Post-abortion Family Planning Research Articles

Prevalence and predictors of post-abortion modern contraceptive utilization among reproductive age women in Ethiopia

The development of a post-abortion family plan is an integral part of comprehensive abortion care. In spite of this, it received insufficient attention as a means of breaking the cycle of repeated abortions, unintended pregnancies, and maternal deaths resulting from abortion. Therefore, this study examined post abortion modern contraceptive utilization among Ethiopian women as well as associated factors. The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of post abortion contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. Overall prevalence of post abortion contraceptive use was observed to be 25.6% (95% CI: 23.24, 28.12). Women's age 15–24 (AOR = 2.34; 95% CI: 1.11, 4.93), and 25–34 (AOR = 1.94; 95% CI: 1.27, 2.98), married women (AOR = 2.6; 95% CI: 1.43, 4.96), women who had 1–4 (AOR = 4.13; 95% CI: 1.79, 9.57) and ≥ 5 number of children (AOR = 8.80; 95% CI: 3.30, 13.49), Being in metropolitan region (AOR = 9.14; 95% CI: 1.79, 12.48), women being in urban area (AOR = 1.85; 95% CI: 1.32, 2.24), and community media exposure (AOR = 1.75; 95% CI: 1.11, 3.56) were associated with post abortion modern contraceptive use. Post abortion modern contraceptive use in this study was low. Women age, current marital status, number of living children, residency, community media exposure, and region were significantly associated with post abortion modern contraceptive utilization. Therefore, it is better to provide ongoing health information about post-abortion family planning and its benefits, especially for people who live in rural and small peripheral regions, and public health policymakers should take both individual and community level factors into account when designing family planning programmes.

Postabortion Family Planning Utilization and Associated Factors among Women seeking Abortion Services: A Cross-Sectional Study

Ethiopia is a country which suffers with one of the highest levels of unintended pregnancies and unsafe abortion practices. The aim of this study was to assess the utilization of post-abortion family planning and associated factors among women seeking abortion services in Asella town health facilities. A facility based cross-sectional study design was conducted among women who came for abortion services from July 15 to October 15, 2019. Two hundred seventy-six participants were included using a systematic random sampling technique. Both descriptive and logistic regression analysis were conducted. In multivariate analysis, variables which had a p-value < 0.05 was considered as significantly associated with the outcome variable. Postabortion family planning utilization among study participants was 146 (53.7%) (95% CI=47.4, 59.2). Formal education (AOR=4.45: 95% CI: (1.18, 16.74), previous history of abortion (AOR=0.35; 95% CI: (0.14, 0.85), positive attitude to towards family planning (AOR=2.62; 95% CI: (1.09, 6.27), counseled on postabortion family planning utilization (AOR=3.12; 95% CI: (1.30, 7.51) were significantly associated with post abortion family planning utilization. In this study, nearly fifty percent of the respondents did not utilize Postabortion Family Planning (PAFP). Educational status, history of pervious abortion, decision when to have a child, attitude toward PAFP utilization and counseling about PAFP were significantly associated with post-abortion family planning use. The health care providers who give abortion service should give counseling for all women who get abortion service. More accents should be given to misperception of PAFP to change the negative attitude of utilization of PAFP.

Improving safe post-abortion care practices: A study on interventions implemented by Ipas Pakistan.

