Original research articleThe effectiveness of contraceptive counseling for women in the postabortion period: an intervention study
Introduction
Two thirds of the unintended pregnancies worldwide are due to the inadequate use of contraceptive methods or methods with high failure rates [1]. As a result, a large number of pregnancies end in abortion.
According to a report of the Ministry of Health in Brazil, a large proportion of women who have undergone abortion were using contraceptive methods, but its use was inconsistent and/or incorrect [2]. Because induced abortion in this country is only permitted when pregnancy is a result of rape or when it threatens a woman's life [3], most abortions are usually carried out clandestinely and under risky conditions. As a consequence, abortion has been considered one of the major causes of maternal mortality in Brazil [4].
Contraceptive counseling has been one of the actions recommended by the World Health Organization, aiming to reduce rates of unwanted pregnancies, unsafe abortions and maternal mortality [5]. A personalized and comprehensive counseling should include free and easy provision of contraceptive methods that may increase satisfaction and method compliance [6], [7], [8]. Furthermore, a personalized contraceptive counseling, in contrast to informational counseling, should motivate women to express and cope with their concerns, feelings, beliefs and expectations and contribute to their empowerment to make decisions about their sexuality and reproductive health [6], [9], [10].
The effectiveness of postabortion contraceptive counseling in promoting acceptance and adherence to the methods has been demonstrated [6], [7], [8]. However, in some developing countries that have counseling programs in the postabortion period, most of these programs are still substandard [5].
Randomized intervention trials in evaluating the effectiveness of personalized postabortion contraceptive counseling are still scarce, especially in developing countries [7]. Furthermore, the results of these studies are still controversial [7], [9], [11], [12].
We performed a prospective randomized trial to assess the effectiveness of personalized postabortion counseling on acceptability and use of contraceptive methods in low-income women from the northeast region of Brazil.
Section snippets
Study site
This study was conducted at the Centro de Atenção a Mulher at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), a teaching hospital located in the city of Recife, in the northeast of Brazil. The city of Recife is a major urban center and has a population of 1,561,659 inhabitants, with a Human Development Index of 0.797 [13], and 65% of the population are women in reproductive age [14]. In Recife, there is no family planning service exclusively for women in the postabortion
Results
Of the 310 women recruited, 246 agreed to participate and were randomly distributed into intervention (n=123) and control (n=123) groups. All the women who took part in the intervention group returned for follow-up after 6 months. Among the assigned women in the control group, four of them did not choose any method, and another four did not return for the follow-up, resulting in a loss of 6.5% (Fig. 1). Table 1 shows the sociodemographic characteristics and reproductive history of the study
Discussion
This is the first Brazilian trial evaluating the effectiveness of contraceptive counseling in women in the postabortion period. The results of this trial show that women who received individualized contraceptive counseling had greater acceptance and use of contraceptive methods and its correct use in the first 6 months after abortion compared with the control group. This study also showed that women in the intervention group were more likely to use the more effective and long-acting
Acknowledgment
We would like to thank IMIP for its support.
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2018, ContraceptionCitation Excerpt :The approach to discussing contraception in the abortion setting is not a universal standard [8–11]. Despite various counseling models, the effectiveness of contraception counseling to prevent subsequent unintended pregnancy has not been consistently proven [11–20]. A pilot survey-based study of 202 women seeking first-trimester surgical abortion in northern California showed that 65% of respondents did not want to discuss contraception at the time of abortion [21].
N<sup>o</sup> 360 - Avortement provoqué: avortement chirurgical et méthodes médicales au deuxième trimestre
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Comme bon nombre de femmes n'ont pas de rendez-vous de suivi, des méthodes contraceptives répondant aux besoins des patientes devraient être offertes avant un AP40,41. Un ECR a montré que le counseling contraceptif augmentait le recours aux contraceptifs après l'avortement, comparativement à l'absence de counseling42, mais le type de counseling et le moment où il devrait avoir lieu demeurent incertains43,44. Plusieurs ECR et études de cohortes ont montré que l'insertion d'un DIU immédiatement après un AC donnait lieu à un taux d'utilisation à long terme plus élevé et à un taux d'avortements répétés plus faible que le report de l'insertion d'un DIU ou le début immédiat d'une autre méthode contraceptive45–49.
No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods
2018, Journal of Obstetrics and Gynaecology CanadaThe promotion of intrauterine contraception in low- and middle-income countries: a narrative review
2017, ContraceptionCitation Excerpt :Two projects with particular emphases on IUDs, one in Malawi and the other in Thailand, showed high uptake of this method among HIV-positive women after counseling [9,12]. Nine publications, summarized in Table 2, concerned contraceptive counseling and provision following birth, abortion or miscarriage [16–24]. A major effort to provide postpartum IUD services in six countries, three in Asia and three in Africa, involved 330 hospitals in India and 78 health facilities (mainly hospitals) in the other countries.
Contraceptive use and the role of contraceptive counseling in reproductive-aged women with cancer
2014, ContraceptionCitation Excerpt :Furthermore, there is some evidence to support that cancer survivors may be at higher risk for unintended pregnancy compared to age-matched controls [16]. Several studies demonstrate the positive impact of contraceptive counseling on women's acceptance of contraception [17–19]. While some studies assess the impact of counseling in women with significant comorbidities [20,21], there is no discussion in the literature of the effect of contraceptive counseling in women with cancer.