Contraceptive Provision after Medication and Surgical Abortion

ObjectiveThis study sought to compare contraception provided to patients after medication and surgical abortion.Study DesignWomen who underwent first trimester induced abortion at a university-based urban clinic between May 2009 and May 2014 were identified. Medical records were reviewed to determine the method of contraception provided by the clinic to patients after medication and surgical abortion. Postabortal contraception was defined as any contraception administered or prescribed from our health system within 4 weeks of surgical abortion or mifepristone administration.ResultsWe reviewed 824 women who were 9 weeks gestational age or less and able to choose between medication and surgical termination of pregnancy. Overall, 587 (71.1%) had a surgical abortion and 237 (28.9%) had a medication abortion. Women who had surgical abortions were more likely to initiate long-acting reversible contraception (41.9% vs. 23.2%; p < .0001) and more likely to be provided with any type of contraception overall (83% vs. 64.6%; p < .0001). The overall follow-up rate after medication abortion was 71.7%.ConclusionsWomen who had surgical abortions had a greater odds of receiving long-acting reversible contraception than those who had medication abortions. Surgical abortion patients were also more likely to be provided contraception overall. Further prospective research is needed to determine the reasons for this difference and to ensure that all patients obtain the contraception that they desire.     

Benefits of using a digital video disk for providing information about abortion to women requesting termination of pregnancy

BackgroundA patient information digital video disk (DVD) on abortion was produced for use in a hospital abortion service (Scotland) for women requesting termination of pregnancy.Study DesignSelf-administered anonymous surveys of patients and clinic staff (doctors and nurses), before and after introduction of the DVD, was conducted.ResultsQuestionnaires were completed by 106 patients before introduction of the DVD and by 100 patients and 20 staff following its introduction. Patient satisfaction (score out of 10) with information received was significantly higher following introduction of DVD (mean, 9.2 vs. 8.3, with and without DVD, respectively; p<.001). Women liked the DVD's clear explanations (65% responses, n=35), and staff felt women were better informed (56.6% responses, n=13) and that it liberated time to discuss specific concerns and contraception (26.1%, n=6).ConclusionsThe DVD provided high-quality information for women requesting abortion and resulted in staff having more time to discuss patient concerns and contraception.     

Systemic hormonal contraception initiation after abortion: A systematic review and meta-analysis

BackgroundImmediate contraceptive initiation, including start of a method before abortion completion, is a convenient option for women seeking abortion care.ObjectivesTo evaluate the effect of systemic hormonal contraception initiation on medical abortion effectiveness and the safety of hormonal contraceptive methods following abortion.Data sourcesPubMed, Popline, Cochrane Library, and Clinicaltrials.gov.Study eligibility criteriaStudies that assessed medical abortion effectiveness after systemic hormonal contraception initiation and the safety of hormonal contraception initiation after abortion.ParticipantsPregnant persons undergoing or who had recently undergone an abortion.InterventionsInitiation of systemic hormonal contraception post abortion or on the day of the first pill of the medical abortion.Study appraisal and synthesis methodsWe assessed study quality using the US Preventive Services Task Force evidence grading system. We created narrative summaries and calculated pooled relative risks when appropriate.ResultsWe identified 16 studies for inclusion, 7 randomized controlled trials, and 9 cohorts. Nine studies assessed medical abortion effectiveness with hormonal contraception initiation and generally found no decreased risk of abortion success or increased risk of additional treatment. One fair-quality study reported a small increase in ongoing pregnancy rate with immediate depot medroxyprogesterone (DMPA) compared with delayed DMPA initiation (3.6% vs 0.9%, risk difference 2.7%, 90% confidence interval 0.4–5.6). We identified no bleeding-related safety concerns following hormonal contraception initiation after medical or surgical abortion. Pooled results were too imprecise to draw firm conclusions.LimitationsIncluded studies were poor or fair quality and primarily in high-income or upper-middle-income settings.ConclusionsAbortion effectiveness did not differ between immediate vs delayed initiation of most systemic hormonal contraceptive methods after a first trimester medical abortion. However, immediate DMPA initiation did show increased ongoing pregnancy. Bleeding effects with hormonal contraception initiation postabortion appeared minimal.ImplicationsInitiating a hormonal contraceptive method after an abortion and as early as the same day as the first pill of the medical abortion is an option if contraception is desired. The slight increase in ongoing pregnancy with immediate DMPA initiation highlights the importance of information provision during contraceptive counseling.     

