title: Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context.
abstract: OBJECTIVE
  To examine experiences of contraceptive care from the perspective of health professionals and women seeking abortion, in the contexts of hospital gynaecology departments and a specialist sexual and reproductive health centre (SRHC).
  
  
  METHODS
  We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation ≤9weeks) from one SRHC and two hospital gynaecology-department-based abortion clinics in Scotland. We also interviewed 25 health professionals (nurses and doctors) involved in abortion and contraceptive care at the same research sites. We analysed interview data thematically using an approach informed by the Framework method, and comparison was made between the two clinical contexts.
  
  
  RESULTS
  Most women and health professionals felt that contraceptive counselling at abortion was acceptable and appropriate, if provided in a sensitive, nonjudgmental way. Participants framed contraceptive provision at abortion as significant primarily as a means of preventing subsequent unintended conceptions. Accounts of contraceptive decision making also presented tensions between the priorities of women and health professionals, around 'manoeuvring' women towards contraceptive uptake. Comparison between clinical contexts suggests that women's experiences may have been more positive in the SRHC setting.
  
  
  CONCLUSIONS
  Whilst abortion may be a theoretically and practically convenient time to address contraception, it is by no means an easy time to do so and requires considerable effort and expertise to be managed effectively. Training for those providing contraceptive care at abortion should explicitly address potential conflicts between the priorities of health professionals and women seeking abortion.
  
  
  CONCLUSIONS
  This paper offers unique insight into the detail of women and health professionals' experiences of addressing contraception at the time of medical abortion. The comparison between hospital and community SRHC contexts highlights best practise and areas for improvement relevant to a range of settings.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom. Electronic address: carrie.purcell@glasgow.ac.uk.
authors.forename: Carrie
authors.initials: C
authors.lastname: Purcell
authors.affiliation: Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom. Electronic address: sharon.cameron@ed.ac.uk.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cameron
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom. Electronic address: j.lawton@ed.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Lawton
authors.affiliation: Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom. Electronic address: anna.glasier@ed.ac.uk.
authors.forename: Anna
authors.initials: A
authors.lastname: Glasier
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom. Electronic address: jeni.harden@ed.ac.uk.
authors.forename: Jeni
authors.initials: J
authors.lastname: Harden
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D001291:Attitude of Health Personnel; D003151:Community Health Centers; D003267:Contraception / Q000379:methods*; D003376:Counseling; D005260:Female; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D060728:Reproductive Health; D012606:Scotland
keywords: Long-acting reversible contraception (LARC); Medical abortion; Postabortion contraception; Qualitative research