Postabortion Contraceptive Acceptance Research Articles

Understanding factors affecting the acceptance of post-abortion contraception: A comprehensive analysis

To assess the proportion of post-abortion contraceptive acceptance and the determinant factors in the utilization of contraception. It is a prospective observational study done on 468 women who presented for abortion care in a tertiary care centre. Data were collected using a pre-structured questionnaire, counselled for contraceptive usage. The family planning method accepted was noted and followed up after one month. Data were analysed using descriptive statistics and expressed in the form of frequency and percentages. In the present study, the magnitude of acceptance of post-abortion contraception was 73.08%. Most women were in the age group 21-30 years (62.82%), the majority belonged to lower socioeconomic status (43.16%), 78.62% were homemakers. Age of the women, education status, and history of the previous usage of contraception showed a positive association with acceptance of post-abortion contraception. The most accepted method was tubectomy (24.35%) followed by barrier contraception (20.51%). During follow-up after 1 month, 69.24% were willing to continue the same method and 5.1% opted for a change in the contraceptive method. The common determinant factors for not opting for post-abortion contraception were due to religious belief, partner opposition, fear of side effects of contraceptive methods and willingness to concieve again shortly. The proportion of post-abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion strongly influenced the usage of family planning services especially in rural areas where the accessibility is comparatively low. Family planning counseling during the time of abortion plays an important role in accepting post-abortion family planning services. At all levels of health care, family planning counseling and services should be provided to those who come for abortion to reduce maternal morbidity and mortality.

Postabortion Contraceptive Acceptance Rate and Its Determinants among Women Receiving Abortion Service before Discharge from the Health Facilities in Harar, Eastern Ethiopia.

Background Annually, around 121 million unintended pregnancies occur in the world and more than 73 million encountered abortion. Ethiopia is also losing 19.6% of mothers due to unsafe abortion. Despite that postabortion contraceptive service is a climactic entry point for the prevention of unwanted pregnancy and associated deaths, the service magnitude and determinants immediately before discharge are not characterized well in Ethiopia. Hence, this study aimed to assess the magnitude of postabortion contraceptive utilization and associated factors among women receiving abortion care service before being discharged from health facilities in Harar, Eastern Ethiopia. Methods A facility-based cross-sectional study was conducted among 390 women receiving abortion care services. At discharge, data about contraceptive acceptance and related maternal characteristics were collected. A binary logistic regression model was used to assess the association between independent and dependent variables (postabortion contraceptive utilization). Analysis was done with SPSS 22. Statistical significance was considered at P < 0.05. Result The overall prevalence of postabortion contraceptive utilization was 81.5% (95% CI: 77.9, 85.4). Being unmarried (AOR, 0.05; 95% CI (0.02, 0.16)), having no history of previous abortion (AOR, 0.11; 95% CI (0.04, 0.34)), being multigravida (AOR 8.1; 95% CI (2.20, 13.40), lacking desire to have an additional child (AOR, 6.3; 95% CI (2.65, 15.34), and history of family planning use (AOR, 17.20; 95% CI (6.5, 38.60)) were determinants of postabortion contraceptive utilization before being discharged from the health facilities. Conclusion Postabortion contraceptive utilization in Harar health facilities still needs improvement as per the WHO and national recommendations. Therefore, the family planning provision strategies should be convincing and friendly, especially for unmarried mothers, and those who had no history of abortion should be counseled in friendly and systematically convincing schemes for enabling them to take the service before discharge from the health facility.

Post-abortion fertility desires, contraceptive uptake and unmet need for family planning: voices of post-abortion care clients in Tanzania.

Post-abortion care (PAC) integrates elements of care that are vital for women's survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women's fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client-provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

Availability, practices and acceptance of postabortion contraceptive services in health facilities: A study in six states of India

ObjectiveTo assess the availability of and practices around postabortion contraceptive services in health facilities, and document women’s acceptance of postabortion contraception in six Indian states. Study DesignWe conducted a survey of 4001 public and private health facilities that provide abortion-related care in six Indian states. In this analysis, we assess the availability and range of contraceptive methods offered, the protocols and practices around postabortion contraceptive counseling, the extent to which facilities require women to adopt contraception, and contraceptive uptake among women. ResultsAlthough some contraceptive methods and information were available at a majority of facilities (75–97%), the range of methods was lacking and the information provided to women varied considerably by state. 8–26% of facilities required women seeking induced abortions to accept a modern contraceptive method. Only half to two-thirds of postabortion patients adopted a modern method. ConclusionThe limited number of methods offered in facilities suggests that some women may not obtain the method they desire, or get information about the full range of methods that should be available. While contraceptive uptake should be voluntary, the requirement imposed by some facilities for women to adopt a modern contraceptive method in order to obtain an abortion must be addressed. ImplicationsSome 15.6 million Indian women had an induced abortion in 2015. Understanding the provision of postabortion contraceptive services in health facilities, including counseling, is necessary to inform policies and practices to better enable women and couples to make informed decisions to prevent future unintended pregnancies.

