Abstract Background This study aims to evaluate the effects of a community-based counselling intervention to improve contraception use among immigrant and native residents in deprived neighbourhoods. Methods Randomized controlled trial. Women aged 14–49 years and men aged 14–39 years from two low-income neighbourhoods with high proportion of immigration in Barcelona (Catalonia, Spain) who had not undergone irreversible contraception and were not planning a pregnancy were recruited (2011–13). A culturally developed and theoretically based brief counselling intervention was delivered in community settings. The primary outcome was the consistent use of effective contraceptive methods (optimal use). Secondary outcomes were the incorrect use of effective methods and the use of less effective methods stratified by sex and migrant status. Differences within subgroups from baseline to the 3-month follow-up were analysed by intention to treat and per protocol. The effects were assessed with adjusted robust Poisson regressions. Results The study enrolled and randomized 746 eligible participants. There were no differences between the intervention and control groups in demographic characteristics. Optimal use significantly increased in men, women, immigrants and natives in the intervention group, with no changes in the control group. In the intervention group, inconsistent use of effective methods decreased by 54.9% and that of less effective methods by 47.2%. The overall adjusted prevalence ratio of optimal use in the intervention group versus the control group was 1.138 (95% CI: 1.010–1.284). Conclusion This brief counselling intervention increased the consistent use of effective contraception in low-income neighbourhoods with a high proportion of immigration. Introduction Birth control is crucial for the healthy development of countries.1 Although unintended pregnancy rates have progressively decreased worldwide in the last 50 years, inequalities in reproductive health persist both within and between countries.2 They are associated with determinants such as migrant status and income.3 Increasing the uptake of highly effective contraceptive methods and improving contraceptive use are important strategies to decrease unintended pregnancy. Contraceptive counselling based on theory and behavioural methods has been recommended to promote informed contraceptive choice, but there is a need for evaluative research on brief interventions for improving contraceptive use in socially disadvantaged groups, distinct ethnic groups and low resources settings.4–7 Spain is among the countries with the lowest fertility rates in the world.2 In the first decade of the 21st century, it experienced an unprecedented influx of economic migrants from poorer countries, especially to major cities. This was associated with increased fertility and teenage pregnancy rates in Barcelona. Abortion rates among immigrants were three times the native rates.8 In this context, public health services of Barcelona were commissioned to set up and evaluate a pilot intervention the aim of which was to lower these inequalities as well as to assess the intervention extension for the future. As economic immigrants tend to live in less affluent areas, where housing is more affordable, we developed a counselling intervention (SIRIAN programme) and tested it in deprived areas with a high proportion of the newly arrived. The objective of this study was to evaluate whether a community brief intervention improved optimal contraceptive use at 3 months, by sex and migration status (immigrants or natives) among residents living in two deprived neighbourhoods. Methods Study aims, setting and participants A randomized, controlled, parallel-group trial was conducted over 36 months, from October 2011 to September 2014, in two neighbourhoods in the lowest quintile of available family income of Barcelona (Bon Pastor and Baró de Viver) and with a high proportion of immigrants.9,10 The trial protocol was approved by the institutional ethics committee, and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided signed informed consent. Participants were recruited for the study from residents in the selected neighbourhoods by flyers and posters in the streets and referrals from civic, community and primary health centres. The participants were asked to invite neighbours, relatives and friends, with a view to generating a snowball recruiting strategy. Eligible participants were women aged 14–49 years and men aged 14–39 years, regardless of their partnership status. Adolescents and young adult men were included because previous investigations had shown that they had limited knowledge about contraceptive methods and could be receptive to changing their sexual behaviour.6,11 We excluded those who had undergone an irreversible contraceptive method and those who desired a pregnancy. Randomization Stratified blocked randomization by country of origin was performed with a web-based system for the first 10 cases of every country in a 1:1 