Departments of Obstetrics and Gynecology, General Practice and Primary Health Care, and Public Health, University of Helsinki, the Helsinki University Hospital, and the National Institute for Health and Welfare (THL), Helsinki, and the City of Vantaa, Vantaa, Finland; and the Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden.
Obstet Gynecol. 2018 Dec;132(6):1453-1460. doi: 10.1097/AOG.0000000000002966.
To study the rate of induced abortion in a population in whom long-acting reversible contraceptive (LARC) methods are offered free of charge as part of primary health care services.
We conducted a register-based cohort study on females aged 15-44 years in the city of Vantaa, Finland. We assessed the rate of abortion among females entitled to LARC methods free of charge by survival analysis in four cohorts: those visiting public family planning clinics and initiating free-of-charge LARC methods during 2013-2014 (LARC cohort, n=2,035); those visiting public family planning clinics not choosing LARC methods (no LARC cohort, n=7,634); and three age-matched control participants for every LARC and no LARC participant from the general population not using the services (nonservice users, n=5,981 and 22,748). The patients were followed up by means of Finnish national registers until February 28, 2016.
During the 78,500 woman-years accumulated, altogether 996 patients in Vantaa underwent an abortion (12.3 abortions/1,000 woman-years, 95% CI 11.6-13.1). Of these, 16 abortions occurred in the LARC cohort (3.9/1,000, 95% CI 2.4-6.0), 243 in the no LARC cohort (15.3/1,000, 95% CI 13.5-17.2), and 737 (12.6/1,000, 95% CI 11.7-13.5) among matched nonservice users. The adjusted abortion rate in the LARC cohort was 80% lower than in the no LARC cohort (risk ratio [RR] 0.20, 95% CI 0.11-0.32) and 74% lower than among their matched control participants (RR 0.26, 95% CI 0.15-0.43). In contrast, there was no difference in the abortion rate between the no LARC cohort and the control participants (adjusted RR 1.01, 95% CI 0.87-1.18).
When providing a population with free-of-charge LARC methods, the abortion rate was markedly lower among patients initiating free-of-charge LARC compared with patients using the services but not initiating a LARC method. Programs of this kind could be of major importance in populations with high rates of unintended pregnancy.
研究在将长效可逆避孕（LARC）方法作为初级保健服务的一部分免费提供给人群中，人工流产的发生率。
我们对芬兰万塔市 15-44 岁的女性进行了基于登记的队列研究。我们通过生存分析评估了四个队列中有权免费使用 LARC 方法的女性的流产率：在 2013-2014 年期间访问公共计划生育诊所并开始免费使用 LARC 方法的女性（LARC 队列，n=2035）；访问公共计划生育诊所但不选择 LARC 方法的女性（无 LARC 队列，n=7634）；以及从一般人群中每有 1 名 LARC 和无 LARC 参与者匹配 3 名未使用服务的非参与者（非服务使用者，n=5981 和 22748）。通过芬兰国家登记册对患者进行随访，直至 2016 年 2 月 28 日。
在累计的 78500 名女性年中，万塔共有 996 名患者进行了堕胎（12.3 例/1000 名女性年，95%CI 11.6-13.1）。其中，LARC 队列中有 16 例（3.9/1000，95%CI 2.4-6.0），无 LARC 队列中有 243 例（15.3/1000，95%CI 13.5-17.2），而匹配的非服务使用者中有 737 例（12.6/1000，95%CI 11.7-13.5）。LARC 队列的调整后堕胎率比无 LARC 队列低 80%（风险比[RR]0.20，95%CI 0.11-0.32），比其匹配的对照组低 74%（RR0.26，95%CI 0.15-0.43）。相比之下，无 LARC 队列和对照组之间的堕胎率没有差异（调整后的 RR1.01，95%CI 0.87-1.18）。
在为人群提供免费 LARC 方法时，与使用服务但未开始 LARC 方法的患者相比，开始免费 LARC 方法的患者的堕胎率明显降低。在意外怀孕率较高的人群中，这种类型的计划可能具有重要意义。
