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Prevalence and predictors of initiation of intrauterine devices and subdermal implants immediately after surgical abortion

  • Author Footnotes
    1 Present address: Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA.
    ,
    Author Footnotes
    2 Present address: University of Pennsylvania, Department of Obstetrics and Gynecology, 3400 Spruce Street, Philadelphia, PA 19104.
    Andrea Hsu Roe
    Correspondence
    Corresponding author. Tel.: +1 267 254 0225; fax: +1 215 349 8513.
    Footnotes
    1 Present address: Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA.
    2 Present address: University of Pennsylvania, Department of Obstetrics and Gynecology, 3400 Spruce Street, Philadelphia, PA 19104.
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA

    Harvard Medical School, Boston, MA

    Planned Parenthood League of Massachusetts, Boston, MA
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  • Jennifer Fortin
    Affiliations
    Planned Parenthood League of Massachusetts, Boston, MA
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  • Elizabeth Janiak
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA

    Harvard Medical School, Boston, MA

    Planned Parenthood League of Massachusetts, Boston, MA
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  • Rie Maurer
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA
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  • Alisa B. Goldberg
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA

    Harvard Medical School, Boston, MA

    Planned Parenthood League of Massachusetts, Boston, MA
    Search for articles by this author
  • Author Footnotes
    1 Present address: Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA.
    2 Present address: University of Pennsylvania, Department of Obstetrics and Gynecology, 3400 Spruce Street, Philadelphia, PA 19104.

      Abstract

      Objectives

      To estimate uptake of long-acting reversible contraception (LARC) methods immediately after surgical abortion in a system that makes these methods readily available, and to determine demographic, medical, social, and visit-specific predictors of immediate post-abortion intrauterine device (IUD) and implant initiation.

      Study design

      We performed a retrospective cohort study of LARC (levonorgestrel intrauterine system [IUS], copper IUD, and subdermal implant) initiation at the time of surgical abortion up to 21w0d gestation at Planned Parenthood League of Massachusetts from 2012 through 2017. We calculated proportions of IUD and implant initiation and used mixed effect logistic regression to estimate predictors of each outcome.

      Results

      Among 26,858 surgical abortion patients, 25.4% received immediate post-abortion LARC: 14.2%, 4.2%, and 7.0% received a levonorgestrel IUS, copper IUD, and implant, respectively. Compared to White women, Black women had lower odds of initiating an IUD (aOR 0.81, 95% CI 0.74–0.89). Multiparous women had greater odds than nulliparous women of initiating an IUD (aOR 1.69, 95% CI 1.57–1.82) or implant (aOR 1.36, 95% 1.20–1.53). We found age was the strongest predictor of implant initiation (<18 versus≥35: aOR 3.26, 95% CI 2.26–4.71), but was not associated with IUD uptake. Gestational age was not associated with IUD or implant uptake. Implant uptake increased from 2.4% (2012) to 8.7% (2017) (aOR 3.65, 95% CI 2.36–5.65) while IUD uptake remained fairly constant.

      Conclusion

      About 25% of women chose to initiate intrauterine or implantable contraception immediately after surgical abortion when these methods are readily available. Implant uptake has increased significantly in recent years. Women who initiated IUDs and implants differed in their demographic and social profiles.

      Implications

      Women seeking surgical abortion should have same-day access to IUDs and implants. Clinicians and researchers should analyze IUD and implant initiation separately.

      Keywords

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