Predictors of More Effective Contraceptive Method Use at 12 Weeks Post-Abortion: A Prospective Cohort Study

Understanding factors associated with contraceptive use post-abortion can inform clinical practices to improve contraception uptake. This prospective cohort study included adult women who completed the survey before surgical abortion at an Atlanta, Georgia clinic, with an online survey 12 weeks later. Poisson regression models assessed associations between demographic and reproductive factors and use of more effective (contraceptive pill, ring, patch, injectables, intrauterine device [IUD], implant, sterilization) versus less effective (none, condoms, withdrawal, rhythm methods) contraception at follow-up. Three hundred ninety three women completed the initial survey; 180 (46%) completed follow-up. Of those completing follow-up, 109 (61%) expressed interest in initiating more effective methods in-clinic, yet only 85 (47%) reported using these methods at follow-up. Sixty-one women (34%) were not using their preferred contraceptive at follow-up; 34 (56%) of whom preferred to use IUD, implant, or sterilization. More effective contraception use was significantly associated with age over 30 (adjusted risk ratio, aRR 1.71, 95% confidence interval (CI): 1.14-2.57); nulliparity (aRR 1.70, 95% CI: 1.20-2.42); use of more effective methods at most recent conception (aRR 2.56, 95% CI: 1.73-3.79); interest in more effective methods at the time of the abortion (aRR 1.55, 95% CI: 1.11-2.18); and receiving a contraceptive/prescription at the time of abortion (aRR 1.97, 95% CI: 1.37-2.81). Over half of women use less effective contraception 3 months post-abortion, despite a high interest in more effective contraception. Additional research is needed to understand contraceptive decision making in the context of abortion care to inform interventions to increase contraceptive uptake.