Fertility counselling in Finnish primary health care - Current practices in the family planning centres of Helsinki, Tampere, and Turku

Abstract

The trend to delaying childbearing in the developed countries seems evident, with the average age of first birth for mothers currently being around 30 years globally. In Finland, where the present study was conducted, the average age of first-time mothers was 28.5 years in 2013. Postponing childbearing is a complex social process influenced by several economic, social, and personal factors. Also, research indicates that a lack of accurate information may influence the decisions done on parenthood which in turn can have implications to adverse maternal, foetal and infant outcomes, and infertility.

There is a need to enhance awareness and increase fertility knowledge. In order to make this goal feasible, it is critical to examine the current practices related to fertility counselling (which aims to increase knowledge on fertility) provided in primary health care. The main aim of the present study was to examine the current practices of fertility counselling in the context of sexual health services provided in the family planning centres of three major cities, Helsinki, Tampere, and Turku. The study also aimed for producing information on the perceptions of the sexual health professionals on the importance and availability of fertility counselling within the public sexual health services.

This study seeks to answer to the following research problems: are the professionals familiar with the term and the concept of fertility counselling; do they see fertility counselling important for their work and for sexual health services; how work circumstances challenge and/or support and enable fertility counselling as a part of their work; and finally, are there gaps between the need of information on fertility and actual practices, especially in relation to fertility counselling given in the context of age and Chlamydia infection.

The qualitative data of the present study have been gathered through a survey executed as a questionnaire consisting of open-ended questions. The participants have been identified among the personnel (mainly nurses and physicians) working in the field of sexual health services or family planning in the family planning centres of Helsinki, Tampere, and Turku.

According to the findings, fertility counselling is acknowledged as an essential part of both contraceptive counselling and sexual health services and it is widely given within the other services provided in the family planning centres. However, it appears that some gaps between the need for counselling and actual practices still remains and it seems that whereas Chlamydia-related fertility counselling is a close to a norm within contraceptive counselling the need for the counselling related to the impact of ageing seems largely unmet. Thus, it is recommended that fertility counselling and especially age-related counselling should be targeted for everyone and at every level of health care services in order to achieve comprehensive level of fertility awareness. Sexual education given in all levels of educational health and the integration of fertility counselling as a part of services provided in the primary health care are crucial for meeting this goal.

The results of this study may be utilised in the future planning and integration of sexual health services and especially fertility counselling within sexual health care and primary health care as well as in planning for the training of the sexual health professionals.