Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study

Reproductive Health

Amy Ong Tsui⁵  Luiza Akiko Komura Hoga²  Elizabeth Fujimori⁴  Funmilola OlaOlorun³  Ana Luiza Vilela Borges¹ 

[1] School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 419, São Paulo, cep 05403-000, Brazil;Department of Maternal, Child and Psychiatric Care, University of São Paulo School of Nursing, São Paulo, Brazil;Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria;Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil;Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

关键词: Abortion;    Pregnancy intention;    Family planning;    Post-abortion;    Sexual and reproductive health;   

Others  :  1231216
DOI  :  10.1186/s12978-015-0087-7

 received in 2014-12-05, accepted in 2015-10-08,  发布年份 2015

【 摘 要 】

Background

Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive.

Methods

This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion.

Results

Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13–3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25–34 vs. 15–24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use.

Conclusions

In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women’s pregnancy intention following an abortion is recommended, as well as a wide range of contraceptive methods, including long-acting reversible methods, even in restrictive abortion laws contexts.

【 授权许可】

   
2015 Borges et al.

【 图 表 】

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【 参考文献 】

• [1]Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A. Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet. 2013; 379:625-632.
• [2]Victora CS, Aquino EML, Leal MC, Monteiro CA, Barros FA, Szwarcwald CL. Maternal and child health in Brazil: progress and challenges. Lancet. 2011; 377:1863-1876.
• [3]Diniz D, Medeiros M. Abortion in Brazil: a household survey using the ballot box technique. Ciencia Saúde Coletiva. 2010; 15:959-966.
• [4]Monteiro MFG, Adesse L. Estimativas de aborto induzido no Brasil e grandes regiões (1992–2005). Encontro Nacional de Estudos Populacionais, Caxambu; 2006.
• [5]Nations U. Dept. of Public Information: The Millennium Development Goals: Report 2005. United Nations Publications, New York; 2005.
• [6]Melkamu Y, Enquselassie F, Ali A, Gebresilassie H, Yusuf L. Assessment of quality of post abortion care in government hospitals in Addis Ababa. Ethiopia Ethiop Med J. 2005; 43(3):137-149.
• [7]Banerjee SK, Andersen KL, Warvadekar J. Pathways and consequences of unsafe abortion: a comparison among women with complications after induced and spontaneous abortions in Madhya Pradesh, India. Int J Gynaecol Obstet. 2012; 118(2):S113-S120.
• [8]Diniz SG, d’Oliveira AFPL, Lansky S. Equity and women's health services for contraception, abortion and childbirth in Brazil. Rep Health Matters. 2012; 20(40):94-101.
• [9]International Federation of Gynecology and Obstetrics. Consensus Statement – Family Planning: a Key Component of Post Abortion Care. FIGO, London; 2009.
• [10]Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 (5 ed). World Health Organization, Geneva; 2007.
• [11]Atenção Humanizada ao Abortamento. Norma Técnica. Série Direitos Sexuais e Direitos Reprodutivos – Caderno no 4. 2a edição. Ministério da Saúde, Brasília; 2011.
• [12]Corbett MR, Turner KL. Essential elements of postabortion care: origins, evolution and future directions. Int Fam Plan Perspect. 2003; 29(3):106-111.
• [13]Pheterson G, Azize Y. Abortion practice in the northeast Caribbean: “Just write down stomach pain”. Reprod Health Matters. 2005; 13(26):44-53.
• [14]Arambepola C, Rajapaksa LC, Galwaduge C. Usual hospital care versus post-abortion care for women with unsafe abortion: a case control study from Sri Lanka. BMC Health Serv Res. 2014; 14:470. BioMed Central Full Text
• [15]Shellenberg KM, Moore AM, Bankole A, Juarez F, Omideyi AK, Palomino N et al.. Social stigma and disclosure about induced abortion: results from an exploratory study. Glob Public Health. 2011; 6 Suppl 1:S111-S125.
• [16]Shepard BL, Becerra LC. Abortion policies and practices in Chile: ambiguities and dilemmas. Reprod Health Matters. 2007; 15(30):202-210.
