Contraceptive use over five years after receipt or denial of abortion services

Context: Nonuse and inconsistent use of contraceptives contribute to a high incidence of unintended pregnancy and abortion among U.S. women. Little is known, however, about how these outcomes shape women's subsequent contraceptive use and unintended pregnancy risk.

Methods: Contraceptive use was examined among 880 participants in the Turnaway Study, a five-year longitudinal study of women who sought abortions at 30 U.S. facilities in 2008-2010. Multivariable mixed-effects logistic and multinomial regression models assessed differences in use by whether women received the abortion; results were used to calculate predicted percentages of women using each method. The main groups of interest were 415 women who had an abortion at a gestation near their facility's limit and 160 who were denied abortion because they were beyond the limit, and who consequently gave birth.

Results: During each of the approximately five years of follow-up, the predicted percentage using any contraceptive method was 86% among women who had the abortion and 81% among those denied it. Over the entire period, the former women were more likely than the latter to use any method (odds ratio, 1.8). However, they were less likely to rely on female sterilization, rather than no method (risk ratio, 0.5), and more likely to use barrier methods (1.7) or short-acting reversible contraceptives (2.6).

Conclusion: Women's elevated risk of unintended pregnancy after abortion is likely due at least partly to reliance on methods with relatively low effectiveness. Factors affecting contraceptive access postabortion, as well as individual characteristics such as fecundability, require research attention.