ratio. The following cases were assigned by minimisation to balance recruitment12,13 (Supplementary Material S1). Participants were assigned to either a group receiving a counselling intervention on contraceptive methods or to a control group without intervention. Both groups completed a questionnaire at baseline and 3 months later. Accepting an alpha risk 0.05 and a beta risk below 0.2 in a bilateral contrast, we estimated that a sample size of 250 participants assigned to receive the contraceptive counselling and 250 in the control group would allow an 80% power to detect a between-group difference of 12.5% in the primary end point of the trial with a baseline proportion of use of effective methods of 55%.3 The participants underwent an initial screening for eligibility and a study counsellor obtained informed consent. Then, the counsellor opened a randomization list and administered the questionnaire or the counselling intervention. By telephone, interviews were arranged to take place 3 months after baseline at a time convenient to the participant (Supplementary Material S2). For ethical reasons, the control group underwent the intervention after the follow-up assessment. The community counselling intervention The counselling sessions lasted up to 45 min, depending on individual need.4,14 The interview was based on World Health Organization guidelines and communication tools.14,15 They were structured on the basis of social cognitive theory, addressing factors that could help reduce risk-taking and improve self-efficacy and motivation, and in motivational interviewing, with active listening and a non-judgemental attitude.16,17 The intervention was culturally adapted in line with the results of formative investigation.18 Given the limited information on the reproductive health needs of immigrant women, we conducted a qualitative study prior to the development of the programme. The study populations were prioritized according to the classification of non-EU citizen’s residents, abortion rates and the opinion of experts. We studied communities from Latin America, Morocco, Romania, Senegal, Pakistan, China and the Philippines. We conducted interviews with key informants and 15 focus groups in which 108 women participated. We explored their views on motherhood, the importance of having children, relationships and sexuality, contraception, teenage pregnancy, abortion and social and religious norms. The sample was intentional. In light of these results the research group structured the intervention. According to the psychosocial determinants emerged in the qualitative study, materials were prepared for each community, which were refined with pre-test interviews. The development and implementation of the intervention followed the Intervention Mapping planning model, which relies on theoretical and logic models.19 All counselling was specifically tailored to individual needs. Throughout the interview, topics were proposed using materials written to discuss the main benefits of contraception from the perspective of the immigrant communities. These included guided discussions on family planning during the life course, the amount of time required to care for children, the economic resources required for newborns and children, along with an assessment of knowledge on contraceptive methods, and of their actual use (whether optimal or not). Samples of contraceptive methods were presented and abortion and emergency contraception were addressed. Knowledge on access to primary health care centres and sexual and reproductive health clinics was reinforced. Participants were given condoms, the leaflet, and a 10-trip urban travel card, as an incentive. Counselling was provided mainly (92%) by two public health nurses and one health psychologist, and the rest was provided by physicians, all of them with specific training. Fidelity to the protocol was assessed in the training sessions. The satisfaction of participants was very high. All interviews were performed in community facilities (public library, community centres…) or in a separate facility within the primary health care centre. The questionnaire was developed according to the results of a formative investigation and was adapted from the Barcelona Health Survey questionnaire and other studies assessing contraceptive use and knowledge in the city.11,20 It covered demographic variables (sex, age, country of birth, educational attainment, occupational situation, partner relationships and parity with categories as described in table 1). Use of methods was assessed by asking which form or forms of contraception (if any) were they currently using (oral contraception, male condoms, ring, implant, patches, intrauterine device, injections, female condoms, female sterilization, vasectomy and tubal occlusion, withdrawal and periodic abstinence) and how these methods were used. The questionnaire was administered by the counsellors within the counselling in the intervention group, and in an interview in the control group. Table 1 