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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Article Info
Publication History
Published online: May 10, 2019
Accepted:
May 1,
2019
Received in revised form:
April 29,
2019
Received:
November 20,
2018
Footnotes
☆The findings and conclusions expressed in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, Inc.
☆☆Funding Source: This work was supported by the Society of Family Planning Research Fund [grant number SFPRF17-2].
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
