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Misoprostol vs. placebo prior to IUD insertion in nulliparous women: a randomized controlled trial
Abstracts / Contraception 84 (2011) 302–336 O15
O17
THE “LEGITIMACY PARADOX” IN US ABORTION PROVISION Harris L University of Michigan, Ann Arbor, MI, USA
MISOPROSTOL VS. PLACEBO PRIOR TO IUD INSERTION IN NULLIPAROUS WOMEN: A RANDOMIZED CONTROLLED TRIAL
Debbink M, Martin L, Hassinger J
Swenson C University of Utah, Salt Lake City, Utah, USA
Objectives: Abortion is highly stigmatized. Abortion stigma prevents women from speaking openly about their abortions, leading to an impression that abortion is uncommon, when it is quite prevalent. Kumar et al. called this a “prevalence paradox.” We sought to explore the effects of stigma on physicians who perform abortions. Specifically, we wondered if stigma prevents physicians from speaking openly about their work and if a physician variant of the “prevalence paradox” exists. Methods: We conducted a qualitative national study of the Providers Share Workshop. Providers Share is a five-session group workshop for abortion caregivers intended to reduce the psychosocial burdens of abortion work. Workers at six sites across the US participated. Sessions were recorded, transcribed and analyzed for themes with the assistance of Nvivo. Results: We found that many physicians who perform abortions remain silent about their abortion work in social and professional circles. Silence is motivated by fear of becoming a target of violence; wishing to protect their children from judgment/harassment; and desire to avoid abortion work eclipsing other aspects of their identity and to avoid being marginalized, looked down upon or having their skills as a “legitimate” physician called into question. Silence often isolates physicians from their peers and communities. Conclusions: Many physicians do not speak openly about abortion work, for reasons that reflect pervasive abortion stigma. We therefore identify a “legitimacy paradox”: As a result of abortion stigma, well-trained, competent physicians remain silent about their work, leading to a false impression that “legitimate” physicians do not do abortions.
307
Turok D, Ward K, Jacobson J Objective: This study evaluates the use of at-home administration of misoprostol prior to IUD insertion in nulliparous women. Methods: Nulliparous women requesting either the copper T380A or levonorgestrel IUD were randomized to receive misoprostol 400 mcg or placebo 3–4 h prior to IUD insertion. The primary outcome was provider ease of insertion recorded on a visual analogue scale (VAS) (anchors: 0=extremely easy, 100=impossible). Subjects completed questionnaires addressing pain using a validated VAS (anchors: 0=none, 100=worst imaginable) prior to insertion, immediately postinsertion and prior to clinic discharge. Results: Of the 107 women enrolled in the study, 54 received misoprostol and 53 received placebo. There was no difference in provider ease of insertion between the two groups (25.1 mm vs. 27.4 mm, respectively, p=.67). Women who received misoprostol had significantly higher pain scores prior to IUD placement (p=.003). The groups did not differ in perception of pain immediately following IUD insertion (58.4 mm, 56.9 mm, p=.74). There were two expulsions in the misoprostol group and none in the placebo group. Failed insertions, need for adjuvant pain medication and need for cervical dilation or US guidance did not differ between the two groups. Conclusions: Misoprostol does not improve provider ease of insertion or reduce perceived pain in nulliparous women prior to IUD insertion. Our data do not support the routine use of misoprostol prior to IUD insertion in nulliparous women.
