Postabortion Contraceptive Uptake Research Articles

Contraceptive behavior of women in India after induced abortion.

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

Post abortion contraceptive uptake and continuation rates at Korle-Bu Teaching Hospital, Accra, Ghana

Introduction: The tragedy of unsafe abortion is that it is one of the easily preventable causes of maternal death. In Ghana, the maternal mortality ratio was 319/100,000 live births. (WHO, 2015) of which 11% of these were abortion related. 13% of abortions had complications including chronic pelvic pain, offensive discharge and uterine perforation In spite of the above, this study sought to find out factors that affect uptake and continuation rates of post abortion contraception at the Korle Bu Teaching Hospital. Methods: This was a longitudinal study using interviewer administered questionnaire of women reporting for elective termination of pregnancy or for uterine evacuation for incomplete abortion either induced or spontaneous. Participants were followed up by telephone calls at end of 1, 3 and 6 months. Simple proportions was calculated for post-abortion contraception uptake and continuation rates. Multiple logistic regression was used to determine factors associated with uptake and continuation rates. A p-value of less than or equal to 0.05 was considered as statistically significant. Results: The study included 338 participants. The overall uptake was 132 (39.1%). Eighty-seven (25.7%) on discharge and 45 (13.4%) additional uptake within one month of the follow-up. Continuation rate at 6 months was 68.9%. Significantly associated factors were educational level, employment and marital status, gravidity/parity and previous contraceptive use. Conclusion: Post-abortion contraception uptake of 39.1% with 68.9% continuation rate at 6 months found in this study is low. This implies high unmet need for post-abortion contraception that needs to be addressed urgently.

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.

Socio-demographic and reproductive characteristics of clients that accepted contraceptives at abortion center at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa: a cross-sectional study (January-July 2021).

access to family planning services is an important preventive strategy against maternal mortality as it can considerably reduce unintended pregnancies and prevent sequelae of unsafe abortion. We aimed to describe the socio-demographic and reproductive characteristics of abortion seekers and investigate factors associated with uptake of contraceptives following induced abortion at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. this study was a cross-sectional study among women who had legal termination of unwanted pregnancy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1st January 2021 to July 2021. Questionnaires were administered to 80 consenting consecutive clients after undergoing induced abortion. Information on socio-demographic and reproductive characteristics and pattern of contraceptive uptake of the respondents were obtained. Descriptive and bivariate analysis were conducted to determine the pattern and relationship of socio-demographic and reproductive characteristics and contraceptive uptake. the mean age of the 80 respondents was 25.6 ± 6.6 years. Majority of the participants were of the Black race (96.25%, n= 77/80), single (90.00%, n= 72/80), of the Christian faith (80.00%, n= 64/80) and unemployed. The median number of children alive among the clients was 1(0-2), with about 37.5% of the participants being nulliparous. About 16.25% of the participants had had at least one previous termination of pregnancy. The prevalence of post-abortion contraceptive uptake was 97.5% (95%CI: 90.36% - 99.39%, N=78/80). More than half chose injectable contraceptive (53.85%, 95%CI: 42.60% - 64.71%, N= 42/78), followed by oral contraceptive pills (21.79%, 95%CI: 13.90% - 32.49% N= 17/78). We found no association between socio-demographic and reproductive characteristics, and contraceptive uptake among the abortion clients (p values >0.05). the immediate post-abortion contraceptive uptake in our facility is very high. Majority of the clients accepted injectable contraceptives. The demographic and reproductive characteristics of our clients did not affect uptake of post-abortion contraception. More education is needed to improve uptake of other long-acting contraceptives that may not require frequent contact with the health facility.

Pregnancy trends and associated factors among Kenyan adolescent girls and young women pre- and post-COVID-19 lockdown

