Peri-abortion contraceptive care: Can we reduce the incidence of repeat abortions?

Introduction. It is of great importance for repeat unwanted pregnancies to be prevented rather than aborted. We therefore sought to: determine the rea sons for contraceptive failure in women seeking repeat abortions, audit the r periabortion contraception services offered at our hospital, and make rec ommendations regarding periabortion contraception services based on the abo ve findings. Method. A self-administered questionnaire was used to deter-mine the contra ceptive practices and details of periabortion contraceptive counselling rec eived by 50 women undergoing a repeat, and 83 women undergoing a first-time , abortion. Results. Ninety-eight percent of women undergoing a repeat abortion reporte d using contraception at the time of conception, as compared to 83% of wome n undergoing a first-time abortion. This difference was significant (p = 0. 009). Condoms were the main method used by 57% of women undergoing a repeat and 70% of women undergoing a first-time abortion. The oral contraceptive pill (OCP), including both combined oral contraceptive and progestogen-only pill, was the main method used by 37% of M,omen undergoing a repeat and 25 % undergoing a first-time abortion. Both these methods were found to be ine ffective because of user-dependent failures. All women received periabortio n contraceptive counselling, but the perceived contents varied. Follow-up c ontraceptive appointments were made in less than half of women. Although mo st women chose an optimal contraceptive method as a result of the counselli ng, compliance with the chosen method in women undergoing repeat abortions was poor. Conclusions. Standards of audit were met with regards to receipt of contrac eptive counselling and agreeing a contraceptive method before discharge. Th e content of this counselling needs ro be improved. The ineffectiveness of the OCP and barrier methods of contraception needs to be highlighted during counselling. Adequate follow-up arrangements need to be provided to ensure compliance of the chosen method of contraception.