Audrey Brown
Speeches:
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Continuation rate of contraceptive implant fitted
on the day of a termination of pregnancy
Brown, A; Nixon, H
NHS Greater Glasgow and Clyde, UK
Sandyford is an integrated sexual health service with over 100 000
visits annually. Our termination of pregnancy (TOP) service sees
over 1500 women annually. Around 30% of TOPs are in women
who have previously had at least one TOP. As a strategy to reduce
repeat TOP, we encourage uptake of long-acting reversible
contraception on the day of a TOP. Anecdotally, clinic staff were
reporting that many women having a contraceptive implant onthe day of abortion were returning in a short time to have it
removed.
Aim: To assess: uptake of contraceptive implant on the day of the
TOP; and continuation rate at one year after the TOP.
Methods: Records of women attending from May to October
2010 were accessed to record: method of contraception provided
on day of the TOP; rate of removal at one year after the TOP;
and reason for removal.
Results: During the 6 month period, 707 women had a TOP.
One hundred and fifty-two women (21%) had a contraceptive
implant fitted on the day of the TOP.
During the first year, 27 women had the implant removed for
reasons including bleeding (20), mood problems (2), weight gain
(2), planned pregnancy (2) and not sexually active (1).
One hundred and twenty-five women (82%) continued with
the implant for at least 1 year after insertion.
Discussion: Published series demonstrate implant continuation
rates of around 75% at 1 year. Implants are cost-effective at one
year of use. In our audit, women having an implant fitted on the
day of the TOP do not have a higher removal rate than standard
implant users. -
Improving the Provision of Contraception of the Day of Medical Abortion
Helen Nixon and Audrey Brown, NHS Greater Glasgow and Clyde, UK
Introduction:
Annually over 13000 women undergo therapeutic abortion in Scotland. Over 25% of these abortions are carried out in women who have previously undergone abortion. One strategy to reduce the number of abortions is to ensure the provision of reliable contraception on the day of abortion.
Objectives:
To describe national campaigns to increase uptake of long-acting reversible contraception, and to improve contraceptive provision at the time of medical abortion,
to describe a local training programme to achieve the national standards
to compare the provision of reliable contraception at the time of medical abortion before and after the introduction of the above
Methods: Case notes of women requesting medical abortion and accessing our abortion assessment clinic were reviewed for a 3 month period in 2007 (n=180) and 2010 (n= 157). Method of contraception chosen at the time of abortion assessment was recorded, as was method of contraception provided on the day of abortion.
Results:
% requesting method in 2007
% supplied with method in 2007
% requesting method in 2010
% supplied with method in 2010
COCP
33
39
31
38
POP
13
16
7
6
Implant
19
1
32
26
IUD/IUS
11
0
10
0
DMPA
14
18
11
11
Barrier
1
4
3
3
Nil/undecided
9
22
6
16
TOTAL
100
100
100
100
Discussion: Women who choose the oral or injectable contraception are usually provided with the method on the day of medical abortion in both 2007 and 2010. Although 19% of women chose a contraceptive implant in 2007, only 1% of women were fitted with an implant on the day of medical abortion. Several national campaigns, and local projects to enable medical abortion unit staff to fit contraceptive implants, took place during 2008 and 2009. Between 2007 and 2010, there was an increase in number of women choosing a contraceptive implant, from 19% to 32%. In addition, a contraceptive implant was fitted on the day of medical abortion in 26% of women, compared to 1% three years previously. Intra-uterine contraceptive methods are not fitted on the day of medical abortion in our unit. Despite around 1 in 10 women choosing this method, they cannot be provided with their chosen method at the time of abortion. Most women fail to return for interval IUD/IUS insertion, potentially leaving them at risk of further pregnancy. Consideration should now be given to improving timely provision of intra-uterine methods.
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Uptake of independent counselling in addition to
termination of pregnancy consultation
Nixon, H; Brown, A
Sandyford, NHS Greater Glasgow and Clyde, UK
Sandyford is an integrated sexual health service with over 100 000
visits annually. Our termination of pregnancy and referral
(TOPAR) service sees over 1500 women annually and offers
information, assessment and admission for medical and surgical
termination of pregnancy (TOP). There is access to a trained
counsellor if wished.
Recently in the UK, there have been demands to make
additional counselling or a ‘cooling off’ period compulsory.
Aim: To assess: uptake of counselling in addition to the TOPAR
consultation; and relationship between time to TOP and eventual
decision.
Methods: Records of women attending from September to
November 2011 were accessed to record:
(i) certainty of decision at first visit.
(ii) uptake of additional counselling.
(iii) waiting time to TOP date and final outcome to proceed to
TOP or continue the pregnancy.
Results: Of 384 women with confirmed pregnancies at
consultation:
(i) Twenty-six decided to continue the pregnancy.
(ii) Three hundred and forty-one wanted a TOP and this was
arranged.
(iii) Twenty-eight subsequently did not attend for a TOP and
continued the pregnancy.
(iv) Seventeen women wished more time to consider their
decision and were offered an appointment with a trained
counsellor – two women accepted.
(v) Sixof the undecided women continued thepregnancy,
including the two women who attended for counselling and 11 had
aTOP.
(vi) Neither time to the TOP or gestation influenced the
decision to abort or continue the pregnancy.
Our results suggest that the vast majority of women do not
wish or need additional counselling and that introducing a
‘cooling off’ period or delay would not alter the decision.Post Abortion Family Planning (PAFP) is a key part of any
comprehensive TOP service as this is a vital opportunity in which
to provide family planning, to avoid future unwanted pregnancies.
In order to understand the factors that may impact on the
uptake of PAFP, MSI undertook a baseline survey of all clients
accessing services in four of the MSI country programmes. The
data was collected for 1 month, September 2011.
In total 4081 clients availed themselves of TOP services across
MSI centres in Ethiopia (1974), Nepal (1160), Vietnam (888), and
Zambia (59).
The average age of clients was 27–29 years. Ethiopia was the
only programme with a lower than average age of 22 years.
Eighty-three percent of TOP were performed at under 9 weeks
of gestation. Medical TOP was chosen by an average of 61% of
women: Zambia (90%), Vietnam (76%), Ethiopia (62%), Nepal
(16%).
Sixty-eight percent of women had not been using any
contraception when they became pregnant. Thirteen percent were
using male condom, 9% the oral contraceptive pill, 4% injection,
1% emergency contraception, and 1% traditional methods. No
one had been using implants, IUDs, male or female sterilisation as
a method of contraception when they became pregnant.
This review reflects the baseline factors of MSI clients,
including the low use of contraception in women seeking TOP,
and highlights variables to consider when providing PAFP and
informing the ongoing MSI PAFP project that focuses on
increasing levels of PAFP uptake.