An Overview of Comprehensive Abortion Care at Tertiary care Teaching Hospital

Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics &amp; Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of pregnancy. The reason in the first trimester was completed family (39.25%) and the main reason for the second trimester was maternal mental health (48.71%). Among the total study population, 16.37% (n=28) accepted contraception. The most common accepted contraceptive method was implant (n=14; 8.1%), followed by inj. depot medroxyprogesterone acetate (n=8; 4.6%).Conclusions: The prevalence of second-trimester abortion is high despite the availability of first-trimester comprehensive abortion care service. The main reason for induced abortion in first trimester was completed family and in second-trimester was maternal mental health. Post-abortion contraceptive acceptance among comprehensive abortion care clients was very low.

Post-abortion contraceptive acceptance and choice among women receiving abortion care at Saint Paul's Hospital, Addis Ababa, Ethiopia: a cross-sectional study

Abstract Background An exploration and comparison of the characteristics and choices of women who did and did not accept post-abortion contraception would help to provide recommendations for more effective and appropriate contraceptive counselling and services. We aimed to determine the contraceptive acceptance rate and factors associated with choice of contraception, in particular modern and long-acting methods, in women after an abortion at a hospital in Addis Ababa, Ethiopia. Methods We did a cross-sectional study at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, with women who received abortion care services for induced or spontaneous abortions from January to June, 2015. Logistic regression was used to determine factors associated with acceptance and choice of method of contraceptives. Findings 552 women were included in the study. 478 had spontaneous abortions and 74 had induced abortions. 500 (91%) of them adopted modern contraception post-abortion and 103 (19%) received long-acting reversible contraceptives (LARC). Multivariable analysis showed that being a housewife (adjusted odds ratio [aOR] 3·43, 95% CI 1·20–9·80), being married (3·31, 1·41–7·74), and parity greater than 1 (2·70, 1·04–7·03) had a significant association with the odds of adopting any modern method of contraception after abortion. Adoption of LARC was positively associated with being a student (4·62, 1·50–14·22), parity greater than 1 (2·21, 1·12–4·36), and induced abortion (2·91, 1·46–5·80). Interpretation The post-abortion contraceptive acceptance rate was higher than other studies done in Ethiopia. However, there should be increased advocacy and multipronged activities by the hospital and federal Ministry of Health to further increase the acceptance of LARC post abortion. Further research to assess follow-up discontinuation rates of contraceptive methods after discharge is an important next step. Funding Saint Paul's Hospital Millennium Medical College.

4. Post-abortion Contraceptive Acceptance and Choice Determinants among Women Receiving Abortion Care at Saint Paul’s hospital, Addis Ababa, Ethiopia

Post-abortion Contraceptive Acceptance and Choice Determinants among Women Receiving Abortion Care at Saint Paul’s hospital, Addis Ababa, Ethiopia Matiyas Asrat1, MD; Delayehu Bekele2, MD, MPH; Sarah D. Rominski3, PhD 1-2Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia 3Department of Obstetrics and Gynecology, University of Michigan Abstract Background: The Ethiopian DHS in 2016 estimates that 412 women died of pregnancy related causes for every 100,000 live births. In 2008, an estimated 382,000 induced abortions were performed in Ethiopia. To reduce rates of unplanned pregnancy and unsafe abortion, increased access to high-quality contraceptive care is needed. Objectives: To determine the contraceptive acceptance rate and examine factors associated with choice of contraception, in particular modern and long acting methods, in women after an abortion. Methods: A cross-sectional study was undertaken at Saint Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Women who received post abortion care service and had induced abortion from January to June 2015 were included. Logistic regression was used to determine factors associated with acceptance and choice of method of contraceptives. Major findings: A total of 552 women were included in the study; 90.6% of them adopted modern contraception post-abortion and 19% received long acting reversible contraceptives. Multivariable analysis showed that being a housewife, married and parity greater than one had statistically significant association with the odds of adopting any modern method of contraception after abortion. Adoption of LARC was positively associated with being student, with parity greater than one and induced type of abortion. Conclusion: The post abortion contraceptive acceptance rate was higher than other studies done in Ethiopia. Higher parity, being married and a housewife were independent predictors of modern contraceptive method acceptance. Induced abortion, higher parity and being student were significant predictors of adoption of LARC. Keywords: Abortion, Contraception, Long acting reversible contraceptive, Choice, Ethiopia (Ethiopian Journal of Reproductive Health 2018;10:35-48)

What Factors Contribute to Postabortion Contraceptive Uptake By Young Women? A Program Evaluation in 10 Countries in Asia and sub-Saharan Africa.