O16 O18 THE EFFECT OF PARENTAL INVOLVEMENT LAWS ON THE TIMING OF TEENAGERS' ABORTIONS Judge S The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
ONE-YEAR CONTINUATION OF ETONORGESTREL CONTRACEPTIVE IMPLANT IN WOMEN WITH POSTABORTAL VS. INTERVAL PLACEMENT
Objectives: This study analyzes the impact of abortion restrictions known as “parental involvement laws.” These laws require a parent to be notified of or consent to a minor's decision to have an abortion, but permit minors to bypass the requirement under certain conditions. Given that abortions at later gestational ages tend to be more risky, costly and difficult to obtain, the study examines whether the laws are associated with significant delays in minors' abortions and, thus, the potential for a more problematic procedure. Methods: The study uses a regression discontinuity design to analyze individual-level data on abortions reported to the National Center for Health Statistics by selected states in years from 1978 to 1992. This design examines whether the effect of the “treatment” of the law is associated with a significant discontinuity — and, thus, a significant delay — between the predicted gestation of abortions obtained by minors and those obtained by adults. Results: In Rhode Island and Kansas, the laws were associated with significant delays of 3.3 and 5 days, respectively, for abortions received by all minors, as well as significant increases in the percentage of minors' abortions occurring at 12 or more weeks' gestation. Results from three states without the laws — Montana, Oregon and Vermont — showed no gestational delays in minors' abortions during the same time period. Conclusions: Parental involvement laws in Rhode Island, Kansas and other states with similarly worded provisions may contribute to delays in minors' abortions and to the percentage of those abortions occurring after 12 weeks' gestation.
Mark A Boston University, Boston, MA, USA Sonalkar S, Borgatta L Objectives: Women undergoing abortion have a demonstrated need for safe, effective birth control. Postabortal use of the etonorgestrel contraceptive implant has potential to decrease unintended pregnancy and repeat abortion; however, there is no information on discontinuation rates of the implant in this population. The aim of this study was to determine whether women having the implant placed in the immediate postabortal period have similar discontinuation rates to women with interval placement. Methods: This was a prospective cohort study of women who had the etonorgestrel contraceptive implant inserted at Boston Medical Center from 2008 to 2010. Women were enrolled at the time of insertion and followed for 12 months. Results: We enrolled 105 participants, 2 of whom were lost to follow-up. Overall, 26/103 participants (25.2%) discontinued their implant by 12 months, 16/51 (31.4%) in the postabortal group and 10/52 (19.2%) in the interval group. The unadjusted rate of discontinuation was slightly higher in the abortion than interval group, but the confidence interval crossed one (HR=1.79, 95% CI 0.81–3.96). Adjustment for possible confounders did not impact this association. Average days to discontinuation were longer in the postabortal subjects (186.1±94.5) than the interval subjects (129.2±73.1).
O17
THE “LEGITIMACY PARADOX” IN US ABORTION PROVISION Harris L University of Michigan, Ann Arbor, MI, USA
MISOPROSTOL VS. PLACEBO PRIOR TO IUD INSERTION IN NULLIPAROUS WOMEN: A RANDOMIZED CONTROLLED TRIAL
Debbink M, Martin L, Hassinger J
Swenson C University of Utah, Salt Lake City, Utah, USA
Objectives: Abortion is highly stigmatized. Abortion stigma prevents women from speaking openly about their abortions, leading to an impression that abortion is uncommon, when it is quite prevalent. Kumar et al. called this a “prevalence paradox.” We sought to explore the effects of stigma on physicians who perform abortions. Specifically, we wondered if stigma prevents physicians from speaking openly about their work and if a physician variant of the “prevalence paradox” exists. Methods: We conducted a qualitative national study of the Providers Share Workshop. Providers Share is a five-session group workshop for abortion caregivers intended to reduce the psychosocial burdens of abortion work. Workers at six sites across the US participated. Sessions were recorded, transcribed and analyzed for themes with the assistance of Nvivo. Results: We found that many physicians who perform abortions remain silent about their abortion work in social and professional circles. Silence is motivated by fear of becoming a target of violence; wishing to protect their children from judgment/harassment; and desire to avoid abortion work eclipsing other aspects of their identity and to avoid being marginalized, looked down upon or having their skills as a “legitimate” physician called into question. Silence often isolates physicians from their peers and communities. Conclusions: Many physicians do not speak openly about abortion work, for reasons that reflect pervasive abortion stigma. We therefore identify a “legitimacy paradox”: As a result of abortion stigma, well-trained, competent physicians remain silent about their work, leading to a false impression that “legitimate” physicians do not do abortions.
