Pregnancy intentions and contraceptive uptake after miscarriage

Intentions for post-abortion contraceptive use among women who received abortion services in health facilities of Harar city and Dire Dawa city

Background

A woman's specific beliefs about contraceptives influence her engagement and adherence to these methods. The intention to use post-abortion contraceptive methods is a critical aspect of reproductive health, particularly for women who have undergone abortion procedures. The use of less effective contraceptive methods, inconsistent usage, and discontinuation significantly contribute to unintended pregnancies, which are a primary cause of abortion. Studies indicate low contraceptive utilization and a high prevalence of abortion in the study area. Therefore, this study aimed to assess the intention to use post-abortion contraceptives and the associated factors among women visiting health facilities for abortion services, utilizing a behavioral model.

Objective

To assess intention to use post abortion contraceptive use and associated factors among women visiting health facilities for abortion services in Harari region and Dire Dawa City Administration, eastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among 609 women who received abortion services in the Harari region and Dire Dawa city administration health facilities. All women who sought abortion services at these health facilities during the study period were included in the research. Data were collected using a structured, interviewer-administered questionnaire. Binary logistic regression was employed to predict the association between dependent and independent variables. Variables with a p-value of less than 0.05 were considered statistically significant.

Result

The overall prevalence of intention to use post abortion contraceptive of women came for abortion service was 74.7% (95% CI: 71.3-78.2). Women who had contraceptive use history [AOR 2.580; 95%CI (1.216-5.473)], no pregnancy plan within the next two years [AOR 2.859; 95%CI (1.451-5.635)], positive attitude [AOR 3.335; 95%CI (1.831-6.077)], high level of subjective (perceived) norm [AOR 3.348; 95%CI (1.805-6.210)], high level of perceived behavioral control [AOR 6.784; 95%CI [(3.650-12.607)] were positively associated with intention to use post abortion contraceptive. Women who were divorced [AOR 0.149; 95%CI (0.039-0.578)] and had wanted pregnancy abortion [AOR 0.336; 95%CI (0.153-0.735)] variables were negatively associated with intention to use post abortion contraceptive.

Conclusion

This study revealed that more than two-thirds of the participants expressed an intention to use contraception following an abortion. Healthcare providers should offer comprehensive education and counseling on contraceptive options for women post-abortion. Furthermore, it is essential to provide personalized counseling to address each woman's unique needs and concerns regarding contraceptive choices.

Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study

BACKGROUND

Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed.

OBJECTIVE

This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention.

METHODS

This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception.

RESULTS

Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort.

CONCLUSIONS

We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care.

Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss

OBJECTIVES

To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss.

METHODS

We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression.

RESULTS

We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005).

CONCLUSIONS

Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping.

PRACTICE IMPLICATIONS

Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.

Views of clinicians towards providing contraceptive advice and contraception to women following early pregnancy loss: a qualitative study

INTRODUCTION

National guidelines advise that clinicians caring for women post-pregnancy should give women opportunities to discuss contraception, regardless of pregnancy outcome, and provide contraception to women who choose to take up a method. This study aimed to explore knowledge, views and needs of Early Pregnancy Unit (EPU) clinicians around discussing and offering contraception and discussing pregnancy intendedness with women after early pregnancy loss using a qualitative approach.

METHODS

Semi-structured, audio-recorded interviews with 11 clinicians from a single regional EPU in Edinburgh, Scotland. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Clinicians were reluctant to discuss contraception as they believed women would find the topic overwhelming and distressing. Thoughts on discussing pregnancy intendedness were polarised; some considered it insensitive, and others essential. Barriers to discussing contraception and providing it were numerous and included time pressure, and inadequate knowledge and training on contraception. Participants suggested training on contraception, closer working with sexual and reproductive health (SRH) services, and availability of information on contraception specifically aimed at women who have experienced an early pregnancy loss could facilitate discussions and method provision.

CONCLUSIONS

EPU clinicians require ongoing training and support to be effective at discussing pregnancy intendedness and discussing and providing post-pregnancy contraception. This will require close working with SRH services and development of sensitive information around contraception for women experiencing an early pregnancy loss.

Parity and Pregnancy Intention related to the Use of Contraceptives in Women of Reproductive

Background: The use of contraceptives in reproductive women is still a problem today. The association between contraceptive use and parity and pregnancy intention amongs legally married reproductive women has never been studied  Objectives: To determine the relationship between parity and pregnancy intention with contraceptive use among legally married women.  Methods: A cross-sectional study was conducted with the involvement of 262 legally-married reproductive women, aged 15-49 years, in Bantul District, Indonesia.  Socio-demographic data including age, education, income, parity, pregnancy intentions, and use of contraceptives were collected using a structured questionnaire by trained enumerators. Chi-square test was used to test the association between socio-demographic data and parity and pregnancy intention, while simple logistic regression models were used to examine the relationship between contraceptive use and parity and pregnancy intention. Data analysis was performed using statistical software by SPSS.   Results: Thirty-eight point five per cent of women of reproductive age who have ≥ 3 children and 16.5% of women of reproductive age who do not want to have children do not use contraception. Parity in women of childbearing age was not related to contraceptives (OR=2.58; 95%:0.67-1.76). Women of reproductive age who had intention of getting pregnant were 61% less likely (OR= 0.39; 95%: 0.37-0.74) to use contraceptives than those who did not have intention of getting pregnant.  Conclusions: The pregnancy intention is associated with a low contraceptive use in reproductive-age women. Thus, it is necessary to educate women in the reproductive age, their partners and family regarding the importance of birth spacing.