Contraception after medical abortion

Availability, practices and acceptance of postabortion contraceptive services in health facilities: A study in six states of India

OBJECTIVE

To assess the availability of and practices around postabortion contraceptive services in health facilities, and document women's acceptance of postabortion contraception in six Indian states.

STUDY DESIGN

We conducted a survey of 4001 public and private health facilities that provide abortion-related care in six Indian states. In this analysis, we assess the availability and range of contraceptive methods offered, the protocols and practices around postabortion contraceptive counseling, the extent to which facilities require women to adopt contraception, and contraceptive uptake among women.

RESULTS

Although some contraceptive methods and information were available at a majority of facilities (75-97%), the range of methods was lacking and the information provided to women varied considerably by state. 8-26% of facilities required women seeking induced abortions to accept a modern contraceptive method. Only half to two-thirds of postabortion patients adopted a modern method.

CONCLUSION

The limited number of methods offered in facilities suggests that some women may not obtain the method they desire, or get information about the full range of methods that should be available. While contraceptive uptake should be voluntary, the requirement imposed by some facilities for women to adopt a modern contraceptive method in order to obtain an abortion must be addressed.

IMPLICATIONS

Some 15.6 million Indian women had an induced abortion in 2015. Understanding the provision of postabortion contraceptive services in health facilities, including counseling, is necessary to inform policies and practices to better enable women and couples to make informed decisions to prevent future unintended pregnancies.

Contraceptive behaviour of Christian and Muslim teenagers at the time of abortion and post-abortion in Thrace, Greece

OBJECTIVES

The aims of the study were to compare the contraceptive behaviour of Christian and Muslim adolescents who had an abortion in Thrace, Greece, and to examine whether extensive contraceptive counselling at the time of abortion modified their subsequent contraceptive practices.

METHODS

Adolescents, aged 14-19 years, who had undergone an elective abortion in our department, were included in a prospective 12-year study. Extensive contraceptive counselling was offered before discharge from the hospital. Attitudes to contraception were assessed by means of a simple questionnaire at the time of abortion and at 1-year follow-up.

RESULTS

The study population comprised of 95 Christian Orthodox adolescents (Group A) and 79 Muslim adolescents (Group B). At the time of abortion, contraceptive behaviour differed significantly between the two groups (p = .004). Contraceptive methods used in Group A in comparison with Group B were as follows: oral contraceptives (27.4% vs. 12.7%), condoms (22.1% vs. 38.0%), interrupted coitus (18.9% vs. 20.3%), periodic abstinence (16.8% vs. 25.3%) and emergency contraception (14.7% vs. 3.8%). The commonest source of information on contraception in Group A was the gynaecologist (17.9%) and family planning clinic (15.8%), whereas in Group B it was the individual's partner (25.3%) and parents (16.4%). Contraceptive behaviour was significantly modified in both groups at post-abortion follow-up (both p < .001). The original difference between the groups, however, persisted (p = .006). In Group A, oral contraceptives were the dominant method (48.4%), followed by condoms (30.5%), whereas in Group B, the order was still the reverse (24.1% and 46.8%, respectively).

CONCLUSION

Cultural differences significantly affect the contraceptive behaviour. Nevertheless, interventions that promote contraception can still be successful in different populations.

Contraceptive behavior among women after abortion in Nepal

OBJECTIVE

To investigate the timing of contraceptive use and estimate the discontinuation rates of temporary methods among women after abortion, or a live birth or stillbirth.

METHODS

A sample of married women with detailed pregnancy and contraceptive histories was analyzed in a population-based cross-sectional study based on calendar data extracted from the 2011 Nepal Demographic and Health Survey. Kaplan-Meier cumulative and discrete-time hazard models were used to estimate the timing of contraceptive use and discontinuation rates among users of temporary methods.

RESULTS

The final analysis sample included 3190 women. Of 684 women who had had an abortion, 298 (43.6%) had not initiated any contraceptive use in the 12 months afterwards. Women initiated contraceptive use significantly earlier after abortion (hazard ratio [HR] 2.25; 95% CI, 1.96-2.59; P<0.001). The rate of discontinuation among contraceptive users was significantly higher in the postabortion group (HR 1.32; 95% CI, 1.05-1.65; P<0.05). Women who were educated, wealthier, had used contraceptives before the index pregnancy, had two sons and had autonomy initiated contraceptive use significantly earlier in the post-abortion period than their counterparts.

CONCLUSION

Postabortion contraceptive use is low in Nepal. Postabortion family-planning counseling and related services should be strengthened with systematic monitoring and follow-up interventions.

Copper containing intra-uterine devices versus depot progestogens for contraception

BACKGROUND

Highly effective contraception is essential to reduce unintended pregnancies and the effect these have on individuals, society and public health resources. Intrauterine devices (IUDs) and depot progestogens are two commonly used long-acting, reversible contraceptive methods with different risk and benefit profiles.

OBJECTIVES

To compare the contraceptive and non-contraceptive benefits and risks of using the copper-containing IUD versus depot progestogens for contraception.

SEARCH STRATEGY

In June 2009 we searched the Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane Central Register of Controlled Trials, Pubmed, Popline, Clinical Trials.gov, the Current Controlled Trials metaRegister, EMBASE and LILACS, and contacted study authors.

SELECTION CRITERIA

Randomized trials comparing women using copper-containing IUDs with women using depot progestogens.

DATA COLLECTION AND ANALYSIS

We assessed eligibility and trial quality, extracted and double-entered data.

MAIN RESULTS

Two studies were included in the review. In the one study in HIV infected women, the IUD was compared with depot progestogen or the oral contraceptive, according to the women's choice. As the majority of women chose depot progestogen, we have included this study in the review, within a mixed hormonal contraception sub-group.Overall, the copper IUD was more effective than depot progestogens/hormonal contraception at preventing pregnancy (risk ratio (RR) 0.45; 95% confidence interval (CI) 0.24 to 0.84). HIV disease progression was reduced in the IUD group (RR 0.58; 95% CI 0.39 to 0.87). There was no significant difference in pelvic inflammatory disease rates between the two groups. Discontinuation of the allocated method was less frequent with the IUD in one study, and less frequent with hormonal contraception in the other study (in which women were allowed to switch between various hormonal methods).

AUTHORS' CONCLUSIONS

In the populations studied, the IUD was more effective than hormonal contraception with respect to pregnancy prevention. High quality research is urgently needed to compare the effects, if any, of these two commonly used contraception methods on HIV acquisition/seroconversion and HIV/AIDS disease progression.

Intrauterine contraception: the pendulum swings back

Intrauterine contraception is the most widely used method of reversible fertility regulation in the world. Finally, IUC is undergoing a renaissance in the US and it's role will expand as new devices and systems are developed and as old biases among clinicians and women are erased. Successful fertility regulation is a defining factor of the overall health of a population; the expanded use of IUC can help achieve that public health success.

Update on medication abortion

This article provides an overview of medication abortion in the United States 6 years after the approval of mifepristone (RU486; Mifeprex; Danco Laboratories, LLC, New York, NY) by the US Food and Drug Administration (FDA). The adoption of mifepristone is considered in the context of epidemiologic data on abortion, abortion access, and the safety of abortion. The risks of medication and aspiration abortion are discussed in the context of abortion-related mortality, recent experience with obstetric and gynecologic infection with Clostridium sordellii, and the limits of scientific knowledge on the incidence of this infection in women. Innovative protocols studied since FDA approval of mifepristone are presented, and implications for clinical practice are discussed.