A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial
Introduction
In the United States, 21–27% of women experience a repeat pregnancy within 12 months after abortion, and 11–15% have a repeat abortion within one to three years after abortion [1], [2]. In the European Union, 20–60% of abortions are performed for women with a history of a prior abortion [3]. Immediate provision of long-acting reversible contraceptives (LARC), which include intrauterine devices (IUDs) and contraceptive implants, reduces rates of repeat pregnancy within one year after abortion [4], [5], [6], [7], [8]. Several trials have investigated contraception counseling at the time of abortion, but most have not shown an increase in contraceptive uptake [9], [10]. However, a recent cluster randomized controlled trial (RCT) demonstrated increased LARC uptake among women attending both family planning and abortion clinics in which multiple interventions to increase LARC uptake occurred including counselor training about LARC [11]. Thus, it appears that contraception counseling training can have an effect on LARC uptake at the abortion visit.
Motivational interviewing (MI) is a patient-centered counseling style that aims to create a collaborative relationship between counselor and patient. MI uses skills such as open-ended questioning, reflective listening, empathic statements, and exploration of ambivalence to elicit a patient’s intrinsic motivation for behavior change. MI counselors support patients to build confidence and self-efficacy, encouraging patients to design their own plans to change. The spirit of MI recognizes that people are “the undisputed experts on themselves,” and counselors avoid arguing for change [12]. Studies of women’s contraceptive decision-making preferences have found that women strongly value autonomy but appreciate provider input and expertise [13], [14]. Thus, a collaborative and non-coercive style of counseling, such as MI, may represent an approach that aligns well with women’s preferences for contraceptive decision-making.
The primary aim of this study was to determine the effect of an MI-based intervention on young women’s use of LARC after abortion. We hypothesized that more women in the intervention group would start a LARC method within 4 weeks of the abortion procedure, including immediate same-day initiation, compared to a control group receiving non-standardized counseling.
Section snippets
Study procedures
This RCT was a 1:1 parallel group pilot trial of an MI-based contraception counseling intervention, conducted at an urban academic center. English speaking women aged 15–29 years presenting for abortion were eligible. Women requesting abortion for fetal or maternal medical indications, with pregnancy resulting from sexual assault, or with a desire for repeat pregnancy within 6 months were not eligible. We obtained written informed consent from all eligible and interested participants prior to
Results
The study was conducted from June to November 2013 (Fig. 1). The majority of participants was non-Hispanic Black and single with annual household income of less than $30,000. Participants presented to clinic with a median gestational age of 58 days. At baseline, participants in the control arm were more likely to have an annual income of less than $10,000. Participants in the control group were less likely to identify a LARC method as their intended postabortion method of contraception. The two
Discussion
This pilot randomized controlled trial found a large and significant increase in LARC uptake among women who were randomized to receive the MI-based contraception counseling intervention compared to non-standardized counseling. Use of LARC three months after the abortion was also significantly higher in the intervention group. Results of this study also suggest that MI-based contraception counseling may positively impact satisfaction with contraceptive methods. Additionally, almost all
Conflict of interest
The authors report no conflicts of interest.
Financial support
This study was funded by National Institutes of Health (NIH) grant 5 K23HD067403. The NIH played no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Ms. Martins’ efforts on manuscript preparation were funded, in part, by the University of Minnesota’s Center for Leadership Education in Maternal and Child Public Health (US- DHHS/HRSA T76-MC00005; Hellerstedt, PI).
Use of REDcap for
Acknowledgement
None.
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- 1
Present affiliation: The University of Minnesota, School of Public Health, Division of Epidemiology and Public Health, Minneapolis, MN, USA.
- 2
Present affiliation: Planned Parenthood of Illinois, Chicago, IL 60603, USA.