Paul Mandira, Iyengar Sharad D, Essén Birgitta, Gemzell-Danielsson Kristina, Iyengar Kirti, Bring Johan, Klingberg-Allvin Marie
Department of Women's and Children's health / International Maternal and Child Health (IMCH), Uppsala University, Akademiska Sjukhuset, Uppsala, SE-751 85, Uppsala, Sweden.
Action Research & Training for Health (ARTH), 313011, Udaipur, Rajasthan, India.
BMC Public Health. 2016 Oct 17;16(1):1087. doi: 10.1186/s12889-016-3726-1.
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.
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).
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.
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.
Clinicaltrials.gov NCT01827995.
印度堕胎后避孕措施的使用率较低，现代避孕方法的使用很少见，尤其是在农村地区。本研究主要比较了在资源匮乏的初级卫生保健机构中，在诊所评估堕胎结果的妇女与在家中评估堕胎结果的妇女之间的避孕措施使用情况。此外，还调查了背景特征和堕胎服务提供情况如何影响堕胎后的避孕措施使用。
一项随机对照、非劣效性试验（RCT）比较了堕胎后2周时诊所随访与在家中评估堕胎结果的情况。此外，通过对RCT中一个主要为城市的女性子样本进行横断面随访访谈，调查了堕胎后3个月时的避孕措施使用情况。纳入了妊娠周数达9周及以下且同意进行2周随访的寻求堕胎的妇女（n = 731）。排除已知有药物流产禁忌证、血红蛋白低于85mg/l以及年龄在18岁以下的妇女。2013年4月至2014年8月期间，在拉贾斯坦邦的6家初级卫生保健诊所收集数据。使用计算机随机数生成器以6个一组的方式创建随机化序列（1:1）。在成功随访的妇女中，于2周时测量避孕措施的使用情况（n = 623）；在子样本妇女中，于3个月时测量避孕措施的使用情况，这些子样本妇女需满足在城市研究地点之一招募、拥有电话并同意进行3个月随访（n = 114）。
3个月时，研究组之间在避孕措施使用和持续情况方面无差异（诊所随访组为76%，家庭评估组为77%），然而，诊所随访组的妇女在2周时最有可能采用避孕方法（62±12%），而家庭评估组的妇女在下一次月经后最有可能采用避孕方法（60±13%）。在2周时开始采用某种方法的妇女中，52%选择了3个月注射剂或铜宫内节育器。只有4%的妇女倾向于绝育。种姓、教育程度或居住类型不影响避孕措施的使用。
如果在堕胎当天尽早提供避孕服务，那么在资源匮乏的环境中，早期药物流产后简化随访不会改变妇女获得避孕措施的机会。在资源匮乏的环境中，药物流产后3个月时妇女的堕胎后避孕措施使用情况不太可能受到随访方式的影响。临床指南需要鼓励堕胎时避孕，提供全面的循证方法，尤其是长效可逆方法。
Clinicaltrials.gov NCT01827995
