J Gynecol Obstet Hum Reprod. 2017 Mar;46(3):255-259

High abortion rate in Martinique (F.W.I.) in spite of a large contraceptive availability. What are the determinants?

Vergnaud L, Volumenie JL and Bonnier C

Abstract

Introduction: Despite a similar health insurance coverage and access to contraception, Martinique F.W.I. has a higher rate of abortion than continental France (25.6 versus 15.3 per thousand respectively). The reasons are still largely unknown. A different contraceptive pattern, a lower use of emergency contraception in Martinique may be involved. We sought to explore the contraceptive pattern, to evaluate the use of emergency contraception and the reasons leading to an unwanted pregnancy among women seeking for an abortion.

Material and methods: An anonymous cross-sectional survey about the contraceptive use in the year and in the month before abortion, the use of emergency contraception and the reasons why, to patients' point of view, they became pregnant albeit not willing it was proposed to women seeking for an abortion in the dedicated unit of the university hospital of Martinique.

Results: Six hundred patients were included. A total of 83.7% of patients declared having a regular contraceptive use during the year preceding. Just before abortion, 61.1% of women had no contraception or a low reliable method (fertility awareness, withdrawal...). Lack of recognition of pregnancy risk was the main reason leading to abortion, accounting for 51.1% of cases, explaining a low use of emergency contraception (13.8%), whereas a difficult access to contraception was rarely quoted. Emergency contraception was used in 27.8% of relevant situations.

Conclusions: Insufficient estimation of pregnancy risk is the main reason leading to unwanted pregnancy. Availability of emergency contraception does not reduce the risk.

Comment: Sometimes one wonders why a woman with good access to contraception, still finds herself with an unplanned pregnancy. This paper elegantly describes how education about reproduction and contraception must also include teaching about the risk of pregnancy after unprotected intercourse in all phases of the cycle. (HMV)