Abstract
AimThe aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.MethodsThis study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013–May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7–10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0.ResultsOut of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21–25 (OR: 2.35; p < 0.029) and 26–30 (OR: 2.22; p < 0.038), and previous experience of 1–2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%).ConclusionsPAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.
Highlights
Many regions of the world have high numbers of unwanted pregnancies and unmet contraceptive needs [1,2,3,4,5]
Age groups of 21–25 (OR: 2.35; p < 0.029) and 26–30 (OR: 2.22; p < 0.038), and previous experience of 1–2 gravidities were independent factors associated with the up-take
The aim of this study was to investigate contraception up-take, associated factors and satisfaction among women who received post abortion contraceptive counselling from midwives and physicians in a low-resource setting in Kenya
Summary
Many regions of the world have high numbers of unwanted pregnancies and unmet contraceptive needs [1,2,3,4,5]. An estimated half of sexually active women of reproductive age (15–49 years) in low-income countries or 818 million women, want to avoid pregnancy [6] Among these women, about 17%, or 140 million, do not use any contraception, while 9%, or 75 million, use less-effective traditional methods. The case-fatality rate is estimated to be 460 deaths per 100,000 unsafe abortions on the African continent, compared to 30 deaths per 100,000 in high-income countries [8] These deaths are almost entirely preventable, and contraception is a primary preventive strategy, with evident beneficial effects beyond maternal health: it increases the economic wellbeing of individuals, families, communities and nations and promotes environmental sustainability [1, 6, 8]
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