Open Access Open Access  Restricted Access Subscription or Fee Access

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana

Caesar Agula, Elizabeth G. Henry, Patrick O. Asuming, Charles Agyei-Asabere, Mawuli Kushitor, Edmund W. Kanmiki, Iqbal Shah, Ayaga A. Bawah

Abstract

This paper examined women’s pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion. (Afr J Reprod Health 2021; 25[6]: 20-31).

Full Text:

PDF

References

Bearak J, Popinchalk A, Ganatra B, Moller AB, Tunçalp Ö, Beavin C, Kwok L, Alkema L. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. The Lancet Global Health 2020;8(9):e1152-61.

Singh S, Remez L, Sedgh G, Kwok L, Onda T. Abortion worldwide 2017: uneven progress and unequal access. Guttmacher Institute, New York. 2018.

Guttmacher Institute. Abortion in Ghana. 2013. https://www.guttmacher.org/fact-sheet/abortion-ghana. Accessed 25 April 2019.

Aniteye P, Mayhew SH. Globalisation and transitions in abortion care in Ghana. BMC Health Services Research 2019;19(1): 185.

Boah M, Bordotsiah S, Kuurdong S. Predictors of unsafe induced abortion among women in Ghana. Journal of Pregnancy 2019. https://doi.org/10.1155/2019/9253650.

Agula C, Henry EG, Asuming PO, Agyei-Asabere C, Kushitor M, Canning D, Shah I, Bawah AA. Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana. BMC Women's Health. 2021; 21(1):1-2.

Rominski SD, Lori JR. Abortion care in Ghana: A critical review of the literature. African Journal of Reproductive Health 2014;18(3): 17-35.

Asamoah BO, Moussa KM, Stafström M, Musinguzi G. Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study. BMC Public Health 2011;11(1): 159.

Johnson BR, Ndhlovu S, Farr SL, Chipato T. Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception. Studies in family planning 2002;33(2):195-202.

Asrat M, Bekele D, Rominski SD. Post-abortion contraceptive acceptance and choice determinants among women receiving abortion care at Saint Paul’s hospital, Addis Ababa, Ethiopia. Ethiopian Journal of Reproductive Health 2018;10(1): 14-14.

Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, Griffin R.. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Global Public Health 2018;13(1): 35-50.

Gemzell-Danielsson K, Kallner HK, Faúndes A. Contraception following abortion and the treatment of incomplete abortion. International Journal of Gynecology and Obstetrics 2014;126: S52-S55.

Moges Y, Hailu T, Dimtsu B, Yohannes Z, Kelkay B. Factors associated with uptake of post-abortion family planning in Shire town, Tigray, Ethiopia. BMC Research Notes 2018; 11(1): 928.

Huber D, Curtis C, Irani L, Pappa S, Arrington L. Postabortion care: 20 years of strong evidence on emergency treatment, family planning, and other programming components. Global Health: Science and Practice 2016;4(3): 481-494.

International Federation of Gynecology and obstetrics (FIGO), International Confederation of Midwives (ICM), International Council of Nurses (ICN), United States Agency for International Development (USAID), White Ribbon Alliance (WRA), Department for International Development (DFID), Bill and Melinda Gates Foundation. Post abortion family planning: a key component of post abortion care: consensus statement. 2013.

Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF. Ghana maternal health survey 2017: key indicators report. Accra, Ghana: Ghana Statistical Service. 2018.

Opoku BK. Contraceptive preferences of post-abortion patients in Ghana. 2012.

Rominski SD, Morhe ES, Lori J. Post-abortion contraception choices of women in Ghana: a one-year review. Global Public Health 2015;10(3): 345-353.

Ghana Health Service (GHS). Prevention and Management of Unsafe Abortion: Comprehensive Abortion Care Services Standards and Protocols. 2012.

Kwasi P. Effects Of Rapid Urbanisation On Urban Livelihoods In Ghana. Modern Ghana. 2014.

Hove M, Ngwerume ET, Muchemwa C. The urban crisis in Sub-Saharan Africa: A threat to human security and sustainable development. 2013.

Ezeh AC, Kodzi I, Emina J. Reaching the urban poor with family planning services. Studies in Family Planning 2010;41(2): 109-116.

Henry EG, Agula C, Asuming PO, Kaur N, Kruk M, Shah I, Bawah AA. Conducting a household survey in poor urban settlements in Ghana: challenges and strategic adaptations for fieldwork. Journal of Global Health Science. 2021 Jun 22;3(1).

Schreiber CA, Sober S, Ratcliffe S, Creinin MD. Ovulation resumption after medical abortion with mifepristone and misoprostol. Contraception 2011;84(3): 230-233.

Boyd Jr, EF, Holmstrom EG. Ovulation following therapeutic abortion. American Journal of Obstetrics and Gynecology 1972;113(4): 469-473.

Boesen, H.C., RØrbye, C., NØrgaard, M. and Nilas, L., 2004. Sexual behavior during the first eight weeks after legal termination of pregnancy. Acta obstetricia et gynecologica Scandinavica, 83(12), pp.1189-1192.

Appiah-Agyekum NN. Medical abortions among university students in Ghana: implications for reproductive health education and management. International Journal of Women's Health 2018; 10: 515.

Aniteye P, O’Brien B, Mayhew SH. Stigmatized by association: challenges for abortion service providers in Ghana. BMC Health Services Research 2016; 16(1): 486.

Mekuria A, Gutema H, Wondiye H, Abera M. Postabortion contraceptive use in Bahir Dar, Ethiopia: a cross sectional study. Contraception and Reproductive Medicine 2019;4(1), 19.

Refbacks

  • There are currently no refbacks.