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Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Department of Obstetrics and Gynecology in Eksjö, County Council of Jönköping.
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. Linköping University, Faculty of Medicine and Health Sciences.
Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping.
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2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 5, p. 565-571Article in journal (Refereed) Published
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Abstract [en]

IntroductionDespite high access to contraceptive services, 42% of the women who seek an abortion in Sweden have a history of previous abortion(s). The reasons for this high repeat abortion rate remain obscure. The objective of this study was to study the choice of contraceptive method after abortion and related odds of repeat abortions within 3-4 years. Material and methodsThis is a retrospective cohort study based on a medical record review at three hospitals in Sweden. We included 987 women who had an abortion during 2009. We reviewed medical records from the date of the index abortion until the end of 2012 to establish the choice of contraception following the index abortion and the occurrence of repeat abortions. We calculated odds ratios (OR) with 95% CI. ResultsWhile 46% of the women chose oral contraceptives, 34% chose long-acting reversible contraceptives (LARC). LARC was chosen more commonly by women with a previous pregnancy, childbirth and/or abortion. During the follow-up period, 24% of the study population requested one or more repeat abortion(s). Choosing LARC at the time of the index abortion was associated with fewer repeat abortions compared with choosing oral contraceptives (13% vs. 26%, OR 0.36; 95% CI 0.24-0.52). Subdermal implant was as effective as intrauterine device in preventing repeat abortions beyond 3 years. ConclusionsChoosing LARC was associated with fewer repeat abortions over more than 3 years of follow up.

Place, publisher, year, edition, pages
WILEY-BLACKWELL , 2016. Vol. 95, no 5, p. 565-571
Keywords [en]
Long-acting reversible contraception; post-abortion contraception; repeat abortion; subdermal implant; termination of pregnancy
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-128136DOI: 10.1111/aogs.12874ISI: 000374349400012PubMedID: 26871269OAI: oai:DiVA.org:liu-128136DiVA, id: diva2:929614
Note

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

Available from: 2016-05-19 Created: 2016-05-19 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, HelenaAlehagen, SiwBrynhildsen, Jan

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Faculty of Medicine and Health SciencesDivision of Nursing ScienceDepartment of Medical and Health SciencesDepartment of Gynaecology and Obstetrics in NorrköpingDivision of Clinical SciencesDepartment of Gynaecology and Obstetrics in Linköping
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