Goyal Vinita, Canfield Caitlin, Aiken Abigail R A, Dermish Amna, Potter Joseph E
Population Research Center and LBJ School of Public Affairs, University of Texas at Austin, and Planned Parenthood of Greater Texas, Austin, Texas.
Obstet Gynecol. 2017 Apr;129(4):655-662. doi: 10.1097/AOG.0000000000001926.
To compare preference for long-acting contraception (LARC) and subsequent use, year-long continuation, and pregnancy among women after induced abortion who were and were not eligible to participate in a specialized funding program that provided LARC at no cost.
Between October 2014 and March 2016, we conducted a prospective study of abortion patients at Planned Parenthood in Austin, Texas (located in Travis County). We compared our primary outcome of interest, postabortion LARC use, among women who were eligible for the specialized funding program (low-income, uninsured, Travis County residents) and two groups who were ineligible (low-income, uninsured, non-Travis County residents, and higher income or insured women). Secondary outcomes of interest included preabortion preference for LARC and 1-year continuation and pregnancy rates among the three groups.
Among 518 women, preabortion preference for LARC was high among all three groups (low-income eligible: 64% [91/143]; low-income ineligible: 44% [49/112]; and higher income 55% [146/263]). However, low-income eligible participants were more likely to receive LARC (65% [93/143] compared with 5% [6/112] and 24% [62/263], respectively, P<.05). Specifically, after adjusting for age, race-ethnicity, and education, low-income eligible participants had a 10-fold greater incidence of receiving postabortion LARC compared with low-income ineligible participants (incidence rate ratio 10.13, 95% confidence interval [CI] 4.68-21.91). Among low-income eligible and higher income women who received postabortion LARC, 1-year continuation was 90% (95% CI 82-97%) and 86% (95% CI 76-97%), respectively. One-year pregnancy risk was higher among low-income ineligible than low-income eligible women (hazard ratio 3.28, 95% CI 1.15-9.31).
Preference for postabortion LARC was high among all three eligibility groups, yet women with access to no-cost LARC were more likely to use and continue these methods. Low-income ineligible women were far more likely to use less effective contraception and become pregnant. Specialized funding programs can play an important role in immediate postabortion contraceptive provision, particularly in settings where state funding is limited.
比较人工流产后符合和不符合参与一项免费提供长效避孕方法（LARC）的专门资助项目的女性对LARC的偏好、后续使用情况、一年期持续使用情况及妊娠情况。
2014年10月至2016年3月期间，我们对德克萨斯州奥斯汀市计划生育组织（位于特拉维斯县）的流产患者进行了一项前瞻性研究。我们比较了符合专门资助项目条件（低收入、未参保、特拉维斯县居民）的女性与两组不符合条件的女性（低收入、未参保、非特拉维斯县居民以及高收入或已参保女性）中我们感兴趣的主要结局——流产后LARC的使用情况。感兴趣的次要结局包括流产前对LARC的偏好以及三组的一年期持续使用情况和妊娠率。
在518名女性中，三组流产前对LARC的偏好均较高（符合条件的低收入女性：64%[91/143]；不符合条件的低收入女性：44%[49/112]；高收入女性：55%[146/263]）。然而，符合条件的低收入参与者更有可能接受LARC（分别为65%[93/143]，相比之下，不符合条件的为5%[6/112]，高收入女性为24%[62/263]，P<0.05）。具体而言，在调整年龄、种族和教育因素后，符合条件的低收入参与者接受流产后LARC的发生率比不符合条件的低收入参与者高10倍（发生率比为10.13，95%置信区间[CI]为4.68 - 21.91）。在接受流产后LARC的符合条件的低收入女性和高收入女性中，一年期持续使用率分别为90%（95%CI 82 - 97%）和86%（95%CI 76 - 97%）。不符合条件的低收入女性的一年期妊娠风险高于符合条件的低收入女性（风险比为3.28，95%CI为1.15 - 9.31）。
在所有三个符合条件的组中，流产后对LARC的偏好都很高，但能够获得免费LARC的女性更有可能使用并持续使用这些方法。不符合条件的低收入女性更有可能使用效果较差的避孕方法并怀孕。专门的资助项目在流产后立即提供避孕措施方面可以发挥重要作用，特别是在州资金有限的情况下。