Globally, COVID-19 has had a negative impact on health systems and health outcomes, with evidence of differential gender impacts emerging. The COVID-19 timeline of events spanning from closures and restrictions to phased reopenings is well-documented in Kenya. This unique COVID-19 situation offered us the opportunity to study a natural experiment on pregnancy trends and outcomes in a cohort of Kenyan adolescent girls and young women (AGYW), enrolled in the KENya Single-dose HPV-vaccine Efficacy (KEN SHE) Study. The KEN SHE Study enrolled sexually active AGYW aged 15–20 years from central and western Kenya. Pregnancy testing was performed at enrollment and every 3 months. We determined pregnancy incidence trends pre- and post-COVID-19 lockdown, pregnancy outcomes (delivery, spontaneous, or induced abortion), and postabortion and postpartum contraceptive uptake. Kaplan–Meier survival estimates of incidence rates were used to estimate the cumulative probability of pregnancy during the study period. Cox regression was used to investigate factors associated with pregnancy incidence. Of the 2,223 AGYW included in the analysis, median age was 18.6 IQR (17.6–20.3), >90% had at least secondary school education, 95% were single at the time of enrollment, and 82% had a steady/primary sexual partner. Pregnancy incidence peaked at 2.27 (95% CI [1.84, 2.81])/100 women-years of observation at the end of the first quarter of 2020, a period coinciding with the government-imposed lockdown. AGYW had 60% increased risk of being pregnant during the lockdown when compared to prelockdown period (HR = 1.60, 95% CI [1.25, 2.05]). Among the 514 pregnancies reported, 127 (25%) ended in abortion, of which 66 (52%) were induced abortions. Our findings demonstrate the adverse sexual and reproductive health (SRH) consequences of the COVID-19 pandemic and the lockdown measures among AGYW. As services continue to be disrupted by the pandemic, there is an urgent need to strengthen and prioritize AGYW-centered SRH services, including contraception and safe abortion.

BARRIERS TO USE CONTRACEPTIVE METHODS AMONG POST ABORTION CLIENTS IN SARGODHA, PAKISTAN: A QUALITATIVE STUDY


 
 
 World Health Organization (WHO) recommends at least 6 months interpregnancy interval after an abortion. Pakistan has a low contraceptive prevalence rate and a high unmet need for contraception. Post-abortion women are the potential clients for contraception but national data reveal low uptake of the contraceptive methods by these clients. This study aimed to explore the barriers to adopting contraception among post-abortion clients in the district of Sargodha, Pakistan. A qualitative research design was used. Study participants were recruited from three private and three public sector hospitals in the district of Sargodha, Pakistan. The study was conducted from July 2018 to November 2018. Ninety-nine in-depth interviews (IDIs) of post-abortion women were conducted using an unstructured interview guide within the period of one month after abortion. Detailed field notes were made. Interviews continued until thematic saturation had reached. The content was organized into a matrix based on themes and sub-themes. A descriptive thematic analysis using both inductive and deductive coding was conducted. Reasons for not adopting contraceptive methods were explored Although many clients expressed a desire to limit fertility, some barriers were found to be hindering the uptake of contraception. Major barriers expressed by clients were the unwillingness of the husband, the resistance of other family members and real or perceived fear of side effects of contraceptive methods. Lack of adequate knowledge about fertility and contraception was another factor which contributed to the decision not to adopt contraception. Socio-cultural norms to have large family sizes were also reported by some clients. Other barriers include religious beliefs, focus on other health issues, financial unaffordability, infrequent intercourse and plan for tubal ligation. The study concluded that without addressing the barriers post-abortion contraceptive uptake is unlikely to improve. Identification of barriers is the first step to addressing the existing unmet need for contraception.
 
 

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.

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana.

This paper examined women's pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion.

An examination of the characteristics and contraceptive acceptance of post-abortion clients in Ethiopia

ABSTRACT This national study examined the socio-demographic, health facility, and provider characteristics associated with the use of postabortion contraception in Ethiopia in 2014. We used data from a Prospective Morbidity Survey (PMS) conducted in Ethiopia in 2014 to measure abortion incidence and morbidity nationally. Data were collected on the presentation, care and treatment of 5,604 women who sought abortion services in 365 health facilities over 30 days. Descriptive and multivariate logistic regression analysis were used to examine postabortion contraceptive uptake. Nearly 75% of abortion clients received postabortion contraception. The majority received short-acting methods, around one-third chose a long-acting or permanent method. Most women sought abortion services at public health centers (61.8%) and were cared for by midlevel providers (82.5%). Multivariate regression results showed that women who sought services during the first trimester (odds ratio/OR = 1.44; 95% confidence interval/CI 1.06, 1.95), for induced abortions (OR = 3.55; 95% CI 2.52, 4.99), from public sector facilities, and those served by midlevel providers, had greater odds of receiving postabortion contraception. We conclude that providing strong contraceptive services postabortion in government facilities, including long-acting methods in the method mix, and providing this care by midlevel providers could further reduce unmet need for contraception and repeat abortions.

