Plain English Summary
Background and study aims
Women resident in the boroughs of Lambeth, Southwark and Lewisham experience some of the highest rates of unplanned pregnancies, abortions and repeat abortions in the UK. This situation could be due to poor uptake and continuation of effective contraception after abortion. We believe that there is a gap between provision of abortion care and effective post-abortion care which needs to be improved. Our study is designed to see if specialist support provided to women during the few months following an abortion to help them with their contraception could reduce unplanned pregnancies and repeat abortions in the near future. The aim of this study is to see if specialist support after abortion helps women with their use of contraception to prevent unplanned pregnancies in future.
Who can participate?
Patients undergoing abortion under the National Health Service (NHS) in Lambeth, Southwark and Lewisham (London, UK).
What does the study involve?
If you do decide to take part you will be asked to sign a consent form and we will collect some personal information, e.g. date of birth, ethnicity, postcode, education, relationship status, number of previous pregnancies, contraception used. You will be allocated by chance to either the standard care group or the specialist support group. Everyone has an equal chance of being in either group; you will not be allowed to choose and will not be told which group you have been assigned to at the time of enrolment into the study. This ensures that both groups are similar, so that if there are any differences between how the groups do, we know it will be due to the specialist support. If you are placed in the standard care group, your follow-up care after abortion will remain the same as is current standard practice. You will be given full information about contraceptive choices available and where to access them. If you are placed in the specialist support group, in addition to standard contraceptive care, you will be offered a consultation with a contraception specialist doctor/nurse from King’s College Hospital. At 2-4 weeks after your abortion you will attend a telephone or face-to-face clinic appointment lasting about 30 minutes. During this consultation, the specialist will try to help you choose a contraceptive method that suits you or help you with any problems you may have with a contraceptive method you are already using. If you miss your appointment we will ring you to offer another suitable appointment. 3 months after your abortion, you will receive a telephone call from the research doctor/nurse lasting about 15 minutes to address any problems you may have with your chosen method of contraception and offer help with changing the method if you wish. Both groups will receive a telephone follow-up lasting about 15 minutes with the research doctor/nurse 6 months after their abortion to see how they are doing with their contraception. We will also be studying routinely collected data on abortions to see if there are any repeat abortions in the study participants during the 2-year period following the abortion. This will not involve you as we do not need to contact you after the telephone call at 6 months.
What are the possible benefits and risks of participating?
If you are allocated to the specialist support group , you will have the opportunity to have a specialist nurse contact you to discuss contraception. We hope that this will be helpful to everyone, as you may want to ask her questions, and receive advice on where you can go to get contraception, and in some case be referred to a specialist doctor. If you are allocated to the standard care group the benefits to you are less, but you will have the opportunity to speak with the specialist nurse at 6 months after your abortion. You will be asked questions about your contraceptive method and have the opportunity to ask questions to the specialist nurse yourself if you wish. This study will help us find out if specialist support helps women to effectively use contraception and prevent further unplanned pregnancy. If such follow-up specialist support proves to be beneficial, we will make recommendations for this to be made standard practice. There have been no risks identified from participating in this study. All information which is collected about you during the course of the research will be kept strictly confidential. However, there will be limits to confidentiality should something of concern be disclosed. If you agree to join the study, the data collected for the study will be looked at by authorised persons from the research team.
Where is the study run from?
Camberwell Sexual Health Centre (UK).
When is the study starting and how long is it expected to run for?
From October 2011 to July 2015.
Who is funding the study?
London Sexual Health Programme (UK).
Who is the main contact?
Dr Usha Kumar
Dr Usha Kumar
Department of Sexual Health
Camberwell Sexual Health Centre
King’s College Hospital NHS Foundation Trust
100 Denmark Hill
Randomised controlled study of the impact of provision of follow-up contraceptive support to women who have had an abortion
PACS (Post-Abortion Contraception Support)
Compare the effect of a specialist intervention to provide contraceptive support following abortion with that of the existing arrangement of ad-hoc follow-up.
On 11/12/2014 the following changes were made to the trial record:
1. The target number of participants was changed from 743 to 569. Recruitment was slower than anticipated and ceased at 569 patients on 28/02/2013 due to withdrawal of two recruitment centres from the study.
2. The overall trial end date was changed from 31/03/2014 to 01/07/2015.
First MREC, 22/03/2011, ref: 11/H0709/1
Randomised interventional trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
The intervention will be in the form of a structured follow-up consultation with a specialist in a Reproductive and Sexual Health service either by telephone or a face-to-face clinic appointment depending on patient preference, 2-4 weeks after the abortion to discuss contraception and a telephone follow-up 3 months after to provide further contraceptive support. Women will be offered the opportunity to bring their male partners to the follow-up appointment if they wish for participation in contraceptive counseling. Those who Do Not Attend (DNA) their 2-4 week appointment will be contacted by telephone to identify reason for DNA and will be offered another suitable appointment for a telephone consultation or face-to-face clinic appointment with the specialist. We hope that this intervention will facilitate uptake of reliable methods of contraception and their continuation, ultimately intended to lower repeat abortion rates.
UK Sample Size: 743; However, recruitment was slower than anticipated and ceased at 569 patients on 28/02/2013 due to withdrawal of two recruitment centres from the study.
Based on abortion data for Lambeth, Southwark and Lewisham residents in 2009, there were 2885 NHS abortions at BPAS, 1725 at Marie Stopes International (MSI) and 748 in King's College Hospital. From this data, we can deduce the average of number of abortions at 3 months as: 721 (54%) abortions at BPAS, 431 (32%) at MSI and 187 (14%) at King's College Hospital with a total number of abortions for all three centres estimated as 1339.
Based on published papers (Schunmann et. al), there was 68% uptake of long-acting reversible contraception (LARC) or contraceptive pills at 4 months following abortion; we have assumed the same at 6 months post-abortion. 34.84% refused to participate in the above study; we have used 35% refusal to participate for sample size calculation. There was 61.5% follow-up rate at 4 months in the above study. We have used 60% follow-up rates at 6 months for sample size calculation.
Description: Specialist contraceptive follow-up support will be provided 2-4 weeks and 3 months post-abortion to patients randomised to the intervention arm. Both arms will be contacted at 6 months post-abortion to obtain information on contraceptive uptake and continuation.
Follow Up Length: Data on repeat abortion data at 1 and 2 years post-abortion will be obtained for all participants using data-linkage from routinely collected abortion data from Department of Health.
Primary outcome measures
Six-month post-abortion contraceptive uptake and continuation
Secondary outcome measures
Repeat abortion at 1 and 2 years
Overall trial start date
Overall trial end date
Participant inclusion criteria
Patients undergoing abortion under the National Health Service (NHS) in Lambeth, Southwark and Lewisham (London, UK) who have consented to participate in the study
Target number of participants
Participant exclusion criteria
1. Patients who do not speak English
2. Patients who will be leaving the country for 6 months after the abortion and hence will not be available for the follow-up appointments or telephone follow-ups
3. Patients who lack capacity to consent for themselves
4. Patients who attend for the pre-abortion consultation but do not go ahead with the abortion
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Department of Sexual Health
Camberwell Sexual Health Centre King’s College Hospital NHS Foundation Trust 100 Denmark Hill
London Sexual Health Programme (UK)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
To be confirmed at a later date
Intention to publish date
Participant level data
Not expected to be available
Results - basic reporting