Post-abortion initiation of long-acting reversible contraception in NewZealand

Abstract

Background Post-abortion initiation of longacting reversible contraception (LARC) reduces subsequent abortion rates within 24 months, but the prevalence of post-abortion LARC use in New Zealand is unknown. Aim To describe post-abortion initiation of intrauterine and implantable LARC methods in New Zealand between 2007 and 2012, and to determine what impact the introduction of government-funded (free) levonorgestrel (LNG) implants in August 2010 had on overall LARC use. Design and setting Retrospective observational study involving New Zealand abortion clinic data. Methods Nationally collated data on post-abortion LARC insertions were obtained for the period 2007-2012, and individual-level discharge data for patients attending a large urban hospital abortion clinic were analysed using descriptive statistics to describe annual uptake rates, and the demographic profile of LARC users during this period. Logistic regression analyses examined whether LARC use differed by parity and/or age over time. Results Post-abortion LARC use increased from 20.2%in 2007 to 45.6% in 2012. Intrauterine device use increased from 20.2% to 31.8% during this period, with implants contributing a further 14% to the overall use of LARC methods by 2012. Clinic data showed that LARC use increased among most demographic subgroups between 2009 and 2012, with the greatest increase among nulliparous under-20-year-olds (from 17.2% to 42.0%). Conclusions Post-abortion LARC use has been steadily increasing in New Zealand since 2007. Overall LARC use significantly increased following the introduction of government-funded implants, particularly among young and nulliparous women. Improving access to alternative methods of LARC may further increase uptake and reduce unwanted pregnancy rates.