***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Young women in Malawi face many challenges in accessing family planning ( FP ) , including distance to the health facility and partner disapproval . Our primary objective was to assess if training HSAs in couples counseling would increase modern FP  uptake among young women . Methods In this cluster r and omized controlled trial , 30 HSAs from Lilongwe , Malawi received training in FP .  The HSAs were then r and omized 1:1 to receive or not receive additional training in couples counseling . All HSAs were asked to provide FP counseling to women in their communities and record their contraceptive uptake over 6 months . Sexually-active women < 30 years of age who had never used a modern FP method were included in this analysis . Generalized estimating equations with an exchangeable correlation matrix to account for clustering by HSA were used to estimate risk differences ( RDs ) and 95 % confidence intervals ( CIs ) . Results 430 ( 53 % ) young women were counseled by the 15 HSAs who received couples counseling training  , and 378 ( 47 % ) were counseled by the 15 HSAs who did not . 115 ( 26 % ) from the couples counseling group had male partners present during their first visit , compared to only 6 ( 2 % ) from the other group ( RD : 0.21 , 95 % CI : 0.09 to 0.33 , p<0.01 ) . Nearly all ( 99.5 % ) initiated a modern FP method , with no difference between groups ( p = 0.09 ) . Women in the couples counseling group were 8 % more likely to receive male condoms ( RD : 0.08 , 95 % CI : -7 % to 23 % , p = 0.28 ) and 8 % more likely to receive dual methods ( RD : 0.08 , 95 % CI : -0.065 , 0.232 , p = 0.274 ) . Conclusion Training HSAs in FP led to high modern FP uptake  among young women who had never used FP .  Couples counseling training increased male involvement with a trend towards higher male condom uptake Objectives To compare two post-abortion family planning ( FP ) service packages on contraceptive use and repeat abortion rate  among young women in three cities in China . Methods In this cluster-r and omized trial , one FP service package included provision of limited information and referral to existing FP services , and the other , more comprehensive , package consisted – in addition to the above simple package – of individual counselling , free provision of contraceptive material s , and involvement of the male partner . Eight matched pairs of hospitals were certified by central ized r and omization . Women undergoing abortion were followed up for six months , and data were collected in two rounds , before and after the intervention . Results We followed a total of 2336 women younger than 25 years ( 555 before and 555 after the simple intervention package ; 634 before and 592 after the comprehensive intervention package ) . Both packages increased use of any contraceptive method , but the comprehensive approach also increased use of more effective methods . Odds ratios for consistent and correct use of condoms were 2.32 ( 95 % confidence interval 1.55–3.46 ) and 2.78 ( 1.81–4.26 ) , respectively , compared with the simple package . The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages , with no significant statistical difference between them . Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance OBJECTIVE : To estimate whether daily educational text messages affect oral contraceptive pill ( OCP ) continuation at 6 months . METHODS : We r and omized young women electing OCPs at an urban family planning health center to either routine care or routine care plus 180 days of daily educational text messages .  Investigators masked to treatment allocation r and omized participants who were not masked to treatment . The primary outcome measure was self-reported OCP continuation through a telephone call at 6 months ( contacts between 5 and 8 months ) . RESULTS : We enrolled 962 participants ( 480 intervention and 482 routine care ) and obtained continuation data on 683 ( 346 and 337 , respectively ) . At the follow-up , 64 % of participants r and omized to the intervention were still OCP users compared with 54 % of the routine care group ( P=.005 ) . Continuation was highest in the intervention group if the interview took place while the intervention was ongoing ( 75 % compared with 54 % , P=.003 ) ; the effect of the intervention on continuation was less after the intervention ended ( 60 % compared with 54 % , P=.16 ) . Participants receiving the intervention were more likely to continue oral contraception than control participants at 6 months ( odds ratio 1.44 , 95 % confidence interval 1.03–2.00 ) in analyses adjusted for age , race or ethnicity , age at coitarche , pregnancy history , and OCP experience . CONCLUSION : The use of daily educational text messages improves OCP continuation at 6 months over routine care alone . Ten women would need to receive this simple intervention to improve continuation in one . This effect is strongest in the women whose follow-up took place while the text intervention was ongoing . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . Clinical Trials.gov , NCT00677703 . LEVEL OF EVIDENCE : OBJECTIVE Adoption of long-acting reversible contraception ( LARC ) ( ie , the intrauterine device or the contraceptive implant ) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion . Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors ; data on theory-based counseling interventions for postabortion contraception are lacking . STUDY DESIGN Informed by the transtheoretical model of behavioral change , a video intervention was developed to increase awareness of , and dispel misconceptions about ,  LARC methods .  The intervention was evaluated in a r and omized controlled trial among women aged 18 - 29 years undergoing surgical abortion at a clinic in Chicago , IL . Participants were r and omized 1:1 to watch the intervention video or to watch a stress management video ( control ) , both 7 minutes in duration . Contraceptive methods were supplied to all participants free of charge . Rates of LARC initiation immediately after abortion were compared . RESULTS Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms ; 59.6 % in the intervention and 51.6 % in the control arm chose a LARC method ( P = .27 ) . CONCLUSION This study result ed in an unexpectedly high rate of LARC initiation immediately after abortion . High rates of  LARC initiation could not be attributed to a theory-based counseling intervention This study tested the hypothesis that individual counselling in the third trimester would increase postpartum contraceptive use to a greater extent than only providing an educational leaflet . A total of 180 third trimester pregnant women of mean age 28.3 years who were attending Marmara University Hospital for prenatal care were enrolled . One-third were r and omly allocated to receive prenatal contraceptive counselling and the remaining two-thirds ( control group ) received an educational leaflet . Participants were followed-up