Long-Acting Reversible Contraceptive Uptake Post-Termination of Pregnancy
ESC Congress Library. Smith A. May 28, 2014; 50582; A-167
Dr. Amy Smith
Dr. Amy Smith
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Abstract
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Introduction


Long-acting reversible contraception (LARC) can reduce unwanted pregnancies. Within our Fertility Control Unit we have a family planning nurse who discusses previous and future contraception with all women independent from termination of pregnancy (TOP) consultation. This minimises risk of coercion and promotes objectivity.


Objective


Review of LARC uptake in a Fertility Control Unit at a district general hospital. 


Method


Five year retrospective review of 2019 terminations


Results


Mean age of 24.7 years (range 13 to 46 years). Under 16 years of age accounted for 2.9%. Majority (88%) were between 20 and 35 years.


Thirty percent had undergone one or more terminations prior to presentation. Only 5% of the total had undergone previous TOP at our hospital.


Prior to index pregnancy, most women <16 years of age had not been on a form of contraception and 40% claimed to use sheaths. Oral contraceptive pill (OCP) was used by 8.5% however, 3.4% admitted to poor compliance with pill intake. One patient had an Implanon device.


Majority of 16-19 year olds used no contraception or sheath only (39.6% and 34.5%, respectively). A total of 20.9% used OCP with 6.4% poor compliance. Seven used a LARC.


In 20-35 year olds, 40.9% had unprotected intercourse and 30.9% claimed to use the sheath. The OCP was taken by 23.1% with 4.8% declaring poor compliance. Fourteen patients had LARC.


Amongst the >35 group, 42.5% had no contraception and 34.7% claimed to use the sheath. Thirteen percent used OCP and 2.4% had poor compliance. Five patients had LARC.


Following termination, LARC update was 62.7%, 53.5%, 57.1% and 47.3% for <16, 16-19, 20-35 and >35 years, respectively. In addition, 4.5% of 20-35 and 16.2% of >35 years opted for permanent contraception. Amongst women <16 years, 81% of LARC users chose the contraceptive implant versus 17.7% of >35. Intrauterine contraception was chosen by 2.7% versus 65.8% in these same age groups respectively.


After TOP 15.3%, 12.3%, 13.0% and 14.4% of women in each increasing age group elected for non-reliable methods (no contraception, sheath, abstinence and undecided)


Conclusion


The presence of a Family Planning Nurse to discuss contraception prior to TOP consultation reduces the number of women attending for repeat termination. Uptake of LARC following termination is good, although significant improvement could be made. An area of particular concern is the proportion of women leaving the Fertility Control Unit without a reliable method of future contraception.

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