Contraceptive intent among elective abortion patients
Abortion, Contraception
Awarded 2013
Complex Family Planning Fellowship Research
Natalie Whaley, MD
Johns Hopkins University

Women who present for an elective abortion represent a population that is at risk for unintended pregnancy, and their contact with the health care system may seem an ideal time to discuss and provide contraception. Despite the fact that 90-95% of women receive a form of contraception at the time of an abortion, approximately half of the 1.2 million abortions performed annually in the United States are repeat procedures.  The reasons women discontinue various types of birth control has been well studied, with evidence that at six months, approximately 50% of women have discontinued their contraceptive method. However, little research has examined the effect of the patient’s intent or desire to use contraception on their continuation rates.
This goal of this research project was to identify the reasons that women presenting for abortion decline contraception and to study the relationship between the intent or desire to start contraception after an abortion and the subsequent continuation rates months after an abortion.  Women were recruited to participate in this research project when they presented for elective abortions.  Women who agreed to participate answered a short survey that included questions about their pregnancy history, past use of birth control and willingness to discuss or start contraception at the time of their abortion.  Study participants agreed to be contacted at 1 month and 4 months after their abortion procedure and answer questions about what birth control method they were using. Also, participants were asked to complete a qualitative semi-structured interview which asked more in-depth questions about previous birth control use, knowledge and attitudes about pregnancy and birth control. The intention of the interviews was to conduct an equal number of interviews with patients who intended and also those that did not intend to use birth control after their elective abortion procedures in order to compare both groups of patients. However, since we did not find that many of our patients did not intend to use birth control, all 17 of the interviews conducted were with patients who intended to use birth control.
Other studies have found that one-third of women who present for abortions are not interested in birth control. The findings from this study contradict this and of the 144 women who agreed to participate in this study, 137 stated they were interested in starting birth control.  Reasons for this difference include: a difference in the patients who present for abortion care at our clinic, the unwillingness of patients to admit they are not interested in birth control when they present to an abortion appointment because it may be viewed as an “incorrect” answer and the impact of asking patients about birth control in a research setting. Because there were only a few women who did not intend to start birth control after their abortion in our study, we were unable to draw statistically meaningful conclusions about this population.  Rather, as we continue to analyze the data, we will explore factors that impact decisions about birth control and continuation of birth control for women after abortion. 
The relevance of this study is that identifying and understanding women who decline birth control after an abortion continues to be a challenge.