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Need for better indicators of contraception after abortion
  1. Chris Smith1,2
  1. 1 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
  2. 2 Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Chris Smith, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan; christopher.smith{at}

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I completely agree with points made by Kelly Blanchard that contraception after medication abortion should be determined by convenience and choice.1 It is important to provide information on contraception at the time when women are seeking medication abortion care, but acknowledge that people may wish to delay decision-making or starting a method for various reasons.

This accords with our formative research to develop an intervention for post-abortion contraception in Cambodia where women reported wanting to discuss this with their husband or partner, or wait until the abortion was complete, before deciding to start a method.2 Such reports have led to the development of interventions to support contraception use after abortion or menstrual regulation over extended periods, with effective contraception use as the primary outcome.3 4

However, an important issue is raised regarding indicators of post-abortion contraception use. Indicators that focus on the proportion of people leaving the service with a method or starting a method within a specific period of time are common health service indicators and study outcome measures, but as mentioned, may undermine autonomy and real choice.

I would be interested in any thoughts on what might be suitable indicators to measure the quality of post-abortion contraception provision, and how to incentivise healthcare workers to provide information on contraception methods without coercing people into starting a method in order to hit a target.



  • Competing interests None declared.

  • Patient consent Not required.

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