OBJECTIVES: The abortion rate varies greatly within the French overseas territories including the Caribbean island of Guadeloupe and La Réunion in the Indian Ocean. We compare women's contraceptive paths surrounding an abortion in both territories. METHODS: The data for this study are part of a nationally representative survey of women undergoing abortion in France in 2007. The analysis included 1,211 women from Guadeloupe and 1531 from La Réunion. RESULTS: Results show differences in women's use of contraception before the abortion by study location. Women in Guadeloupe were more likely not to have used contraception in the month they conceived (40% vs. 32%, p < 0.0001). Among those using no contraception or less effective contraception before the abortion, 74% in Guadeloupe and 86% in La Réunion received a prescription for a very effective method such as a hormonal method or intrauterine device after the procedure. In both settings, women with no health insurance or a government health plan were 70% less likely to have received a prescription for a very effective method. CONCLUSIONS: While this study shows a significant increase in the prescription of very effective methods, it also indicates the ineffectiveness of the health care system in closing the gap in the pre-abortion contraceptive disparities observed between Guadeloupe and La Réunion.