Effectiveness of peri-abortion counselling in preventing subsequent unplanned pregnancy: a systematic review of randomised controlled trials

Stewart, H. C.; McCall, Steve; McPherson, C. K.; Towers, Lucinda C; Lloyd, B.; Fletcher, Jack Μ.; Bhattacharya, Sohinee

doi:10.1136/jfprhc-2014-101096

Cited by 22 publications

(18 citation statements)

References 22 publications

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“…Peri‐abortion information‐giving alone does not appear to influence uptake of LARC or risk of further unplanned pregnancy; it should be part of a pathway to facilitate access to and initiation of contraception.…”

Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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“…No trials found substantial effects, and the pooled odds ratios for subsequent unplanned pregnancy, uptake of LARC, and method continuation at 3 months were non-significant. None of trials reported a solid theoretical foundation in their intervention development [24]. In one of the few studies to report a theoretical framework for intervention development, Davidson et al used a used a video intervention designed specifically to increase immediate LARC uptake after abortion.…”

Section: Discussionmentioning

confidence: 99%

A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial

Whitaker

Quinn

Munroe

et al. 2016

Patient Education and Counseling

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Objective To determine if a counseling intervention using the principles of motivational interviewing (MI) would impact uptake of long-acting reversible contraception (LARC) after abortion. Methods We conducted a pilot randomized controlled trial comparing an MI-based contraception counseling intervention to only non-standardized counseling. Sixty women 15-29 years-old were randomized. Primary outcome: uptake of LARC within four weeks of abortion. Secondary outcomes: uptake of any effective contraceptive, contraceptive use three months after abortion and satisfaction with counseling. Bivariate analysis was used to compare outcomes. Results In the intervention arm, 65.5% of participants received a long-acting method within four weeks compared to 32.3% in the control arm (p=0.01). Three months after the abortion, differences in LARC use endured (60.0% vs. 30.8%, p=0.05). Uptake and use of any effective method were not statistically different. More women in the intervention arm reported satisfaction with their counseling than women in the control arm (92.0% vs. 65.4%, p=0.04). Conclusion Twice as many women in the MI-based contraception counseling intervention initiated and continued to use LARC compared to women who received only non-standardized counseling. Practice Implications A contraception counseling session using the principles and skills of motivational interviewing has the potential to impact LARC use after abortion.

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“…The approach to discussing contraception in the abortion setting is not a universal standard [8][9][10][11]. Despite various counseling models, the effectiveness of contraception counseling to prevent subsequent unintended pregnancy has not been consistently proven [11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%