Elsevier

Contraception

Volume 85, Issue 1, January 2012, Pages 51-55
Contraception

Original research article
Preventing repeat abortion in Canada: is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions?

https://doi.org/10.1016/j.contraception.2011.05.002Get rights and content

Abstract

Background

In 2005, 97,254 abortions were performed in Canada, of which 38% were repeat abortions. The objective of this research was to determine if provision of free intrauterine devices (IUDs) postabortion is associated with a reduction in health-care costs and repeat abortions in a Canadian population compared with provision of oral contraceptives (OCPs) or depo-medroxyprogesterone acetate (DMPA).

Study Design

A retrospective cohort study was conducted by intention-to-treat chart review in a facility providing the majority of abortions in a Canadian health region. All (n=1782) residents of this region who underwent abortion in 2003, 2004 and 2008 were included. One- and 5-year rates of repeat abortion were calculated, and a cost-effectiveness analysis was conducted to compare health-care system costs of providing patients with IUDs, OCPs or DMPA and subsequent repeat abortions.

Results

In 2003 and 2004, 1101 index abortions occurred. The main contraceptive cohorts were immediate IUD insertion (n=117, 10.6%), immediate OCP (n=413, 37.5%) and immediate DMPA administration (n=357, 32.4%). After 5 years repeat abortion rates in the respective cohorts were: IUD, 9.4%, OCP, 17.4%, DMPA, 16.2% (p=.05). One-year rates of repeat abortion were not significantly different. Costs of providing contraception and subsequent abortions over 5 years were $142.63 (IUD), $385.61 (OCP) and $384.81 (DMPA) per user.

Conclusion

The immediate insertion of IUDs postabortion is associated with a lower 5-year rate of repeat abortion than provision of OCPs or DMPA. A cost reduction to the health-care system occurs when providing IUDs postabortion vs. alternate contraception of equivalent duration.

Introduction

In 2005, 97,254 abortions were performed in Canada [1], 38% of which were repeat abortions [2]. Canadian women requiring repeat abortion have increased risk for sexually transmitted infections and intimate partner violence [3]. Further, women have increased rates of unintended pregnancy when exposed to both intimate partner reproductive control and violence [4], and disadvantaged women experience higher rates of unintended pregnancy than more affluent women [5]. Immediate insertion of intrauterine devices (IUDs) is known to be highly effective [6], [7], [8], safe [9], [10] and desirable [11] as postabortion contraception. Previous studies seeking to determine the effect of immediate IUD insertion on repeat abortion rates have been carried out in large urban settings where women have multiple options for abortion care facilities. Thus, the rates of repeat visit to the index facility may be less than ideally indicative of a true rate of repeat abortion.

We focused our research on women seeking abortions within a Canadian health region where a single clinic primarily provides the abortion services for a region with several hundred thousand residents. As a result, women are more likely to return to this clinic for subsequent abortions in the event of a repeat unintended pregnancy. We aimed to demonstrate rates of repeat abortion in a Canadian population categorized by initial choice of contraception postabortion and to determine cost-effectiveness from the health system perspective for the provision of free copper IUDs postabortion. The intention of this analysis is to inform health system decision makers of possible benefits accrued by the immediate provision of long-acting reversible contraception following abortion.

Section snippets

Setting, participants and outcomes

A retrospective observational cohort study examined all abortions performed at the sole abortion clinic in the health region from January 1, 2003, to December 31, 2004, and January 1, 2008, to December 31, 2008, on residents of the same health region.

Data were collected on an intention-to-treat basis for five groups by choice of postabortion contraception: (1) immediate insertion of a copper IUD (Flexi-T 300; Prosan), (2) immediate supply of oral contraceptive pills (OCPs), (3) immediate

Results

In 2003 and 2004, 1101 residents of this health region underwent abortions at the clinic and 681 residents underwent abortions in 2008. Women choosing IUDs in 2003–2004 were older and with higher parity than those choosing OCPs, and this difference declined in the 2008 cohort (Table 2, Table 3).

To compare demographics between the 2003–2004 and the 2008 cohorts, p values were obtained for each demographic variable. No significant differences were observed between subjects in these groups when

Discussion

Data obtained from the 2003–2004 and 2008 groups are comparable in terms of most patient demographics. However, the statistically significant difference in mean maternal age is a potential confounder. The increase between the two study periods in mean gestational age is related to an increased wait time from initial contact to request an appointment to the admission for receiving abortion care.

The decreased mean maternal age of women selecting IUDs postabortion between the 2003–2004 and 2008

Acknowledgments

The authors would like to thank Jonathan Berkowitz for his support in statistical analyses. Additionally, we are grateful for the many hours of assistance in data collection by A.G.

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  • Trends and determinants of postabortion contraception use in a Canadian retrospective cohort

    2019, Contraception
    Citation Excerpt :

    IUD increased throughout the duration of the study period. In comparison to OCP and DMPA, IUD users had approximately half the odds of having a subsequent abortion at 1 or 5 years after the index abortion, confirming the results of the previous study [5]. These results also agree with studies performed in the United States, Finland, Sweden and New Zealand, which found that IUDs are significantly more effective at reducing subsequent abortions than OCP [4,6–9].

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Sources of funding: The authors gratefully acknowledge the British Columbia College of Family Physicians’ Research Award and the College of Family Physicians of Canada Research and Education Foundation. We extend our thanks to the Federation of Medical Women of Canada for awarding the Margaret Owens-Waite Memorial Fund in support of presenting this research.

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