Strengthening contraceptive counselling: gaps in knowledge and implementation research.

Ensuring access to contraception is fundamental to upholding human rights as well as contributing to improved health outcomes. It is enshrined in the United Nations’ Sustainable Development Goal 3 on Good Health and Well-being and explicitly its target 3.7.1: Ensure universal access to sexual and reproductive healthcare services, including family planning .1 Despite increases in contraceptive use in recent decades, an estimated 218 million women of reproductive age, mostly in low- and middle-income countries, have an unmet need for modern contraceptive methods.2 Meeting the unmet need for contraception across the reproductive cycle in low- and middle-income countries and offering all pregnant women and their newborns the standard care recommended by the World Health Organizatoin (WHO) would result in dramatic reductions of unintended pregnancies by 68%, unsafe abortions by 72%, maternal deaths by 62% and neonatal deaths by 69%.3 In addition, adequate contraceptive coverage among users can be improved by addressing suboptimal use and high discontinuation rates.4 Effective contraceptive counselling can help individuals choose a method that meets their needs and preferences, manage any side effects, and continue using their preferred method or switch to an alternative one.5 Indeed, a systematic review that synthesised the evidence on the comparative effectiveness of different contraceptive counselling strategies found that contraceptive counselling has the potential to improve the effective use of modern contraception and reduce unmet need.6 Interventions targeting women requesting or initiating a chosen method, including structured counselling on side effects, tended to show positive effects on contraceptive continuation. Counselling interventions focused …