How effective are contraceptive counseling, provision interventions for women?

Contraceptive counseling and provision of services beyond usual care are both effective at improving contraceptive use without increasing sexually transmitted infections (STIs) or reducing condom use, results of a systematic review and meta-analysis have shown.

A team of investigators searched the databases of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and Medline from 1 January 2000 to 3 February 2022, as well as reference lists of key studies and systematic reviews.

Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both compared with usual care or an active control were included in the meta-analysis. A profile likelihood random-effects model was used to combine results.

Thirty-eight trials including 25,472 participants met the eligibility criteria. Use of contraceptives increased with various counseling interventions (risk ratio [RR], 1.39, 95 percent confidence interval [CI], 1.16‒1.72; I², 85.3 percent; n=10 trials), provision of emergency contraception in advance of use (RR, 2.12, 95 percent CI, 1.79‒2.36; I², 0.0 percent; n=8), and counseling or provision postpartum (RR, 1.15, 95 percent CI, 1.01‒1.52; I², 6.6 percent; n=5) or at the time of abortion (RR, 1.19, 95 percent CI, 1.09‒1.32; I², 0.0 percent; n=5) relative to usual care or active controls in multiple clinical settings.

Rates of pregnancy were also lower with these interventions, but most trials were underpowered and did not distinguish pregnancy intention. In addition, interventions did not increase the risk for STIs (RR, 1.05, 95 percent CI, 0.87‒1.25; I², 0.0 percent; n=5) or reduce condom use (RR, 1.03, 95 percent CI, 0.94‒1.13; I², 0.0 percent; n=6).

“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,” the authors said.

This meta-analysis was limited by varied interventions and trials that were not adequately designed to determine unintended pregnancy outcomes.