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Peri-abortion contraceptive care: Can we reduce the incidence of repeat abortions?
  1. Malini Garg, MB BS, DGO, DFFP, Senior House Officer1,
  2. Madan Singh, MB BS, DGO, DFFP, Senior House Officer1 and
  3. Diana Mansour, BM BCh, MRCOG, MFFP, Consultant in Community Gynaecology and Reproductive Healthcare2
  1. Royal Victoria Infirmary, Newcastle Upon Tyne, UK
  2. Newcastle General Hospital, Newcastle Upon Tyne, UK
  1. Correspondence Mr M Singh, Department of Gynaecology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK Tel: 0191 232 5131, Fax: 0191 227 5173

Abstract

Introduction It is of great importance for repeat unwanted pregnancies to be prevented rather than aborted. We therefore sought to: determine the reasons for contraceptive failure in women seeking repeat abortions; audit the peri-abortion contraception services offered at our hospital, and make recommendations regarding peri-abortion contraception services based on the above findings.

Method A self-administered questionnaire was used to determine the contraceptive practices and details of peri-abortion contraceptive counselling received by 50 women undergoing a repeat, and 83 women undergoing a first-time, abortion.

Results Ninety-eight percent of women undergoing a repeat abortion reported using contraception at the time of conception, as compared to 83% of women undergoing a first-time abortion. This difference was significant (p = 0.009). Condoms were the main method used by 57% of women undergoing a repeat and 70% of women undergoing a first-time abortion. The oral contraceptive pill (OCP), including both combined oral contraceptive and progestogen-only pill, was the main method used by 37% of women undergoing a repeat and 25% undergoing a first-time abortion. Both these methods were found to be ineffective because of user-dependent failures. All women received peri-abortion contraceptive counselling, but the perceived contents varied. Follow-up contraceptive appointments were made in less than half of women. Although most women chose an optimal contraceptive method as a result of the counselling, compliance with the chosen method in women undergoing repeat abortions was poor.

Conclusions Standards of audit were met with regards to receipt of contraceptive counselling and agreeing a contraceptive method before discharge. The content of this counselling needs to be improved. The ineffectiveness of the OCP and barrier methods of contraception needs to be highlighted during counselling. Adequate follow-up arrangements need to be provided to ensure compliance of the chosen method of contraception.

  • contraception
  • counselling
  • repeat abortions
  • Accepted June 26, 2000.

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