Objective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation. Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale. Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1). Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome.

Objective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation. Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale. Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1). Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome.

Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders. Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle. Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2). Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders. Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle. Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2). Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders.

Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle.

Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP Δ-scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP Δ-scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP Δ-scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2).

Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders.

Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle.

Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2).

Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

Objectives: To address the associations between emotional, physical and sexual violence, specifically multiple violence victimisation, and sexual ill health and sexual risk behaviours in youth, as well as possible gender differences. Methods: A cross-sectional population-based survey among sexually experienced youth using a questionnaire with validated questions on emotional, physical, and sexual violence victimisation, sociodemographics, health risk behaviours, and sexual ill health and sexual risk behaviours. Proportions, unadjusted/adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: The participants comprised 1192 female and 1021 male students aged 15 to 22 years. The females had experienced multiple violence (victimisation with two or three types of violence) more often than the males (21% vs. 16%). The associations between multiple violence victimisation and sexual ill health and sexual risk behaviours were consistent for both genders. Experience of/involvement in pregnancy yielded adjusted ORs of 2.4 (95% CI 1.5-3.7) for females and 2.1 (95% CI 1.3-3.4) for males, and early age at first intercourse 2.2 (95% CI 1.6-3.1) for females and 1.9 (95% CI 1.2-3.0) for males. No significantly raised adjusted ORs were found for non-use of contraceptives in young men or young women, or for chlamydia infection in young men. Conclusions: Several types of sexual ill health and sexual risk behaviours are strongly associated with multiple violence victimisation in both genders. This should be taken into consideration when counselling young people and addressing their sexual and reproductive health.

Objectives: To address the associations between emotional, physical and sexual violence, specifically multiple violence victimisation, and sexual ill health and sexual risk behaviours in youth, as well as possible gender differences.

Methods: A cross-sectional population-based survey among sexually experienced youth using a questionnaire with validated questions on emotional, physical, and sexual violence victimisation, sociodemographics, health risk behaviours, and sexual ill health and sexual risk behaviours. Proportions, unadjusted/adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: The participants comprised 1192 female and 1021 male students aged 15 to 22 years. The females had experienced multiple violence (victimisation with two or three types of violence) more often than the males (21% vs. 16%). The associations between multiple violence victimisation and sexual ill health and sexual risk behaviours were consistent for both genders. Experience of/involvement in pregnancy yielded adjusted ORs of 2.4 (95% CI 1.5-3.7) for females and 2.1 (95% CI 1.3-3.4) for males, and early age at first intercourse 2.2 (95% CI 1.6-3.1) for females and 1.9 (95% CI 1.2-3.0) for males. No significantly raised adjusted ORs were found for non-use of contraceptives in young men or young women, or for chlamydia infection in young men.

Conclusions: Several types of sexual ill health and sexual risk behaviours are strongly associated with multiple violence victimisation in both genders. This should be taken into consideration when counselling young people and addressing their sexual and reproductive health.

Objectives To determine the use of long-acting reversible contraceptives (LARCs) in the UK over the period 2004 to 2010, using the general practice database The Health Improvement Network (THIN).

Methods Women in THIN, aged 18 to 44 years during 2004 to 2010, who had been registered with their general practitioner for at least five years, with a prescription history of at least one year were included. THIN was searched using the Read and MULTILEX codes for: copper intrauterine devices (Cu-IUDs), the levonorgestrel releasing-intrauterine system (LNG-IUS), progestogen-only implants, and progestogen-only injections.

Results The prevalence of progestogen-only implant use rose from 0.5 to 3.4%, and that of the LNG-IUS from 3.1 to 5.2%. The annual incidence and prevalence of progestogen-only implant use increased for all age groups but was most marked in younger women, whereas the use of the LNG-IUS augmented with increasing age. For all women, there was a small decrease in the prevalence of use of Cu-IUDs (from 5.4 to 4.8%) and progestogen-only injections (from 3.6 to 3.2%).

Conclusions Uptake of progestogen-only implants and the LNG-IUS increased over the period 2004 to 2010 in the UK, but LARC use in young women remains low.

