Journal of Women's Health Care

Journal of Women's Health Care
Open Access

ISSN: 2167-0420

Research Article - (2022)Volume 11, Issue 11

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Factors that influence post-abortion family planning utilization.in the Harari region, Harar, Ethiopia 2021

Arif Hussen Jamie1* and Elias Sertse Gebremedhin2
 
*Correspondence: Arif Hussen Jamie, Department of Pediatrics Nursing, Harar Health Science College, Ethiopia, Email:

Author info »

Abstract

Introduction: Abortion is expulsion of a fetus from the uterus before it has reached the stage of viability, usually about the 20th week of gestation. It may occur spontaneously or induced. Methods and materials: Institutional based cross-sectional study design was conducted from September 1st - November 27th, 2021. All reproductive aged women who came for abortion care service formed the sampling frame. The Sample size was 385.Purposive Sampling Techniques was used to select the participants. IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp) was used to assess the association between the dependent and independent variables.

Result: The overall Post-abortion contraception acceptance among the study participants in this study was 70.39 %. Among the rest who decline the care majority of them gave a reason for not using, fear of side effect followed by wanted child. This study indicated that the odds of being use post abortion family planning were 4 times higher among younger than old age (AOR=4.14; CI 95% 1.40–7.85; P=0.013). The odds of post-abortion family planning utilization was 3 times higher among who attended secondary educational level than those who is illiterate [AOR= 2.93 (95%CI: 1.57, 10.01)]. Client whose abortion procedure was performed using a MVA method were 4 more likely to use post abortion family planning than those whose abortion procedure was done using both method (AOR=4.13, 95% CI: 2.27,6.98, P=0.001).

Conclusion: Post-abortion family planning utilization is low in Jugal hospital, Harar which is 70.39 %. Age, educational status and type of abortion procedure were predictors of post-abortion family planning service utilization. The findings suggest that it is preferable to approach young ladies by creating a connection with educational institutions and strengthening family planning health education. Longer-term follow-up research with greater qualitative is essential to better understand reasons for objections to Post abortion family planning.

Keywords

Post-abortion; Contraceptive use; Associated factor; Cross sectional study; Ethiopia

Introduction

Abortion is the removal of a fetus from the uterus before it reaches viability, usually around the 20th week of pregnancy. It can happen naturally or be provoked [1]. According to the World Health Organization (WHO), around 800,000 women will die each year as a result of abortion-related complications, accounting for 19.6% of all maternal fatalities [2], whereas 6.9 million women in developing countries are at risk of unsafe abortion complications [3]. Ethiopia has one of the highest maternal mortality rates in the world, with a rate of 412 per 100,000 live births [4]. More over a third of pregnancies in Ethiopia are unintended, with an estimated 620,300 induced abortions done each year. Around half of them worked outside of health-care facilities [5]. Family planning is an effective method of preventing abortion, as it prevents 32 percent of maternal deaths [6]. PAFP (post-abortion family planning) is the practice of beginning family planning measures right after an abortion [7]. It is a component of abortion care that increases contraceptive use and reduces unintended pregnancies and risky abortion [8]. WHO guidelines recommend waiting at least six months for her body to regain its strength and organize itself for a safe pregnancy [9].

According to studies conducted in underdeveloped countries, the use of post-abortion family planning ranged from 15.5 to 90.6 percent [10-18]. Residence, higher mother education level, occupation, spontaneous abortion, getting post abortion family planning counseling, strong knowledge of family planning, and availability of family planning were all linked factors in several Ethiopian studies [13,19,20]. In the Hararri region, there are few studies that show the prevalence and associated aspects of postabortion family planning services. The goal of this study was to find out how common post-abortion family planning services are in the Hararri region, as well as the factors that influence them.

Methods and Materials

Design, area, and timeframe of the research

At Jugal hospital in Harar town, 525 kilometers east of Addis Ababa, an institutional-based cross-sectional study was conducted. The research took place from September 1st to November 27th, 2021.

Population and sampling technique

During the study period, all reproductive-aged women who sought abortion care at Jugal hospital in Harar town formed the sampling frame. The Sample size was calculated by using single population proportion formula, considering P value 64.8 percent which found in similar study done in Northwest Ethiopia and after adding 10 percent non-respondent rate, the sample size was 385. Purposive Sampling Techniques which all clients who sought abortion services were selected consecutively till sample is fulfilled was utilized [21].

Data collection

Data was gathered using a standardized questionnaire that was created after a thorough examination of the literature. The questionnaire was written in English first, and then translated into the local tongue. Pretesting was carried out by 5% of the sample size in Amir Nur health center, which was not included in the study, prior to the main trial. The questionnaire was adjusted as needed based on the results of the pretest. After their clinical visit was done and while ready to leave the hospital, clients were interviewed by trained 4 BSc. Midwives. Socio-demographic variables, reproductive performance, previous abortion history, prior knowledge and use of any contraceptive techniques, and interest in future fertility were all included in the inquiries.

