Family planning service – addressing potential barriers

Sammanfattning: Background: Access to family planning service is crucial for reproductive health. Family planning service include contraceptive methods as well as safe methods for pregnancy termination when needed. It was estimated in 2019 that 163 million women globally in fertile age (18-49 years) have an unmet need for contraception. Reasons include poor knowledge among users and providers, experience or fear of side effects, limited availability of family planning services of good quality, limited resources and sometimes also religious or political opposition. Similar barriers are also present for access to abortion service of good quality. Aim: To evaluate recently pregnant women’s perceptions of contraceptive methods and to evaluate the effect of structured contraceptive counselling on contraceptive uptake. In most settings home administration of misoprostol is offered up to 9 weeks of pregnancy and we wanted to also evaluate the efficacy and women’s perceptions of home administration of misoprostol in medical abortion up to 10 weeks of gestation and to explore women’s perception of a pre abortion ultrasound when opting for medical abortion on-line. Material and methods: We performed a survey, among recently pregnant women in Kiev, Ukraine, which included questions regarding experience and knowledge about contraceptive methods. We also performed a randomized controlled trial where young women were allocated to either advanced, structured counselling abort different contraceptive method or regular counselling. The primary outcome was to measure if the effect on participants choice of effective contraceptive methods would differ between the intervention and the control groups. In order to expend access to home medical abortion we included women with a gestational age up to 70 days, opting for medical abortion using home administration of misoprostol. We investigated effect of the treatment and women’s perception. We also made an analysis of data from the website Women on Web where women opting for medical abortion on line participated. We evaluated the use of pre abortion ultrasound and women’s perception about the need for this examination. Results: We found that the knowledge on effective contraceptive methods were low in our study group and that fear of side effects were a common reason for not using some methods. Structured counselling was found to have a profound impact on the young women’s preferences for effective contraceptive methods. A significant increase in long-acting reversible contraceptives was observed in the intervention group. Our abortion study supports the previously shown data that it is safe and effective to offer home administration of misoprostol for medical abortion up to 10 weeks of gestation. Most women opting for medical abortion through the online service did not have a pre abortion ultrasound scan and they did not find that necessary. Lack of resources or privacy issues were reasons stated. Conclusion: The studies in the thesis confirm that there is still a need to increase knowledge regarding effective methods for family planning. It also shows that constructive counselling has an effect on the uptake of contraceptive methods. Home administration of misoprostol for medical abortion is as safe up to 70 days of gestation as it is in earlier gestations. Pre abortion ultrasound examination can be a barrier to access abortion service and women opting for abortion in our study do not perceive this a necessary demand.