Original research articleEffectiveness of preabortion counseling on postabortion contraceptive use
Introduction
Over the last several decades, the demand for abortion has been increasing, not least in the teenage population [1]. About one fourth of all abortions in Iceland occur among teenage women and half of all pregnancies among women aged 15–19 end in abortion [1]. These pregnancies are unwanted or mistimed, which indicates no or ineffective contraceptive use. The national abortion register shows that during 1976–1996, between 56 and 68% of the women in all age groups requesting abortion did not use any contraception around the time of conception [2]. A rise in the overall abortion rates over the last decades raises questions about availability, accessibility and quality of contraceptive services, especially for young people [2]. The quality of contraceptive services, especially counseling, has received little attention in Iceland. Until recently, contraceptive services for teenagers have not been prioritized and emergency contraception has not been made widely known or available [3], [4].
To counteract this, a team of healthcare professionals (a gynecologist, a nurse and a midwife) initiated, in 1997, the development of a contraceptive service for women who applied for abortion at Landspitali University Hospital in Reykjavik. The aim was to reach out to these women postabortion and provide them with improved counseling about contraception in order to facilitate their contraceptive use. Initially, it was not known if it was better to counsel women before, after or both before and after the abortion procedure. The main advantage of a preabortion service was considered to be the greater number of women who could be contacted, but the disadvantage was mainly the shortage of time because of admission interviews and the possibility of information overload. After the abortion, there was more time to provide information, at the cost of a higher drop-out rate.
There are few studies where the effectiveness of contraceptive counseling or client–provider interaction to improve contraceptive use has been evaluated [5], [6], [7], [8], [9], [10], [11], [12]. Only one of them [10] dealt with preabortion counseling and two were based on a randomized control trial design [6], [12]. One of those two studies showed effectiveness of contraceptive developmental counseling for adolescents [6], but the other study [12] among postpartum women showed no effect. Counseling about sexual and reproductive health, with emphasis on individual contraceptive needs, involves two-way communication. It is based on voluntary and informed decision-making and is supposed to enable the client to use contraception correctly [8], [13]. The aim of such counseling is to contribute to clients' satisfaction with the method of choice, which can lead to continued and successful method use [8], [14]. Few studies have focused on contraceptive counseling and even fewer have been based on randomized trial. The purpose of the present study was to evaluate the effectiveness of intensive preabortion contraceptive counseling on the postabortion contraceptive use among women and describe their contraceptive use after abortion.
Section snippets
Study design and procedure
Women who requested termination of a first-trimester pregnancy in the abortion clinic at Landspitali University Hospital in Reykjavik between April 1999 and May 2000 were asked to participate in a randomized trial. They were contacted a few days before the abortion when they attended for their booking visit. The clinic's daily lists were used to randomly assign the women to intervention and control groups by using random number tables. The study was explained to the participants and informed
Background characteristics
Random assignment to the two groups did not yield identical groups (Table 1). The two original groups were significantly different regarding age (p = 0.000), childbearing (p = 0.019) and previous abortions (p = 0.002). Women originally assigned to the intervention group were younger, had fewer children and fewer previous abortions compared to the original control group. Comparing the follow-up intervention and control groups showed again significant differences regarding age (p = 0.000) and
Discussion
The purpose of this study was to evaluate the effect of intensive contraceptive counseling and describe short-term contraceptive use after abortion. The results indicated that there was no difference in contraceptive use between those who had more detailed counseling compared to those who had routine information about contraception. The vast majority of the women in both groups started to use contraception after the abortion. Other studies have shown a similar percentage of contraceptive use
Acknowledgments
The authors would like to thank Ragnheidur I. Bjarnadottir, gynecologist, and Anna Gudny Bjornsdottir, midwife, who took part in the initial steps of this research project. Special thanks also to the nurses Heida Magnusdottir, Kristin Sigurdardottir and Ragnheidur Thorvaldsdottir who participated in the data collection. Orn Olafsson, mathematician/statistician, provided expert advice and assistance with statistical analysis.
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2016, ContraceptionCitation Excerpt :Around one third of women who have abortions in United Kingdom and half in the United States will go on to have a subsequent abortion [1,2]. Evidence varies regarding the impact of specialist contraceptive counselling at abortion on contraceptive uptake and rates of subsequent abortion [3–5], although evidence that long-acting reversible contraception (LARC) in particular can contribute to reducing subsequent unintended conceptions continues to grow [6–9]. It is thought that women having an abortion may be highly motivated to secure contraception, particularly LARC, and that this may also be a convenient time for them to do so [10,11].