Correlates of contraceptive use 4 months postabortion: findings from a prospective study in Bangladesh

Abstract Objectives Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels. Study design This prospective study assessed correlates of contraceptive use 4 months p...

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Bibliographic Details
Published in:Contraception (Stoneham) 2017-03, Vol.95 (3), p.279-287
Main Authors: Pearson, Erin, Biswas, Kamal Kanti, Andersen, Kathryn L, Moreau, Caroline, Chowdhury, Rezwana, Sultana, Sharmin, Shahidullah, S.M, Surkan, Pamela J, Decker, Michele R
Format: Article
Language:English
Subjects:
Abortion
Abortion, Induced
Adult
Aftercare
Bangladesh
Contraception - methods
Contraception Behavior - statistics & numerical data
Counseling
Decision Making
Family Planning Services
Female
Humans
Intimate Partner Violence
Logistic Models
Multivariate Analysis
Obstetrics and Gynecology
Postabortion contraception
Pregnancy
Prospective Studies
Time Factors
Vacuum Curettage
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Summary:Abstract Objectives Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels. Study design This prospective study assessed correlates of contraceptive use 4 months postabortion and timing of initiation using a facility-based sample of 398 abortion clients who selected pills, condoms, injectables or no method immediately following the procedure. We measured potential correlates immediately following abortion, inclusive of spontaneous or induced abortion, and assessed contraceptive use outcomes 4 months postabortion. Multivariable logistic regression models identified correlates at each level. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling. Results Reported contraceptive use 4 months postabortion was high (85.4%). Contraceptive use at the index pregnancy (resulting in abortion) was the primary correlate of contraceptive use 4 months postabortion (adjusted odds ratio=2.9; 95% confidence interval: 1.5–5.9). Delayed contraceptive initiation was more common among women who reported past year IPV (36.8% vs. 19.5%; p=.03) particularly with spousal accompaniment for abortion, those in relationships with discordant fertility intentions (44.4% vs. 21.9%; p=.04) and those receiving medication abortion (56.7%) or dilation and curettage (57.1%), compared to manual vacuum aspiration (12.6%; p
ISSN:0010-7824
1879-0518
DOI:10.1016/j.contraception.2016.10.002