Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

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Paul, Mandira,1985-Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Internationell kvinno- & mödrahälsovård och migration/Essén (author)

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

Article/chapterEnglish2016

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2016-10-17
Springer Science and Business Media LLC,2016
electronicrdacarrier

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LIBRIS-ID:oai:DiVA.org:du-23281
https://urn.kb.se/resolve?urn=urn:nbn:se:du-23281URI
https://doi.org/10.1186/s12889-016-3726-1DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:134389158URI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-306363URI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion.METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114).RESULTS: There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use.CONCLUSIONS: Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods.TRIAL REGISTRATION: Clinicaltrials.gov NCT01827995.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
Hälsa och välfärd
Health and Welfare

Added entries (persons, corporate bodies, meetings, titles ...)

Iyengar, Sharad DAction Research & Training for Health (ARTH), Udaipur, Rajasthan, India (author)
Essén, Birgitta,1961-Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Internationell kvinno- & mödrahälsovård och migration/Essén(Swepub:uu)bires412 (author)
Gemzell-Danielsson, KristinaKarolinska Institutet,Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, WHO collaborating Centre, Stockholm, Sweden (author)
Iyengar, KirtiAction Research & Training for Health (ARTH), Udaipur, Rajasthan, India (author)
Bring, JohanStatisticon, Stockholm, Sweden (author)
Klingberg-Allvin, MarieKarolinska Institutet,Högskolan Dalarna,Omvårdnad,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden(Swepub:du)mkl (author)
Uppsala universitetInternationell mödra- och barnhälsovård (IMCH) (creator_code:org_t)

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