Postabortion contraceptive uptake among vulnerable individuals in a New York City public hospital

Introduction Contraceptive provision at the time of abortion lowers rates of subsequent unplanned pregnancy but cost, method availability and other considerations impact decision-making. We examined factors associated with contraceptive preferences at the time of abortion in a US safety net hospital. Methods This is a retrospective cohort study. We abstracted medical records for patients seen in the gynaecology clinic between April 2019 and June 2021 who received a medication or procedural abortion for an undesired pregnancy. We collected demographic and clinical data from the electronic medical record. We generated descriptive statistics using Stata V.18 and used R to perform a latent class analysis to identify patterns of association with selected demographic variables and chosen contraceptive methods. Results 638 met inclusion criteria. Latent group 1, which was largely Hispanic, on Medicaid, and/or undergoing medication abortion, most often chose the subdermal implant or pills. Latent group 2, which was largely non-Hispanic and undergoing procedural abortion, most often chose a levonorgestrel intrauterine device (LNG IUD) or declined birth control. Nearly 80% initiated any contraceptive method, with over 20% choosing an LNG-IUD and over 40% choosing any IUD or the subdermal implant. Contraceptive uptake was highest among Spanish-speaking individuals (115/131, 87.8%). Non-initiation occurred most frequently among individuals who did not have insurance/self-paid (24/72, 33.3%), spoke a language other than English or Spanish (8/27, 29.6%), or had a procedural abortion <14 weeks (38/171, 22.2%). Conclusions Contraceptive uptake was high among abortion-seeking individuals. Further research can clarify how other factors impact decision-making and uptake among vulnerable populations.