Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context

Purcell, C. , Cameron, S., Lawton, J., Glasier, A. and Harden, J. (2016) Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context. Contraception, 93(2), pp. 170-177. (doi: 10.1016/j.contraception.2015.09.016) (PMID:26434646) (PMCID:PMC4712046)

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). Materials and methods We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation≤9 weeks) 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, nonjudgemental 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. Implications 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.

• Item Type: Articles
• Additional Information: The study was funded by the Chief Scientist Office, which is part of the Scottish Government Health and Social Care Directorate. CZH4906
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Purcell, Dr Carrie
• Authors: Purcell, C., Cameron, S., Lawton, J., Glasier, A., and Harden, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Contraception
• Publisher: Elsevier Inc.
• ISSN: 0010-7824
• ISSN (Online): 1879-0518
• Copyright Holders: Copyright © 2016 Elsevier Inc.
• First Published: First published in Contraception 93(2):170-177
• Publisher Policy: Reproduced under a Creative Commons License