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

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

References

[1] Kost K, Zolna M, Murro R. Pregnancies in the United States by desire for pregnancy: Estimates for 2009, 2011, 2013, and 2015. Demography 2023; 60:837-63.

[2] Kost K, Maddow-Zimet I, Little AC. Pregnancies and pregnancy desires at the state level: estimates for 2017 and trends since 2012. 2021. Available: https://doi.org/10.1363/2021.33141

[3] Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion surveillance United States, 2018. MMWR Surveill Summ 2020; 69:1-29.

[4] Jones R, Jerman J, Ingerick M. Which abortion patients have had a prior abortion? Findings from the 2014 U.S. abortion patient survey. J Womens Health (Larchmt) 2018; 27:58-63.

[5] Schreiber CA, Sober S, Ratcliffe S, et al. Ovulation resumption after medical abortion with mifepristone and misoprostol. Contraception 2011; 84:230-3.

[6] Moslin TA, Rochat RW. Contraceptive use among clients of the Atlanta feminist women's health center at three to five weeks postabortion. Matern Child Health J 2011; 15:759-64.

[7] Langston AM, Joslin-Roher SL, Westhoff CL. Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice. Contraception 2014; 89:103-8.

[8] Pohjoranta E, Suhonen S, Gissler M, et al. Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial. Hum Reprod 2020; 35:796-804.

[9] Schmidt-Hansen M, Hawkins JE, Lord J, et al. Long-acting reversible contraception immediately after medical abortion: systematic review with meta-analyses. Hum Reprod Update 2020; 26:141-60.

[10] Access to Postabortion Contraception: ACOG Committee Opinion, Number 833. Obstet Gynecol 2021; 138:e91-5.

[11] Becker D, Tsui AO. Reproductive health service preferences and perceptions of quality among low-income women: racial, ethnic and language group differences. Perspect Sex Reprod Health 2008; 40:202-11.

[12] White K, Portz KJ, Whitfield S, et al. Women's postabortion contraceptive preferences and access to family planning services in Mississippi. Womens Health Issues 2020; 30:176-83.

[13] Cannon R, White K, Seifert B, et al. Exploring the physician's role in contraceptive counseling at the time of abortion in the US. Contraception 2021; 103:316-21.

[14] Krashin JW, Stuart GS, Garrett J, et al. Contraception insurance coverage and receipt of long-acting reversible contraception or Depot Medroxyprogesterone Acetate on the day of abortion. Obstetrics & Gynecology 2017; 130:109-17.

[15] Rocca CH, Goodman S, Grossman D, et al. Contraception after medication abortion in the United States: results from a cluster randomized trial. Am J Obstet Gynecol 2018; 218:107.

[16] Fuerst M, Mandelbaum A, Nacev E, et al. Trends in interstate abortion travel to Oregon following the Dobbs court decision. Contraception 2024;138.

[17] Mandelbaum AD, Nacev EC, Fuerst MF, et al. Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon. Contraception 2024;136.

[18] Rader B, Upadhyay UD, Sehgal NKR, et al. Estimated travel time and spatial access to abortion facilities in the US before and after the Dobbs v Jackson women's health decision. JAMA 2022; 328:2041-7.

[19] Toor OL Brian Broderick and Skye. How far americans live from the closest hospital differs by community type. Pew Research Center; 2018. Available: https://www.pewresearch.org/short-reads/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/ [Accessed 13 Oct 2025].

[20] Biggs MA, Taylor D, Upadhyay UD. Role of insurance coverage in contraceptive use after abortion. Obstet Gynecol 2017; 130:1338-46.

[21] Roe AH, Fortin J, Janiak E, et al. Prevalence and predictors of initiation of intrauterine devices and subdermal implants immediately after surgical abortion. Contraception 2019; 100:89-95.

[22] Fang NZ, Sheeder J, Teal SB. Factors associated with initiating long-acting reversible contraception immediately after first-trimester abortion. Contraception 2018; 98:292-5.

[23] Upadhyay UD, Johns NE, Meckstroth KR, et al. Distance traveled for an abortion and source of care after abortion. Obstet Gynecol 2017; 130:616-24.

[24] Goyal V, Canfield C, Aiken ARA, et al. Postabortion contraceptive use and continuation when long-acting reversible contraception is free. Obstet Gynecol 2017; 129:655-62.