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.

<b>背景</b><b>:</b> 流产与后续妊娠之间应至少间隔六个月。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）在此间隔期内可有效避免非意愿妊娠。

<b>目的</b><b>:</b> 评估流产后宫内节育器（Post Abortal IUCD, PAIUCD）与流产后醋酸甲羟孕酮避孕针（Post Abortal DMPA, PADMPA）这两种长效可逆避孕方式的接受度，分析影响受术者选择长效可逆避孕方式的人口学与产科因素，并统计接受者的避孕持续率。

<b>研究设计与场景</b><b>:</b> 本研究为单中心纵向描述性研究。

<b>研究方法</b><b>:</b> 本研究纳入在研究机构接受早孕期或中孕期人工流产的女性。排除合并葡萄胎、感染性流产、存在DMPA/IUCD使用禁忌证，以及选择短效避孕方式或绝育手术的女性；剩余女性均接受长效可逆避孕方式的咨询。同意使用IUCD或DMPA的女性接受访谈，并随访至流产后6个月以观察避孕方式持续使用情况。

<b>研究结果</b><b>:</b> 本研究共纳入350名女性，其中164名（46.9%）接受了长效可逆避孕方式。在这些接受者中，96名（58.5%）选择了宫内节育器。接受长效可逆避孕的女性多为年龄较大、妊娠时长更长、居住于农村、妊娠次数较多且有过手术分娩史的人群。宫内节育器的避孕持续率为94.8%，显著高于DMPA的44.1%。避孕持续情况与宗教信仰及避孕方式选择相关。闭经是最主要的停用避孕方式的原因，其次为丈夫反对。

<b>研究结论</b><b>:</b> 近半数研究对象接受了流产后长效可逆避孕，且宫内节育器在植入6个月后的持续使用率显著更高。通过针对避孕方式选择的精准咨询与后续随访，可帮助女性坚持使用其选定的避孕方式。

<b>研究精简摘要</b><b>:</b> 本研究中，46.9%的人工流产女性接受了长效可逆避孕方式，其中73.8%的接受者坚持使用所选避孕方式。相较于DMPA，宫内节育器的接受度与持续使用率均更高。存在人口学与产科易感因素的女性更倾向于选择长效可逆避孕，而穆斯林女性的避孕持续率更高。通过提供可及性良好的流产后长效可逆避孕服务，可帮助女性自主规划生育，避免非意愿妊娠。