title: High abortion rate in Martinique (F.W.I.) in spite of a large contraceptive availability. What are the determinants?
abstract: BACKGROUND
  Despite a similar health insurance coverage and access to contraception, Martinique F.W.I. has a higher rate of abortion than continental France (25.6 versus 15.3 per thousand respectively). The reasons are still largely unknown. A different contraceptive pattern, a lower use of emergency contraception in Martinique may be involved. We sought to explore the contraceptive pattern, to evaluate the use of emergency contraception and the reasons leading to an unwanted pregnancy among women seeking for an abortion.
  
  
  METHODS
  An anonymous cross-sectional survey about the contraceptive use in the year and in the month before abortion, the use of emergency contraception and the reasons why, to patients' point of view, they became pregnant albeit not willing it was proposed to women seeking for an abortion in the dedicated unit of the university hospital of Martinique.
  
  
  RESULTS
  Six hundred patients were included. A total of 83.7% of patients declared having a regular contraceptive use during the year preceding. Just before abortion, 61.1% of women had no contraception or a low reliable method (fertility awareness, withdrawal…). Lack of recognition of pregnancy risk was the main reason leading to abortion, accounting for 51.1% of cases, explaining a low use of emergency contraception (13.8%), whereas a difficult access to contraception was rarely quoted. Emergency contraception was used in 27.8% of relevant situations.
  
  
  CONCLUSIONS
  Insufficient estimation of pregnancy risk is the main reason leading to unwanted pregnancy. Availability of emergency contraception does not reduce the risk.
authors.affiliation: Unité d'orthogénie, service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Martinique, BP 632, 97261 Fort de France cedex, Martinique. Electronic address: lauver64@hotmail.fr.
authors.forename: L
authors.initials: L
authors.lastname: Vergnaud
authors.affiliation: Unité d'orthogénie, service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Martinique, BP 632, 97261 Fort de France cedex, Martinique. Electronic address: jean-luc.volumenie@chu-fortdefrance.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Volumenie
authors.affiliation: Unité d'orthogénie, service de gynécologie-obstétrique, maison de la femme, de la mère et de l'enfant, CHU de Martinique, BP 632, 97261 Fort de France cedex, Martinique. Electronic address: catherine.bonnier@chu-fortdefrance.fr.
authors.forename: C
authors.initials: C
authors.lastname: Bonnier
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D044363:Contraception, Postcoital; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008395:Martinique / Q000453:epidemiology; D011247:Pregnancy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Abortion; Contraceptive pattern; Emergency contraception; French West Indies