An estimated 50 million induced abortions occur in developing countries annually, and an estimated 7 million women are treated for complications associated with unsafe abortions. According to a 2012 estimate, 15 per 1,000 women aged 15-49 years seek treatment for abortion-related health complications in both private and public sectors. A high unmet need for family planning in Pakistan and a low percentage of women adopting a contraceptive method in the post-partum period led to unwanted pregnancy becoming one of the reasons for unsafe abortion. Post-abortion care (PAC) is an integrated service delivery model that includes both maternal health and family planning interventions. The study aims to examine improvement in abortion-related practices through the implementation of the PAC model at all tiers of public health service delivery systems in the two most populous provinces-Punjab, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory (ICT) region-of Pakistan. The improvement model comprises clinical training of healthcare providers, community engagement, and counseling of community women on safe post-abortion practices. It was a descriptive study utilizing data of 27,616 PAC clients recorded and reported by the service providers on the logbooks from 104 selected public health facilities from March 2018 to December 2021 in ICT, Punjab, Sindh, and Khyber Pakhtunkhwa provinces of Pakistan. Women who received PAC services were older than 25 years, 22,652 (82%), with a mean age of 29 years. Most of these women were in their first trimester, 26,110 (95%), and the majority diagnosed with PAC (incomplete, missed, or threatened abortion), 26,838 (97%). The majority of women, 25,324 (92%), received safe methods for post-abortion care that included the use of misoprostol, 15,804 (58%), and manual vacuum aspiration, 8,898 (32%). In total, 17,105 (72%) of women opted for a contraceptive method that included long-acting reversible contraceptives, 2,313 (10%); short-term excluding condoms, 3,436 (27%); and condoms, 8,113 (34%). The key predictors identified for uptake of the post-abortion family planning method indicated that women more than 25 years of age, in the early second trimester, and who were counseled on post-abortion family planning were more likely to adopt the contraceptive method than others. Increased access to post-abortion care and family planning could potentially reduce the incidence of unsafe abortion, unintended pregnancies, and associated maternal mortality. The experience of Pakistan suggests that the integrated post-abortion care service delivery model can be effectively implemented across the public health systems.

Factors Associated with the Choice of Contraceptive Method following an Induced Abortion after Receiving PFPS Counseling among Women Aged 20–49 Years in Hunan Province, China

There is limited research on postabortion family planning (PAFP) services and subsequent contraception in China. The current study aimed to identify women's contraceptive methods choices and associated factors after receiving PAFP services. A cross-sectional study used a cluster, stratified and multistage random sample to collect data. All eligible data were analyzed using SPSS 26.0. The chi-square test was used to assess the association between categorical variables. Significant variables (p < 0.05) and all potential variables were then included in the binary logistic regression model for analysis. Approximately 84.7% (1043/1231) of participants had received pre-abortion PAFP counselling, and approximately 90% of them chose reliable methods. Farmers or workers (OR = 0.297, 95% CI: 0.130-0.683), family monthly income (3000-4999 RMB, OR = 0.454, 95% CI: 0.212-0.973; ≥5000 RMB, OR = 0.455, 95% CI: 0.228-0.909), reliable advice from services providers before abortion (OR = 0.098, 95% CI: 0.039-0.250), painless surgical abortion (OR = 3.465, 95% CI 1.177-10.201), and postabortion follow-up (OR = 0.543, 95% CI: 0.323-0.914) and were associated with contraception choice after receiving PAFP services. This study emphasizes the importance of pre-abortion PAFP counselling, postabortion follow-up, and increased focus on women who have experienced painless abortion. The study provides direction for PAFP services policymakers, as well as a reference for contraceptive counselling research around the world.

Second trimester post-abortion family planning uptake and associated factors in 14 public health facilities in Central Uganda: a cross-sectional study

BackgroundPost-abortion family planning counselling and provision are known high impact practices preventing unintended pregnancies. Little is known, however, about specific needs in the second trimester. Our study aims to assess post-abortion family planning uptake and its associated factors among women with second-trimester incomplete abortion.MethodsWe conducted a cross-sectional survey of 1191 women with incomplete second trimester abortion that received treatment at 14 comprehensive emergency obstetric care public health facilities in central Uganda from August 2018 to November 2021. We computed the post-abortion uptake of family planning within 2 weeks of treatment, described the types of methods accepted, and the reasons for declining family planning. We described the socio-demographic, reproductive, abortion-related, and health facility characteristics. We used mixed effects generalized linear models to obtain percentage differences for factors independently associated with post-abortion family planning uptake.ResultsSecond-trimester post-abortion family planning uptake was 65.6%. Implants (37.5%) and progestin only injectables (36.5%) were the commonly chosen methods; natural (0.1%), permanent (0.8%), and condoms (4%) were the least chosen methods. 45.2% of the women who declined family planning desired another pregnancy soon. Women whose spouses were aware of the pregnancy or had planned pregnancy had 11% (− 10.5, 95% CI − 17.1 to − 3.8) and 12% (− 11.7, 95% CI − 19.0 to − 4.4) less uptake compared to women whose spouses were not aware of the pregnancy or those with unplanned pregnancies respectively. Uptake was 8% (− 7.8, 95% CI − 12.6% to − 3.0%) lower among Islamic women compared to Anglicans. Women who received post-abortion family planning counselling or had more than four live births had 59% (59.4, 95% CI 42.1 to 76.7) and 13% (13.4, 95% CI 4.0 to 22.8%) higher uptake compared to women who did not receive counselling or women with no live births, respectively.ConclusionsThe uptake of second-trimester post-abortion family planning in Uganda was higher than previous estimates. Post-abortion family planning counselling, grand multiparity, and the need to avoid an unplanned pregnancy enhance post-abortion family planning uptake in the second trimester. Ministry of Health should strengthen post-abortion family planning counselling, especially couple counselling; at all health facilities in the country and also ensure an adequate and accessible supply of a wide contraceptive method mix.

