Clinical contraceptive counselling can decrease unintended pregnancies

Contraceptive counselling for female patients who are sexually active can increase contraceptive use, without increasing the risk of sexually transmitted infections

At a time when abortion rights are threatened in the US, contraceptive counselling can support patients in achieving their reproductive goals by providing provision and follow-up services as needed – and can lessen women’s chances of unintended pregnancies.

An editorial published in Annals of Internal Medicine suggests that contraceptive counselling and provision must immediately become a routine part of medical care, to protect the sexual health of women and promote safe sex.

A review and meta-analysis of 38 randomized controlled trials found that counselling patients about contraceptive use and providing contraceptives for patients wanting them in various clinical practice settings increases contraceptive use without increasing the risk for sexually transmitted infections (STIs).

Overall, researchers found that counselling and provision interventions can decrease unintended pregnancy in trials designed to evaluate this outcome.

Counselling does not reduce condom use compared to usual practice

The use and safety of contraceptives are well-established through both professional recommendations and Food and Drug Administration clearances. However, access to and coverage of contraceptive care can be limited.

The team analysed 38 randomised controlled trials of the effectiveness of contraceptive counselling and provision interventions for women, in order to increase the use of contraceptives and reduce unintended pregnancy.

The trials demonstrated the effectiveness of enhanced contraceptive counselling, provision, and follow-up services – providing emergency contraception in advance – and delivering services immediately postpartum or at the time of abortion.

The effectiveness of contraceptive counselling

Overall, results demonstrated consistently higher contraceptive use during the months following the interventions for adolescents and women, compared to usual care or controls – such as receiving educational materials without accompanying counselling.

Unintended pregnancy was reduced in the few trials designed for this outcome.

Additionally, the trials also showed no adverse effects of counselling and provision interventions related to STIs or condom use, although none evaluated additional potential harms, such as anxiety, stigma, and reproductive coercion.

These findings can provide valuable implications for clinicians who care for patients who can become pregnant, as pregnancy can frequently be associated with adverse patient outcomes – especially when unintended.