What Factors Contribute to Postabortion Contraceptive Uptake By Young Women? A Program Evaluation in 10 Countries in Asia and sub-Saharan Africa

Benson, Janie; Andersen, Kathryn; Healy, Joan; Brahmi, Dalia

doi:10.9745/ghsp-d-17-00085

Cited by 28 publications

(45 citation statements)

References 28 publications

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“…Our findings did not suggest an association of postabortion LARC use with age among young women. This finding is not consistent with studies done in Australia [10] and in ten countries of Asia and Sub-Saharan Africa [18]. This might be due to the disinclination of providers to promote LARC use among all young clients (24 and below) coupled with low demand by young clients because of the fear of infertility [6, 33].…”

Section: Discussioncontrasting

confidence: 59%

“…Evidence suggests that high-quality and client-centered counseling on contraception with a focus on modern contraceptives, including LARC, pre-procedure and during the postabortion period is effective to increase LARC use [1, 18, 25, 31]. However, the Nepal Demographic Health Survey 2016, revealed that only about half of the abortions (51%) nationally were conducted in authorized facilities.…”

Section: Discussionmentioning

confidence: 99%

“…In Nepal, legalization of abortion took place in September 2002 and safe abortion service provision started in March 2004 [18, 19]. In line with the National Safe Abortion Policy 2002, safe abortion services for abortion before 13 weeks gestation were expanded to all districts in Nepal through selected public and private health institutions [20].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among young women (24 and below) in Nepal: Strategy in the search for improvements

Mehata

Bhattarai²,

Menzel³

et al. 2019

Reprod Health

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Introduction Postabortion contraceptive use differs across countries, suggesting the need for country-level research to identify barriers and suggest appropriate interventions. This study aimed to identify the prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among women aged 24 or younger in Nepal. Methods This is a cohort study using Health Management Information System (HMIS) data where individual case records of women seeking induced abortion or postabortion care were documented using structured HMIS 3.7 records. Analysis was performed on the individual case records of 20,307 women 24 years or younger who received induced abortion or postabortion care services in the three-year period from July 2014 to June 2017 at 433 public and private health facilities. Findings Overall, LARC uptake during the study period was 11% (IUD: 3% and implant: 8%). The odds of LARC acceptance was higher for young women (24 and below) who belonged to Brahmin/Chhetri (AOR = 1.23; 95% CI: 1.02–1.47) and Janajatis (AOR = 1.20; 95% CI: 1.01–1.43) as compared to Dalits; young women who had an induced abortion (AOR = 3.75; 95% CI: 1.75–8.06) compared with postabortion care; and those receiving service from public sector health facilities (AOR = 4.00; 95% CI: 2.06–7.75) compared with private sector health facilities. Conclusion The findings from this study indicate the need to focus on barriers to acceptance of LARC among several groups of young women (24 and below) receiving abortion care in Nepal: Dalits, Madhesis and Muslims; nulliparous women; and those receiving services at private sector health facilities.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among young women (24 and below) in Nepal: Strategy in the search for improvements

Mehata

Bhattarai²,

Menzel³

et al. 2019

Reprod Health

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“…Majority of them were in the age group of 21 to 25 years (48.5%) followed by 26-30 years (28.2%), ≤20 years (13.2%), 31-35 years (7.9%) and ≥36 years (2.3%). Similar findings where in the highest uptake was among women ≥25 years of age (78%) was seen in a multicentric study done by Benson J et al 13 The majority 2/3 rd (64.3%) of uptake of inj DMPA in our study were primipara, only 0.8% nullipara and the rest being multipara. In a study done by Patel A et al in Ahmedabad, 84% patients were multi para and 10% were primipara.…”

Section: Discussionsupporting

confidence: 92%

Profile and compliance of recipients of injection depot medroxy progesterone acetate as a contraceptive method in the government tertiary care hospital in Mandya, South Karnataka, India