Unintended pregnancy disproportionately affects young women and adolescents in developing countries. The abortion care setting offers a unique opportunity for adolescents and young women to access a full range of contraceptive services. This evaluation assesses the factors that influence contraceptive uptake among adolescents and young women seeking abortion care in health facilities. Following provider training, we analyzed client log book data from 921,918 abortion care cases in 4,881 health facilities in 10 countries from July 2011 through June 2015. Log book data included client characteristics such as age, pregnancy gestation, type of service provided, and contraceptive method provision. Health facility characteristics were obtained through administration of a site baseline form prior to initiation of programmatic support by Ipas, an international NGO. Programmatic support included integration of postabortion contraceptive services with abortion care, improvements in commodities logistics, health worker training, upgraded recordkeeping, and post-training follow-up with providers and sites to solve problems and improve performance. We analyzed abortion cases by 3 age categories, ≤19 years, 20-24 years, and ≥25 years, and conducted unadjusted and adjusted analyses for the primary outcomes of interest: receipt of a contraceptive method at the time of care; type of contraceptive method selected; and the client, clinical care, and facility characteristics associated with contraceptive uptake. Overall, 77% of women left the facility with a contraceptive method. The majority (84%) of contraceptive acceptors selected a short-acting method, especially oral contraceptives. In the adjusted model, women ≤19 were less likely to choose a method than women 25 years or older (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.79 to 0.96). Adolescents and young women were also significantly less likely to choose a long-acting, reversible contraceptive than those ages 25 or older (≤19 years: OR, 0.59; 95% CI, 0.52 to 0.67; 20-24 years: OR, 0.68; 95% CI, 0.63 to 0.73). Women treated by an Ipas-trained provider were significantly more likely to select postabortion contraception than women treated by non-Ipas-trained providers (OR, 1.37; 95% CI, 1.20 to 1.57). Programmatic support to health systems, including provider training in contraceptive counseling and provision, was associated with women's higher acceptance of postabortion contraception. However, gaps remained for young women, especially adolescents, who were significantly less likely than older women to accept postabortion contraception. Health systems and facilities should pay increased attention to meeting the contraceptive needs of young women and adolescents.

Uptake of postabortion care services and acceptance of postabortion contraception in Puntland, Somalia

Unsafe abortion is responsible for at least 9% of all maternal deaths worldwide; however, in humanitarian emergencies where health systems are weak and reproductive health services are often unavailable or disrupted, this figure is higher. In Puntland, Somalia, Save the Children International (SCI) implemented postabortion care (PAC) services to address the issue of high maternal morbidity and mortality due to unsafe abortion. Abortion is explicitly permitted by Somali law to save the life of a woman, but remains a sensitive topic due to religious and social conservatism that exists in the region. Using a multipronged approach focusing on capacity building, assurance of supplies and infrastructure, and community collaboration and mobilisation, the demand for PAC services increased as did the proportion of women who adopted a method of family planning post-abortion. From January 2013 to December 2015, a total of 1111 clients received PAC services at the four SCI-supported health facilities. The number of PAC clients increased from a monthly average of 20 in 2013 to 38 in 2015. During the same period, 98% (1090) of PAC clients were counselled for postabortion contraception, of which 955 (88%) accepted a contraceptive method before leaving the facility, with 30% opting for long-acting reversible contraception. These results show that comprehensive PAC services can be implemented in politically unstable, culturally conservative settings where abortion and modern contraception are sensitive and stigmatised matters among communities, health workers, and policy makers. However, like all humanitarian settings, large unmet needs exist for PAC services in Somalia.

Uptake of Post-abortion Care (PAC) Services and Acceptance of Post-Abortion Contraception in Remote Areas of Puntland, Somalia

Uptake of Post-abortion Care (PAC) Services and Acceptance of Post-Abortion Contraception in Remote Areas of Puntland, Somalia

Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning counseling and services before leaving the facility, especially because fertility returns rapidly (within 2 to 3 weeks); postabortion family planning services can be quickly replicated to multiple sites with high acceptance rates. Voluntary family planning uptake by method should always be monitored to document program and provider performance. In addition, vacuum aspiration and misoprostol should replace sharp curettage to treat incomplete abortion for women who meet eligibility criteria.

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States.

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty‐one percent of the women accepted postabortion contraceptive methods: 53 percent short‐term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first‐trimester services, received induced abortion, attended primary‐level health facilities, and had medical abortions. Doctors receiving post‐training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service‐delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy.

