Elsevier

Contraception

Volume 84, Issue 4, October 2011, Pages 377-383
Contraception

Original research article
The effectiveness of contraceptive counseling for women in the postabortion period: an intervention study

https://doi.org/10.1016/j.contraception.2011.02.003Get rights and content

Abstract

Background

Brazilian women who have undergone abortion use contraceptive methods; however, their use of contraceptive methods is inconsistent and/or inappropriate.

Study Design

This randomized trial evaluated the effectiveness of a personalized counseling on contraceptive acceptability and its use for postabortion women in the northeast of Brazil. It was conducted in July 2008 to September 2009, enrolling 246 women randomly distributed in intervention (n=123) and control (n=123) groups. An intention-to-treat analysis was performed.

Results

In the follow-up, 98.4% women in the intervention group were using contraceptive methods compared with 70.6% women in the control group (p<.001). The probability of adherence and of the use of any kind of contraceptive method 6 months after the abortion was 41% greater in the intervention group.

Conclusions

The strategy on individualized contraceptive counseling increased the acceptance and the use of contraceptive methods and increased the adequate use of the methods.

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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