Objectives To explore midwives' perceptions regarding virginity control and hymen 'reconstructions', and how these practices can be debated from a gender perspective. Methods An international group of 266 midwives answered an open-ended question in a Web survey. The great majority came from the Western world, among them, the majority were from Europe. Data were analysed using qualitative content analysis. Results Three themes emerged: misogynistic practices that cement the gender order, which revealed how the respondents viewed virginity control and hymen 'reconstructions'; raising public awareness and combatting practices that demean women, which were suggested as strategies by which to combat these practices; and promoting agency in women and providing culturally sensitive care, which were considered to improve health care encounters. Conclusions Virginity control and hymen 'reconstructions' are elements of patriarchy, whereby violence and control are employed to subordinate women. To counter these practices, macro and micro-level activities are needed to expand women's human rights in the private and the public spheres. Political activism, international debates, collaboration between sectors such as health care and law-makers may lead to increased gender equality. A women-centred approach whereby women are empowered with agency will make women more capable of combatting virginity control and hymen 'reconstruction'.

The objective of this study was to explore religious beliefs of Somali men residing in Finland that may influence their use of condoms and their perceptions of contraceptive use by women of their community. Both quantitative and qualitative methods were used to study 98 refugee Somali married men aged 30-65 years. Participants filled in self-administered questionnaires (in English or in Somali) but were also interviewed. The interviews were semi-structured, featuring thematically clustered open-ended questions; they were conducted in Somali or in English. Participants had arrived in Finland between 1990-1998. They had from 2-12 children. For religious reasons, 63% of the men avoided using condoms and were opposed to women's contraceptive use. The remaining 37% were not deterred by religious beliefs from using condoms and from approving women's contraceptive practices. In conclusion, for religious reasons, most Somali men assessed avoided using condoms and disapproved of the use of contraception by women.

Purpose: The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries.

Materials and methods: A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions.

Results: Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child.

Conclusions: Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.

Objectives: To investigate sex education in Swedish schools regarding content, satisfaction, and suggested improvements, as described by teenagers and young adults. Methods: Waiting-room survey conducted among 225 female patients (aged 13-25) at youth and student health clinics in one large-, and one medium-sized Swedish city. Results: Most participants (97%, n = 218) had received sex education in school, of varying content and quality. Sixty percent thought basic body development was sufficiently covered. Insufficiently covered topics included sexual assault (96%), sexual harassment (94%), pornography (90%), abortion (81%), emergency contraception (80%), fertility (80%), and pregnancy (59%). Thirty percent received no information about chlamydia, and almost half reported that condyloma and human papillomavirus had not been addressed. The youngest respondents (13-19 years) were significantly more likely to have been told about emergency contraception, homosexuality, bisexuality, and transsexuality. Nearly half (46%) considered ''acceptable'' the knowledge gained from sex education provided at school whereas more than a third considered it ''poor'' or ''very poor''. Suggested improvements included more information, more discussion, greater emphasis on sexual diversity, and more knowledgeable teachers. Conclusions: Content and quality of sex education varied greatly. Most respondents thought many topics were insufficiently covered, sex education should be more extensive, and teachers better educated.

Objective To gain deeper understanding of how teenage males view abortion, adolescent   fatherhood, sexual behavior, and use of contraception.  Method We conducted six focus-group interviews with 17-year-old boys (n 1⁄4 40). The interviews were tape-recorded, transcribed verbatim, and analyzed using manifest content analysis.  Results Adolescent fatherhood was considered to be a catastrophe and abortion a moral   dilemma. Most participants agreed that the unrestricted right to decide on abortion rests upon the girl, but some were frustrated by not having any legal right to influence the decision. Contraceptive failure was viewed as common and mainly due to the influence of alcohol or in relation to unplanned sex. Boys perceived girls as having a greater responsibility in avoiding pregnancy, and they often put a blind trust in the girls’ use of hormonal contraceptives or initiation of emergency contraception. Several groups had insufficient knowledge about fetal development and other aspects of reproduction. Many were unsatisfied with the sex education they had received at school, but still considered it to be an important counterweight to other sources of information concerning sex, such as  pornography.  Conclusion Equal responsibility among boys and girls regarding reproductive issues is still a challenge, but nevertheless an important key to the prevention of unwanted pregnancies.

