Contraceptive use and associated factors among women seeking induced abortion in Debre Marko’s town, Northwest Ethiopia: A cross-sectional study

  • Reproductive Health, Volume 17, No. 1, Year 2020

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Study Justification:
– The study aimed to assess the history of contraceptive use and identify associated factors among women seeking induced abortion services in Debre Marko’s town, Ethiopia.
– Contraceptive utilization is important for individuals or couples to avoid unwanted pregnancies.
– Despite the widespread availability of contraceptives, induced abortion remains a significant public health problem in Ethiopia.
– The study aimed to provide insights into the factors influencing contraceptive use among women seeking induced abortion, which can inform interventions and policies to improve contraceptive access and utilization.
Study Highlights:
– The study found that only 41.3% of women seeking induced abortion had used contraceptives in the last 6 months before pregnancy.
– Factors associated with increased odds of contraceptive use included good knowledge about contraceptives, positive attitude towards contraceptives, having living children, frequent sexual practice, and discussing contraceptives with sexual partners.
– The study highlights the need to focus on abortion-seeking women to meet their contraceptive needs and encourage partner discussions about contraceptives to improve joint decision-making.
Study Recommendations:
– Interventions should be targeted towards women seeking induced abortion to improve their access to and utilization of contraceptives.
– Efforts should be made to increase knowledge and awareness about contraceptives among women and their sexual partners.
– Health education programs should promote positive attitudes towards contraceptives and emphasize the importance of joint decision-making between partners.
– Family planning services should be easily accessible to ensure that women can access contraceptives conveniently.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies related to reproductive health and family planning.
– Health Institutions: Provide reproductive health services, including family planning and abortion services.
– Non-Governmental Organizations (NGOs): Play a role in providing reproductive health services and implementing interventions to improve contraceptive use.
– Community Health Workers: Involved in community outreach and education programs to raise awareness about contraceptives and promote their use.
– Women’s Rights Organizations: Advocate for women’s reproductive rights and access to contraceptives.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers on family planning counseling and contraceptive methods.
– Health Education and Awareness Campaigns: Allocate funds for community-based education programs, including the development and dissemination of informational materials.
– Contraceptive Supplies: Budget for the procurement and distribution of contraceptives to health institutions.
– Infrastructure and Equipment: Allocate funds for improving the infrastructure and equipment of health institutions to ensure the provision of quality reproductive health services.
– Monitoring and Evaluation: Set aside resources for monitoring and evaluating the implementation and impact of interventions aimed at improving contraceptive use among women seeking induced abortion.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional study, which provides a snapshot of contraceptive use among women seeking induced abortion. The sample size is adequate, and systematic random sampling was used to select participants. The data collection process was supervised, and data quality was assured through pre-testing and training. Descriptive statistics, bivariate analysis, and multivariable logistic regression were conducted to analyze the data. However, the abstract does not provide information on the response rate or the representativeness of the sample. Additionally, the abstract does not mention any limitations of the study. To improve the evidence, future studies could consider addressing these limitations and providing more details on the study population and methodology.

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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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile clinics: Implementing mobile clinics that provide maternal health services, including contraceptive counseling and services, in remote areas or areas with limited access to healthcare facilities.

2. Telemedicine: Using telemedicine technology to provide remote consultations and follow-up care for women seeking maternal health services, including contraceptive counseling and prescriptions.

3. Community health workers: Training and deploying community health workers to provide education, counseling, and distribution of contraceptives within their communities, particularly in areas where healthcare facilities are scarce.

4. Task-shifting: Expanding the roles and responsibilities of healthcare providers, such as nurses and midwives, to include contraceptive counseling and provision, allowing for increased access to these services.

5. Public-private partnerships: Collaborating with private healthcare providers and organizations to increase the availability and accessibility of maternal health services, including contraceptives, in underserved areas.

6. Digital health solutions: Developing and implementing digital health solutions, such as mobile applications or SMS reminders, to provide information, support, and reminders for contraceptive use and maternal health appointments.

7. Community engagement and awareness campaigns: Conducting community engagement activities and awareness campaigns to promote the importance of contraceptive use and maternal health, addressing cultural and social barriers, and increasing demand for services.

