Quality statement 3: Contraception after an abortion

Quality statement

Women who request an abortion discuss contraception with a healthcare practitioner and are offered a choice of all methods when they are assessed for abortion and before discharge.

Rationale

Ensuring women can make an informed choice about contraception following an abortion will reduce the risk of future unplanned pregnancies. Having the opportunity to discuss contraception when they are being assessed for an abortion will give them time to consider all the options. Further discussion before discharge from the abortion service can help ensure timely access to contraception.

Quality measures

Structure

a) Evidence of local processes to ensure that women discuss contraception and all contraceptive methods with a healthcare practitioner when being assessed for an abortion.

Data source: Local data collection.

b) Evidence of local processes to ensure that a healthcare practitioner offers women a choice of all contraceptive methods before discharge from an abortion service.

Data source: Local data collection.

Process

a) Proportion of women who discuss contraception and all contraceptive methods with a healthcare practitioner at an assessment for abortion.

Numerator – the number in the denominator who discuss contraception and all contraceptive methods with a healthcare practitioner.

Denominator – the number of women having an assessment for abortion.

Data source: Local data collection.

b) Proportion of women who are offered a choice of all contraceptive methods before discharge from an abortion service.

Numerator – the number in the denominator who are offered a choice of all contraceptive methods before discharge.

Denominator – the number of women discharged from an abortion service.

Data source: Local data collection.

Outcome

a) Uptake of long-acting reversible contraception at the time of abortion.

Data source: Local data collection.

b) Contraception uptake rate after abortion.

Data source: Local data collection.

c) Women who have more than 1 abortion.

Data source: Local data collection. The Department of Health's Abortion statistics include data on repeat abortions.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers (including secondary care, community genitourinary medical and private sector services) establish protocols to ensure that healthcare practitioners discuss contraception and all contraceptive methods with women at their assessment for abortion and before discharge. Service providers offer women a choice of all contraceptive methods before discharge. If contraceptives are not provided at discharge, service providers ensure that referral pathways to a contraceptive service are in place.

Healthcare practitioners (including GPs, hospital doctors and nurses) discuss contraception and all contraceptive methods with women at their assessment for an abortion and before discharge. Healthcare practitioners offer women a choice of all contraceptive methods before discharge. If contraceptives are not provided at discharge, they offer to refer women to a contraceptive service.

Commissioners (clinical commissioning groups) ensure that abortion services discuss contraception and all contraceptive methods with women at their assessment for an abortion and before discharge. Commissioners ensure that abortion services offer women a choice of all contraceptive methods before discharge, or offer a referral to a contraceptive service if contraceptives are not provided. Commissioners could consider a local performance indicator for abortion services to improve uptake of contraception at discharge.

What the quality statement means for women

Women who plan to have an abortion are offered the chance to discuss contraception with a healthcare practitioner during assessment for their abortion and again before they are discharged. They are offered a choice of all contraceptive methods before they are discharged or referral to a contraceptive service if contraception is not provided.

Source guidance

Definitions of terms used in this quality statement

Discussion about contraception

When discussing contraception, emphasise that women are fertile immediately after an abortion and give details of all contraceptive methods including:

  • how the method works

  • how to use it

  • how it is administered

  • insertion and removal (for implants and IUDs)

  • suitability

  • how long it can be used for

  • risks and possible side effects

  • failure rate

  • non-contraceptive benefits

  • when to seek help.

[Adapted from NICE's guidelines on contraceptive services for under 25s and long-acting reversible contraception and expert opinion]

All contraceptive methods

This quality standard focuses on all methods of contraception. These are divided into 3 groups:

Long-acting reversible contraceptives that need administration less than once per month. These are:

  • contraceptive implant

  • contraceptive injection

  • intrauterine system (IUS)

  • intrauterine device (IUD).

[Adapted from NICE's guideline on long-acting reversible contraception]

Methods that depend on the person remembering to take or use them. These include:

  • contraceptive vaginal ring

  • contraceptive patch

  • combined oral contraceptive pill

  • progestogen-only pill

  • male condom

  • female condom

  • diaphragm or cap with spermicide

  • natural family planning.

Permanent methods of contraception. These are:

  • vasectomy

  • female sterilisation.

[Adapted from the Faculty of Sexual & Reproductive Healthcare guidelines on barrier methods for contraception and STI prevention, fertility awareness methods, progestogen-only pills and combined hormonal contraception]

Equality and diversity considerations

Age, religion and culture may affect which contraceptive methods the woman considers suitable. When discussing contraception, healthcare practitioners should give information about all methods and allow the woman to choose the one that suits her best.

If a healthcare practitioner's beliefs do not let them supply contraception, they should ensure that the woman can see another practitioner as soon as possible.