Utilization of Post Abortion Contraceptive and Associated Factors among Women who Came for Abortion Service : a Hospital Based Cross Sectional Study

C l i n M e d International Library Citation: Kokeb L, Admassu E, Kassa H, Seyoum T (2015) Utilization of Post Abortion Contraceptive and Associated Factors among Women who Came for Abortion Service: a Hospital Based Cross Sectional Study. J Fam Med Dis Prev 1:022 Received: October 19, 2015: Accepted: December 10, 2015: Published: December 14, 2015 Copyright: © 2015 Kokeb L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kokeb et al. J Fam Med Dis Prev 2015, 1:4 ISSN: 2469-5793


Introduction
Worldwide maternal mortality continues to be the concern in advance.Each year, approximately 500,000 maternal deaths had occurred worldwide.Among 99% of these deaths occur in developing countries from which Sub-Saharan Africa accounts for 50% of the maternal death burden [1].The World Health Organization (WHO) estimates that, worldwide, almost 20 million unsafe abortions take place each year.
On 80,000 maternal deaths per year are thought to be due to abortion complications, accounting for about 13% of all maternal deaths in the world [2].
The World Health Organization (WHO) estimates that every year, nearly 5.5 million African women have an unsafe abortion.In Eastern Africa it is estimated that 18% of all maternal deaths are the result of complications of poorly performed abortions (WHO 2011) [3].
In Ethiopia, The induced abortion rate was estimated to be 23 per 1,000 women in reproductive age group in 2008, and 101 per 1,000 was rate of unintended pregnancy [4].The high proportion of unintended pregnancies contributes to one of the highest maternal mortality ratios in 676 maternal deaths per 100,000 live births.Family planning reduces maternal mortality by enabling women to prevent conception [5].

ISSN: 2469-5793
the women and partner that family planning measures can save their time, pain and resources.Provision of post abortion counselling and contraception is also needed to meet the service standard [8].However, most of the researches so far in our country focus on general abortion care.
Research areas regarding the post abortion family planning utilization among abortion clients remain untouched.Therefore, this study aimed to assess prevalence and factors associated with post abortion family planning utilization among women came for abortion service.

Study Design and period
An institutional based cross-sectional study was conducted from August to October 2014.

Study Area
The study was conducted in Debre Markos town, Located in north western Ethiopia, in Amhara National Regional State, East Gojjam zone, at a distance 300 km from Addis Ababa, and 265 km from Bahirdar the regional capital.There is one referral hospital, 7 health posts, one governmental Referral Hospital, three health centers and 2 reproductive health based NGO clinics found in the town.These health institutions gave comprehensive abortion health service for Debre Markos town and surrounding population including reproductive health services, abortion and family planning activity, for reproductive age group.

Study population
All women came for abortion care service in Debre Markos health institutions during data collection period.

Sample size determination
The sample size is determined by using single population proportion formula.The utilization of post abortion contraceptive utilization which was conducted in Addis Ababa was 57%.The total sample size of the study is 414 of women seeking abortion care.

Sampling procedure
All Health insitutions who give abortion service were included from public and Ngo in Debre Markos town.The sampling allocation was based on the two months average number of client flow for abortion services in each of the health institution.All Health insitutions who give abortion service were included from public and Ngo in Debre Markos town.The data collection period took three months in the health institutions.The allocated sample for each institution was collected from August to October and the allocated sample divided for each institution for three months.The systematic random sampling method was used to select the study participants.

Dependent variable: Post abortion contraceptive utilization
Independent Variables: Socio-demographic variables: (age, religion, marital status, occupation, educational level, residence); Previous historyvariables: (parity, fertility plan, FP use history, previous abortion history, previous visit of Health insitutions); Present history variables: (post abortion FP counselling , reason for current abortion, method used for abortion, condition of current pregnancy)

Data collection procedures
The questionnaire wasprepared in English and then translated in to Amharic.The data was collected via One BSc nurse.The data was collected after the woman get the abortion care service.

Data quality
A Pre-test was conducted on fifteen participants in Amanuel Health centre district before the actual data was collected.Data collectors and supervisor received a half day training regarding the questionnaire interviewing techniques, purpose of the study, confidentiality and importance of privacy.Confidentiality of the study participants were kept during distribution and data collection periods.The principle investigator checked the collected data for completeness, accuracy, clarity and consistency through the data collocation period and the necessary corrections was made on the field.

Data analysis
The data was entered into Epi-info version 3.5.4package and then exported to SPSS version 20 statistical software packages.Multiple logistic regressions were used to analyse the association between PAFP utilization and various socio-demographic and reproductive health variables.Odds ratio and confidence interval were used to measure the strength of associations.The results were considered statistically significant at P ≤ 0.05.

Ethical consideration
Ethical clearance was obtained from the Ethical review board of the University of Gondar, department of midwifery.Communication with the head of each health institution and department head was made through formal letter obtained from the University of Gondar.After the purpose and the objective of the study had informed, verbal consent was obtained from each study participantand participants' anonymity and confidentiality was kept.Participants were informed about the right not to participate in or withdraw from the study at any stage.

