Contraceptive counselling for women with multiple unintended pregnancies: the abortion client’s perspective

Abstract

Objectives: Some women have multiple unintended pregnancies. Appropriate interventions could prevent some of the abortions that follow. This article presents the opinions of some abortion clients about their contraception and the counselling they received. It also formulates suggestions for counselling strategies of health care providers (HCPs) and other interventions that can support effective contraceptive behaviour.

Methods: A mixed method approach was used. A quantitative survey was carried out in one clinic in the Netherlands (N = 201), assessing topics related to contraceptive use and counselling. Semi-structured interviews (n = 11) were conducted with women who had had at least three unintended pregnancies. Interview topics included the type of contraceptive counselling, experience with contraceptive counselling and preferences regarding access to contraceptive information.

Results: Women who had had multiple abortions were more likely to express a need for contraceptive counselling and more often discussed contraception with their HCP compared with women who had had one abortion. Several themes emerged from the semi-structured interviews that had partially contributed to further unplanned pregnancies: experience with counselling, acceptability of the contraceptive method, sources of information and cultural influences. Many women with multiple unintended pregnancies could not find suitable advice and stated preferences for future decision making.

Conclusion: This study offers insight into the motives for contraceptive use of women with multiple unintended pregnancies. Contraceptive efficacy could be improved by implementing counselling that is adapted to individual needs. The respondents stated that they would appreciate other sources of information, such as support through other forms of communication. The formation of a working group would be helpful in developing these services.

Chinese abstract

目的：许多妇女有过多次意外妊娠。适当的干预措施可以防止一些后续流产。本文介绍了一些流产者关于避孕及她们接受到的咨询服务的意见。本文同时也为卫生保健提供者（HCPS）的咨询策略和其他的有助于有效避孕行为的干预措施提出建议。

方法：采用混合方法研究。定量研究在荷兰的一个诊所进行, 用于评估避孕方法应用和咨询的相关问题(N = 201)。半结构化访谈是针对至少发生过三次意外妊娠的妇女(n = 11)。访谈主题包括避孕咨询的形式, 避孕咨询的经历以及获得避孕信息途径的喜好。

结果：与仅有一次流产的女性相比, 有过多次流产的妇女更愿意表达对避孕咨询的需求, 也更多的和她们的HCPs讨论避孕问题。通过半结构化访谈, 对将来的意外妊娠起部分作用的一些因素显现出来, 包括：咨询经历, 避孕方法的可接受性, 信息来源和文化影响。许多有多次意外怀孕的妇女无法找到合适的避孕建议同时表达了对未来做出决定的优先选择。

结论：从这个研究可以了解到多次意外妊娠妇女避孕方法应用的动机。通过提供适合个人需求的避孕咨询可以提高避孕效果。受访者表示, 她们愿意接受其他来源的信息, 比如通过其它沟通形式的支持。工作组形式将有助于开发这些服务。

Keywords:

• Abortion
• abortion clients
• contraceptive counselling
• intervention mapping
• mixed method approach
• motivational interviewing
• prevention
• unintended pregnancy

Disclosure statement

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of this article.