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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 33  |  Issue : 2  |  Page : 228-231

Uptake of post-abortion contraception among women who had manual vacuum aspiration at Federal Medical Centre, Owerri: A 5-year review


1 Obstetrics and Gynaecology Department, Federal Medical Centre, Owerri, Imo State, Nigeria
2 Department of Physical and Health Education, Nnamdi Azikiwe Unversity, Awka, Nigeria

Date of Web Publication13-Oct-2016

Correspondence Address:
O A Onyegbule
Obstetrics and Gynaecology Department, Federal Medical Centre, Owerri
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-5117.192234

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  Abstract 

Background: Unexpected or unplanned pregnancy poses a major public health challenge in women of reproductive age, especially in low resource countries. Post-abortion contraception is one of the key methods of reducing maternal mortality globally.
Objectives: This study was conducted to determine the uptake of contraception among women who received post-abortion care following spontaneous or induced abortion at the Federal Medical Centre, Owerri.
Materials and Methods: This study was a 5-year retrospective study that involved 480 women who received post-abortion care from January 1 st 2009 to December 31 st 2013 in the Federal Medical Centre, Owerri.
Results: The overall uptake of contraception among the study population was 79.8%. This was found to be 78.7% among nulliparous women whereas an uptake of 80.9% was seen among parous women. The age range was from 15 to 46 years with a mean age of 28.5 ± 3.5 years. Women aged between 20 and 39 years accounted for 94% of the study population. While 77.9% accepted to use the barrier method, 20.2% did not accept any method of contraception. Incomplete abortion contributed to 81.3% of the total cases.
Conclusion: The uptake of contraception was high at the Federal Medical Centre, Owerri. It was found to be higher with the parous women than nulliparous women. Most of the women were between 20 and 39 years and were highly sexually active; therefore, reinforcing the importance of contraception from time to time among this age group will help reduce the incidence of unplanned/unwanted pregnancies, and thus, the morbidities and mortality associated with abortion.

Keywords: Abortion; contraception; manual vacuum aspiration.


How to cite this article:
Onyegbule O A, Onumajuru C C, Ododo N A, Idih E E, Onyegbule P C. Uptake of post-abortion contraception among women who had manual vacuum aspiration at Federal Medical Centre, Owerri: A 5-year review. Trop J Obstet Gynaecol 2016;33:228-31

How to cite this URL:
Onyegbule O A, Onumajuru C C, Ododo N A, Idih E E, Onyegbule P C. Uptake of post-abortion contraception among women who had manual vacuum aspiration at Federal Medical Centre, Owerri: A 5-year review. Trop J Obstet Gynaecol [serial online] 2016 [cited 2019 Nov 20];33:228-31. Available from: http://www.tjogonline.com/text.asp?2016/33/2/228/192234


  Introduction Top


An estimated 123 million couples, mainly in low resource countries, do not use any method of modern contraceptives, despite a desire to space or limit their childbearing. [1] If contraception were accessible and used consistently and correctly by women desiring to avoid pregnancy, maternal deaths would decline by an estimated 25-35%; non-use or inconsistent use of contraception contributed to most of the unwanted pregnancies. [2] Post-abortion counseling incorporated into post-abortion care has been regarded as an appropriate venue or vehicle to decrease unwanted pregnancies and induced abortions. [3] Post-abortion counselling is pertinent especially in countries like Nigeria that has restrictive abortion laws.

Regardless of the model used, providing post-abortion family planning benefits individuals, families, communities and countries in many ways leading to increased modern contraceptive use and decreased abortion, reduced maternal and child mortality, prevention of mother-to-child human immunodeficiency virus (HIV) transmission and new HIV infections and reduced social costs. [4]

Those who did not use any contraceptive method may lack access or face barriers to using contraception. These barriers include lack of awareness, lack of access, cultural factors, religion, opposition to use by partners or family members and fear of health risks and side effects of contraceptives. [5] Other factors include age, women's educational level including the educational level of the husband/partner, occupation, environment (urban/rural) and high price of contraceptives. [6]

Fortunately, studies have suggested that gender equality may encourage women's autonomy and may facilitate the uptake of contraception because of increased female participation in decision making. [7] Consequently, much of the relevant demographic literature that has addressed the links between gender inequality and fertility regulation has focused on women's autonomy. [8] Uptake of a method has also been shown to be influenced by counselling time. [9]


  Materials and Methods Top


This study was a retrospective study carried out at the Federal Medical Centre, Owerri. It was based on the manual vacuum aspirations (MVAs) done from January 1 st 2009 to December 31 st 2013. Ethical approval was obtained from the Ethical Committee of the Federal Medical Centre, Owerri. The case notes were retrieved from the hospital medical records and studied in detail. The Information needed for analysis was obtained from the register in the MVA room.

