Population Council Research that makes a difference

This study compared patterns of postabortion contraception among women who underwent medical abortion (MA) and manual vacuum aspiration (MVA). The study was located in four clinics in Patna (Bihar), and Ranchi and Jamshedpur (Jharkhand) operated by the NGO Janani, a major provider of reproductive health care in these states. All women undergoing abortion at these clinics from November 2009 to May 2010 who were aged 15 or above, married at the time of the survey, and who consented to an interview at or around the time of their abortion and six months later were recruited into the study. A total of 679 women (308 and 371 who underwent MA and MVA, respectively) were recruited; 598 were successfully re-interviewed six months later.

In total, 89 percent of MA clients and 94 percent of MVA clients had adopted a contraceptive method within six months of their abortion. Women who underwent MA were significantly less likely than those who had undergone MVA to have adopted contraception in the first month following the abortion (58% vs. 86%), attributable to the fact that one-third of MA clients (32%) abstained from sexual relations in that first month prior to adopting contraception. Differences narrowed considerably by the second month (82% vs. 91%). Method adoption varied considerably between the two groups, with MVA clients most likely to opt for sterilization and intrauterine contraceptive devices (IUCDs), and MA clients tending to opt for IUCDs or condoms.

Cumulative percentages of women who continued to use a nonterminal contraceptive method (e.g., condom, oral contraceptive, IUCD) were estimated using the Kaplan-Meier survival technique. Week-wise estimates indicate no statistically significant differences between MA and MVA clients with respect to the continuation of nonterminal contraception. The rate of contraceptive discontinuation after six months ranged from 5 percent to 8 percent among those who underwent MA and MVA, respectively. No significant differences were observed in method-specific discontinuation rates reported by women who adopted MA and MVA.

A report and a policy brief pertaining to this study have been prepared and will be used by the World Health Organization's Reproductive Health and Research Department to disseminate evidence on medical abortion in developing countries. Anarticle has also been accepted for publication in International Journal of Gynecology and Obstetrics.