Postabortion contraceptive uptake among vulnerable individuals in a New York City public hospital

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This article has been updated. A Correction to this article was published on .

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The Original Article was published on

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The Original Article was published on

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This article has been updated

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Abstract

Introduction Contraceptive provision at the time of abortion lowers rates of subsequent unplanned pregnancy but cost, method availability and other considerations impact decision-making. We examined factors associated with contraceptive preferences at the time of abortion in a US safety net hospital.

Methods This is a retrospective cohort study. We abstracted medical records for patients seen in the gynaecology clinic between April 2019 and June 2021 who received a medication or procedural abortion for an undesired pregnancy. We collected demographic and clinical data from the electronic medical record. We generated descriptive statistics using Stata V. 18 and used R to perform a latent class analysis to identify patterns of association with selected demographic variables and chosen contraceptive methods.

Results 638 met inclusion criteria. Latent group 1, which was largely Hispanic, on Medicaid, and/or undergoing medication abortion, most often chose the subdermal implant or pills. Latent group 2, which was largely nonHispanic and undergoing procedural abortion, most often chose a levonorgestrel intrauterine device (LNG IUD) or declined birth control. Nearly 80% initiated any contraceptive method, with over 20% choosing an LNGIUD and over 40% choosing any IUD or the subdermal implant. Contraceptive uptake was highest among Spanish-speaking individuals $(115/\mathrm{131,87.8}\mathrm{\%})$. Noninitiation occurred most frequently among individuals who did not have insurance/self-paid (24/72, 33.3%), spoke a language other than English or Spanish (8/27, 29.6%), or had a procedural abortion <14 weeks (38/171, 22.2%).

Conclusions Contraceptive uptake was high among abortion-seeking individuals. Further research can clarify how other factors impact decision-making and uptake among vulnerable populations.

Acknowledgements The authors would like to thank Dr Lauren Jacobowitz and Dr Gwendolyn Quinn for their assistance with this project.

Contributors A0 and SF contributed significantly to data analysis and manuscript writing/review. EF and BK were responsible for data abstraction, manuscript writing and review. SN is responsible for overall study design and oversight, as well as manuscript writing and review. She is the guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests SN is a Nexplanon trainer for Organon. The remaining authors have no competing interest/no conflict of interest.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication Not applicable.

Ethics approval The Institutional Review Board at New York University Grossman School of Medicine approved this study on 23 September 2021 (i21-01131). The Board granted a waiver of informed consent for this retrospective medical record review.

Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See https://creativecommons.org/licenses/by-nc/4.0/.

ORCID iD

Siripanth Nippita https://orcid.org/0000-0002-5862-5383

CHANGE HISTORY

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