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

Janie Benson; Kathryn Andersen; Joan Healy; Dalia Brahmi

doi:10.9745/GHSP-D-17-00085

Figures & Tables

Tables

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TABLE 1.

Background Characteristics of Abortion Clients Treated in Health Facilities in 10 Countries, by Client Age, 2011–2015

	Age Group (in years)			Total (N=921,918) No. (%)
	≤19 (n=68,265) No. (%)	20–24 (n=282,695) No. (%)	≥25 (n=570,958) No. (%)	Total (N=921,918) No. (%)
Region
Africa	43,741 (64)	86,356 (31)	170,101 (30)	300,198 (33)
Asia	24,524 (36)	196,339 (69)	400,857 (70)	621,720 (67)
Country
India	12,351 (18)	140,765 (50)	227,526 (40)	380,642 (41)
Nigeria	18,639 (27)	45,592 (16)	94,631 (17)	158,862 (18)
Bangladesh	7,959 (12)	35,162 (12)	112,872 (20)	155,993 (17)
Ghana	13,534 (20)	21,990 (8)	42,639 (7)	78,163 (8)
Zambia	10,221 (15)	17,301 (6)	30,981 (5)	58,503 (6)
Nepal	3,352 (5)	14,144 (5)	36,914 (6)	54,410 (6)
Pakistan	697 (1)	5,437 (2)	20,234 (4)	26,368 (3)
Myanmar	165 (<1)	831 (<1)	3,311 (1)	4,307 (<1)
Uganda	844 (1)	1,006 (<1)	1,359 (<1)	3,209 (<1)
Sierra Leone	503 (1)	467 (<1)	491 (<1)	1,461 (<1)
Facility sector^a
Private	18,062 (26)	72,249 (26)	142,644 (25)	232,955 (25)
Public	50,203 (74)	210,446 (74)	428,314 (75)	688,963 (75)
Facility level^b
Primary	30,014 (44)	135,047 (48)	295,074 (52)	460,135 (50)
Secondary	30,239 (44)	115,472 (41)	212,371 (37)	358,082 (39)
Tertiary	8,012 (12)	32,176 (11)	63,513 (11)	103,701 (11)
Ipas-trained provider
Yes	43,373 (64)	165,235 (58)	342,928 (60)	551,536 (60)
No	24,892 (36)	117,460 (42)	228,030 (40)	370,382 (40)
Gestational age, weeks^c
≤12 weeks	59,940 (91)	257,377 (95)	525,011 (95)	842,328 (95)
≥13 weeks	5,657 (9)	12,927 (5)	25,087 (5)	43,671 (5)
Missing	2,668	12,391	20,860	35,919
Type of abortion^c
Induced abortion	35,712 (55)	155,123 (59)	327,872 (60)	518,707 (60)
Postabortion care	29,374 (45)	107,331 (41)	215,776 (40)	352,481 (40)
Missing	3,179	20,241	27,310	50,730
Abortion method^c
MVA/EVA	48,400 (71)	202,512 (73)	413,550 (75)	664,462 (74)
Medical abortion	16,241 (24)	58,114 (21)	113,812 (21)	188,167 (21)
D&C/D&E/Other	3,086 (5)	15,488 (6)	24,530 (4)	43,104 (5)
Missing	538	6,581	19,066	26,185

Abbreviations: D&C, dilation and curettage; D&E, dilation and evacuation; EVA, electric vacuum aspiration; MVA, manual vacuum aspiration.
↵a NGO-sponsored facilities were recategorized as public or private based on country context.
↵b Approximately 6% of cases in India and Uganda were served in facilities that were categorized as “other”; these were recategorized as “primary.”
↵c Missing data were not included in the calculation of percentages.

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TABLE 2.

Contraceptive Uptake at the Time of Abortion Care Among Clients in 10 Countries, by Client Age, 2011–2015

	Age Group (in years)			Total (N=921,918) No. (%)
	≤19 (n=68,265) No. (%)	20–24 (n=282,695) No. (%)	≥25 (n=570,958) No. (%)	Total (N=921,918) No. (%)
Any uptake of postabortion contraception
Yes	48,725 (71)	215,964 (76)	444,503 (78)	709,192 (77)
No	13,948 (20)	39,631 (14)	77,857 (14)	131,436 (14)
Missing	5,592 (8)	27,100 (10)	48,598 (9)	81,290 (9)
Method category
Short-acting	42,104 (86)	186,685 (86)	366,709 (82)	595,498 (84)
Long-acting reversible	6,621 (14)	29,279 (14)	77,794 (18)	113,694 (16)
Method type
Condoms	13,142 (27)	60,007 (28)	92,072 (21)	165,221 (23)
Oral contraceptive pills	16,900 (35)	95,821 (44)	194,932 (44)	307,653 (43)
Injectables	12,062 (25)	30,857 (14)	79,705 (18)	122,624 (17)
Implants	4,471 (9)	7,669 (4)	20,296 (5)	32,436 (5)
Intrauterine device	2,150 (4)	21,610 (10)	57,498 (13)	81,258 (11)

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TABLE 3.

