Long-acting contraception linked to fewer repeat abortions

Women who use long-acting reversible contraception (LARC), especially intrauterine devices (IUDs), are significantly less likely have a repeat abortion, New Zealand researchers report.

Their prospective cohort study at a public hospital abortion clinic in New Zealand examined repeat abortion rates at 24-month follow-up among 510 women who had been offered a choice of contraceptives free of charge after an initial abortion, then were contacted 6 months later to find out what kind of birth control, if any, they used. The overall repeat abortion rate at 2 years was 9.61%. Women using LARC methods (IUD and depo medroxyprogesterone acetate [DMPA]), had significantly lower return rates (6.45%) than women who didn’t use LARC (14.5%). The repeat abortion rate was 13% for women taking oral contraceptives and 17% for women whose partners used condoms. Researchers found a significant correlation between the postabortion contraceptive method used and the likelihood of another abortion after controlling for major demographic factors and previous pregnancy history. The study was published online July 11 in the American Journal of Obstetrics and Gynecology.

“This study provides strong support for promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion,” the authors write. “Significantly fewer women who chose an intrauterine method for postabortion use had returned for a subsequent abortion within the 24-month follow-up period.” DMPA also reduced the probability of return, but not significantly.

The researchers urge greater efforts to increase availability of and access to LARC methods for women seeking abortion and the general population. They note that “in the United States, widespread access to IUDs has been hampered by barriers including costs, lack of provider training, and misconceptions held by both patients and providers.”

The investigators also advocate further research into ways to improve retention of LARC methods beyond the 3- to 6-month period typically required for side effects, particularly changes in menstrual bleeding, to resolve. 

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