Postabortion contraception: qualitative interviews on counseling and provision of long-acting reversible contraceptive methods.
BACKGROUND
Long-acting reversible contraceptive (LARC) methods (IUDs and implants) are the most effective and cost-effective methods for women. Although they are safe to place immediately following an abortion, most clinics do not offer this service, in part because of the increased cost.


METHODS
In 2009, telephone interviews were conducted with 20 clinicians and 24 health educators at 25 abortion care practices across the country. A structured topic guide was used to explore general practice characteristics; training, knowledge and attitudes about LARC; and postabortion LARC counseling and provision. Transcripts of the digitally recorded interviews were coded and analyzed using inductive and deductive processes.


RESULTS
Respondents were generally positive about the safety and effectiveness of LARC methods; those working in clinics that offered LARC methods immediately postabortion tended to have greater knowledge about LARC than others, and to perceive fewer risks and employ more evidence-based practices. LARC methods often were not included in contraceptive counseling for women at high risk of repeat unintended pregnancy, including young and nulliparous women. Barriers to provision were usually expressed in terms of financial cost--to patients and clinics--and concerns about impact on the smooth flow of clinic procedures. Education and encouragement from professional colleagues regarding LARC, as well as training and adequate reimbursement for devices, were considered critical to changing clinical practice to include immediate postabortion LARC provision.


CONCLUSIONS
Despite evidence about the safety and cost-effectiveness of postabortion LARC provision, many clinics are not offering it because of financial and logistical concerns, resulting in missed opportunities for preventing repeat unintended pregnancies.
Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA. morsej@obgyn.ucsf.edu
Jessica
J
Morse
Lori
L
Freedman
J Joseph
JJ
Speidel
Kirsten M J
KM
Thompson
Laura
L
Stratton
Cynthia C
CC
Harper
D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003376:Counseling / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D007436:Intrauterine Devices, Medicated; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D014481:United States
D003271:Contraceptive Agents, Female