307
Turok D, Ward K, Jacobson J Objective: This study evaluates the use of at-home administration of misoprostol prior to IUD insertion in nulliparous women. Methods: Nulliparous women requesting either the copper T380A or levonorgestrel IUD were randomized to receive misoprostol 400 mcg or placebo 3–4 h prior to IUD insertion. The primary outcome was provider ease of insertion recorded on a visual analogue scale (VAS) (anchors: 0=extremely easy, 100=impossible). Subjects completed questionnaires addressing pain using a validated VAS (anchors: 0=none, 100=worst imaginable) prior to insertion, immediately postinsertion and prior to clinic discharge. Results: Of the 107 women enrolled in the study, 54 received misoprostol and 53 received placebo. There was no difference in provider ease of insertion between the two groups (25.1 mm vs. 27.4 mm, respectively, p=.67). Women who received misoprostol had significantly higher pain scores prior to IUD placement (p=.003). The groups did not differ in perception of pain immediately following IUD insertion (58.4 mm, 56.9 mm, p=.74). There were two expulsions in the misoprostol group and none in the placebo group. Failed insertions, need for adjuvant pain medication and need for cervical dilation or US guidance did not differ between the two groups. Conclusions: Misoprostol does not improve provider ease of insertion or reduce perceived pain in nulliparous women prior to IUD insertion. Our data do not support the routine use of misoprostol prior to IUD insertion in nulliparous women.
O16 O18 THE EFFECT OF PARENTAL INVOLVEMENT LAWS ON THE TIMING OF TEENAGERS' ABORTIONS Judge S The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
ONE-YEAR CONTINUATION OF ETONORGESTREL CONTRACEPTIVE IMPLANT IN WOMEN WITH POSTABORTAL VS. INTERVAL PLACEMENT
Objectives: This study analyzes the impact of abortion restrictions known as “parental involvement laws.” These laws require a parent to be notified of or consent to a minor's decision to have an abortion, but permit minors to bypass the requirement under certain conditions. Given that abortions at later gestational ages tend to be more risky, costly and difficult to obtain, the study examines whether the laws are associated with significant delays in minors' abortions and, thus, the potential for a more problematic procedure. Methods: The study uses a regression discontinuity design to analyze individual-level data on abortions reported to the National Center for Health Statistics by selected states in years from 1978 to 1992. This design examines whether the effect of the “treatment” of the law is associated with a significant discontinuity — and, thus, a significant delay — between the predicted gestation of abortions obtained by minors and those obtained by adults. Results: In Rhode Island and Kansas, the laws were associated with significant delays of 3.3 and 5 days, respectively, for abortions received by all minors, as well as significant increases in the percentage of minors' abortions occurring at 12 or more weeks' gestation. Results from three states without the laws — Montana, Oregon and Vermont — showed no gestational delays in minors' abortions during the same time period. Conclusions: Parental involvement laws in Rhode Island, Kansas and other states with similarly worded provisions may contribute to delays in minors' abortions and to the percentage of those abortions occurring after 12 weeks' gestation.
Mark A Boston University, Boston, MA, USA Sonalkar S, Borgatta L Objectives: Women undergoing abortion have a demonstrated need for safe, effective birth control. Postabortal use of the etonorgestrel contraceptive implant has potential to decrease unintended pregnancy and repeat abortion; however, there is no information on discontinuation rates of the implant in this population. The aim of this study was to determine whether women having the implant placed in the immediate postabortal period have similar discontinuation rates to women with interval placement. Methods: This was a prospective cohort study of women who had the etonorgestrel contraceptive implant inserted at Boston Medical Center from 2008 to 2010. Women were enrolled at the time of insertion and followed for 12 months. Results: We enrolled 105 participants, 2 of whom were lost to follow-up. Overall, 26/103 participants (25.2%) discontinued their implant by 12 months, 16/51 (31.4%) in the postabortal group and 10/52 (19.2%) in the interval group. The unadjusted rate of discontinuation was slightly higher in the abortion than interval group, but the confidence interval crossed one (HR=1.79, 95% CI 0.81–3.96). Adjustment for possible confounders did not impact this association. Average days to discontinuation were longer in the postabortal subjects (186.1±94.5) than the interval subjects (129.2±73.1).