Does dedicated pre-abortion contraception counselling help to improve post-abortion contraception uptake?

OBJECTIVE: Many studies have shown a disappointing periabortion contraceptive uptake. This study investigated whether the provision of dedicated and targeted contraception counselling at the pre-abortion assessment visit can improve the post-abortion contraception uptake. METHODS: The study comprised a 3-month prospective reaudit of the abortion clinic. RESULTS: Of the 104 women seen during the re-audit period, 96% received post-abortion contraception. The majority (73%) of the women chose and received one of the less user-dependent contraceptive methods such as intrauterine contraceptive devices, the intrauterine contraceptive system, the progestogen injectable and subdermal implants. CONCLUSION: It was found that the provision of targeted contraception counselling by a dedicated team during the pre-abortion assessment visit can dramatically improve post-abortion contraception uptake.     

Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya

This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10-18 years reported having used contraception, as compared to 60% of clients aged 27-46 years. After the abortion and family planning counselling session, only 6% of clients aged 10-18 chose a method, as compared to 96% of clients aged 27-46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.     

流产后服务对未婚女性避孕知识及措施的干预效果调查

目的:评价开展流产后避孕咨询服务在降低未婚女性再次人工流产中的作用。方法:选择2007年7～9月在本院妇科门诊就诊的、未婚且有过人工流产史者为研究对象400人。自愿接受流产后避孕咨询服务的200人为研究组,另200人作为对照组。研究组于流产后进行避孕咨询服务。术后1年采用电话追踪方法,对两组对象避孕知识的认知、再次人工流产的比率变化等进行调查。结果:对照组在人工流产前后对避孕知识的认知无差异,再次人工流产的比率28.3%;研究组再次人工流产率为10.37%,且对生殖避孕知识的认知有所提高。结论:开展流产后避孕咨询综合服务能降低未婚女性再次人工流产比率,应该提倡并广泛开展此项工作。     

Service provider perspectives on post-abortion contraception in Nepal

The government of Nepal has articulated a commitment to the provision of post-abortion contraception since the implementation of a legal safe abortion policy in 2004. Despite this, gaps in services remain. This study examined the perspectives of abortion service providers and administrators regarding strengths and shortcomings of post-abortion contraceptive service provision. In-depth interviews were conducted with 24 abortion providers and administrators at four major health facilities that provide legal abortion in Nepal. Facility factors perceived to impact post-abortion contraceptive services included on-site availability of contraceptive supplies, dedicated and well-trained staff and adequate infrastructure. Cultural norms emerged as influencing contraceptive demand by patients, including method use being unacceptable for women whose husbands migrate and limited decision-making power among women. Service providers described their personal views on appropriate childbearing and the use of specific contraceptive methods that influenced counselling. Findings suggest that improvements to a facility’s infrastructure and training to address provider biases and misinformation may improve post-abortion family planning uptake. Adapting services to be sensitive to cultural expectations and norms may help address some barriers to contraceptive use. More research is needed to determine how to best meet the contraceptive needs of women who have infrequent sexual activity or who may face stigma for using family planning, including adolescents, unmarried women and women whose husbands migrate.     

Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya

This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10–18 years reported having used contraception, as compared to 60% of clients aged 27–46 years. After the abortion and family planning counselling session, only 6% of clients aged 10–18 chose a method, as compared to 96% of clients aged 27–46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.     

1998～2007年负压吸引人工流产术人群特征回顾性分析

目的：探讨近年来人工流产人群特征及流行病学变化趋势。方法：采用流行病学系统抽样的研究方法,逐年抽取1998～2007年每个季度第3个月在本院施行人工流产手术者21869例进行回顾性分析。结果：受术者平均年龄28岁,其中以20～29岁者居多,占66.5%;未婚者占19.5%;未产者占64.2%;外地户籍者占30.7%;术前未采取避孕措施者占71.3%。随着年代递进,未婚、未产、术前未采取避孕措施及外地户籍的比例分别由1998～2002年的15.5%、58.6%、62.2%和23.6%上升至2003～2007年的22.1%、67.8%、77.2%和35.2%。结论：20～29岁年龄组以及未产妇女在此调查中所占比例最大,是进行流产后计划生育服务的重点人群,对未婚、未产及流动人口应加大服务力度。     

