Contraception satisfaction and effectiveness post abortion: A randomized controlled trial
Awarded 2010
Large Research Grants
Wendy V. Norman, MD, MHSc
University of British Columbia

Background: In Canada, 35.5% of all induced abortions are repeat abortions. To prevent recurrent unintended pregnancy, our service offers a copper intrauterine device (IUD), placed at the time of first trimester abortion. Our six year retrospective review indicated higher than expected one and five year repeat abortion rates among women with an IUD placed at abortion. This prospective randomized controlled trial examined satisfaction and effectiveness of post abortion contraception by comparing the two types of copper IUDs currently available in Canada – Flexi-T380+ and Nova-T200, and including a non intervention group of other contraceptive options. This is the first prospective study comparing expulsion for these devices. Hypotheses: We hypothesize: (1) Recurrent abortion in women who choose to have an IUD placed at the time of abortion is directly related to expulsion of the device rather than voluntary removal or device failure; (2) Expulsion rates vary between copper IUDs currently available in Canada; and (3) Women who choose to have IUDs inserted immediately post-abortion have the highest rate of satisfaction and the lowest rate of repeat pregnancy when compared to other methods. Methods: Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation were randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380+ or a Nova-T200 IUD. The primary outcome measure is IUD expulsion rate at one year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, were included for comparison of secondary outcomes. Contraception satisfaction questionnaires and clinical records were used to access primary and secondary outcomes. One and five year pregnancy rates will be analyzed subsequent to this study, using access to government-linked health administrative databases. Results: Participants were recruited October 5, 2010 to August 28, 2012. Among 1103 women assessed, 959 (86.9%) met eligibility criteria and among these 534 (55.7%) consented to participate. Women who chose to use an IUD (n=406) were randomly assigned into the two intervention groups, while those who chose to use other contraceptive methods (n=128) were enrolled into the control group. Participants were contacted to complete Contraception Satisfaction Questionnaires (CSQ) at intake, three months, six months and one year after enrollment. The response rates were 31.8%, 26.0% and 32.4%, respectively. Two clinic chart reviews were conducted in 2012 and 2013 at the study clinic as well as all the other provincial abortion clinics in BC to capture any post-abortion visit related to primary and secondary outcome data. The analysis of data collected through CSQ and clinical records is being undertaken. Additionally, we have received permission to obtain linkage to the provincial health administrative databases to assess primary and secondary outcomes, and expect access to this data near the end of 2013. Study findings are expected to be available in Spring 2014. Discussion: This study offers a unique opportunity to compare the effectiveness of post abortion contraceptive methods currently available in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at one year post-abortion for women choosing a range of post-abortion contraceptive options.