Postabortion contraceptives uptake and its associated factors among clients visiting abortion care services in public hospitals in West Shewa Zone, Oromia regional state, Ethiopia, 2021.

Postabortion contraception is the initiation and use of postabortion contraceptive methods immediately after an abortion. It is a critical approach for preventing unwanted pregnancy, alleviating its complications, and avoiding repeated abortions by promoting immediate postabortion contraceptives provision. To assess the level of postabortion contraceptives uptake and its associated factors among clients visiting abortion care services in public hospitals in West Shewa Zone, Oromia regional state, Ethiopia. An institutional-based cross-sectional study was conducted in public hospitals in the West Shewa Zone from 1 March 2021 to 30 May 2021, among 227 proportionally allocated clients based on the proportion of the client served in the previous 3 months of the study period. Data were collected through face-to-face interviews using semi-structured and pretested questionnaire from women who received the abortion services. Bivariable and multivariable logistic regression were used to assess the association of independent variables with postabortion contraceptive uptake. Findings with p-value of 0.05 at 95% confidence interval were considered as statistically significant. The overall postabortion contraception uptake among abortion service clients in public hospitals was 164 (74%) while about 42% of them used long-term contraceptive methods. Postabortion contraceptive uptake was significantly associated with media exposure to postabortion family planning information (adjusted odds ratio: 3.4 (95% confidence interval: 1.03-11.27)) and counseling on postabortion family planning (adjusted odds ratio: 20.48 (95% confidence interval: 5.02-83.64)). Level of postabortion contraceptive method uptake in West Shewa was low as compared to the national target. Greater attention should be given on providing postabortion contraceptive counseling to increase the postabortion contraceptive uptake.

Postabortion Family Planning and Associated Factors Among Women Attending Abortion Service in Dire Dawa Town Health Facilities, Eastern Ethiopia.

BackgroundPostabortion family planning is a part of comprehensive package of postabortion care. However, it did not receive due attention to break the cycle of repeated abortion, unintended pregnancies, and abortion-related maternal morbidity and mortality. Therefore, this study aimed to determine the utilization of postabortion family planning and associated factors among women attending abortion service in Dire Dawa health facilities, Eastern Ethiopia.MethodsA facility-based cross-sectional study design was employed among 483 clients who sought abortion service in Dire Dawa from 15 May to 30 June 2020. A structured interviewer-administered questionnaire was used for data collection. The collected data were entered into EpiData version 3.2 and exported to SPSS version 22 for analysis. The multivariate logistic regression models were fitted to identify factors associated with utilization of postabortion family planning. Adjusted odds ratios (AORs) along with 95% CI were estimated to measure the strength of the association and statistical association was declared statistical at a p-value < 0.05.ResultsMore than three-fourths (77.8%) [95% CI: (73.4–81.6%)] of respondents were utilized postabortion family planning methods. Respondents with age 15–24 years [AOR: 5.59, (95% CI: (1.5, 19.7)], attended postsecondary [AOR: 7.6, (95% CI: (2.7, 21.2)], single marital status [AOR: 11.1, (95% CI: (4.6, 26.5)], a monthly income 500–1,000 birr [AOR: 7.9, (95% CI: (3.2, 19.4)], parity ≥ 5 [AOR: 0.41, (95% CI: (0.18, 0.92)], desire of current pregnancy [AOR: 4.2, (95% CI: (1.9, 9.3)], and ever used family planning [AOR: 4.4, (95% CI: (2.2, 8.9)] were major factors significantly associated with postabortion family planning utilization.ConclusionIn this study, more than three-fourths of respondents utilize postabortion family planning. Most of the factors associated with postabortion family planning were modifiable. Therefore, policymakers and health planners need to integrate with comprehensive abortion care to improve the utilization of postabortion family planning.