Objectives: To explore young men's perceptions of (i) the risk for themselves and their partners in connection with unprotected intercourse, and (ii) the main barriers to practising safe sex. Methods: Qualitative latent content analysis of interviews involving 22 Swedish males aged 16-20, who requested a Chlamydia test. Results:The main categories identified were: (1) Low perceived threat regarding sexual risk-taking - personal consequences in focus. Threats could be both immediate and distant with varying preventative strategies. The young men worried more about their personal consequences than about the consequences for their partner. They were confident that an unintended pregnancy would be terminated, leading to decreased motivation for sharing pregnancy-preventing practices with their partner. (2) Perceived barriers to practising safe sex. Main barriers to condom use were interference with spontaneity, pleasure reduction, fear of loosing one's erection, and embarrassment or distrust. Other obstacles were the girl's use of hormonal contraception, and difficulties in communicating about safe sex. Conclusion The young men did not seem to worry about risks when having unprotected sex. To protect men's - and women's - sexual and reproductive health, efforts are needed to increase the former's contraceptive responsibilities and awareness of consequences related to unprotected sex.

Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

OBJECTIVES: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

METHODS: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

RESULTS: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

CONCLUSION: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

PURPOSE: Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives.

MATERIALS AND METHODS: Internet-based e-survey of Swedish women of fertile age, 16-49 years.

RESULTS: In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services 'as usual'. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001).

CONCLUSIONS: During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated.

SHORT CONDENSATION The COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.

PURPOSE: Explore contraceptive use, unmet need of and attitudes towards contraceptive use in Sweden. Secondly, to investigate knowledge of contraceptives, prevalence and outcomes of unintended pregnancies.

MATERIALS AND METHODS: Internet based e-survey of Swedish women aged 16-49. The e-survey contained 49 questions with both spontaneous and multi-choice character on demographics, contraceptive use, knowledge of and attitudes towards contraception, importance of monthly bleeding, and experience of unintended pregnancy. The e-survey was closed when reaching the estimated sample size of 1000 respondents.

RESULTS: A total of 1016 women participated, whereof 62.4% used contraception, 31.8% did not and 5.8% had stopped in the last 12 months. Unmet need for contraception was estimated at 17.2%. At least one unintended pregnancy was experienced by 19.9%. All women rated effectiveness as the most important characteristic of a contraceptive method.

CONCLUSIONS: Use of contraception in Swedish women remains low, 62.4%, and the unmet need for contraception has increased to 17.2%. Method effectiveness and health benefits of hormonal contraception should be emphasised during contraceptive counselling, and actions are needed to target groups with low use of effective contraception as well as to reach those who never seek contraception.

KEY MESSAGE Close to one third of Swedish women do not use contraception and one fifth have experienced at least one unintended pregnancy. Unmet need for contraception is high despite easy access and subsidies for young women.

Objective To study the experiences of teenagers using contraceptives at an out-patient abortion clinic and to explore the reasons behind their choices. Methods Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used. Results One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use. Conclusion The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was unsatisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to initiate it. Friends and the Internet were the main sources for acquiring information.

Objective: A survey was conducted to explore worries, fears and preparedness relating to the recollected experience of having an induced abortion.

Methods: The Web-based survey was carried out in Sweden among 185 women. Respondents answered open-ended questions and gave retrospective self-reported ratings about their abortion-related worries, fears, preparedness and satisfaction with information obtained from health professionals and the Web. Data were analysed using qualitative content analysis and descriptive statistics.

Results: Worries and fears included the abortion process, physical reactions and psychosocial aspects. The abortion was associated with unexpected events, including the abortion process, poor health professional treatment and support, and side effects and complications. Respondents described a lack of preparatory information, leading to uncertainties due to insufficient information. Many searched for Web-based information, but respondents experienced difficulties finding high-quality sources. Respondents also recounted that the preparatory information received did not reflect the actual abortion experience.

Conclusion: There is room for improvement with regard to informing, preparing and supporting women who seek an abortion. The results emphasise the importance of health professionals’ giving sufficient preparatory information to enable preparedness and lessen the impact of possible unexpected events. There is a need for the development of a trustworthy Web-based service that contains honest and high-quality information.