Data processing and analysis

IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp) was used to entering, cleaning and analyzing. First descriptive statistics of percentages and frequency distribution using tables was carried out to explore the socio demographic characteristics. Logistic regression was used to assess the association between the dependent and independent variables. All factors with P<0.05 in bi-variate logistic regression analysis were further entered into multi-variate model to control confounding effects. Adjusted odds ratio (OR) with 95% confidence interval (CI) and P values was calculated. P< 0.05 considered statistically significant.

Ethical considerations

Ethical approval for this study was obtained from Harar Health Science College Ethics and Research Committee (Ref. Number HHSC-96/2021). Permissions from appropriate authority were obtained to conduct the study and informed written consent was taken from all study participants.

Result

Socio-demographic characteristics

In this study 385 mothers participated, among them greater than one third (41.30%) of them were in age category of 25-39. Greater than two third (69.61%) of them were urban residents. Greater than half (58.18%, 56.36%) of them were not married and attends primary school respectively. Majority of them were un- employed, see Table 1.

Variable Category Frequency Percent
Age in years Less than 18 12 3.12
19–24 118 30.65
25–30 159 41.30
31–35 62 16.10
≥36 34 8.83
Residence Urban 268 69.61
Rural 117 30.39
Current marital status Married 161 41.82
Not married 224 58.18
Educational status illiterate 97 25.19
Primary school 217 56.36
Secondary school 63 16.36
Higher education 8 2.08
Occupation Employed 113 29.35
Not Employed 272 70.65

Table 1. Socio-demographic characteristic of the respondents.

Characteristics related with reproductive health

Among a total participants, slightly greater than quarter (26.49%) of them used family planning ever, slightly greater than half (51%)of them gave birth, quarter 25%) of them had previous abortion history. four fifth (80%) of clients had induced abortion and for majority abortion was done and/or completed by nurses or midwives by using MVA methods. All of the study participants had received counseling on family planning Table 2.

Variable Category Frequency Percent
Have you ever been counseled by HP health about FP Yes 187 48.57
No 198 51.43
Have you ever used FP? Yes 102 26.49
No 283 73.51
Have you ever given birth? Yes 199 51.69
No 186 48.31
Have you ever had a history of abortion Yes 98 25.45
No 287 74.55
Have you ever  receive abortion care service Yes 98 25.45
No 287 74.55
Was  this pregnancy planned Yes 77 20.00
No 308 80.00
Type of abortion Spontaneous 77 20.00
Induced 308 80.00
Type of abortion procedure Medication 95 24.68
MVA 187 48.57
Both 103 26.75
Sex of service provider Male 161 41.82
Female 224 58.18
Profession of service provider Nurse / Midwifery 296 76.88
General practitioner 89 23.12
Have you hear  about PAFP method Yes 359 93.25
No 26 6.75
Source of information Friends 41 10.65
Husband 10 2.60
Health Provider 299 77.66
Mass media 35 9.09
Do you get Post-abortion counseling Yes 385 100.00
No 0 0.00
Have you willingness to start PAFP Yes 271 70.39
No 114 29.61
If No ,Reasons for refusal fear of side effect 34 29.82
Infrequent sex 11 9.65
Partner opposition 15 13.16
Inconvenient to use 11 9.65
Want of children 31 27.19
Religious opposition 12 10.53
What is your method of choice Injectable 39 14.39
Implant 143 52.77
IUCD 72 26.57
Pills 17 6.27

Table 2. Characteristics related with reproductive health.

Magnitudes of post abortion family planning utilization

The overall Post-abortion contraception acceptance among the study participants in this study was 70.39 %. Among the rest who decline the care majority of them gave a Reason for Not Using, fear of side effect followed by wanted child, see Table 2.

Factors of post-abortion family planning utilization

Variables considered for multivariate logistic regression analysis were those with a p-value<0.5 in bi-variate analysis and those significantly associated with bi-variable analysis were; age, current marital status, educational status, past FP usage, type of pregnancy (planned) and type of abortion procedure. After controlling confounding variables using multiple logistic regressions; age, educational status and type of abortion procedure were significantly associated with post-abortion family planning utilization.

