Audit of contraception before and after termination of pregnancy

Audit of contraception before and after termination of


O. Graham

Abacus Clinics for Contraception and Reproductive Health,

Liverpool, England, UK

Introduction: Concern had been raised locally about the

number of clients attending for repeat TOP despite regular contraceptive advice

and provision of most methods of choice on site. Repeat request for TOP is

perceived to be a problem even though the rate was similar to that in other

parts of Europe and North America.

Aims and Methods: As part of the audit on repeat TOP, we

aimed to make recommendations on how to minimise the risk of having repeat TOP.

We therefore looked at the contraceptive practices of clients before their last

TOP and what they intended to use after their last TOP and compared these with

what was being used when they returned for another TOP

Results: 291 women had a record of their contraceptive

practice before their last TOP, what method of contraception they were planning

to use after their last TOP and the contraceptive used prior to their current

TOP. Forty-five percent were not using any contraception and 30.9% were using

condoms as their sole method prior to their last TOP. Contraceptive intentions

changed towards a more reliable method after the TOP with more than 56.3%

choosing COC and 21 % choosing DMPA. However when they returned for their

current TOP contraceptive practices had changed again. Of the 164 women

intending to use COC after their last TOP only a third (52) were recorded to be

using COC prior to the current TOP. Nearly two-thirds (102) were using condoms

or no contraception. Sixty-one clients intended to use DMPA after their last TOP

but only two said they were using DMPA prior to their current TOP and 47 (77%)

were using condoms or no contraceptives. Twenty-two women planned to use IUD/IUS

following their last TOP but only 4 were using IUD/ IUS before their current

TOP. Fifteen women were using condoms or no contraception.

Conclusion: Although clients chose good, effective

contraceptives after TOP, their use was not always maintained after the

procedure. Further work is needed to understand the reasons for the change of

method and plans to improve acceptability and accessibility to more effective

contraception are being developed to assist women in having more control over

their fertility.

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