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Predicting poor compliance with follow-up and intrauterine contraception services after medical termination of pregnancy
  1. Elina Pohjoranta1,
  2. Maarit Mentula1,
  3. Satu P Suhonen2,
  4. Oskari Heikinheimo1
  1. 1 Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2 Centralised Family Planning, Department of Social Services and Health Care, Helsinki, Finland
  1. Correspondence to Professor Oskari Heikinheimo, Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, 00029-HUS, Finland; oskari.heikinheimo{at}helsinki.fi

Abstract

Background Attendance at post-abortion follow-up visits is poor, but little is known about factors affecting it.

Objective To assess the factors associated with non-compliance with post-abortion services and to evaluate differences in rates of attendance and intrauterine device (IUD) insertion according to the type of service provision.

Methods 605 women undergoing a first trimester medical termination of pregnancy (MTOP) and planning to use intrauterine contraception were randomised into two groups. Women in the intervention group (n=306) were booked to have IUD insertion 1–4 weeks after the MTOP at the hospital providing the abortion, while women in the control group (n=299) were advised to contact their primary healthcare (PHC) centre for follow-up and IUD insertion.

Results In the intervention group, 21 (6.9%) women failed to attend the follow-up visit, whereas in the control group 67 (22.4%) women did not contact the PHC to schedule a follow-up (p<0.001). In both groups, non-attendance was associated with history of previous pregnancy and abortion. Not having an IUD inserted within 3 months was significantly more common in the control group (73.6% (n=220)) than in the intervention group (9.2% (n=28), p<0.001). In the intervention group, predictive factors for not having an IUD inserted were anxiety, history of pregnancy and abortion. However, we identified no significant predictive factors in the control group.

Conclusions Factors predicting low compliance with post-MTOP follow-up are few. Comprehensive provision of abortion care and post-abortion services seems beneficial for minimising the loss to follow-up and delay in initiation of effective contraception.

Trial registration number NCT01223521; Results.

  • termination of pregnancy
  • intrauterine devices
  • compliance
  • follow-up

https://doi.org/10.1136/bmjsrh-2018-200098

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    Footnotes

    • Contributors All authors participated in the study design, data analysis and writing of the manuscript. EP wrote the first draft of the manuscript. EP, MM, SP, and OH organised the study, recruited and managed the patients. SPS and OH had overall responsibility, and obtained the necessary approvals and funding for the study.

    • Funding This study was supported by Helsinki University Central Hospital Research funds and by research grants provided by the Antti and Jenny Wihuri Foundation and the Yrjö Jahnsson Foundation. The intrauterine devices were provided by the City of Helsinki.

    • Competing interests OH has served on advisory boards for Bayer Healthcare, Gedeon Richter and Sandoz AG, and designed and lectured at educational events of these companies. SPS has served as an advisor for Exeltis and Gedeon Richter and lectured at educational events of Bayer. EP and MM have no conflicts of interest to declare.

    • Patient consent Obtained.

    • Ethics approval This study received approval from the ethics committee of the Hospital District of Helsinki and Uusimaa (HUS 260/13/03/03/2009 and §12/30.03.2010) and the City of Helsinki (10-1138/054). The trial was web-posted at www.clinicaltrials.gov [NCT01223521]).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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      British Medical Journal Publishing Group
      BMJ Sexual & Reproductive Health 2018; 44 233-234 Published Online First: 10 Oct 2018. doi: 10.1136/bmjsrh-2018-200213