Women's reports on postabortion family-planning services provided by the public-sector legal abortion program in Mexico City

ObjectiveTo investigate patients’ views of family-planning services provided in Mexico City during abortion care at public facilities and their acceptance of postabortion contraception. MethodsIn total, 402 women seeking first-trimester abortion care in Mexico City were surveyed. Logistic regression was used to test whether postabortion contraception varied according to abortion visit characteristics or patient sociodemographics. ResultsMost participants (328 [81.6%]) reported being offered contraception at their visit and 359/401 (89.5%) selected a contraceptive method for postabortion use, with 236/401 (58.9%) selecting an intrauterine device. Women who underwent surgical abortion were more likely than those who underwent medical abortion to report being offered contraception (P<0.001); women attended by a female physician were more likely than those attended by a male physician to report being offered contraception (P<0.05). Women who attended the general hospital were less likely to report being offered contraception (P<0.001). ConclusionPublic-sector facilities in Mexico City provide a high level of postabortion family-planning care, and uptake of postabortion contraception is high.

Determinants of Contraceptive Acceptance Among Cambodian Abortion Patients

Although Cambodia's total fertility rate is declining, limited access to and use of contraceptives has meant that some women rely upon induced abortion, legal since 1997, to achieve their fertility intentions. This study identifies factors that facilitate acceptance of postabortion contraception among women using Cambodia's public health facilities. Data were collected in all of Cambodia's hospitals with obstetric and delivery services (n = 71) and a representative sample of 115 of its 887 health-care centers, and from women seeking induced abortion or with abortion complications who presented to selected facilities during a three-week period (n = 933). Weighted data from 316 women who reported not wanting to become pregnant within the next few months and who presented to facilities that provide postabortion contraceptives were analyzed for bivariate and multivariate associations. Approximately 42 percent of women accepted contraceptives at the conclusion of care. After controlling for individual and facility characteristics, women who presented at facilities where a nurse/midwife managed abortion services, where contraceptives and abortions were provided in the same room, and where a larger range of methods were offered had significantly higher odds of contraceptive acceptance following abortion care. Improving contraceptive counseling and training for midwives and physicians, increasing contraceptive choices, and promoting access to contraceptives on site may reduce Cambodian women's risk of unwanted pregnancy and, potentially, unsafe abortion.

Contraceptive behaviour of abortion seekers in Sri Lanka

Data collected from 306 abortion seekers were used to investigate their knowledge of contraception, the type of contraceptives used at the time of conception, and their intentions for future fertility and post-abortion contraception. Even though three-quarters of the clients were using a contraceptive method at the time of conception, 74 per cent of these were relying on safe period and/or withdrawal. Only half of the users of traditional methods possessed correct knowledge of a woman's fertile period. The unwanted conceptions among these respondents were primarily due to non-use or relying on less effective contraceptives, despite the fact that modern contraceptives are available throughout the country. The acceptance of post-abortion contraception was only 66 per cent, indicating lack of effective counselling. The practice of traditional contraception could lead to repeated abortions, and in that scenario women may consider induced abortion as a contraceptive method or back-up procedure for contraceptive failure.

Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration

When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.

Safety and acceptability of post-abortal IUD insertion and the importance of counseling

This nonrandomized observational clinical study evaluated the safety and acceptability of intrauterine device insertion either immediately or 2 weeks after abortion, according to the patient’s preference. Participants were 300 women with first-trimester abortions who agreed to immediate or delayed insertion. End points were bleeding patterns, pregnancy, expulsion, perforation, infection and device removal at 2, 6 and 10 weeks after insertion, and acceptance rates before and after counseling procedures were improved. The overall initial acceptance rate was 35.8%, and the actual acceptance rate was 31.7%. After counseling procedures were improved, the initial and actual acceptance rates increased substantially (17.7% vs. 44.3% and 10.2% vs. 42.0%, respectively). Bleeding, expulsion rates and pain did not differ significantly between the immediate and delayed insertion groups after IUD insertion. No pregnancies, perforations or cases of pelvic inflammatory disease were recorded in either group. Immediate post-abortal insertion offers the advantage of being a painless procedure. The quality of counseling is critical to improving acceptance of post-abortion contraception.

Study of "spontaneous" abortion in Thailand.

This analysis includes data on 3 530 patients with septic or incomplete, inevitable or threatened abortions who were treated at the Siriraj Hospital in Bangkok between January 1972 and December 1973. Data on the patients' socio-demographic characteristics; their reproductive, abortion, and medical histories; their pre- and postabortion contraceptive acceptance; and a clinical profile of their abortion treatment, including procedure time, length of hospitalization, and immediate and delayed postoperative complications are analyzed.