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The contraceptive consultation differs across international healthcare systems in relation to the setting, scope of practice, provider-responsibility and the available time frame. The key to a successful consultation is to ensure that the patient leaves with their contraceptive needs met, either with the immediate provision of a contraceptive method or a plan for initiation at a specified future date. This chapter provides guidance on how to fulfill this outcome. In a generalist setting, posters inviting patients to discuss sexual health issues, brochures on contraception and information on confidentiality may be of assistance in setting the scene for the consultation. Where time is limited, an effective contraception consultation lies in its shaping. There are a variety of tools ranging from websites to models that can be useful to support a contraceptive consultation. The chapter presents cases, which illustrate approaches and principles in a sample of contraceptive consultations across the reproductive lifespan.
We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy.
This was a prospective cohort study of 13 261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321).
Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3–0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95%CI 1.1–2.6), or who were refused a termination (RR 2.9, 95%CI 1.3–6.3).
The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.
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