Acceptance and continuation of long-acting reversible contraception following abortion among Indian women

<b>Background</b><b>:</b> There should be minimum six months interval between
abortion and next conception. Post abortal long-acting reversible contraception
(PALARC), intra-uterine contraceptive device (IUCD) or Depot
medroxy-progesterone acetate (DMPA) injection are very effective in averting
unwanted pregnancies during this interval.

<b>Aim</b><b>:</b> To assess acceptance
of LARC as either PAIUCD or post abortal DMPA (PADMPA), demographic and
obstetric factors affecting the choice of LARC and contraceptive continuation
rate among the acceptors.

<b>Design and setting:</b>
Longitudinal, single hospital-based descriptive study.

<b>Methods:</b>
Women undergoing 1st or 2nd trimester abortion at the
study site were eligible to participate. Women with molar pregnancy, septic
abortions, contraindications to DMPA/IUCD and those opting for short-acting
methods or sterilisation were excluded, remaining were counselled for LARC.
Women accepting IUCD or DMPA were interviewed and then followed up for method
continuation till 6 months.

<b>Results:</b>
Total 350 women were included in the study. There were 164 (46.9%) women who
accepted LARC. Among them 96 (58.5%) accepted IUCD. Acceptance was associated
with higher age, longer period of gestation, rural residence, higher number of
pregnancies and previous operative delivery. Continuation rate was higher for
IUCD at 94.8% as opposed to 44.1% for
DMPA. Continuation depended on religion and method choice. Amenorrhea
was the most important reason for discontinuation followed by husband’s
disapproval.

<b>Conclusion:</b>
Nearly half of the study participants accepted PALARC with significantly higher
continuation rate for IUCD after six months of insertion. Counselling for
correct method choice and follow-up will enable women to continue their chosen
method.

<b>SHORT CONDENSATION</b>

There were 46.9% women who accepted LARC after medical
termination of pregnancy and 73.8% acceptors continued method. Acceptance and
continuation were higher for IUCD compared to DMPA. Women with demographic and
obstetric vulnerabilities were more likely to accept LARC while Muslim women
were more likely to continue. Making post-
abortal LARC available and accessible, these women can control their fertility
and avoid unwanted pregnancies.

背景：人工流产与下次妊娠之间的间隔应至少为六个月。流产后长效可逆避孕（Post abortal long-acting reversible contraception, PALARC）、宫内节育器（intra-uterine contraceptive device, IUCD）及醋酸甲羟孕酮避孕针（Depot medroxy-progesterone acetate, DMPA）在该间隔期内可有效避免非意愿妊娠。

研究目的：评估流产后宫内节育器（Post abortal intra-uterine contraceptive device, PAIUCD）或流产后醋酸甲羟孕酮避孕针（Post abortal Depot medroxy-progesterone acetate, PADMPA）形式的长效可逆避孕（long-acting reversible contraception, LARC）的接受度，分析影响长效可逆避孕选择的人口学与产科因素，以及受术者的避孕持续率。

研究设计与研究地点：本研究为单中心医院纵向描述性研究。

研究方法：本研究纳入研究地点内接受妊娠早期或妊娠中期人工流产的女性作为研究对象。排除葡萄胎妊娠、感染性流产、存在DMPA/IUCD使用禁忌证，以及选择短效避孕方法或绝育手术的女性；剩余受试者均接受长效可逆避孕咨询。对自愿选择IUCD或DMPA的女性进行访谈，并随访至术后6个月以观察避孕方法的持续使用情况。

研究结果：本研究共纳入350名女性，其中164名（46.9%）自愿接受长效可逆避孕。在接受LARC的受试者中，96名（58.5%）选择宫内节育器。LARC接受度与更高年龄、更长孕周、农村居住、更多妊娠次数及既往手术产史相关。宫内节育器的6个月持续使用率为94.8%，显著高于醋酸甲羟孕酮避孕针的44.1%。避孕持续情况与宗教信仰及避孕方法选择相关。闭经是最主要的避孕方法停用原因，其次为丈夫反对。

研究结论：近半数研究受试者接受了流产后长效可逆避孕，且宫内节育器在置入6个月后的持续使用率显著更高。通过针对避孕方法选择的正确咨询及随访，可帮助女性坚持使用自主选择的避孕方式。

简短总结：本研究中，46.9%的人工流产术后女性接受了长效可逆避孕，其中73.8%的受术者坚持使用所选避孕方法。与醋酸甲羟孕酮避孕针相比，宫内节育器的接受度与持续使用率均更高。存在人口学与产科高危因素的女性更倾向于接受长效可逆避孕，而穆斯林女性的避孕持续率更高。通过提供可及的流产后长效可逆避孕服务，女性可自主调控生育力，避免非意愿妊娠。