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Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion.
Contraception 2015; 92(6):553-9C

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.

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA. Electronic address: sokoloffa@obgyn.ucsf.edu.Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26093190

Citation

Steinauer, Jody E., et al. "Choice of the Levonorgestrel Intrauterine Device, Etonogestrel Implant or Depot Medroxyprogesterone Acetate for Contraception After Aspiration Abortion." Contraception, vol. 92, no. 6, 2015, pp. 553-9.
Steinauer JE, Upadhyay UD, Sokoloff A, et al. Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion. Contraception. 2015;92(6):553-9.
Steinauer, J. E., Upadhyay, U. D., Sokoloff, A., Harper, C. C., Diedrich, J. T., & Drey, E. A. (2015). Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion. Contraception, 92(6), pp. 553-9. doi:10.1016/j.contraception.2015.06.013.
Steinauer JE, et al. Choice of the Levonorgestrel Intrauterine Device, Etonogestrel Implant or Depot Medroxyprogesterone Acetate for Contraception After Aspiration Abortion. Contraception. 2015;92(6):553-9. PubMed PMID: 26093190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion. AU - Steinauer,Jody E, AU - Upadhyay,Ushma D, AU - Sokoloff,Abby, AU - Harper,Cynthia C, AU - Diedrich,Justin T, AU - Drey,Eleanor A, Y1 - 2015/06/17/ PY - 2015/02/07/received PY - 2015/06/11/revised PY - 2015/06/12/accepted PY - 2015/6/21/entrez PY - 2015/6/21/pubmed PY - 2016/9/9/medline KW - Contraception KW - Intimate partner violence KW - Long-acting reversible contraceptive KW - Postabortion SP - 553 EP - 9 JF - Contraception JO - Contraception VL - 92 IS - 6 N2 - 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. SN - 1879-0518 UR - https://www.unboundmedicine.com/medline/citation/26093190/Choice_of_the_levonorgestrel_intrauterine_device_etonogestrel_implant_or_depot_medroxyprogesterone_acetate_for_contraception_after_aspiration_abortion_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0010-7824(15)00251-6 DB - PRIME DP - Unbound Medicine ER -