流产后关爱行为对未生育女性避孕和生育影响的研究

目的 探讨流产后关爱行为对未生育女性避孕方式、生育结局的影响,为预防女性重复流产提供理论指导.方法 选择2019年7月—2019年10月温州市人民医院接诊的流产女性患者306例作为研究对象,以随机数表法分为对照组和研究组各153例,对照组患者接受常规人工流产服务,研究组患者在流产后给予关爱行为服务(PAC).比较两组患...     

北京市项目社区已婚育龄妇女人工流产现况调查

目的了解北京市项目社区育龄妇女人工流产的情况,并探讨其影响因素。方法采用多阶段整群抽样方法,对北京市项目社区的两个街道579名育龄妇女进行结构式问卷调查。结果 330人(56.99%)有过人工流产的经历,人工流产的平均次数为(1.36±0.67)次。人工流产的主要原因是避孕失败(51.66%)和未避孕(36.56%)。学历为高中/中专的育龄妇女,其人工流产比例高于初中及以下对象[(近似值差异率(oddratio,OR)=1.754,95%可信区间(confidenceinterval,CI):1.063～2.895];与职业为农民/工人的育龄妇女相比,无业育龄妇女的人工流产率较高(OR=2.213,95%CI:1.063～4.608)。结论不使用或者不正确使用避孕方法,以及对人工流产的错误认识都是人工流产比例居高不下中不可忽视的因素。因此,需针对不同学历、不同职业的育龄妇女开展针对性的避孕节育服务,以降低人工流产的比例,并开展流产后保健服务以减少重复流产率。     

重复人工流产女性避孕态度及行为的调查分析

目的了解重复人工流产女性、避孕态度及避孕行为,为制定相应干预措施提供依据.方法 对2005年9月至2006年8月间,参与北京海淀区“早孕终止妊娠后避孕干预效果分析”项目的1098例早孕重复人工流产女性进行问卷调查,干预后6个月时进行随访,了解其避孕行为.结果 对于是否避孕及避孕方法的选择,仅65.0％的已婚者及57...     

Contraceptive policies affect post-abortion provision of long-acting reversible contraception

Background

Placement of long-acting reversible contraceptives (LARC) — intrauterine devices (IUDs) and the implant — directly after an abortion provides immediate contraceptive protection and has been proven safe.

Study Design

We conducted a survey of National Abortion Federation member facilities (n=326; response rate 75%) to assess post-abortion contraceptive practices. Using multivariable logistic regression, we measured variations in provision of long-acting contraception by clinic factors and state contraceptive laws and policies.

Results

The majority (69%) of providers surveyed offered long-acting methods, but fewer offered immediate post-abortion placement of intrauterine devices (36%) or implants (17%). Most patients were provided with contraception; 6.6% chose LARC methods offering the highest level of protection. Post-abortion provision of these methods was lower in stand-alone abortion clinics (p≤.001), but higher with recent clinician training (p≤.001) and in the absence of clinic flow barriers (p≤.001). State policies had a significant impact on how women paid for contraception and the likelihood of LARC use. Patient use was higher in states with contraceptive coverage mandates (p≤.01) or Medicaid family planning expansion programs (p≤.05).

Conclusions

Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.     

