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Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice

      Abstract

      Objective

      The objective was to evaluate whether having intrauterine devices (IUDs), contraceptive implants and injections immediately available to women undergoing abortion, compared to requiring an additional visit for these methods, leads to fewer pregnancies and fewer abortions in the following 12 months.

      Methods

      We conducted a historical cohort study using health records of Medicaid-insured women obtaining a first-trimester surgical abortion within a single practice in New York City. Women in Cohort 1 (2007–2008) needed an additional visit to initiate the IUD or injection. Women in Cohort 2 (2008–2009) were able to initiate these contraceptives and implants during the abortion visit. Women in both cohorts received these methods without additional cost, and all could receive a pill, patch or ring prescription. We compared the proportions of each cohort who experienced a pregnancy that began in the 12 months following the index abortion and also evaluated the outcomes of those pregnancies.

      Results

      Cohorts 1 and 2 consisted of 407 and 405 women, respectively. The proportions with pregnancy beginning over the following 12 months were substantially greater in Cohort 1 than Cohort 2 (27.3% versus 15.3%, p<.001). Women in Cohort 1 then underwent both more additional abortions (17.2% versus 9.9%, p=.003) and more births (7.9% versus 3.7%, p=.02). The proportion of women in Cohort 1 who initiated IUDs and implants within 12 months was smaller than in Cohort 2 (11% versus 46%, p<.001).

      Conclusions

      Among women insured by Medicaid, offering immediate comprehensive contraceptive access — including IUDs and implants — on the same day as an induced abortion, compared to requiring an additional visit, increased uptake of IUDs and implants and decreased repeat pregnancies in the next 12 months and abortions.

