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Rosenberg JD, Raymond E, Shochet T. An examination of loss to follow-up and potential bias in outcome ascertainment in a study of direct-to-patient telemedicine abortion in the United States. Contraception 2023; 122:109996. [PMID: 36841460 DOI: 10.1016/j.contraception.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES To examine associations between factors associated with loss to follow-up and effectiveness in the TelAbortion project, which provided medication abortion by direct-to-patient telemedicine and mail in the United States. STUDY DESIGN The study population for this descriptive analysis included abortions among participants enrolled in the TelAbortion study with data present in a web-based database tool from November 2018 to September 2021 who were mailed a medication package. The analysis included information on abortions across nine sites. In this analysis, we used generalized estimating equations to examine factors associated with loss to follow-up and effectiveness. RESULTS Of the 1831 abortions included in this analysis, 1553 (84.8%) were classified as having complete follow-up and 278 (15.2%) were classified as lost to follow-up. In a multivariable analysis, factors significantly associated with loss to follow-up included history of medical abortion, education, gestational age, study site, and whether the TelAbortion was performed pre- or post-COVID-19 onset (p < 0.05). The rate of treatment failure (i.e., abortions resulting in continuing pregnancy or uterine evacuation) reported in this study was 5.1%. The only covariate associated with both loss to follow-up and treatment failure was higher gestational age. However, using gestational age to impute missing abortion outcomes did not substantially change the estimated failure rate. CONCLUSIONS Abortions that were lost to follow-up differed substantially from those with complete follow-up, which could bias the effectiveness estimate. However, imputing outcomes based on available and appropriate pretreatment data did not substantially affect the estimate. This finding is encouraging, although it does not exclude the possibility of bias due to unmeasured factors. IMPLICATIONS Significant differences between abortion cases with complete follow-up and those lost to follow-up provide insights into abortion cases that may be at a higher risk for being lost. The low treatment failure rate indicates that the telemedicine provision of medication abortion is effective.
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Affiliation(s)
- Jessica D Rosenberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Guttmacher Institute, New York, NY, USA.
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Quinteros Baumgart C, Vivas MM, Ortiz J, Westhoff CL, Chavkin W. Associations between contraceptive availability and rate of subsequent legal abortions in Colombia: A historical cohort analysis. Int J Gynaecol Obstet 2023; 160:226-236. [PMID: 35695422 DOI: 10.1002/ijgo.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe factors associated with subsequent abortions in Colombia and evaluate whether high-efficacy contraceptive availability (IUD) post-index abortion was associated with higher efficacy contraceptive initiation and fewer subsequent abortions within 2 years. METHODS The study population comprised patients aged 15-44 years who underwent index abortion in 2017 at four clinics in Bogotá, Colombia. Using charts, we conducted a retrospective cohort study with 2-year follow-up (2017-2019) after the index abortion for outcomes of contraceptive initiation and subsequent abortion. We evaluated associations between demographic or clinical characteristics and outcomes using Pearson chi-square and multivariate logistic regression. RESULTS Of 9175 patients with index abortion, 3409 (37.2%) initiated an intrauterine device (IUD) and 467 (5.1%) had a subsequent abortion within the study period (2017-2019). IUD availability (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.39-1.93) and insurance use (aOR, 5.03; 95% CI, 4.37-5.78) were associated with high-efficacy contraceptive initiation; medication abortion was inversely associated (aOR, 0.24; 95% CI, 0.22-0.27). Initiation of no (aOR, 4.94; 95% CI, 3.59-6.80) or moderate-efficacy (injection: aOR, 4.21 [95% CI, 3.14-5.62]; oral contraceptive pill: aOR, 4.60 [95% CI, 3.21-6.59]) methods were associated with subsequent abortion. CONCLUSION Subsequent abortion is inversely associated with initiated postabortion contraceptive efficacy, which is modifiable on a systems level by improving access to effective postabortion contraception.
