Contraception After Abortion and Risk of Repeated Unintended Pregnancy Among Health Plan Members

Overview

Journal Perm J

Specialties General Medicine
Health Services

Date 2018 Sep 20

PMID 30227910

Citations 1

Authors

Debbie Postlethwaite

Justine Lee

Maqdooda Merchant

Amy Alabaster

Tina Raine-Bennett

Affiliations

Soon will be listed here.

Abstract

Context: Optimizing access to effective contraception at the time of abortion can reduce repeated unintended pregnancies.

Objective: To assess contraception initiation and repeated unintended pregnancies among women receiving abortions in Kaiser Permanente Northern California (KPNC) facilities and through outside contracted facilities.

Design: A retrospective cohort study was conducted using a randomized proportional sample of women aged 15 to 44 years having abortions in KPNC, to determine contraception initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, contraceptive method initiated, and pregnancies within 12 months) were collected from electronic health records. Descriptive statistics, χ tests, t-tests, and logistic regression models assessed predictors of long-acting reversible contraception (LARC) initiation and having another unintended pregnancy within 12 months of abortion.

Results: Women having abortions from contracted facilities were significantly less likely to initiate LARC within 90 days compared with those receiving abortions in KPNC facilities (11.99% vs 19.10%, p = 0.012). Significant factors associated with 90-day LARC initiation included abortions in KPNC facilities (adjusted odds ratio [aOR] = 1.87, p = 0.007) and gravidity of 3 or more. Women initiating short-acting or no contraception were significantly more likely to have an unintended pregnancy within 12 months of the abortion than those initiating LARC (aOR = 3.66, p = 0.005; no contraception vs LARC, aOR = 3.75, p = 0.005).

Conclusion: In response to this study, KPNC now provides reimbursement for LARC in all outside abortion contracts, internalized more abortions in KPNC facilities, and strengthened clinical recommendations for immediate, effective postabortion contraception, especially LARC.

Citing Articles

Prevalence and Predictors of Contraceptives Use among Women Aged (15-49 years) with Induced Abortion History in Ghana.

Salifu M, Mohammed K Adv Prev Med. 2020; 2020:2630905.

PMID: 32908708 PMC: 7474737. DOI: 10.1155/2020/2630905.

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