1
|
Niemeyer Hultstrand J, Törnroos E, Tydén T, Larsson M, Makenzius M, Gemzell‐Danielsson K, Sundström‐Poromaa I, Ekstrand Ragnar M. Contraceptive use among women seeking an early induced abortion in Sweden. Acta Obstet Gynecol Scand 2023; 102:1496-1504. [PMID: 37493190 PMCID: PMC10577618 DOI: 10.1111/aogs.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women. MATERIAL AND METHODS Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented. RESULTS In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. CONCLUSION The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.
Collapse
Affiliation(s)
| | - Elin Törnroos
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Tanja Tydén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Margareta Larsson
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Marlene Makenzius
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Kristina Gemzell‐Danielsson
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- WHO CenterKarolinska University HospitalStockholmSweden
| | | | - Maria Ekstrand Ragnar
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Department of Health SciencesLund UniversityLundSweden
| |
Collapse
|
2
|
Johansson L, Vesström J, Alehagen S, Kilander H. Women's experiences of dealing with fertility and side effects in contraceptive decision making: a qualitative study based on women's blog posts. Reprod Health 2023; 20:98. [PMID: 37381022 DOI: 10.1186/s12978-023-01642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Worldwide, there is limited knowledge regarding women's views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women's experiences of contraceptive methods based on data gathered from individual blog posts. METHODS Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. RESULTS Two themes were identified. Theme 1, 'Seeking control over reproduction and optimise fertility' including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women's sexuality, A wish to understand the body's normal fertility function and Limited knowledge-sharing information about the menstrual cycle during counselling and Theme 2, 'Making the complex decision on their own' including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. CONCLUSIONS During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.
Collapse
Affiliation(s)
- Lydia Johansson
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Julia Vesström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helena Kilander
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, P.O. Box 1026, 551 11, Jönköping, Sweden.
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
3
|
Gómez-Torres P, Lucha-López AC, Martínez-Pérez GZ, Sheridan T, Vera Cruz G. Acceptability and Determinants of using Male Hormonal Contraceptives: A Systematic Review from a Gender Perspective. PSYCHOLOGY & SEXUALITY 2023. [DOI: 10.1080/19419899.2023.2191606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Piedad Gómez-Torres
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
| | - Ana C. Lucha-López
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
- Unidad de Investigación en Fisioterapia (UIF), University of Zaragoza, Zaragoza, Spain
| | | | - Taylor Sheridan
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Germano Vera Cruz
- Department of Psychology, University of Picardie Jules Verne, Amiens, France
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations UR 7273 CRP-CPO, University of Picardie Jules Verne, Amiens, France
| |
Collapse
|
4
|
Chace Dwyer S, Jain A, Baruwa S, Okafor E, Babajide Oluseyi D, Ubuane O. How do fertility intentions lead to contraceptive continuation among a cohort of family planning users who received services from the private sector in Nigeria. Gates Open Res 2022; 5:103. [PMID: 35677699 PMCID: PMC9086212 DOI: 10.12688/gatesopenres.13253.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The Federal Ministry of Health of Nigeria is exploring task sharing family planning (FP) services to Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs). Yet few studies have explored contraceptive continuation of clients who received FP services from pharmacies and drug shops. This paper uses longitudinal data and looks at women's contraceptive continuation approximately nine months after they received FP services from CPs and PPMVs in Kaduna and Lagos states. Methods: Longitudinal data for this analysis come from an evaluation of the IntegratE project. 491 women were interviewed within 10 days after receiving a FP service from an IntegratE CP or PPMV and approximately nine months later. The dependent variable is contraceptive continuation at the follow-up interview and the independent variable is fertility intentions as reported at enrollment. Multivariate logistic regression models were used to assess the association between fertility intentions and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who intended to have a child in more than two years were significantly more likely to continue using contraception compared to women who intended to have a child within two-years (AOR 2.6; 95% CI 1.1-6.1). Among women who were asked about the quality of care received, 93% said the CP/PPMV asked whether they wanted to have a/another child in the future and 85% said they were asked when they would like to have that child. Conclusion: The fertility intentions of women who seek FP services from CPs and PPMVs in Nigeria can predict contraceptive continuation. As Nigeria task shares FP services to CPs and PPMVs, training on comprehensive FP counseling will be essential for scale-up. Since many women continued using FP, CPs and PPMVs have the potential to expand access to, and support women's continued use of, FP.
