Long-acting reversible contraception initiation after medication abortion: a retrospective cohort study.

Abstract

Background: Medication abortion (MAB) accounts for an increasing proportion of in-clinic abortions in the United States and poses unique considerations for provision of long-acting reversible contraception (LARC). Studies of LARC initiation among MAB patients mostly consist of trials where financial barriers to LARC were removed. We sought to identify correlates of LARC initiation post-MAB in a community-based setting.

Methods: This is a retrospective cohort study of patients who presented to a Planned Parenthood Health Center in Minnesota in 2016 for MAB, chose LARC as their intended post-abortion contraceptive method in counseling, and returned to the clinic for their routine follow-up visit (n = 335). We abstracted sociodemographic and reproductive health history variables and used logistic regression to estimate odds ratios (ORs) for LARC initiation post-abortion (≤ 30 days of mifepristone administration).

Results: Study participants predominantly self-identified as non-Hispanic and White and had a mean age of 26 years. Overall, 72.8% (n = 244) initiated their desired LARC method by 30 days post-abortion. There was no significant (p < 0.05) association between LARC initiation and most variables: race, ethnicity, age, distance from clinic, body mass index, gestational age, gravidity, prior abortions, and number of children. However, odds of LARC initiation were significantly lower among participants who did not use any health insurance (vs. private insurance) for contraceptive coverage at their MAB follow-up visit (age-adjusted OR 0.35, 95% CI 0.18-0.69). Findings were similar for initiation of the IUD, specifically (age-adjusted OR 0.42, 95% CI 0.18-0.97), but not statistically significant for the implant.

Conclusions: Lack of health insurance may be a barrier to LARC initiation for MAB patients. Facilitators of LARC initiation in the context of MAB remain unclear and warrant further research to optimize patient-centered care.