Increased contraceptive use one year post-abortion

Contraceptive counselling of women seeking abortion - a qualitative interview study of health professionals' experiences

OBJECTIVES

A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.

METHODS

We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

RESULTS

Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

CONCLUSIONS

HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

Contraceptive counselling to teenagers at abortion visits--a qualitative content analysis

OBJECTIVE

Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager.

METHODS

Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps.

RESULTS

Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up.

CONCLUSION

The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.

Contraceptive use among clients of the Atlanta Feminist Women's Health Center at three to five weeks post-abortion

Little is known about women's contraceptive use and sexual activity in the immediate post-abortion period although effective contraceptive use is paramount during this time because fertility returns almost immediately. This study sought to learn more about women's contraceptive use and sexual behaviors to inform abortion providers and help them serve their clients better, potentially leading to a decline in the rates of unintended pregnancy and repeat abortion. Abortion clients of an Atlanta, GA clinic were surveyed over the telephone 3-5 weeks post-abortion. Background information was collected from clinic medical charts. Simple and stratified frequencies and logistic regression were used to describe women's sexual activity and contraceptive use in the immediate post-abortion period and to determine if variables known at the time of the abortion could predict contraceptive use 3-5 weeks post-abortion. 54.2% (n = 39) of women had engaged in sexual intercourse in the immediate post-abortion period. Of these, 30.8% (n = 12) were not using a contraceptive method or were not using it effectively. Women who said they did not want or need information about birth control on their medical history form were less likely to be using contraception 3-5 weeks post abortion. Emphasizing the rapid return of fertility and risk of conception in pre-abortion counseling sessions could prevent future unintended pregnancies among abortion clients. Further research could explore the interaction between a willingness to talk about contraceptive methods at the time of abortion and method use post-abortion.

Role of induced abortion in attaining reproductive goals in Kyrgyzstan: a study based on KRDHS-1997

Estimates indicate that about 42 million pregnancies are voluntarily terminated every year at the global level, of which more than 80% occur in developing countries. Abortion has been one of the major reproductive health concerns in post-Soviet nations, especially when it is commonly used as a means of fertility regulation. On average, every woman has had around 1.6 abortions in Kyrgyzstan. This paper attempts to measure the role of abortion in fertility regulation using data from the Kyrgyz Republic Demographic and Health Survey (KRDHS), 1997. The analysis reveals that Kyrgyzstan can attain replacement level fertility in the absence of induced abortion by raising the contraceptive prevalence to 70% at the current level of effectiveness. The study also shows that women's attitude towards becoming pregnant and their partner's perception about abortion are significantly associated with the propensity to opt for an induced abortion. Reproductive health programmes need to address these issues, including the enhancement of male involvement in family planning.

Legislated right for donor-insemination children to know their genetic origin: a study of parental thinking

BACKGROUND

In Sweden, a child born as a result of donor insemination (DI) has the right to receive information both about the DI and the identity of the donor. The present study aimed to elucidate parents' thoughts regarding these possibilities, and whether, how and when they had told their offspring about the DI. An additional aim was to examine the parents' experiences of the attitudes of healthcare providers.

METHODS

A follow-up study using semi-structured telephone interviews with 19 couples, including 19 women and 17 men.

RESULTS

More than half of the parents (61%) had told all their child/ren about the DI, but almost everyone had told another person. Mean age for disclosure was 5 years for the first child. Reasons given for disclosure were to avoid accidental discovery, a desire for openness and a persons' fundamental right to know his/her genetic origin. Parents who did not intend to tell their child/ren considered DI a private matter and were afraid of other people's attitudes. Sixty-one percent of the parents had not yet told their children about the possibility of identifying the donor. Healthcare staff had impacted on the parents' thinking, and a majority of those who had been encouraged to tell their child/ren about the DI had done so.

CONCLUSIONS

There was a discrepancy between the intentions of the legislation and how parents act in relation to them. To improve compliance, it is crucial to organize education, support and ethical discussion among professionals, and to offer parents, and parents-to-be, counselling, support and group sessions with other DI families.

Contraception after medical abortion

OBJECTIVES

This study's objectives were to examine current evidence on contraception after abortion and to formulate guidelines for the use of different contraceptives after medical abortion based on current evidence.

METHODS

This study was based on review of published literature and guidelines on postabortion use of contraception.

RESULTS

Contraception needs to be initiated early following a first-trimester abortion. Postabortion family planning is an integral part of comprehensive abortion care. Concurrent contraception with surgical abortion has been found to be practical and effective, with high contraception usage following abortion. Most methods can be safely used following medical abortion and can be initiated either on the day of misoprostol administration (oral pills, condoms and injectable contraceptives) or after the next menstrual cycle (intrauterine device and sterilization).

CONCLUSION

With proper precautions, almost all contraceptive methods can be effectively used following medical abortion.