Objective: A survey was conducted to explore worries, fears and preparedness relating to the recollected experience of having an induced abortion. Methods: The Web-based survey was carried out in Sweden among 185 women. Respondents answered open-ended questions and gave retrospective self-reported ratings about their abortion-related worries, fears, preparedness and satisfaction with information obtained from health professionals and the Web. Data were analysed using qualitative content analysis and descriptive statistics. Results: Worries and fears included the abortion process, physical reactions and psychosocial aspects. The abortion was associated with unexpected events, including the abortion process, poor health professional treatment and support, and side effects and complications. Respondents described a lack of preparatory information, leading to uncertainties due to insufficient information. Many searched for Web-based information, but respondents experienced difficulties finding high-quality sources. Respondents also recounted that the preparatory information received did not reflect the actual abortion experience. Conclusion: There is room for improvement with regard to informing, preparing and supporting women who seek an abortion. The results emphasise the importance of health professionals' giving sufficient preparatory information to enable preparedness and lessen the impact of possible unexpected events. There is a need for the development of a trustworthy Web-based service that contains honest and high-quality information.

Objective: A survey was conducted to explore worries, fears and preparedness relating to the recollected experience of having an induced abortion. Methods: The Web-based survey was carried out in Sweden among 185 women. Respondents answered open-ended questions and gave retrospective self-reported ratings about their abortion-related worries, fears, preparedness and satisfaction with information obtained from health professionals and the Web. Data were analysed using qualitative content analysis and descriptive statistics. Results: Worries and fears included the abortion process, physical reactions and psychosocial aspects. The abortion was associated with unexpected events, including the abortion process, poor health professional treatment and support, and side effects and complications. Respondents described a lack of preparatory information, leading to uncertainties due to insufficient information. Many searched for Web-based information, but respondents experienced difficulties finding high-quality sources. Respondents also recounted that the preparatory information received did not reflect the actual abortion experience. Conclusion: There is room for improvement with regard to informing, preparing and supporting women who seek an abortion. The results emphasise the importance of health professionals' giving sufficient preparatory information to enable preparedness and lessen the impact of possible unexpected events. There is a need for the development of a trustworthy Web-based service that contains honest and high-quality information.

Objectives Cognitive control, which can be described as the ability to moderate impulses, has not previously been investigated in users of combined hormonal contraception (CHC). Given the suggested modulatory role of ovarian steroids in prefrontal dopaminergic function, which in turn taps into cognitive control, this randomised, double-blinded, placebo-controlled oral contraceptive trial set out to investigate the brain activity pattern during response inhibition in CHC users. Methods Thirty-four women were randomised to one treatment cycle with a levonorgestrel-containing CHC or placebo. The women performed a Go/NoGo task to measure brain activity during response inhibition by use of event-related functional magnetic resonance imaging (fMRI) prior to and during the CHC/placebo treatment cycle. Results No differences between CHC and placebo users in number of correct inhibitions were found during treatment, but only women on CHC significantly improved their performance between the baseline and treatment assessments. During the treatment cycle CHC users displayed decreased activity in the right middle frontal gyrus in comparison with placebo users. No other significant activations were evident between treatment groups or within groups. Conclusion Overall, CHC use had marginal effects on brain activity during response inhibition. If anything, the findings of the study may suggest reduced effort or increased efficiency in maintaining orbitofrontal cortex inhibitory cognitive control when using a combined oral contraceptive.

OBJECTIVE: To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. METHODS: Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. RESULTS: Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). CONCLUSION: Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.

OBJECTIVE: To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. METHODS: Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. RESULTS: Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). CONCLUSION: Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.

Objectives 

We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT’s potential to identify young people in need of special care and monitoring.

Methods

The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors’ responses to SEXIT were analysed.

Results 

All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15–24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer.

Conclusions

The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors. 

Objectives: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXITs potential to identify young people in need of special care and monitoring. Methods: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors responses to SEXIT were analysed. Results: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15-24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. Conclusions: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors.

Objectives: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT's potential to identify young people in need of special care and monitoring. Methods: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors' responses to SEXIT were analysed. Results: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15-24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. Conclusions: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors.

OBJECTIVES: This study investigates sexual risk-taking among young men testing for sexually transmitted infections (STI).

SAMPLING METHOD: 452 participants (aged 18-30) completed surveys concerning their backgrounds, sexual risk-taking, and experience with STI.