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Affiliation(s)
| | | | - Juliette Ortiz
- Research Division, Fundación Oriéntame, Bogotá, Colombia
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Wendy Chavkin
- Mailman School of Public Health, Columbia University, New York, New York, USA
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Specialist follow-up contraceptive support after abortion-Impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial. PLoS One 2019; 14:e0217902. [PMID: 31185058 PMCID: PMC6559659 DOI: 10.1371/journal.pone.0217902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/18/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the impact of specialist contraceptive support after abortion on effective contraceptive use at six months and subsequent abortions within two years. METHODS Multicentre randomised controlled trial among women undergoing induced abortion in three London boroughs. Allocation was through electronically concealed stratified randomisation by centre, blinding clinicians and participants to arm allocation until interventions. Control group received standard care, comprising advice to follow up with their general practitioner or contraceptive clinic as needed. Intervention group additionally received specialist contraceptive support via telephone or face-to-face consultation at 2-4 weeks and 3 months post-abortion. Primary outcome was rate of effective contraceptive use at six months post-abortion. Secondary outcomes were subsequent abortions within two years. RESULTS 569 women were recruited between October 2011 and February 2013, randomised to intervention (282) and control (287) groups; 290 (142 intervention, 148 control) were available for primary outcome analysis. Intention-to-treat analysis showed no significant difference between the two groups in effective contraceptive use after abortion (62%, vs 54%, p = 0·172), long-acting contraceptive use (42% versus 32%, p = 0·084), and subsequent abortion (similar rates, at 1 year: 10%, p = 0·895, between 1-2 years: 6%, p = 0·944). Per-protocol analysis showed those who received the complete intervention package were significantly more likely to use effective contraception (67% versus 54%, p = 0·048), in particular long-acting contraception (49% versus 32%, p = 0·010) and showed a non-significant reduction in subsequent abortions within 2 years (at 1 year: 5% versus 10%, p = 0·098; and between 1-2 years: 3% versus 6%, p = 0·164, respectively). CONCLUSIONS Structured specialist support post-abortion did not result in significant use of effective contraception at six months or reduction in subsequent abortions within two years. Participants engaging with the intervention showed positive effect on effective contraception at six months post-abortion. The potential benefit of such intervention may become evident through further studies with increased patient participation.
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4
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Society of Family Planning clinical recommendations: contraception after surgical abortion. Contraception 2019; 99:2-9. [DOI: 10.1016/j.contraception.2018.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 11/22/2022]
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Bryant AG, Speizer IS, Hodgkinson JC, Swiatlo A, Curtis SL, Perreira K. Contraceptive Practices, Preferences, and Barriers Among Abortion Clients in North Carolina. South Med J 2018; 111:317-323. [PMID: 29863217 DOI: 10.14423/smj.0000000000000820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Abortion clinics provide an ideal setting for women to receive contraceptive care because the women served may not have other contacts with the health system and are at risk for unintended pregnancies. The objective of this study was to understand practices, preferences, and barriers to use of contraception for women obtaining abortions at clinics in North Carolina. METHODS We conducted a cross-sectional survey of abortion clients and facilities at 10 abortion clinics in North Carolina. We collected data on contraceptive availability at each clinic. We collected individual responses on women's experiences obtaining contraception before the current pregnancy and their intentions for future use of contraception. RESULTS From October 2015 to February 2016, 376 client surveys were completed at 9 clinics, and 10 clinic surveys were completed. Almost one-third of women (29%) reported that they had wanted to use contraception in the last year but were unable. Approximately three-fourths of respondents (76%) stated that they intend to use contraception after this pregnancy. Approximately one-fifth of women stated that would like to use long-acting reversible contraception (LARC) after this abortion. Only the clinics that accepted insurance for abortion and other services provided LARC at the time of the abortion (40%). CONCLUSIONS This study provides a unique, statewide view into the contraceptive barriers for women seeking abortion in North Carolina. Addressing the relatively high demand for LARC after abortion could help significantly reduce unintended pregnancy and recourse to abortion in North Carolina.
