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  • 1.
    Falk, G
    et al.
    Department of Obstetrics and Gynecology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Falk, L
    Department of Dermatology and Venereology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Hanson, U
    Department of Obstetrics and Gynecology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Milsom, I
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies2001In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 64, no 1, p. 23-27Article in journal (Refereed)
    Abstract [en]

    Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15-25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Orebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

  • 2.
    Falk, Gabriella
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology.
    Teenagers at risk for unintended pregnancies.2006Other (Other (popular science, discussion, etc.))
    Abstract [en]

      Licentiate thesis in Teenage Obstetrics and Gynecology to be publicly defended at a licentiate seminar in B-husets aula Örebro University Hospital, Örebro. Friday October 6, 2006.   

  • 3.
    Falk, Gabriella
    Linköping University, Department of Clinical and Experimental Medicine.
    Teenagers´unintended pregnancies and contraception2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure.

    Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period.

    Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion.

    Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion.

    In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’.

    Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.

     

    List of papers
    1. Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies
    Open this publication in new window or tab >>Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies
    2001 (English)In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 64, no 1, p. 23-27Article in journal (Refereed) Published
    Abstract [en]

    Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15-25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Orebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-52308 (URN)10.1016/S0010-7824(01)00225-6 (DOI)11535209 (PubMedID)
    Available from: 2009-12-15 Created: 2009-12-15 Last updated: 2017-12-12
    2. Teenage mothers - a high-risk group for new unintended pregnancies
    Open this publication in new window or tab >>Teenage mothers - a high-risk group for new unintended pregnancies
    Show others...
    2006 (English)In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, no 6, p. 471-475Article in journal (Refereed) Published
    Abstract [en]

    Introduction: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies. Purpose: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies. Methods: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Örebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained. Results: A total of 250 deliveries were recorded, 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group. Conclusion: This study shows that teenagers giving birth constitute a high-risk group for future unintended pregnancies and legal abortion. © 2006 Elsevier Inc. All rights reserved.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-37186 (URN)10.1016/j.contraception.2006.07.014 (DOI)33893 (Local ID)33893 (Archive number)33893 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    3. Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis
    Open this publication in new window or tab >>Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis
    2009 (English)In: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, ISSN 1473-0782, Vol. 14, no 5, p. 357-364Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager. METHODS: Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps. RESULTS: Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up. CONCLUSION: The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-52310 (URN)10.3109/13625180903171815 (DOI)000277147800006 ()19916762 (PubMedID)
    Available from: 2009-12-15 Created: 2009-12-15 Last updated: 2010-05-20
    4. Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?
    Open this publication in new window or tab >>Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?
    2010 (English)In: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, ISSN 1362-5187, Vol. 15, no 4, p. 271-279Article in journal (Refereed) Published
    Abstract [en]

    Objective: To study experiences with contraceptives of teenagers at an out-patient abortion clinic and to explore the reasons behind their choices.

    Methods: Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

    Results: One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Influences on contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

    Conclusion: The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was not satisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to start using it. Friends and the Internet were the main sources for acquiring information.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2010
    Keywords
    Contraception, Abortion, Contraceptive counselling, Contraceptive failure, Teenagers, Qualitative content analysis, Tonåringar, oplanerade graviditeter, preventivmedel, abort, innehållsanalys
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-56477 (URN)10.3109/13625187.2010.493623 (DOI)000280900400007 ()
    Projects
    Doktorsavhandling
    Available from: 2010-05-18 Created: 2010-05-18 Last updated: 2011-01-12
  • 4.
    Falk, Gabriella
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ivarsson, Ann Britt
    School of Health and Medical Sciences, rebro University, rebro, Sweden.
    Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis2009In: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, ISSN 1473-0782, Vol. 14, no 5, p. 357-364Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager. METHODS: Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps. RESULTS: Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up. CONCLUSION: The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.

  • 5.
    Falk, Gabriella
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Ivarsson, Ann-Britt
    University of Örebro.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?2010In: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, ISSN 1362-5187, Vol. 15, no 4, p. 271-279Article in journal (Refereed)
    Abstract [en]

    Objective: To study experiences with contraceptives of teenagers at an out-patient abortion clinic and to explore the reasons behind their choices.

    Methods: Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

    Results: One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Influences on contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

    Conclusion: The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was not satisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to start using it. Friends and the Internet were the main sources for acquiring information.

  • 6.
    Falk, Gabriella
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Östlund, Ingrid
    Magnusson, Anders
    Schollin, Jens
    Nilsson, Kerstin
    Teenage mothers - a high-risk group for new unintended pregnancies2006In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, no 6, p. 471-475Article in journal (Refereed)
    Abstract [en]

    Introduction: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies. Purpose: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies. Methods: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Örebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained. Results: A total of 250 deliveries were recorded, 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group. Conclusion: This study shows that teenagers giving birth constitute a high-risk group for future unintended pregnancies and legal abortion. © 2006 Elsevier Inc. All rights reserved.

  • 7.
    Palmquist, Moa
    et al.
    Linköping University, Faculty of Medicine and Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Falk, Gabriella
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Organisation of contraceptive care and attitudes among healthcare providers in two Swedish cities with different socio-demographic profiles2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 170-180Article in journal (Refereed)
    Abstract [en]

    Objective To compare contraceptive services provided by family planning clinics in Linkoping and Norrkoping in Ostergotland County, Sweden. The two cities are of similar size but have different socio-demographic profiles. The abortion rate in Link ping (15.3 per 1000) is substantially lower than in Norrkoping (21.1 per 1000). Methods The study was performed in two steps. First, the clinics providing contraceptive services in the two cities were studied using ten pre-defined quality indicators. Thereafter, 11 healthcare providers were interviewed: six in Linkoping and five in Norrkoping. The interviews were analysed using qualitative content analysis. Results No differences were found in the organisation of contraceptive care in the two cities. Neither city met the criteria for five of the ten quality indicators. The analysis of the interviews generated four themes: Guidelines and electronic record template, Criteria for good contraceptive counselling, Availability of contraception, and Sexual health. The interviews revealed that the clinical leadership in Norrkoping was insuffincient. Conclusion Clinics in the two cities are organised in the same way so that differences in abortion rates cannot be related to differences in organisation. The reasons for the differences in abortion rates in the two cities have yet to be determined.

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