Shilpa

Shwetha

2020

Int J Reprod Contracept Obstet Gynecol

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Background: The advanced contraceptive devices available nowadays have minimal side effects and utmost efficacy. The use of safe and effective contraception is the need of the hour in India. Inj. Depot medroxy progesterone (DMPA) has been found to provide effective, long acting and reversible contraception in lactating mother and post-abortal patients. Objective of this study was to describe the profile of women utilizing inj. DMPA as a contraceptive, to determine its compliance and to assess the factors affecting discontinuation of inj. DMPA (Anthara) at the government tertiary care institute in Mandya.Methods: The present study was a record-based study of 18 months (January 2018 to June 2019). The records of 266 women who utilized inj. DMPA as contraception in our institution was analysed.Results: It was observed that out of 266 women 48.5% were from age group of 21-25 years and 64.3% were primipara. Most of the women who initiated inj. DMPA (Anthara) were in the lactational period (56.0%). Most common side effect was irregular bleeding (54.8%). Discontinuation rate was 55.6% after first injection and 16.9% after second injection and gradually reduced with subsequent injections. The most common reason for discontinuation was irregular spotting per vagina (53.9%).Conclusions: Inj. DMPA is a safe, effective, long acting contraceptive taken once in three months. Many women in early reproductive age and lactational period are using inj. DMPA (Anthara) for contraception because of its convenience of dosing and is easily made available at government health care centres free of cost and has no effect on lactation. Discontinuation rate can be reduced by proper counselling.

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“…Therefore, it is important for public primary health centers to be equipped and providers trained to use appropriate uterine evacuation technologies, such as misoprostol, to avoid delays in treatment associated with referring patients to other facilities. In addition, with only three out of five PAC patients receiving modern contraception at discharge from primary health centers, task-shifting and training of mid-level providers to provide short and long acting contraception in primary health centers could ensure a wide range of choices and increase contraceptive uptake among PAC patients [22,23]. Our analysis also shows that only 38% of referral-level facilities have the capability to provide blood transfusion services, which is vital for women with hemorrhage and/or anemia, both common post-abortion complications.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

Riley

Madziyire

Owolabi

et al. 2020

BMC Health Serv Res

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Background: An estimated 65,000 abortions occurred in Zimbabwe in 2016, and 40 % resulted in complications that required treatment. Quality post-abortion care (PAC) services are essential to treat abortion complications and prevent future unintended pregnancies, and there have been recent national efforts to improve PAC provision. This study evaluates two components of quality of care: structural quality, using PAC signal functions, a monitoring framework of key life-saving interventions that treat abortion complications; and process quality, which examines the standards of care provided to PAC patients. Methods: We utilized a 2016 national census of health facilities in Zimbabwe with PAC capacity (n = 227) and a prospective, facility-based 28-day survey of women seeking PAC in a nationally representative sample of those facilities (n = 1002 PAC patients at 127 facilities). PAC signal functions, which are the critical services in the management of abortion complications, were used to classify facilities as having the capability to provide basic or comprehensive care. All facilities were expected to provide basic care, and referral-level facilities were designed to provide comprehensive care. We also assessed population coverage of PAC services based on the WHO recommendation for obstetric services of 5 facilities per 500,000 residents. Results: We found critical gaps in the availability of PAC services; only 21% of facilities had basic PAC capability and 10% of referral facilities had comprehensive capability. For process quality, only one-fourth (25%) of PAC patients were treated with the appropriate medical procedure. The health system had only 41% of the basic PAC facilities recommended for the needs of Zimbabwe's population, and 55% of the recommended comprehensive PAC facilities. Conclusion: This is the first national assessment of the Zimbabwean health system's coverage and quality of PAC services. These findings highlight the large gaps in the availability and distribution of facilities with basic and comprehensive PAC capability. These structural gaps are a contributing barrier to the provision of evidence-based care. This study shows the need for increased focus and investment in expanding the provision of and improving the quality of these essential, life-saving PAC services.

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What Factors Contribute to Postabortion Contraceptive Uptake By Young Women? A Program Evaluation in 10 Countries in Asia and sub-Saharan Africa

Abstract: Across the 10 countries, 77% of 921,918 women left with a contraceptive method after receiving abortion care. While contraceptive uptake was high among all age groups, adolescents ages 15–19 were less likely to choose a method than women 25 years or older.

Cited by 28 publications

References 28 publications

Prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among young women (24 and below) in Nepal: Strategy in the search for improvements

Prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among young women (24 and below) in Nepal: Strategy in the search for improvements

Profile and compliance of recipients of injection depot medroxy progesterone acetate as a contraceptive method in the government tertiary care hospital in Mandya, South Karnataka, India

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

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