Result Socio-demographic characteristics
A total of four hundred and fourteen (414) women came from abortion care service were interviewed from three health centres making response rate of 100%.The majority of the respondents (41.3%) women's were in the age group 20-24.From those women's participated 358 (86.5%) were orthodox followed by 9.4% 266 (64.1%) were single from the respondents 365 (88.2%) attended formal education from elementary to higher education.Regarding of the occupation 129 (31%) women's was employed (Table 1).

Previous and current obstetric and contraceptive History
The study revealed that among the four Hundred fourteen respondents, More than two third of 298 (72%) respondents were reported that they never give birth and (12.3%) had a history of previous abortion.The majority of the respondents 352 (84.8%) had sources of information for the different family planning services.Majority of the respondents 300 (72.5%) had unwanted, unplanned and unsupported among this 230 (55.6%) were terminate the pregnancy by Tablet/pill.29 (7%) occurrence of pregnancy is while taking contraceptive.The respondents (52.9 %) got post abortion contraceptive counselling in both public and NGO insitutions (Table 2).

Factors associated with post abortion contraceptive utilization
On Bivariate analysis age, marital status, educational status, occupation, type clinic choose, history of previous abortion, post abortion family planning counseling variables had associated with utilization of post abortion contraceptive.Married, secondary school, higher education and post abortion family planning counselling were the only variables that showed significant association on multivariate logistic regression.Respondents received post abortion contraceptive counselling were 4 times more likely to have post abortion contraceptive [AOR: 4.2, 95% CI: (2.55, 6.91)] use as compared to women who did not get the post abortion contraceptive counseling (Table 3).

Discussion
In this study post abortion contraceptive utilization was 59.2%.Which is lower than study done in Brazil (97.4%),Nepal (83%) and Tanzania (89%).The disparity may be in Brazil (27%) respondents had history of previous abortion as compared to this study (12%).However, in Nepal eighty percent respondents have good knowledge and previous practice of contraceptives.The Tanzania study design was cohortand it is different from the current study.The other possible reasons might below counselling, cultural difference, desire to have more children, lack of availability of all contraceptive methods all the time, judgmental approach of health care provider, miss conceptions rumours on family planning methods [8,9,10].However, the study done in Kenya (31%) is lower than this study finding.The probable reason for this could be the study include only the private clinics but our study included public and NGO clinics [11].Similarly post abortion contraceptive utilization was low in Tigray (31%), this could be due to lack of awareness on contraceptive methods and poor set up of service delivery system (family planning service was not integrated with abortion care services in the tigray [12].On the other hand, this finding was consistent with studies conducted in Guraghe (56.5%)And Addis Ababa (57%) the possible reason might be the time closeness, study design and study set up [13,14].Even though the percentage of women who use PAFP is greater than the women who didn't use, we cannot say it is satisfactory because most of the women who came to get abortion care service had unintended/unplanned pregnancy, they all need to use contraception to avoid similar incidents.
Marital status was one factor that associated with PAFP utilization.In contrary, study done in Addis Ababa showed that marital status had not statistically significant association with using post abortion care services utilization.Married women were 44% less like to use post abortion contraceptive compared to unmarried women [14].The possible reason could be Married women involve their partner and there may be partner disapproval.Two-sided decision is not as easy like single and also married women less likely to fear unwanted pregnancy than unmarried.unmarried have strong desire to use contraceptive due to fear of cultural out cast out cast and social discrimination [14,15].Women with Higher and secondary Education have 2 times more likely to utilize post abortion contraceptives as compared to those who are unable to read and write.This study is supported by a study done in Pakistan, Tanzanian and Adissababa.This might be educate individuals can acesss information and the will have more knowledge about reproductive health right.As a result they will pass informed decisions.Furthermore, educated women's are more concerned about their carrier development and they would put their child desire aside [15,16,17].
Respondents who got post abortion contraceptive counselling were 4 times more likely to utilize post abortion contraceptive compared to women who did not get the counseling.The current study in line with study done in Kenya which stated that women received contraceptive counselling were five times more likely to adopt a modern contraceptive method.This clearly indicated that post abortion Family planning counselling will make real difference on post abortion contraceptive utilization [11].

Conclusion
In the current study post abortion contraceptive utilization was low as compared to other study.Being married, secondary and higher education and post abortion family planning counseling had statistically significant association with post abortion contraceptive utilization in Debre Markos health instiutions.In conclusion much should be done by obstetric care providers to strength the post abortion contraceptive counseling and increase contraceptive utilization after abortion.

Table 1 :
Socio-demographic characteristic of women who came for abortion care service in Debre Markos health institutions 2014 (n = 414)

Table 2 :
Previous and current obstetric and contraceptive history of women who came for abortion care service in Debre Markos health insitutions 2014

Table 3 :
Bivariate and multivariate analysis out put on factors associated with post abortion contraceptive utilization among women who came for abortion service in Debre Marcos health institution, 2014 ISSN: 2469-5793