The cases that met the inclusion criteria for the study were selected. Woman who had induced or spontaneous abortion and MVA during the period of the study were included in the study. Post-abortion period was defined as the period between abortion and 6 weeks post abortion. During the 60-month study period, 480 women were included having undergone MVA at Federal Medical centre, Owerri. The data collected and analyzed were age, parity, gestational age at which the abortion occurred and uptake of at least a method of contraception.


  Results Top


The overall acceptance of at least one method of contraception was found to be 79.8% of the total patients who underwent MVA. The acceptance among nulliparous women was 78.7%, whereas acceptance among the parous women was slightly higher at 80.9%. Three hundred and seventy four (77.9%) women accepted to use the barrier method of contraception, whereas 97 (20.2%) did not accept to use any form of contraception. Only 6 (1.3%) women out of the 480 women accepted using hormonal contraception after the procedure.

The age ranged from 15 to 46 years, and the mean age was 28.5 ± 3.5 years. Most of the women (451) were in the 20-39 years age range [Table 1], i.e, the highly sexually active group. They contributed 94% of the study population.
Table 1: Age distribution of the study group


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From our study, 239 (49.8%) were nulliparous, while 241 (50.2%) were parous [Table 2]. The overall acceptance of at least one method of contraception was found to be 79.8% of the total patients who had manual vacuum aspiration done. The acceptance among nulliparous women was 78.7%, while acceptance among the parous women was slightly higher at 80.9%. Three hundred and seventy four (77.9%) women accepted to use the barrier method of contraception, while 97 (20.2%) did not accept to use any form of contraception. Only 6 (1.3%) women out of the 480 subjects accepted to use hormonal contraception after the procedure [Table 3].
Table 2: Obstetrics characteristics of participants


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Table 3: Type of contraceptive use amongst participants


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Incomplete abortion was found to be the most common indication for MVA among both groups of women, i.e, 390 cases constituting 81.3% of the total cases. Among the parous women, 60 (24.9%) had missed abortion, approximately 5 times as much as the proportion of missed abortion among the nulliparous women. Conversely, 16 (6.7%) of the 239 nulliparous women had septic abortion, almost 6 times as much as the proportion of septic abortion among the parous women [Table 4].
Table 4: Distribution of women according to their type of abortion


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Overall, nearly 50% of cases occurred at the gestational age of between 11 and 13 weeks. This was largely contributed by parous women. However, among the nulliparous women, 49.8% occurred at the gestational age of 8-10 weeks [Table 5].
Table 5: Gestational ages at which manual vacuum aspiration was performed


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  Discussion Top


While complications associated with abortions globally lead to 13-25% of maternal deaths, it is estimated that these would decline by 25-35% if contraception was accessible and used consistently by women desiring to avoid pregnancy. [10] Many women do not receive immediate post-abortion family planning services, even though they are at risk of pregnancy within 2 to 3 weeks. In addition, 31 million women have spontaneous abortions each year. While many of these women desire to replace the pregnancy that was lost, experts recommend birth spacing of 6 months after a spontaneous abortion of a desired pregnancy for optimal pregnancy outcomes. [11]

From this study, the overall acceptance of at least a form of contraception after MVA was 79.8%. This is higher than the 70% acceptance rate recorded in Tanzania. [12] However, this contrasts with some studies conducted in Zimbabwe [13] and China [14] that gave an acceptance rate close to 100%. This disparity may have been due to some barriers that are peculiar to our sub-region, including religious and cultural beliefs.

The barrier method was the most common (77.9%) form of contraception accepted by the patients. This contrasted with a study done in Brazil where the most common method chosen was hormonal contraceptive (83.6%) whereas only 15.1% chose the barrier method. [15] This may be due to aversion to hormonal contraception because some believe that it may prevent them from getting pregnant when they eventually get married.

It was seen that 94% of the women were in the 20-39 years age range, with a mean age of 28.5 ± 3.5 years. This is slightly above the mean age of 25 years recorded in studies done in Brazil [15] and Addis Ababa, Ethiopia. [16] In Nnewi, southeast, Nigeria, the mean age was found to be 23.5 ± 4.4 years. [17] The lower mean age in that study may have been due to the fact that a majority of the study population were students, including secondary school students, who were much younger.


