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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Article info
Publication history
Published online: November 07, 2013
Accepted:
October 10,
2013
Received in revised form:
September 10,
2013
Received:
July 2,
2013
Footnotes
☆Funding: grant from the Society of Family Planning.
☆☆Potential financial and other conflicts of interest: Carolyn Westhoff receives support from Merck and Bayer as a DSMB member and from Agile as an advisory board member; she does not hold stocks and is not a speaker’s bureau member.
★Presentations: oral presentation at Reproductive Health 2012, New Orleans, LA, September 20–22, 2012; poster presentation at North American Forum on Family Planning 2012, Denver, CO, October 27–29, 2012.
★★Implications: Availability of intrauterine devices, implants and depot medroxyprogesterone acetate immediately postabortion during the same visit leads to fewer pregnancies in the next 12 months and fewer abortions.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
