Predictors of Less Effective Contraceptive Method Use at Twelve Weeks Post-Outpatient Abortion, Atlanta, Georgia Open Access

Abstract

Objective: Abortion clinic visits represent an important intervention point to prevent repeat unintended pregnancy. This study identifies factors associated with less effective contraceptive use 12 weeks post-abortion.

Methods: 114 women, aged 18 years or older, completed a baseline survey on the day of their elective 1^st or 2^nd trimester surgical abortion at the Atlanta Women's Center. 50 women (44%) completed an online follow-up survey 12 weeks later and were included in this analysis. Bivariate and multivariate logistic regression models assessed associations between demographic and reproductive health factors and use of less effective contraception (defined as no method, condoms, withdrawal, and natural rhythm methods) versus more effective contraception (defined as oral contraceptives, ring, patch, injectibles, IUD, implant, and sterilization) at follow-up.

Results: Most women (96%) reported resuming sexual activity at the time of follow-up. Seventeen women (34%) reported using less effective contraception, which was significantly associated with high school education or less (adjusted risk ratio, aRR= 2.80, 95% confidence interval (CI): 1.53 - 5.13) and not receiving a contraceptive method or prescription on the day of their abortion visit (aRR = 4.52, 95%CI: 1.55 - 13.19). The association between a history of prior abortion and less effective contraception trended toward significance (aRR=1.85, 95%CI: 0.91 - 3.78).

Conclusions: Over one third of women are at increased risk for unintentional pregnancy three months post-abortion due to less effective contraceptive use and resumed sexual activity. Education and abortion history may play an important role in more effective contraceptive use post-abortion. Immediate provision of contraceptives during the abortion visit is strongly associated with more effective contraceptive use following the procedure.

Table of Contents

Chapter I - Background/Literature Review

Unintended Pregnancy in the United States - 1

Trends in Contraceptive Use - 2

Abortion Incidence and Repeat Abortion - 3

The Importance of Post-Abortion Contraception - 4

Identifying Patients at the Highest Risk for Unintended Pregnancy - 6

Importance of this Research Study - 7

References - 8

Chapter II - Manuscript

A.Title, Authors, Abstract - 12

B.Introduction - 13

C.Methods - 15

D.Results - 17

E.Discussion - 19

F.Acknowledgements - 24

G.References - 25

H.Figures and Tables - 29

Chapter III - Summary, Public Health Implications, Possible Future Directions

Summary of Results - 34

Public Health Implications - 34

Possible Future Directions - 35

Appendices

Appendix 1 - Additional Tables - 37

Appendix 2 - In-clinic Survey Questions - 39

Appendix 3 - Follow-up Survey Questions - 52

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Abortion Contraception
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Committee Members	Haddad, Lisa, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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