RESULTS: Over one-third had used alcohol during their last sexual encounter, one-fifth were reluctant to use condoms due to concerns about erection difficulties, 14.7% had experienced sexual coercion and one-fifth reported having had contracted the most common STI, chlamydia trachomatis (CT). Older participants (aged 25-30) were more reluctant to use condoms because of erection worries and to report having had CT. Immigrant men reported more unprotected sex while men who have sex with men (MSM) were more exposed to sexual coercion than others, but less likely to use alcohol when having sex.

CONCLUSIONS: There are important differences in sexual risk-taking within the group of young men testing for sexually transmitted infections which need to be taken into account in developing effective counselling and promotion strategies in sexual and reproductive health care. Further research on young men's sexual risk-taking is needed to broaden understanding of factors associated with young men's sexual health.

Objectives: To prospectively investigate if women with multiple sclerosis (MS) experience changes in MS-symptoms in relation to cyclical hormonal changes.

Methods: Sixty-three women with MS, either with regular, spontaneous menstrual cycles or taking combined oral contraceptives (COCs), were asked to score their MS symptoms every day during three cycles. Symptom scores were analysed in relation to different phases of the spontaneous menstrual- or pill-driven cycle.

Results: Twenty-three women completed the score record. Among the 16 women who were not using a COC there were no significant differences in symptom scores between the phases of the menstrual cycle. The seven women taking a COC reported significantly higher symptom score points for weakness, numbness and tiredness during the pill-free interval compared with the phase during which they took the COC daily.

Conclusions: This prospective study appears to contradict earlier retrospective studies regarding variations in MS symptoms in relation to the menstrual cycle in women who are not using a COC. The lower symptom scores during the three weeks of pill taking suggest a positive effect of the steroids on the manifestations of MS. Further studies concerning both short-and long-term effects of OC-use on MS symptoms are needed.

Objectives To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999. Methods In a cluster sample of 20 classes, students (N = 387), median age 16 years, completed a questionnaire consisting of 46 questions. Results More girls than boys had experienced petting (p <= 0.003) and had received oral sex (p <= 0.01). More boys than girls had masturbated (p <= 0.0001) and watched pornography (p <= 0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p <= 0.0002), and contraceptive use at first (p <= 0.0001) and latest (p <= 0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p <= 0.0001). Conclusions Girls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.

 Objectives To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999. Methods In a cluster sample of 20 classes, students (N = 387), median age 16 years, completed a questionnaire consisting of 46 questions. Results More girls than boys had experienced petting (p <= 0.003) and had received oral sex (p <= 0.01). More boys than girls had masturbated (p <= 0.0001) and watched pornography (p <= 0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p <= 0.0002), and contraceptive use at first (p <= 0.0001) and latest (p <= 0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p <= 0.0001). Conclusions Girls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.

Objectives: To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999.

Methods: In a cluster sample of 20 classes, students (N = 387), median age 16 years, completed a questionnaire consisting of 46 questions.

Results: More girls than boys had experienced petting (p ≤ 0.003) and had received oral sex (p ≤ 0.01). More boys than girls had masturbated (p ≤ 0.0001) and watched pornography (p ≤ 0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p ≤ 0.0002), and contraceptive use at first (p ≤ 0.0001) and latest (p ≤ 0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p ≤ 0.0001).

Conclusions: Girls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.

Objectives: To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999. Methods In a cluster sample of 20 classes, students (N387), median age 16 years, completed a questionnaire consisting of 46 questions. Results More girls than boys had experienced petting (p≤0.003) and had received oral sex (p≤0.01). More boys than girls had masturbated (p≤0.0001) and watched pornography (p≤0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p≤0.0002), and contraceptive use at first (p≤0.0001) and latest (p≤0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p≤0.0001). Conclusion sGirls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.

OBJECTIVES: To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999.

METHODS: In a cluster sample of 20 classes, students (N = 387), median age 16 years, completed a questionnaire consisting of 46 questions.

RESULTS: More girls than boys had experienced petting (p ≤ 0.003) and had received oral sex (p ≤ 0.01). More boys than girls had masturbated (p ≤ 0.0001) and watched pornography (p ≤ 0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p ≤ 0.0002), and contraceptive use at first (p ≤ 0.0001) and latest (p ≤ 0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p ≤ 0.0001).

