Improving contraceptive use after abortion: a cluster randomised
controlled trial of personalised, expert contraceptive advice and provision at
the time of termination of pregnancy
C. Schünmann (1), A. Glasier (2)
Institute of Naval Medicine, Portsmouth, UK (1); Lothian Primary Care NHS
Trust and Department of Obstetrics and Gynaecology, University of Edinburgh,
Edinburgh, UK (2)
Introduction: Abortion is common. In 2002 over 11,500
terminations of pregnancy (TOP) were reported in Scotland. Reducing the rate
of unintended pregnancy has been the aim of successive UK governments. In the
UK between 20 and 25% of women undergoing pregnancy termination will have
another abortion at some time during their reproductive lives. This group of
women offers a target for interventions aimed at improving correct and
consistent use of contraception. We have undertaken a study to determine
whether personalised, expert contraceptive advice and provision of adequate
supplies of the chosen contraceptive method at the time of TOP influence
contraceptive choice and continuation after abortion.
Methods: Using a cluster
randomised controlled study design, 613 women undergoing TOP in Edinburgh were
randomised to receive personalised contraceptive advice and immediate
provision of their chosen method (316 women) or standard care with limited
method provision (297 women). 16 weeks after the procedure all participating
women were contacted to determine their pattern of contraceptive use.
Statistical analysis took account of clustered randomisation by using
two-sample t-tests at a weekly level based on summary statistics for each
intervention and control week. Associations were tested using chi-squared
tests, Mann-Whitney tests or Spearman rank correlation and McNemar’s test
was used to examine changes in contraceptive use at different times.
At 16-week follow-up, there were no differences between the proportion of
women using any contraceptive method or in continuation rates for individual
contraceptive methods. However women who received tailored advice were
significantly more likely to be using a long-acting, user independent method
of contraception such (IUD/IUS, injectable or implant).
Personalised contraceptive advice and immediate provision of contraceptive
method at the time of TOP are associated with a higher uptake of long-acting,
reversible methods of contraception than standard provision of a more limited
choice of contraceptive methods. Whether this would reduce the rate of repeat
abortion would require very long term follow-up.