Medical Faculty of Dicle University

Published in BMC Public Health, this 7-page report describes the impact of post-abortion family planning counseling in bringing about contraceptive usage in women who had an induced abortion in a Turkish family planning clinic. The intervention was designed to respond to World Health Organization (WHO) estimates that, worldwide, almost 20 million unsafe abortions take place each year, with 95% of these performed in developing countries. About 80,000 maternal deaths per year are thought to be due to abortion complications, accounting for one in eight pregnancy-related deaths. Post-abortion counseling incorporated into post-abortion care has been regarded as an appropriate venue or vehicle to decrease unwanted pregnancies and induced abortions.

As explained here, the Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and non-governmental organisation (NGO) whose family planning clinic serves the lower socio-economic populations of Diyarbakir. In this city, only 28.1% of the women have used one of the modern contraceptive methods. All health services at the clinic are offered free of charge, and the nurses and physicians work voluntarily. Three physicians and seven nurses were trained by a trainer from Dicle University. A core principle applied was that adults learn easier if the subject is relevant to their interest and previous experiences, if their feelings and attitudes are identified, and if they are actively involved in the learning process. Physicians and nurses were also trained on good interpersonal communication skills, including questioning effectively, listening actively, paraphrasing clients' comments or problems, and adopting a non-judgmental, helpful manner. The training session lasted 2 weeks (40 hours), in which half of the lectures were based on practice.

Counseling was conducted in a private room, with sufficient time (20 to 45 minutes) and confidentiality assured. The goal was to help clients understand their reproductive legal rights, to learn to reach their self-determined goals through well-informed choices. Information about modern contraceptive methods was given. Condoms, combined oral contraceptive pills, and the intrauterine device (IUD) were introduced by physicians and nurses - who then followed up with clients by telephone calls or by home visits to address any questions or concerns about the chosen contraceptive method. Trainers from Dicle University also supervised physicians and nurses on their adherence to proper counseling principles.

The records of 322 women who underwent induced abortion and who had been provided post-abortion counseling between May 2003 and April 2004 were the main source of this study. One year after the abortion date women were invited to the clinic by telephone call or home visit. In total, 237 women could be reached, followed, and interviewed. Evaluators found that before induced abortion was performed, the total contraception usage (modern methods + traditional methods) rate was 44.7%; this rate increased to 80.1% at the end of one year. The modern method usage rate increased 62.0%. For instance, there were no women with an IUD before induced abortion. At the end of one year, 124 (52.3%) women had an IUD. "A modern method was introduced immediately after abortion" was, according to evaluators, "the most important factor increasing modern method usage."

These results advocate that post-abortion counseling may be an effective tool to increase contraceptive use. Evaluators explain that the post-abortion period is the right time to introduce contraceptive advice, because women are more ready to receive messages. They stress that "introducing some advices or methods is not sufficient; more qualified counseling techniques including proper communication skills is required in post abortion period." In conclusion, they emphasise that "[i]mproved and more qualified post-abortion family planning counseling should be an integral part of abortion services."

BioMed Central.