Does Immediate Post-abortion Long-Acting Reversible Contraception Reduce Rates of Repeat Abortion? [14I

Abstract

INTRODUCTION: Despite overall declining abortion rates in the US, rates of repeat abortion remain high, and previous unplanned pregnancy or elective abortion are significant risk factors for future abortions. This research aims to examine whether immediate no-cost post-abortion placement of long-acting reversible contraception (LARC) is associated with decreased chance of having a repeat abortion, compared to similar patients who did not opt for immediate LARC. METHODS: We conducted a retrospective cohort study using records from an abortion provider where no-cost post-abortion LARC devices were available to patients. We reviewed surgical abortions between September 2015 and February 2016 (LARC cohort, n=117; no-LARC cohort, n=154), and assessed the rate at which they returned for repeat abortion at the same facility within 3 years. This study was approved by Cleveland Clinic IRB. RESULTS: During the 3-year rolling follow-up period, for the LARC group there were 15 patients (12.8%) returning for a total of 20 abortions, compared with the no-LARC group, who had 50 patients (32.5%) return for a total of 86 abortions. The relative risk of any repeat abortion within 3 years was 0.39 for the LARC group (95% CI 0.24–0.67). CONCLUSION: Immediate post-abortion LARC is associated with significantly lower rate of repeat abortion within the next 3 years. Immediate post-abortion LARC should be offered to all patients undergoing elective surgical abortion. These findings should be used to inform healthcare policy, with a goal of reducing rates of repeat elective abortion.