A post-abortion contraception text-and-call service to support patients to access effective contraception after telemedicine abortion.

Background: Most abortions in Scotland are conducted at home before 12 weeks' gestation using telemedicine. The volume of information given at a pre-abortion consultation may feel overwhelming and contraception may not be prioritised. Telemedicine limits immediate provision of some methods. Pathways to improve access to post-abortion contraception (PAC) are needed.

Methods: We piloted a PAC 'text-and-call' service for patients having telemedicine abortion in Edinburgh. Those agreeing to contact were sent a text message 4-6 weeks later. The message offered a follow-up telephone call with a nurse to discuss contraception. An online decision aid was used to support method selection where needed. Rapid access to the chosen method was arranged.

Results: During the period February-April 2022, 672 patients accessed abortion care, of whom 427 (64%) agreed to post-abortion text message contact. Most (354/427, 83%) did not respond or declined further contact, and 73/427 (17%) requested a follow-up call.Two participants did not respond to the follow-up call. Most (63/73, 86%) knew what method they wanted prior to the call. Just over half of these patients (34/73, 54%) changed to a higher-effectiveness method than they were currently using and the remainder obtained further supplies of their existing method. Eight participants had not selected a method prior to the call and received structured counselling; five chose long-acting reversible contraception (LARC) but only one subsequently initiated this.

Conclusions: This PAC service was taken up by a small proportion of patients but supported a sizeable minority to connect to further contraceptive supplies, half of whom accessed more effective methods.