Examining factors associated with post-abortion family planning among women in refugee settings in Uganda

Post-abortion family planning (PAFP) is an essential component of post-abortion care (PAC) and a recommended family planning high-impact practice. Although PAFP uptake remains low, determinants of its uptake, especially in humanitarian settings, are not well understood.

To identify the factors associated with PAFP uptake and examine whether women's perceptions of person-centered PAC quality of care (QoC) were associated with PAFP uptake among women receiving PAC in refugee settings in Uganda.

We administered a cross-sectional prospective morbidity survey (PMS), part of a larger study using the abortion incidence complications methodology to estimate abortion incidence in all 13 refugee settlements in Uganda.

We analyzed data from a PMS of 341 women with post-abortion complications who received PAC in the 13 refugee settlements. PAFP uptake was measured by asking patients if they left the health facility with a family planning method (Yes/No) after completing PAC. The quality of PAC was assessed using a modified 19-item Person-Centered Abortion Care scale. We used logistic regression to identify factors independently associated with PAFP uptake among women receiving PAC in refugee settings in Uganda.

PAC patients in refugee settings in Uganda reported medium to high levels of QoC, with deficits mainly observed in the communication and autonomy subdomain. Women's own perception of QoC was not significantly associated with whether a PAC patient leaves with a method across models. Earning money in the past month before the survey (adjusted odds ratio (aOR) = 3.215; 95% confidence interval (CI) 1.124-9.199) and having a desire to leave with a family planning method (aOR = 270.532; 95% CI 78.921-927.348) were associated with PAFP, after controlling for women's, facility level, and provider characteristics.

Our findings highlight persistently low uptake of PAFP in refugee settings in Uganda, underscoring the need for targeted interventions that both increase family planning use and uphold reproductive autonomy. There is a need to strengthen family planning counseling as part of PAC provision and improve the quality of PAC services with particular attention to communication and patient autonomy.