Post-abortion family planning utilization and associated factors in health facilities of Wolaita Zone, Southern Ethiopia: Mixed study.

BackgroundUnintended pregnancy due to disuse of family planning is the main cause of abortion globally. Women with a history of abortion are at higher risk of developing another unintended pregnancy, which may lead to repeated abortions and life-threatening complications. The immediate post-abortion period before women leave health institutions is a crucial time to provide family planning services. In Ethiopia, many women leave health facilities without using family planning methods. Therefore, this study aimed to determine the utilization of post-abortion family planning and its associated factors in health institutions in Wolaita Zone, Southern Ethiopia.MethodsFacility-based mixed cross sectional study was conducted between April 1 and June 30, 2018. A systematic sampling method was used to select the 408 participants. Seven key informants were selected for in-depth interviews and observations were made using a checklist. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into EPI INFO 3.5.1 and exported to SPSS 21 for cleaning and analysis. Bivariate analysis was employed and a P-value <0.25 was considered for the multivariable analysis. Qualitative data were coded and thematically analyzed to support the quantitative findings.ResultsData were obtained from 400 participants (response rate, 98%). The magnitude of post-abortion family planning was 67.3% [95% CI (62.8, 71.8)]. Marital status [AOR 95% CI 3.86(1.9, 7.8)], Good knowledge about post-abortion family planning [AOR 95% CI 2.48(1.22, 5.03)], Non-governmental health facility [AOR 95% CI 6.62(3.47, 12.6)] Counseling [AOR 95% CI 3.6(2.02, 6.4)] and husbands’ support [AOR 95% CI 3.21(1.81–5.7)] were significantly associated with Post-abortion family planning utilization.ConclusionThe utilization of post-abortion family planning was low in Wolaita Sodo health institutions. Marital status, knowledge of post-abortion family planning, use of services at non-governmental health facilities, counseling, and husbands’ support were determinants of post-abortion family planning.

The effects of interventions to integrate long-acting reversible contraception with treatment for incomplete abortion: Results of a 6-year interrupted time series analysis in hospitals in mainland Tanzania and Zanzibar.

To evaluate an intervention that aimed at strengthening voluntary access to long-acting reversible contraception (LARC) within postabortion care (PAC) in hospitals in mainland Tanzania and Zanzibar. From 2016 to 2018, we conducted PAC quality improvement interventions, emphasizing family planning (FP) counseling and voluntary access to LARC. Researchers conducted an interrupted time-series analysis of service statistics compiled from 2014 to 2020 using segmented linear mixed effects regression models to assess the interventions' effect on postabortion contraceptive uptake. The intervention in mainland Tanzania was associated with an immediate 38% increase in postabortion LARC uptake, a trend that declined from late 2016 to mid-2020 to 34%. In Zanzibar, the intervention was associated with a gradual increase in LARC uptake that peaked in late 2018 at 23% and stabilized at approximately 15% by mid-2020. Whereas the interventions in mainland facilities did not generate significant changes in postabortion FP uptake overall, the launch of interventions in Zanzibar in mid-2016 was associated with a precipitous rise in that outcome over time, which plateaued at approximately 54% by 2019. Increased voluntary uptake of postabortion contraception was associated with the introduction of training in PAC, including FP, and quality improvement interventions and gains were sustained over time.

