INTRODUCTION
Globally there is a continued high unmet need for contraception.1 Long-acting reversible contraceptives (LARC) such as the intrauterine device (IUD) are one of the most effective ways to plan and space pregnancies but women face numerous barriers to access.2-6 In South Africa, two out of three women have had an unplanned pregnancy in the previous five years with only 1.6% reportedly using an IUD.7
The availability of contraception, including LARC, is a fundamental part of post-abortion care.8 Clinical trials have shown that the use of the IUD is higher after immediate compared to delayed insertion, after surgical and medical abortion in the first trimester, and after dilatation and evacuation in the second trimester, but that expulsion rates are often higher.9-11 The evidence is conflicting with respect to immediate or early post-partum insertion after vaginal delivery, with expulsion or removal rates varying between 3% and 47%, but in most contexts the benefits of immediate contraception were found to outweigh the risks.12-14
It remains unclear whether the IUD can be effectively inserted after medical abortion (MA) in the second trimester.15 To our knowledge no studies have evaluated the risk-benefit of immediate insertion of the IUD after MA at 17-20 gestational weeks (GW) where higher cumulative dose of the uterotonic misoprostol is often needed.