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Affiliation(s)
- Amy G Bryant
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Ilene S Speizer
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Jennifer C Hodgkinson
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Alison Swiatlo
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Siân L Curtis
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Krista Perreira
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina School of Medicine, the Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, University of North Carolina, and the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
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Korjamo R, Heikinheimo O, Mentula M. Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy. EUR J CONTRACEP REPR 2018. [DOI: 10.1080/13625187.2018.1440385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Riina Korjamo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Whitaker AK, Quinn MT, Munroe E, Martins SL, Mistretta SQ, Gilliam ML. A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:1663-9. [PMID: 27211225 PMCID: PMC5028248 DOI: 10.1016/j.pec.2016.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/04/2016] [Accepted: 05/08/2016] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To determine if a counseling intervention using the principles of motivational interviewing (MI) would impact uptake of long-acting reversible contraception (LARC) after abortion. METHODS We conducted a pilot randomized controlled trial comparing an MI-based contraception counseling intervention to only non-standardized counseling. Sixty women 15-29 years-old were randomized. PRIMARY OUTCOME uptake of LARC within four weeks of abortion. SECONDARY OUTCOMES uptake of any effective contraceptive, contraceptive use three months after abortion and satisfaction with counseling. Bivariate analysis was used to compare outcomes. RESULTS In the intervention arm, 65.5% of participants received a long-acting method within four weeks compared to 32.3% in the control arm (p=0.01). Three months after the abortion, differences in LARC use endured (60.0% vs. 30.8%, p=0.05). Uptake and use of any effective method were not statistically different. More women in the intervention arm reported satisfaction with their counseling than women in the control arm (92.0% vs. 65.4%, p=0.04). CONCLUSION Twice as many women in the MI-based contraception counseling intervention initiated and continued to use LARC compared to women who received only non-standardized counseling. PRACTICE IMPLICATIONS A contraception counseling session using the principles and skills of motivational interviewing has the potential to impact LARC use after abortion.
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Affiliation(s)
- Amy K Whitaker
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA.
| | - Michael T Quinn
- The University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, Chicago, IL, USA
| | - Elizabeth Munroe
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Summer L Martins
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Stephanie Q Mistretta
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
| | - Melissa L Gilliam
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, Chicago, IL, USA
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Whitaker AK, Quinn MT, Martins SL, Tomlinson AN, Woodhams EJ, Gilliam M. Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention. Contraception 2015; 92:323-9. [PMID: 26093191 DOI: 10.1016/j.contraception.2015.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility, impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. STUDY DESIGN A single-session postabortal contraception counseling intervention for young women aged 15-24 years incorporating principles, skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention, their competency was assessed, and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants, ability to complete the full intervention without interruption and participant satisfaction with the counseling. RESULTS We approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact, 95% and 77% of participants reported that the session was helpful, respectively. CONCLUSIONS MI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles, skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. IMPLICATIONS The use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered, directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic.
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Affiliation(s)
- A K Whitaker
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637.
| | - M T Quinn
- The University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, 5841 S. Maryland Ave. MC 6092, Chicago, IL, 60637
| | - S L Martins
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - A N Tomlinson
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - E J Woodhams
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
| | - M Gilliam
- The University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. MC 2050, Chicago, IL, 60637
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Steinauer JE, Upadhyay UD, Sokoloff A, Harper CC, Diedrich JT, Drey EA. Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion. Contraception 2015; 92:553-9. [PMID: 26093190 DOI: 10.1016/j.contraception.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Women who have abortions are at high risk of contraception discontinuation and subsequent unintended pregnancy. The objective of this analysis was to identify factors associated with choice of highly effective, long-acting, progestin-only contraceptive methods after abortion. STUDY DESIGN Women presenting for surgical abortion who selected the levonorgestrel intrauterine device (IUD), the progestin implant or the progestin injection (depot medroxyprogesterone acetate or DMPA) as their postabortion contraceptives were recruited to participate in a 1-year prospective cohort study. We used multivariable multinomial logistic regression to identify factors associated with choosing long-acting reversible contraceptives (IUD or implant) compared to DMPA. RESULTS A total of 260 women, aged 18-45 years, enrolled in the study, 100 of whom chose the IUD, 63 the implant and 97 the DMPA. The women were 24.9 years old on average; 36% were black, and 29% were Latina. Fifty-nine percent had had a previous abortion, 66% a prior birth, and 55% were undergoing a second-trimester abortion. In multivariable analyses, compared with DMPA users, women who chose the IUD or the implant were less likely to be currently experiencing intimate partner violence (IPV); reported higher stress levels; weighed more; and were more likely to have finished high school, to have used the pill before and to report that counselors or doctors were helpful in making the decision (all significant at p<.05, see text for relative risk ratios and confidence intervals.) In addition, women who chose the IUD were less likely to be black (p<.01), and women who chose the implant were more likely to report that they would be unhappy to become pregnant within 6 months (p<.05) than DMPA users. CONCLUSION A variety of factors including race/ethnicity, past contraceptive use, feelings towards pregnancy, stress and weight were different between LARC and DMPA users. Notably, current IPV was associated with choice of DMPA over the IUD or implant, implying that a desire to choose a hidden method may be important to some women and should be included in counseling. IMPLICATIONS In contraceptive counseling, after screening for IPV, assessing patient's stress and taking a history about past contraceptive use, clinicians should discuss whether these factors might affect a patient's choice of method.
