NEW YORK (Reuters Health) – Telephone counseling separate from abortion consultation is associated with improved contraception rates after abortion, according to results from the British Pregnancy Advisory Service (BPAS).
“Women seem to want options in terms of when and how they access contraception counseling before abortion,” Dr. Patricia A. Lohr from BPAS, in Stratford-upon-Avon, told Reuters Health by email. “For some, a dedicated remote session was preferred, perhaps because it allowed for a more in-depth discussion or was more private. For others, an integrated visit was preferred, perhaps because it was more efficient.”
Many women presenting for abortion welcome an opportunity to discuss contraception, but time limitations make thorough counseling challenging.
Dr. Lohr and colleagues used data from more than 18,500 women who had an abortion between 2011 and 2014 and had a choice of counseling models to compare contraceptive choices and methods between those who chose telephone counseling separate from the abortion consultation (31.2%) and those who chose face-to-face counseling integrated into the consultation (68.8%).
Women who chose telephone counseling were more likely to be non-white and more likely to report difficulty obtaining contraception in the past and less likely to be using any contraception or a Tier 1 method of contraception at the time of conception, compared with women who chose integrated counseling.
Overall, 93.0% of women chose a method of contraception after counseling, the researchers report in the Journal of Family Planning and Reproductive Health Care, online March 5. Fewer women in the telephone group than in the integrated counseling group declined contraception or chose a less effective/Tier 3 method.
The proportion of women who received a Tier 1 method was significantly higher among those who had telephone counseling (57.7%) than among those who had integrated counseling (48.2%). Significantly fewer women who had telephone counseling (6.0%) received a Tier 3 method after their abortion compared with those who had integrated counseling (19.2%).
These differences persisted after adjusting for clinical and demographic covariates.
Most women in both groups who chose to receive their method of contraception at the time of the abortion actually received it as planned.
“Telephone-based contraception counseling separate from the abortion consultation may serve some women better than integrated counseling, particularly those reporting past difficulty obtaining contraception,” the researchers conclude. “The present study provides support for a randomized comparison between telephone and integrated contraception counseling in the context of abortion care.”
“Think about innovative ways to deliver contraception counseling peri-abortion, and work with your client group to design services to meet their needs,” Dr. Lohr suggested.
Dr. Kristyn Brandi, a family-planning specialist from Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, in Los Angeles, told Reuters Health by email, “I think it is a great idea to offer telephone counseling around contraception as another way to have this conversation while still giving patients the space to get the information they need about their abortion care. I am surprised that so many women choose contraception afterwards and even more surprised that women receiving separate counseling chose Tier 1 methods like the IUD or contraceptive implant.”
“I think in general it is quite challenging to counsel patients around contraception at the time of abortion, and my research has shown that some patients find it actually stigmatizing (suggesting birth control implies they should have been on it to avoid the initial abortion),” said Dr. Brandi, who was not involved in the study. “I think offering contraception at the time of abortion is appropriate, but it should be based on the patient’s convenience, not our own. Asking ‘would you be interested in talking about contraception today’ would help determine which patients may want in-office counseling versus a separate telephone or office encounter.”
“While I think focusing on giving women more access to contraception is important, I worry about how much value this article places on using a ‘Tier 1’ method as a reason to change counseling,” Dr. Brandi added. “We should be focusing on finding methods that work best for each individual patient and giving them the information in a setting that is more comfortable to them so that they can make the best decision for themselves.”
“We looked at differences in choice and receipt of Tier 1 methods (IUD and implant), but I think it’s important to say that our goal was not to shift women toward certain methods,” Dr. Lohr noted. “Rather, we wanted to find a new way to help women who want to use contraception to learn about all methods and then access the one that’s right for them.”
SOURCE: https://bit.ly/2qd9DyH
J Fam Plann Reprod Health Care 2018.
Tidak ada komentar:
Posting Komentar