New Project Evaluates Immediate Provision of Progestin-only Contraceptives after Medical Abortion

Finding ways to make medical abortion services more comprehensive and convenient is a high priority. One aspect that has been under-researched is the design of services to ensure easy access to effective contraception after medical abortion. A strategy that has shown promise for increasing contraceptive uptake is initiation of the selected contraceptive method as soon as the woman decides to adopt it. This “quickstart” approach has become standard after surgical abortion, but in medical abortion settings, it has been a challenge to apply it to contraceptives other than pills and barrier methods. Because routine clinical follow-up after a medical abortion is increasingly recognized to be unnecessary, the surest or even the only opportunity to apply quickstart is to initiate the contraceptive at the clinic visit at which the abortion drugs are provided. However, if the chosen contraceptive is a progestin-based method, concerns have been raised that the progestin in the contraceptive could counteract mifepristone, an antiprogestin, which is provided for abortion. This drug interaction, if important, could theoretically impair mifepristone efficacy and increase the risk of a medical abortion failure. Notably, a small increase in medical abortion failure could be acceptable to some people if, as hoped, the quickstart strategy reduces the risk of repeat unintended pregnancy over the long term.

Gynuity’s project will include randomized trials to compare quickstart (provision of contraception on day of mifepristone) to standard start (provision of contraception after complete abortion is confirmed). Contraceptive implants and the injectable contraceptive depot medroxyprogesterone acetate will be studied in separate trials among first trimester medical abortion patients. The trials will assess two primary outcomes: medical abortion failure and repeat pregnancy risk within six months after the abortion. The project will be led by Dr. Elizabeth Raymond and will be conducted at multiple sites in the United States and internationally.

This project capitalizes on Gynuity Health Project’s expertise in research and expands its contraception program area. In partnership with other experts and organizations, Gynuity’s new work will add to our body of knowledge on medical abortion and contraception and pave a path toward reducing unplanned pregnancies worldwide.

This research is made possible by a grant from an anonymous donor. For more information, please email: pubinfo@gynuity.org.