Follow-Up Rates And Contraceptive Choices After Medical Abortion In Adolescents At Cook County Hospital

Abstract Study Objective To determine follow-up rates for adolescent patients undergoing medical abortion in comparison to adult patients, identify patient factors associated with follow-up, and evaluate contraceptive choices at the time of follow-up. Design Setting and Participants: A retrospective cohort study of adolescent patients (ages 15-19) undergoing first-trimester medical abortions at John H. Stroger, Jr. Hospital of Cook County from 2014 through 2017. Interventions None Main Outcome Measures Rate of follow-up after medical abortion, demographic factors associated with higher follow-up rates, and contraceptive choices by adolescents at follow-up encounters. Results During the study period, 8,111 medication abortions were performed in our clinic. Adolescents accounted for 5.5% of these patients (446/8111=5.5%). Among adolescents, the follow-up rate was 51.8% (231/446). We determined the follow-up rates among a random sample of patients ages 20 to 24 (n=494) and 25 to 39 (n=397) to be 43.1% (213/494), and 40.5% (161/397), respectively. African American adolescents were significantly less likely to follow-up when compared to their Hispanic and white counterparts (RR 0.76, 95% CI 0.66-0.89). Those enrolled in college were significantly more likely to follow-up when compared to those who reported lower levels of education (RR 1.4, 95% CI 1.0-1.9). Only 2.5% of adolescents reported ever using a tier 1 contraception option before presenting for an abortion and among those that did follow-up, only 18% chose a tier 1 option for ongoing pregnancy prevention. Conclusions Approximately half of our adolescent study population is at risk for undetected failed medical abortion and subsequent unplanned pregnancy.