Contraception before and after abortion: what do women seek? – experience of an abortion referral centrecentre in Lisboa, Portugal.
Catarina Reis Carvalho, Joaquim Neves, Raquel Gonçalves, Carlos Calhaz-Jorge
Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
Introdution: Abortion by women’s request is one of the most commonly performed procedures in the world. The objective of this study was therefore to assess the choice of contraceptive method after abortion and the factors that may determine this choice.
Methods: This was a retrospective cohort study based on a medical record review at one hospital in Portugal. We included 613 women who had an abortion in January 2015- March 2016. We conducted associations between age, number of previous abortions, educational status and receipt of contraception at the time of abortion.
Results: Among the women included, the average age was 28 years (13-47), 47.3% nulliparous and 10.2% unemployed. Concerning obstetric history, 41.4% had a previous, voluntary abortion (1-8) with18.6% within the last five years. Previous to the abortion, 20.1 % had no contraception, 1.8% used natural methods, 22.2% barrier methods and 36.4% oral contraceptives. When asked, 76% knew why the previous method failed, identifying the main cause as forgetfulness in taking oral contraceptives followed by voluntary suspension of the method. After the abortion, 19.2 % had no review consultation or refused counselling, without getting contraception or adopting their previous method, 14.9% preferred oral contraceptives and the majority (51%) chose long-acting reversible contraceptives (LARC). Women with a previous history of abortions seem to adhere less to later contraception and prefer oral contraceptives while the others prefer LARC (p=0.003). We found no association between age and educational status and contraceptive choice (p=1.12, p=0,67).
Conclusions: Despite high access to contraceptive services, subsequent voluntary abortions are a reality. Education on contraception is an essential element of high-quality abortion care. Choosing LARC was popular for these women. A major limitation of this study is the short follow-up of the women. More studies are needed.