at 6–9 months postpartum . The majority of subjects ( 91.5 % ) wanted to use contraception after delivery but 26.7 % did not know which method to use . At follow-up , 79.6 % of all women had begun a postpartum contraceptive regime and 68.7 % were using a modern contraceptive method . Overall , there was no statistically significant difference in postpartum contraception use between the control and intervention groups in this study population . It is , therefore , concluded that prenatal counselling was not superior to educational leaflets for increasing the use of effective and modern postpartum contraception OBJECTIVES This study was undertaken to determine the relative efficacy of home visitation with and without husb and participation on the use of modern contraception in Ethiopia . METHODS A r and omized field trial of a family planning education intervention using home visitation with and without husb and participation was conducted in Addis Ababa , Ethiopia , from August 1990 to December 1991 and included a 12-month postintervention follow-up . A total of 266 experimental and 261 control subjects were entered , of whom 91.7 % and 88.9 % , respectively , were followed through 12 months . RESULTS A greater proportion of couples in the experimental group were practicing modern contraception at 2 months ( 25 % vs 15 % ) and 12 months ( 33 % vs 17 % ) following the home visit intervention . By 12 months following the home visits , experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay . CONCLUSIONS The inclusion of husb and s in family planning programs will result in relevant increases in the use of modern contraception . However , there exists an important " sleeper " effect to the education intervention , reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples Recent efforts to involve patients more actively in therapeutic decisions have suggested the relevance of computer-based interventions at clinic visits . This paper presents a longitudinal , experimental study evaluating a computer-based contraceptive decision aid in Chicago and Madison family planning clinic visits . Patient interviews at three time points evaluated patient acceptance by  and  program impact on 949 young women . Both Chicago and Madison patients reported high acceptance . The program result ed in improved short-term knowledge and confidence in oral contraceptive ( OC ) efficacy for Chicago and Madison patients . In addition , compared to their control group , Madison experimental group patients had higher OC knowledge 1 year after the initial visit and a trend for fewer pregnancies ( P < 0.074 ) . Compared to their control group , a higher percent of the Chicago experimental group patients adopted OC 's after stating their intention to do so at the initial visit . Exposure to the computer program had no observable impact on the number of months on the oral contraceptive for Chicago or Madison patients . Overall findings suggest the usefulness of informatics tools as a supplement to patient-provider interactions The study examined the effect of pretreatment counseling upon discontinuation of 150 mg depo-medroxyprogesterone acetate ( Depo-Provera ( DMPA ) ) , given for contraception . A total of 421 Chinese women participated , 204 receiving detailed structured pretreatment and ongoing counseling on the hormonal effects and probable side effects of DMPA and 217 receiving only routine counseling .  The primary study endpoint was termination rate ; secondary endpoints were frequency of medical events and reasons for termination . Study termination rates were significantly lower in the intensive structured counseling group than in the routine counseling group . At one year , the total cumulative termination rates were 11 % ( 23/204 ) and 42 % ( 92/217 ) , respectively ( p < 0.0001 ) . The most common reasons for terminating DMPA were menstrual changes . No pregnancy , serious or unexpected medical events were reported , nor were statistically or clinical ly significant changes in vital signs observed . We conclude that pretreatment counseling on expected side effects increases the acceptability of DMPA OBJECTIVE To evaluate the addition of structured contraceptive counseling to usual care on choice , initiation , and continuation of very effective contraception after uterine aspiration . METHODS We conducted a RCT of a version of the WHO Decision-Making Tool for Family Planning Clients and Providers with women having a procedure for a spontaneous or induced abortion . Our intervention provided structured , st and ardized counseling . We r and omized women to usual care or usual care with structured counseling . Our outcomes included choosing a very effective contraceptive method and 3 months continuation . RESULTS Fifty-four percent of all participants chose a very effective method . Women in the intervention group were no more likely to choose a very effective method ( OR 0.74 , 95 % CI 0.44 , 1.26 ) or to initiate their method compared to the usual care group ( OR 0.65 , 95 % CI 0.31 , 1.34 ) . In multivariate models , structured counseling was not associated with using a very effective method at 3 months ( AOR 1.06 , 95 % CI 0.53 , 2.14 ) . CONCLUSION In this setting , structured counseling had little impact on contraceptive method choice , initiation , or continuation . PRACTICE IMPLICATION S Adding structured counseling did not increase the proportion choosing or initiating very effective contraception in a practice setting where physicians already provide individualized counseling Abstract Objectives : To evaluate impact of postnatal health education for mothers  on infant care and postnatal family planning practice s in Nepal . Design : R and omised controlled trial with community follow up at 3 and 6 months post partum by interview . Initial household survey of study areas to identify all pregnant women to facilitate follow up . Setting : Main maternity hospital in Kathm and u , Nepal . Follow up in urban Kathm and u and a periurban area southwest of the city . Subjects : 540 mothers r and omly allocated to one of four groups : health education immediately after birth and three months later ( group A ) , at birth only ( group B ) , at three months only ( group C ) , or none ( group D ) . Interventions : Structured baseline household question naire ; 20 minute , one to one health education at birth and three months later . Main outcome measures : Duration of exclusive breast feeding , appropriate immunisation of infant , knowledge of oral rehydration solution and need to continue breast feeding 
    Output:
    
Interventions targeting women initiating a method ( including structured counselling on side effects ) tended to show positive effects on contraceptive continuation .
In contrast , the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect .
Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use , regardless of their timing in pregnancy or postpartum .
Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision .