Debbie Postlethwaite1, Justine Lee2, Maqdooda Merchant3, Amy Alabaster4, Tina Raine-Bennett5. 1. Clinician Researcher and the Assistant Director of the Biostatistical Consulting Unit within the Division of Research in Oakland, CA (debbie.a.postlethwaite@kp.org). 2. Ob/Gyn at the Vallejo Medical Center in CA (justine.w.lee@kp.org). 3. Group Leader with the Division of Research Biostatistical Consulting Unit in Oakland, CA (maqdooda.merchant@kp.org). 4. Senior Consulting Data Analyst with the Division of Research Biostatistical Consulting Unit in Oakland, CA (amy.alabaster@kp.org). 5. Research Director of the Women's Health Research Institute at the Division of Research in Oakland, CA (tina.r.raine-bennett@kp.org).
Abstract
CONTEXT: Optimizing access to effective contraception at the time of abortion can reduce repeated unintended pregnancies. OBJECTIVE: To assess contraception initiation and repeated unintended pregnancies among women receiving abortions in Kaiser Permanente Northern California (KPNC) facilities and through outside contracted facilities. DESIGN: A retrospective cohort study was conducted using a randomized proportional sample of women aged 15 to 44 years having abortions in KPNC, to determine contraception initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, contraceptive method initiated, and pregnancies within 12 months) were collected from electronic health records. Descriptive statistics, χ2 tests, t-tests, and logistic regression models assessed predictors of long-acting reversible contraception (LARC) initiation and having another unintended pregnancy within 12 months of abortion. RESULTS: Women having abortions from contracted facilities were significantly less likely to initiate LARC within 90 days compared with those receiving abortions in KPNC facilities (11.99% vs 19.10%, p = 0.012). Significant factors associated with 90-day LARC initiation included abortions in KPNC facilities (adjusted odds ratio [aOR] = 1.87, p = 0.007) and gravidity of 3 or more. Women initiating short-acting or no contraception were significantly more likely to have an unintended pregnancy within 12 months of the abortion than those initiating LARC (aOR = 3.66, p = 0.005; no contraception vs LARC, aOR = 3.75, p = 0.005). CONCLUSION: In response to this study, KPNC now provides reimbursement for LARC in all outside abortion contracts, internalized more abortions in KPNC facilities, and strengthened clinical recommendations for immediate, effective postabortion contraception, especially LARC.
CONTEXT: Optimizing access to effective contraception at the time of abortion can reduce repeated unintended pregnancies. OBJECTIVE: To assess contraception initiation and repeated unintended pregnancies among women receiving abortions in Kaiser Permanente Northern California (KPNC) facilities and through outside contracted facilities. DESIGN: A retrospective cohort study was conducted using a randomized proportional sample of women aged 15 to 44 years having abortions in KPNC, to determine contraception initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, contraceptive method initiated, and pregnancies within 12 months) were collected from electronic health records. Descriptive statistics, χ2 tests, t-tests, and logistic regression models assessed predictors of long-acting reversible contraception (LARC) initiation and having another unintended pregnancy within 12 months of abortion. RESULTS:Women having abortions from contracted facilities were significantly less likely to initiate LARC within 90 days compared with those receiving abortions in KPNC facilities (11.99% vs 19.10%, p = 0.012). Significant factors associated with 90-day LARC initiation included abortions in KPNC facilities (adjusted odds ratio [aOR] = 1.87, p = 0.007) and gravidity of 3 or more. Women initiating short-acting or no contraception were significantly more likely to have an unintended pregnancy within 12 months of the abortion than those initiating LARC (aOR = 3.66, p = 0.005; no contraception vs LARC, aOR = 3.75, p = 0.005). CONCLUSION: In response to this study, KPNC now provides reimbursement for LARC in all outside abortion contracts, internalized more abortions in KPNC facilities, and strengthened clinical recommendations for immediate, effective postabortion contraception, especially LARC.
Authors: Heather L Hohmann; Matthew F Reeves; Beatrice A Chen; Lisa K Perriera; Jennifer L Hayes; Mitchell D Creinin Journal: Contraception Date: 2011-09-13 Impact factor: 3.375
Authors: Ann M Stanek; Paula H Bednarek; Mark D Nichols; Jeffrey T Jensen; Alison B Edelman Journal: Contraception Date: 2008-10-22 Impact factor: 3.375
Authors: Suzan Goodman; Sarah K Hendlish; Courtney Benedict; Matthew F Reeves; Madeline Pera-Floyd; Anne Foster-Rosales Journal: Contraception Date: 2008-06-18 Impact factor: 3.375