Survival Analysis of Patient Contraceptive Choice Method at Time of Abortion — Honolulu Hawai‘i May 2010–December 2016

摘要

The relationship between contraceptive method choice at the time of abortion and risk for subsequent abortions is not well understood. This article uses an existing data set from the University of Hawai‘i Women's Options Center between May 2010 and December 2016 to examine if such a relationship exists. A multivariate Cox proportional hazards regression survival analysis was used to evaluate contraceptive method prescribed or provided at index abortion encounters and likelihood of additional abortions. Patients who received a prescription of oral contraceptive pills, patches or rings at their index abortion were 61% more likely to have an additional abortion than those who had no contraceptive method recorded (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14–2.28). Patients who received a long-acting reversible contraceptive method at their index abortion were 59% less likely to have an additional abortion when compared with a patient receiving no method (HR, 0.41; 95% CI, 0.20–0.86). The findings show that patients who were prescribed oral contraceptives pills, patches, or rings were more likely than patients who had no contraceptive method prescribed or provided to have more than one abortion during the data collection period. Contraceptive method choice at time of abortion is complex and providers should be thorough in their counseling about failure rates, while also remaining vigilant in supporting patient autonomy and avoiding coercive or stigmatizing language.