Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service.

OBJECTIVE: To examine contraceptive choices among women seeking termination of pregnancy (TOP) and the provision of the chosen methods.

DESIGN: Population-based study.

SETTING: British Pregnancy Advisory Service (BPAS) clinics in England and Wales.

POPULATION: Between 1 January 2011 and 31 December 2014, 211 215 women had a TOP at BPAS, were offered contraceptive counselling, and were eligible to obtain contraception at no cost.

METHODS: We examined electronic records from BPAS and assessed the proportions of women who accepted contraceptive counselling and chose a contraceptive method, as well as the distributions of methods chosen, analysed by provider and by TOP type. We calculated the proportions receiving their chosen method and the methods chosen by women using no method at conception. We used logistic regression to examine the factors associated with choice of an intrauterine contraceptive (IUC) or implant.

MAIN OUTCOME MEASURES: Post-TOP contraceptive method choice. Receipt of chosen method post-TOP.

RESULTS: Eighty-five per cent of women accepted contraceptive counselling and 51% chose to obtain a method from BPAS rather than from a GP or contraception and sexual health clinic post-TOP. [correction added on 25 November 2016 after first online publication: 51% has been inserted in the preceding sentence.] Among those who wanted to receive contraception from BPAS, 51% chose an IUC or implant and 19% chose oral contraceptives. Ninety-one per cent of women who obtained contraception from BPAS received their chosen method. Women were more likely to choose an IUC or implant if they obtained contraception from BPAS, had a surgical TOP, were parous, young, white, or had one or more previous TOPs.

CONCLUSIONS: The standards set for patient-centred TOP care should emphasise the need for a full range of contraceptive options to be offered and provided post-TOP.

TWEETABLE ABSTRACT: Uptake targets for long-acting reversible methods do not reflect women's post-TOP contraceptive preferences.