Contraceptive awareness and birth control selection in female kidney and liver transplant recipients

Objective(s)

Interest has increased regarding the issue of contraception in transplant recipients. The purpose of this study was to assess birth control selection and the role of contraceptive counseling sessions in female kidney transplant (KT) and liver transplant (LT) recipients.

Study Design

A cross-sectional single-center survey study of 217 female organ recipients (KT, 137 and LT, 80), aged 18–45 years, met the study criteria. Patients were asked 43 questions regarding their pre- and posttransplantation use of contraceptive methods, birth control awareness, contraception counseling and the factors determining the selection of effective contraception (hormonal contraception, intrauterine devices and female sterilization).

Results

Thirty-three percent (5/15) of patients who had undergone the transplantation within 1 year prior to study inclusion were unaware of the necessity to use contraception. Both of the groups studied did not differ significantly in terms of the rates of pre- and posttransplantation consultations on effective contraception (KT: 26% vs. 34%; p=0.153 and LT 38% vs. 35%; p=0.729). Effective posttransplantation contraception was used by one in three patients, as indicated by posttransplantation consultations (KT: 30% vs. LT: 29%; p=0.910). The following factors affected the posttransplantation use of effective contraception: the presence of posttransplantation counseling on effective contraception [odds ratio (OR): 6.67; 95% confidence interval (CI): 2.12–20.1] and infrequent sexual activity prior to transplantation (OR: 0.56; 95% CI: 0.35–0.89).

Conclusion(s)

The selection of effective contraception in KT and LT recipients remain suboptimal. Despite the low numbers of women who received contraceptive counseling in this study, consultation was nonetheless associated with choosing an effective method of contraception.

Implication

Current literature and data regarding contraception among female organ transplant recipients remain limited and are predominantly limited to a single population. The purpose of the study was to assess the level of satisfaction and the reasons underlying birth control selection in female kidney and LT recipients.     

Understanding women's desires for contraceptive counseling at the time of first-trimester surgical abortion

Objective

The objective was to investigate whether or not women presenting for a first-trimester surgical abortion want to discuss contraception on the day of their procedure.

Study Design

Between October 2012 and January 2013, an anonymous self-administered survey was distributed to women receiving first-trimester surgical abortions at four northern California family planning clinics. The survey obtained demographic information about each woman and inquired about her desire for contraceptive counseling during her appointment. Results were analyzed using both univariate and multivariable regression analyses to assess trends in responses related to desire for contraceptive counseling based on demographic and other variables.

Results

Of the 199 respondents, 64% reported that they did not want to talk to a counselor or doctor about contraception on the day of their abortion. About half of the women (52%) who did not want to discuss contraception indicated they already knew what they wanted for pregnancy prevention. Of the 25% who reported that they did want to discuss contraception, the most important topic desired from the counseling was identification of methods that were easier to use than what they used previously.

Conclusion

The majority of women seeking first-trimester surgical abortion may not desire additional information about contraception on the day of the procedure.

Implications Statement

This study demonstrates that a significant proportion of women may not want contraceptive counseling on the day of a planned surgical abortion.     

Partner approval and intention to use contraception among Zanzibari women presenting for post-abortion care

Objective

We examined the effect of partner approval of contraception on intention to use contraception among women obtaining post-abortion care in Zanzibar.

Study design

Our data source was a 2010 survey of 193 women obtaining post-abortion care at a large public hospital in Zanzibar. We used multivariable logistic regression analysis to assess associations between partner approval and intention to use contraception.

Results

Overall, 23% of participants had used a contraceptive method in the past, and 66% reported intending to use contraception in the future. We found that partner approval of contraception and ever having used contraception in the past were each associated with intending to use contraception in the future. In the multivariable model, adjusting for past contraception use, partner approval of contraception was associated with 20 times the odds of intending to use contraception (odds ratio, 20.25; 95% confidence interval, 8.45–48.56).

Conclusions

We found a strong association between partner approval and intention to use contraception. Efforts to support contraceptive use must include both male and female partners.