Service Delivery and Clinical Care Characteristics of Clients Receiving Any Postabortion Contraception^a at the Time of Abortion Care in 10 Countries, Bivariate and Adjusted Analysis, 2011–2015

	Accepted Postabortion Contraception (n=709,192) No. (%)	Did Not Accept Postabortion Contraception (n=212,726) No. (%)	Bivariate Analysis (n=921,918)		Adjusted Analysis^b (n=816,880)
	Accepted Postabortion Contraception (n=709,192) No. (%)		OR	95% CI	AOR	95% CI
Facility sector
Private	187,124 (26)	45,831 (22)	Reference		Reference
Public	522,068 (74)	166,895 (78)	0.77***	(0.76, 0.78)	0.88	(0.71, 1.10)
Ipas-trained provider
Yes	449,492 (63)	102,044 (48)	1.88***	(1.86, 1.90)	1.37***	(1.20, 1.57)
No	259,700 (37)	110,682 (52)	Reference		Reference
Client age
≤19	48,725 (7)	19,540 (9)	0.71***	(0.70, 0.72)	0.87**	(0.79, 0.96)
20–24	215,964 (30)	66,731 (31)	0.92***	(0.91, 0.93)	0.96	(0.92, 1.01)
≥25	444,503 (63)	126,455 (59)	Reference		Reference
Gestational age, weeks^c
≤12	663,391 (96)	178,937 (91)	Reference		Reference
≥13	25,777 (4)	17,894 (9)	0.39***	(0.38, 0.40)	0.73***	(0.65, 0.81)
Missing	20,024	15,895
Type of abortion^c
Induced abortion	438,742 (65)	79,965 (41)	Reference		Reference
PAC	238,504 (35)	113,977 (59)	0.38***	(0.38, 0.39)	0.55***	(0.45, 0.67)
Other/missing	31,946	18,784
Abortion method^c
MVA/EVA	514,163 (75)	150,299 (72)	Reference		Reference
Medical abortion	151,801 (22)	36,366 (17)	1.22***	(1.20, 1.24)	1.20*	(1.01, 1.43)
D&C/D&E/other	20,645 (3)	22,459 (11)	0.27***	(0.26, 0.27)	0.34***	(0.27, 0.42)
Other/missing	22,583	3,602

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; D&C, dilation and curettage; D&E, dilation and evacuation; EVA, electric vacuum aspiration; MVA, manual vacuum aspiration; OR, odds ratio; PAC, postabortion care.
↵* P<.05; ** P<.01; *** P<.001.
↵a Sterilization excluded.
↵b Adjusted odds ratios control for country variation and cluster on facility (using non-missing data only).
↵c Other/missing data were not included in the calculation of percentages.

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TABLE 4.

Service Delivery and Clinical Care Characteristics of Clients Receiving a LARC at the Time of Abortion Care in 10 Countries, Bivariate and Adjusted Analysis, 2011–2015

	Accepted LARC (n=113,694) No. (%)	Did Not Accept LARC (n=595,498) No. (%)	Bivariate Analysis (n=709,192)		Adjusted Analysis^a (n=638,666)
	Accepted LARC (n=113,694) No. (%)	Did Not Accept LARC (n=595,498) No. (%)	OR	95% CI	AOR	95% CI
Facility sector
Private	36,785 (32)	150,339 (25)	Reference		Reference
Public	76,909 (68)	445,159 (75)	0.71^***	(0.70, 0.72)	1.42^**	(1.16, 1.74)
Ipas-trained provider
Yes	72,856 (64)	376,636 (63)	1.04^***	(1.02, 1.05)	0.97	(0.85, 1.11)
No	40,838 (36)	218,862 (37)	Reference		Reference
Client age, years
≤19	6,621 (6)	42,104 (7)	0.74^***	(0.72, 0.76)	0.59^***	(0.52, 0.67)
20–24	29,279 (26)	186,685 (31)	0.74^***	(0.73, 0.75)	0.68^***	(0.63, 0.73)
≥25	77,794 (68)	366,709 (62)	Reference		Reference
Gestational age, weeks^b
≤12	107,155 (96)	556,236 (96)	Reference		Reference
≥13	3,899 (4)	21,878 (4)	0.93^***	(0.89, 0.96)	1.04	(0.93, 1.27)
Missing	2,640	17,384
Type of abortion^b
Induced abortion	78,926 (72)	359,816 (63)	Reference		Reference
PAC	30,918 (28)	207,586 (37)	0.68^***	(0.67, 0.69)	0.44^***	(0.38, 0.50)
Other/missing	3,850	28,096
Abortion method^b
MVA/EVA	83,998 (80)	430,165 (74)	Reference		Reference
Medical abortion	19,382 (18)	132,419 (23)	0.75^***	(0.74, 0.76)	0.52^***	(0.44, 0.63)
D&C/D&E/other	2,204 (2)	18,441 (3)	0.61^***	(0.59, 0.64)	0.86	(0.68, 1.08)
Missing	8,110	14,473

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; D&C, dilation and curettage; D&E, dilation and evacuation; EVA, electric vacuum aspiration; LARC, long-acting reversible contraceptive; MVA, manual vacuum aspiration; OR, odds ratio; PAC, postabortion care.
↵* P<.05; ** P<.01; *** P<.001.
↵a Adjusted odds ratios control for country variation and cluster on facility (using non-missing data only).
↵b Other/missing data were not included in the calculation of percentages.