Post-abortion Contraception: Study Shows opportunity to improve uptake


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THE OUTCOME of a recent study by Ipas organisation has shown that more women who have undergone post-abortion care in developing countries are now embracing contraception to prevent recurrence of unwanted pregnancies.

The study conducted earlier in the year and published in the journal, Global Public Health was directed by Ipas Vice President Janie Benson.

Ipas works with local partners around the world to improve women’s and girls’ access and right to safe, high-quality abortion care and reproductive health services.

The outcome of the research which was published last September is coming ahead of the 4th National Biennial Conference on Family Planning in Nigeria organized by the Association for Advancement of Family Planning in Nigeria (AAFP) in collaboration with the Federal Ministry of Health.

The forthcoming conference holding in Abuja between November 7 and 9, is expected to showcase the milestones achieved with regards to Family Planning in the country.

Nigeria is currently known to have a national contraceptive prevalence of 9 percent and efforts are in top gear to ensure this contraception prevalence improves to meet the sustainable development goals (SDG) by 2030.

Ipas research had examined contraceptive uptake among 319,385 women seeking abortion in eight countries of Bangladesh, Ethiopia, Ghana, India, Nepal, Nigeria, South Africa and Zambia and found that 73 percent of the women immediately embraced modern contraception after surviving postabortion care (PAC).

Contraception is known to be an essential element of high-quality abortion care. But studies have proven that women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of more unintended pregnancy.

The Ipas study took cognisance of contraceptive uptake in 319,385 women seeking abortion in 2,326 public-sector health facilities in the eight African and Asian countries using the Ministries of Health integrated contraceptive and abortion services.

According to Benson, the overall findings showing postabortion contraceptive uptake of 73 percent underscore a “tremendous opportunity” to reduce the unmet need for contraception, reduce unintended pregnancy and decrease unsafe abortion.

Benson is reported to have pointed out that the organisation’s findings demonstrate high contraceptive uptake when it is delivered at the time of an abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs.

The Ipas study equally found district variations between Abortion clients in Africa and Asia.

For instance, one of the findings showed that in Africa, younger women were more likely to present for PAC, more likely to present in the second trimester of pregnancy and more likely to receive medical abortion than vacuum aspiration than their Asian counterparts.

While in Africa, 22% of the women who presented for PAC were younger than 20years of age, in Asia only 3 percent of the women were less than 20years of age.

Moreso, in Africa, of the number of women who needed PAC, about 37 percent presented themselves while in Asia, 26 percent of women with unwanted pregnancy presented for PAC

Other findings indicated as follows:

In Africa -12 percent presented in 2nd trimester while in Asia, 3percent similarly presented.

In Africa – 40% received Medical Abortion while in Asia, about 19 percent similarly received same treatment

Overall. There is an increase in take of PAC contraceptive of 73percent Broken down: Africa 69percent and Asia 77percent.

There is High uptake of contraceptive among abortion clients in countries with low national modern contraceptive prevalence for married women.

Nigeria has a national contraceptive prevalence of nine percent but uptake of contraception from the study shows that postabortion contraceptive uptake rises to 56 percent.

Ghana has a national contraceptive prevalence of 23 percent but it rises to 69percent after postabortion care. Likewise Ethiopia which has a national prevalence of contraceptive use of 40 percent rose to 86 percent in postabortion care.

The study found prevalence of Contraceptive method mix among Acceptors as follows: Implants: 9%, IUD: 9%, Sterilisation: 9%, Condom: 14%, Injectable: 30% and Oral Contraceptive 29%.

In the countries of study too, Ipas found that contraceptive uptake varies by

Facility level of care: PHC:- 85%;           SHC-68%;           Tertiary– 60%

Client’s Age:             PHC-<25(75%)       SHC-<20(74%)     Tertiary-20-24(73%)

Gestational Age/Wks: PHC-<12(76%)   SHC-<19(59%)     Tertiary– 13-18(53%)

Diagnosis: PHC-Induced Abortion (81%) SHC– Treatment of complication (60%) Tertiary: Nil

Abortion Technology Used: PHC-Medical Abortion(81%) SHC-MVA/EVA(72%) Tertiary: D&C (44%)


Programmatic interventions

During the period of analysis, Ipas provided technical assistance to Ministries of Health and service providers in the eight countries on programs designed to increase women’s access to postabortion contraception.

Interventions included updating national service guidelines; training providers, both on clinical skills and on counselling clients for informed choice; making contraceptive methods available where abortion services were provided; and updating processes for service statistics. In some settings, there was community outreach to inform women about contraceptive and abortion care.

“Integrating contraceptive counselling and provision into the abortion visit helps women prevent unintended pregnancies and contributes to their reproductive health.”


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