Discussion Questions

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  Why is this question important?

  
  
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  What was the overall study design?

  
  
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  How would you describe the study population?

  
  
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  What analytic methods were used?

  
  
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  What were the main study findings?

  
  
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  What were the study’s strengths and limitations?

Unintended pregnancies and repeat abortion are pressing issues around the world. Recent figures suggest that in the United States, over 1 million unintended pregnancies per year end in abortion. For the patient, abortion can be a source of emotional distress, and the surgical procedure is associated with small risks for bleeding and infection. Overall, unintended pregnancies and abortion represent a major public health issue. Therefore, attention has recently turned to the safety, efficacy, and patient acceptability of long-acting reversible contraceptive (LARC) methods. These methods include injectable, implantable, and intrauterine devices.

This month, Journal Club participants discussed a prospective follow-up study from New Zealand that underscores the value of LARC methods in reducing the rate of repeat abortions. In the original 2008 study, which took place over a 10-week period, women were offered free long-acting contraception after abortion—either the levonorgestrel intrauterine system (LNG-IUS), depot medroxyprogesterone acetate (DMPA), or the copper multiload Cu375 IUD (Cu-IUD). Implantable devices were not offered. Patients also received intense education and patient counseling about these methods. They were then contacted by phone at 6 weeks and 6 months to assess continuation rates. At the 6-month mark, investigators reached 78% of the women and learned that 81% with a LNG-IUS and 74% with a Cu-IUD had retained them; 71% of DMPA users were continuing use. For the new study, the rate of repeat abortion was ascertained at 24 months by matching National Health Index numbers (a unique identifier for each subject) to hospital abortion clinic discharge data.