Purcell Carrie, Cameron Sharon, Lawton Julia, Glasier Anna, Harden Jeni
Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom.
Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9LN, United Kingdom.
Contraception. 2016 Feb;93(2):170-7. doi: 10.1016/j.contraception.2015.09.016. Epub 2015 Oct 3.
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).
We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation ≤9weeks) 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.
Most women and health professionals felt that contraceptive counselling at abortion was acceptable and appropriate, if provided in a sensitive, nonjudgmental 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.
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.
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.
从卫生专业人员和寻求堕胎的女性的角度，考察在医院妇科部门和专业性与生殖健康中心（SRHC）的背景下，避孕护理的经历。
我们对46名在苏格兰一家SRHC以及两家基于医院妇科部门的堕胎诊所接受药物流产（妊娠≤9周）时接受过避孕护理的女性进行了深入的半结构化访谈。我们还采访了在相同研究地点参与堕胎和避孕护理的25名卫生专业人员（护士和医生）。我们采用基于框架法的方法对访谈数据进行了主题分析，并对两种临床背景进行了比较。
大多数女性和卫生专业人员认为，如果以敏感、无偏见的方式提供，堕胎时的避孕咨询是可以接受且恰当的。参与者将堕胎时提供避孕措施主要视为预防后续意外怀孕的一种手段。避孕决策的描述也显示了女性和卫生专业人员在优先事项上围绕促使女性接受避孕措施方面的紧张关系。临床背景之间的比较表明，女性在SRHC环境中的经历可能更为积极。
虽然堕胎在理论上和实际操作中可能是解决避孕问题的便利时机，但绝非易事，需要付出相当大的努力和专业知识才能有效管理。为在堕胎时提供避孕护理的人员提供的培训应明确解决卫生专业人员和寻求堕胎的女性在优先事项上的潜在冲突。
本文对女性和卫生专业人员在药物流产时处理避孕问题的经历细节提供了独特见解。医院和社区SRHC背景之间的比较突出了适用于一系列环境的最佳实践和改进领域。
