Résumé : The purpose of this study of 3385 women hospitalized for abortion services in developing countries was to 1) establish the effect of counseling on the incidence of repeat pregnancy and abortion; 2) establish the effect of contraceptive acceptance and use on the incidence of repeat pregnancy and abortion; 3) study the effect of postabortion counseling on contraceptive acceptance and use; 4) document their sociodemographic characteristics, reproductive history, and knowledge and use of contraceptive methods; and 5) study the immediate complications of abortion. The study was conducted between late 1987 and August 1990 in Nairobi, Kenya (17.7% of the women); Harare, Zimbabwe (32.9%); Lusaka, Zambia (13.8%); Mexico City, Mexico (9.9%); Lagos, Nigeria (18,4%); and Jos, Nigeria (7,3%). All women who presented with abortion, whether spontaneous or induced, were randomly assigned to either a noncounseled control group or a postabortion counseled study group, using computer-generated random numbers. Counseling was a one-time event, and the counseling protocol was not standardized among centers. Both groups of women were given 3 follow-up appointments over the next year, and 60% were followed-up. 17% of the women were adolescents, 36% were single, and most were literate. Most women (78%) had had 1 or more pregnancies prior to the index abortion, while 35% had experienced 1 or more abortions. The index pregnancy was unwanted in two-thirds of the cases; up to 41% admitted that the index abortion had been induced. 25% of all women and 13% of the teenagers were using contraception prior to the index abortion, and use was shown to be dependent upon the level of contraceptive knowledge. During follow-up, 63% of all women and 59% of the teenagers were found to have accepted and used a method, and 57% used the method for at least 6 months. Increased acceptance was associated with age (older women) and education (well-educated). Counseling did not increase the overall acceptance of family planning (FP). Within the 1-year follow-up, 333 pregnancies (16.5% pregnancy rate) and 66 abortions (20.9%) were recorded. Counseling was associated with a significant overall reduction in the risk of repeat pregnancy (11.7% among the counseled women, 21.5% among the noncounseled group); however, among those women who got pregnant, counseling did not exert any direct protective effect against repeat abortion, but did lead to a significantly longer median interval between abortion and repeat pregnancy (9.4 months for counseled women vs. 6.8 months for the noncounseled). The author concluded that improved abortion-care facilities are needed; improved FP knowledge and services are needed; counseling may not influence FP acceptance in locations where overall acceptance rates are already high; contraceptive use is associated with significant reduction of repeat pregnancies; and counseling does not directly reduce the incidence of repeat abortion, but it indirectly lowers the need by reducing the number of unwanted repeat pregnancies (the author attributes this apparent paradox to the strong motivation for abortion among those women with unwanted pregnancy). Based upon these results, the author recommended the provision of postabortion FP services; further research to standardize and test appropriate counseling packages; studies to document the effect of more intensive counseling; and provision of follow-up services for women who are identified as being at high risk for repeat pregnancy and/or abortion.
Notes : Inglés/anglais/English, nbsp;Abstract : Popline (http://db.jhuccp.org/popinform/basic.html) - PIP 101357