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Contraceptive implants and injections linked to repeat abortions

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Women who use contraceptive implants or injections after an initial termination are among those with an increased likelihood of a repeat abortion in the long term, according to a large UK study.

The research found women who used either implants or the contraceptive injection Depo-Provera were more likely to have another abortion two to five years after the first termination, compared to those who used other methods.

“There is a need to identify women who are more likely to have repeat terminations and put in place targeted interventions”

Study authors

Long-acting reversible contraception such as implants and Depo-Provera are often promoted as contraceptive method of choice for women undergoing abortion.

While such methods are “effective”, “discontinuation rates are high, and therefore make terminations more likely”, said the study authors.

Reasons for discontinuation of implants and injectable contraceptive methods include side effects such as irregular bleeding, and the need for periodic replacement.

The authors called for careful contraceptive counselling that takes into consideration women’s views, and for continued follow-up, particularly after the initial two-year period.

“From a public health perspective there is a need to identify women who are more likely to have repeat terminations and put in place targeted interventions to prevent unplanned pregnancies,” said the researchers from the University of Aberdeen and NHS Grampian in the Journal of Family Planning and Reproductive Health Care.

They carried out a retrospective study using data on terminations in the NHS Grampian region between 1997 and 2003. Of the 13,621 women who had an initial termination, 23.4% went on to have a repeat abortion.

Results showed that women aged below 20 years at the initial termination had an estimated 5.59 times higher chance of having a repeat termination.

Women with two previous live births at the time of their initial termination had an estimated 1.51 higher likelihood of having a repeat termination compared to women with a single termination.

Meanwhile, women in the most socially deprived group had an estimated 1.23 higher chance of having a repeat termination when compared to those in the least deprived group.

Those with more than one termination were more likely to have had an implant as their post-termination contraceptive method.

In addition, women who were fitted with an implant after their initial termination had an estimated 1.78 times higher chance of a repeat termination, compared to those with no method, or unknown or natural methods of contraception two years after the initial termination.

The authors suggested “a targeted call/recall system of follow up in the community may be effective in reducing discontinuation rates”.

They also recommended that “downloadable mobile phone applications may play an important role in the future in reminding women that their contraceptive implant is due for renewal”.

 

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