Original Article

Contraception Initiation after Early Abortion in a Family Medicine Setting: A Retrospective Chart Review

Authors: Cresandra E. Corbin, MD, Anna Sliwowska, MD, Jeffrey P. Levine,MD, MPH, Samantha Stimmel, MD, Jennifer R. Amico, MD, MPH

Abstract

Objectives: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office.

Methods: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status.

Results: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%).

Conclusions: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.
Posted in: Family Planning & Reproductive Health13

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Jones RK, Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. Am J Public Health 2017;107:1904–1909.
 
2. Bennett IM, Baylson M, Kalkstein K, et al. Early abortion in family medicine: clinical outcomes. Ann Fam Med 2009;7:527–533.
 
3. National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of Abortion Care in the United States. Washington, DC: National Academies Press; 2018.
 
4. Yanow S. It is time to integrate abortion into primary care. Am J Public Health 2013;103:14–16.
 
5. Nothnagle M, Sicilia JM, Forman S, et al. Required procedural training in family medicine residency: a consensus statement. Fam Med 2008;40:248–252.
 
6. Kelly BF, Sicilia JM, Forman S, et al. Advanced procedural training in family medicine: a group consensus statement. Fam Med 2009;41:398–404.
 
7. Wu JP, Godfrey EM, Prine L, et al. Women’s satisfaction with abortion care in academic family medicine centers. Fam Med 2015;47:98–106.
 
8. Rubin SE, Godfrey E, Gold M. Patient attitudes toward early abortion services in the family medicine clinic. J Am Board Fam Med 2008;21:162–164.
 
9. Summit A, Casey LM, Bennett AH, et al. “I don’t want to go anywhere else”: patient experiences of abortion in family medicine. Fam Med 2016;48:30–34.
 
10. Godfrey EM, Rubin SE, Smith EJ, et al. Women’s preference for receiving abortion in primary care settings. J Womens Health (Larchmt) 2010;19:547–553.
 
11. Sweet E. Abortion services: a family doctor’s perspective. https://womensmediacenter.com/news-features/abortion-services-a-family-doctors-perspective. Published March 31, 2021. Accessed May 13, 2024.
 
12. Kavanaugh ML, Jones RK, Finer LB. How commonly do US abortion clinics offer contraceptive services? Contraception 2010;82:331–336.
 
13. Yassin AS, Cordwell D. Does dedicated pre-abortion contraception counselling help to improve post-abortion contraception uptake? J Fam Plann Reprod Health Care 2005;31:115–116.
 
14. Kavanaugh ML, Carlin EE, Jones RK. Patients’ attitudes and experiences related to receiving contraception during abortion care. Contraception 2011;84:585–593.
 
15. Brandi K, Woodhams E, White KO, et al. An exploration of perceived contraceptive coercion at the time of abortion. Contraception 2018;97:329–334.
 
16. Srinivasulu S, Maldonado L, Prine L, et al. Intention to provide abortion upon completing family medicine residency and subsequent abortion provision: a 5-year follow-up survey. Contraception 2019;100:188–192.
 
17. Winikoff B, Dzuba IG, Chong E, et al. Extending outpatient medical abortion services through 70 days of gestational age. Obstet Gynecol 2012; 120:1070–1076.
 
18. World Health Organization, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. Family planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration, 3rd ed. https://apps.who.int/iris/handle/10665/260156. Published 2018. Accessed May 13, 2024.
 
19. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(3):1–103.
 
20. US Census Bureau. QuickFacts: New Brunswick city, New Jersey. https://www.census.gov/quickfacts/newbrunswickcitynewjersey. Accessed March 17, 2022.
 
21. Gomez AM, Fuentes L, Allina A. Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods. Perspect Sex Reprod Health 2014;46:171–175. 
 
22. Schwei RJ, Kadunc K, Nguyen AL, et al. Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups. Patient Educ Couns 2014;96:333–338.
 
23. Patel P. Forced sterilization of women as discrimination. Public Health Rev 2017;38(1). Available from: http://dx.doi.org/10.1186/s40985-017-0060-9.
 
24. Owen C, Goldstein E, Clayton J, et al. Racial and ethnic health disparities in reproductive medicine: an evidence-based overview. Semin Reprod Med 2013;31:317–324.
 
25. Langston AM, Joslin-Roher SL, Westhoff CL. Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice. Contraception 2014;89:103–108.
 
26. Karlin J, Sarnaik S, Holt K, et al. Greasing the wheels: the impact of COVID19 on US physician attitudes and practices regarding medication abortion. Contraception 2021;104:289–295.
 
27. Raymond EG, Grossman D, Mark A, et al. Commentary. No-test medication abortion: a sample protocol for increasing access during a pandemic and beyond. Contraception 2020;101:361–366.
 
28. Kennedy CE, Yeh PT, Gaffield ML, et al. Self-administration of injectable contraception: a systematic review and meta-analysis. BMJ Glob Health 2019;4:e001350.
 
29. Curtis KM, Nguyen A, Reeves JA, et al. Update to U.S. selected practice recommendations for contraceptive use: self-administration of subcutaneous depot medroxyprogesterone acetate. MMWR Morb Mortal Wkly Rep 2021; 70:739–743.
 
30. Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and changes since 2008. https://www.guttmacher.org/sites/default/files/report_pdf/characteristics-us-abortion-patients-2014.pdf. Published May 2016. Accessed March 17, 2023.
 
31. Horn IG. Dobbs v. Jackson Women’s Health Organization 142 S. Ct. 2228 (2022). Ohio Northern University Law Rev 2023;49:7.
 
32. Committee opinion no. 642. Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2015; 126:e44–e48.