Follow-up Rates and Contraceptive Choices after Medical Abortion in Adolescents at Cook County Hospital

Study Objective: To determine follow-up rates for adolescent patients who underwent medical abortion compared with adult patients, identify patient factors associated with follow-up, and evaluate contraceptive choices at the time of follow-up. Design, Setting, and Participants: A retrospective cohort study of adolescent patients (ages 15-19 years) who underwent first-trimester medical abortions at John H. Stroger, Jr. Hospital of Cook County from 2014 through 2017. Interventions: None. Main Outcome Measures: Rate of follow-up after medical abortion, demographic factors associated with higher follow-up rates, and contraceptive choices by adolescents at follow-up encounters. Results: During the study period, 8111 medication abortions were performed in our clinic. Adolescents accounted for 446 of these patients (446/8111; 5.5%). Among adolescents, the follow-up rate was 231/446 (51.8%). We determined the follow-up rates among a random sample of patients ages 20-24 years (n = 494) and 25-39 years (n = 397) to be 213/494 (43.1%), and 161/397 (40.5%), respectively. African American adolescents were significantly less likely to follow-up compared with their Hispanic and white counterparts (relative risk, 0.76; 95% confidence interval, 0.66-0.89). Those enrolled in college were significantly more likely to follow-up compared with those who reported lower levels of education (relative risk, 1.4; 95% confidence interval, 1.0-1.9). Only 2.5% of adolescents reported ever using a tier 1 contraception option before presenting for an abortion and among those who did follow-up, only 18% chose a tier 1 option for ongoing pregnancy prevention. Conclusion: Approximately half of our adolescent study population is at risk for undetected failed medical abortion and subsequent unplanned pregnancy.