Collapse
|
5
|
Stern J, Molin MS, Fernaeus M, Georgsson S, Carlsson T. Contraceptive counseling about adverse reactions of intrauterine contraception: Exploration of narratives found in web-based discussion boards. Midwifery 2021; 104:103166. [PMID: 34717242 DOI: 10.1016/j.midw.2021.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the possibility of experiencing adverse reactions is an important aspect of contraceptive decision-making and information about this topic is highlighted as an essential aspect of contraceptive counseling. The aim of this study was to explore experiences of contraceptive counseling about potential adverse reactions of intrauterine contraception. DESIGN exploratory qualitative study of messages in discussion boards, analyzed with inductive qualitative content analysis. SETTING two large public Swedish web-based discussion boards about sexual and reproductive health. PARTICIPANTS threads related to the aim were identified through searches in the discussion boards during 2019 and 2020, resulting in in 43 included posters who had written 140 messages in total. FINDINGS the themes 'difficulties making an informed decision due to insufficient and untrustworthy information about adverse reactions' and 'feeling dismissed when communicating about experienced adverse reactions' illustrate the results. Posters emphasized the importance of sufficient information about adverse reactions. However, professionals were perceived as overly optimistic regarding intrauterine contraception and focusing on mild or common reactions. The importance of feeling that their adverse reactions were acknowledged was articulated, but posters felt that some professionals dismissed the reactions when being told about it, resulting in frustration and dissatisfaction with care. The discussion boards contained narratives describing a resistance among professionals to send in a formal report about the adverse reaction. KEY CONCLUSIONS according to statements made by posters who have experience of adverse reactions of intrauterine contraception, contraceptive counseling have room for improvement in regard to inclusion of comprehensive information about adverse reactions. The findings illustrate the importance that clients who experience adverse reactions of intrauterine contraception feel they are acknowledged and offered adequate support. IMPLICATIONS FOR PRACTICE echoing guidelines for high-quality contraceptive counseling, the narratives provide further weight that professionals need to have adequate training and resources to offer comprehensive information about adverse reactions of intrauterine contraception. The findings call attention to the importance of follow-up services for clients who experience adverse reactions.
Collapse
Affiliation(s)
- Jenny Stern
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden; Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden
| | | | - Maja Fernaeus
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden
| | - Susanne Georgsson
- The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden; Karolinska Institutet, Department of Clinical science, Intervention and technology, SE-171 77 Stockholm, Sweden
| | - Tommy Carlsson
- Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden; The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden.
| |
Collapse
|
6
|
Svahn S, Niemeyer Hultstrand J, Tydén T, Ekstrand Ragnar M. Contraception use and attitudes: women's concerns regarding hormonal contraception and copper intrauterine devices. EUR J CONTRACEP REPR 2021; 26:473-478. [PMID: 34590968 DOI: 10.1080/13625187.2021.1975267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of contraceptive method use among women, assess concerns about hormonal contraception (HC) and copper intrauterine device (Cu-IUD) and determine characteristics associated with concerns of HC and Cu-IUD. METHOD Cross-sectional study. Swedish speaking women (n = 212) aged 16-50 attending midwives at four outpatient clinics in two of Sweden's larger cities answered a waiting room questionnaire. Content analysis was used to categorise open-ended questions with free text answers. RESULTS Long-acting reversible contraceptives (LARC) was used by 30.4%, short acting reversible contraceptives (SARC) by 28.0%, and 16.4% did not use any contraception during most recent intercourse. Four out of ten (41.2%) had concerns about using HC and 52.3% about using Cu-IUD. The most common reason for having concerns regarding HC was unspecified side effects, fear of hormones and adverse mood symptoms; regarding Cu-IUD, concerns related to increased bleeding and menstrual pain. Among those expressing concerns, experience of induced abortion was twice as common. Women who did not have concerns about HC were using combined oral contraception (COC) to a higher extent. CONCLUSION Concerns about using HC and Cu-IUD are common. This needs to be considered during contraceptive counselling.
