Acceptance and continuation of long-acting reversible contraception following abortion among Indian women

Summary:  View help for Summary Background: There should be minimum six months interval between abortion and next conception. Post abortal long-acting reversible contraception (PALARC), intra-uterine contraceptive device (IUCD) or Depot medroxy-progesterone acetate (DMPA) injection are very effective in averting unwanted pregnancies during this interval. Aim: To assess acceptance of LARC as either PAIUCD or post abortal DMPA (PADMPA), demographic and obstetric factors affecting the choice of LARC and contraceptive continuation rate among the acceptors. Design and setting: Longitudinal, single hospital-based descriptive study. Methods: Women undergoing 1st or 2nd trimester abortion at the study site were eligible to participate. Women with molar pregnancy, septic abortions, contraindications to DMPA/IUCD and those opting for short-acting methods or sterilisation were excluded, remaining were counselled for LARC. Women accepting IUCD or DMPA were interviewed and then followed up for method continuation till 6 months. Results: Total 350 women were included in the study. There were 164 (46.9%) women who accepted LARC. Among them 96 (58.5%) accepted IUCD. Acceptance was associated with higher age, longer period of gestation, rural residence, higher number of pregnancies and previous operative delivery. Continuation rate was higher for IUCD at 94.8% as opposed to   44.1% for DMPA. Continuation depended on religion and method choice. Amenorrhea was the most important reason for discontinuation followed by husband’s disapproval. Conclusion: Nearly half of the study participants accepted PALARC with significantly higher continuation rate for IUCD after six months of insertion. Counselling for correct method choice and follow-up will enable women to continue their chosen method. SHORT CONDENSATION There were 46.9% women who accepted LARC after medical termination of pregnancy and 73.8% acceptors continued method. Acceptance and continuation were higher for IUCD compared to DMPA. Women with demographic and obstetric vulnerabilities were more likely to accept LARC while Muslim women were more likely to continue.  Making post- abortal LARC available and accessible, these women can control their fertility and avoid unwanted pregnancies.