Background: Contraceptive utilization is a practice that helps individuals or couples to avoid unwanted pregnancy. Even though there is the widespread availability of contraceptives, induced abortion remains an alarming public health problem in Ethiopia. Nationally, more than a third (35%) of women seeking an induced abortion service had a previous history of abortion. Therefore, this study aimed to assess the history of contraceptive use and identify associated factors among women seeking an induced abortion service in Debre Marko’s town, Ethiopia. Methods: An institutional-based cross-sectional study was conducted from March 15 to May 15, 2019. The sample size was 416 and each health institution was proportionally allocated based on the previous 2 months of patient flow. Systematic random sampling was used to select the study participants. A structured questionnaire was used to collect the data. Data were entered by EPI-data and analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were carried out. Model fitness was assured. Results: The proportion of contraceptive use within the last 6 months before pregnancy was 41.3% among women seeking an induced abortion. Women who had good knowledge about contraceptives (AOR = 3.9; 95%CI: 2.36, 6.54), women who had a positive attitude about contraceptives (AOR=; 95%CI: 1.02, 2.56), women who had living children (AOR = 2.1; 95%CI; 1.04, 4.11), women who had frequent sexual practice (AOR = 2.5; 95% CI; 1.53, 4.21) and women discussed with their sexual partners about contraceptives (AOR = 1.9; 95%CI: 1.18, 3.18) were increase the odds of contraceptive use among women seeking an induced abortion. Conclusion: Contraceptive use among women seeking an induced abortion was low despite the expected national goal of 55% contraceptive use in 2020. Having good knowledge and having a positive attitude on contraceptives, and having a discussion on contraceptives with sexual partner were increase the odds of contraceptive use. The intervention should focus on abortion seeking women to achieve their contraceptive needs and encourage sexual partner discussion about contraceptives to improve joint partner collective decision-making.
An institution-based cross-sectional study was conducted from March 15 to May 15, 2019, among women seeking an induced abortion in Debre Marko’s town which is located at 300kms from Addis Ababa, capital city of Ethiopia. The town has one governmental referral hospital, 3 health centers, and two non-governmental organizations (NGO) clinics that give legal abortion services at the time of study period. The study population was women seeking an induced abortion services in the selected health institutions within the study period. Women having induced abortion due to obstetrical reasons were excluded from the study. History of contraceptive use: use of any contraceptive method regularly with in the last 6 months before the current pregnancy time of conception. Induced abortion refers to deliberate intervention to terminate the pregnancy. Good knowledgeable: Refers study participants who answered ≥72% (mean score) of nine contraceptives knowledge questions. Poor knowledgeable: Refers study participants who answered < 72% (mean score) of nine contraceptives knowledge questions. Positive attitude: Refers study participants who answered ≥70% (mean score) of nine contraceptives attitude questions. Negative attitude: Refers study participants who answered < 70% (mean score) of nine contraceptives attitude questions. Bad history of contraceptives: A women who an experience of failure of contraceptive methods and/or got bad side effects with in the last 1 year before index pregnancy. Accessibility: if the family planning service delivery center reached within 2 h (30 km) on foot was considered as access to family planning [10]. EPI-info software was used to calculate the sample size using single proportion population formula by considering the following assumptions: p- contraceptive practice among women seeking abortion (p = 56.6%) [11]; margin of error (5%) and 95% CI (z1/2 = 1.96). The final sample size was 416 by considering 10% non- response rate. All health institutions which provide legal abortion service in the study area were included. The sample size for each health institution was determined proportionally based on the previous 2 months of clients flow. Systematic random sampling was used to select the study participants (Fig. 1). The kth interval of systematic sampling was determined by dividing the previous 2 months client flow with the required sample size from each health institutions. Sampling procedures, Debre Marko’s, Ethiopia, 2019 Interviewer administered questionnaire was used to collect the data. The questionnaires initially prepared in English and translated to Amharic and again back to English to check the consistency. The questionnaire constitutes socio-demographic variables, reproductive and sexual characteristics, health institution accessibility, knowledge and attitude questions on contraceptive and contraceptive use question. The questionnaire was filled by the health professionals who were working in the same health institution out of maternal and child health room. One BSc Midwife was assigned as a supervisor who supervises the data collection throughout the process in each health institution. Data quality was assured using pre-testing and training of data collectors and supervisors. The topics of the training were data confidentiality, responders’ right, informed consent, the objective of the study, on the techniques of the interview and filling the questionnaire. Data were entered using EPI data and analyzed using SPSS version 23. Descriptive statistics were used to describe the data. Bivariate analysis was employed to examine the association between dependent and independent variables. Finally, multivariable logistic regression was done to determine the independent effect of each factor and control confounding effect. A p-value < 0.05 was used as cut of point to declare statistically significant. Multicollinearity was checked to see the correlation among independent variables. Model fitness was checked with Hosmer Lemshow test. Knowledge questions were categorized and coded as (good = 1 and poor = 0) whereas attitude questions were categorized and coded as (1 = Positive attitude and 0 = Negative attitude). Cronbach alpha was checked to assure the internal consistency of attitude measuring questions.
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