Contraceptive Implants and Injections Associated With repeat abortions

‘Teenage pregnancy, social deprivation, and previous live births or miscarriages at the time of an initial abortion are also linked with subsequent terminations.’

Women who used contraceptive implants or injections after an initial termination were among those with an increased likelihood of a repeat abortion in the long term, finds a study published online in the Journal of Family Planning and Reproductive Health Care. Abortion is the ‘ending of pregnancy by removing a fetus or embryo from the womb before it can survive on its own. ^.An abortion which

occurs spontaneously is also known as a miscarriage. An abortion may be caused purposely and is then called an induced abortion, or less frequently, “induced miscarriage”. The word abortion is often used to mean only induced abortions or unwanted pregnancy.

The research studied large numbers of UK women and found that women who used either implants or the contraceptive injection Depo-Provera were more likely to have another abortion 2–5 years after the first termination compared to those who used other methods. Long-acting reversible contraception (LARC) such as implants and Depo-Provera are often promoted as contraceptive method of choice for women undergoing abortion. While LARC methods are “effective”, explain the researchers, “discontinuation rates are high, and therefore make terminations more likely reasons for discontinuation of implants and injectable says BMJ.




The authors carried out a retrospective study using data from the Termination of Pregnancy Database in the NHS Grampian(Scotland) region between 1997 and 2003. The study took into account factors, such as age, socioeconomic deprivation, previous obstetric history,and sexual health history. Of the 13,621 women who had an initial termination, 23.4% went on to have a repeat abortion. Results showed that women aged below 20 years at the initial termination had an estimated 5.59 times higher chance of having a repeat termination. Women with two previous live births at the time of their initial termination had an estimated 1.51 higher likelihood of having a repeat termination compared to women with a single termination.Women in the most socially deprived group had an estimated 1.23 higher chance of having a repeat termination when compared to those in the least deprived group’ explained BMJ reporter.

Contraceptive methods come side effects such as irregular bleeding, and the need for periodic replacement but  the researchers do not advise against the use of contraceptive implants and injections but a careful contraceptive counselling that takes into consideration women’s views, continued follow-up, particularly after the initial 2-year period . Around one third of women have more than one termination in the UK as reported. Abortion is safe overall, but can be distressing, and is ethically complex, and occasionally leads to complications such as preterm labour in subsequent pregnancies days says researchers.

“From a public health perspective there is a need to identify women who are more likely to have repeat terminations and put in place targeted interventions to prevent unplanned pregnancies,” says the authors .

Furthermore, these women were more likely to have been tested for blood borne virus and were more likely to test positively for a chlamydia infection. Women with more than one termination were more likely to have had an implant as their post-termination contraceptive method; and women who were fitted with an implant after their initial termination had an estimated 1.78 times higher chance of a repeat termination compared to those with no method, or unknown or natural methods of contraception 2 years after the initial termination reported BMJ.

The researchers conclusion was that, ‘Teenage pregnancy, social deprivation, two or more previous live births or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera were associated with repeat termination 2–5 years after the first termination’. While BMJ reporter felt the research ‘was an observational study and  so no firm conclusions about cause and effect can be drawn’.

Sources

• Article from BMJ: Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data ‘
• BMJ Published Journal of Stephen J McCall .Etal: Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data