Long-acting reversible contraception (LARC)
take-up following termination of pregnancy.
A local audit
Kirkham, D1; Holt, E2; Agass, R3; Holland, C4;
1 Stockport NHS Foundation Trust, UK; 2 Royal Bolton NHS
Foundation Trust, UK; 3 Pennine Acute Hospital NHS Trust, UK;4 Salford Royal NHS Foundation Trust, UK
Objectives: Identify the percentage of women undergoing a
termination discharged with LARC, and factors inﬂuencing take-
Methods: Age, contraceptive history, parity, previous termination,
and discharge contraception were recorded for women attending a
termination clinic over two months. Ninety-nine cases were
Discharge contraception was discussed with 100% of cases;
92.9% made a contraception decision, 79.8% were discharged with
a chosen method, 13.1% were guided to a family planning centre,
7.8% declined contraception (condoms supplied), 59.6% were
discharged with LARC.
Relevance/Impact: Less than 10% of unintended pregnancies are
due to true contraception failure, 30–50% because no method was
used, the remainder due to incorrect/inconsistent use. In
unintended pregnancies 40.6% lead to termination of pregnancy
(TOP); 27–48% of all TOP are repeats. Women seeking TOP are
highly motivated to seek effective contraception. LARC methods
are not user-dependent, so are very effective. LARC is more cost-
effective than the combined oral contraceptive pill (COCP) after
just 1 year. A reduction in unwanted pregnancies and
terminations beneﬁts the physical/mental health of women and
the NHS ﬁnancially.
Outcomes speciﬁc patient groups may beneﬁt from targeted
counselling to increase uptake of LARC: (i) Patients conceiving
on the COCP (ii) 14–17 year olds (iii) Nulliparous women
(iv) Patients with previous terminations.
Discussion: Sixty-ﬁve percent of patients using no contraception
or condoms, and 75% of women aged 18–22 years old were
discharged with LARC. Only 32% of patients conceiving on the
COCP were discharged with LARC, and only 40% of 14–17 year
olds, with 53% being discharged on the COCP and one with
condoms. Forty-two percent of nulliparous women were
discharged with LARC. Patients with previous terminations were
no more likely to be discharged with LARC.