title: Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion.
abstract: OBJECTIVE
  Women who have abortions are at high risk of contraception discontinuation and subsequent unintended pregnancy. The objective of this analysis was to identify factors associated with choice of highly effective, long-acting, progestin-only contraceptive methods after abortion.
  
  
  METHODS
  Women presenting for surgical abortion who selected the levonorgestrel intrauterine device (IUD), the progestin implant or the progestin injection (depot medroxyprogesterone acetate or DMPA) as their postabortion contraceptives were recruited to participate in a 1-year prospective cohort study. We used multivariable multinomial logistic regression to identify factors associated with choosing long-acting reversible contraceptives (IUD or implant) compared to DMPA.
  
  
  RESULTS
  A total of 260 women, aged 18-45 years, enrolled in the study, 100 of whom chose the IUD, 63 the implant and 97 the DMPA. The women were 24.9 years old on average; 36% were black, and 29% were Latina. Fifty-nine percent had had a previous abortion, 66% a prior birth, and 55% were undergoing a second-trimester abortion. In multivariable analyses, compared with DMPA users, women who chose the IUD or the implant were less likely to be currently experiencing intimate partner violence (IPV); reported higher stress levels; weighed more; and were more likely to have finished high school, to have used the pill before and to report that counselors or doctors were helpful in making the decision (all significant at p<.05, see text for relative risk ratios and confidence intervals.) In addition, women who chose the IUD were less likely to be black (p<.01), and women who chose the implant were more likely to report that they would be unhappy to become pregnant within 6 months (p<.05) than DMPA users.
  
  
  CONCLUSIONS
  A variety of factors including race/ethnicity, past contraceptive use, feelings towards pregnancy, stress and weight were different between LARC and DMPA users. Notably, current IPV was associated with choice of DMPA over the IUD or implant, implying that a desire to choose a hidden method may be important to some women and should be included in counseling.
  
  
  CONCLUSIONS
  In contraceptive counseling, after screening for IPV, assessing patient's stress and taking a history about past contraceptive use, clinicians should discuss whether these factors might affect a patient's choice of method.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Ushma D
authors.initials: UD
authors.lastname: Upadhyay
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA. Electronic address: sokoloffa@obgyn.ucsf.edu.
authors.forename: Abby
authors.initials: A
authors.lastname: Sokoloff
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Diedrich
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Eleanor A
authors.initials: EA
authors.lastname: Drey
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002755:Choice Behavior; D003267:Contraception / Q000379:methods / Q000523:psychology*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003657:Decision Making; D017135:Desogestrel / Q000008:administration & dosage; D004343:Drug Implants / Q000627:therapeutic use; D004522:Educational Status; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology / Q000706:statistics & numerical data; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000008:administration & dosage; D016015:Logistic Models; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D011446:Prospective Studies; D044469:Racial Groups; D013315:Stress, Psychological / Q000523:psychology; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D016912:Levonorgestrel; D017135:Desogestrel; D017258:Medroxyprogesterone Acetate
keywords: Contraception; Intimate partner violence; Long-acting reversible contraceptive; Postabortion