Objectives: To describe the contraceptive usage of women undergoing termination of pregnancy in order to identify problems with contraception, and therefore suggest ways in which contraceptive services can be improved.
Design: Prospective study of attenders for NHS termination of pregnancy over a three month period.
Setting: Community based assessment clinics for NHS termination of pregnancy in inner London.
Subjects: Two hundred and sixty-nine women asking for assessment for NHS termination of pregnancy.
Main outcome measures: Source of contraception, method used around time of conception, and problems experienced.
Results: Respondents tell into three groups: those using contraception around the time they became pregnant; those who had ceased to use contraception; and those that had never used contraception. The method of contraception used by the majority of the first group was the condom and the main source of the method was the chemist shop. The second group had most commonly used oral contraceptives in the past and had ceased use in many cases as a result of side effects. The majority of the third group did not speak English and had limited knowledge of methods of contraception.
Conclusions: High usage of chemists means women avoid service providers who could offer help and advice. Women were prepared to put themselves at risk of unwanted pregnancy rather than return for further help and the lack of knowledge about emergency birth control was of some concern. The needs of black and ethnic minority women requires detailed work to improve access and acceptability of contraceptive services.
PIP: To assess the contraceptive needs of induced abortion patients, a 3-month (1992-93) prospective study was conducted of 269 women presenting to a National Health Service clinic in London, England, for pregnancy termination. 163 women (62.6%) had been using contraception--primarily condoms--around the time they became pregnant, but 86 failed to use the method correctly. Another 81 women (31.2%) had used contraceptives in the past, but not at the time of the index conception. 73 of these women were former pill users and 39 had used condoms. 39.5% of these women had discontinued use because of contraceptive side effects, particularly nausea. Finally, 16 women (6.2%) had never used a contraceptive method. 15 of these women were from outside the UK and had difficulties speaking English. When asked what form of contraception they would like to use in the future, 48.8% of abortion patients identified the pill, 11.9% wanted Depo-Provera, 7.3% chose condoms, and 6.5% wanted the IUD. Chemists were a major source of contraceptive supplies for women in this study, and this trend may represent a way of avoiding discussions of sexual activity with health professionals. Among the recommendations emerging from this study are more widespread education about and availability of emergency contraception, health promotion education in pharmacies, enhanced training of general practitioners in pill prescribing criteria and counseling, efforts to prevent repeat unwanted pregnancies, and the preparation of educational materials for non-English speaking family planning clients.