Audit of contraception before and after termination of
pregnancy
O. Graham
Abacus Clinics for Contraception and Reproductive Health,
Liverpool, England, UK
Introduction: Concern had been raised locally about the
number of clients attending for repeat TOP despite regular contraceptive advice
and provision of most methods of choice on site. Repeat request for TOP is
perceived to be a problem even though the rate was similar to that in other
parts of Europe and North America.
Aims and Methods: As part of the audit on repeat TOP, we
aimed to make recommendations on how to minimise the risk of having repeat TOP.
We therefore looked at the contraceptive practices of clients before their last
TOP and what they intended to use after their last TOP and compared these with
what was being used when they returned for another TOP
Results: 291 women had a record of their contraceptive
practice before their last TOP, what method of contraception they were planning
to use after their last TOP and the contraceptive used prior to their current
TOP. Forty-five percent were not using any contraception and 30.9% were using
condoms as their sole method prior to their last TOP. Contraceptive intentions
changed towards a more reliable method after the TOP with more than 56.3%
choosing COC and 21 % choosing DMPA. However when they returned for their
current TOP contraceptive practices had changed again. Of the 164 women
intending to use COC after their last TOP only a third (52) were recorded to be
using COC prior to the current TOP. Nearly two-thirds (102) were using condoms
or no contraception. Sixty-one clients intended to use DMPA after their last TOP
but only two said they were using DMPA prior to their current TOP and 47 (77%)
were using condoms or no contraceptives. Twenty-two women planned to use IUD/IUS
following their last TOP but only 4 were using IUD/ IUS before their current
TOP. Fifteen women were using condoms or no contraception.
Conclusion: Although clients chose good, effective
contraceptives after TOP, their use was not always maintained after the
procedure. Further work is needed to understand the reasons for the change of
method and plans to improve acceptability and accessibility to more effective
contraception are being developed to assist women in having more control over
their fertility.
