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Telephone or integrated contraception counselling before abortion: impact on method choice and receipt
  1. Patricia A Lohr1,
  2. Abigail R A Aiken2,
  3. Tracey Forsyth1,
  4. James Trussell3,4
  1. 1 Clinical Department, British Pregnancy Advisory Service (BPAS), Stratford upon Avon, UK
  2. 2 LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
  3. 3 Office of Population Research, Princeton University, Princeton, New Jersey, USA
  4. 4 Clinical Effectiveness Unit, Chalmers Centre, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Patricia A Lohr, Clinical Department, British Pregnancy Advisory Service (BPAS), Stratford upon Avon, CV37 9BF, UK; patricia.lohr{at}bpas.org

Abstract

Background Incorporating thorough contraception counselling into an abortion consultation is challenging. We compared contraceptive choices and methods received between two counselling models: (1) telephone counselling separate from the abortion consultation and (2) face-to-face counselling integrated into the consultation.

Methods We obtained de-identified data on demographic characteristics and contraceptive methods that had been chosen and received by women who had an abortion at British Pregnancy Advisory Service between 2011 and 2014 and had a choice of counselling models. We compared the characteristics of women who chose each model of counselling and the contraceptive methods they chose and received using Fisher’s exact test, and used logistic regression to explore associations between counselling model and choice and receipt of Tier 1 contraceptive methods (intrauterine contraception, implant, sterilisation), controlling for covariates.

Results The sample included 18 573 women. Women choosing telephone counselling were more likely to be non-White (34% vs 22%, P<0.001), to report prior difficulty obtaining contraception (40% vs 3%, P<0.001), and to have not used contraception at conception (37.1% vs 33.8%, P<0.001). Overall, 93% of women chose a contraceptive method after counselling. Telephone counselling was significantly associated with both choosing and receiving a Tier 1 method (OR 1.80, 95% CI 1.66 to 1.96 and OR 1.60, 95% CI 1.42 to 1.71, respectively). Fewer women who had telephone counselling received a less effective method (eg, condom, diaphragm) compared with those who chose integrated counselling (6.0% vs 19.2%, P<0.001).

Discussion Telephone-based contraception counselling separate from the abortion consultation may serve some women better than integrated counselling, particularly those reporting past difficulty obtaining contraception.

  • abortion
  • contraception
  • counselling
  • telemedicine
  • telehealth
  • long-acting reversible contraception

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Footnotes

  • Contributors PAL, ARAA & JT originated the study and contributed to the study design. ARAA conducted the analyses and prepared the tables and figures. PAL, ARAA, JT & TF contributed to the interpretation of results. PAL wrote the first draft the manuscript. PAL, ARAA, JT & TF contributed to several rounds of manuscript drafting and approved the final manuscript.

  • Funding Support was provided in part by infrastructure grants for population research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health R24HD04284 (ARAA) and P2C HD047879 (JT). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests PAL is the Medical Director of British Pregnancy Advisory Service. TF is the Nurse Manager of the telephone-based contraception counselling service at BPAS. ARAA reports grants from National Institutes of Health during the conduct of the study.

  • Ethics approval The protocol for this project was submitted to BPAS’s Research and Ethics Committee and the Institutional Review Board of Princeton University (IRB #7075) and was granted exemption from full review on the basis that no identifying data were collected and that all data were retrospective and held in an existing electronic database.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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