Socio-demographic characteristics of respondents
Out of 416 women estimated in sample size, atotal of 409 abortion clients were interviwed in this study with response rate of 98.3%. The mean age of study particpants was 24.2 (SD ±6.11). About two-third of the respondents 249 (60.9%) were in the age group of 15–24 years. Majority of the respondents 329 (80.4%) were served in public health facility and urban residents 295 (72%). Three hundred seventy four (91.4%) of the study participants belongs to Tigray ethinicity. The study participants with educational status of secondary school (9–12 grade) were 136 (33.3%). Regarding to marital status and occupation, 188 (46%) were single and 140 (34.2%) were house wife respectively. The median monthly income was $ 26. Most of respondents 172 (42.1%) were in the income category of $15–26 per month. The majority of study subjects 360 (88%) were Orthodox Christian followers. Concerning to family size, only 64(15.6%) of the study subjects were live with 5 or above family size (Table
1).
Table 1
Socio-demographic characterstics of the respondents, central zone of Tigray, North Ethiopia, 2015
Age |
15–24 | 249 | 60.9 |
25–34 | 119 | 29.1 |
35+ | 41 | 10 |
Residence |
Urban | 295 | 72.1 |
Rural | 114 | 27.9 |
Ethnicity |
Tigray | 374 | 91.4 |
Amhara | 30 | 7.3 |
Others | 5 | 1.2 |
Education |
Can not read and write | 78 | 19.1 |
Can only read and write | 33 | 8.1 |
| 94 | 23.0 |
| 136 | 33.3 |
College and higher | 68 | 16.6 |
Occupation |
House wife | 140 | 34.2 |
Student | 129 | 31.5 |
Employed | 74 | 18.1 |
Un employed | 26 | 6.4 |
Commercial sex worker | 21 | 5.1 |
Trader | 19 | 4.6 |
Marital status |
Married or living together | 178 | 43.5 |
Single | 188 | 46.0 |
Divorced and Widowed | 43 | 11.0 |
Monthly income |
≤ $15 | 167 | 40.8 |
$16–26 | 172 | 42.1 |
$27–55 | 51 | 12.5 |
> $55 | 19 | 4.6 |
Religion |
Orthodox | 360 | 88.0 |
Muslim | 35 | 8.6 |
Others (Protestant & Catholic) | 14 | 3.4 |
Family size |
1–4 | 345 | 84.4 |
5 and above | 64 | 15.6 |
Almost all 400(97.8%) of the study subjects were counseled for post abortion family planning and 216 (52.8%) of them were counseled during the procedure. Even though almost all were counseled, 290 (70.9%) of them were received the contraceptive after abortion service. Regarding to type of health facility served, 329(80.4%) of the contraceptive users were served in public health facilities (Table
2).
Table 2
Post-abortion contraceptive use and facility related variables, central zone of Tigray, North Ethiopia, 2015 (n = 409)
Counseled for FP |
Yes | 400 | 97.8 |
No | 9 | 2.2 |
When was the FP Counseling provided |
Before the procedure | 216 | 52.8 |
During the procedure | 42 | 10.3 |
After the procedure | 151 | 36.9 |
Received contraception after abortion |
Yes | 290 | 70.9 |
No | 119 | 29.1 |
Room (place) received the contraceptive (n = 290) |
At the abortion room | 221 | 76.20 |
At FP room | 65 | 22.4 |
other rooms (OPD/ Gynecology) | 4 | 1.4 |
Type of health facility served (n = 409) |
Public | 329 | 80.4 |
Private | 47 | 11.5 |
NGO | 33 | 8.1 |
Bivariable logistic regration was used to determine the association of each independent variables with post abortion contraceptive use with out controlling the effect of any other variables. Variables which were significantly associated with post abortion FP use in bivariable logistic regression were; health facility type, pregnancy history, abortion history, plan before the index pregnancy, the index pregnancy planning, the main decider of when to have child, knowledge on a women can get pregnant sooner after abortion, how soon can a women get pregnant again after abortion, husband’s attitude towards contraceptive use and the time of counselling conducted..
From the variables associated with PAFP in bivariable logistic regression; type of health facilities, the decider of when to have child, know a women can get pregnant sooner after abortion, and husband’s attitude towards contraception were statistically significant with the PAFP in the multivariable logistic regression analysis.
Multivariable logistic regression analysis identified type of health facility served has strongest association with PAFP. Individuals served in NGO were 6.7 times more likely to receive contraceptives than individuals served in public facilities AOR = 6.668 [95% CI; 1.418, 31.361] where as, abortion clients served in private for profit facilities were 72.4% less likely to utilize as compared to the public facilities AOR = 0.276 [95% CI; 0.127, 0.601].
