Cost as a Determinant for Use of Highly Effective Reversible Contraception After Induced Abortion

Summary and Comment |
March 21, 2017

Cost as a Determinant for Use of Highly Effective Reversible Contraception After Induced Abortion

  1. Robert L. Barbieri, MD

Low-income women eligible for free HERC had the highest rates of HERC use and the lowest rates of pregnancy during the first year after an abortion.

  1. Robert L. Barbieri, MD

Increasing the uptake of highly effective reversible contraception (HERC; intrauterine devices or subdermal progestin implants) is our best hope for reducing the 50% unintended pregnancy rate in the U.S. In a prospective observational study of factors determining use of contraception following induced abortion, investigators studied 518 women who received abortions at Texas Planned Parenthood clinics: low-income women (household income <200% of federal poverty level) eligible for free contraception (Group 1); low-income women ineligible for free contraception (Group 2); and higher-income women (Group 3).

At study entry, most women reported a desire to use HERC after abortion. Following abortion, HERC was used by 65%, 5%, and 24% of women in Groups 1, 2, and 3, respectively. Among women who did not use HERC, the most commonly used contraceptives were pills (36%), condoms and/or emergency contraception (15%), or progestin injections (12%). Overall, >85% women who opted for HERC were still using this method 1 year after abortion. During the first postabortion year, pregnancy rates were 4%, 11%, and 7% in Groups 1, 2, and 3, respectively.

Comment

Many hurdles prevent women who would like to use HERC from receiving this form of contraception, including the high initial cost of the devices as well as access to clinicians with expertise in providing these contraceptives. Lowering the barriers to use of HERC is a high-priority intervention that will improve population health.

Editor Disclosures at Time of Publication

  • Disclosures for Robert L. Barbieri, MD at time of publication Editorial boards UpToDate (Editor-in-Chief, Obstetrics/Gynecology and Women’s Health); OBG Management (Editor-in-Chief)

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