Gate, San Francisco, CA 94109, USA

Received 7 December 2007; received in revised form 5 March 2008; accepted 5 March 2008. published online 16 May 2008.

Abstract 

Background

Of the 1.3 million abortions performed annually in the United States, approximately half are repeat procedures. Immediate postabortal intrauterine device (IUD) insertion is a safe, effective, practical and underutilized intervention that we hypothesize will significantly decrease repeat unintended pregnancy and abortion.

Study design

All women receiving immediate postabortal IUD insertion in eight clinics of a Northern California Planned Parenthood agency during a 3-year period comprise the IUD cohort. We selected a cohort of controls receiving abortions but choosing other, non-IUD contraception on the day of the abortion visit in a 2:1 ratio matched by date of abortion. We obtained follow-up data on repeat abortions within the agency for both cohorts through 14 months after the 3-year period. We evaluated differences in repeat abortion between cohorts. All analyses were intent-to-treat.

Results

Women who received an immediate postabortal IUD had a lower rate of repeat abortions than controls (p<.001). Women who received a postabortal IUD had 34.6 abortions per 1000 woman-years of follow-up compared to 91.3 for the control group. The hazard ratio for repeat abortion was 0.38 [95% confidence interval (CI), 0.27–0.53] for women receiving a postabortal IUD compared to controls. When adjusted for age, race/ethnicity, marital status, and family size, the hazard ratio was 0.37 (95% CI, 0.26–0.52).

Conclusion

Immediate postabortal intrauterine contraception has the potential to significantly reduce repeat abortion.

Keywords: Repeat abortion, IUD, IUC, Intrauterine contraception, Postabortal

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☆ Financial support for this study was provided by FEI Women's Health (now DuraMed), producers of ParagardÒ T380A intrauterine copper contraceptive, who sponsored a Staff Training Pilot at Planned Parenthood Golden Gate (part of the intervention study). Ms. Hendlish is concurrently a research consultant for Berlex, Inc (now Bayer Health Care, Inc.), producers of Mirena® levonorgestrel-releasing intrauterine system.

PII: S0010-7824(08)00108-X

doi:10.1016/j.contraception.2008.03.003

Contraception
Volume 78, Issue 2 , Pages 143-148, August 2008

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