Women's Health Research Unit, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa.
Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
BMC Health Serv Res. 2021 Dec 4;21(1):1304. doi: 10.1186/s12913-021-07306-2.
The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion.
We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text.
Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial.
Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.
现代避孕方法的可及性，包括长效可逆避孕方法（LARC），是流产后护理的基本组成部分。南非最近一项随机对照试验（RCT）的结果比较了在妊娠 17-20 周行药物流产（MA）后立即和延迟放置铜宫内节育器（IUD），结果显示立即放置可提高流产后 6 周的 IUD 使用率，但排出率明显高于延迟放置。本研究旨在探讨与妊娠中期 MA 后立即放置 IUD 相关的实施障碍、促进因素和具体环境因素。
我们在 RCT 中进行了一项定性研究，对 14 名为研究参与者提供医疗服务的工作人员和 24 名研究参与者进行了深入访谈。研究问题探讨了立即放置 IUD 的实施障碍和促进因素、避孕决策，以及环境和补充试验活动对服务提供的影响。采访进行了录音并翻译成英文。我们对转录的采访文本进行了三角主题分析。
流产中心的研究护士进行的避孕咨询提高了知识，纠正了误解，并增加了流产后对 IUD 的需求。女性明确表示更喜欢立即放置。方便、避孕和隐私问题至关重要，女性表示更喜欢与了解她们流产史的工作人员接触，并与那些与她们有联系的工作人员接触。医生和护士普遍赞成立即放置，并表示如果女性希望这样，可以将其纳入标准护理。这与研究团队需要干预以加强工作人员按照试验分配提供避孕措施的一致性形成对比。
女性和工作人员赞成妊娠中期 MA 后立即放置 IUD，但服务提供可能需要确保流产后及时放置、连续护理、沟通以减轻失访、以及培训工作人员以确保能力的结构。
