Women more open to post abortion contraceptive methods: study

contraceptive femaleWomen are more open to accepting post abortion contraceptive methods following an induced abortion or post abortion care, a study has shown.

This study “Associations Between Abortion Services and Acceptance of Post abortion Contraception in Six Indian States’’ highlights the prevalence and attributes of post abortion contraceptive acceptance from 2,456 health facilities in six states, among 292,508 women who received abortion care services from July 2011 through June 2014.

Eighty-one percent of the women accepted modern contraception immediately after abortion: 53 percent prefer short-term methods like oral contraceptive pills, condoms and injectables, 11 percent intrauterine devices, and 16 percent sterilization, according to the study authored by Sushanta K. Banerjee, Sumit Gulati, Kathryn L. Andersen, Valerie Acre, Janardan Warvadekar, and Deepa Navin. Women receiving induced abortions or post abortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes.

Further, post abortion contraceptive acceptance increased from 68 percent in the first month of the intervention to 88 percent towards the end of the intervention period, suggesting that program improvements and post-training provider support visits to health facilities likely helped integrate post abortion contraception into comprehensive abortion care.

Says Dr. Sushanta Banerjee, Senior Advisor, Research and Evaluation, Ipas Development Foundation: “Post abortion contraception is an integral component of comprehensive abortion care services. It needs to be seen as a part of the package of services for women seeking safe abortion services rather than a standalone intervention. It provides an opportunity for a CAC trained provider and the woman to discuss her ability to effectively manage her reproductive choices. It also offers a unique opportunity for counseling on management of future pregnancies and prevention of unplanned pregnancies as per her health and convenience.’’

Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first-trimester services, received induced abortion, and attended primary-level health facilities. Comprehensive service-delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy, the study says.

In India, Ipas Development Foundation (IDF) collaborates with state health systems to reduce maternal mortality and morbidity resulting from unsafe abortion by implementing a comprehensive abortion care model to improve access to safe abortion services at all levels of health facilities (primary, secondary, and tertiary) in rural and urban areas. The comprehensive abortion care (CAC) model is integrated into the health system, and interventions are characterized by training of providers, facility preparation, post-training provider follow-up and mentoring, monitoring of performance data, community-level education, and advocacy.

This study was conducted in six Indian states where IDF collaborated with state governments between July 2011 and June 2014. These are Maharashtra from the western region, Madhya Pradesh and Uttarakhand from the central region, Rajasthan from the northern region, and Bihar and Jharkhand from the eastern region. These states contain 33 percent of the country’s population and account for an estimated 27 percent of the total number of annual induced abortions.

During the three-year study period, 292,508 women received abortion services from 2,456 IDF supported health facilities in six states. As many as 37 percent women were aged 24 years or younger, almost two-thirds of the women (65 percent) requested induced abortion services and the remaining 35 percent received treatment for incomplete abortion or post abortion complications. A large majority received abortion services in the first trimester (91 percent) and only 2 percent in the second trimester. Gestational age was missing for 7 percent of cases, primarily among women who presented with incomplete abortion.

Women predominantly underwent surgical abortion (83 percent), including manual/electric vacuum aspiration (MVA/EVA) (76 percent) or dilation and curettage (7 percent), while 15 percent received medical abortion (MA) using mifepristone and misoprostol. Because the IDF intervention was primarily focused on the public health system, the majority of abortion cases were recorded at public facilities (82 percent).

“Woman centered CAC training is much more than training doctors on conducting the abortion procedure. It also includes training on contraceptive technologies, counselling, infection prevention, reproductive rights, management of complications etc. post abortion contraception is a critical component of safe abortion services. Ensuring availability of counselling services and access to contraceptive choices increases the chances of women accepting post abortion contraception services and thereby reducing future requirements of abortion services. If the woman seeks abortion because she could not get contraception, we have failed her. If she leaves without post abortion contraception, we have failed her again,’’ says Dr Bannerjee.

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