Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women
| Autor: | Heidi D. Nelson, Amy Cantor, Rebecca M. Jungbauer, Karen B. Eden, Blair Darney, Katherine Ahrens, Amanda Burgess, Chandler Atchison, Rose Goueth, Rongwei Fu |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Ann Intern Med |
| ISSN: | 1539-3704 0003-4819 |
| DOI: | 10.7326/m21-4380 |
| Popis: | BACKGROUND: The effectiveness and harms of contraceptive counseling and provision interventions are unclear. PURPOSE: To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives, reduce unintended pregnancy, or cause harms. DATA SOURCES: English-language searches of Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1/1/2000-2/3/2022); reference lists. STUDY SELECTION: Randomized controlled trials of interventions providing enhanced contraceptive counseling, provision of contraceptives, or both versus usual care or active control. DATA EXTRACTION: Dual extraction and quality assessment of studies; results combined by profile likelihood random-effects model. DATA SYNTHESIS: 38 trials (43 articles [25,472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions versus usual care or active control in different clinical settings (risk ratio [RR], 1.39 [95% CI, 1.16-1.72]; I(2)=85.3%; 10 trials); provision of emergency contraception in advance of use (RR, 2.12 [95% CI, 1.79-2.36]; I(2)=0.0%; 8 trials); and counseling or provision postpartum (RR, 1.15 [95% CI, 1.01-1.52]; I(2)=6.6%; 5 trials) or at the time of abortion (RR, 1.19 [95% CI, 1.09-1.32]; I(2)=0.0%; 5 trials). Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Risks were similar for STIs (RR, 1.05 [95% CI, 0.87-1.25]; I(2)=0.0%; 5 trials) and condom use (RR, 1.03 [95% CI, 0.94-1.13]; I(2)=0.0%; 6 trials). LIMITATIONS: Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes. CONCLUSIONS: 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. |
| Databáze: | OpenAIRE |
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