Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.).
Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.).
Ann Intern Med. 2022 Jul;175(7):980-993. doi: 10.7326/M21-4380. Epub 2022 May 24.
The effectiveness and harms of contraceptive counseling and provision interventions are unclear.
To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives and reduce unintended pregnancy, as well as evidence of their potential harms.
English-language searches of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1 January 2000 to 3 February 2022) and reference lists of key studies and systematic reviews.
Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both versus usual care or an active control.
Dual extraction and quality assessment of studies; results combined using a profile likelihood random-effects model.
A total of 38 trials (43 articles [25 472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions (risk ratio [RR], 1.39 [95% CI, 1.16 to 1.72]; = 85.3%; 10 trials), provision of emergency contraception in advance of use (RR, 2.12 [CI, 1.79 to 2.36]; = 0.0%; 8 trials), and counseling or provision postpartum (RR, 1.15 [CI, 1.01 to 1.52]; = 6.6%; 5 trials) or at the time of abortion (RR, 1.19 [CI, 1.09 to 1.32]; = 0.0%; 5 trials) than with usual care or active controls in multiple clinical settings. Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Interventions did not increase risk for sexually transmitted infections (STIs) (RR, 1.05 [CI, 0.87 to 1.25]; = 0.0%; 5 trials) or reduce condom use (RR, 1.03 [CI, 0.94 to 1.13]; = 0.0%; 6 trials).
Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes.
Contraceptive counseling and provision interventions that provide services beyond usual care increase contraceptive use without increasing STIs or reducing condom use. Contraceptive care in clinical practice could be improved by implementing enhanced contraceptive counseling, provision, and follow-up; providing emergency contraception in advance; and delivering contraceptive services immediately postpartum or at the time of abortion.
Resources Legacy Fund. (PROSPERO: CRD42020192981).
避孕咨询和提供干预措施的效果和危害尚不清楚。
评估针对女性的避孕咨询和提供干预措施增加避孕措施使用和减少非意愿妊娠的有效性证据，以及评估其潜在危害的证据。
2000 年 1 月 1 日至 2022 年 2 月 3 日，对 Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、PsycINFO、SocINDEX 和 MEDLINE 的英文搜索，以及关键研究和系统评价的参考文献列表。
提供增强型避孕咨询、避孕药具或两者的干预措施与常规护理或活性对照的随机对照试验。
对研究进行双重提取和质量评估；使用似然比随机效应模型对结果进行合并。
共有 38 项试验（43 篇文章[25472 名参与者]）符合纳入标准。各种咨询干预措施增加了避孕措施的使用（风险比[RR]，1.39[95%CI，1.16 至 1.72]； = 85.3%；10 项研究）、提前提供紧急避孕（RR，2.12[CI，1.79 至 2.36]； = 0.0%；8 项研究）以及产后（RR，1.15[CI，1.01 至 1.52]； = 6.6%；5 项研究）或堕胎时（RR，1.19[CI，1.09 至 1.32]； = 0.0%；5 项研究）提供的咨询或提供的服务比常规护理或活性对照更能增加避孕措施的使用在多个临床环境中。干预措施通常会降低怀孕率，尽管大多数试验的效力不足，并且无法区分怀孕意向。干预措施并未增加性传播感染（STI）的风险（RR，1.05[CI，0.87 至 1.25]； = 0.0%；5 项研究）或减少避孕套使用（RR，1.03[CI，0.94 至 1.13]； = 0.0%；6 项研究）。
干预措施各不相同；很少有试验设计合理，无法确定非意愿妊娠的结果。
提供超出常规护理的服务的避孕咨询和提供干预措施可增加避孕措施的使用，而不会增加 STI 或减少避孕套的使用。通过实施强化避孕咨询、提供和随访、提前提供紧急避孕、以及立即在产后或堕胎时提供避孕服务，可以改善临床实践中的避孕护理。
资源遗产基金。（PROSPERO：CRD42020192981）。
