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Contraception after medication abortion in the United States: results from a cluster randomized trial.
Am J Obstet Gynecol 2018; 218(1):107.e1-107.e8AJ

Abstract

BACKGROUND

Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered postabortion contraceptive care.

OBJECTIVE

The objective of this study was to investigate the differences in contraceptive counseling, method choices, and use between medication and aspiration abortion patients.

STUDY DESIGN

This subanalysis examines data from 643 abortion patients from 17 reproductive health centers in a cluster, randomized trial across the United States. We recruited participants aged 18-25 years who did not desire pregnancy and followed them for 1 year. We measured the effect of a full-staff contraceptive training and abortion type on contraceptive counseling, choice, and use with multivariable regression models, using generalized estimating equations for clustering. We used survival analysis with shared frailty to model actual intrauterine device and subdermal implant initiation over 1 year.

RESULTS

Overall, 26% of participants (n = 166) had a medication abortion and 74% (n = 477) had an aspiration abortion at the enrollment visit. Women obtaining medication abortions were as likely as those having aspiration abortions to receive counseling on intrauterine devices or the implant (55%) and on a short-acting hormonal method (79%). The proportions of women choosing to use these methods (29% intrauterine device or implant, 58% short-acting hormonal) were also similar by abortion type. The proportions of women who actually used short-acting hormonal methods (71% medication vs 57% aspiration) and condoms or no method (20% vs 22%) within 3 months were not significantly different by abortion type. However, intrauterine device initiation over a year was significantly lower after the medication than the aspiration abortion (11 per 100 person-years vs 20 per 100 person-years, adjusted hazard ratio, 0.50; 95% confidence interval, 0.28-0.89). Implant initiation rates were low and similar by abortion type (5 per 100 person-years vs 4 per 100 person-years, adjusted hazard ratio, 2.41; 95% confidence interval, 0.88-6.59). In contrast to women choosing short-acting methods, relatively few of those choosing a long-acting method at enrollment, 34% of medication abortion patients and 53% of aspiration abortion patients, had one placed within 3 months. Neither differences in health insurance nor pelvic examination preferences by abortion type accounted for lower intrauterine device use among medication abortion patients.

CONCLUSION

Despite similar contraceptive choices, fewer patients receiving medication abortion than aspiration abortion initiated intrauterine devices over 1 year of follow-up. Interventions to help patients receiving medication abortion to successfully return for intrauterine device placement are warranted. New protocols for same-day implant placement may also help patients receiving medication abortion and desiring a long-acting method to receive one.

Authors+Show Affiliations

Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA; Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA. Electronic address: corinne.rocca@ucsf.edu.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA; Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA.Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.Planned Parenthood of Northern, Central, and Southern New Jersey Inc, Morristown, NJ.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28986072

Citation

Rocca, Corinne H., et al. "Contraception After Medication Abortion in the United States: Results From a Cluster Randomized Trial." American Journal of Obstetrics and Gynecology, vol. 218, no. 1, 2018, pp. 107.e1-107.e8.
Rocca CH, Goodman S, Grossman D, et al. Contraception after medication abortion in the United States: results from a cluster randomized trial. Am J Obstet Gynecol. 2018;218(1):107.e1-107.e8.
Rocca, C. H., Goodman, S., Grossman, D., Cadwallader, K., Thompson, K. M. J., Talmont, E., ... Harper, C. C. (2018). Contraception after medication abortion in the United States: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology, 218(1), pp. 107.e1-107.e8. doi:10.1016/j.ajog.2017.09.020.
Rocca CH, et al. Contraception After Medication Abortion in the United States: Results From a Cluster Randomized Trial. Am J Obstet Gynecol. 2018;218(1):107.e1-107.e8. PubMed PMID: 28986072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contraception after medication abortion in the United States: results from a cluster randomized trial. AU - Rocca,Corinne H, AU - Goodman,Suzan, AU - Grossman,Daniel, AU - Cadwallader,Kara, AU - Thompson,Kirsten M J, AU - Talmont,Elizabeth, AU - Speidel,J Joseph, AU - Harper,Cynthia C, Y1 - 2017/10/03/ PY - 2017/06/22/received PY - 2017/09/19/revised PY - 2017/09/21/accepted PY - 2017/10/8/pubmed PY - 2018/1/26/medline PY - 2017/10/8/entrez KW - abortion KW - implant KW - intrauterine device KW - long-acting reversible contraception KW - medical abortion KW - medication abortion KW - postabortion contraception KW - randomized trial SP - 107.e1 EP - 107.e8 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 218 IS - 1 N2 - BACKGROUND: Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered postabortion contraceptive care. OBJECTIVE: The objective of this study was to investigate the differences in contraceptive counseling, method choices, and use between medication and aspiration abortion patients. STUDY DESIGN: This subanalysis examines data from 643 abortion patients from 17 reproductive health centers in a cluster, randomized trial across the United States. We recruited participants aged 18-25 years who did not desire pregnancy and followed them for 1 year. We measured the effect of a full-staff contraceptive training and abortion type on contraceptive counseling, choice, and use with multivariable regression models, using generalized estimating equations for clustering. We used survival analysis with shared frailty to model actual intrauterine device and subdermal implant initiation over 1 year. RESULTS: Overall, 26% of participants (n = 166) had a medication abortion and 74% (n = 477) had an aspiration abortion at the enrollment visit. Women obtaining medication abortions were as likely as those having aspiration abortions to receive counseling on intrauterine devices or the implant (55%) and on a short-acting hormonal method (79%). The proportions of women choosing to use these methods (29% intrauterine device or implant, 58% short-acting hormonal) were also similar by abortion type. The proportions of women who actually used short-acting hormonal methods (71% medication vs 57% aspiration) and condoms or no method (20% vs 22%) within 3 months were not significantly different by abortion type. However, intrauterine device initiation over a year was significantly lower after the medication than the aspiration abortion (11 per 100 person-years vs 20 per 100 person-years, adjusted hazard ratio, 0.50; 95% confidence interval, 0.28-0.89). Implant initiation rates were low and similar by abortion type (5 per 100 person-years vs 4 per 100 person-years, adjusted hazard ratio, 2.41; 95% confidence interval, 0.88-6.59). In contrast to women choosing short-acting methods, relatively few of those choosing a long-acting method at enrollment, 34% of medication abortion patients and 53% of aspiration abortion patients, had one placed within 3 months. Neither differences in health insurance nor pelvic examination preferences by abortion type accounted for lower intrauterine device use among medication abortion patients. CONCLUSION: Despite similar contraceptive choices, fewer patients receiving medication abortion than aspiration abortion initiated intrauterine devices over 1 year of follow-up. Interventions to help patients receiving medication abortion to successfully return for intrauterine device placement are warranted. New protocols for same-day implant placement may also help patients receiving medication abortion and desiring a long-acting method to receive one. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28986072/Contraception_after_medication_abortion_in_the_United_States:_results_from_a_cluster_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(17)31135-3 DB - PRIME DP - Unbound Medicine ER -