Olga Loeber

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    Challenges in contraceptive counselling in abortion care

    Olga Loeber (The Netherlands)

    Mildredhuis, Centre for Contraception, Sexuality and Abortion, Arnhem, The Netherlands

    Use of contraception prior to abortion

     

    One would assume there is no problem: all forms of contraception are possible after an uncomplicated first trimester abortion. Moreover in the clinics in the Netherlands there is always attention to contraceptive counselling after abortion. So, why is the repeat abortion so high?

    In the eighties this percentage was around 25%, now it is more than 36%. The abortion rate is also higher: in 1992 this was 5,5 per 1000 women in the fertile age, in 1999the rate was 7,4  and in 2006 the rate was 8,6.

    Apparently for some women effective use of contraception is a growing problem. Ineffective use of contraception is directly related to use of less effective methods but also to personal factors. Personal ideas that can cause ineffective use are opinions like: all those hormones cannot be good for you, he should use something; using contraception means you have a stable relationship or want to have sex.

    A survey in Sweden of the characteristics of the women with a repeat abortion showed a psychological vulnerability: they had many problems and a feeling of insecurity towards partners and contraceptive use. The cause of the contraceptive failure was not the lack of knowledge or information, but the lack of the ability to integrate this in actual behaviour.

    Other research in the Netherlands showed that these women do not seem to learn from former experiences.

    A last factor seems to be related to country of origin. In the Netherlands many women who have a (repeat) abortion come originally from other countries. About 57% of our abortion clients is born in another country, a huge overrepresentation compared to the general population. This group uses more often no contraception at all and makes more mistakes in using the pill, condoms are unpopular. Among the countries of origin differences are apparent because of differences in background, per region and in culture.

    Compared to the Netherlands the contraceptive use in other countries can be very different from that of the Netherlands due to

    • different man/woman relations,
    • religious conceptions,
    • availability of contraception,
    • fear of some forms of contraception,
    • fertility wishes,
    • discussion of sexual matters can be taboo.

    These differences are important in counselling women about contraception after abortion, so as to find the best contraceptive choice for this one individual patient in front of you.

    Conclusions and recommendations.

    • Thorough knowledge of contraceptive problems and solutions
    • Attention to factors responsible for failure of contraception
    • Knowledge of cultural factors
    • Counselling with these factors in mind
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    Contraceptive counselling after abortion

     

    Olga Loeber  MD, Mildredhuis-Rutgershuis, Centre for Contraception, Sexuality and Abortion, Arnhem, The Netherlands

     

    In the Netherlands contraceptive counselling forms an integral part of the intake procedure. Almost all forms of contraception is feasible after an uncomplicated first trimester abortion. Still the number of repeat abortion is relatively high in most countries even if there are a broad knowledge about and availability of contraceptive possibilities.

     

    Knowledge and availability are only partly the prerequisite for effective contraception. Social personal factors (for instance fears, myths, ambivalence towards pregnancy, ability to negotiate, characteristics of the relationship with the partner) are equally important. Personal counselling with tailored advice is of utmost importance. This counselling could be done not only by doctors but also by various other personnel with a broad understanding and knowledge of contraception and underlying personal factors as for instance nurses and  midwives.

    Possible explanations for the repeat abortion rate and practical solutions will be discussed.

    Cases and points of view dealing with this topic will be the basis of a discussion with the participants of the workshop. Comparison between countries could lead to a better understanding of the subject.