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About half of the 1.3 million U.S. women who undergo abortions each year have had previous abortions. Researchers examined whether minimizing barriers to use of intrauterine devices (IUDs) augmented their use and, in another study, whether IUD insertion immediately following surgical abortion diminished risk for subsequent abortions.
During a 14-month period, clinicians in a Northern California Planned Parenthood agency were trained and authorized to insert IUDs immediately after abortions in eligible women. For the next 6 months, the agency also simplified its patient screening criteria, which allowed eligible women (key contraindications summarized in Table 1) to have IUDs inserted on the same day that they were screened (i.e., without waiting for culture results).
Women who tested positive for chlamydia or gonorrhea were recalled and treated according to current CDC guidelines. During the 20 months encompassing these procedural changes, 2172 IUDs (679 postabortion) were inserted; the insertion rate thus rose from 28 monthly during the 16-month control period that preceded the interventions to 122 monthly during the final 6 months of the study. At a similar agency that did not allow immediate postabortion or same-day IUD insertions, IUD insertion rates did not rise appreciably during the same time interval. IUD-associated complications (expulsion, infection, failure, displaced strings, syncope, and pain) were uncommon, with no significant differences in rate between the pre- and postintervention periods.
In a second study by the same group, the repeat abortion rate in 673 women who had IUDs inserted on the day of their abortions was compared with that in 1346 women who chose other contraceptive methods after their abortions (non-IUD group). Throughout the study period, and during the 14 months after the end of study enrollment, 41 (6%) of those women who chose IUDs and 206 (15%) of those who did not choose IUDs underwent repeat abortions at eight area agency clinics. No reported pregnancies occurred in women who had IUDs in place. Twelve of the repeat abortions in the IUD cohort took place after known voluntary IUD removals. Overall, the IUD cohort had a significantly lower repeat abortion rate than did the non-IUD group (35 vs. 91 per 1000 woman-years of use).
Goodman S et al. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception 2008 Aug; 78:136.
Goodman S et al. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception 2008 Aug; 78:143.
Comment
Providing immediate postabortion — or, more relevant for most clinicians, day-of-service — IUD insertions for eligible women had no serious adverse effects in this study and substantially lessened the likelihood of repeat abortions. Some populations, notably adolescents, can be difficult to recall for treatment when tests for sexually transmitted infections are positive; this situation is worth considering if same-day IUD insertions are offered. In their own practices, clinicians might want to consider lowering barriers to use of this highly effective, long-acting, reversible contraceptive method, which requires only one-time action by the user.