Postlethwaite Debbie, Lee Justine, Merchant Maqdooda, Alabaster Amy, Raine-Bennett Tina
Clinician Researcher and the Assistant Director of the Biostatistical Consulting Unit within the Division of Research in Oakland, CA (
Ob/Gyn at the Vallejo Medical Center in CA (
Perm J. 2018;22:18-058. doi: 10.7812/TPP/18-058.
Optimizing access to effective contraception at the time of abortion can reduce repeated unintended pregnancies.
To assess contraception initiation and repeated unintended pregnancies among women receiving abortions in Kaiser Permanente Northern California (KPNC) facilities and through outside contracted facilities.
A retrospective cohort study was conducted using a randomized proportional sample of women aged 15 to 44 years having abortions in KPNC, to determine contraception initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, contraceptive method initiated, and pregnancies within 12 months) were collected from electronic health records. Descriptive statistics, χ tests, t-tests, and logistic regression models assessed predictors of long-acting reversible contraception (LARC) initiation and having another unintended pregnancy within 12 months of abortion.
Women having abortions from contracted facilities were significantly less likely to initiate LARC within 90 days compared with those receiving abortions in KPNC facilities (11.99% vs 19.10%, p = 0.012). Significant factors associated with 90-day LARC initiation included abortions in KPNC facilities (adjusted odds ratio [aOR] = 1.87, p = 0.007) and gravidity of 3 or more. Women initiating short-acting or no contraception were significantly more likely to have an unintended pregnancy within 12 months of the abortion than those initiating LARC (aOR = 3.66, p = 0.005; no contraception vs LARC, aOR = 3.75, p = 0.005).
In response to this study, KPNC now provides reimbursement for LARC in all outside abortion contracts, internalized more abortions in KPNC facilities, and strengthened clinical recommendations for immediate, effective postabortion contraception, especially LARC.
在堕胎时优化有效避孕措施的获取途径可减少意外妊娠的再次发生。
评估在北加利福尼亚凯撒医疗集团（KPNC）机构以及通过外部签约机构接受堕胎的女性中避孕措施的开始使用情况和意外妊娠的再次发生情况。
进行了一项回顾性队列研究，使用从KPNC接受堕胎的15至44岁女性的随机比例样本，以确定90天内避孕措施的开始使用情况。从电子健康记录中收集人口统计学和临床特征（年龄、种族/族裔、妊娠次数、产次、开始使用的避孕方法以及12个月内的妊娠情况）。描述性统计、卡方检验、t检验和逻辑回归模型评估了长效可逆避孕（LARC）开始使用的预测因素以及堕胎后12个月内再次发生意外妊娠的情况。
与在KPNC机构接受堕胎的女性相比，在签约机构接受堕胎的女性在90天内开始使用LARC的可能性显著降低（11.99%对19.10%，p = 0.012）。与90天内开始使用LARC相关的显著因素包括在KPNC机构进行的堕胎（调整后的优势比[aOR] = 1.87，p = 0.007）以及妊娠次数为3次或更多。与开始使用LARC的女性相比，开始使用短效避孕措施或未采取避孕措施的女性在堕胎后12个月内发生意外妊娠的可能性显著更高（aOR = 3.66，p = 0.005；未采取避孕措施与LARC相比，aOR = 3.75，p = 0.005）。
针对这项研究，KPNC现在为所有外部堕胎合同中的LARC提供报销，在KPNC机构内纳入了更多堕胎服务，并加强了关于立即、有效堕胎后避孕尤其是LARC的临床建议。