Characteristics of participants at baseline Intervention (n = 293) % Control (n = 278) % P Sex Female 73.4 75.9 0.502 Age group (years) 14–19 24.9 20.5 0.360 20–29 23.5 24.1 30–39 32.4 30.9 40–49 19.1 24.5 Median (IQR) 30 (18.5) 31 (19) Birth country Spain 61.8 57.2 0.177 Morocco 12.6 10.4 Ecuador 9.9 11.2 Other countries 15.7 21.2 Educational level Less than primary 4.9 7.9 0.496 Primary 31.7 31.4 Secondary 58.1 53.7 University 5.3 6.9 Occupational situation Housework 17.7 16.9 0.812 Student 22.9 21.2 Worker 23.2 27.7 Unemployed 28.7 26.6 Other 7.5 7.6 Partner relationship Yes 72.7 72.3 0.926 Parity 0 49.8 41.7 0.112 1 17.7 17.6 2 18.4 26.3 3 or more 14.0 14.4 Intervention (n = 293) % Control (n = 278) % P Sex Female 73.4 75.9 0.502 Age group (years) 14–19 24.9 20.5 0.360 20–29 23.5 24.1 30–39 32.4 30.9 40–49 19.1 24.5 Median (IQR) 30 (18.5) 31 (19) Birth country Spain 61.8 57.2 0.177 Morocco 12.6 10.4 Ecuador 9.9 11.2 Other countries 15.7 21.2 Educational level Less than primary 4.9 7.9 0.496 Primary 31.7 31.4 Secondary 58.1 53.7 University 5.3 6.9 Occupational situation Housework 17.7 16.9 0.812 Student 22.9 21.2 Worker 23.2 27.7 Unemployed 28.7 26.6 Other 7.5 7.6 Partner relationship Yes 72.7 72.3 0.926 Parity 0 49.8 41.7 0.112 1 17.7 17.6 2 18.4 26.3 3 or more 14.0 14.4 SIRIAN randomized controlled trial Outcomes and statistics The primary outcome was the consistent use of effective methods. Such methods included oral contraception, male condoms, ring, implant, patches, intrauterine device, injections, female condoms, female sterilization, vasectomy and tubal occlusion.21 Secondary outcomes were: (i) Inconsistent use of effective methods (common examples are condoms used in some intercourse episodes and not in others, or condoms used improperly, or taking birth control pills but missing too many doses for pregnancy prevention), and (ii) Use of less effective methods (withdrawal and periodic abstinence).21 Practices such as douching were not considered a contraceptive method. We used two analysis strategies. Changes in the primary outcome were analysed by using data from the full-analysis set, which included all participants who underwent randomization (intention to treat). In intention-to-treat analyses, the only imputation performed on the missing values was last-data-carried-forward,22 in this case, the baseline data. The secondary outcomes were analysed among participants assessed after baseline (per protocol). We calculated within-group participant changes in the outcome measures between baseline and follow-up with McNemar tests on dichotomous variables of the primary endpoint and the secondary endpoints. Then, a per protocol analysis was performed to estimate relative risks and the prevalence ratio derived from robust variance Poisson regression models.23 The models included the intervention group, with the baseline value of the relevant variable as a covariate, and were adjusted by sex, age, migration status, ethnicity, educational attainment and partner status. Finally, in the intention-to-treat strategy, the latter models were repeated for the whole randomized sample. Results Participant flow is presented in figure 1. Of 838 individuals screened, 80 did not meet the eligibility criteria, 12 didn’t want to participate and 746 were enrolled and randomized. Table 1 characterizes the total samples by the assigned condition and analysis strategy. There were no significant differences between the intervention and control groups in any demographic characteristics or between those followed-up and those lost to follow-up. Figure 1 View largeDownload slide Participant enrollment and follow-up. SIRIAN randomized controlled trial of community contraceptive counselling. Barcelona 2013 Figure 1 View largeDownload slide Participant enrollment and follow-up. SIRIAN randomized controlled trial of community contraceptive counselling. Barcelona 2013 Table 2 shows the baseline and 3-month follow-up percentages of participants incorrectly using an effective contraceptive method, those using less effective methods and those employing optimal contraception. At follow-up, the overall percentage of participants in the intervention group who had been inconsistently using effective methods was reduced by 54.9%, those using less effective methods decreased by 47.2% and optimal use increased by 22.2% in the intervention group (P < 0.001) and 10.4% in the control group (P = 0.036). Optimal use significantly increased in men, women, immigrants and natives in the intervention group, with no changes in those in the control group. Table 2 Inconsistent use of effective contraception, use of less effective methods and optimal use of contraception at baseline and month 3 by intervention group, stratified by sex and migrant status Intervention Control Pre Post Varb P Pre Post Varb P % % % % % % Inconsistent use of effective methodsa Menc 19.2 3.8 −80.2 0.004 20.9 17.9 −14.4 0.754 Womend 8.4 5.6 −33.3 0.286 9.0 6.2 −31.1 0.238 Migrantse 8.9 5.4 −39.3 0.424 10.1 12.6 24.8 0.508 