Implications

Public health and educational efforts to increase contraceptive use must include men and be targeted to both male and female partners. Given that male partners are often not present when women obtain health care, creative efforts will be required to meet men in community settings.     

Patient and provider perspectives on Bedsider.org,an online contraceptive information tool,in a low income,racially diverse clinic population

Objective

To explore patient and provider perspectives regarding a new Web-based contraceptive support tool.

Study Design

We conducted a qualitative study at an urban Medicaid-based clinic among sexually active women interested in starting a new contraceptive method, clinic providers and staff. All participants were given the opportunity to explore Bedsider, an online contraceptive support tool developed for sexually active women ages 18–29 by the National Campaign to Prevent Teen and Unplanned Pregnancy and endorsed by the American Congress of Obstetricians and Gynecologists. Focus groups were conducted separately among patient participants and clinic providers/staff using open-ended structured interview guides to identify specific themes and key concepts related to use of this tool in an urban clinic setting.

Results

Patient participants were very receptive to this online contraceptive support tool, describing it as trustworthy, accessible and empowering. In contrast, clinic providers and staff had concerns regarding the Website's legitimacy, accessibility, ability to empower patients and applicability, which limited their willingness to recommend its use to patients.

Conclusion

Contrasting opinions regarding Bedsider may point to a potential disconnect between how providers and patients view contraception information tools. Further qualitative and quantitative studies are needed to explore women's perspectives on contraceptive education and counseling and providers' understanding of these perspectives.

Implications Statement

This study identifies a contrast between how patients and providers in an urban clinic setting perceive a Web-based contraceptive tool. Given a potential patient–provider discrepancy in preferred methods and approaches to contraceptive counseling, additional research is needed to enhance this important arena of women's health care.     

Women's questions after postabortion insertion of intrauterine contraception

Background

Postabortion insertion of intrauterine contraception has the potential to decrease unintended pregnancy and repeat abortions, but little is known about how to ensure that women receive appropriate counseling about this method in this setting. The goal of this investigation was to document women's questions and to assess retention of information provided during contraceptive counseling after immediate postabortion intrauterine contraceptive placement.

Study Design

Women who received postabortion intrauterine contraceptives (IUCs) at an urban, hospital-based abortion clinic were surveyed 2–3 months postabortion to evaluate for expulsion, assess their concerns about IUC and evaluate retention of information provided during contraceptive counseling.

Results

Of 141 women contacted, 121 participated. Almost half of participants (46%) had responses to the question “Do you have any questions or concerns about your intrauterine device?” that fell into the following categories: spotting/bleeding (16%), cramping/pain (15%), string management (10%), expulsion concern (5%). Seventy percent reported less bleeding during menses than prior to IUC placement, and 37% had less cramping. Sixty-three percent were able to accurately report statistics regarding IUC efficacy, 56% recalled common side effects, and 42% remembered what to do if expulsion occurred.

Conclusion

Although IUCs are highly effective and their placement in the abortion setting is safe, women frequently have questions and do not recall critical counseling information about IUCs. In order to improve IUC continuation, techniques to improve both patient knowledge retention and anticipatory guidance should be studied further.     

Unmet demand for highly effective postpartum contraception in Texas

Objectives

We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth.

Methods

We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18–44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery.

Results

At 6 months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using long-acting reversible contraception (LARC).

Conclusions

This study shows a considerable preference for LARC and permanent methods at 6 months postpartum. However, there is a marked discordance between women’s method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception.

Implications

In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Women’s contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites.     

Contraceptive use and the role of contraceptive counseling in reproductive-aged women with cancer

Objective

Few data on contraceptive choices in women with cancer exist. Contraception is challenging for women with cancer, particularly those with breast cancer, who are limited to nonhormonal methods. This study characterized contraceptive use during cancer treatment in a group of reproductive-aged women with a recent cancer diagnosis and assessed the impact of contraceptive counseling on the methods they selected.