Post Abortion Family Planning Utilization and Associated Factors Among Women Received Abortion Services at Adama Hospital Medical College, Oromia, Ethiopia

Worldwide post abortion contraceptive prevalence varies within a range of from 69% in Eastern and Southern Europe to 78% in Northern Europe. In Asia, South America and Africa post-abortion family planning utilization variation is ranging from 61 to 97%. In Ethiopia 48– 59% of clients left their institution with post-abortion family planning services which showed wide variations in the percentage of women who received post-abortion contraception. Post-abortion family planning has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. Now it is important to investigate the level post abortion family planning and act on the factors accordingly. So this study aimed to assess post abortion family planning utilization and associated factors among women getting abortion services at Adama Hospital Medical College, 2021. Method: Institutional based cross-sectional study was conducted from january-1 to february-28, 2021. A sample of 471 women were enrolled consecutively. Data was collected by semi-structured questionnaires which were administered via face to face interview. Data was entered using Epi-Info version 7 then exported to SPSS version 20 for processing and analysis. Descriptive statistics was used to explore the participant’s characteristics. Binary & multiple logistic regression was used to assess the association between dependent & independent variables. The magnitude of association between dependent & independent variables were measured by odds ratios along with estimated 95% confidence interval. Finally the significance of association was declared by p-value of less than 0.05. Results: The magnitude of post abortion contraceptive was found to be 73.9% (95% CI: 70.1-77.9). The odds of using post abortion family planning for women having diploma level of education was 28.37 (AOR=28.37; 95% CI: 4.09-196.834) times higher than those having no formal educations. After surgical termination the odds of post abortion contraceptive use was 58.9% (AOR=0.411; 95% CI: 0.169-0.991) times lesser than for medical abortion. Conclusion & recommendations: The magnitude of post abortion family planning in this study seems lesser. Independent predictors like maternal education, procedure done, counseling, reason of termination and knowledge status were significantly associated with the outcome variable. So attention should be given for counseling & level of education for consistent & efficient use.

Task Shifting With Pharmacists to Increase Access and Uptake of Medical Abortion and Contraceptive Services among Adolescents in Kenya

The World Health Organization (WHO) recommends and recognize the importance of involvement of community providers in self-care including medical abortion (MA) among patients. In Kenya, young people between the ages of 15 to 24 constituting one-fifth of the total population are disadvantaged in accessing affordable and quality drugs at the pharmacies or chemists. Although, Misoprostol and mifepristone, used all over the world for MA are sold in many pharmacies in Kenya, adolescent women encounter barriers, including long queues, vigorous screenings and questioning to ascertain whether they are ‘genuine’ or mystery clients when accessing these drugs. The Kenyan, Family Planning guidelines also authorize pharmacies to dispense various forms of contraception, including pills and condoms. These contraceptives can be accessed for free in Kenyan public facilities but are available for sale from private pharmacies. KMET implements an Adolescents health program dubbed Safire, that supports adolescents integrated Sexual and Reproductive Health through a task shifting. The goal is to Improve access of quality adolescent sexual reproductive health (ASRH) services to women ages 10-19 years through task-shifting to minimize missed opportunities. The objective is to evaluate the acceptability, efficiency, and effectiveness of Safire delivery model in providing quality ASRH services for girls. The program received support from Kenya pharmacy Association and Ministry of health to map, recruit, and train 108 pharmacists and 56 health providers in Kiambu, Uasin Gishu, and Bungoma Counties. The pharmacists and providers were trained on quality provision of Sexual and Reproductive Health information and Services to patients. The pharmacies were then linked with trained community volunteers from likeminded civil society organizations (CSOs) to conduct community education and make referrals for sexual reproductive health information and services including abortion. After receiving the services, the volunteers follow up such clients to assess their satisfaction and feedback on services received from the pharmacies. The project has served 7,900 girls (aged 10-19 years) with MA services with 84% (6,636) receiving post-abortion family planning (PAFP) from March 2020 to February 2022 and no reported complication. Among the girls served, successful referrals by community volunteers to the pharmacies constituted 60% (4,740) during the period. Most of the clients served reported high satisfaction level after following up by the volunteers. The strengthened relationship among community health volunteers and the pharmacists created a synergy enabling cross referrals of clients for various services. This improved successful referrals and linkages. Routine quality of care assessments, support supervision and mentorship empowered the pharmacists for improved quality service provision. The engagement of local commodity distributors at negotiated price ensured reduced stock outs among the pharmacist and prices standardization for quality MA products to clients. The ministry of health should invest in training pharmacists as a task shifting approach in offering quality adolescent sexual reproductive information and services in Kenya.

