Impact of contraceptive counselling, an essential element of post-abortion care, on uptake of contraceptives: a cross-sectional study of adolescents who received post-abortion care services in Makueni County, Kenya

Background: Contraceptive counselling and provision of contraceptives are essential elements of the post-abortion care model which was first published in 1994 with an aim of promoting post-abortion care as an effective public health strategy. Despite being core elements of this model, they are often overlooked during provision of post-abortion care services as health care workers focus on emergency services and removing the retained products of conception. The aim of this study was to assess the impact of contraceptive counselling on uptake of contraceptives among adolescents presenting for post-abortion care.Methods: A cross-sectional study involving 100 adolescent girls who presented for post-abortion care at the Kibwezi-east sub-county hospital, Makueni county, Kenya. Self- administered questionnaires were used for data collection and data was analyzed using SPSS version 25. Chi-square was used to compare study participants who received/did not receive contraceptive counselling and their uptake of contraceptives.Results: The mean age of the 100 participants was 17 years (SD=1.457). 98% of them were formally educated, 57% had the mother as their only guardian and majority of them were of Christian religion (56%). 41% (n=41) received contraceptive counselling services and 59% (n=59) were not counselled. Among the 41 participants who received contraceptive counselling, 92% (n=37) of them took up a contraceptive method and 8% (n=4) did not take up any method and among the 59 participants who did not receive contraceptive counselling, 51% (n=30) of them took up a contraceptive method while 49% (n=29) did not.Conclusions: Contraceptive counselling remains an integral part of post abortion care and in this study it was found to have a positive correlation with utilization of post abortion contraceptives (rs=0.412, p=0.000).

How Does Contraceptive Use Affect Women’s Sexuality? A Novel Look at Sexual Acceptability

Among the components of a healthy life, sexuality is an essential part, contributing not only to psychophysical well-being, but also to the social well-being of women and, consequently to their quality of life. A poorly investigated standpoint is the acceptability of a contraceptive method, not only in terms of tolerability and metabolic neutrality, but also concerning the impact that it can have on sexual life. In this context, we will provide an overview of the different methods of contraception and their effects on female sexuality from the biological changes, to organic, social, and psychological factors, which can all shape sexuality.A MEDLINE/PUBMED review of the literature between 2010 and 2021 was conducted using the following key words/phrases: hormonal contraception, contraceptives, female sexual function, libido, sexual arousal and desire, and sexual pain. Recent studies have supported the effects of contraceptives on women’s sexuality, describing a variety of positive and negative events on several domains of the sexual function (desire, arous-al, orgasm, pain, enjoyment). However, satisfaction with sexual activity depends on factors that extend beyond sexual functioning alone. A more holistic approach is needed to better under-stand the multitude of factors linked to women’s sexuality and contraception. Contraceptive counselling must necessarily consider these important elements since they are closely related to good compliance.

Immediate IUD insertion after second trimester abortion: implications for service delivery

Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

Contraceptive counselling experiences in Spain in the process of creating a web-based contraceptive decision support tool: a qualitative study

Background The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. Methods/design Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects’ experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. Results In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. Conclusions Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment.

Talen en spiralen: kennis en besluitvorming in anticonceptieconsultaties met een taalbarrière

Misconception and contraception: knowledge and decision-making in contraceptive consultations with a language barrier Just like in general medical consultations, different domains of knowledge come together and are negotiated in contraceptive consultations, followed by decision-making on the contraceptive method. Research shows that a language barrier can hamper knowledge negotiation and decision-making in medical consultations. Our paper contributes to those findings by focussing on contraceptive counselling as a specific and underexplored consultation type. We gathered our data in a Belgian abortion clinic, where contraception is discussed during the consultations, and where an important part of the consultations are characterised by a language barrier. We adopt a Bourdieusian view on language as capital, and use a linguistic ethnographic and interactional sociolinguistic approach, complemented with analytical tools from conversation analysis on epistemics and deontics. The analysis of data fragments, ranging from a limited to a double language barrier, shows that this barrier is connected in various ways with how, and how much, knowledge is negotiated. Incomplete renditions, interruptions, epistemic and deontic claims from non-professional interpreters, along with a lack of shared contextualisation, impede clients to gather information and therefore influence decision-making. We conclude that a language barrier involves a potential risk for knowledge negotiation and decision-making in contraceptive consultations. More attention from healthcare professionals to language barriers could empower women in their sexual and reproductive health choices.