Collapse
Affiliation(s)
- Susanna Svahn
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | | | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Maria Ekstrand Ragnar
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Böttcher B, Abu-El-Noor M, Abu-El-Noor N. Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers. BMC WOMENS HEALTH 2019; 19:165. [PMID: 31856794 PMCID: PMC6923918 DOI: 10.1186/s12905-019-0869-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. METHODS A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data. RESULTS Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods. CONCLUSION Women's contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women's choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.
Collapse
Affiliation(s)
- Bettina Böttcher
- Faculty of Medicine, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine.
| | - Mysoon Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine
| | - Nasser Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine
| |
Collapse
|
8
|
Koo Andersson M, Tydén T. Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website. EUR J CONTRACEP REPR 2019; 25:1-7. [DOI: 10.1080/13625187.2019.1695117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Melinda Koo Andersson
- Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
9
|
Eriksson C, Skinstad M, Georgsson S, Carlsson T. Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study. Reprod Health 2019; 16:172. [PMID: 31775765 PMCID: PMC6882246 DOI: 10.1186/s12978-019-0835-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality. Objective The overarching aim was to investigate the quality of websites about long-acting reversible contraception. Methods Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index. Results The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29–55) indicating moderate to difficult readability levels, corresponding to a grade level of 9. Conclusions The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.
Collapse
Affiliation(s)
| | | | - Susanne Georgsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical science, Intervention and technology, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Carlsson
- Sophiahemmet University, Stockholm, Sweden. .,The Swedish Red Cross University College, Huddinge, Sweden. .,Department of Women's and Children's Health, Uppsala university, MTC-huset, Dag Hammarskjölds väg 14B, 1 tr, SE-75237, Uppsala, Sweden.
| |
Collapse
|
10
|
Ulbricht S, Beyer A, John U. Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study. BMC WOMENS HEALTH 2019; 19:120. [PMID: 31627718 PMCID: PMC6798342 DOI: 10.1186/s12905-019-0821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
Background To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered. Methods We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression. Results There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model. Conclusions Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.
Collapse
Affiliation(s)
- Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany.
| | - Angelika Beyer
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, D-17487, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany
| |
Collapse
|
11
|
Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Ups J Med Sci 2019; 124:203-212. [PMID: 31495254 PMCID: PMC6758707 DOI: 10.1080/03009734.2019.1653407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
Collapse
Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- CONTACT Yvonne Skogsdal Maternal Health Care Unit, Region Örebro County, Box 1613, SE-701 16, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala, Sweden
| |
Collapse
|
12
|
Skogsdal YRE, Karlsson JÅ, Cao Y, Fadl HE, Tydén TA. Contraceptive use and reproductive intentions among women requesting contraceptive counseling. Acta Obstet Gynecol Scand 2018; 97:1349-1357. [PMID: 30007091 PMCID: PMC6175138 DOI: 10.1111/aogs.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
Abstract
Introduction Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish‐speaking women requesting contraceptive counseling. MATERIAL AND METHODS A cross‐sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future. Results In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short‐acting reversible contraception, 22.8% (n = 443) used long‐acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse. Conclusions Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.
Collapse
Affiliation(s)
| | - Jan Åke Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Yang Cao
- School of Medical Sciences, Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.,Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Elisabeth Fadl
- Faculty of Medicine and Health, Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Tanja Adele Tydén
- Department of Women's and Children's Health, Academic Hospital, Uppsala, Sweden
| |
Collapse
|