成都市未婚女性重复人工流产情况及影响因素

目的:了解成都市未婚女性重复人工流产情况及影响因素,探讨降低未婚人工流产率的措施。方法:在成都市3类不同等级医院选择人工流产的18～24岁未婚女性进行匿名问卷调查。结果:调查合格对象416人,其中有重复人工流产史者158人,占38.00%;重复人工流产对象中,有3次及以上者高达37.40%。38.00%的对象在20岁前做了首次人工流产;调查对象的妊娠与避孕知识得分低(55.77分);重复人工流产组与非重复人工流产组比较有较高比例的多性伴(57.00%,30.20%,P<0.001)和与异性同居(60.80%,48.10%,P<0.05)。最近半年及本次妊娠前调查对象使用避孕措施情况差,且较多使用低效避孕措施。结论:多性伴、与异性同居、不使用或不当使用避孕措施是发生重复人工流产的危险因素。加强对未婚青年的教育,提高安全性行为意识,正确和坚持使用避孕措施,对于降低未婚人工流产率十分重要。     

我国三城市未婚女青年人工流产后服务需求调查

目的:了解未婚青少年人工流产后计划生育服务需求。方法:在北京、上海、郑州3城市共随机选取27家医院,对2005年7～9月在所选医院寻求早孕人工流产服务的全部<25岁未婚女青年进行问卷调查。结果:39.3%的调查对象在20岁前发生首次性行为,4.1%经历过非意愿性行为,31.3%有重复人工流产史,65.4%本次妊娠缘于未采取避孕措施,仅25.3%选用过紧急避孕药。在用过避孕套的785人中,仅9.0%能坚持每次性行为都使用避孕套。54.7%能主动向医务人员寻求咨询服务,在服务中19.1%主动提出了关于避孕措施的问题,17.9%反映医务人员推荐了合适的避孕措施,仅0.9%获得了当场提供的免费避孕药具。未婚女青年年龄、首次性行为年龄、性伴数、婚前同居、文化水平是重复人工流产的影响因素;避孕知识受到调查对象年龄、首次性行为年龄、文化水平、咨询避孕相关问题主动性等因素的影响。结论:行人工流产的未婚青少年对流产后计划生育服务需求较大,但目前仍未被满足。     

Psychological distress and post-abortion contraceptive method effectiveness level chosen at an urban clinic

ObjectiveWe investigated whether more psychological distress before an abortion is associated with the effectiveness of contraception selected (low, moderate, or high effectiveness) at an abortion clinic visit.MethodUsing data from 253 women attending an urban abortion clinic that primarily serves low-income women, we tested the association between pre-abortion psychological distress and the effectiveness level of post-abortion contraceptive choice. Based on typical use failure rates, we classified effectiveness of contraceptive choice into three levels—low, moderate, and high effectiveness. We measured psychological distress with four validated measures of depressive, anxious, and stress symptoms, and negative affect, as well as with a global measure comprising these four measures. We used multivariable ordinal logistic regression to measure the association of each psychological distress measure with post-abortion contraceptive method effectiveness level, adjusting for sociodemographic factors, pregnancy history, trimester of abortion, and importance of avoiding pregnancy in the next year.ResultsWe found that compared to women experiencing less stress symptoms, negative affect and global psychological distress, women experiencing more stress symptoms [AOR=1.028, 95% CI: 1.001–1.050], negative affect [AOR=1.05, 95% CI: 1.01–1.09] and global psychological distress [AOR=1.46, 95% CI: 1.09–1.95] were more likely to choose more effective versus less effective methods, p<.05, in adjusted models. Using dichotomous psychological measures we found similar results.ConclusionsWomen experiencing more psychological distress before an abortion selected more effective contraceptive methods after their abortion. Future research should examine whether this distress is associated with subsequent contraceptive use or continuation.ImplicationsThe current study suggests that contraceptive providers should not assume that women experiencing more psychological distress prefer to use less effective contraceptive methods.     