Nativesf 12.7 5.7 −55.1 0.007 13.2 6.3 −52.3 0.013 Allg 11.3 5.1 −54.9 0.005 11.9 9.0 −24.4 0.185 Use of less effective methodsh Menc 14.1 3.8 −73.0 0.008 13.4 14.9 11.2 1.000 Womend 11.6 7.4 −36.2 0.064 15.6 12.3 −21.2 0.167 Migrantse 10.7 4.5 −57.9 0.039 17.6 16.0 −9.1 0.774 Nativesf 13.3 7.7 −42.1 0.031 13.2 10.7 −18.9 0.424 Allg 12.3 6.5 −47.2 0.002 15.1 12.9 −14.6 0.327 Optimal usei Menc 57.7 78.2 35.5 0.002 50.7 56.7 11.8 0.454 Womend 54.4 63.7 17.1 0.012 51.7 57.3 10.8 0.065 Migrantse 60.7 71.4 17.6 0.036 57.1 60.5 6.0 0.503 Nativesf 51.9 65.2 25.6 0.001 47.2 54.7 15.9 0.050 Allg 55.3 67.6 22.2 0.000 51.8 57.2 10.4 0.036 Intervention Control Pre Post Varb P Pre Post Varb P % % % % % % Inconsistent use of effective methodsa Menc 19.2 3.8 −80.2 0.004 20.9 17.9 −14.4 0.754 Womend 8.4 5.6 −33.3 0.286 9.0 6.2 −31.1 0.238 Migrantse 8.9 5.4 −39.3 0.424 10.1 12.6 24.8 0.508 Nativesf 12.7 5.7 −55.1 0.007 13.2 6.3 −52.3 0.013 Allg 11.3 5.1 −54.9 0.005 11.9 9.0 −24.4 0.185 Use of less effective methodsh Menc 14.1 3.8 −73.0 0.008 13.4 14.9 11.2 1.000 Womend 11.6 7.4 −36.2 0.064 15.6 12.3 −21.2 0.167 Migrantse 10.7 4.5 −57.9 0.039 17.6 16.0 −9.1 0.774 Nativesf 13.3 7.7 −42.1 0.031 13.2 10.7 −18.9 0.424 Allg 12.3 6.5 −47.2 0.002 15.1 12.9 −14.6 0.327 Optimal usei Menc 57.7 78.2 35.5 0.002 50.7 56.7 11.8 0.454 Womend 54.4 63.7 17.1 0.012 51.7 57.3 10.8 0.065 Migrantse 60.7 71.4 17.6 0.036 57.1 60.5 6.0 0.503 Nativesf 51.9 65.2 25.6 0.001 47.2 54.7 15.9 0.050 Allg 55.3 67.6 22.2 0.000 51.8 57.2 10.4 0.036 a Inconsistent use of effective methods: Inconsistent use of oral contraception, male condoms, ring, implant, injection, patches, intrauterine device, female condoms, female sterilization, vasectomy or tubal occlusion. b Var, percentage of variation = [(%Post − %Pre)/%Pre]. c Men (n = 145): intervention (n = 78), control (n = 67). d Women (n = 426): intervention (n = 215), control (n = 211). e Migrants (n = 231): intervention (n = 112), control (n = 119). f Natives (n = 340): intervention (n = 181), control (n = 159). g All (n = 571): intervention (n = 293), control (n = 278). h Use of less effective methods: Withdrawal or periodic abstinence. i Optimal use: consistent use of at least one effective contraceptive method (oral contraception, male condoms, ring, implant, injection, patches, intrauterine device, female condoms, female sterilization, vasectomy or tubal occlusion). Table 3 shows that, in the per-protocol analysis, optimal use increased with the intervention among men [aPR: 1.402 (1.092–1.799)] and in the whole sample [aPR: 1.184 (1.040–1.349)]. By intention to treat, these effects remained significant [aPR: 1.344 (1.053–1.716)] [aPR: 1.138 (1.010–1.284)]. Table 3 Prevalence ratios of optimal contraceptive usea in the intervention group versus the control group at 3 months stratified by sex and migrant status Per protocol (n = 571) Intention to treat (n = 746) RR (95% CI)b aPR (95% CIc aPR (95% CIc Women 1.306 (0.885 − 1.929) 1.111 (0.953 − 1.296) 1.075 (0.935 − 1.236) Men 2.738 (1.329 − 5.642) 1.402 (1.092 − 1.799) 1.344 (1.053 − 1.716) Migrants 1.632 (0.941 − 2.830) 1.187 (0.984 − 1.432) 1.120 (0.939 − 1.336) Natives 1.550 (1.001 − 2.400) 1.191 (0.196 − 1.424) 1.158 (0.983 − 1.363) All 1.560 (1.109 − 2.194) 1.184 (1.040 − 1.349) 1.138 (1.010 − 1.284) Per protocol (n = 571) Intention to treat (n = 746) RR (95% CI)b aPR (95% CIc aPR (95% CIc Women 1.306 (0.885 − 1.929) 1.111 (0.953 − 1.296) 1.075 (0.935 − 1.236) Men 2.738 (1.329 − 5.642) 1.402 (1.092 − 1.799) 1.344 (1.053 − 1.716) Migrants 1.632 (0.941 − 2.830) 1.187 (0.984 − 1.432) 1.120 (0.939 − 1.336) Natives 1.550 (1.001 − 2.400) 1.191 (0.196 − 1.424) 1.158 (0.983 − 1.363) All 1.560 (1.109 − 2.194) 1.184 (1.040 − 1.349) 1.138 (1.010 − 1.284) a Consistent use of at least one effective contraceptive method: oral contraception, male condoms, ring, implant, injection, patches, intrauterine device, female condoms, female sterilization, vasectomy or tubal occlusion. b Relative risk. c Adjusted prevalence ratio derived from robust variance Poisson regression models adjusted by sex, age, migration status, ethnicity, educational attainment and partner status. Discussion This study demonstrates that a brief theory-based counselling intervention can lead to an improvement in the reported use of effective contraception by residents in deprived urban neighbourhoods with a high proportion of immigrants. Among men, optimal contraceptive use rose by 35%. Counselling was associated with an 80.2% decrease in inconsistent use of effective methods and a 73% reduction in the use of less effective methods. These results highlight the importance of gender-inclusive approaches in reducing unmet need for family planning.24 Most interventions on sexual health among men aim to reduce sexually transmitted diseases and HIV infections through condom use, which prevents unintended pregnancy, but not as a primary goal. Low involvement among men has been related to the following issues: gender roles in sexual, family and reproductive