title: Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study.
abstract: BACKGROUND
  Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive.
  
  
  METHODS
  This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion.
  
  
  RESULTS
  Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13-3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25-34 vs. 15-24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use.
  
  
  CONCLUSIONS
  In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women's pregnancy intention following an abortion is recommended, as well as a wide range of contraceptive methods, including long-acting reversible methods, even in restrictive abortion laws contexts.
authors.affiliation: Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil. alvilela@usp.br.|School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 419, cep 05403-000, São Paulo, Brazil. alvilela@usp.br.
authors.forename: Ana Luiza Vilela
authors.initials: AL
authors.lastname: Borges
authors.affiliation: Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria. fmolaolorun@gmail.com.
authors.forename: Funmilola
authors.initials: F
authors.lastname: OlaOlorun
authors.affiliation: Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil. efujimor@usp.br.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fujimori
authors.affiliation: Department of Maternal, Child and Psychiatric Care, University of São Paulo School of Nursing, São Paulo, Brazil. kikatuca@usp.br.
authors.forename: Luiza Akiko Komura
authors.initials: LA
authors.lastname: Hoga
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. atsui1@jhu.edu.
authors.forename: Amy Ong
authors.initials: AO
authors.lastname: Tsui
mesh_terms: D000028:Abortion, Induced; D000022:Abortion, Spontaneous; D000328:Adult; D001938:Brazil; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011446:Prospective Studies; D012725:Sexual Behavior