A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial

Abstract

Objective To determine if a counseling intervention using the principles of motivational interviewing (MI) would impact uptake of long-acting reversible contraception (LARC) after abortion. Methods We conducted a pilot randomized controlled trial comparing an MI-based contraception counseling intervention to only non-standardized counseling. Sixty women 15-29 years-old were randomized. Primary outcome: uptake of LARC within four weeks of abortion. Secondary outcomes: uptake of any effective contraceptive, contraceptive use three months after abortion and satisfaction with counseling. Bivariate analysis was used to compare outcomes. Results In the intervention arm, 65.5% of participants received a long-acting method within four weeks compared to 32.3% in the control arm (p=0.01). Three months after the abortion, differences in LARC use endured (60.0% vs. 30.8%, p=0.05). Uptake and use of any effective method were not statistically different. More women in the intervention arm reported satisfaction with their counseling than women in the control arm (92.0% vs. 65.4%, p=0.04). Conclusion Twice as many women in the MI-based contraception counseling intervention initiated and continued to use LARC compared to women who received only non-standardized counseling. Practice Implications A contraception counseling session using the principles and skills of motivational interviewing has the potential to impact LARC use after abortion.

Long-Acting Reversible Contraception

“…Women in the intervention group also reported higher rates of satisfaction with counseling than those in the control group (92% versus 65%) (A). 24 Studies have shown that the continuity and satisfaction rates with the contraceptive method are greater when the decision is made by the patient. Women prefer to decide on their contraceptive method autonomously, with less influence of the health professional, and after appropriate advice (B).…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…The content of contraceptive counselling heavily influences method selection, especially among younger women. [33][34][35] While it is important to avoid coercion and ensure patient-centred, shared decision-making, we contend that it is time for a more directive approach, one in which women are explicitly informed that LARCs constitute first-line contraception. In this approach, counselling is standardised and methods are presented in order from most to least effective.…”

Contraceptive counselling in abortion care

“…Both motivational interviewing (MI) and person-centred counselling seem to improve the conversation about contraception at the time of an abortion, measured in increased contraceptive uptake [72,73]. Previous research has reported mixed findings regarding contraceptive counselling in the context of an abortion and the effect on contraceptive use post-abortion.…”

“…Previous research has reported mixed findings regarding contraceptive counselling in the context of an abortion and the effect on contraceptive use post-abortion. Few studies have explored the impact of person-centred counselling or MI at the time of an abortion in clinical practice [17,18,72,73].…”