Postabortion contraception use among women with and without a history of mental disorders: A Dutch prospective 5-year follow-up study

Abstract

Background To provide optimal care, the Dutch national abortion care guidelines support immediate postabortion contraception counseling. As a consequence, uptake of contraception after abortion is supposed to be high. Surprisingly little is known about contraception continuation after abortion over time. Research has shown that women with a history of mental disorders (HMD) are at increased risk for repeat abortion, related to less (effective) contraception use. Objectives In the current study, we will investigate whether HMD predicts longterm contraception use after abortion, and explore whether decisional autonomy may in part explain this relationship. Method The study is based on the first and the third (last) wave of the Dutch Abortion and Mental Health Study (DAMHS), a five-year prospective cohort study of mental health among women who terminated an unwanted pregnancy (n=325). Data were collected using structured face-to-face interviews. Hypotheses were tested using regression models adjusting for SES, age, and desire to have a family. Preliminary results The proportion of women using no contraception at all was strikingly similar before abortion and 5 years after. Furthermore, LARC use had increased significantly in the five years after abortion, whereas oral contraceptives and condom use had decreased. Preabortion mental disorders did not predict long-term postabortion contraception use in general (age did), but it did predict the use of highly effective contraception (LARC) 5 years postabortion (pConclusion Contraception nonusers may continue their contraceptive nonuse in the five years postabortion, but other women using oral contraceptives or condoms preabortion may be more motivated to start using more effective contraception methods postabortion. Women with HMD might benefit from contraception counseling including LARC options, to ensure they make the choice that fits their needs.