Women who get an abortion may be interested
in long-acting forms of birth control, but they might not come back for another
visit to get them. A new study suggests offering women those types of
contraception right away may lower the chance they'll have another unintended pregnancy.
More than one million abortions took place
in the US in 2008, and about half of women getting an abortion had already had
one before. Researchers wanted to see if offering women long-acting reversible
contraception immediately after an abortion would mean more of them would opt
to use it.
They also hoped this would reduce the
number of second and third unintended pregnancies seen at their New York City facility.
Long-acting reversible contraception methods include intrauterine devices
(IUDs), contraceptive implants inserted in the arm and hormone shots.
"Our patients already had access to
effective contraceptives at no cost through a community clinic; however that
required organising an additional visit. That might sound easy, but for many it
is hard to arrange childcare and additional time off from work that would
permit another visit," Dr Carolyn Westhoff told Reuters Health in an
email. Westhoff worked on the study at the Columbia University Mailman School
of Public Health in New York.
"The result was that many women simply
didn't make it back. Therefore we wanted to see what would happen if we could
remove the obstacle of an extra visit," she said. The study included women
covered by Medicaid, the government-sponsored insurance program for the poor,
who came into the facility for a first-term abortion.
A different clinic
the first year of the study, women were given advice on various forms of birth
control, but had to go to a different clinic if they were interested in
long-acting contraception. The next year women were given similar advice, but
they were also offered the option of getting an IUD, implant or hormone shot
immediately following the abortion, in the same facility.
Throughout the study period, women had
equal access to other forms of birth control like condoms and the Pill, the
researchers wrote in the journal Contraception.
the 407 women seen the first year, 135 were interested in referrals for IUDs,
but only 45 actually had them inserted that year. 49 women were interested in
hormone shot referrals, but only one had the injection. Implants were not available.
Out of 405 women who were seen the next
year and offered long-acting contraception immediately, 152 had IUDs inserted
the same day. Another 33 had implants inserted and 17 women were given hormone shots.
Highly effective method
researchers followed women in both groups for one year after their initial abortion.
Women who didn't have immediate long-acting contraception access went on to have
111 pregnancies, including 70 abortions and 32 live births.
Women who were offered long-acting
reversible contraception right away had 62 pregnancies that resulted in 40
abortions and 15 births. "Women are willing and even eager to adopt a
highly effective method when offered," Westhoff said. She believes
immediate access to long-acting contraception could be implemented across the
country."We still need to simplify how to access insurance coverage for
these more effective contraceptives at the same visit as a procedure. Maybe
these results will stimulate some needed changes in insurance," she said.
New York State Medicaid currently covers abortions and long-acting
contraception, but not both if they're provided on the same day.
"It makes perfect sense if you provide
a service that is more convenient for women at a time when they're very
receptive to receiving information about preventing unplanned pregnancies that
you're going to be more effective," Dr Paula Adams Hillard told Reuters
Health. Hillard is a professor at the Stanford University School of Medicine
and provides paediatric, adolescent and adult gynaecology services at the
Lucile Packard Children's Hospital and Stanford Hospitals and Clinics.
Hillard explained that offering long-acting
contraception immediately after abortions is both safe and cost-effective. She
hopes this study helps prove those concepts."There are physicians who
still have lots of misunderstandings and have not been taught that it's okay to
insert an IUD immediately after an abortion procedure," she said. But more
providers are learning that it's safe.
Depending on the type, IUDs remain highly
effective for five to 10 years. Implants work for three years. The DMPA hormone
shot must be repeated every 12 weeks. "Analysis after analysis shows the
contraception is good public health, it's good preventive medicine and it's
cost-effective. It just works," Hillard said.