CONCLUSIONS: Girls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.

Objectives To investigate consumption of and attitudes toward pornography in relation to demographic factors and relationships to parents among third-year high school students. Methods A random sample of 718 students with a mean age 18 years range 1721 completed a classroom questionnaire consisting of 89 questions. Results More students in practical than in theoretical study programmes had parents with a practical profession p < 0.001. More parents to students attending theoretical programmes owned their housing p < 0.001. More men than women had ever consumed pornography 98 vs. 72; p < 0.001. More practical than theoretical students were influenced by watching pornographic films, fantasising about p < 0.05 or having performed acts inspired by pornography p < 0.05. Both theoretical and practical male students had more favourable attitudes toward pornography than either group of female students p < 0.001; p 0.037. More female, than male students, were of the opinion that pornography could create uncertainty and demands. Conclusion Students' high school programme choices partly reflect their social background. Pornography was consumed mainly by male students, who also had the most favourable attitudes, while females mainly had negative attitudes. To promote sexual health these differences between genders and study programmes should be taken into consideration in counselling, and in sex- and relationships education.

OBJECTIVES: To investigate consumption of and attitudes toward pornography in relation to demographic factors and relationships to parents among third-year high school students. METHODS: A random sample of 718 students with a mean age 18 years (range 17-21) completed a classroom questionnaire consisting of 89 questions. RESULTS: More students in practical than in theoretical study programmes had parents with a practical profession (p < 0.001). More parents to students attending theoretical programmes owned their housing (p < 0.001). More men than women had ever consumed pornography (98% vs. 72%; p < 0.001). More practical than theoretical students were influenced by watching pornographic films, fantasizing about (p < 0.05) or having performed acts inspired by pornography (p < 0.05). Both theoretical and practical male students had more favourable attitudes toward pornography than either group of female students (p < 0.001; p = 0.037). More female, than male students, were of the opinion that pornography could create uncertainty and demands. CONCLUSION: Students' high school programme choices partly reflect their social background. Pornography was consumed mainly by male students, who also had the most favourable attitudes, while females mainly had negative attitudes. To promote sexual health these differences between genders and study programmes should be taken into consideration in counselling, and in sex- and relationships education.

Objectives: Family planning counselling is an essential part of sexual and reproductive health care; however, health care professionals often fail to offer sexual and reproductive health services to women with intellectual disability (ID), based on a misconception of inactive sexuality. The aims of this study were to gain a deeper understanding of midwives' perceptions of sexual health and contraceptive use of women with ID, and of midwives' practices in providing contraceptive counselling to women with ID.

Methods: Five focus group interviews were conducted with 19 midwives at five antenatal/family planning clinics in central Sweden between December 2016 and February 2017.

Results: The findings are presented in a paradigm model comprising the following components: context, causal conditions for women with ID needing contraception, intervening conditions, action and interaction strategies based on the midwives' approach and performance during the consultation, and finally consequences. Midwives strived to enhance informed choice, whenever possible, and tried to maintain a neutral attitude during counselling. They wanted to provide the most suitable contraceptive method balanced against any risk of long-term use and possible side effects. Midwives raised the need for teamwork and inter-professional support to improve health care, security and access to other related services for women with ID.

Conclusions: Few women with ID request contraceptive counselling, which limits midwives' knowledge, experience and competence. Midwives, therefore, plan consultations carefully and strive to enable women with ID to make informed contraceptive choices. Increased teamwork could be a way to strengthen the role of midwives and thereby improve counselling.

OBJECTIVE: To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods.

METHODS: A cross-sectional register-based study including 16,181 women aged 30-49 years participating in the screening programme for cervical cancer in a Swedish County in 2017-2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test.

RESULTS: There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04-1.41, and aOR 1.41; 95% CI 1.22-1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02-2.06, and aOR 1.56; 95% CI 1.13-2.16, respectively). No significant differences were found in HPV clearance rates.

CONCLUSIONS: Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

INTRODUCTION: There is a lack of knowledge in women's and men's experience of miscarriage. The Revised Impact of Miscarriage Scale (RIMS) has been used in United States to measure the experiences after miscarriage. The first objective was to test the consistency of RIMS for Swedish conditions. The second purpose of this study was to compare Swedish and American couples' experience of miscarriage by use of the RIMS.

