Postabortion Contraceptive Use and Continuation When Long-Acting Reversible Contraception Is Free

Abstract

Objective: To compare preference for long-acting contraception (LARC) and subsequent use, year-long continuation, and pregnancy among women after induced abortion who were and were not eligible to participate in a specialized funding program that provided LARC at no cost.

Methods: Between October 2014 and March 2016, we conducted a prospective study of abortion patients at Planned Parenthood in Austin, Texas (located in Travis County). We compared our primary outcome of interest, postabortion LARC use, among women who were eligible for the specialized funding program (low-income, uninsured, Travis County residents) and two groups who were ineligible (low-income, uninsured, non-Travis County residents, and higher income or insured women). Secondary outcomes of interest included preabortion preference for LARC and 1-year continuation and pregnancy rates among the three groups.

Results: Among 518 women, preabortion preference for LARC was high among all three groups (low-income eligible: 64% [91/143]; low-income ineligible: 44% [49/112]; and higher income 55% [146/263]). However, low-income eligible participants were more likely to receive LARC (65% [93/143] compared with 5% [6/112] and 24% [62/263], respectively, P<.05). Specifically, after adjusting for age, race-ethnicity, and education, low-income eligible participants had a 10-fold greater incidence of receiving postabortion LARC compared with low-income ineligible participants (incidence rate ratio 10.13, 95% confidence interval [CI] 4.68-21.91). Among low-income eligible and higher income women who received postabortion LARC, 1-year continuation was 90% (95% CI 82-97%) and 86% (95% CI 76-97%), respectively. One-year pregnancy risk was higher among low-income ineligible than low-income eligible women (hazard ratio 3.28, 95% CI 1.15-9.31).

Conclusion: Preference for postabortion LARC was high among all three eligibility groups, yet women with access to no-cost LARC were more likely to use and continue these methods. Low-income ineligible women were far more likely to use less effective contraception and become pregnant. Specialized funding programs can play an important role in immediate postabortion contraceptive provision, particularly in settings where state funding is limited.

Figure 1

Current contraceptive use at time of follow-up interview among post-abortion study participants by eligibility for LARC Access Program. Chi-squared tests of independence comparing eligibility groups at each interval were significantly different, P<.001. Completed interviews among nonpregnant, unsterilized women at 3–6 months included 78 low-income eligible, 68 low-income ineligible, and 161 higher-income participants. Completed interviews at 7–10 months included 99 low-income eligible, 66 low-income ineligible, and 192 higher-income participants. Completed interviews at 11–14 months included 101 low-income eligible, 63 low-income ineligible, and 189 higher-income participants. Sterilization was reported by 2 participants at 3–6 months, 3 participants at 7–10 months, and 7 participants at 11–14 months. “Less-effective methods” include barrier methods, withdrawal, spermicide, and fertility-awareness based methods. “Short-term hormonal methods” include oral contraceptive pills, transdermal patch, vaginal ring, and injection. LARC, long-acting reversible contraception.