Abstract
To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa. Cross-sectional data from Kenya, Malawi, Mozambique, and Uganda collected as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity. Medical record review and the audio computer-assisted self-interviewing system were used to collect information on women's demographic and clinical characteristics and their experience of care. The percentage of women who did not receive a contraceptive was estimated and the methods of choice for different types of contraceptives were identified. Potential determinants of nonreceipt of contraception were grouped into three categories: sociodemographic, clinical, and service-related characteristics. Generalized estimating equations were used to identify the determinants of nonreceipt of a contraceptive following a hierarchical approach. A total of 1190 women with abortion-related complications were included in the analysis, of which 33.9% (n=403) did not receive a contraceptive. We found evidence that urban location of facility, no previous pregnancy, and not receiving contraceptive counselling were risk factors for nonreceipt of a contraceptive. Women from nonurban areas were less likely not to receive a contraceptive than those in urban areas (AOR 0.52; 95% CI, 0.30-0.91). Compared with women who had a previous pregnancy, women who had no previous pregnancy were 60% more likely to not receive a contraceptive (95% CI, 1.14-2.24). Women who did not receive contraceptive counselling were over four times more likely to not receive a contraceptive (AOR 4.01; 95% CI, 2.88-5.59). Many women leave postabortion care having not received contraceptive counselling and without a contraceptive method. There is a clear need to ensure all women receive high-quality contraceptive information and counselling at the facility to increase contraceptive acceptance and informed decision-making.
Highlights
Unintended pregnancy is a global issue that contributes to unsafe abortion, and maternal morbidity and mortality
A systematic review published in 2020 by Izugabara et al.[6] identified only a small number of studies from sub-Saharan Africa that looked at levels of contraceptive uptake among women in postabortion care (PAC).7–9 The estimates varied widely between studies: in Ghana in 2012–2013, for example, 39.9% of women who were receiving care for postabortion complications left the facility without a contraceptive[6]; substantially lower estimates of women leaving a facility without a contraceptive were found in Tanzania (2004) and Ethiopia (2018).[8,9]
In light of the paucity of data on the levels of contraceptive uptake among women seeking PAC, and the challenge of comparing previously published estimates across different settings, the objective of the present paper is to investigate women's preference for contraceptive type, and the level and determinants of nonreceipt of contraceptives among women admitted to facilities with abortion- related complications in Kenya, Malawi, Mozambique, and Uganda using data from the World Health Organization (WHO) Multi-Country Survey on Abortion- related morbidity (MCS-A)
Summary
Unintended pregnancy is a global issue that contributes to unsafe abortion, and maternal morbidity and mortality. The World Health Organization (WHO) reported that 48% of pregnancies were unintended between 2015 and 2019,1 with 25 million unsafe abortions between 2010 and 2014.2 High-quality postabortion care (PAC) is essential to reduce the morbidity and mortality associated with unsafe and incomplete abortions. Alongside providing uterine evacuation, treating infection, referring women to other sexual health services, and addressing women's psychological and physical needs, offering family planning counselling and providing effective contraception during PAC is considered best practice by many global and national organizations.[3,4] For many women, access to effective contraceptives is critical for preventing unintended pregnancies, repeat abortions, and maternal mortality.[5]. A systematic review published in 2020 by Izugabara et al.[6] identified only a small number of studies from sub-Saharan Africa that looked at levels of contraceptive uptake among women in PAC.7–9 The estimates varied widely between studies: in Ghana in 2012–2013, for example, 39.9% of women who were receiving care for postabortion complications left the facility without a contraceptive[6]; substantially lower estimates of women leaving a facility without a contraceptive were found in Tanzania (2004) and Ethiopia (2018) (approximately 10%).[8,9] In Rwanda in 2012, only 53% of PAC clients treated with misoprostol reported receiving a method of contraception before discharge.[10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Gynecology & Obstetrics
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
