Post-abortion contraceptive uptake of clients and its related factors in Northwest Ethiopia, 2020

The post-abortion period is the right time to introduce contraceptive services as women's fertility returns early. A majority of women in Ethiopia had an abortion for unwanted pregnancies and this cycle could continue unless contraceptive counseling and services are available and provided for women after an abortion. Thus, our study aimed to fill this gap and prepare strategies to improve uptake.

Institution-based cross-sectional study was conducted to collect data in private and public health facilities in northwest Ethiopia. Data were entered with Epi-info and transported to Stata 14 for cleaning (using frequencies, sorting, and listing to identify missed values and outliers) and analysis. Bivariate analysis was carried out first to observe the crude association between independent and outcome variables. The variables with p-value < 0.2 in bivariate analysis, not collinear (checked with Variance Inflation Factor -VIF-Value 0.86), were entered into multiple logistic regressions to assess net effect by controlling confounders. Finally, statistically significant variables were reported with the odds ratio, a 95% confidence interval, and p-value < 0.05.

About, about three-fifth (61.5%) utilized Post Abortion Contraception (PAC) immediately after the procedure. Five hundred thirty-one (86%) reported that they had counseling sessions. Having post-abortion contraceptive counseling [AOR = 4.83, 95% CI: (2.77-8.40)]; ever use of contraceptives [AOR = 1.75, 95% CI: (1.04-2.96)]; history of abortion [AOR = 0.32, 95% CI: (0.15-0.68)]; being aged 24 to 28 years [AOR = 0.28, 95% CI: (0.09-0.81)], Primigravida [AOR = 0.48, 95% CI: (0.24-0.96)], wanted pregnancy status [AOR = 0.36, 95% CI: (0.21-0.62)]; being single [AOR = 2.42, 95% CI: (1.25-4.71)], never married [AOR = 0.55, 95% CI: (0.31-0.97)], and separated from partner [AOR = 0.37, 95% CI: (0.2-0.68)] were found to have significant association with postabortion contraception use.

The study found that PAC uptake was low compared with the recommendations. Strengthening contraceptive counseling (regardless of women's status) by giving priorities for who had unstable relationships (single and separated), have first pregnancy, and encountering repeated abortion care services. Moreover, provision of value clarification training for providers could also improve service use. We recommended that researchers to explore deep feelings and reasons that women had for nonuse through in-depth interviews.