Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive.

This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion.

Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13–3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25–34 vs. 15–24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use.

In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women’s pregnancy intention following an abortion is recommended, as well as a wide range of contraceptive methods, including long-acting reversible methods, even in restrictive abortion laws contexts.

Table 1

Demographic characteristics of all participants, of participants who used contraception, and of participants who reported a pregnancy. Sao Paulo, 2012

Variables	All participants		Participants who used contraception		Participants who reported pregnancy
	Time Point		Time Point		Time Point
	Month 1	Month 6	Month 1	Month 6	Endline
Mean age (years)	29.1 (7.4)	29.6 (7.3)	29.5 (6.8)	29.7 (7.4)	26.8 (6.9)
Mean age at first intercourse (years)	17.2 (2.9)	17.4 (2.9)	17.2 (3.1)	17.4 (2.8)	16.9 (1.9)
Mean age at first pregnancy (years)	21.7 (5.2)	21.9 (5.1)	22.0 (4.9)	21.7 (5.0)	20.7 (5.1)
Mean number of previous pregnancies	2.5 (1.4)	2.5 (1.4)	2.6 (1.4)	2.6 (1.5)	2.3 (1.1)
Mean educational level (years)	9.3 (2.5)	9.5 (2.5)	9.5 (2.6)	9.3 (2.6)	9.8 (1.4)
Color (%)
White	49.6	55.2	50.6	52.9	47.1
Brown	45.6	40.0	47.1	44.7	52.9
Black	4.8	4.8	2.3	2.4	-
Religion (%)
Catholic	43.5	43.8	46.0	45.9	35.4
Protestant	32.7	35.2	31.0	34.1	29.4
Other	6.1	5.7	6.9	5.9	17.6
None	17.7	15.3	16.1	14.1	17.6
Employed (%)	59.9	60.9	64.4	58.8	58.8
Current living with partner (%)	76.9	76.2	82.8	74.1	88.2
Desire to have more children (%)	66.7	66.7	70.1	66.5	76.5
Previous pregnancy plan (%)
Planned	29.9	31.4	29.9	27.1	41.2
Ambivalent	49.0	49.5	50.6	50.6	35.3
Unplanned	21.1	19.1	19.5	22.3	23.5
Total number of women	147	105a	87	85	17

Standard deviation (sd) in parentheses

anot included 17 women who reported a pregnancy

Below: Utilization of medical consultation and receipt of contraception counseling reported by study respondents over a 6-month period post-abortion, by month. Sao Paulo, 2012