Contraceptive policies affect post-abortion provision of long-acting reversible contraception.
BACKGROUND
Placement of long-acting reversible contraceptives (LARC) - intrauterine devices (IUDs) and the implant - directly after an abortion provides immediate contraceptive protection and has been proven safe.


METHODS
We conducted a survey of National Abortion Federation member facilities (n=326; response rate 75%) to assess post-abortion contraceptive practices. Using multivariable logistic regression, we measured variations in provision of long-acting contraception by clinic factors and state contraceptive laws and policies.


RESULTS
The majority (69%) of providers surveyed offered long-acting methods, but fewer offered immediate post-abortion placement of intrauterine devices (36%) or implants (17%). Most patients were provided with contraception; 6.6% chose LARC methods offering the highest level of protection. Post-abortion provision of these methods was lower in stand-alone abortion clinics (p ≤.001), but higher with recent clinician training (p ≤.001) and in the absence of clinic flow barriers (p ≤.001). State policies had a significant impact on how women paid for contraception and the likelihood of LARC use. Patient use was higher in states with contraceptive coverage mandates (p ≤.01) or Medicaid family planning expansion programs (p ≤.05).


CONCLUSIONS
Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, UCSF Box 0744, San Francisco, CA 94143, USA. thompsonkm@obgyn.ucsf.edu
Kirsten M J
KM
Thompson
J Joseph
JJ
Speidel
Vicki
V
Saporta
Norma Jo
NJ
Waxman
Cynthia C
CC
Harper
D000028:Abortion, Induced / Q000379:methods*; D003267:Contraception / Q000379:methods* / Q000592:standards; D004343:Drug Implants; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D011247:Pregnancy
D004343:Drug Implants