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Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members.
Perm J 2018; 22:18-058PJ

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, χ2 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.

Authors+Show Affiliations

Clinician Researcher and the Assistant Director of the Biostatistical Consulting Unit within the Division of Research in Oakland, CA (debbie.a.postlethwaite@kp.org).Ob/Gyn at the Vallejo Medical Center in CA (justine.w.lee@kp.org).Group Leader with the Division of Research Biostatistical Consulting Unit in Oakland, CA (maqdooda.merchant@kp.org).Senior Consulting Data Analyst with the Division of Research Biostatistical Consulting Unit in Oakland, CA (amy.alabaster@kp.org).Research Director of the Women's Health Research Institute at the Division of Research in Oakland, CA (tina.r.raine-bennett@kp.org).

Pub Type(s)

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

Language

eng

PubMed ID

30227910

Citation

Postlethwaite, Debbie, et al. "Contraception After Abortion and Risk of Repeated Unintended Pregnancy Among Health Plan Members." The Permanente Journal, vol. 22, 2018, pp. 18-058.
Postlethwaite D, Lee J, Merchant M, et al. Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members. Perm J. 2018;22:18-058.
Postlethwaite, D., Lee, J., Merchant, M., Alabaster, A., & Raine-Bennett, T. (2018). Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members. The Permanente Journal, 22, pp. 18-058. doi:10.7812/TPP/18-058.
Postlethwaite D, et al. Contraception After Abortion and Risk of Repeated Unintended Pregnancy Among Health Plan Members. Perm J. 2018;22:18-058. PubMed PMID: 30227910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members. AU - Postlethwaite,Debbie, AU - Lee,Justine, AU - Merchant,Maqdooda, AU - Alabaster,Amy, AU - Raine-Bennett,Tina, PY - 2018/9/20/entrez PY - 2018/9/20/pubmed PY - 2019/5/2/medline SP - 18 EP - 058 JF - The Permanente journal JO - Perm J VL - 22 N2 - 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, χ2 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. SN - 1552-5775 UR - https://www.unboundmedicine.com/medline/citation/30227910/Contraception_after_Abortion_and_Risk_of_Repeated_Unintended_Pregnancy_among_Health_Plan_Members_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30227910/ DB - PRIME DP - Unbound Medicine ER -