June 5th, 2020

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Immediate Initiation of Oral Contraceptive Pills After Surgical Abortion: A Randomized Controlled Trial
Authors:  Sarah W. Prager, M.D., M.A.S., Sarah Averbach, M.D., M.A.S., Elizabeth M. Roberts, M.D., Ijeoma Okeigwe, M.D., M.P.H., Abby Sokoloff, M.P.H., Eleanor A. Drey, M.D., Ed.M., and Jody E. Steinauer, M.D., M.A.S.
  OBJECTIVE: To determine whether immediate initiation of oral contraceptive pills (OCPs) at the time of abortion improves continuation. To evaluate this, we compared immediate versus delayed initiation of OCPs after first-trimester aspiration and second-trimester dilation and evacuation.

STUDY DESIGN: This is a randomized, single-blinded, controlled trial in which 295 women who chose OCPs as their contraceptive method were randomized to initiating OCPs either the same day as the abortion or the first Sunday following the abortion. Follow-up telephone surveys were administered at 2 and 6 months after abortion. Contraceptive continuation was evaluated per intent-to-treat analysis.

RESULTS: A total of 295 women were randomized: 155 women to immediate and 140 to delayed initiation. Overall follow-up rates were 77% and 61% at 2 and 6 months, respectively. At 6 months, 57% of women in the immediate group and 66% in the delayed group were using OCPs (p=0.34). Eleven participants total (4 and 7 in the immediate and delayed arms, respectively) had become pregnant since their abortion (p=0.23).

CONCLUSION: Immediate initiation of OCPs following abortion did not improve contraceptive continuation at 6 months.
Keywords:  abortion, induced; abortion applicants; contraception; contraceptive behavior; contraceptive method switching; contraceptive methods; contraceptive usage; contraceptives; oral contraceptives; patient compliance; unintended pregnancy; unplanned pregnancy
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