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.