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Affiliation(s)
- Jody E Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Abby Sokoloff
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
| | - Cynthia C Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Justin T Diedrich
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - Eleanor A Drey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
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Abstract
This study aims to describe factors associated with the number of past abortions obtained by New York City (NYC) abortion patients in 2010. We calculated rates of first and repeat abortion by age, race/ethnicity, and neighborhood-level poverty and the mean number of self-reported past abortions by age, race/ethnicity, neighborhood-level poverty, number of living children, education, payment method, marital status, and nativity. We used negative binomial regression to predict number of past abortions by patient characteristics. Of the 76,614 abortions reported for NYC residents in 2010, 57% were repeat abortions. Repeat abortions comprised >50% of total abortions among the majority of sociodemographic groups we examined. Overall, mean number of past abortions was 1.3. Mean number of past abortions was higher for women aged 30-34 years (1.77), women with ≥5 children (2.50), and black non-Hispanic women (1.52). After multivariable regression, age, race/ethnicity, and number of children were the strongest predictors of number of past abortions. This analysis demonstrates that, although socioeconomic disparities exist, all abortion patients are at high risk for repeat unintended pregnancy and abortion.
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Affiliation(s)
- Amita Toprani
- Centers for Disease Control and Prevention Epidemic Intelligence Service, Atlanta, GA, USA,
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Abstract
More than 1 million abortions are performed annually in the United States. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. For these reasons, abortion represents an optimal time to initiate effective contraception. There is strong evidence that most methods of contraception, including intrauterine devices and the contraceptive implant, should be initiated at the time of the abortion procedure. Most women ovulate within the first month after an abortion. If provision of contraception is delayed, women are less likely to use effective contraception and more likely to have a repeat unintended pregnancy. Although some methods of permanent contraception can be safely performed at the time of abortion, federal and state laws often restrict these procedures being performed concurrently. Contraceptive counseling and provision at the time of abortion are important strategies to decrease rates of unintended pregnancy.
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Langston AM, Joslin-Roher SL, Westhoff CL. Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice. Contraception 2013; 89:103-8. [PMID: 24309218 DOI: 10.1016/j.contraception.2013.10.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/10/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- Aileen M Langston
- Columbia University Medical Center and New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sophie L Joslin-Roher
- Columbia University Medical Center, Department of Obstetrics and Gynecology, PH 16-80, New York, NY 10032, USA.
