Immediate Versus Delayed Postpartum and Postabortion Insertion of Long-Acting Reversible Contraception: An Umbrella...

Unintended pregnancy and repeat abortion remain significant challenges in the field of reproductive health.

To summarize evidence from systematic reviews and meta-analyses (SRMAs) comparing immediate versus delayed long-acting reversible contraception (LARC) insertion in postpartum and postabortion populations.

Five databases were systematically searched in April 2025 without restrictions.

SRMAs were included if they assessed the possible health outcomes between immediate and delayed LARC insertions for postabortion or postpartum populations.

Pooled results were extracted as reported, with most effect sizes presented as relative risks (RRs) with 95% confidence intervals (CIs). Eligible SRMAs were assessed utilizing AMSTAR-2 for methodological quality. Evidence certainty was assessed by GRADE tool or predefined criteria.

From 1998 screened records, nine SRMAs were included, yielding 92 comparisons. Compared with the delayed group, postpartum women in the immediate group had higher LARC initiation, higher 6-month LARC utilization and lower 6-month pregnancy rates (RR, 0.16; 95% CI, 0.04-0.71; moderate-certainty evidence). Similar comparison results of such outcomes were discovered in postabortion populations. However, immediate intrauterine device insertion significantly increased the risk of expulsion, especially in the vaginal delivery subgroup for postpartum populations (RR, 5.09; 95% CI, 2.04-12.73; high-certainty evidence) and in the first trimester subgroup for medical abortion populations (RR, 2.02; 95% CI, 1.37-2.98; moderate-certainty evidence).

Compared with delayed insertion, immediate LARC placement after delivery (moderate-certainty) or abortion (low-certainty) was more effective in preventing unintended pregnancies. Additionally, abortion methods should be considered in future guideline updates, though supporting evidence was of low-certainty.

PROSPERO number: CRD420251031374.