Abortion among adolescents in Cuba

Purpose: To understand which adolescents in Havana, Cuba, seek abortions and reasons for pregnancy termination.Methods: The sample included all adolescents (n = 248) under the age of 20 years who sought pregnancy termination over a 1-month period in 1995. The participants completed a questionnaire exploring a range of issues including age of onset of sexual intercourse, pregnancy history, and reasons for pregnancy termination.Results: There was no difference in age of onset of sexual intercourse between pregnant adolescents who did and did not seek an abortion. Three fourths of all adolescents who aborted a pregnancy were students, and interruption of studies was a major reason for pregnancy termination. Other reasons included being a single mother and poor socioeconomic conditions. More than half of those who sought to terminate their pregnancy did so at a clinic outside of the community in which they lived.Conclusion: As in other countries, in Cuba, concerns over education interruption remain the predominant reason for abortion. Likewise, while abortion has been legal and widely available in Cuba since 1969, there remains sufficient stigma so that over half of young women seek pregnancy termination outside their community of residence.     

364例中期妊娠引产相关原因调查与分析

目的了解育龄妇女中期妊娠引产原因,提出减少中期妊娠引产的预防对策,减少非意愿妊娠发生。方法选择2007～2010年在宜昌市夷陵区计划生育服务站进行中期妊娠引产的364例育龄妇女为研究对象,回顾性分析病历资料及当初的问卷调查,将研究对象的临床资料进行搜集整理。结果 364例怀孕妇女中未婚93例(25.5%),初婚256例(70.3%),再婚15例(4.1%)。避孕措施失败236例(64.8%),未采取避孕措施128例(35.2%),其中含政策内怀孕医学原因终止妊娠11例。导致中期引产的主要原因为:相关知识缺乏和认识误区,生育意愿和生育政策相悖,特殊原因错过早期人工流产时机。结论加强对育龄妇女及未婚女性避孕节育知识的宣传教育,使她们充分认识到避孕节育知情选择的重要性和必要性,自愿选择合适自己的有效避孕方法,减少非意愿性妊娠。加强对意外妊娠早发现早终止的知识教育,减少中期妊娠引产,保护育龄妇女的身体健康。     

Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai

BackgroundRural-to-urban migrant women in Shanghai have poor reproductive health; the incidence of postpartum unintended pregnancy and contraceptive practices has not been adequately studied in this population.Study DesignThis retrospective study examined the incidence of postpartum unintended pregnancy and associated factors among migrant women and included a medical records reviews, telephone interviews and in-depth face-to-face interviews.ResultsThe incidence of unintended pregnancy during the first and second years postpartum was 12.8 and 12.9 per 100 women-years, respectively. Eighty-six percent resulted from nonuse of contraception, and 88% ended in induced abortions. Median times of sexual activity resumption and contraception initiation were 2 months and 7.5 months postpartum, respectively. Approximately 17% of women did not adopt effective contraceptive methods until undergoing induced abortion.ConclusionsConcentrated efforts, including contraception counseling prior to discharge and early postpartum visits, are required to increase early use of effective contraception among rural-to-urban migrant women in Shanghai and to reduce their high level of postpartum unintended pregnancy.     

女青年人工流产情况及避孕知识调查

目的:了解郑州市女青年人工流产和避孕知识知晓情况,探讨人工流产影响因素。方法:采用自填式调查问卷,对郑州市年龄≤25岁1100名人工流产女青年进行横断面调查。结果:调查对象年龄为(22.50±1.68)岁,平均月收入为800元,职业以公司职员为主(29.4%),大部分未婚,流动人口占75.1%,初中以下文化程度和常住人口相比有统计学意义;34.9%的女青年经历过流产,首次流产未婚者占72.6%,且随着年龄增加,重复流产率逐渐增高;本次妊娠原因67.9%的女青年未采用避孕措施,32.1%为避孕失败,避孕失败的主要原因是避孕套(44.5%)、安全期(25.2%)和体外排精(15.9%);过去3个月中,最常用的避孕方法是避孕套(82.3%),其次为紧急避孕(28.5%)、安全期(27.7%)、体外排精(22.7%);谈及避孕知识,深入到避孕措施具体使用方法回答正确率较低。结论:非意愿妊娠的主要原因是未采用避孕措施,而使用避孕措施的女青年中,坚持使用和正确使用有效避孕措施率低,且流产女青年掌握的避孕知识有限,应加强未婚人群和流动人口的避孕知识宣教和咨询,内容侧重坚持、正确使用高效避孕措施的宣传,提供优质的计划生育服务,从而避免非意愿妊娠和人工流产。     

Connecting Knowledge about Abortion and Sexual and Reproductive Health to Belief about Abortion Restrictions: Findings from an Online Survey

