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Womens experiences of contraceptive counselling in the context of an abortion - An interview study
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Eksjo Nassjo Hosp, Sweden.ORCID iD: 0000-0003-1588-135X
Jonkoping Univ, 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.
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 103-107Article in journal (Refereed) Published
Abstract [en]

Objective: To identify and understand womens lived experiences of contraceptive counselling given at the same time as abortion counselling. Methods: We interviewed 13 women aged 20-39 who had experienced an abortion and the related counselling. The women were recruited from five hospitals in Sweden. Interviews were analysed using an interpretative phenomenological approach. Results: We identified two themes: need for respectful counselling and needs for guidance and access to contraceptives. The essence "Being in a state of limbo and feeling sceptical" was coalesced from the themes. The women described a state of limbo, as being caught in an unwanted and emotionally charged situation. They reported that respectful counselling and meeting a skilled health professional helped to dispel their scepticism and influenced their plans for contraceptive use post abortion. Furthermore, women who wanted an intrauterine device described difficulties in access post abortion. Conclusion: The women seem to have a limited receptivity to contraceptive counselling when they have an unwanted pregnancy and are sceptical about contraceptives. Women, who experience respect in the counselling, report being helped in contraceptive decision-making. To receive respectful counselling and to have good access to intrauterine devices emerged as central needs among women at the time of an abortion.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2018. Vol. 17, p. 103-107
Keywords [en]
Accessibility; Contraception; Family planning; Intrauterine device; Pregnancy termination; Respect
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-152074DOI: 10.1016/j.srhc.2018.07.007ISI: 000445980700018PubMedID: 30193713OAI: oai:DiVA.org:liu-152074DiVA, id: diva2:1258313
Note

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

Available from: 2018-10-24 Created: 2018-10-24 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)
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Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2018-11-26Bibliographically approved

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Kilander, HelenaBerterö, CarinaBrynhildsen, JanAlehagen, Siw
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Division of Nursing ScienceFaculty of Medicine and Health SciencesDivision of Children's and Women's healthDepartment of Gynaecology and Obstetrics in Linköping
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