Contraceptive Counselling In Abortion Care

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.

The objective of this guideline is to present the complete set of all WHO recommendations and best practice statements relating to abortion. While legal, regulatory, policy and service-delivery contexts may vary from country to country, the recommendations and best practices described in this document aim to enable evidence-based decision-making with respect to quality abortion care. This guideline updates and replaces the recommendations in all previous WHO guidelines on abortion care.

The Clinical practice handbook for safe abortion care is intended to facilitate the practical application of the clinical recommendations from the second edition of Safe abortion: technical and policy guidance for health systems (World Health Organization [WHO] 2012). While legal, regulatory, policy and service-delivery contexts may vary from country to country, the recommendations and best practices described in both of these documents aim to enable evidence-based decision-making with respect to safe abortion care.

The main aim of this practical Handbookis to strengthen counselling and communication skills of skilled attendants (SAs) and other health providers, helping them to effectively discuss with women, families and communities the key issues surrounding pregnancy, childbirth, postpartum, postnatal and post-abortion care. Counselling for Maternal and Newborn Health Careis divided into three main sections. Part 1 is an introduction which describes the aims and objectives and the general layout of the Handbook. Part 2 describes the counselling process and outlines the six key steps to effective counselling. It explores the counselling context and factors that influence this context including the socio-economic, gender, and cultural environment. A series of guiding principles is introduced and specific counselling skills are outlined. Part 3 focuses on different maternal and newborn health topics, including general care in the home during pregnancy; birth and emergency planning; danger signs in pregnancy; post-abortion care; support during labor; postnatal care of the mother and newborn; family planning counselling; breastfeeding; women with HIV/AIDS; death and bereavement; women and violence; linking with the community. Each Session contains specific aims and objectives, clearly outlining the skills that will be developed and corresponding learning outcomes. Practical activities have been designed to encourage reflection, provoke discussions, build skills and ensure the local relevance of information. There is a review at the end of each session to ensure the SAs have understood the key points before they progress to subsequent sessions.

Pregnancy and Abortion Counselling is written for professionals who give information and support to women deciding whether to terminate or continue with their pregnancy. The authors provide a comprehensive review of the social, moral and legal issues surrounding contraception and abortion and offer clear guidelines for establishing good practice. Illustrated throughout with case examples the book includes detailed information on * current legislation * methods of abortion * stages of foetal development * screening for foetal abnormality * client confidentiality and consent * ethical considerations This book is relevant to many health professionals, including doctors, health visitors, midwives and nurses as well as those involved in community work and counselling.

There was a growing concern in the 1970s about the number of unwanted pregnancies and the problems these posed for parents, children and society. Originally published in 1977, this was the first book which, with extensive reference to research material and illustrative case studies, provided a comprehensive analysis of the social and psychological background to unwanted pregnancy and a guide to ways of helping the people concerned. It should still be useful to doctors, nurses, midwives, teachers, social workers, and other professional and lay people whose work brings them into contact with those who are unhappy about a pregnancy. Juliet Cheetham, whose previous contributions to the problem areas of social welfare are widely respected, discusses the different meanings of unwanted pregnancy, and goes on to explore its relationship to the changing position of women; to the role of the contemporary family; to the special problems experienced by natural children and their parents; to existing social and medical provisions. She examines the possibilities, risks and limitations of the various responses to unwanted pregnancy and the services available at the time, and analyses the difficulties men and women experience in using contraception. Juliet Cheetham shows how the beliefs and attitudes of lay and professional people can influence their understanding of, and response to, these highly controversial and emotional subjects. She offers suggestions about the ways in which this influence may be appropriately modified, and the book concludes with a discussion of the special opportunities and problems of counselling those faced with an unwanted pregnancy.

In today's contentious political environment surrounding abortion, clinicians, counselors and social workers need a clear framework for providing skilled, compassionate decision counseling. They need help working with the hard stuff: "What do I do when my patient asks me if God will forgive her?" or "What do I say when a woman says that she feels like she's killing her baby?" These are the questions asked by clinicians and mental health professionals everywhere; these are also the questions for which this book offers answers. The fields of healthcare and counseling psychology have long-awaited a manual for conducting pregnancy decision counseling across the spectrum of patient issues, employee skill levels, and clinic resources. Using case examples, individual and group exercises, guided self-reflection, and values clarification, the reader will develop the necessary skills to provide compassionate and informed pregnancy decision counseling. This book will define the gold standard for decision assessment and counseling for all pregnancy options and will be cited as the definitive guide for learning, teaching, and providing high-quality, compassionate counseling in abortion and family planning clinics nationwide.

At a UN General Assembly Special Session in 1999, governments recognised unsafe abortion as a major public health concern, and pledged their commitment to reduce the need for abortion through expanded and improved family planning services, as well as ensure abortion services should be safe and accessible. This technical and policy guidance provides a comprehensive overview of the many actions that can be taken in health systems to ensure that women have access to good quality abortion services as allowed by law.