Surgical abortion can provide an important opportunity to start contraception, but the most effective contraceptive methods are underused. Structural barriers, such as clinic flow, device stocking, and insurance reimbursement, have historically limited access to post-abortion long-acting reversible contraception (LARC), which includes the intrauterine device and the subdermal implant. In addition, patients may be poorly informed about the availability, safety, and effectiveness of LARC, and some women are not interested in learning about or receiving contraception on the day of abortion. Where previous studies have employed interventions at the time of the clinic visit, we tested an intervention that took place prior to the visit. We hypothesized that calling patients prior to the abortion appointment to inform them about contraceptive availability would improve their contraceptive awareness and knowledge at the time of abortion.
We performed a randomized controlled trial of a telephone intervention prior to the surgical abortion visit. Patients with an upcoming surgical abortion appointment were approached by telephone prior to their visit and invited to participate in the study. Enrolled subjects were randomized to the intervention message, a standardized notification about the safety, efficacy, and availability of LARC and short-acting contraception (SARC) on the day of the abortion, or to the control message, a reiteration of appointment logistics without information about contraception. At the abortion visit, participants completed a pre-procedure survey to assess knowledge of contraceptive availability, effectiveness, and safety, as well as acceptability of the intervention. Participants also completed a post-procedure survey to assess contraceptive decision-making autonomy. After discharge, we abstracted their ultimate contraceptive method from the medical record.
We enrolled 234 participants, with 117 in the intervention arm and 117 in the control arm.