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Collaboratively seeking to improve contraceptive counselling at the time of an abortion: a case study of quality improvement efforts in Sweden
  1. Helena Kilander1,2,
  2. Jan Brynhildsen3,
  3. Siw Alehagen1,
  4. Amanda Fagerkrantz4,
  5. Johan Thor5
  1. 1 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  2. 2 Department of Obstetrics and Gynaecology, Region Jönköping County, Eksjö, Sweden
  3. 3 Obstetrics and Gynecology, Clinical and Experimental Medicine, Linköping, Sweden
  4. 4 Department of Obstetrics and Gyneacology, Norrköping, Region Ostergotland, Linköping, Sweden
  5. 5 Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
  1. Correspondence to Dr Helena Kilander, Department of Medical and Health Sciences, Linköping University, Linköping 581 83, Sweden; helena.kilander{at}


Background Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals’ (HCPs’) counselling in clinical practice, and in women’s subsequent choice of, and access to, contraception.

Methods Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March–November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data.

Results Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women’s feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women’s post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%–40% received it within 30 days post-abortion.

Conclusion The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.

  • accessibility
  • long- acting reversible contraception
  • pregnancy termination
  • person-centred counselling
  • user involvement
  • quality improvement collaboratives
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  • Contributors HK, JT, SA and JB participated in designing, planning and conducting the study. HK, JT and SA participated in data acquisition. HK, JT, SA, JB and AF participated in data analysis and interpretation. All authors participated in writing the manuscript.

  • Funding This study was funded by grants from Futurum, the Academy for Healthcare, in the Jönköping County Council, and the Medical Research Council of Southeast Sweden (FORSS).

  • Competing interests One of the coauthors (JB) has been reimbursed by Merck Sharpe & Dohme, Bayer AB Sweden and Actavis for running educational programmes and giving lectures. All the other coauthors have stated that they have no conflicts of interest in connection with this article.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Regional Ethical Review Board in Linköping.

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

  • Data sharing statement No data are available.

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