Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018:22:18-058.
doi: 10.7812/TPP/18-058.

Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members

Debbie Postlethwaite  1 , Justine Lee  2 , Maqdooda Merchant  3 , Amy Alabaster  4 , Tina Raine-Bennett  5
Affiliations

Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members

Debbie Postlethwaite et al. Perm J. 2018.

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement

Four of the authors (Debbie Postlethwaite, Maqdooda Merchant, Amy Alabaster, and Tina Raine-Bennett) are participating in a US Food and Drug Administration-mandated safety study funded by Bayer Global. The author(s) have no additional conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Contraception category initiated within 90 days, by abortion service. KPNC = Kaiser Permanente Northern California; LARC = long-acting reversible contraception.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kavanaugh ML, Jones RK, Finer LB. How commonly do US abortion clinics offer contraceptive services? Contraception. 2010 Oct;82(4):331–6. doi: 10.1016/j.contraception.2010.04.010. - DOI - PubMed
    1. Ames CM, Norman WV. Preventing repeat abortion in Canada: Is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions? Contraception. 2012 Jan;85(1):51–5. doi: 10.1016/j.contraception.2011.05.002. - DOI - PubMed
    1. Thompson KM, Speidel JJ, Saporta V, Waxman NJ, Harper CC. Contraceptive policies affect post-abortion provision of long-acting reversible contraception. Contraception. 2011 Jan;83(1):41–7. doi: 10.1016/j.contraception.2010.06.008. - DOI - PubMed
    1. Hohmann H, Reeves MF, Chen BA, Perriera LK, Hayes JL, Creinin MD. Immediate versus delayed insertion of the levonorgestral-releasing intrauterine device following dilation and evacuation: A randomized controlled trial. Contraception. 2012 Mar;85(3):240–5. doi: 10.1016/j.contraception.2009.05.058. - DOI - PubMed
    1. Goodman S, Hendlish SK, Benedict C, Reeves MF, Pera-Floyd M, Foster-Rosales A. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception. 2008 Aug;78(2):136–42. doi: 10.1016/j.contraception.2008.03.008. - DOI - PubMed

Publication types

LinkOut - more resources