Nurse with client

After ruling out the presence of any medical conditions that may affect medical eligibility (see Appendix D – Medical Eligibility Criteria for Contraceptive Use), the following methods may be started immediately.

Contraceptive First-trimester medical/surgical abortion Second-trimester medical/surgical abortion Special considerations
Reversible methods (in order of effectiveness)
Intrauterine device (IUD) Can insert at the time success of abortion is determined Can insert at the time success of abortion is determined, but insertion must be done by a specially trained person Avoid after septic abortion


Progestin-only injectables

Combined injectable contraceptives (monthly)

Combined patch

Combined ring

Combined oral contraceptives

Progestin-only pills

Can start immediately after abortion; in the case of medical abortion, can start immediately after the first pill of the medical abortion regimen Self-administration of injectable can be considered

and cap
Can start immediately after abortion Wait for 6 weeks  
Irreversible (permanent) methods
Female sterilization Can have this surgery immediately after abortion The decision to have this surgery must be made in advance of the abortion

Additional considerations:

  • IUD insertion immediately after a second-trimester abortion is associated with a higher risk for expulsion, which the woman should be informed about, and the insertion requires a specially trained provider.
  • The option of self-administration of injectable contraception in the post-abortion period should be offered to women as an alternative to provider-administered injections (see Teaching Clients to Self-inject, in Chapter 4 – Progestin-Only Injectables).
  • If pills are the chosen method, provide up to 1 year’s supply of pills, depending on the woman’s preference and anticipated usage.
  • Sterilization is permanent and must be decided upon in advance of the abortion, and not while a woman is sedated, under stress, or in pain. Counsel carefully and be sure that the client understands they have the option to choose a reversible method (see Because Sterilization Is Permanent, in Chapter 12 – Female Sterilization).
  • Clients who choose to initiate the contraceptive ring should be instructed to check for expulsion in the event of residual or heavy bleeding during/after the medical abortion process.
  • The diaphragm must be refitted after uncomplicated first-trimester miscarriage or abortion. After uncomplicated second-trimester miscarriage or abortion, refitting of the diaphragm should be delayed 6 weeks to allow the uterus to return to normal size.
  • Fertility awareness-based methods (FABs): A woman can start symptoms-based methods once she has no infection-related secretions or bleeding due to injury to the genital tract. She can start calendar-based methods with her next monthly bleeding, if she is not having bleeding due to injury to the genital tract (see Chapter 18 – Fertility Awareness Methods, in particular the sections on Providing Calendar-Based Methods and Providing Symptoms-Based Methods).

Help Women Obtain Family Planning