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  • Opt-in versus universal codeine provision for medical abortion up to 10 weeks of gestation at British Pregnancy Advisory Service: a cross-sectional evaluation

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Original research
Opt-in versus universal codeine provision for medical abortion up to 10 weeks of gestation at British Pregnancy Advisory Service: a cross-sectional evaluation
  1. Neda Taghinejadi1,
  2. Hannah McCulloch2,
  3. Michał Krassowski3,
  4. Amelia McInnes-Dean2,
  5. Katherine C Whitehouse2,
  6. Patricia A Lohr2
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
  3. 3 Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Neda Taghinejadi, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; neda.taghinejadi{at}conted.ox.ac.uk

Abstract

Objective To assess patient experiences of pain management during medical abortion up to 10 weeks’ gestation with opt-in versus universal codeine provision.

Methods We invited patients who underwent medical abortion up to 10 weeks of gestation to participate in an online, anonymous, English-language survey from November 2021 to March 2022. We performed ordinal regression analyses to compare satisfaction with pain management (5-point Likert scale) and maximum abortion pain score (11-point numerical rating scale) in the opt-in versus universal codeine provision groups.

Results Of 11 906 patients invited to participate, 1625 (13.6%) completed the survey. Participants reported a mean maximum pain score of 6.8±2.2. A total of 1149 participants (70.7%) reported using codeine for pain management during their abortion. Participants in the opt-in codeine provision group were significantly more likely to be satisfied with their pain management than those in the universal group (aOR 1.48, 95% CI 1.12 to 1.96, p<0.01). Maximum abortion pain scores were lower on average among the opt-in codeine provision group (OR 0.80, 95% CI 0.66 to 0.96, p=0.02); however, this association was not statistically significant in the model adjusted for covariates (aOR 0.85, 95% CI 0.70 to 1.03, p=0.09).

Conclusion Our findings suggest that patients have a better experience with pain management during medical abortion when able to opt-in to codeine provision following counselling versus receiving this medication routinely.

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. Requests should be submitted to research@bpas.org for consideration.

https://doi.org/10.1136/bmjsrh-2023-201893

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request. Requests should be submitted to research@bpas.org for consideration.

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    Footnotes

    • KCW and PAL are joint senior authors.

    • X @drnedatnejadi, @krassowski_m, @Lohrpa

    • Contributors PAL conceived of this evaluation and the project was designed by NT, KCW and PAL. Analysis was performed by MK with input from NT, HM and PAL. Recruitment was completed by HM and AM-D. The manuscript was led by NT with input from HM, KCW, MK, AM-D and PAL. PAL and NT are responsible for the overall content as guarantors.

    • Funding The authors have not declared a specific grant for this evaluation from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PAL is Medical Director of BPAS. KW is a paid consultant of Feral GMBH. The authors declare that they have no other known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Author note NT is a National Institute for Health Research Academic Clinical Fellow in Community Sexual and Reproductive Health and is supported by the Oxford University Clinical Academic Graduate School (OUCAGS), University of Oxford. MK has been supported by the Scatcherd European Scholarship.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.