Society of Family Planning clinical recommendations: contraception after surgical abortion

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Andrea Hsu Roe, Deborah Bartzb

Contraception Journal - January 1, 2019

September 06, 2018 - Published

IUDs can be safely placed at the time of surgical abortion and do not increase the risk of infection or perforation. IUD expulsion rates are significantly higher after second-trimester surgical abortion than after first-trimester surgical abortion, but expulsion rates after first-trimester surgical abortion may not differ significantly from interval placement.

Excerpts from Abstract

These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy. IUD insertion immediately following uterine aspiration is safe. While this may be associated with a higher risk of device expulsion than with interval placement, expulsion rates remain low, and this risk must be weighed against the fact that patients often do not receive their desired IUD at an interval insertion and therefore experience higher rates of subsequent unintended pregnancy. Many patients experience barriers that prevent access to the full spectrum of postabortion contraceptive options, particularly IUDs and implants. Advancements in health-systems-based point-of-care provision and policies are needed to improve comprehensive contraceptive availability following surgical abortion. These recommendations will address clinical considerations for postabortion contraceptive provision and recommend interventions to improve contraceptive access following uterine evacuation.

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Contraception

An International Reproductive Health Journal

Wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion.