title: Contraceptive discontinuation and pregnancy postabortion in Nepal: a longitudinal cohort study.
abstract: OBJECTIVE
  To examine postabortion contraceptive discontinuation and pregnancy in Nepal, where abortion was decriminalized in 2002.
  
  
  METHODS
  We conducted an observational cohort study of 654 women obtaining abortions from four public and nongovernmental facilities in 2011. Patients completed questionnaires at their abortion visit and 6 and 12 months later. We used Cox proportional hazards models to assess contraceptive discontinuation and pregnancy by method initiated postabortion and other sociodemographic and reproductive factors.
  
  
  RESULTS
  Among the 78% (508/654) of women who initiated a modern contraceptive method within 3 months postabortion, the 1-year contraceptive discontinuation rate was 62 per 100 person-years. Discontinuation was far lower among the 5% of women using long-acting reversible methods (21/100 person-years) than among those using condoms (74/100 person-years), pills (61/100 person-years) and the injectable [64/100 person-years; adjusted hazard ratio (aHR)=0.32 (0.15-0.68)]. Unmarried women and those not living with their husband experienced higher contraceptive discontinuation [aHR=2.16 (1.47-3.17)]. The 1-year pregnancy rate for all women was 9/100 person-years. Pregnancy was highest among those who initiated no modern method postabortion (13/100 person-years) and condoms (12/100 person-years), and pregnancy was lowest among users of long-acting reversible methods (3/100 person-years). The poorest women were at increased pregnancy risk [aHR=2.31 (1.32-4.10)].
  
  
  CONCLUSIONS
  Women using intrauterine devices and implants experienced greatly reduced contraceptive discontinuation and pregnancy within a year postabortion, although initiation of these long-acting methods was low. Increased availability of long-acting methods in Nepal and similar settings may help to prevent unwanted pregnancy and attendant maternal mortality and morbidities.
  
  
  CONCLUSIONS
  Initiation of modern contraception was high postabortion; however, 1-year discontinuation was high for the condom, pill and injectable, the methods most commonly used. Rates for intrauterine devices and implants were low. Results support efforts to facilitate patient knowledge and access to the full range of contraceptives, including long-acting reversible methods.
authors.affiliation: Center for Research on Environment Health & Population Activities (CREHPA), Kusunti, Lalitpur, PO Box 9626, Kathmandu, Nepal.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Puri
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA; Kaiser Permanente Center for Health Research, Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.affiliation: Center for Research on Environment Health & Population Activities (CREHPA), Kusunti, Lalitpur, PO Box 9626, Kathmandu, Nepal.
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA. Electronic address: roccac@obgyn.ucsf.edu.
authors.forename: Corinne H
authors.initials: CH
authors.lastname: Rocca
mesh_terms: D000028:Abortion, Induced; D000029:Abortion, Legal; D000328:Adult; D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D004343:Drug Implants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D009390:Nepal; D011247:Pregnancy; D018873:Pregnancy Rate; D011275:Pregnancy, Unwanted; D016016:Proportional Hazards Models; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D004343:Drug Implants
keywords: Continuation; Long-acting reversible contraception; Postabortion contraception; Pregnancy