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.

Reducing Barriers to Postabortion Contraception: The Role of Expanding Coverage of Postabortion Care in Dar es Salaam, Tanzania.

In Tanzania, limited access to postabortion care (PAC) contributes to high rates of maternal mortality. To address the issue, Pathfinder International and the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) introduced and expanded coverage of PAC in 64 public health facilities in Dar es Salaam, Tanzania. During a 30-month period, we implemented a multifaceted approach to introduce and expand PAC, including clinical training and mentorship for health care providers; service reorganization, equipment provision, and an expanded method mix offering; standardization of PAC reporting tools; and community engagement and referral. We assessed outcomes using PAC service statistics from 64 public health facilities in 4 districts of Dar es Salaam and health care provider mentorship data from 385 observed PAC visits. From January 2016 to June 2018, voluntary postabortion contraceptive uptake increased steadily. A total of 6,636 PAC clients, including 2,731 young people (ages 10-24), adopted a method post-procedure. Average semesterly client volume per facility increased from 27 to 52.4 manual vacuum aspiration clients and 17.6 to 43.9 postabortion contraceptors between the first and last periods. Overall postabortion contraceptive uptake was 80.6% (6,636/8,230), with a method mix of 58.3% implant, 18.9% intrauterine device, 13.7% pills, 8.6% injectables, and 0.5% permanent methods. Adults and young people had comparable method mix. Mentored providers showed improvements in service quality indicators. During the last period, 92% counseled the client on contraception, 93% considered the client's sexual and reproductive health intentions, 94% provided correct method information and supply, and 96% documented services on the client's family planning card. Different provider types (mid- and senior-level) performed comparably. Expanding PAC coverage to primary- and secondary-level facilities led to high uptake of voluntary contraception among postabortion clients. Key interventions included PAC clinical training and mentorship; service reorganization, equipment provision, and an expanded method mix offering; use of standardized PAC registers; and community engagement for awareness building and linkage to PAC.

Voluntary Contraceptive Uptake Among Postabortion Care Clients Treated With Misoprostol in Rwanda.

Unsafe abortion remains a problem in Rwanda, where abortion is highly restricted by law. To reduce mortality and morbidity from unsafe abortion, Rwanda implemented a national postabortion care (PAC) program in 2012, which included using misoprostol to treat incomplete abortion. Key components of PAC are offering and providing voluntary contraceptive methods and counseling on their use, but little is known about contraceptive uptake among PAC clients treated with misoprostol. The objectives of the current study were (1) to assess the contraceptive uptake of PAC clients treated with misoprostol, including whether extended bleeding hinders uptake; and (2) to assess providers' knowledge of contraception and their willingness to counsel PAC clients on contraception, provide methods, or refer for contraceptive services. We surveyed 68 PAC clients treated with misoprostol and 43 providers (84% nurses) in 17 health facilities across 3 districts in Rwanda where misoprostol for PAC had been introduced recently. PAC clients were recruited into the study prior to facility discharge and surveyed between 10 days and 1 month after discharge. We asked PAC clients and providers about demographic characteristics and attitudes toward contraception. We also asked PAC clients about contraceptive counseling received and postabortion contraceptive uptake or reasons for nonuse, and providers about their knowledge about return to fertility, pregnancy and contraceptive counseling, practices related to contraceptive method provision, and their knowledge and potential biases about PAC clients using contraception. We used descriptive statistics for analysis. PAC clients were 19-46 years old, and most (69%) had at least 1 child. Almost all PAC clients (94%) reported being counseled on contraception, but only 47% reported choosing and receiving a method before being discharged from the facility. Nevertheless, by the time of the survey, 71% reported using a method. PAC clients' main reason for not using contraception was wanting to become pregnant. Only 1 woman reported nonuse because of bleeding. Among providers, more than half (56%) reported there are contraceptive methods PAC clients should never use and about a quarter (26%) reported incorrect information on when PAC clients' fertility could return. We found no evidence that bleeding associated with misoprostol for PAC influenced women's contraceptive uptake. However, as PAC programs expand to include misoprostol as a treatment option, accurate and high-quality postabortion contraception counseling and method provision at both treatment and follow-up visits must be strengthened.