health, leading to the perception that reproductive health is a woman’s domain; poor knowledge of contraception and the misconception that contraceptive methods disrupt sexual activity; the limited choice of available male contraceptives, mainly restricted to the condom, including fears about vasectomy; the preference for large families and concerns that women’s use of contraceptives will lead to extramarital sexual relations in rural and traditional settings; clinical settings perceived as unfriendly by men, and educational status.3,25,26 The decrease in the proportion of inconsistent contraceptive use among men was of the utmost importance. In our study, the only inconsistently used methods reported by men were condoms (data not shown). Our results are consistent with the few interventions aiming to reduce condom use errors among males, proven to be quite effective.27 A brief, single-session programme, similar to ours, though performed in a clinical setting, modestly reduced the rate of condom use errors in a sample of young black men.28 Most men in the study used effective contraception, but 14% reported using less effective methods (all used withdrawal), a similar proportion to that reported in many developed countries.2 Withdrawal use has been associated with the perception by men that condoms are likely to diminish sexual pleasure,29 and is more likely to be used by men with low incomes or lower educational levels.30 In our intervention, men’s use of withdrawal was substantially reduced in the intervention group. Consistent optimal use of contraception is the primary determinant of its effectiveness.31 Worldwide, hormonal contraceptives are among the most popular reversible methods. Despite their high theoretical effectiveness, typical use results in much lower effectiveness. This disparity largely reflects difficulties in adherence to the contraceptive regimen and low rates of long-term continuation.32 Even when effective contraceptives are readily available, behavioural practices such as switching and discontinuation of contraceptive methods may have a detrimental effect on the efficacy of contraception. Among women, optimal contraceptive use rose with the intervention but this increase lost significance in the multivariate analysis; a similar randomized controlled trial (RCT) reported a lower use of ineffective contraception at 4 months (OR 0.56; 95% CI 0.31–0.98).33 In contrast to the results for men, women in the specific behaviour analysis did not report changes in less effective or inconsistent contraception use, and change concentrated on greater use of effective contraception. In our study, women’s inconsistent use was much lower than men’s and remained unchanged, as in other strategies to aid women’s contraceptive adherence which have proved elusive.32,34 Migrants, even within the same country, may be at a greater risk for poor health due to circumstances which include their economic transition, decreased access to health services, the complications of the host health systems and, usually, a kind of ethnic and racial intolerance and hostility in the host community.35 Being an immigrant can also be a risk factor for unmet family planning needs.3,4,7,36 In this study, use of less effective methods decreased by 57.9% and optimal use increased by 17.6% among migrants in the intervention group. However, these increases did not remain significant in the adjusted models. Most immigrant participants were from Latin America, the most populous community in Spain. Studies in countries hosting Latin community immigrants have documented gaps in reproductive health and contraception knowledge, gendered attitudes about condoms and contraception and associations between family planning and power relationships in couples.37 This pattern may be changing in recent times, as a qualitative study observed no patriarchal ideology supporting women’s subordination to men or cultural influences discouraging access to and use of birth control in the Hispanic community.26 Our results are consistent with this finding, as immigrants were open to participating in this study and in discussing and changing sexual behaviours, as in other culturally tailored interventions.35,38 Strengths and limitations This study has several strengths. First, the internal validity of the findings was reinforced by the randomized trial design, the small percentage of losses to follow-up (24%),6 and the lack of differences in losses to follow-up between the groups. Regarding external validity, the results of this RCT could easily be replicated in other neighbourhoods in Barcelona and cities with similar contexts. Furthermore, a large proportion of the target populations were reached. A total of 15.2% (571/3751) of residents in the targeted age group participated in the study (12.7% of men, 11.8% of women, 23.4% of immigrants and 12.3% of natives). This may be due to the overall planning of the intervention,19 to the outreach approach4,7 and to our taking advantage of community-based