Background:
A cornerstone of preconception care is helping women have pregnancies when they desire them. This talk will outline barriers to post-abortion contraception, ways to improve use of contraception and details of post-abortion use of the most effective methods.
About half of the 6 million annual pregnancies in the U.S. are unintended and about 42% of unintended pregnancies are terminated in abortion. Since about half of women having abortions have more than one, an integral part of post-abortion care is contraception. According to a 2006 report by the Guttmacher Institute, women who have repeat abortions differ from women having first abortions in only two ways: they are older and are more likely to have a child. They are also slightly more likely to have been using an effective hormonal contraceptive method, refuting the suggestion that women intend to use abortion as primary contraception.
Although women and providers often encounter barriers to starting effective contraception at an abortion visit, comprehensive contraception counseling and provision is a standard component of high quality abortion care. Barriers to post-abortion contraception include those erected by insurance companies, state and federal programs, health care systems, providers and even the women themselves. When providers understand the barriers, they can effectively utilize this opportunity to help women prevent repeat unintended pregnancy.
The 11% of women who use no contraception have just under half of the abortions, so helping women identify, start and continue any method is a giant step towards fewer abortions. There are many simple ways providers can go beyond writing a prescription to help women use contraception. Discussing non-contraceptive benefits as well as risks, using Quick Start, educating about use, understanding payment and formularies and preempting negative rumors and media can all help women prevent unintended pregnancies.
Since the other half of women who present for abortion were using some contraception during the month they became pregnant, we clearly have room for improvement in helping women choose long-acting, low-intervention contraceptive methods. As one 2001 study concluded, “A village would be nice but...it takes a long-acting contraceptive to prevent repeat adolescent pregnancies.” Studies of adult women find the same. More and more providers are offering intrauterine contraception and implants as safe, appropriate and extremely effective options after abortion.

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