Predictors and Barriers to Post Abortion Family Planning Uptake in Hai District, Northern Tanzania: A Mixed Methods Study.

Introduction:Post Abortion Care (PAC) encompassing family planning counselling and contraception provision is a key strategy to reducing maternal morbidity and mortality especially in countries with restrictive abortion laws. Various factors affect the uptake of PAC modern family Planning (FP) in different settings. This study aimed at determining the prevalence, assessment of factors and barriers to PAC modern FP uptake in Hai district, Northern TanzaniaMethods:A mixed-methods study was conducted using an explanatory sequential design. Exit interviews using questionnaires was conducted among 189 women. In-depth interviews were conducted with 26 healthcare providers (HCPs) and 28 women who received PAC in Hai district hospital, Machame hospital and Moshi Specialists health centre in Hai district. Quantitative data was analysed using a Statistical Package for Social Science (IMB SPSS Statistics for Windows version 20.0 (SPSS Inc., Chicago, Ill., USA)). Bivariate and multivariable analyses were applied to estimate the predictors of uptake of PAC modern FP. Thematic content analysis was employed to explore barriers to uptake of post-abortion modern family planning.Results:The prevalence of uptake of modern family planning following PAC was 59/189(31.2%). 56% of the 189 women who received PAC did not receive counselling services on family planning. Marital status and partner's support were predictors of PAC modern family planning uptake (p=.007 vs. p= <.05, respectively).Misinformation and misconception about modern contraceptives, lack of knowledge and fear of side effects were reported to be the major barriers to uptake of post-abortion family planning. Most women reported to have not received comprehensive family planning information from the HCPs. On the other hand, HCPs perceived their poor counselling skills as the barrier to post-abortion family planning uptake. This study observed poor coordination of PAC services within each visited facility and this was linked to women leaving the facility without family planning counselling and/or contraceptives provision.Conclusion:Suboptimal modern family planning counselling during PAC contributes to the low uptake of contraceptives methods in this setting. Strategies are needed to improve PAC modern family planning services uptake. Strategies such as; provision of counselling skills to HCPs with comprehensive information targeting local contextual misconception and promoting PAC provision as a one-stop service.

Assessment of Post-abortion Care Services in Punjab Pakistan

Background: Globally, Post abortion and pregnancy complications such as sepsis, hemorrhage and hypertensive diseases are the prominent bases of maternal mortality. Post-abortion family planning and effective treatment for unintended pregnancies could provide high quality post-abortion care. Limited data available in Punjab, Pakistan regarding post-abortion care services in health system. Aim: The purpose of the current study was to evaluate the post-abortion care services in health care system of Punjab, Pakistan. Materials and Methods: This cross-sectional study was carried out on 226 post-abortion patients of multi health care centers of Punjab, Pakistan from November 2020 to April 2021. Individual’s history, age, demographic characteristics, reproductive history, post-abortion attitude were surveyed using pre-designed and structured questionnaire. Also, post-abortion care such as pain management, treatment cost, waiting time, service confidentiality, contraceptive device cost, and patient’s interaction as well as family planning were assessed. Stata software was used for data analysis. Results: Of all the post-abortion cases, 207 (91.6%) were found satisfactory regarding post-abortion care. Effective pain management during treatment, treatment cost affordability, proper waiting time (&lt; 0.5 hours), patient’s effective interaction, service’s confidentiality, and premises cleanliness were statistically significant when correlated with satisfied women (p-value&lt;0.001). Conclusion: Our study found higher prevalence (91.6%) of post-abortion care satisfied women. However, effective treatment and regular follow-up should be assured for management of post-abortion complications such as services confidentiality, pain management, patient’s interaction and client’s optimal satisfaction with services. Keywords: Assessment, Post-abortion care, Health facilities

Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study

BackgroundAfghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services.MethodsAccessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions.ResultsMost facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage.ConclusionsThis study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.