METHODS: Forward and back translation was used for translating RIMS into Swedish. This is a hospital-based comparative study including Swedish couples (n = 70) and American couples (n = 70). The couples were matched by the women's age, week of miscarriage and number of children. All participants answered socio-demographic, fertility and depression-scale questions in addition to RIMS.

RESULTS: Cronbach's alpha analysis was above 0.650, the mean value was 0.824. There was no significant difference between the Swedish and American participants on the factors 'Isolation/Guilt' and 'Devastating event', but the Swedish women and men scored significantly lower on the factor 'Loss of baby' than the American women and men. The men, Swedish and American combined, scored lower than the women in all factors but the correlation within the couples was similar for both Swedish and American couples.

CONCLUSIONS: The high consistency between the countries suggests that the RIMS questionnaire is reliable for both women and men to be used in both countries and two of three factors were similar between the two countries.

Objectives To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females' requests for a virginity certificate or hymen restoration. Method A qualitative study, consisting of semi-structured interviews of healthcare providers from different parts of Sweden and from different medical specialties and professions, who had experience of women who asked for a virginity certificate or a hymen repair. Results Using content analysis, ten themes emerged regarding healthcare personnel's attitudes and reasoning about young female patients and their requests for demonstration of virginity. The themes logically were categorised as values, beliefs, and cultural affiliation. Conclusions Responders had a more pragmatic and permissive view than the restrictive, official Swedish policy opposing hymenoplasties within the public healthcare system. There were degrees of willingness to accommodate such requests, due, for example, to different moral beliefs and medical concerns. Responders expressed frustration over the difficulty of following up patients, a situation likely due to the restrictive policy. The patient-centred approach adopted by a Dutch team of health professionals would probably better enable quality assurance.

Objectives To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females’ requests for a virginity certificate or hymen restoration.

Method A qualitative study, consisting of semi-structured interviews of healthcare providers from different parts of Sweden and from different medical specialties and professions, who had experience of women who asked for a virginity certificate or a hymen repair.

Results Using content analysis, ten themes emerged regarding healthcare personnel's attitudes and reasoning about young female patients and their requests for demonstration of virginity. The themes logically were categorised as values, beliefs, and cultural affiliation.

Conclusions Responders had a more pragmatic and permissive view than the restrictive, official Swedish policy opposing hymenoplasties within the public healthcare system. There were degrees of willingness to accommodate such requests, due, for example, to different moral beliefs and medical concerns. Responders expressed frustration over the difficulty of following up patients, a situation likely due to the restrictive policy. The patient-centred approach adopted by a Dutch team of health professionals would probably better enable quality assurance.

Objective: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners.

Methods: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners.

Results: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception.

Conclusion: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

OBJECTIVE: To gain knowledge about the male partner's experience of being present during an induced home abortion. METHODS: Twenty-three couples, whose male partner had been present when the woman aborted at home, were interviewed one to two weeks post-abortion. RESULTS: Each of the men supported his partner in her decision to have a home abortion, as this gave him the possibility of being near and of caring for her needs on the expulsion day. All the men were present and all their partners confirmed that they had been supportive. Half the men had been anxious prior to the expulsion, but most considered that their experiences during the expulsion had been 'easier than expected' and their dominant feeling was one of relief. CONCLUSIONS: Abortion is an important life event. When taking place at home, it increases the possibility for the couple to share the experience. Sharing an abortion may have a positive impact on those men who lack a sense of responsibility regarding reproductive issues, such as contraceptive use. This could facilitate society's efforts to involve men as a target group in this field. Designing an abortion policy that caters for the needs of both partners is a challenge.

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.

Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

Results: Three clusters were identified: ‘Complex counselling’, ‘Elements of counselling’ and ‘Finding a method’. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalg experiences of providing contraceptive counselling to women seeking an abortion. Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis. Results: Three clusters were identified: Complex counselling, Elements of counselling and Finding a method. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method. Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalg experiences of providing contraceptive counselling to women seeking an abortion.

Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

Results: Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website for patient counselling. Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience. Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives. Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.