1. CONTRACEPTION POST ABORTION

2. Some Statistics
39% of women who had an abortion in England and Wales in had one or more previous abortion
40% of pregnancies worldwide are unplanned (WHO)
A woman can ovulate as early as 8 days post abortion
90% of women ovulate within one month
Therefore post abortion contraception is a vital part of abortion provision and aftercare

3. Why so important? Highly motivated at this time
Known not to be pregnant
Currently accessing healthcare “captive audience”
Reduces chances of another unintended pregnancy
Chance to review contraceptive history, were they using any contraception at all? If so did it fail? If it failed why did it fail?

4. Methods of Contraception
Pills-OCP, POP
Patch-Evra
Ring-Nuvaring
Injection-Depo-provera
Implant-Implanon
IUD/IUS-Copper IUDs, Mirena, Kyleena, Jaydess
Barrier-Condoms, diaphragm
Sterilisation

5. Long Acting Reversible Contraception
Implant, IUD, IUS and injection
Abortion consultations are an ideal opportunity to promote LARC

6. Contraceptive method Earliest time post medical
ICGP Interim Guideline P26. Table 4: Contraception Methods and post-termination initiation timeframes
Contraceptive method Earliest time
post medical
of initiation Earliest time of initiation
termination post surgical termination
Combined hormonal contraception (pills, patch or ring)
Progesterone only pill
Subdermal implant
DPMA ( Depo-provera)
Condoms & spermicide
IUD/IUS
Day of mifepristone
As soon as intercourse resumes
Once expulsion has occurred
Immediately

7. Surgical Abortion All methods can be commenced on the same day
IUD/IUS-There is an increased risk of expulsion if fitted on the day of the surgical abortion 27.5% vs 4% if insertion delayed

8. Medical Abortion
All methods, exception IUD and IUS, can be started at the time of medical abortion ie same day as MIFE
Depoprovera MAY increase the incomplete abortion rate by 2.7%. However this was one small study, needs further research and should not prevent the use of depoprovera
Implanon can be fitted on the same day as Mifepristone

9. IUD/IUS
Cannot be fitted until confirmation that the abortion is complete
The 2 week check up is an ideal time to fit once low sensitivity pregnancy test is negative
Consider bridging

10. Conclusion
There are 2 if not 3 consultations in the process of an abortion
Each consultation should be an opportunity to promote contraception in particular LARC (Long acting reversible contraception)
Think CONTRACEPTION and think LARC