Eighteen million reproductive aged women living in rural America experience marked access limitations to contraceptive services. Rural U.S. counties also lack abortion clinics, and patients must travel to larger communities for care. Provision of affordable post-abortion contraception, particularly LARC methods, may fill a crucial service gap for rural patients but is challenging to implement due to cost and Title X or insurance restrictions. Though limited data suggest that rural patients may be more likely to select immediate post-abortion LARC over a short-acting method, the patterns of post-abortion contraceptive use and contraceptive decision making in this population are inadequately explored.

Our overall objective is to explore geographic disparities in contraceptive method choice and decision making immediately after abortion. We hypothesize that rural dwelling patients are more likely than their urban dwelling peers to select LARC methods after abortion as a result of limited local access. We will draw on existing contraceptive use data in our population in addition to collecting novel survey data through a prospective cohort study in order to accomplish the following aims:

• Describe prior contraceptive use and immediate post-abortion contraceptive choice in rural versus urban dwelling patients
• Determine the role of geographic barriers in post-abortion contraceptive decision making
• Explore geographic disparities in post-abortion contraception method continuation and satisfaction

Identifying rural contraceptive needs and barriers to care lays the foundation for development of methods to improve both post-abortion and routine contraceptive service delivery to ensure equitable access for all communities.