What Proportion of Canadian Women Will Accept an Intrauterine Contraceptive at the Time of Second Trimester Abortion? Baseline Data From a Randomized Controlled Trial
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OBJECTIVE: This report details enrolment findings related to a Canadian randomized controlled trial comparing immediate to delayed intrauterine contraception (IUC) placement after a second trimester abortion. We report acceptance of IUC, satisfaction with prior contraception, adherence to the CONSORT criteria, and challenges faced in the recruitment process. METHODS: Women seeking second trimester abortion and selecting either of two methods of IUC as their preferred contraception method were enrolled and randomized to insertion either immediately post-abortion or four weeks later. Enrolled participants completed a Contraception Satisfaction Questionnaire detailing prior contraceptive satisfaction. RESULTS: Among 1813 women assessed, 1500 (83%) met eligibility criteria and IUC was chosen for post-abortion contraception by over one half of them (792/1500, 53%). When both types of device were available cost-free, women selected the levonorgestrel-releasing intrauterine system more than 20 times more frequently than a copper IUD. Participants had an average age of 26.0 (standard deviation [SD] 6.8) years, and an average gestational age of 16.1 (SD 3.1) weeks. Almost one half (48.4%) had had a prior abortion and 46.9% had a prior delivery. Two thirds of participants were using a contraception method at the time of conception, but almost one third of these were using methods in the lowest tiers of effectiveness. There was a weak correlation between prior contraceptive compliance and education level. CONCLUSION: More than one half of eligible women seeking a second-trimester abortion chose IUC for post-abortion contraception. In Canada, health care for unintended pregnancies is universally subsidized but contraception is not. Offering comprehensive information on the range of contraceptive methods and providing cost-free IUC is an effective strategy to increase uptake of intrauterine contraception among Canadian women who wish to prevent further unintended pregnancy.