P082Rural-urban differences in post-abortion contraception use and past contraceptive access: A cohort study of abortion patients in utah

Abstract

<h3>Objectives</h3> To evaluate the role of geography in post-abortion contraception choice and prior contraceptive barriers. <h3>Methods</h3> We recruited English- and Spanish-speaking abortion clients, aged 18–45, at a single facility in Salt Lake City, Utah. Participants enrolled between June 2021 and January 2022, and completed a baseline survey on the day of the abortion and a follow-up survey at three months. Rural-urban residence was determined using the Rural Urban Community Area (RUCA) classification system. We assessed demographic variables, method choice, and prior access barriers relative to geographic status. No-cost contraception was available for uninsured clients. <h3>Results</h3> We approached 779 clients and 527 (68%) completed the baseline survey (9.3% were rural). Rural clients were more likely to be multiparous and not in a committed relationship. Most participants (86.9%) planned to start a method after the abortion. Method choice was similar between groups, and long-acting reversible contraceptive (LARC) methods were most frequently selected (45.2% vs. 44.2%; p=0.62). Rural and urban clients reported similar rates of contraceptive access barriers in the past year (10.2% vs. 14.2%; p=0.52). Rural clients were more likely to report a >30-minute drive for contraception (15.4% vs. 9.2%; p=0.04), and higher rates of discomfort discussing contraception with local providers (30.4% vs. 10.9%; p=0.001). Regardless of residence, clients reporting prior difficulty accessing contraception (n=69) were more likely to select a LARC method (68.1% vs. 41.1%; p<0.01). <h3>Conclusions</h3> The contraceptive needs of rural and urban clients are similar; however, rural clients face unique barriers. The abortion visit is an important opportunity for care provision for clients with limited local access.