  Conclusion Top


Uptake of contraception was found to be high in Federal Medical Centre, Owerri. It was more common with parous women. Barrier method was found to be the most common form of contraception. Most women in the study belonged to the age group that is known to be highly sexually active; therefore, reinforcing the importance of contraception from time to time among this age group will help reduce the incidence of unplanned/unwanted pregnancies, and thus, the morbidities and mortality associated with abortion.

Limitation of the study

The women were not classified to have had either induced or spontaneous abortion because the uptake was expected to be different in each group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Family planning. Research on Reproductive Health at WHO - pushing the frontiers of knowledge. Biennial Report 2002-2003 Geneva; WHO 2004.  Back to cited text no. 1
    
2.
Luke E, Suigh S, Chrowohury SA. Fertility regulation behaviour and their costs: Contraception and unintended pregnancy in Africa, Eastern Europe, Central Asia and Washington DC: World Bank; 2007.  Back to cited text no. 2
    
3.
Ceylan A, Erten M, Saka G, Akdeniz N. Post abortion family planning counselling as a tool to increased contraception use. BMC Public Health 2009;9:20.  Back to cited text no. 3
    
4.
Curtis C, Huber D, Moss-Knight T. Post abortion family planning: Addressing the cycle of repeated unwanted pregnancy and abortion. Int Perspect Sex Reprod Health 2010;36:44-8.  Back to cited text no. 4
[PUBMED]    
5.
Carr D, Khan M. The unfinished agenda: Meeting the needs for family planning in less developed countries. Washington, DC: Population reference bureau; 2004.  Back to cited text no. 5
    
6.
Bjelica A, Trninic-Pjevic A. Review of identified factors influencing contraceptive use. Med Pregl 2008;61:151-5.  Back to cited text no. 6
    
7.
Hakim A, Salway S, Mumtaz Z. Women's autonomy and uptake of contraception in Pakistan. Asia Pac Popu J 2003;18:63-81  Back to cited text no. 7
    
8.
Furuta M, Aalway S. Women's position within the household as a determinant of maternal health care use in Nepal. Int Fam Plan Perspect 2006;32:17-27.  Back to cited text no. 8
    
9.
Onyango MA, Oguttu M, Barger M. Predictive factors for uptake of post abortion contraception in westen Kenya. Afr J Midwifery Womens health 2010;4:115-20.  Back to cited text no. 9
    
10.
Opoku B. Contraceptive preferences of post-abortion patients in Ghana. J Womens Health Care 2012;1:109.  Back to cited text no. 10
    
11.
United States agency for international development. What works; a policy and programme guide to the evidence on family planning, safe Motherhood and STI/HIV/AIDS Interventions. Module 2: Post abortion Care. Washington DC; 2007.  Back to cited text no. 11
    
12.
Wanjiru M, Askew I, Munguti N, RamaRao S, Homan R. Assessing the feasibility, acceptability and cost of introducing comprehensive post abortion Care in health centres and dispensaries in rural Tanzania. Final Report. The Population Council 2007:1-2.  Back to cited text no. 12
    
13.
Mturi A, Joshua K. Falling Fertility And Increase In Use Of Contraception In Zimbabwe. Afr J Reprod Health 2011;15:31-44.  Back to cited text no. 13
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14.
Cheng Y, Xu X, Wuillaume F, Zhu J, Gibson D, Temmerman M. The need for integrating family planning and post-abortion care in China. Int J Gynaecol Obstet 2008;103:140-3.  Back to cited text no. 14
[PUBMED]    
15.
Ferreira AL, Sonza AI, Lima RA, Braga. Choices of post-abortion contraceptive methods in post-abortion family planning clinic in the Northeast Brazil. Reprod Health J 2010;7:5.  Back to cited text no. 15
    
16.
Ndola P, Suzanne B, Holston M, Gerdts C, Melkamu Y. Factors associated with choice of post-abortion Contraception in Addis Ababa, Ethiopia. Afr J Reprod Health 2011;15:55-62.  Back to cited text no. 16
    
17.
Adimma ED, Adimma JI, Iwuoha C, Akiode A, Oji E, Okoh M. Knowledge and practices among medical abortion seekers in South Eastern Nigeria. Southeast Asian J Trop Med public Health 2012;4:471-8.  Back to cited text no. 17
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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