The influence of trust in health care systems on postabortion contraceptive choice

This study investigates whether trust in the health care system or other patient-level characteristics are associated with interest in immediate initiation of long-acting reversible contraception (LARC) after abortion.

A structured, self-administered survey was provided to English-speaking women 18 years or older presenting to a reproductive health center in the Southeastern United States for first-trimester surgical abortion. The survey collected information about patient characteristics, choice of postabortion contraception, health literacy and trust in the health care system. Trust was measured using a 17-item, previously validated survey and was treated as the primary independent variable. Our primary outcome variable is interest in immediate LARC placement postabortion. Statistical analysis was performed using Chi-square tests, Student's t tests and logistic regression with SAS® 9.2.

Of 162 respondents who completed the survey, 24% planned to use LARC postabortion, which increased to 37% if LARC placement was available on the day of their abortion. The mean trust score was 59±8 (possible score of 17-85) and did not differ significantly between women who indicated an interest in immediate LARC placement postabortion and those who did not (p=.9). Women with a history of a prior birth were 3.4 times more likely to indicate interest in immediate postabortion LARC than others (adjusted odds ratio 3.42, 95% confidence interval 1.63, 7.18).

Desire to accept LARC immediately postabortion is associated with history of a prior birth but not with trust in the health care system or other demographic variables. Participant interest in postabortion LARC varied based on immediate device availability.

This research underscores the importance of policies and clinical practices that promote access to LARC methods on the day of an abortion. Further research is needed to elucidate factors that correlate with choice of LARC postabortion.