| | - Carolyn L Westhoff
- Columbia University Medical Center and New York Presbyterian Hospital, New York, NY, USA
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Salcedo J, Sorensen A, Rodriguez MI. Cost analysis of immediate postabortal IUD insertion compared to planned IUD insertion at the time of abortion follow up. Contraception 2013; 87:404-8. [DOI: 10.1016/j.contraception.2012.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/03/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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Steinauer JE, Sokoloff A, Roberts EM, Drey EA, Dehlendorf CE, Prager SW. Immediate versus delayed initiation of the contraceptive patch after abortion: a randomized trial. Contraception 2013; 89:42-7. [PMID: 24176251 DOI: 10.1016/j.contraception.2013.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/28/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Immediate start of the contraceptive patch has not been studied in women after surgical abortion. STUDY DESIGN Women presenting for surgical abortion who had chosen the transdermal patch for contraception were randomized to either delayed start of the patch (beginning the Sunday after their abortion) or immediate start (directly observed application of the patch in the clinic). Subjects were contacted at 2 and 6 months to assess contraceptive use. RESULTS Two hundred ninety-eight women were randomized, and the follow-up rate was 71% at 2 months and 53% at 6 months. Method continuation did not differ by timing of initiation. At 2 months, 71% in the delayed-start group and 74% in the immediate-start group were using the patch [p=.6, with a difference of 3.1%, 95% confidence interval (CI)=-17.2% to +11.2%]. At 6 months, 55% in the delayed-start group and 43% in the immediate-start group were using the patch (p=.13, with a difference of 11.9%, 95% CI=-19.2% to +34%). CONCLUSION Immediate initiation of the contraceptive patch after surgical abortion was not associated with increased use of patch at 2 or 6 months.
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Affiliation(s)
- Jody E Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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Eliminating the routine postoperative surgical abortion visit. Contraception 2012; 86:397-401. [DOI: 10.1016/j.contraception.2012.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/18/2012] [Accepted: 02/28/2012] [Indexed: 11/20/2022]
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McNicholas C, Hotchkiss T, Madden T, Zhao Q, Allsworth J, Peipert JF. Immediate postabortion intrauterine device insertion: continuation and satisfaction. Womens Health Issues 2012; 22:e365-9. [PMID: 22749197 PMCID: PMC3608473 DOI: 10.1016/j.whi.2012.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/28/2012] [Accepted: 04/30/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The provision of intrauterine devices (IUDs) immediately postabortion has the potential to decrease unintended pregnancy in the United States. Studies have demonstrated safety and efficacy; however, there are limited data about continuation, satisfaction, and bleeding patterns among women receiving immediate postabortion IUDs. STUDY DESIGN We performed a retrospective cohort study of women undergoing immediate postabortion IUD insertion. Demographics and clinical data were collected from intake forms and procedure notes. We attempted to contact women by telephone to administer a short questionnaire to assess continuation, satisfaction, and bleeding patterns. RESULTS We were able to contact 77 of 225 (34%). Women lost to follow-up were more likely to have higher parity or a pregnancy of greater gestational age at the time of abortion compared with women who were successfully contacted. Continuation and satisfaction rates were high (80.5% and 80.6%, respectively). Reported bleeding patterns with IUD use were similar to previously reported patterns. CONCLUSION Follow-up of women undergoing immediate postabortion IUD insertion is challenging. However, we found that women choosing immediate postabortion IUD had high rates of continuation and satisfaction.
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Affiliation(s)
- Colleen McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
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Guiahi M, Westover C, Lim S, Westhoff CL. The New York City mayoral abortion training initiative at public hospitals. Contraception 2012; 86:577-82. [PMID: 22464409 DOI: 10.1016/j.contraception.2012.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 02/16/2012] [Accepted: 02/19/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND We set out to describe and understand the first-ever abortion training political initiative on the provision of abortion services and abortion residency training. STUDY DESIGN We completed in-depth interviews with 22 participants (response rate of 92%) who have knowledge of abortion training and services in the New York City (NYC) public hospital system before and/or after the initiative. We used grounded theory to describe the initiative's effects. RESULTS Respondents identified strategies that helped achieve renovation of abortion facilities, updating of abortion services and protocols, and training of abortion providers. Respondents also identified public health impacts including improvement of abortion services, empowerment of abortion providers, and legitimization of abortion training and services. CONCLUSION This NYC political initiative can be a model for other city governments to influence obstetrics and gynecology resident training and the provision of abortion services.
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Affiliation(s)
- Maryam Guiahi
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Mailstop B198-2, Aurora, CO 80045, USA.