This study indicated that the odds of being use post abortion family planning were 4 times higher among younger than old age (AOR=4.14; CI 95% 1.40–7.85; P=0.013). The odds of postabortion family planning utilization was 3 times higher among who attended secondary educational level than those who is illiterate [AOR=2.93 (95%CI:1.57, 10.01)]. Client whose abortion procedure was performed using a MVA method were 4 more likely to use post abortion family planning than those whose abortion procedure was done using both method (AOR=4.13, 95% CI: 2.27,6.98, P=0.001), see Table 3

Variables Injury   COR With 95% CI AOR With 95% CI P value
Age  ≤35 2.03(1.619,6.108)* 4.14 (1.40,7.85)** 0.013
≥36 1 1  
Current marital status Married 1 1  
Un married 4.14 (1.40,7.85)* 1.66 (0.57.8.01) 0.061
Educational  status Un able to write & read 1 1  
Primary school 2.02(1.25,6.18)* 1.03 (0.27,5.41) 0.092
Secondary school 2.11(1.59,9.84)* 2.93 (1.57.10.01)** 0.020
Higher education 1.03 (0.57.19.01) 2.93 (0.27.6.48) 0.121
Past FP usage Yes 3.54(1.19,7.18)* 2.11 (0.07,11.11) 0.171
No  1 1  
Pregnancy Planned 1 1  
Un planed 4.53(1.09,9.66)* 2.03 (0.27.9.19) 0.065
Abortion procedure Medication 3.32(1.69,13.08)* 2.93 (0.29.16.98) 0.071
MVA 2.21(1.04,11.17)* 4.13 (2.27,6.98)** 0.001
Both 1 1  

Table 3. Bivariate and Multivariate analysis.

Discussion

This study showed that the prevalence post abortion family planning acceptance was 70.39 %. Which is higher than studies done in Eretria, 26.4 %, Kenya 60.9%, Burkina Faso 65.7%, Bahir dar, Ethiopia 61%. However, it is lower than a study done in Asia and Sub-Saharan Africa (SSA) 77%, and another study done in Bahir Dar, Ethiopia 78.5% and India 81% [22-28]. This difference might be due methodological difference, like study setting, design, period, socio demographic and economic characteristics.

Regarding the type of post-abortion family planning methods utilized, the most commonly utilized post-abortion family planning was Implant 143(52.77%), IUCD 72(26.57%), Injectable 39(14.3%), pills 17(6.27%). Whereas the most commonly utilized post-abortion family planning in study conducted in Brazil, Pakistan, India, and Nepal was injectable 33.23%, implants 24.71%, oral contraceptive pills 23.42%, intrauterine devices 9.12%, and condom 7.43% [29-32]. This difference might be due to study period; because now a day’s Ethiopian government initiate long acting reversible family planning method due to this reason in this study mostly used family planning was long acting methods.

This study showed that there is an association between Postabortion contraception acceptance and age. In this study age group ≤ 35 years were 4 times more likely to accept post-abortion family planning as compared with those aged ≥36 years, this is similar with studies done in Burayu town, Oromia, Ethiopia and Kenya [33,34]. The possible reasons may be that young women have a greater probability of having unintended pregnancy which will end up with abortion.

In this study Women with Higher and secondary Education have 3 times more likely to utilize post abortion contraceptives as compared to those who are unable to read and write. This study is similar with studies done in Pakistan, Tanzanian and Adis ababa. [35-37].

In this study the odds of post-abortion family planning utilization among women whose abortion procedure managed by MVA was 4 times higher compared to women managed by both medication & MVA. This finding is in line with the previous studies conducted in England and Wales [38] and Pakistan [39].

Limitations

Since the study was cross sectional and therefore temporal relationship is not known and another the stud only comprises only one public government hospital and not represent all health professionals in the Harar, Ethiopia.

Conclusion and Recommendation

Post-abortion family planning utilization in Jugal hospital, Harar was low which 70.39 %. Age, educational status and type of abortion procedure were predictors of post-abortion family planning service utilization. The findings suggest that it is preferable to approach young ladies by creating a connection with educational institutions and strengthening family planning health education. Longer-term follow-up research with greater qualitative is essential to better understand reasons for objections to PAFP.

Conflict of Interest

The authors declare no conflict of interest.

Acknowledgment

The authors gratefully acknowledge the study participants for their time and voluntary participation.

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Author Info

Arif Hussen Jamie1* and Elias Sertse Gebremedhin2
 
1Department of Pediatrics Nursing, Harar Health Science College, Ethiopia
2Department of Pediatrics Nursing, Hiwot fana specialized hospital, Harar, Ethiopia
 

Citation: Jamie AH, Gebremedhin ES (2022) Factors that Influence Post-Abortion Family Planning Utilization in the Harari region, Harar, Ethiopia 2021. J Women's Health Care 11(11):614.

Received: 03-Nov-2022, Manuscript No. JWH-22-19932; Editor assigned: 04-Nov-2022, Pre QC No. JWH-22-19932 (PQ); Reviewed: 18-Nov-2022, QC No. JWH-22-19932; Published: 26-Nov-2022 , DOI: 10.35248/2167-0420.22.11.614

Copyright: © 2022 Jamie AH, 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

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