      Keywords

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      References

        • Jones R.K.
        • Kavanaugh M.L.
        Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion.
        Obstet Gynecol. 2011; 117: 1358-1366
        • Daily E.F.
        • Nicholas N.
        • Nelson F.
        • Pakter J.
        Repeat abortions in New York City: 1970–1972.
        Fam Plann Perspect. 1973; 5: 89-93
        • Jones R.K.
        • Kooistra K.
        Abortion incidence and access to services in the United States, 2008.
        Perspect Sex Reprod Health. 2011; 43: 41-50
        • Jones R.K.
        • Darroch J.E.
        • Henshaw S.K.
        Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001.
        Perspect Sex Reprod Health. 2002; 34: 226-235
        • Langston A.M.
        • Rosario L.
        • Westhoff C.L.
        Structured contraceptive counseling — a randomized controlled trial.
        Patient Educ Couns. 2010; 81: 362-367
        • Fisher W.
        • Singh S.S.
        • Shuper P.A.
        • Carey M.
        • Otchet F.
        • MacLean-Brine D.
        • et al.
        Characteristics of women undergoing repeat induced abortion.
        Can Med Assoc J. 2005; 172: 637-641
      1. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 121. American Congress of Obstetricians and Gynecologists.
        Obstet Gynecol. 2011; 118: 184-196
        • Trussell J.
        Contraceptive failure in the United States.
        Contraception. 2011; 83: 397-404
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • Buckel C.
        • Madden T.
        • Allsworth J.E.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998-2007
        • Mestad R.
        • Secura G.
        • Allsworth J.E.
        • Madden T.
        • Zhao Q.
        • Peipert J.F.
        Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project.
        Contraception. 2011; 84: 493-498
        • Short M.
        • Dallay D.
        • Omokanye S.
        • Hanisch J.U.
        • Inki P.
        Acceptability of the levonorgestrel releasing-intrauterine system and etonogestrel implant: one-year results of an observational study.
        Eur J Contracept Reprod Health Care. 2012; 17: 79-88
        • Kaneshiro B.
        • Aeby T.
        Long-term safety, efficacy, and patient acceptability of the intrauterine copper T-380A contraceptive device.
        Int J Womens Health. 2010; 2: 11-20
        • Blumenthal P.D.
        • Wilson L.E.
        • Remsburg R.E.
        • Cullins V.E.
        • Huggins G.R.
        Contraceptive outcomes among post-partum and post-abortal adolescents.
        Contraception. 1994; 50: 451-460
        • Bednarek P.H.
        • Creinin M.D.
        • Reeves M.F.
        • Cwiak C.
        • Espey E.
        • Jensen J.T.
        Immediate versus delayed IUD insertion after uterine aspiration.
        N Engl J Med. 2011; 364: 2208-2217
        • Grimes D.A.
        • Lopez L.M.
        • Schulz K.F.
        • Stanwood N.L.
        Immediate postabortal insertion of intrauterine devices.
        Cochrane Database Syst Rev. 2010; 16: CD001777
        • Fox M.C.
        • Oat-Judge J.
        • Severson K.
        • Jamshidi R.M.
        • Singh R.H.
        • McDonald-Mosley R.
        • et al.
        Immediate placement of intrauterine devices after first and second trimester pregnancy termination.
        Contraception. 2011; 83: 34-40
        • Steenland M.W.
        • Tepper N.K.
        • Curtis K.M.
        • Kapp N.
        Intrauterine contraceptive insertion postabortion: a systematic review.
        Contraception. 2011; 84: 447-464
        • Guttmacher Institute
        Repeat abortion, repeat unintended pregnancy, repeated and misguided government policies. Guttmacher Policy Review Spring 2007; Volume 10, Number 2.
        (Available at:) (Retrieved April 10, 2010)
        • Thompson K.M.
        • Speidel J.J.
        • Saporta V.
        • Waxman N.J.
        • Harper C.C.
        Contraceptive policies affect post-abortion provision of long-acting reversible contraception.
        Contraception. 2011; 83: 41-47
        • Goodman S.
        • Hendlish S.K.
        • Benedict C.
        • Reeves M.F.
        • Pera-Floyd M.
        • Foster-Rosales A.
        Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion.
        Contraception. 2008; 78: 136-142
        • Secura G.M.
        • Allsworth J.E.
        • Madden T.
        • Mullersman J.L.
        • Peipert J.F.
        The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception.
        Am J Obstet Gynecol. 2010; 203: 115.e1-115.e7
        • Goodman S.
        • Hendlish S.K.
        • Reeves M.F.
        • Foster-Rosales A.
        Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.
        Contraception. 2008; 78: 143-148
        • Roberts H.
        • Silva M.
        • Xu S.
        Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand.
        Contraception. 2010; 82: 260-265
        • Rose S.B.
        • Lawton B.A.
        Impact of long-acting reversible contraception on return for repeat abortion.
        Am J Obstet Gynecol. 2011; 206: 37.e1-37.e6
        • Cameron S.T.
        • Glasier A.
        • Chen Z.E.
        • Johnstone A.
        • Dunlop C.
        • Heller R.
        Effect of contraception provided at termination of pregnancy and incidence of subsequent termination of pregnancy.
        BJOG. 2012; 119: 1074-1080
        • Heikinheimo O.
        • Gissler M.
        • Suhonen S.
        Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion.
        Contraception. 2008; 78: 149-154
        • Cremer M.
        • Bullard K.A.
        • McDonald-Mosley R.
        • Weiselberg C.
        • Molaei M.
        • Lerner V.
        • et al.
        Immediate versus delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks gestation.
        Contraception. 2011; 83: 522-527
        • National Institutes of Health
        Research — general information.
        (Available at:) (Retrieved on August 13, 2010)
        • Madden T.
        • Westhoff C.L.
        Rates of follow-up and repeat pregnancy in the 12 months after first-trimester induced abortion.
        Obstet Gynecol. 2009; 113: 663-668
        • Postlethwaite D.
        • Trussell J.
        • Zoolakis A.
        • Shabear R.
        • Petitti R.
        A comparison of contraceptive procurement pre- and post-benefit change.
        Contraception. 2007; 76: 360-365
        • Secura G.M.
        • Allsworth J.E.
        • Madden T.
        • Mullersman J.L.
        • Peipert J.F.
        The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception.
        Am J Obstet Gynecol. 2010; 203: 115.e1-115.e7
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • Petrosky E.
        • Madden T.
        • Eisenberg D.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105-1113
        • Peipert J.F.
        • Madden T.
        • Allsworth J.E.
        • Secura G.M.
        Preventing unintended pregnancy by providing no-cost contraception.
        Obstet Gynecol. 2012; 120: 1291-1297
        • Reeves M.
        • Smith K.J.
        • Creinin M.D.
        Contraceptive effectiveness of immediate compared with delayed insertion of intrauterine devices after abortion, a decision analysis.
        Obstet Gynecol. 2007; 109: 1286-1294
        • Trussell J.
        Update on and correction to the cost effectiveness of contraceptives in the United States.
        Contraception. 2012; 85: 218
        • The United States Government
        Healthy People 2020 objectives.
        (Available at:) (Retrieved April 9, 2010)
        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485