In this study, the main decision maker on when to have child was also found to be significant factor for receiving PAFP. The odds of receiving PAFP in clients whom their husband were the main deciders were 85% less likely to receiving contraception as compared to the women who make decisions themselves AOR = 0.149 [95% CI; 0.034, 0.650]. Participants who had opposition from their husband to receiving contraception were about 77.7% less likely to utilize PAFP before leaving the facilty than compared to the women who are supported by their husbands AOR = 0.223 [95% CI; 0.103, 0.482]. Those who were uncertain of their husbands’ attitude towards contraceptive were also 66% less likely to receive FP AOR = 0.3403 [95% CI; 0.160, 0.722].
Utilizing of PAFP was also increased with knowledge of study participants on knowing fertility returns sooner which was also significantly associated. Study participants who knows that could get pregnant again sooner after abortion (10-14 days) were observed to utilize PAFP 2 times than those who do not know AOR = 2.188 (1.105, 4.334) (Table
3).
Table 3
Multivariable analysis of factors associated with Post-abortion contraceptive use, central zone of health facilities, Tigray, North Ethiopia, 2015 (n = 409)
Type of Health facility | Public | 88(73.9) | 241(83.1) | 1 | 1 |
Private | 29(24.4) | 18(6.2) | 0.23(0.12,0.43)* | 0.28(0.13, 0.6)* |
NGO | 2(1.7) | 31(10.7) | 5.66(1.33, 24.14)* | 6.67(1.4,31.36)* |
Had history of Pregnancy | Yes | 81(68.1) | 151(52.1) | 0.51(0.33, 0.8)* | 0.66 (0.33, 1.35) |
No | 38(31.9) | 139(47.9) | 1 | 1 |
Had history of previous abortion | Yes | 51(42.9) | 72(24.8) | 2.27(1.45, 3.56)* | 0.58 (0.29, 1.16) |
No | 68(57.1) | 218(75.2) | 1 | 1 |
Pregnancy plan before the index Pregnancy | To get pregnant | 38(31.9) | 55(19.0) | 1 | 1 |
Later | 76(63.9) | 210(72.4) | 1.91(1.17, 3.12)* | 1.25 (0.08, 19.28) |
Not at all | 5(4.2) | 25(8.6) | 3.46(1.21, 9.83)* | 3.14 (0.18, 54.95) |
Planning of the index pregnancy | Yes | 40(33.6) | 57(19.7) | 1 | 1 |
No | 79(66.4) | 233(80.3) | 2.07(1.28, 3.34)* | 2.54 (0.17, 39.13) |
Decision maker on FP use | Wife | 4(3.4) | 19(6.6) | 1 | 1 |
Husband | 21(17.6) | 12(4.1) | 0.12(0.33, 0.44)* | 0.15(0.03, 0.65)* |
Both | 47(39.5) | 190(65.5) | 0.851(0.28, 2.72) | 0.83(0.23, 3.04) |
I don’t know | 47(39.5) | 69(23.8) | 0.31(0.01, 0.97)* | 0.27(0.07, 1.03) |
Knowing on time getting pregnant again | Yes | 43(36.1) | 172(59.3) | 2.58(1.66, 4.01)* | 2.19(1.1, 4.3)* |
No | 76(63.9) | 118(40.7) | 1 | 1 |
Knowledge on how soon fertility returns and could get pregnant again | within 10–14 days | 18(15.1) | 92(31.7) | 1 | 1 |
After 3–4 wks | 25(21.0) | 80(27.6) | 0.63(0.32, 1.23) | 0.79(0.37, 1.7) |
don ‘t know | 76(63.9) | 118(40.7) | 0.3(0.17, 0.54)* | 1.91(0.1, 4.3) |
Husbands’ attitude on contraceptive use | Approve | 30(25.2) | 125(43.1) | 1 | 1 |
Disapprove | 42(35.3) | 46(15.9) | 0.26(0.19, 0.47)* | 0.34 (0.160, 0.72)* |
Don’t know | 47(39.5) | 119(41.0) | 0.61(0.36, 1.02) | 0.22(0.10, 0.48)* |
Time of FP counseling provided | Before procedure | 43(36.1) | 173(59.7) | 2.9(1.81, 4.59)* | 1 |
During procedure | 13(10.9) | 29(10.0) | 1.6(0.77, 3.3) | 1.6 (0.9, 2.9) |
After the procedure | 63(52.9) | 88(30.3) | 1 | 1.8(0.71, 4.57) |