BackgroundThe objective of this research was to examine individuals' knowledge about abortion in the context of their knowledge about other sexual and reproductive health (SRH) issues, including contraception, abortion, pregnancy, and birth.MethodsDuring August 2012, we administered an online questionnaire to a randomly selected sample of 639 men and women of reproductive age (18–44 years) in the United States.FindingsRespondents reported the highest levels of perceived knowledge about SRH in general (81%), followed by pregnancy and birth (53%), contraception (48%), and abortion (35%); knowledge of specific items within each of these areas paralleled this pattern. Respondents who believe that abortion should be allowed in at least some circumstances were more likely to be correct regarding the safety and consequences of contraception and abortion. Characteristics associated with higher levels of knowledge regarding abortion-related issues included having higher levels of knowledge about non–abortion-related SRH issues and having less restrictive abortion beliefs.ConclusionsWomen and men are not well-informed about the relative safety and consequences of SRH-related experiences. Many overestimate their knowledge, and personal beliefs about abortion restrictions may influence their knowledge about the safety and consequences of abortion and contraception. Providers of SRH services should provide comprehensive evidence-based information about the risks and consequences of SRH matters during consultations, particularly in the case of abortion providers serving women who hold more restrictive abortion beliefs.     

Patients' attitudes and experiences related to receiving contraception during abortion care

BackgroundHigh risk for additional unintended pregnancies among abortion patients makes the abortion care setting an ideal one for facilitating access to contraception. This study documents attitudes of abortion patients about contraceptive services during their receipt of abortion services and identifies patient characteristics associated with desire for contraception and interest in using a long-acting reversible contraceptive method (LARC).Study DesignStructured surveys were administered to 542 patients at five US abortion-providing facilities between March and June of 2010. Supplementary information was collected from 161 women who had had abortions in the past 5 years through an online survey.ResultsAmong abortion patients, two thirds reported wanting to leave their appointments with a contraceptive method and 69% felt that the abortion setting was an appropriate one for receiving contraceptive information. Having Medicaid and having ever used oral contraceptives were predictive of wanting to leave with a method. Women having a second or higher-order abortion were over twice as likely as women having a first abortion to indicate interest in LARC, while black women were half as likely as white women to indicate this interest.ConclusionMany women are interested in learning about and obtaining contraceptive methods, including LARC, in the abortion care setting.     

城市妇女非意愿妊娠的原因及避孕知识态度和行为调查

目的:了解非意愿妊娠的主要原因,以及有关避孕方法知情选择的知识、态度和行为。方法:采用整群抽样的方法对191例非意愿妊娠妇女进行有关避孕知识、态度和行为问卷调查并应用SPSS/PC10·0分析软件进行统计。结果:2次以上重复流产率占34·6%;本次意外妊娠的原因,有54·4%的人是因为避孕失败。失败的原因依次为安全套57·8%、体外排精14·7%、安全期12·1%、口服避孕药10·3%和紧急避孕药4·3%。仅有11·5%的人能正确回答相关的知识试题。最喜爱的避孕方法前3位为安全套55·0%、安全期20·6%和体外排精10·1%。希望获得避孕信息的途径与现有来源存在一定差距。结论:重复流产率较高,亟待开展流产后服务项目,特别是避孕方法的正确使用。     

意外妊娠终止后继发不孕的原因及影响因素分析

目的:探讨意外妊娠终止后继发不孕的原因及影响因素。方法:以2006年8月～2008年8月到怀化市第一人民医院就诊的82例意外妊娠后继发不孕的妇女作为观察组,进行问卷调查,以同期入院的58例原发性不孕妇女作为对照组,采用SPSS13.0软件进行统计分析。结果:观察组初次性生活年龄早于对照组(P0.001);避孕失败原因依次为未避孕(占57.32%)、避孕套失败(占18.29%)、安全期避孕(10.98%)、体外排精(9.76%);避孕失败后终止妊娠的方式主要为人工流产、药物流产,而输卵管妊娠后继发不孕者亦占一定比例;继发不孕的原因居前4位的分别是输卵管梗阻、慢性输卵管炎、慢性盆腔炎、输卵管积水。结论:意外妊娠终止后继发不孕的主要原因是盆腔炎性疾病后遗症,导致输卵管梗阻或不通畅。初次性生活年龄过早,未避孕或避孕方法不当,多次人工流产、药物流产、输卵管妊娠史是意外妊娠后继发不孕的重要影响因素。     

Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study

ObjectivesWe assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users.MethodsWe offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion.ResultsOne hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0–5.1%). The only positive pregnancy test after treatment occurred in a woman who received oral LNG plus the LNG IUD and who had reported multiple episodes of unprotected intercourse including an episode more than 5 days prior to treatment.ConclusionsStudy participants seeking EC who desired an IUD preferentially chose oral LNG 1.5 mg with the LNG 52 mg IUD over the copper IUD. Neither group had EC treatment failures. Including the option of oral LNG 1.5 mg with concomitant insertion of the LNG 52 mg IUD in EC counseling may increase the number of EC users who opt to initiate highly effective reversible contraception.ImplicationsConsideration should be given to LNG IUD insertion with concomitant use of oral LNG 1.5 mg for EC. Use of this combination may increase the number of women initiating highly effective contraception at the time of their EC visit.     

Induced abortion: Reported and observed practice in Taiwan

This study reports the result of a 1980 survey obtained from a nonrandom sample of 500 Chinese women in Taiwan. A total of 46.6% (223) of the respondents admitted that they had obtained at least one induced abortion for birth control purposes in their lifetime.

The following questions are explored and discussed in relation to the women's abortion experiences: prior contraceptive use, repeated abortion, decision to seek abortion, attitudes toward sexual activity and marriage, gestational age at termination of pregnancy, fear of complication, guilt after abortion, and comparison of abortion and pregnancy experiences.     

人工流产女青年性行为和避孕现状研究

目的:了解北京市人工流产女青年的性行为和避孕现状,探讨人工流产、特别是重复流产的影响因素。方法:采用自填式问卷的方法,对北京市1 008名自愿要求人工流产、在1980年8月1日之后出生的女青年进行现状调查。结果:研究对象首次性行为的平均年龄为(20.70±1.95)岁,54%的人在20岁之前就开始了性生活;首次人工流产的平均年龄为(21.96±1.81)岁,首次流产在20岁之前的占17.0%;将近25%的人曾与2名及以上的男性发生过性关系;人流女青年本次怀孕的原因,60.2%是因为没有避孕,39.7%由于避孕失败;没有避孕的主要原因是"在没有准备好避孕药具的情况下同房"(41.5%)和"知道避孕方法但不想用"(39.7%);避孕失败的主要原因是全安期和体外射精(39.0%)、避孕套(32.7%)和紧急避孕(18.5%);过去3个月中,最常用的避孕方法为避孕套(75.5%)、全安期和体外射精(11.0%)、紧急避孕(8.2%);在避孕套使用者中,只有9.3%能坚持每次同房都用;77.2%的人认为口服避孕药对身体不好;32.4%的研究对象有重复流产。单因素分析发现,文化程度低、未婚同居、首次性生活和首次流产的年龄小、多性伴和不能坚持、正确使用避孕措施是重复流产的影响因素。结论:女青年首次性行为开始早、多性伴比例高、避孕药具使用率低或使用低效的避孕方法是非意愿妊娠和人工流产的主要原因,且重复流产现象比较严重;同时,流动人口在人流女青年中占了相当大的比例。因此,应当对未婚人群和流动人口女青年进行人工流产的危害以及避孕知识的宣传教育,提高现代科学的避孕药具使用率,避免不必要的意外妊娠和人工流产。     

Computer-assisted motivational interviewing for contraceptive use in women leaving prison: A randomized controlled trial

ObjectivesRates of unintended pregnancies in women with a history of incarceration are high and access to contraception before and after arrest can be limited. Individualized counseling can better prepare women for healthy pregnancy or provide an opportunity for contraceptive education and access within correctional facilities. In this study, we assessed the efficacy of motivational interviewing as an individualized intervention to increase the initiation of contraceptive methods while incarcerated and continuation after release in female inmates who wanted to avoid pregnancy for at least one year after release.Study designWe performed an RCT in a population of incarcerated women who wanted to avoid pregnancy. Women were randomized to either a computer-assisted motivational interviewing intervention group (n = 119) or an educational video with counseling control group. (n = 113). The primary outcome was initiation of a method of birth control prior to release from the correctional facility.ResultsInitiation of contraception was higher in the intervention group (56% vs. 42%, p = 0.03), but this difference was not significant after controlling for number of male partners within the year prior to incarceration. There was no difference between the groups in the rates of pregnancies or STIs or continuation of contraception after release, which was generally low (21%).ConclusionComputer-assisted motivational interviewing did not improve uptake or continuation of contraception in this study.ImplicationsPeriods of incarceration provide an opportunity to offer contraceptive services to women who want to avoid a pregnancy. Motivational interviewing may not be an effective method to affect contraceptive behaviors in this population. Future research should explore the family planning values and preferences of women who become involved with the correctional system.