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Rose SB, Lawton BA. Impact of long-acting reversible contraception on return for repeat abortion. Am J Obstet Gynecol 2012; 206:37.e1-6. [PMID: 21944222 DOI: 10.1016/j.ajog.2011.06.102] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 03/24/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to determine the rate of return for repeat abortion in relation to postabortion contraceptive method choice 24 months onward from an intervention study. STUDY DESIGN This was a prospective cohort study involving a hospital note search for 510 women 24 months after an abortion. RESULTS Women using long-acting reversible contraceptive (LARC) methods (intrauterine device [IUD] and depot medroxyprogesterone acetate) had significantly lower return rates for repeat abortion (6.45%; 95% confidence interval [CI], 4.0-9.8) than non-LARC users, of whom 14.5% returned (95% CI, 9.9-20.2). A Cox proportional hazard analysis showed that the postabortion method choice was significantly related to the likelihood of returning for a repeat abortion (P = .002), controlling for major demographic factors and previous pregnancy history. Using the pill as a reference group for risk of repeat abortion, the IUD hazard ratio (HR) was 0.36 (95% CI, 0.17-0.77), the depot medroxyprogesterone acetate HR was 0.55 (95% CI, 0.21-1.45), and the HR for all other methods was 1.8 (95% CI, 0.83-3.92). CONCLUSION This study provides strong support for the promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, Women's Health Research Centre, University of Otago, Wellington, New Zealand
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Guiahi M, McNulty M, Garbe G, Edwards S, Kenton K. Changing depot medroxyprogesterone acetate access at a faith-based institution. Contraception 2011; 84:280-4. [DOI: 10.1016/j.contraception.2010.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 11/25/2022]
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Pohjoranta E, Suhonen S, Heikinheimo O. Attendance at post-abortal follow-up visits is low - can the risks of non-attendance be identified? Acta Obstet Gynecol Scand 2011; 90:543-6. [PMID: 21446985 DOI: 10.1111/j.1600-0412.2011.01099.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Post-abortal follow-up visits are recommended following induced abortion. To assess the rates of attendance and the factors affecting it, we performed a retrospective study of 500 women who had an induced abortion up to 20 weeks of gestation. Altogether, 285 (57%) women attended for the follow-up visit as scheduled. In univariable analysis a history of drug abuse (OR=0.22, 95%CI 0.06-0.81, p=0.02) was associated with non-attendance. Women who underwent medical abortion either at the hospital (OR=3.93, 95%CI 2.61-5.92, p<0.01) or partly at home (OR=3.30, 95%CI 1.86-5.84, p<0.01) and those with a history of human papilloma virus manifestation (OR=2.38, 95%CI 1.04-5.26, p=0.04) were more likely to attend the follow-up visit. The effects of medical abortion and a history of human papilloma virus manifestation persisted in multivariable analysis. We conclude that attendance at post-abortal follow-up visits is low, with only a few clinically significant risk factors predicting non-attendance.
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Affiliation(s)
- Elina Pohjoranta
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland
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Langston AM, Rosario L, Westhoff CL. Structured contraceptive counseling--a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2010; 81:362-7. [PMID: 20869187 DOI: 10.1016/j.pec.2010.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 07/30/2010] [Accepted: 08/04/2010] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To evaluate the addition of structured contraceptive counseling to usual care on choice, initiation, and continuation of very effective contraception after uterine aspiration. METHODS We conducted a RCT of a version of the WHO Decision-Making Tool for Family Planning Clients and Providers with women having a procedure for a spontaneous or induced abortion. Our intervention provided structured, standardized counseling. We randomized women to usual care or usual care with structured counseling. Our outcomes included choosing a very effective contraceptive method and 3 months continuation. RESULTS Fifty-four percent of all participants chose a very effective method. Women in the intervention group were no more likely to choose a very effective method (OR 0.74, 95% CI 0.44, 1.26) or to initiate their method compared to the usual care group (OR 0.65, 95% CI 0.31, 1.34). In multivariate models, structured counseling was not associated with using a very effective method at 3 months (AOR 1.06, 95% CI 0.53, 2.14). CONCLUSION In this setting, structured counseling had little impact on contraceptive method choice, initiation, or continuation. PRACTICE IMPLICATIONS Adding structured counseling did not increase the proportion choosing or initiating very effective contraception in a practice setting where physicians already provide individualized counseling.
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Affiliation(s)
- Aileen M Langston
- Division of Family Planning and Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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