郑州市未婚女青年人工流产现状的定性研究

目的：了解郑州市未婚女青年流产现状和避孕措施使用情况,为开展计划生育流产后服务及减少未婚女青年非意愿妊娠提供决策依据。方法：采用小组专题讨论（FGD）和个人深入访谈（IDI）的方法,对在郑州市8家市级以上医院做人工流产的21名未婚女青年进行面对面访谈。结果：多数未婚女青年能意识到人工流产影响自身健康;由于避孕、生殖健康知识缺乏未采取避孕措施及避孕失败是导致流产的直接原因。目前医院人工流产后提供的避孕、生殖健康知识服务有限,不能满足妇女需求;同时医务人员的态度和就医环境需要改善,还建议男伴要参与计划生育。结论：针对未婚人群,加强有效避孕知识的宣教,改善医院人工流产后计划生育服务,提高避孕的有效性和可及性,降低非意愿妊娠,促进未婚女青年的生殖健康。     

Emergency contraception and prevention of induced abortion in India

OBJECTIVE: Induced abortion is associated with high morbidity and mortality in India. Use of regular contraception with emergency contraception (EC) as backup can reduce the incidence of induced abortion. The study aimed to assess women's knowledge, practice, preference and acceptance of different contraceptive methods with special reference to the causes of induced abortion, and their willingness to use hormonal EC. METHODS: The study comprised a structured questionnaire survey conducted in the family planning clinic of a tertiary teaching hospital in New Delhi, India. A total of 623 women and three men seeking contraceptive advice and/or termination of pregnancy were interviewed. The main outcome measures were knowledge of different contraceptive methods including EC and the reasons for unintended pregnancy. RESULTS: More than 99% of the respondents knew about most of the modern methods of contraception whereas only 37 (5.9%; 95% CI 4.0-7.8) of the respondents knew about EC and none of them had ever used it. Contraceptive method failure led to unintended pregnancy in 39.1% (95% CI 33.7-44.5) of abortion seekers. Correct use of EC could have prevented nearly 65.5% (95% CI 57.0-74.0) of induced abortions due to contraceptive method failure and 25.6% (95% CI 20.7-30.5) of all induced abortions. CONCLUSIONS: More efforts are required to generate awareness about the safety, efficacy and availability of EC, regular use of effective contraception and the health hazards of induced abortion.     

长沙市女性人工流产及避孕现状调查

目的了解女性人工流产状况、避孕现状及其影响因素,为合理采用避孕措施、提高女性生殖健康水平提供参考依据。方法对在长沙市妇幼保健院行人工流产术的3 260例妇女进行问卷调查,其中合格问卷3 056份。收集调查对象的婚育史、流产史、获得避孕节育知识的途径、避孕方法的使用、避孕知识掌握情况、意外妊娠原因等情况,进行统计分析,并提出应对措施。结果未婚人工流产1 449例(47.41%),已婚人工流产1 607例(52.59%);避孕失败2 177例(71.24%),其中采用避孕套失败的653例(21.37%),未采取避孕措施879例(28.76%);两次以上的重复人工流产2 067例(67.64%)。多因素分析结果显示:受教育程度、经济水平和避孕知识掌握情况为重复人工流产的危险因素(P0.05)。结论避孕失败是人工流产的主要因素,未婚女性所占比例与已婚女性相近;应对未婚女性施以正确、专业的生殖健康和避孕知识教育;受教育程度、经济水平和避孕知识掌握情况对重复人工流产具有影响。     

人工流产女青年性行为和避孕现状研究

目的:了解北京市人工流产女青年的性行为和避孕现状,探讨人工流产、特别是重复流产的影响因素。方法:采用自填式问卷的方法,对北京市1 008名自愿要求人工流产、在1980年8月1日之后出生的女青年进行现状调查。结果:研究对象首次性行为的平均年龄为(20.70±1.95)岁,54%的人在20岁之前就开始了性生活;首次人工流产的平均年龄为(21.96±1.81)岁,首次流产在20岁之前的占17.0%;将近25%的人曾与2名及以上的男性发生过性关系;人流女青年本次怀孕的原因,60.2%是因为没有避孕,39.7%由于避孕失败;没有避孕的主要原因是"在没有准备好避孕药具的情况下同房"(41.5%)和"知道避孕方法但不想用"(39.7%);避孕失败的主要原因是全安期和体外射精(39.0%)、避孕套(32.7%)和紧急避孕(18.5%);过去3个月中,最常用的避孕方法为避孕套(75.5%)、全安期和体外射精(11.0%)、紧急避孕(8.2%);在避孕套使用者中,只有9.3%能坚持每次同房都用;77.2%的人认为口服避孕药对身体不好;32.4%的研究对象有重复流产。单因素分析发现,文化程度低、未婚同居、首次性生活和首次流产的年龄小、多性伴和不能坚持、正确使用避孕措施是重复流产的影响因素。结论:女青年首次性行为开始早、多性伴比例高、避孕药具使用率低或使用低效的避孕方法是非意愿妊娠和人工流产的主要原因,且重复流产现象比较严重;同时,流动人口在人流女青年中占了相当大的比例。因此,应当对未婚人群和流动人口女青年进行人工流产的危害以及避孕知识的宣传教育,提高现代科学的避孕药具使用率,避免不必要的意外妊娠和人工流产。     