Study Design

Cross-sectional, survey study of reproductive-aged women at a large tertiary care health system with a recent cancer diagnosis.

Results

A total of 107 women completed the survey. Eighty-two women reported 101 contraceptive choices. Twenty-seven percent (27/101) of all methods selected were Tier I/II, and 35% (35/101) were Tier III/IV. Only 4 used an intrauterine device (IUD). Among women reporting sexual activity after diagnosis, 19 (27%) of 71 reported using Tier I/II methods, 21 (30%) of 71 reported using Tier III/IV methods, 16 (23%) of 71 reported abstinence and 10 (14%) of 71 reported using no method. Factors significantly associated with Tier I/II use in the multivariable model included not having a college degree [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.05–0.92, p=.038], intercourse during treatment (OR 5.92, 95% CI 1.48–23.66, p=.012) and non-breast cancer (OR 3.60, 95% CI 1.03–12.64, p=.046). Report of contraceptive counseling was positively associated with Tier I/II contraceptive use during cancer treatment (OR 6.92, 95% CI 1.14–42.11, p=.036).

Conclusion

Reproductive-aged women diagnosed with cancer underutilized Tier I/II contraceptive agents, especially IUDs. Contraceptive counseling by physicians increases contraceptive use, particularly methods most effective at preventing pregnancy.

Implications

The study uniquely described the contraceptive practices of over 100 women with cancer. The study sample commonly reported abstinence and use of contraceptive methods with high failure rates. Our data suggest that contraceptive counseling from a health care provider may increase use of more effective methods among women with cancer.     

Provision of DMPA by community health workers: what the evidence shows

Background

To reduce a large unmet need for family planning in many developing countries, governments are increasingly looking to community health workers (CHWs) as an effective service delivery option for health care and as a feasible option to increase access to family planning services. This article synthesizes evidence on the feasibility, safety and effectiveness of community-based delivery of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA).

Study Design

Manual and electronic search and systematic review of published and unpublished documents on delivery of contraceptive injectables by CHWs.

Results

Of 600 identified documents, 19 had adequate information on injectables, almost exclusively intramuscular DMPA, provided by CHWs. The data showed that appropriately trained CHW demonstrate competency in screening clients, providing DMPA injections safely and counseling on side effects, although counseling appears equally suboptimal in both clinic and community settings. Clients and CHWs report high rates of satisfaction with community-based provision of DMPA. Provision of DMPA in community-based programs using CHWs expanded access to underserved clients and led to increased uptake of family planning services.

Conclusions

We conclude that DMPA can be provided safely by appropriately trained and supervised CHWs. The benefits of community-based provision of DMPA by CHWs outweigh any potential risks, and past experiences support increasing investments in and expansion of these programs.     

Contraceptive method selection by women with inflammatory bowel diseases: a cross-sectional survey

Objective

Women with inflammatory bowel diseases (IBDs) utilize contraception at a lower rate than the general population. We sought to identify factors associated with contraceptive use and selection of more effective methods in IBD patients at risk for unintended pregnancy.

Study Design

An online survey was distributed to women with IBD in January 2013. Contraceptive methods were categorized by effectiveness and associations with use explored by demographics, disease characteristics and reproductive goals.

Results

A total of 162 respondents were analyzed: 62% had Crohn’s disease and 38% ulcerative colitis. Mean age was 31 (range 20–45), 97% identified as White, and 53% were nulliparas. Seventy-four percent were currently using IBD medications. A quarter of participants (23%) used no contraception, 17% used highly effective methods, 41% used short-term hormonal methods, and 19% chose barrier/behavioral methods. Prior IBD-related surgery, biologic therapy use and low education attainment were associated with no contraception use. Of contraceptive users, age, parity, insurance status, IBD surgery and prior immunomodulator use were associated with highly effective method selection.

Conclusions

A quarter of women with IBD at risk for pregnancy in this study population reported no contraceptive method use. Higher levels of IBD activity influence contraceptive use and method selection, which could guide future patient and provider educational interventions.

