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Induced Abortion in a Population Entitled to Free-of-Charge Long-Acting Reversible Contraception

Gyllenberg, Frida K., MD; Saloranta, Tuire H., MD; But, Anna, MSc; Gissler, Mika, MSocSci, PhD; Heikinheimo, Oskari, MD, PhD

doi: 10.1097/AOG.0000000000002966
Contents: Contraception: Original Research

OBJECTIVE: To study the rate of induced abortion in a population in whom long-acting reversible contraceptive (LARC) methods are offered free of charge as part of primary health care services.

METHODS: We conducted a register-based cohort study on females aged 15–44 years in the city of Vantaa, Finland. We assessed the rate of abortion among females entitled to LARC methods free of charge by survival analysis in four cohorts: those visiting public family planning clinics and initiating free-of-charge LARC methods during 2013–2014 (LARC cohort, n=2,035); those visiting public family planning clinics not choosing LARC methods (no LARC cohort, n=7,634); and three age-matched control participants for every LARC and no LARC participant from the general population not using the services (nonservice users, n=5,981 and 22,748). The patients were followed up by means of Finnish national registers until February 28, 2016.

RESULTS: During the 78,500 woman-years accumulated, altogether 996 patients in Vantaa underwent an abortion (12.3 abortions/1,000 woman-years, 95% CI 11.6–13.1). Of these, 16 abortions occurred in the LARC cohort (3.9/1,000, 95% CI 2.4–6.0), 243 in the no LARC cohort (15.3/1,000, 95% CI 13.5–17.2), and 737 (12.6/1,000, 95% CI 11.7–13.5) among matched nonservice users. The adjusted abortion rate in the LARC cohort was 80% lower than in the no LARC cohort (risk ratio [RR] 0.20, 95% CI 0.11–0.32) and 74% lower than among their matched control participants (RR 0.26, 95% CI 0.15–0.43). In contrast, there was no difference in the abortion rate between the no LARC cohort and the control participants (adjusted RR 1.01, 95% CI 0.87–1.18).

CONCLUSION: When providing a population with free-of-charge LARC methods, the abortion rate was markedly lower among patients initiating free-of-charge LARC compared with patients using the services but not initiating a LARC method. Programs of this kind could be of major importance in populations with high rates of unintended pregnancy.

The rate of induced abortion is markedly lower among females initiating free-of-charge long-acting reversible contraception compared with patients using family planning services who did not initiate such methods.

Departments of Obstetrics and Gynecology, General Practice and Primary Health Care, and Public Health, University of Helsinki, the Helsinki University Hospital, and the National Institute for Health and Welfare (THL), Helsinki, and the City of Vantaa, Vantaa, Finland; and the Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden.

Corresponding author: Oskari Heikinheimo, MD, PhD, Naistenklinikka Hospital, PO Box 140, 00029 HUS, Finland; email:

Supported by research funds from the Hospital District of Helsinki and Uusimaa, used for salary for authors F.K.G. and T.H.S. Author F.K.G. received grants from Finska Läkaresällskapet and The Finnish Association for General Practice. The funders had no role in study design, writing of the report, or in the decision to submit the report for publication.

Presented at the 15th Congress of the European Society of Contraception and Reproductive Health, May 9–12, 2018, Budapest, Hungary; and at the 13th International Federation of Professional Abortion and Contraception Associates Conference, September 14–15, 2018, Nantes, France.

Financial Disclosure Dr. Saloranta has received payments for lectures from Novartis and Bayer. Dr. Heikinheimo serves occasionally on advisory boards for Bayer AG, Exelgyn SAS, Gedeon Richter, Sandoz A/S, and Vifor Pharma and has designed and lectured at educational events of these companies. The other authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available at

Received July 23, 2018

Received in revised form August 27, 2018

Accepted August 29, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.