Utilization and its factors of post abortion modern contraceptive in Ethiopia: a systematic review and meta-analysis

BackgroundProviding post-abortion care service is a widely accepted to reduce maternal morbidity and mortality by promoting, preventing and treating maternal and neonatal health, identifying the utilization and its factor of post abortion contraceptive is crucial. Therefore we tried to review post abortion contraceptive utilization and its factors in Ethiopia.MethodsA review was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic and a comprehensive literature searching mechanism were used without any restriction, through Google scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature databases for reporting utilization of post abortion family planning. Pilo-tested were performed in random sample studies and a standardized data extraction form was used. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was used with a random-effects method. The results are presented using texts, tables and forest plots with measures of effect and 95% confidence interval.ResultsAmong 1221 records, 11 studies were taken in the meta-analysis with 4336 Participants that full fill the inclusion criteria. The pooled prevalence of post abortion contraceptive in Ethiopia was 74.56% (95% CI (73.31%, 75.81%)). Married women (OR 2.01 (95% CI (1.52, 2.66), I2: 0.0%)), women who were counseled (OR 5.36 (95% CI (3.10, 9.29), I2: 79.5%)), women whose educational level tertiary and above (OR 2.28 (95% CI (1.66, 3.17), I2: 0.0%)), women who had ever used contraceptive (OR 3.76 (95% CI (2.19, 6.47), I2: 67.8%)) and those women’s age 15–24 years old (OR 8.35 (95% CI (2.74, 14.74), I2: 87.4)) were statistically significant.ConclusionAccording to World Health Organization (WHO) guideline, "after a miscarriage or induced abortion, the recommended minimum interval to next pregnancy is at least 6 months in order to reduce risks of adverse maternal and perinatal outcomes".. According to this post abortion contraceptive utilization in Ethiopia is not optimal. Marital status, education, Counsel, previously exposed and age were significantly associated. Therefore, the Ministry of Health should work target fully to address those problems to maintain maternal and child health in Ethiopia.

Post-abortion family planning use, method preference, and its determinant factors in Eastern Africa: a systematic review and meta-analysis

BackgroundUtilization of post-abortion family planning is very critical to reduce high levels of unintended pregnancy, which is the root cause of induced abortion. In Eastern Africa, it is estimated that as many as 95% of unintended pregnancies occurred among women who do not practice contraception at all. Therefore, this meta-analysis aimed to assess post-abortion family planning utilization and its determinant factors in Eastern Africa.MethodsPublished papers from Scopus, HINARI, PubMed, Google Scholar, and Web of Science electronic databases and grey literature repository were searched from database inception to January 30, 2020, with no restriction by design and date of publishing. We screened records, extracted data, and assessed risk of bias in duplicate. Cochrane I2 statistics were used to check the heterogeneity of the studies. Publication bias was assessed by Egger and Biggs test with a funnel plot. A random-effects model was calculated to estimate the pooled prevalence of post-abortion family planning utilization.ResultsA total of twenty-nine cross-sectional studies with 70,037 study participants were included. The overall pooled prevalence of post-abortion family planning utilization was 67.86% (95% CI 63.59–72.12). The most widely utilized post-abortion family methods were injectable 33.23% (95% CI 22.12–44.34), followed by implants 24.71% (95% CI 13.53–35.89) and oral contraceptive pills 23.42% (95% CI 19.95–26.89). Married marital status (AOR=3.20; 95% CI 2.02–5.05), multiparity (AOR=3.84; 95% CI 1.43–10.33), having a history of abortion (AOR=2.33; 95% CI 1.44–3.75), getting counselling on post-abortion family planning (AOR=4.63; 95% CI 3.27–6.56), and ever use of contraceptives (AOR=4.63; 95% CI 2.27–5.21) were factors associated with post-abortion family planning utilization in Eastern Africa.ConclusionsThis study revealed that the marital status of the women, multiparity, having a history of abortion, getting counselling on post-abortion family planning, and ever used contraceptives were found to be significantly associated with post-abortion family planning utilization.