Implications

Pregnancy planning is important for women with inflammatory bowel diseases to avoid adverse outcomes in a disease-poor state. Use of contraception assists in avoidance of unintended pregnancy. IBD characteristics are targets for educational interventions to improve uptake of highly effective contraceptive methods.     

What some women want? On-demand oral contraception

Objective

To summarize evidence regarding current demand for on-demand oral contraception.

Study design

We used Medline and collegial contacts to find published and unpublished studies conducted or reported in the past 15 years with information assessing women's interest in using any oral drug preparation, including emergency contraceptive pills, in a coitus-dependent manner either repeatedly or as a primary or planned pregnancy prevention method.

Results

We found 19 studies with relevant information. The studies were conducted in 16 countries. Eight studies provided data on women's attitudes regarding a coitus-dependent oral contraceptive; all suggested substantial interest in using it. Nine studies assessed actual use of oral tablets on demand for primary contraception. In these studies, 9–97% of women in the analysis populations reported using the pills on demand as main method, although frequency and consistency of use varied. Reported reasons for interest in or use of this contraceptive approach included convenience, ease of remembering, ability to conceal use, lack of coital interruption, and infrequent sexual activity. Three studies were clinical trials of investigational on-demand oral contraceptives which reported Pearl indices ranging from 6.8 to 53 pregnancies per 100 woman–years.

Conclusion

Data from a variety of settings suggest that demand for an on-demand oral contraceptive may be widespread. The effectiveness of this potential method is not established, however. Considering the seriousness of the unmet need for contraception, further development research into the public health benefits and risks of such a method would be worthwhile.

Implications

Demand for an on-demand oral contraceptive may be widespread. Efforts should be made to further explore the possibility of developing such a method.     

Routine counseling about intrauterine contraception for women seeking emergency contraception

Objective

To compare contraceptive knowledge and use among women seeking emergency contraception (EC) before and after an inner-city clinic began providing structured counseling and offering same-day intrauterine device (IUD) or implant placement to all women seeking EC.

Study design

For 8 months before and 21 months after this change in clinic policy, women aged 15–45 who wanted to avoid pregnancy for at least 6 months were asked to complete surveys immediately, 3 and 12 months after their clinic visit. In addition, we abstracted electronic medical record (EMR) data on all women who sought EC (n= 328) during this period. We used chi-squared tests to assess pre/post differences in survey and EMR data.

Results

Surveys were completed by 186 women. After the clinic began offering structured counseling, more women had accurate knowledge of the effectiveness of IUDs, immediately and 3 months after their clinic visit. In addition, more women initiated IUD or implant use (survey: 40% vs. 17% preintervention, p=0.04; EMR: 22% vs. 10% preintervention, p=0.01), and fewer had no contraceptive use (survey: 3% vs. 17% preintervention, p<0.01; EMR: 32% vs. 68%, p<0.01) in the 3 months after seeking EC. EMR data indicate that when same-day placement was offered, 11.0% of women received a same-day IUD. Of those who received a same-day IUD, 88% (23/26) reported IUD use at 3-months and 80% (12/15) at 12 months.

Conclusions

Routine provision of structured counseling with the offer of same-day IUD placement increases knowledge and use of IUDs 3 months after women seek EC.

Implications

Women seeking EC from family planning clinics should be offered counseling about highly effective reversible contraceptives with the option of same-day contraceptive placement.     

Variation in postpartum contraceptive method use: results from the Pregnancy Risk Assessment Monitoring System (PRAMS)

Objective

The National Survey of Family Growth has been a primary data source for trends in US women’s contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms.

Study Design

We used the Pregnancy Risk Assessment Monitoring System, a survey of women who are 2–4 months postpartum. Information on women’s current method was available for 18 reporting areas from 2000 to 2009. Using the two most recent years of data, we computed the weighted proportion of women using specific contraceptive methods according to payment for delivery (Medicaid or private insurance) and examined differences across states. We used log binomial regression to assess trends in method use in 8 areas with consecutive years of data.

