Self-reported contraceptive method use at conception among patients presenting for abortion in England: a cross-sectional analysis comparing 2018 and 2023.

Background: Recent media attention has been given to an apparent shift away from hormonal methods of contraception. While an increase in fertility awareness-based or 'natural' family planning methods is reported in the grey literature, there are no robust data to determine any such trend in the UK.

Methods: We compared self-reported contraceptive use at conception among patients presenting for abortion at British Pregnancy Advisory Service from January to June 2018 (N=33 495) and January to June 2023 (N=55 055) using chi-square (χ²) tests of association.

Results: Reported use of fertility awareness-based methods of contraception around the time of conception increased from 0.4% in 2018 to 2.5% in 2023 (p<0.001). In contrast, use of hormonal methods of contraception decreased from 18.8% in 2018 to 11.3% in 2023 (p<0.001) and use of long-acting reversible contraception fell from 3% to 0.6% (p<0.001). Those reporting using no contraception at the time of conception significantly increased by 14% (p<0.001) when comparing data from 2018 (55.8%) with data from 2023 (69.6%).

Conclusions: Significantly fewer abortion patients report using effective methods of contraception around conception while also reporting an increased use of fertility awareness-based methods. Further research is needed to understand the reasons for this change.