Trial of Immediate Versus Delayed Initiation of Transdermal Hormonal Contraception After Therapeutic Abortion

• compare use of patch after abortion between study arms [ Time Frame: six months after enrollment/abortion ] [ Designated as safety issue: No ]
  we will also describe what participants were using two months post-abortion
  
  

• describe post abortion contraception use, side effects and patient satisfaction [ Time Frame: six months post enrollment ] [ Designated as safety issue: No ]
  Secondary outcome will describe contraception use, side effects and patients satisfaction between each study arm as well as the study sample as a whole at two and six months post-enrollment (enrollment is same day as abortion)
  
  
• Bleeding patterns on OCPs after abortion [ Time Frame: assessed at two months post enrollment ] [ Designated as safety issue: No ]
  patients are asked at the two month follow-up what about bleeding patterns in the first couple of weeks after their abortion
  
  
• Satisfaction with OCPs after abortion [ Time Frame: six months post-enrollment ] [ Designated as safety issue: No ]
  

The United States has a higher rate of unintended pregnancy than Canada or any other developed nation in Europe. Hormonal contraception is the most common method of contraception used in this country. Perfect use can lead to failure rates as low as 0.1% per year. Actual failure rates are much higher, often due to non-compliance with contraception use. Several recent studies have examined the "Quick Start", or initiation of hormonal contraception (OCPs and patch) in front of the provider while still at the clinic, regardless of time in the cycle. These studies have shown that women who placed the first patch in the clinic were more likely to continue the patch into the second month. Women who are seen in clinics for a therapeutic abortion (TAB) are often at extremely high risk for another unintended/unwanted pregnancy. If compliance in patch use could be improved in this group of women, unintended/unwanted pregnancy rates could be reduced. One concern about the "Quick Start" technique is that women may have already ovulated or conceived when the patch is initiated mid-cycle. In the post-abortal setting, this is not a concern. Applying the "Quick Start" technique to post-abortion patients and having women place the first patch while still in the clinic after their abortion may improve compliance and continuation of patch use.

This is a prospective, randomized, controlled trial in post-abortal women, and will last approximately 24 months. All of the study subjects will receive a month's worth of the patch and a one-year prescription after their TAB. The women in the immediate start arm will then place their first patch in the clinic, observed by clinic staff, before leaving. The controls will be instructed to place the first patch on the first Sunday following their abortion. All subjects will receive the same medication with the only difference being the timing of initiation of the patch. Measurements of continuation will be determined by telephone interviews administered at two and six months after the subjects' abortion.