Results

Across states, there was a wide range of use of female sterilization (7.0–22.6%) and long-acting reversible contraception (LARC; 1.9–25.5%). Other methods, like vasectomy and the patch/ring, had a narrower range of use. Women with Medicaid-paid deliveries were more likely to report female sterilization, LARC and injectables as their method compared to women with private insurance. LARC use increased ≥ 18% per year, while use of injectables and oral contraceptives declined by 2.5–10.6% annually.

Conclusions

The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix.

Implications

There is considerable variation in contraceptive method use across states, which may result from differences in state policies and funding for family planning services, local medical norms surrounding contraceptive practice, and women’s and couples’ demand or preference for different methods.     

Practice of and attitudes towards family planning among South Asian American immigrants

Background

Previous studies performed outside of the US that examined contraceptive knowledge and beliefs in South Asian women identified significant barriers. Our study aimed to further understand these practices in this population residing in the US.

Methods

This cross-sectional study surveyed women of all ethnicities receiving health care from either of two ambulatory practices in New Jersey from October 2011 to November 2012. Using chi-squared testing, the frequencies of contraceptive outcomes between South Asians and non-South Asians were compared.

Study Design

There were 42 South Asian respondents and 143 non-South Asian respondents. Our results show that South Asians are statistically significantly less likely to routinely use contraception and that gaps in contraceptive knowledge appear to stem from multiple barriers, including family opposition and pressure from spouse or in-laws to have children, cultural prohibitions, fear of side effects and misinformation, lack of education/knowledge about contraceptives and difficulty in accessing contraception. These gaps in contraceptive knowledge were also found to be multigenerational, despite higher levels of education generally seen in the South Asian population.

Conclusions

Clinicians caring for South Asian women should acknowledge both the barriers and the lack of contraceptive knowledge in this population and provide culturally competent family planning information to them during all women's health encounters.     

The COX-2 inhibitor meloxicam prevents pregnancy when administered as an emergency contraceptive to nonhuman primates

Objective

Cyclooxygenase-2 (COX-2) inhibitors reduce prostaglandin synthesis and disrupt essential reproductive processes. Ultrasound studies in women demonstrated that oral COX-2 inhibitors can delay or prevent follicle collapse associated with ovulation. The goal of this study was to determine if oral administration of a COX-2 inhibitor can inhibit reproductive function with sufficient efficacy to prevent pregnancy in primates.

Study Design

The COX-2 inhibitor meloxicam (or vehicle) was administered orally to proven fertile female cynomolgus macaques using one emergency contraceptive model and three monthly contraceptive models. In the emergency contraceptive model, females were bred with a proven fertile male once 2±1 days before ovulation, returned to the females' home cage, and then received 5 days of meloxicam treatment. In the monthly contraceptive models, females were cocaged for breeding with a proven fertile male for a total of 5 days beginning 2±1 days before ovulation. Animals received meloxicam treatment (1) cycle days 5–22, or (2) every day, or (3) each day of the 5-day breeding period. Female were then assessed for pregnancy.

Results

The pregnancy rate with meloxicam administration using the emergency contraception model was 6.5%, significantly lower than the pregnancy rate of 33.3% when vehicle without meloxicam was administered. Pregnancy rates with the three monthly contraceptive models (75%–100%) were not consistent with preventing pregnancy.

Conclusions

Oral COX-2 inhibitor administration can prevent pregnancy after a single instance of breeding in primates. While meloxicam may be ineffective for regular contraception, pharmacological inhibition of COX-2 may be an effective method of emergency contraception for women.

Implications

COX-2 inhibitors can interfere with ovulation, but the contraceptive efficacy of drugs of this class has not been directly tested. This study, conducted in nonhuman primates, is the first to suggest that a COX-2 inhibitor may be effective as an emergency contraceptive.     

The relationship between perinatal psychiatric disorders and contraception use among postpartum women

Background

The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established.

Study Design

This was a prospective cohort study with 831 pregnant women recruited from 10 primary care clinics of the public sector in São Paulo followed up to 18 months after delivery.