Understanding quality of contraceptive services from women’s perspectives in Gujarat, India: a focus group study

ObjectivesUnderstanding quality of contraceptive care from clients’ perspectives is critical to ensuring acceptable and non-harmful services, yet little qualitative research has been dedicated to this topic. India’s history of using incentives to promote contraceptive use, combined with reports of unsafe conditions in sterilisation camps, make a focus on quality important. The study objective was to understand women’s experiences with and preferences for contraceptive counselling and care in the public sector in India.DesignQualitative study using eight focus group discussions (FGDs). FGDs were thematically analysed using a framework approach.SettingRural and urban areas in one district in Gujarat.Participants31 sterilisation and 42 reversible contraceptive users who were married and represented different backgrounds. Inclusion criteria were: (1) female, (2) at least 18 years and (3) receipt of contraception services in the last 6 months from public health services.ResultsProviders motivate married women to use contraception and guide women to specific methods based on how many children they have. Participants found this common practice acceptable. Participants also discussed the lack of counselling about reversible and permanent options and expressed a need for more information on side effects of reversible methods. There were mixed opinions about whether compensation received for accepting long-term methods affects contraceptive decision making. While many women were satisfied with their experiences, we identified minor themes related to provider coercion towards provider-controlled methods and disrespectful and abusive treatment during sterilisation care, both of which require concerted efforts to address systemic factors enabling such experiences.ConclusionsFindings illuminate opportunities for quality improvement as we identified several gaps between how women experience contraceptive care and their preferences, and with ideals of quality and rights frameworks. Findings informed adaptation of the Quality of Contraceptive Counselling Scale for India, and have implications for centring quality and rights in global efforts.

“If we can show that we are helping adolescents to understand themselves, their feelings and their needs, then we are doing [a] valuable job”: counselling young people on sexual health in the Brook Advisory Centre (1965–1985)

First opened in 1964 in London, the Brook Advisory Centres (BAC) were the first centres to provide contraceptive advice and sexual counselling to unmarried people in postwar Britain. Drawing on archival materials, medical articles published by BAC members and oral history interviews with former counsellors, this paper looks at tensions present in sexual health counselling work between progressive views on young people’s sexuality and moral conservatism. In so doing, this paper makes two inter-related arguments. First, I argue that BAC doctors, counsellors and social workers simultaneously tried to adopt a non-judgmental listening approach to young people’s sexual needs and encouraged a model of heteronormative sexual behaviours that was class-based and racialised. Second, I argue that emotional labour was central in BAC staff’s attempt to navigate and smooth these tensions. This emotional labour and the tensions within it is best illustrated by BAC’s pyschosexual counselling services, which on the one hand tried to encourage youth sexual pleasure and on the other taught distinctive gendered sexual roles that contributed to pathologising teenage sexual behaviours and desire.In all, I contend that, in resorting to an emotionally orientated counselling, BAC members reconfigured for the young the new form of sexual subjectivity that had been in the making since the interwar years, that is, the fact that individuals regarded themselves as sexual beings and expressed feelings and anxieties about sex. BAC’s counselling work was as much a rupture with the interwar contraceptive counselling tradition—since it operated in a new climate, stressed a non-judgmental listening approach and catered for the young—as it was a continuity of some of the values of the earlier movement.

Vasectomy interest and awareness among patients and their partners in prenatal clinics in the United States

ObjectiveAlthough vasectomy is safer, more effective and less expensive than tubal ligation, rates of permanent contraception are consistently higher in women than in men. We sought to explore vasectomy interest and awareness in patients and their partners during prenatal visits, a time when contraceptive counselling is typically performed.MethodsAnonymous surveys were distributed between January and July 2019 to a cross-sectional, convenience sample of pregnant women and their partners, if available, presenting for outpatient prenatal care at two hospitals (one public, one private) serving different patient populations in Chicago, Illinois, USA. Survey questions gauged participant awareness and interest in vasectomies.ResultsSurveys were completed by 436 individuals (78% female, 24% male). Seventy percent of respondents indicated interest in vasectomy after achieving optimal family size, but most respondents had never discussed it with their healthcare provider. Factors associated with vasectomy interest included being partnered, having a lower household income, and knowing someone who has had a vasectomy. Almost 50% of respondents would be interested in obtaining information about vasectomies from their obstetrician or prenatal care provider.ConclusionsMany patients and their male partners in the prenatal clinic setting were interested in vasectomy as a method for permanent contraception, but most respondents had never received counselling. Since comprehensive prenatal care includes contraceptive planning, obstetric providers are uniquely positioned to educate individuals on vasectomy.