What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania

BackgroundThe family planning component of postabortion care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving postabortion contraceptive services.MethodsThis analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014.ResultsThis study suggests that efforts to integrate postabortion family planning into treatment for incomplete abortion contributed to higher postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used.ConclusionThe experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.

Evaluating the impact of a quality management intervention on post-abortion contraceptive uptake in private sector clinics in western Kenya: a pre- and post-intervention study

BackgroundIntegration of family planning counselling and method provision into safe abortion services is a key component of quality abortion care. Numerous barriers to post-abortion family planning (PAFP) uptake exist. This study aimed to evaluate the effect of a quality management intervention for providers on PAFP uptake.MethodsWe conducted a pre- and post-intervention study between November 2015 and July 2016 in nine private clinics in Western Kenya. We collected baseline and post-intervention data using in-person interviews on the day of procedure, and follow-up telephone interviews to measure contraceptive uptake in the 2 weeks following abortion. We also conducted semi-structured interviews with providers. The intervention comprised a 1-day orientation, a counselling job-aide, and enhanced supervision visits. The primary outcome was the proportion of clients receiving any method of PAFP (excluding condoms) within 14 days of obtaining an abortion. Secondary outcomes were the proportion of clients receiving PAFP counselling, and the proportion of clients receiving long-acting reversible contraception (LARC) within 14 days of the service. We used chi-squared tests and multivariate logistic regression to determine whether there were significant differences between baseline and post-intervention, adjusting for potential confounding factors and clustering at the clinic level.ResultsInterviews were completed with 769 women, and 54% (414 women) completed a follow-up telephone interview. Reported quality of counselling and satisfaction with services increased between baseline and post-intervention. Same-day uptake of PAFP was higher at post-intervention compared to baseline (aOR 1.94, p < 0.001), as was same-day uptake of LARC (aOR 1.72, p < 0.001). There was no overall increase in uptake of PAFP 2 weeks following abortion. Providers reported mixed opinions about the effectiveness of the intervention but most reported that the supervision visits helped them improve the quality of their services.ConclusionsA quality management intervention was successful in improving the quality of PAFP counselling and provision. Uptake of same-day PAFP, including LARC, increased, but there was no increase in overall uptake of PAFP 2 weeks after the abortion.

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.

What contraception do women use after abortion? An analysis of 319,385 cases from eight countries

ABSTRACTContraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement.

Postpartum and Post‐Abortion Contraception: From Research to Programs

Contraception following delivery or an induced abortion reduces the risk of an early unintended pregnancy and its associated adverse health consequences. Unmet need for contraception during the postpartum period and contraceptive counseling and services following abortion have been the focus of efforts for the last several decades. This article provides an introduction to the more focused contributions that follow in this special issue. We discuss the validity and measurement of the concept of unmet need for family planning during the postpartum period. We then present key findings on postpartum contraceptive protection, use dynamics, and method mix, followed by an assessment of interventions to improve postpartum family planning. The evidence on postabortion contraceptive uptake and continuation of use remains thin, although encouraging results are noted for implementation of comprehensive abortion care and for the impact of post-abortion contraceptive counseling and services. Drawing on these studies, we outline policy and program implications for improving postpartum and post-abortion contraceptive use.

Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention

ObjectiveThe objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility, impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. Study designA single-session postabortal contraception counseling intervention for young women aged 15–24 years incorporating principles, skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention, their competency was assessed, and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants, ability to complete the full intervention without interruption and participant satisfaction with the counseling. ResultsWe approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact, 95% and 77% of participants reported that the session was helpful, respectively. ConclusionsMI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles, skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. ImplicationsThe use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered, directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic.

An evaluation of postabortion contraceptive uptake following a youth-friendly service intervention in Ethiopia

An evaluation of postabortion contraceptive uptake following a youth-friendly service intervention in Ethiopia

Development and pilot testing of a theory-based counseling intervention to improve postabortion contraceptive uptake by young women

Motivational interviewing (MI), a theory-based counseling technique, holds promise for contraceptive counseling. We trained counselors, then developed and pilot-tested an MI-based intervention to improve uptake of highly effective contraception by young women presenting for induced abortion.