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study.

Globally an estimated 55.9 million abortions occur each year. The majority of abortions occur due to unintended pregnancies, which is a result of the non-use of family planning methods. World health organization recommends all clients to utilize modern contraceptive methods after any abortion procedure. However, post-abortion family planning utilization is still low in Ethiopia including the study area. Therefore, this study was expected to determine the utilization of post-abortion family planning and associated factors in Bahir Dar city health facilities in Northwest Ethiopia. Institution based cross-sectional study was conducted among 408 women from March 1 to April 30, 2019. Data were collected through face-to-face interview using a structured and pre-tested questionnaire. Systematic random sampling was used to select the study participants. Data were cleaned, coded, and entered into epi data and exported to SPSS for further analysis. Both bivariable and multivariable logistic regression were employed. Those variables that had a p-value of less than 0.2 during the bivariate analysis were retained for the multivariable analysis. P-value and confidence interval were used to measure the level of significance on multi-variable analysis and those variables whose P-value, less than 0.05 was considered as statistically significant. The finding of this study showed that the magnitude of post-abortion family planning (PAFP) utilization was 61% with 95% CI (55, 65). Secondary education level(AOR, 4.58; 95% CI (1.96, 10.69)), certificate and above education level (AOR, 3.06; 95% CI (1.32, 7.08)), Manual Vacuum Aspiration(MVA) (AOR, 7.05; 95% CI (2.94, 16.90)), both medication and Manual Vacuum Aspiration (AOR, 5.34; 95% CI (2.56, 11.13)) and received Post Abortion Family Planning (PAFP) counseling (AOR, 5.99; 95% CI (3.23, 11.18)) were significantly associated with PAFP utilization. Post-abortion family planning utilization in Bahir Dar health facilities was low compared with the national figure. Secondary and above educational level, respondents who were managed by Manual Vacuum Aspiration (MVA), both Manual Vacuum Aspiration (MVA) and medication and receiving Post Abortion Family Planning (PAFP) counseling were predictors of post-abortion family planning service utilization.

Prevalence and determinants of post--abortion family planning utilization in a tertiary Hospital of Northwest Ethiopia: a cross sectional study

BackgroundProvision of post abortion contraception following an abortion is an excellent opportunity to address unmet family planning needs of women. In Ethiopia, post abortion family planning is minimal and underutilized. The objective of this study is to assess determinant factors for utilization of contraception following any abortion process (induced and/or spontaneous) among reproductive age women (15–49 years) in a tertiary hospital of North West Ethiopia.MethodsA cross-sectional study was conducted on 423 clients who presented for either spontaneous or induced abortion care from September 2016 to August 2017 in Felege Hiwot referral hospital, North West Ethiopia. Respondents were identified using a consecutive sampling method. Data was collected in clinic using an interviewer administered pre-tested questionnaire administered after services were completed. Factors associated with use of post-abortion family planning were explored using multivariable logistic regression analysis.Results64.8% of clients who presented for abortion care received family planning services before discharge from the hospital. Family planning counseling during service provision [AOR: 25.47, 95% CI: (9.11, 71.58)], having previous information about family planning [AOR: 2.16, 95% CI: (1.09, 4.23)], gestational age of index pregnancy less than 3 months [AOR: 1.78, 95% CI:(1.13, 3.05)], being a housewife [AOR: 0.32, 95% CI: (0.16, 0.65)] and monthly income > 5000 ETB [AOR: 0.38, 95% CI:(0.16,0.98)] are significantly associated with post abortion family planning utilization.ConclusionsThe proportion of post abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion services strongly influenced the usage of family planning services. The government and regional health bureau at large as well as health care providers at each health system level have an opportunity to provide information and counsel women on family planning methods to increase utilization of post abortion contraception.

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.

Family planning practices of women working in the Cambodian garment industry: a qualitative study

BackgroundWomen working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care.MethodsWe conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 min and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol.ResultsWe interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women’s attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children.ConclusionThis research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions.