Contraceptive counselling for women with multiple unintended pregnancies: the abortion client's perspective.

OBJECTIVES: Some women have multiple unintended pregnancies. Appropriate interventions could prevent some of the abortions that follow. This article presents the opinions of some abortion clients about their contraception and the counselling they received. It also formulates suggestions for counselling strategies of health care providers (HCPs) and other interventions that can support effective contraceptive behaviour. METHODS: A mixed method approach was used. A quantitative survey was carried out in one clinic in the Netherlands (N = 201), assessing topics related to contraceptive use and counselling. Semi-structured interviews (n = 11) were conducted with women who had had at least three unintended pregnancies. Interview topics included the type of contraceptive counselling, experience with contraceptive counselling and preferences regarding access to contraceptive information. RESULTS: Women who had had multiple abortions were more likely to express a need for contraceptive counselling and more often discussed contraception with their HCP compared with women who had had one abortion. Several themes emerged from the semi-structured interviews that had partially contributed to further unplanned pregnancies: experience with counselling, acceptability of the contraceptive method, sources of information and cultural influences. Many women with multiple unintended pregnancies could not find suitable advice and stated preferences for future decision making. CONCLUSION: This study offers insight into the motives for contraceptive use of women with multiple unintended pregnancies. Contraceptive efficacy could be improved by implementing counselling that is adapted to individual needs. The respondents stated that they would appreciate other sources of information, such as support through other forms of communication. The formation of a working group would be helpful in developing these services.

Wrestling with the hymen: consultations and practical solutions.

OBJECTIVE: To study the consultation and treatment options for young women who desire revirgination surgery, and to offer recommendations. METHODS: During her initial visit to a Dutch clinic, each of these women discussed with a physician her reasons for consulting and the treatment options. RESULTS: One hundred and fifty-four women sought advice for virginity-related issues. They were planning to marry or had experienced some form of sexual violence. Of these, 48 chose hymen reconstruction (HR), 26 a temporary hymen suture (THS), and 27 to resort to some expedient for staining the sheets or to another alternative for surgery. At follow-up, 13 of the 17 women who had THS and six of the 11 who had HR reported blood loss on their wedding night, whereas all six women who inserted a capsule with food colouring stated they had stained the sheets. CONCLUSIONS: Cost-effective procedures help young women who are no longer virgins to avoid reprisals by their husband or family. Pelvic floor exercises will tighten the vaginal opening. THS seems more effective than HR for producing blood loss. There are alternatives should no blood loss occur during penetration.

Wrestling with the hymen: knowledge and attitudes.

BACKGROUND: There is a cultural gap between girls with virginity problems and the western healthcare professionals (HCPs) they approach for help. METHOD: The lack of knowledge concerning virginity-related issues among non-Western migrants in the Netherlands is illustrated by means of a selection of quotations from messages received by a single sexual health service. The differences in cultural beliefs between non-Western and Western societies are also overviewed. CONCLUSION: HCPs should have a better grasp of the ins and outs of the virginity norms prevailing in migrant communities. This would enable them to counsel the young women concerned more efficiently and to find practical, culturally acceptable solutions to their dilemmas.

Motivation and satisfaction with early medical vs. surgical abortion in the Netherlands.

In the Netherlands, most abortions of early pregnancies have been with electric vacuum aspiration (VA). A study was conducted on women's motivations for choosing surgical (VA) or medical abortion and extent of satisfaction with the method chosen. Information was also collected about the proportion of medical abortions to total abortions in the Netherlands and, for comparison, in some other European countries. Of 501 women with early abortions surveyed in 2008/09, 71% opted for VA. Except for "previous experience", women had different motivations for preferring one or other method. At the post-abortion check-up, satisfaction with the medical method was lower compared to VA. Nevertheless, 80% of those who chose medical abortion would do so again. Nineteen out of 20 doctors questioned at a meeting on abortion offered surgical and medical abortion. Seven of the 11 who gave an opinion found medical abortion an excellent alternative and four thought having the choice was important. The proportion of medical abortions per clinic ranged from <1% to 33%. The proportion of medical vs. surgical abortions in all the countries looked at is influenced by provider attitudes and service-related factors. The use of medical abortion in the Netherlands might increase over time but is unlikely to rise as high as in some other European countries.

Aspects of sexuality education in Europe - definitions, differences and developments.

OBJECTIVE: Sexuality education in Europe has been influenced by political, social and ethical movements. This paper considers some of these influences and the implementation of sexuality education in different parts of Europe. CONTENT: The aim of sexuality education is to enable young people to acquire knowledge, attitudes, skills and values to make appropriate choices in their sexual behaviour and thus experience a healthy sex life that is age-appropriate. This should prevent them from acquiring or passing on sexually transmitted infections, including human immunodeficiency virus, from causing or suffering unwanted pregnancies, and from being the perpetrator or victim of violence. It should enhance understanding and respect diversity, thus contributing to a better society. Sexuality education as such has been widely recognised as essential for sexual health, but the content and principles that form the basis of this education have changed over time and differ widely among the countries of Europe. CONCLUSION: Agreeing on common standards of sexuality education across Europe is a challenge for the 21st century.

Factors influencing the percentage of second trimester abortions in the Netherlands.

Second trimester abortion has been legal in the Netherlands since 1984. Factors influencing second trimester abortion in the Netherlands may be different from those that play a role in first trimester abortions. This is important for professionals in counselling and education. In this paper national registration data are used to complement data from a small, qualitative, exploratory file study conducted in three clinics, on the factors associated with second trimester abortions. In 2006, 6.6% of all abortions registered in the National Abortion Registry took place after 12 weeks of gestation. In the qualitative data, relationship problems with the partner were mentioned more frequently as the main reason for second trimester abortions than for first trimester abortions. Factors associated with delay in obtaining an abortion were young age, inability to recognise pregnancy, ambivalence towards the pregnancy, having to travel to the Netherlands for abortion and to a lesser extent being an immigrant from specific countries. Information should be provided for young women and women from specific immigrant groups on early awareness of pregnancy, contraception and reduction of fear about seeking abortion and sexuality education should be provided.

Sexual and reproductive health issues of Turkish immigrants in the Netherlands.

OBJECTIVE: To identify factors that influence aspects of sexual and reproductive health behaviour, such as contraceptive use and teenage pregnancies, among Turkish immigrants in the Netherlands. METHOD: This socio-cultural review compares data from demographic surveys and opinion studies. The explanation for the trends found in these data was sought in the differences between the cultural backgrounds of immigrant and host populations, and in the socio-cultural changes that people undergo after immigration. DATA: In the Netherlands, 2.3% of the population are first- and second-generation Turkish immigrants. These people often originate from more traditional or underdeveloped rural areas in Eastern and Southern Turkey. Reproductive behaviour in the Netherlands differs greatly from that in Eastern and Southern Turkey, especially with regard to the use of contraception, abortion and the age at which women have children. These differences are largely the result of community-bound sets of opinions and role patterns. CONCLUSION: After immigration, the acculturation process will lead to a change in behaviour. During this process conflicts in relationships will arise within and between first- and second generation Turkish immigrants. These conflicts are particularly evident within the second generation that grew up in the Netherlands. These persons have adopted a number of opinions prevailing in the host country but, at the same time, cling to various traditional values. Second-generation Turkish women seem to adapt faster to the new culture than their male counterparts.