Contraceptive method preferences and provision after termination of pregnancy: a population‐based analysis of women obtaining care with the British Pregnancy Advisory Service

Abstract

Objective To examine contraceptive choices among women seeking termination of pregnancy (TOP) and the provision of the chosen methods. Design Population-based study. Setting British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Population Between 1 January 2011 and 31 December 2014, 211 215 women had a TOP at BPAS, were offered contraceptive counselling, and were eligible to obtain contraception at no cost. Methods We examined electronic records from BPAS and assessed the proportions of women who accepted contraceptive counselling and chose a contraceptive method, as well as the distributions of methods chosen, analysed by provider and by TOP type. We calculated the proportions receiving their chosen method and the methods chosen by women using no method at conception. We used logistic regression to examine the factors associated with choice of an intrauterine contraceptive (IUC) or implant. Main outcome measures Post-TOP contraceptive method choice. Receipt of chosen method post-TOP. Results Eighty-five per cent of women accepted contraceptive counselling and chose to obtain a method from BPAS rather than from a GP or contraception and sexual health clinic post-TOP. Among those who wanted to receive contraception from BPAS, 51% chose an IUC or implant and 19% chose oral contraceptives. Ninety-one per cent of women who obtained contraception from BPAS received their chosen method. Women were more likely to choose an IUC or implant if they obtained contraception from BPAS, had a surgical TOP, were parous, young, white, or had one or more previous TOPs. Conclusions The standards set for patient-centred TOP care should emphasise the need for a full range of contraceptive options to be offered and provided post-TOP.

Society of Family Planning clinical recommendations: contraception after surgical abortion

“…At a minimum, women should be made aware of the imminent return of their fertility and of the contraceptive methods available on the day of abortion. Many women find contraceptive counseling in the abortion setting acceptable: In a large, populationbased study of 211,215 women receiving surgical and medical abortion in the United Kingdom, 85% of women accepted contraceptive counseling, which followed a shared decision-making approach, and most of these women then chose to receive a method of contraception from the clinic [18]. In the general population, high-quality interpersonal communication may influence uptake of highly effective contraceptives and continuation of those methods at 6 months [19,20].…”

Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence

“…Thirty-five studies were included in the review and are summarised in S3 Table. Studies were published from 2001 to 2019, with 12 published in the last five years [20,[26][27][28][29][30][31][32][33][34][35][36]. Sixteen studies were cross-sectional quantitative [20,26,[29][30][31][35][36][37][38][39][40][41][42][43][44][45], 13 were cross-sectional qualitative [27,33,34,[46][47][48][49][50][51][52][53][54][55], four were mixed method [56][57][58][59], and two were quantitative cohort studies [28,32]. The study data covered eight countries (Australia, Israel, Netherlands, New Zealand, Portugal, Sweden, UK and the United States...…”

Specialist follow-up contraceptive support after abortion—Impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial

“…Initiating contraception on the day of abortion, in particular LARC, has proven significant in the reduction of subsequent abortions [2,26]. A study by Aiken et al reported that 85% of women undergoing a termination of pregnancy from BPAS clinics in England and Wales accepted contraceptive counselling; 51% chose to obtain their method from the same provider, 33% indicated a preference to obtain their contraception from their GP or a family planning clinic, 7% did not need contraception for a range of reasons and 8% declined counselling or contraception [27]. Other studies exploring women’s desires for contraceptive counselling at the time of their abortion have reported that about one-third [28] to two-thirds [29] of women were not interested in receiving counselling on the day of abortion.…”

“…Recent qualitative research has highlighted the difficulties which young women may experience with their contraceptive method chosen at abortion, suggesting the need for long-term support to help managing side effects or switching to alternative contraception [30]. In addition, there is a natural delay in the immediate post-abortion contraceptive uptake of intrauterine contraceptive methods in women undergoing medical abortions where the second stage occurs at home [27]. As medical abortions constitute an increasing proportion of all induced abortions in England and Wales (62% of all induced abortions in 2016 versus 30% in 2006) [1], more women may be losing out on the opportunity for the full range of LARC methods in the absence of organised contraceptive follow-up.…”