title: Contraceptive counselling for women with multiple unintended pregnancies: the abortion client's perspective.
abstract: OBJECTIVE
  Some women have multiple unintended pregnancies. Appropriate interventions could prevent some of the abortions that follow. This article presents the opinions of some abortion clients about their contraception and the counselling they received. It also formulates suggestions for counselling strategies of health care providers (HCPs) and other interventions that can support effective contraceptive behaviour.
  
  
  METHODS
  A mixed method approach was used. A quantitative survey was carried out in one clinic in the Netherlands (N = 201), assessing topics related to contraceptive use and counselling. Semi-structured interviews (n = 11) were conducted with women who had had at least three unintended pregnancies. Interview topics included the type of contraceptive counselling, experience with contraceptive counselling and preferences regarding access to contraceptive information.
  
  
  RESULTS
  Women who had had multiple abortions were more likely to express a need for contraceptive counselling and more often discussed contraception with their HCP compared with women who had had one abortion. Several themes emerged from the semi-structured interviews that had partially contributed to further unplanned pregnancies: experience with counselling, acceptability of the contraceptive method, sources of information and cultural influences. Many women with multiple unintended pregnancies could not find suitable advice and stated preferences for future decision making.
  
  
  CONCLUSIONS
  This study offers insight into the motives for contraceptive use of women with multiple unintended pregnancies. Contraceptive efficacy could be improved by implementing counselling that is adapted to individual needs. The respondents stated that they would appreciate other sources of information, such as support through other forms of communication. The formation of a working group would be helpful in developing these services.
authors.affiliation: a Rutgershuis-Oost , Nijmegen , Netherlands.
authors.forename: Olga E
authors.initials: OE
authors.lastname: Loeber
authors.affiliation: b Department of General Practice and Elderly Care Medicine , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , Netherlands.|c Department of Medical Humanities , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , Netherlands.
authors.forename: Maaike E
authors.initials: ME
authors.lastname: Muntinga
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D003267:Contraception / Q000523:psychology*; D003376:Counseling / Q000379:methods*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D016387:Women's Health
keywords: Abortion; abortion clients; contraceptive counselling; intervention mapping; mixed method approach; motivational interviewing; prevention; unintended pregnancy