Abstract
BackgroundSince the approval of medical abortion in Cambodia in 2010, the proportion of women reporting an abortion has increased. We describe the characteristics and contraceptive outcomes of women seeking medical abortion compared to surgical abortion at four reproductive health clinics in Cambodia.MethodsSecondary data analysis using data collected in the MObile Technology for Improved Family Planning (MOTIF) trial, a single blind, randomized trial of a personalized, mobile phone-based intervention designed to support post-abortion family planning in Cambodia. Baseline interviews were conducted after women had received post-abortion family planning counselling at the clinic, and follow-up interviews were conducted at 4 and 12 months. We used multivariable logistic regression to assess associations between abortion type and baseline characteristics, contraceptive uptake, repeat pregnancy and repeat abortion. We conducted an exploratory analysis to compare the timing of initiation of long-acting (LA) contraception between women having medical versus surgical abortion over the four-month post-abortion period.ResultsOf the 500 women who participated in the trial, 41% had a medical abortion. In multivariate analyses, women undergoing medical abortion were more likely to be urban residents, have a higher level of education, be undecided or not intending to use family planning, and be undecided or intending to have another child. There was no association between type of abortion and contraceptive uptake, repeat pregnancy or repeat abortion. Women who had medical abortion initiated LA contraception post abortion later than women who had surgical abortion.ConclusionsOur results suggest women having a medical abortion in Cambodia have different baseline characteristics and had delayed uptake of contraception compared to women having a surgical abortion. However, we cannot draw conclusions on the direction of associations and causality. Further research is recommended to explore reasons for the observed findings with view to increasing access to abortion and post-abortion contraception.
Highlights
It is estimated that globally around 25% of pregnancies resulted in induced surgical or medical abortion during the period 2010–2014, equating to an annual abortion rate of 35 per 1000 women aged 15–44. [1] In Cambodia in response to high maternal mortality, estimated at 900/ 100,000 live births, abortion laws were reformed in 1997 to allow abortion on request until the 12th week of pregnancy, and in certain circumstances during the second trimester. [2]
[2] Medical abortion is available in clinic settings and from pharmacies and medical abortion packs have been distributed in Cambodia via social marketing and franchising programmes by non-governmental organisations such as Population Services Khmer
[8] Women are at risk of pregnancy soon after abortion; studies that have examined return to ovulation post-abortion show that this can occur around 2–3 weeks following the abortion, but earlier among some women. [9, 10] All contraceptive methods are safe to use in the immediate post-abortion period to reduce the risk of pregnancy, with the exception of the intra-uterine device (IUD), which can be inserted at the time of surgical abortion but in the case of medical abortion should be delayed until after the abortion is complete. [11,12,13] The type of abortion obtained may affect uptake of post-abortion contraception or the contraceptive method chosen
Summary
It is estimated that globally around 25% of pregnancies resulted in induced surgical or medical abortion during the period 2010–2014, equating to an annual abortion rate of 35 per 1000 women aged 15–44. [1] In Cambodia in response to high maternal mortality, estimated at 900/ 100,000 live births, abortion laws were reformed in 1997 to allow abortion on request until the 12th week of pregnancy, and in certain circumstances during the second trimester. [2]. [3, 6, 7] Following the approval of medical abortion in 2010, the proportion of women having medical rather than surgical abortion increased: from 31% in 2010 to 47% in 2014. We describe characteristics and contraceptive outcomes of women seeking medical abortion vs surgical abortion, using data collected in the MObile Technology for Improved Family Planning (MOTIF) trial. [14] The specific objectives are to compare: (1) baseline characteristics amongst women seeking medical versus surgical abortion in the MOTIF trial; (2) outcomes: contraception use, repeat pregnancy and abortion amongst women seeking medical versus surgical abortion in the trial; and (3) the timing of initiation of long-acting contraception between women having medical versus surgical abortion over the four-month post-abortion period.
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