• [17]Aquino EML, Menezes G, Barreto-de-Araújo TV, Alves MT, Alves SV, Almeida MCC et al.. Quality of abortion care in the Unified Health System of Northeastern Brazil: what do women say? Ciência & Saúde Coletiva. 2012; 17(7):1765-1776.
• [18]Paim P, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011; 377(9779):1778-1797.
• [19]Report of a WHO Technical Consultation on Birth Spacing. World Health Organization, Geneva; 2006.
• [20]Conde-Agudelo A, Belizán IM, Breman R, Brockman SC, Rosas-Bermudez A. Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int J Gyn Obst. 2005; 89:s34-s40.
• [21]Rasch V, Yambesi F, Massawe S. Medium and long-term adherence to postabortion contraception among women having experienced unsafe abortion in Dar es Salaam, Tanzania. BMC Pregnancy Childbirth. 2008; 31(8):32. BioMed Central Full Text
• [22]McDougall J, Fetters T, Clark KA, Rathavy T. Determinants of contraceptive acceptance among Cambodian abortion patients. Stud Fam Plann. 2009; 40(2):123-132.
• [23]Cohen SA. Facts and consequences: legality, incidence and safety of abortion worldwide. Guttmacher Pol Rev. 2009; 12(4):1-6.
• [24]Gemzell-Danielsson K, Kallner HK, Faúndes A. Contraception following abortion and the treatment of incomplete abortion. Int J Gynaecol Obstet. 2014; 126 Suppl. 1:S52-S55.
• [25]Tesfaye G, Oljira L. Post abortion care quality status in health facilities of Guraghe zone, Ethiopia. Reprod Health. 2013; 10:35. BioMed Central Full Text
• [26]Moura ERF, Silva RM, Galvão RT. Family planning services under the Family Health Program in Brazil. Cad Saúde Pública. 2007; 23(4):961-970.
• [27]Heilborn ML, Portella AP, Brandão ER, Cabral CS. Contraception and family planning services as viewed by users of three clinics in the Unified National Health System, Rio de Janeiro State, Brazil. Cad Saúde Pública. 2009; 25(2):S269-S278.
• [28]Osis MJ, Faúndes A, Makuch MY, Mello MB, Sousa MS, Araújo MJO. Family planning in Brazil today: an analysis of recent research. Cad Saúde Pública. 2006; 22(11):2481-2490.
• [29]Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher. Relatório. Ministério da Saúde, Brasília; 2008.
• [30]Borges ALV, Bigio FM, Hoga LAK, Fujimori E, Barbosa LR. Pregnancy planning: prevalence and associated aspects. Rev Esc Enferm USP. 2011; 45(2):1679-1684.
• [31]Barrett G, Smith SC, Wellings K. Conceptualisation, development and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health. 2004; 58:426-433.
• [32]Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42:121-130.
• [33]Ceylan A, Ertem M, Saka G, Akdeniz N. Post abortion family planning counseling as a tool to increase contraception use. BMC Public Health. 2009; 9:20. BioMed Central Full Text
• [34]Sedgh G, Singh S, Shah IH, Åhman E, Henshaw SK, Bankole A. Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet. 2012; 379:625-632.
• [35]Billings DL, Benson J. Postabortion care in Latin America: policy and service recommendations from a decade of operations research. Health Policy Plan. 2005; 20(3):158-166.
• [36]Schunmann C, Glasier A. Specialist contraceptive counseling and provision after termination of pregnancy improves uptake of long-acting methods but does not prevent repeat abortion: a randomized trial. Hum Reprod. 2006; 21(9):2296-2303.
• [37]Nobili MP, Piergrossi L, Brusati V, Moja EA. The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Educ Couns. 2007; 65:361-368.
• [38]Cameron IT, Baird DT. The return to ovulation following early abortion: a comparison between vacuum aspiration and prostaglandin. Acta Endocrinol. 1988; 118:161-167.
• [39]Aborto e Saúde Pública: 20 anos de pesquisas no Brasil. Ministério da Saúde, Brasília; 2008.
• [40]Madden T, Secura GM, Allsworth JE, Peipert JF. Comparison of contraceptive method chosen by women with and without a recent history of induced abortion. Contraception. 2011; 84(6):571-577.
• [41]Cameron S, Glasier A, Chen Z, Johnstone A, Dunlop C, Heller R. Effect of contraception provided at termination of pregnancy on incidence of subsequent termination of pregnancy. BJOG. 2012; 119:1074-1080.