Contraceptive use among uterine evacuation clients in Bangladesh: The role of individual, family, and service delivery factors

post-abortion contraception;uterine evacuation service delivery;intimate partner violence;not listed

Pearson, ErinSherman, Susan G. ;

Johns Hopkins University

关键词: post-abortion contraception;    uterine evacuation service delivery;    intimate partner violence;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39541/PEARSON-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Post-abortion contraception is recommended to reduce subsequent unwanted pregnancy and recourse to unsafe abortion, but little is known about the factors associated with successful post-abortion contraceptive use.Guided by the social-ecological model, this study seeks to understand the multiple levels of influence on women’s post-abortion contraceptive use.Methods: This dissertation uses data from a facility-based sample of 498 public sector uterine evacuation (UE) clients in Bangladesh.Respondents completed a quantitative interview on the day of their UE procedures and a follow-up interview four months later.Logistic regression models assess factors at the individual, family and UE service delivery levels associated with immediate post-abortion contraceptive acceptance (on the day of the UE procedure) and use four months post-abortion.Finally, intimate partner violence (IPV) is explored in greater depth to understand the intersection with other potential constraints to reproductive autonomy and the association between IPV and reproductive health outcomes.Results: Post-abortion contraceptive use was more common at the four-month follow-up (85.4%) compared to the day of the UE procedure (72.7%).Women receiving medication abortion (MA) and dilatation and curettage (D&C) had significantly lower odds of immediate acceptance, compared to women whose procedures were performed using manual vacuum aspiration (MVA) (AOR=0.07 and AOR=0.18, respectively).Though equally likely to be using modern contraception four months post-abortion, MA and D&C clients demonstrated delayed acceptance compared to MVA clients. Women whose fertility intentions were discordant from their husband/partner’s and those who experienced past year IPV were also more likely to have delayed acceptance, particularly if their husband/partner accompanied them for the UE procedure.Experience of IPV was associated with other domains of constrained reproductive autonomy and reproductive health outcomes such as selecting MA, compared to MVA (APR=2.38).Discussion: Use of post-abortion contraception is influenced by individual, family, and UE service delivery characteristics.The higher rate of modern contraceptive use four months post-abortion is encouraging, but also suggests gaps in immediate post-abortion contraceptive provision.Interventions are needed at multiple levels to ensure all women have access to confidential UE and post-abortion contraceptive services.