Society of Family Planning clinical recommendations: contraception after surgical abortion

Abstract

These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy. IUD insertion immediately following uterine aspiration is safe. While this may be associated with a higher risk of device expulsion than with interval placement, expulsion rates remain low, and this risk must be weighed against the fact that patients often do not receive their desired IUD at an interval insertion and therefore experience higher rates of subsequent unintended pregnancy. Many patients experience barriers that prevent access to the full spectrum of postabortion contraceptive options, particularly IUDs and implants. Advancements in health-systems-based point-of-care provision and policies are needed to improve comprehensive contraceptive availability following surgical abortion. These recommendations will address clinical considerations for postabortion contraceptive provision and recommend interventions to improve contraceptive access following uterine evacuation.

Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study

“…Our study adds to growing evidence that when contraceptives are offered for free, women who have recently had an abortion [9–11], as well as those with a history of an induced abortion, will be more likely to choose IUD placement compared to women without such a history. Given the well-established finding that use of effective contraceptives, such as an IUD, have the potential to prevent unintended pregnancies, our results suggest that providing free contraceptives to women with low incomes, such as the unemployed, is an effective method to prevent unintended pregnancies.…”

“…Furthermore, there was no information about the preferences of gynaecologists in regards to promoting the use of IUDs. The woman - gynaecologist interaction may be particularly important in how a contraceptive method is chosen [9], but discussing the reproductive intentions of women requesting contraceptive counseling appears to be challenging [8]. Third, the cross-sectional nature of the study design does not allow conclusions to be made regarding decreases in unintended pregnancies and a reduced number of abortion(s), as shown in previous studies [10, 11].…”

“…Data indicate that the number of unintended pregnancies can be reduced by offering all women access to effective methods of contraception [7]. Appropriate counseling by clinicians and other professionals should respect a woman’s autonomy in regards to her choice for a contraceptive method that is suitable for the specific reproductive stage of her life [8, 9].…”

“…The most effective methods are long-acting contraceptives, including intrauterine devices (IUDs) [7]. The use of IUDs after an abortion has the potential to decrease the number of subsequent unintended pregnancies and the attendant risks of induced abortions [9–11].…”

Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices

“…They effectively reduce the incidence of unintended pregnancies (1), and have been applied increasingly during the past decade, from 5.8% in 2008 to 11.8% in 2014 in the US (2), and 52.3% in 2007 in China (3). IUDs are of two types: copper intrauterine devices (Cu-IUDs) and levonorgestrel intrauterine systems (LNG-IUSs), with 0.8% and 0.2% failure rates, respectively (4). Cu-IUDs are recommended as the preferred long-term contraceptive method for postpartum (5), breastfeeding (6), and perimenopausal women, and even for immediate placement after a surgical abortion (4).…”