Effectiveness of peri-abortion counselling in preventing subsequent unplanned pregnancy: a systematic review of randomised controlled trials.
OBJECTIVE
This systematic review and meta-analysis assessed whether enhanced peri-abortion contraceptive counselling had an effect on subsequent unplanned pregnancies and the uptake and continuation of contraceptive methods.


METHODS
A systematic review of English-language articles published prior to May 2014 was conducted, using MEDLINE, EMBASE and the Cochrane Library. Only randomised controlled trials (RCTs) involving enhanced pre- and post-abortion contraceptive counselling were included. The authors independently applied the inclusion and exclusion criteria to the identified records, and extracted data from each included paper using a predefined extraction form. Risk of bias was assessed using the Cochrane Collaboration's tool. Meta-analyses were undertaken where appropriate and based on random effects models.


RESULTS
Six RCTs met the inclusion criteria. Three RCTs investigated the effect of enhanced counselling on subsequent unplanned pregnancy. The results of the meta-analysis were non-significant [pooled odds ratio (OR) 0.47; 95% confidence interval (95% CI) 0.12-1.90]. Four RCTs reported results relating to the uptake of long-acting reversible contraception (LARC) and continuation of chosen method of contraception at 3 months. Findings were non-significant (pooled OR 1.07; 95% CI 0.20-5.69 and pooled OR 3.22; 95% CI 0.85-12.22, respectively).


CONCLUSIONS
This review found no evidence of effect resulting from enhanced peri-abortion contraceptive counselling on subsequent unplanned pregnancy rate or the uptake of LARC. However, these findings are limited by the small number of relevant studies available and the marked heterogeneity between published studies. Further, larger-scale RCTs should be undertaken to ensure that there is sufficient power to detect an effect.
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Hannah
H
Stewart
Obstetric Epidemiology, Division of Applied Health Sciences, Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen, UK National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Stephen J
SJ
McCall
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Calum
C
McPherson
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Lucinda C
LC
Towers
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Bethany
B
Lloyd
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Jack
J
Fletcher
Obstetric Epidemiology, Division of Applied Health Sciences, Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen, UK.
Sohinee
S
Bhattacharya
D000028:Abortion, Induced; D003376:Counseling / Q000592:standards*; D003657:Decision Making; D005193:Family Planning Services / Q000592:standards*; D005260:Female; D006801:Humans; D015201:Meta-Analysis as Topic; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D016032:Randomized Controlled Trials as Topic; D012736:Sex Education / Q000592:standards*; D016387:Women's Health; D014933:Women's Rights
abortion; counselling; long-acting reversible contraception