Synopsis
Offer immediate voluntary contraception while identifying reproductive coercion, abuse and exploitation through confidential, proportionate safeguarding that preserves access and autonomy.
- Ask whether contraception information is wanted and offer the full reversible range on the same day; accepting a method is never a condition for receiving abortion care.
- Fertility can return rapidly, so methods started at the abortion or within five days generally provide immediate protection under current guidance.
- An implant can be inserted on the day of surgical abortion or when mifepristone is taken; oral, patch and most other hormonal methods can also start immediately.
- Insert an intrauterine method at surgical abortion or as soon as possible after medical expulsion when completion is confirmed and infection is not suspected.
- Intramuscular DMPA may be given with mifepristone, but explain the small possible increase in ongoing-pregnancy risk and ensure completion follow-up.
- Do not use depot medroxyprogesterone in a patient with current or previous meningioma. Seek expert individualised advice before any hormonal method because tumour type and evidence differ; an implant or another hormonal method may also be inappropriate.
- Discuss effectiveness, bleeding, side effects, privacy, contraindications, return to fertility and STI protection in a non-directive way that supports the patient's priorities.
- See every patient alone for part of the assessment and ask about safety, coercion, partner age and power, assault, exploitation and control of reproductive decisions.
- Confidentiality applies to young people, but share information proportionately when law or serious-harm prevention requires it; explain and document the decision when safe.
Key red flags
An accompanying person answering questions, controlling the phone or medicines, refusing private consultation or threatening consequences suggests coercive control and requires a safe private assessment.
Pregnancy in a child under 13 always requires urgent safeguarding escalation; a marked age or power gap, payment, exploitation, trafficking, assault or a partner in a position of trust also requires an immediate proportionate response.
The patient appears to be forced either to terminate or continue the pregnancy; both are forms of reproductive coercion and can invalidate apparent voluntariness.
A method that can be discovered or controlled by an abusive partner may increase danger, so confidentiality, packaging, records and follow-up contact must be planned explicitly.
Homelessness, unsafe housing, learning disability, language barriers or lack of phone access can make home treatment or later contraception follow-up unsafe without additional support.
Investigation priorities
Identify medical conditions, medicines and preferences that change safe method options.
Management branches
The patient wants to discuss contraception during abortion care.
- Ask about effectiveness, bleeding, hormones, privacy, fertility timing and method control, then check medical eligibility without steering toward long-acting contraception.
- Provide the chosen method on the abortion day or at the earliest safe post-expulsion time, using bridging contraception when an intrauterine appointment is delayed.
- Explain onset of protection, side effects, completion follow-up, STI prevention and how to switch or remove the method without needing to justify the request.