Grant: Operating Grant

Women seeking abortion beyond 12 weeks (2nd trimester) are at high risk of recurrent unwanted pregnancy. Often, women seeking a 2nd trimester abortion are disadvantaged by lower education and socio- economic status. The best reversible contraception to prevent repeat abortion is long acting, such as intrauterine contraception (IUC). Current medical practice and package labelling require waiting 4 weeks after a 2nd trimester abortion to insert the IUC. However, most women who receive an abortion do not return for follow-up, and so do not have the IUC inserted. With prompt IUC insertion, more women will benefit from effective birth control for up to 5 years. While there may be a slightly higher risk of the IUC falling out compared to insertion 4 weeks later, on balance the potential benefit to the patient is very high. This Randomized Controlled Trial will be the first to compare the effectiveness of immediate IUC versus 4 week IUC after a 2nd trimester abortion by looking at pregnancy rates one year later. To find one year pregnancy rate we will use a provincial health information database. In this way the research outcome does not rely on follow up participation by enrolled women. The investigators will also conduct an in-depth health economic analysis of the costs and cost savings. The findings of this trial will provide new evidence to inform policy-makers and health care professionals and offer better contraceptive choices to women. Our proposed research aims to improve the health and well-being of women at risk of repeated unwanted pregnancies, and their families, throughout Canada and internationally.