人工流产少女的性行为及避孕现状调查

目的:了解人工流产少女的性行为和避孕现状,找出存在的问题并提出相关建议。方法:以成都市锦江区妇幼保健院作为研究现场,于2009年5月～2010年4月,采用自填式问卷的方法对年龄≤20岁的人工流产少女525例进行调查和统计分析。结果:本次妊娠的主要原因是未避孕(67.6%)和避孕失败(25.2%)。未避孕的最主要原因是认为偶尔无避孕性行为不会妊娠,导致避孕失败的方法依次为体外射精、避孕套、安全期和紧急避孕药。在过去6个月内,每次性行为都使用避孕措施的占4.2%,25.2%研究对象从未使用过任何避孕措施。研究对象与男伴同居的比例非本市户籍(58.1%)高于本市户籍(41.1%),农村(59.8%)高于城镇(47.9%)(P<0.05)。采用逐步回归方法分析影响重复性流产的因素,发现年龄和收入具有统计学意义(P=0.04和P<0.01)。结论:未婚同居、收入水平低、年龄小、避孕措施使用率低和方法低效是非意愿妊娠的主要原因。应加强避孕知识的宣传教育,提高避孕药具可及性及流产后服务水平和能力。     

Wellbeing and mental growth-long-term effects of legal abortion

The present study aims to increase knowledge about coping with legal abortion by studying women's reasoning, reactions and emotions over a period of 1 year. The study comprises interviews focusing on the experiences and effects of abortion in 58 women, 4 and 12 months after the abortion. The women also answered a questionnaire before the abortion concerning their living conditions, decision-making process and feelings about the pregnancy and the abortion. Majority of the women did not experience any emotional distress post-abortion and almost all the woman reported that they had coped well at the 1-year follow-up, although 12 had had severe emotional distress directly post-abortion. Furthermore, almost all described the abortion as a relief or a form of taking responsibility and more than half reported only positive experiences such as mental growth and maturity of the abortion process. Those without any emotional distress post-abortion stated clearly before the abortion that they did not want to give birth since they prioritised work, studies and/or existing children. The study shows that women generally are able to make the complex decision to have an abortion without suffering any subsequent regret or negative effects, as ascertained at the 1-year follow-up.     

Post-abortion contraception choices of women in Ghana: A one-year review

Low rates of contraception in much of sub-Saharan Africa result in unplanned pregnancies, which in young, unmarried women often result in unsafe abortion. Increasing the use of highly effective forms of contraception has the potential to reduce the abortion-related mortality and morbidity. In this cross-sectional study, information collected by the post-abortion family planning counsellor was analysed. De-identified data from one year (June 2012–May 2013) were extracted from the logbook. Multivariate linear and logistic regression was performed. A total of 612 women received care for post-abortion complications from June 2012 to May 2013. Young, unmarried women, and those who were being treated for complications arising from an induced versus spontaneous abortion were more likely to report they would use ‘abstinence’ as their method of contraception following their treatment. This vulnerable group could benefit from an increased uptake of long-acting reversible contraceptive methods to avoid repeated unplanned pregnancies and the potential of future unsafe abortions.