liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Contraceptive counselling of women seeking abortion - a qualitative interview study of health professionals experiences
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Eksjo Nassjo Hospital, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Jönköping University, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
Show others and affiliations
2017 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 22, no 1Article in journal (Refereed) Published
Abstract [en]

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 professionalg 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.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2017. Vol. 22, no 1
Keywords [en]
Contraception; decision-making; family planning; pregnancy termination; prevention; providers perspective; repeat abortion
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-136329DOI: 10.1080/13625187.2016.1238892ISI: 000394925200002PubMedID: 27689407OAI: oai:DiVA.org:liu-136329DiVA, id: diva2:1087913
Note

Funding Agencies|Futurum - the academy for healthcare, in the Jonkoping County Council [306501]; Medical Research Council of Southeast Sweden (FORSS) [467241]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-11-26
In thesis
1. Contraceptive counselling in abortion care
Open this publication in new window or tab >>Contraceptive counselling in abortion care
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Improving women’s knowledge about contraception, and their access to contraceptive methods, is central in order to strengthen their sexual and reproductive rights at the time of an abortion. Contraceptive counselling aims to support women’s reproductive control and prevent unintended pregnancies (UPs). It is unclear, however, how to provide contraceptive counselling and how to organise services at the time of an abortion, in order to achieve this.

Aim: The overall aim was to study women’s choices and use of contraceptive methods post-abortion. The research also aimed to describe contraceptive counselling in the context of an abortion from women’s and health professionals’ (HP’s) perspectives. Initial studies informed subsequent improvement efforts, also evaluated in the thesis, regarding contraceptive counselling and services at the time of an abortion.

Design and Methods: The studies in this thesis involve both quantitative (studies I and IV) and qualitative (studies II–IV) methods, performed at six departments in southeast Sweden. Study I had a quantitative and longitudinal design. The medical records of women (n=987) were reviewed regarding women’s choice of contraceptive method at the index abortion and the odds of repeat abortion within three to four years. Studies II and III were qualitative interview studies, in which 13 women (study II) and 21 healthcare professionals (HPs) (study III) described their experiences of contraceptive counselling at the time of an abortion. The interviews were analysed using interpretive phenomenology (study II) and conventional content analysis (study III). Study IV was a case study regarding a qualitative improvement collaborative (QIC), designed to improve contraceptive counselling and services. Three multi-professional teams involved in abortion care participated in the QIC and two women provided user-experience input. Both qualitative and quantitative data were collected and analysed.

Results: The findings of the thesis are organised into three themes: I) Women and HPs described contraceptive counselling at the time of an abortion as an often - complex meeting. There was scepticism about contraceptive methods and limited receptivity to information among women. Respectful counselling facilitated women’s choice of contraceptive method even if they were sceptical and found the situation emotionally charged. II) Women’s choices, need for guidance and access to the contraceptive methods was described in the second theme. Choice of oral contraceptives (OC) dominated. Overall, 25% of the women experienced repeat abortion during followup. Women who chose long-acting reversible contraception (LARC) experienced fewer repeat abortions compared to women who chose OC. Both women and HPs reported barriers in access to LARC post-abortion. III) In a Quality Improvement Collaborative (QIC), two volunteering women provided user-experience input. HPs participating in this QIC reported strengthened skills in counselling and enhanced ability to evaluate their performance. Despite the team’s prediction that they would reach the QIC goal that ≥50% of women would start LARC within 30 days post-abortion, and the fact that a majority of the women in QIC units chose LARC, none of the teams managed to reach the goal, primarily due to insufficient capacity for timely initiation of LARC.

Conclusion: The findings suggest that women need respectful counselling and guidance at the time of an abortion. Access to a range of contraceptive methods, particularly LARC, is important to prevent repeat UPs. There is room for further improvement in offering coordinated and timely access for women who choose LARC, and to evaluate counselling, in the present settings.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 106
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1631
Keywords
Accessibility, Oral contraceptives, Collaboratives, Long Acting Reversible Contraception, Prevention, Repeat abortion, Respect, Reproductive control, Unintended pregnancy
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-152875 (URN)10.3384/diss.diva-152875 (DOI)9789176852644 (ISBN)
Public defence
2018-11-23, Qulturum, Länssjukhuset Ryhovs, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2018-11-26Bibliographically approved

Open Access in DiVA

fulltext(178 kB)146 downloads
File information
File name FULLTEXT01.pdfFile size 178 kBChecksum SHA-512
b2a9e77500430726717ac39913f68583675ccd3d17e4a6df908abd8c198085f0244a711b8aad4a9ba95abff9569eb180cfb0fd5fa70bbc3bd5a5f524d958d290
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Kilander, HelenaSalomonsson, BirgittaBrynhildsen, JanAlehagen, Siw
By organisation
Division of Nursing ScienceFaculty of Medicine and Health SciencesDivision of Children's and Women's healthDepartment of Gynaecology and Obstetrics in Linköping
In the same journal
European journal of contraception & reproductive health care
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 146 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 67 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf