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A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?
  1. Francesca L Cavallaro1,
  2. Lenka Benova2,3,
  3. Onikepe O Owolabi4,
  4. Moazzam Ali5
  1. 1 University College London, London, London, UK
  2. 2 Institute of Tropical Medicine, Antwerp, Belgium
  3. 3 London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Guttmacher Institute, New York, New York, USA
  5. 5 World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Moazzam Ali, Reproductive health and research, World Health Organization, 1211 Geneva, Switzerland; alimoa{at}


Aim The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages.

Methods Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered.

Results A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types.

Conclusions The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

  • modern contraceptives
  • counselling
  • contraceptive behaviour
  • method continuation
  • client satisfaction
  • family planning service provision

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  • Contributors MA initiated the study and defined the research question. All authors contributed to developing the detailed methodology. FC carried out the literature review, LB and OO acted as second reviewers and data extractors, and MA provided reconciliation in case of any discrepancies. FC drafted the protocol and manuscript. All the other authors edited the draft and approved the final version for publication.

  • Funding This review was conducted with financial support from the Bill and Melinda Gates Foundation. The funding source did not play a role in the study design, analysis or interpretation of data, or in the writing of the report. The conclusions and opinions expressed here are those of the authors and not necessarily those of the funder.

  • Disclaimer This paper contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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