Results

Among 701 postpartum women, 644 women (91.8%) had resumed sexual activity. Two hundred fifty-three women (39.2%) were classified as using a less effective contraception method (LECM). The presence of perinatal psychiatric disorder (in pregnancy and/or postpartum) was not associated with LECM. Resumption of sexual life 3 months or beyond after delivery was associated with LECM (odds ratio=1.28, 95% confidence interval: 1.02–1.56).

Discussion

Although the use of an LECM after delivery is common, contraception choice is not associated with perinatal depressive/anxiety symptoms. However, women who delay the resumption of sexual activity after delivery should be counseled on the use of available contraceptive methods.     

Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study

Objectives

In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.

Study design

This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access).

Results

One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6–8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90–5.13] in the POP group and 2.57 (95% CI, 1.55–4.27) in the rapid access group.

Conclusions

This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings.

Implications statement

For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.     

Time savings – realized and potential – and fair compensation for community health workers in Kenyan health facilities: a mixed-methods approach

Background

Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. This study describes tasks shifted from clinicians to CHWs in Kenya, places monetary valuations on CHWs’ efforts, and models effects of further task shifting on time demands of clinicians and CHWs.

Methods

Mixed methods were used for this study. Interviews were conducted with 28 CHWs and 19 clinicians in 17 health facilities throughout Kenya focusing on task shifting involving CHWs, time savings for clinicians as a result of task shifting, barriers and enabling factors to CHWs’ work, and appropriate CHW compensation. Twenty CHWs completed task diaries over a 14-day period to examine current CHW tasks and the amount of time spent performing them. A modeling exercise was conducted examining a current task-shifting example and another scenario in which additional task shifting to CHWs has occurred.

Results

CHWs worked an average of 5.3 hours per day and spent 36% of their time performing tasks shifted from clinicians. We estimated a monthly valuation of US$ 117 per CHW. The modeling exercise demonstrated that further task shifting would reduce the number of clinicians needed while maintaining clinic productivity by significantly increasing the number of CHWs.

Conclusions

CHWs are an important component of healthcare delivery in Kenya. Our monetary estimates of current CHW contributions provide starting points for further discussion, research and planning regarding CHW compensation and programs. Additional task shifting to CHWs may further offload overworked clinicians while maintaining overall productivity.     

Psychological distress and post-abortion contraceptive method effectiveness level chosen at an urban clinic

Objective

We investigated whether more psychological distress before an abortion is associated with the effectiveness of contraception selected (low, moderate, or high effectiveness) at an abortion clinic visit.

Method

Using data from 253 women attending an urban abortion clinic that primarily serves low-income women, we tested the association between pre-abortion psychological distress and the effectiveness level of post-abortion contraceptive choice. Based on typical use failure rates, we classified effectiveness of contraceptive choice into three levels—low, moderate, and high effectiveness. We measured psychological distress with four validated measures of depressive, anxious, and stress symptoms, and negative affect, as well as with a global measure comprising these four measures. We used multivariable ordinal logistic regression to measure the association of each psychological distress measure with post-abortion contraceptive method effectiveness level, adjusting for sociodemographic factors, pregnancy history, trimester of abortion, and importance of avoiding pregnancy in the next year.

Results

We found that compared to women experiencing less stress symptoms, negative affect and global psychological distress, women experiencing more stress symptoms [AOR=1.028, 95% CI: 1.001–1.050], negative affect [AOR=1.05, 95% CI: 1.01–1.09] and global psychological distress [AOR=1.46, 95% CI: 1.09–1.95] were more likely to choose more effective versus less effective methods, p<.05, in adjusted models. Using dichotomous psychological measures we found similar results.

Conclusions

Women experiencing more psychological distress before an abortion selected more effective contraceptive methods after their abortion. Future research should examine whether this distress is associated with subsequent contraceptive use or continuation.

Implications

The current study suggests that contraceptive providers should not assume that women experiencing more psychological distress prefer to use less effective contraceptive methods.