infrastructures, enhancing accessibility and word-of-mouth dynamics, a most powerful communicator. In addition, the 10-trip urban transport card (costing about 10€) offered in each interview probably acted as a selective incentive, enhancing motivation for participation and adherence among those experiencing greatest economic hardship. Like other behaviours, family planning behaviours are sensitive to incentives.39 Finally, another strength of the study is that the overall analyses were carried out on an intention-to-treat basis, even though the sample size limited the statistical power of the subgroups analysis. Thus, behaviours were analysed per protocol, allowing a better understanding of the intervention effects among those actually receiving the intervention. Admittedly, this study also has a few limitations. One is that, since the intervention involved behavioural change, participants could not be blinded to their treatment allocation. However, blinding is often not feasible for participants or providers in educational interventions. Another limitation is the use of self-report measures on protected sex, which has the potential for several biases. Although self-report measures are standard in contraceptive research, they have been shown to overestimate contraceptive use because of social desirability and other types of information bias. However, this bias probably acts in both measures of each arm and may therefore be less important in terms of evaluating the counselling effects. Effects in the control group are not unusual in this kind of intervention, and this could have occurred in our study, reducing the evidence of its true effectiveness. Three factors might have been in play: the attention received in the control group may have been sufficiently powerful to facilitate a change because all participants had access to clinical care; Hawthorne effects (changes in behaviour resulting from awareness of being observed);40 and contamination, especially in the community setting, as participants in the intervention arms may have passed on the information to participants in the control arm. A further limitation is that this study did not measure long-term effects. Few studies have examined contraceptive use after a short intervention for an extended period, and have not shown consistent results.16 Finally, another limitation is use of self-reported contraceptive use instead of more objective indicators of unintended pregnancy, which is usual in this kind of studies.6 Despite these limitations, the multivariate findings indicate that a gender-sensitive and culturally tailored counselling intervention increased optimal contraception use by 14% among the population of a low-income neighbourhood with a high proportion of immigration. As far as we know, this could be the first RCT on brief contraceptive counselling in a low-income community setting with a high proportion of immigrants. According to the observed benefits in contraceptive use, our results provide a strong rationale for studies assessing the potential effects on unwanted pregnancy rates in the intervention neighbourhoods. In the future, extending this intervention could significantly reduce the rate of unintended pregnancy in low-income areas. Supplementary data Supplementary data are available at EURPUB online. Acknowledgements We would like to acknowledge Lluïsa Estruga, Silvia Martín and Anna Zaragoza for their role and contribution in the study’s implementation. Funding The trial was funded by the Spanish Science and Innovation Ministery (grant number FIS PI05/2727) with additional support from the Barcelona Public Health Agency. The funders had no further role in the design, collection, analysis and interpretation of data; the writing of the article or in the decision to submit the article for publication. Conflicts of interest: None declared. Key points Immigrants and native residents in disadvantaged neighbourhoods experience inequalities in reproductive health. Counselling has been recommended to promote informed choice of contraceptives, but there is a need for evaluative research focused on socially disadvantaged populations and ethnic groups. In Barcelona (Spain), a randomized controlled trial was developed in order to evaluate a community intervention of contraceptive counselling among men and women living in two disadvantaged neighbourhoods with a high proportion of migrants. This brief intervention increased by 14% the consistent use of effective contraceptive methods at 3 months. The strategy can contribute to prevent unwanted pregnancies in urban areas with similar characteristics. References 1 Starrs A. A Lancet Commission on sexual and reproductive health and rights: Going beyond the Sustainable Development Goals. Lancet 2015; 386: 1111– 2. Google Scholar CrossRef Search ADS PubMed 2 United Nations. 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The European Journal of Public Health – Oxford University Press
Published: Feb 1, 2018
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