Preventing Induced Abortion Among Urban Poor In Fortaleza, Brazil: Is Post-Abortion Counselling Effective?

This thesis reports the results of a randomised controlled intervention study carried out between May and November 1993 in a major public hospital in the metropolitan area of Fortaleza City, Ceará, Brazil. The objective was to investigate the impact of postabortion counselling on uptake of contraception and on subsequent pregnancy and abortion. The study population was a sample of women hospitalised with complications of induced abortion which were identified during as larger hospital-based study on abortion. The intervention was half an hour of contraceptive counselling prior to discharge at the study site hospital. No contraceptive method was given. A total of 695 women were enrolled into the study, 345 in the intervention group and 350 in the control group. They were followed up at home at 2 weeks, 6 weeks, 4 months, 8 months and 1 year after discharge. Data were collected by trained interviewers using a structured questionnaire. Outcome measures of interest were; knowledge of contraceptive methods, seeking contraceptive services, uptake of contraception, having unprotected sexual intercourse, subsequent pregnancies and subsequent abortion. The study results show that this particular mode of counselling (single shot hospitalbased post-abortion) increased the level of knowledge of some contraceptive methods, but did not have any effect in changing behaviour such as seeking contraceptive services, uptake of contraception or having unprotected sexual relationship. As a consequence, counselling did not show any impact on preventing another unwanted pregnancy and induced abortion. Among 695 women, 165 (23.7%) became pregnant again before the end of the 1 year follow-up; 81(23.5%) in the intervention group and 84 (24.0%) in the control group. Of the 695 women, 42 (6.0%) had another abortion before the end of the 1 year follow-up; 27 (7.8%) in the intervention group and 15 (4.3%) in the control group. At 6 weeks visit, of the 662 women interviewed, 345 (52.1%) were using contraceptive methods; 178 (53.8%) in the intervention group and 167 (50.5%) in the control group. Women who were not using contraception after abortion tended to be young, single or without a partner. "Not having sexual intercourse" was the most frequently cited reason for not using a contraceptive method during the follow-up period. Suggestions were made on how a more effective intervention that might prove more successful in responding to these women' s needs for enhanced contraception can be