Objective: To study the effect of a public program providing long-acting reversible contraceptive (LARC) methods at no-cost on the risk of unintended pregnancy.
Methods: The City of Vantaa in the Helsinki metropolitan area (approximately 220,000 inhabitants) implemented a program entitling all women their first LARC method at no-cost in January 2013. During 20132014, altogether 9,685 women entitled to a no-cost LARC visited a public family planning clinic and 2,035 women initiated a no-cost LARC. Lacking data on intendedness of pregnancies, we used induced abortion as a proxy for unintended pregnancy. In this register based cohort study, we used Poisson regression to estimate the risk of abortion among women who chose a LARC method (no-cost group) and among women who visited the clinics, were entitled to a LARC but chose otherwise (visitor group), and in an age matched population cohort (1:4) consisting of non-sterilized women entitled to LARC method (n=36,399). The follow-up started on the date of LARC initiation (no-cost group), date of visit (visitor group) or at start of follow-up for the population controls. Follow-up ended at start of gestation, date of sterilization or move abroad, or on 31.5.2016.
Results: In the full model we adjusted for age, age2, previous pregnancies and abortions, and socioeconomic status. The Incidence Risk Ratio for abortion among women initiating no-cost LARC was 0.27 (95%CI 0.170.39) compared to the matched population control. The abortion rate among visitors did not differ from the population controls (IRR 1.09, CIs 0.951.25).
Conclusions: Among women seeking counseling on contraception, initiation of a LARC method is associated with a significantly lower need of subsequent abortion.