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

Abstract

Background Utilization 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. Methods Published 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. Results A 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. Conclusions This 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.

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

“…In this study, women who had a previous history of abortion were 89% more likely to utilize postabortion contraceptives compared to their counterparts. This is consistent with other studies done in East Africa and other parts of the country [ 22 , 30 , 34 ]. The possible explanation could be that the previous exposure to abortion might sensitize and influence the awareness of women towards postabortion contraceptive utilization.…”

“…Multigravida women were 8 times more likely to utilize postabortion contraceptives than primigravida. This finding was supported by the studies conducted in East Africa and other parts of Ethiopia [ 30 , 33 ]. This is due to the fact that women who had conceived frequently would choose to space birth compared to primigravida which might be related to socioeconomic or other related issues.…”

“…This study pointed out that unmarried women were 95% less likely to utilize postabortion contraceptives than their counterparts. This is supported by studies conducted in a different part of Ethiopia [ 14 , 30 – 33 ]. The possible reason could be that married women would live together with their husbands so that they might be prone to more sexual exposure.…”

“…Women who had a previous history of contraceptive usage were 7 times more likely to utilize contraceptives as compared to their counterparts. Similarly, the study conducted in Pakistan [ 25 ] and other Ethiopian studies [ 14 , 21 , 22 , 30 , 33 ] showed that the previous history of contraceptive usage was found to be significantly associated with postabortion contraceptive utilization. The possible explanation could be that the previous exposure to family planning services might influence the awareness of women towards postabortion contraceptive utilization.…”

Women’s Perceived Barriers to Accessing Post-Abortion Care Services in Selected Districts in KwaZulu Natal Province, South Africa: A Qualitative Study

“…However, the study by Erko et al revealed that married women were 6.7 times more likely to utilize post-abortion family planning than unmarried women [ 25 ]. It was thought that married women may be likely to be having sex more regularly than unmarried women, which may explain their high post-abortion family planning utilization [ 26 ]. With parity, the results revealed that 39% of women were nullipara.…”