Unplanned pregnancy and contraceptive use in Hull and East Yorkshire.

OBJECTIVE: This study has two aims. The first is to assess the proportion of unplanned pregnancies among women attending antenatal clinics (ANCs) and those undergoing induced abortion (IA). The second is to assess both their previous contraceptive use and contraceptive intention, with particular focus on the use or consideration of any long-acting reversible contraceptives in Hull and East Riding in order to inform service redesign. STUDY DESIGN: Consecutive women attending their first ANC appointment and women attending a gynecology clinic undergoing IA were asked to complete a two-page questionnaire that contained a validated pregnancy intendedness questionnaire [the London Measure of Unplanned Pregnancy (LMUP)] and questions to establish contraceptive use and access prior to this index pregnancy. RESULTS: The overall response rate was 69%. We received 648 evaluable questionnaires for women undergoing IA. Of these pregnancies, 75.8% [95% confidence interval (CI), 72.3%-79.0%] were unplanned (LMUP, score 0-3). We received 1001 evaluable questionnaires from women booking at ANCs. Of these pregnancies, 5.5% (95% CI, 4.2%-7.0%) were unplanned. Among those with unplanned pregnancies who were not using contraception, 31% reported that they were unable to obtain the method they wanted. Among those using a method immediately prior to the index unplanned pregnancy, 33% stated that it was not the method they wanted; of these, 75% would have preferred sterilization, the implant, injectable or intrauterine contraceptive. CONCLUSION: Unplanned pregnancies in this population are common among women undergoing IA but are uncommon among women attending an ANC. About a third of women not using contraception reported that they were unable to obtain the method they wanted, and about a third of women using contraception stated that they were not using the method they would have preferred. IMPLICATIONS: Opportunities to prevent unplanned pregnancies are missed when staff in primary and secondary care looking after women do not knowledgeably inform, discuss and offer contraception in a timely manner, particularly the most effective long-acting reversible contraceptive methods. Services should be deliverable where women are: this includes within pregnancy care services. Seeking patient experience is an essential component of service redesign.

Reasons provided for requesting a termination of pregnancy in the U.K.

OBJECTIVE: To determine the main reasons for termination of pregnancy (TOP) requests in a UK city. DESIGN: A survey requesting reasons for a pregnancy termination from women attending a TOP clinic. SETTING: A TOP pre-assessment clinic in Hull and East Yorkshire Hospitals, UK. POPULATION: A cohort of pregnant women requesting a TOP in the first trimester. METHODS: A confidential, anonymous, self-administered questionnaire requesting demographic information about age, education, ethnicity and marital status. The questionnaire also asked for the main reasons underlying the TOP request. The main outcome measures were (1) reasons for TOP requests and (2) correlations between the reasons provided and demographic characteristics. RESULTS: A total of 274 women participated in the study and 527 reasons were given. The most common reason was money worries (21.0%) followed closely by contraception failure (20.5%). The third most common reason was the anticipated effect on education or the woman's career (14.6%) Over half (59.5%) of the women were single and 8.8% were divorced or separated. Twenty-eight per cent of the respondents were aged 21 years and below, 36.1% were aged 22-29 years and 29.2% were over 30 years of age. CONCLUSIONS: The main reasons for TOP requests included financial constraints, contraceptive failure, completion of family, and potential interruption of education or career. These reasons differed with age groups and marital status. Focused qualitative research on reasons for a TOP will provide further knowledge and understanding that is needed to enable optimal service provision and policy planning.