Contraceptive counselling of women seeking abortion – a qualitative interview study of health professionals’ experiences

Abstract

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.

Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

Results: Three clusters were identified: ‘Complex counselling’, ‘Elements of counselling’ and ‘Finding a method’. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

Chinese abstract

目的：有相当比例的女性流产后没有使用有效的避孕方式。随后许多人发生了反复非意愿妊娠。因此, 本研究的目的是辨别和描述卫生专业人员的经验, 为寻求流产的女性提供避孕辅导。

方法：我们访谈了21位健康专家（health professionals , HPs）, 在瑞典三家不同规模医院对寻求流产女性进行避孕咨询。访谈逐字记录后使用常规的定性内容分析。

结果：三个组群被确定：复杂情结咨询, 元素咨询和方法寻求。HPs经常经历一些流产当时的复杂性情结咨询, 包括终止妊娠和避孕咨询, 一些脆弱的女性更加需要卫生专业人员提供咨询。HPs在提供避孕咨询时通过自己对一定避孕方法的认识提供不同的避孕方法。HPs描述了如果女性已经找到了有效的方法, 在流产后植入宫内节育器时具有挑战性。

结论：HPs发现在流产时提供避孕咨询和流产后使用宫内节育器具有一定的挑战性。为了阻止反复性非意愿妊娠有必要改善他们的辅导、技巧和知识。

Keywords:

• Contraception
• decision-making
• family planning
• pregnancy termination
• prevention
• providerś perspective
• repeat abortion

Acknowledgements

The authors would like to thank the respondents for sharing their experiences.

Disclosure statement

Jan Brynhildsen has been reimbursed by Merck Sharpe & Dohme (MSD), Bayer AB Sweden and Actavis for running educational programs and giving lectures. All other co-others have stated that there are no conflicts of interest in connection with this paper.

Funding

This work was supported by Futurum – the academy for healthcare, in the Jönköping County Council [No. 306501]; The Medical Research Council of Southeast Sweden (FORSS) [No. 467241].