Provide Important Information

Provide Important Information A woman has important choices and opportunities, before, during, and after abortion care. To make decisions about her health and fertility, she needs to know the following.

• Fertility returns quickly. Following an induced or spontaneous abortion, ovulation can return as early as 8–10 days later and usually within 1 month. Hence, initiating a family planning method immediately after abortion if possible, or as soon as possible within the first month, is important for women who desire to delay or prevent a future pregnancy.
• All contraceptive options may be considered after an abortion. The client’s wishes and her future plans for childbearing are paramount and the woman should be empowered to make an informed choice. Information provided about the different methods should include failure rates since some women may have sought an abortion due to the failure of the contraceptive method they were using. Ultimately, the choice must be made by the woman but her choice should be an informed one.
• If the woman decides to wait before choosing a contraceptive method for ongoing use, she should consider using a backup method in the meantime if she has sex. Backup methods include abstinence, male or female condoms, spermicides,* and withdrawal; the client should be informed that spermicides and withdrawal are the least effective contraceptive methods, and if possible, she should be given condoms and emergency contraceptive pills.
• If the woman decides not to use contraception at this time, providers can offer information on her fertility condition, the most appropriate available methods, and where to obtain them. Providers can also offer condoms, oral contraceptives, and emergency contraceptive pills for women to take home and use later.
• If being treated for infection or vaginal or cervical injury, the woman should wait until she has completed treatment/management of the infection/injury before having sex again.
• If a woman who has suffered a miscarriage wants to become pregnant again soon, the provider should encourage her to wait at least 6 months as this may reduce the risks of low birth weight, premature birth, maternal anemia, and a repeat miscarriage.
• A woman receiving postabortion care may need other reproductive health services. In particular, a provider can help her consider if she might have been exposed to sexually transmitted infections, and may need to ask whether she has experienced sexual violence (see section on Violence Against Women).

Counsel With Compassion

Counseling is more than information provision. It is a focused, interactive process to provide support, information, and non-directive guidance from a trained and skilled person, in an environment where a person can openly share their thoughts, feelings, perceptions, and personal experiences. The process should support final decision-making by the client about the topic being discussed.

Before or after an abortion, some clients may wish to receive counseling. In particular, a woman who has had postabortion complications may need additional support. A woman who has faced the double risk of unplanned pregnancy and unsafe induced abortion especially needs help and support, including psychological services. The counseling should be client-centered.

When offering and providing counseling, it is essential to apply the following guiding principles.

• Ensure that the person agrees to receive counseling and has had the opportunity to choose not to receive counseling.
• Ask the client to explain what she wants or needs and any concerns she may have, including her wishes regarding pregnancy, and consideration of the pros and cons of different methods such as the likely impact on menstrual bleeding, pain, and acne.
• Give her the time she needs, and actively listen to her expressed values, needs, and preferences (including if she wants someone she trusts to be present during counseling).
• Treat the client with respect and avoid making any judgment or criticism.
• Ensure privacy and confidentiality.
• Communicate information in a manner and language that is understandable to the individual.
• Present all suitable options tailored to the person’s medical eligibility, expressed needs and preferences, while avoiding imposing one’s personal values and beliefs onto them.

Make it clear to the client that she will be the one to decide her family planning method.

* A client can use spermicides if they have no vaginal or cervical injury.