Abstract
Aim
The aim of this systematic review was to synthesise the evidence on
the comparative effectiveness of different counselling strategies for
modern contraception on contraceptive behaviour and satisfaction, and to
examine their advantages and disadvantages.
Methods
Six electronic databases (Medline, Embase, Global Health, Popline,
CINAHL Plus, and Cochrane Library) were searched to identify
publications comparing two or more contraceptive counselling strategies
and reporting quantitative results on contraceptive use, uptake,
continuation or switching, or client satisfaction. Studies of women or
couples from any country, published in English since 1990 were
considered.
Results
A total of 63 publications corresponding to 61 studies met the
inclusion criteria. There was substantial heterogeneity in study
settings, interventions and outcome measures. Interventions targeting
women initiating a method (including structured counselling on side
effects) tended to show positive effects on contraceptive continuation.
In contrast, the majority of studies of provider training and
decision-making tools for method choice did not find evidence of an
effect. Additional antenatal or postpartum counselling sessions were
associated with increased postpartum contraceptive use, regardless of
their timing in pregnancy or postpartum. Dedicated pre-abortion
contraceptive counselling was associated with increased use only when
accompanied by broader contraceptive method provision. Male partner or
couples counselling was effective at increasing contraceptive use in two
of five studies targeting non-users, women initiating implants or
seeking abortion. High-quality evidence is lacking for the majority of
intervention types.
Conclusions
The evidence base and quality of studies are limited, and further
research is needed to determine the effectiveness of many counselling
interventions in different settings.
Funder
Bill and
Melinda Gates Foundation
Subject
Obstetrics and Gynecology,Reproductive Medicine
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