8. Integration of services: Integrating maternal health services, including contraceptive counseling and provision, with other healthcare services, such as antenatal care and postpartum care, to ensure comprehensive and continuous care for women.

9. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities, particularly in rural and underserved areas, to ensure the availability of quality maternal health services, including contraceptives.

10. Policy and advocacy: Advocating for policies and regulations that support and prioritize maternal health, including access to contraceptives, and working towards their implementation and enforcement at national and local levels.
AI Innovations Description
Based on the study conducted in Debre Marko’s town, Ethiopia, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Increase awareness and knowledge about contraceptives: Develop educational programs and campaigns to provide accurate information about different contraceptive methods, their effectiveness, and potential side effects. This can be done through community outreach, health education sessions, and the use of multimedia platforms.

2. Promote positive attitudes towards contraceptives: Address misconceptions and cultural barriers that may hinder the acceptance and use of contraceptives. Encourage open discussions about family planning within communities, schools, and religious institutions to promote a positive attitude towards contraception.

3. Strengthen partner involvement: Encourage women to discuss contraceptive options with their sexual partners and involve them in decision-making processes. This can be achieved through couple counseling sessions and promoting communication between partners about family planning.

4. Improve accessibility to family planning services: Ensure that family planning services are easily accessible within the community, with a focus on reaching remote areas. This can be achieved by establishing more health centers and clinics that provide comprehensive family planning services, including counseling, contraceptive methods, and follow-up care.

5. Enhance healthcare provider training: Provide comprehensive training to healthcare providers on family planning counseling, contraceptive methods, and addressing the specific needs and concerns of women seeking induced abortion services. This will ensure that healthcare providers are equipped with the knowledge and skills to provide quality care and support.

6. Strengthen monitoring and evaluation systems: Establish robust monitoring and evaluation systems to track the progress and impact of interventions aimed at improving access to maternal health. Regular data collection and analysis will help identify gaps and areas for improvement, allowing for evidence-based decision-making.

By implementing these recommendations, it is expected that access to maternal health services, including contraceptive use, will improve, leading to a reduction in induced abortions and better overall maternal health outcomes.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive educational programs to increase knowledge about contraceptives and their benefits. This can be done through community outreach programs, workshops, and campaigns targeting women and their partners.

2. Improve contraceptive availability: Ensure that contraceptives are readily available and accessible in health institutions, clinics, and pharmacies. This includes providing a wide range of contraceptive options and ensuring a consistent supply.

3. Strengthen family planning services: Enhance the quality and availability of family planning services in healthcare facilities. This can be achieved by training healthcare providers on family planning counseling and methods, improving infrastructure and equipment, and integrating family planning services into routine antenatal and postnatal care.

4. Promote partner involvement: Encourage open communication and involvement of sexual partners in family planning decisions. This can be done through counseling sessions that involve both partners, promoting joint decision-making, and addressing any misconceptions or concerns.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as contraceptive prevalence rate, contraceptive knowledge, contraceptive use, and partner involvement.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Introduce the recommendations: Implement the recommended interventions in a selected sample population or community. This could involve implementing educational programs, improving contraceptive availability, and strengthening family planning services.

4. Monitor and evaluate: Continuously monitor the implementation of the interventions and collect data on the selected indicators. This can be done through follow-up surveys, interviews, or routine data collection from healthcare facilities.

5. Analyze the data: Analyze the collected data to assess the impact of the interventions on the selected indicators. This can involve comparing the baseline data with the post-intervention data to determine any changes or improvements.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Identify any gaps or areas for improvement and make recommendations for further interventions or adjustments to existing strategies.

7. Repeat the process: Continuously repeat the monitoring and evaluation process to assess the long-term impact of the interventions and make necessary adjustments to ensure sustained improvements in access to maternal health.

Statistics:
Citations: 3
Authors: 3
Identifiers:
DOI: 10.1186/s12978-020-00945-4
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Grounded Theory, randomised-control-trial
Study Approach:
Quantitative
Participants Gender:
Female
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