Factors associated with post-abortion family planning uptake among women in Kawempe national referral hospital, central Uganda

Abstract

Background:Each year, about 4.7% to 13.2% of all maternal deaths are attributed to unsafe abortion. Developing countries have considerable higher rates of abortion, where 37 to 39 per 1000 women abortion rates were reported between 1990 and 2014 and 25% of pregnancies ended up in abortion during the same period.For Uganda, about 15% of unintended pregnancies ended in abortions in 2013and yet 52% of all pregnancies in Uganda are unintended.In Uganda, post-abortion Family Planning(PAFP) is among the components of Post Abortion Care (PAC) and is included in the national family planning implementation plan 2015-2020. Despite the evidence that PAFP is very important, its utilization is still low due to several factors acting as barriers.This studyassessed level ofuptakeand factorsassociated with uptake of family planning services among women receiving PAC. Methods:A descriptive and analytical cross-sectional study design which employed both quantitative and qualitative methods of data collection and analysis was used to study 351 women receiving post abortion care servicesin Kawempe National Referral Hospital.Field data were collected using an interviewer administered questionnaire and interview guide was used to obtain service delivery information from the critical staff that provide PAC. The collected data were entered in Epidata 4.2 and exported into SPSS for analysis. Univariate analysis was used to describe the characteristics of the respondent and bivariate analyses were used to describe the relationship between the studied variablesand uptake of PAFP. The factors that were statistically significant with P<0.005 at 95% confidence level were subjected to multivariate analysis to obtain factors independently associated with uptake of PAFP. Results:The study found uptake of family planning after abortion at 17.0% (59/351). The statically significant factors at individual level that were observed to be associated with uptake of post abortion family planning were decision making power about FP and spousal involvement in FP. Previous use of FP and spousal attitude towards FP were also found significantly associated with uptake of post abortion family planning. There was a high likelihood of uptake of PAC FP among females with spouses that had a positive attitude towards FP (OR 0.312, CI 0.16-0.61; P<.001;) and ware more involved in FP (OR: 0.146; CI 0.07-0.33; P<.001;)respectively.When decisions about FP ware made by other people other than the woman herself, there was a lower likelihood of uptake of post abortion family planning. For instance, there was a significantly lower likelihood if the decision was made by a Health worker (OR 0.28, CI 0.11-0.69; P=.006;) or another person (OR 0.174; CI 0.08 0.38; P<.001;). Results also showed that there was a high likelihood of uptake of PAC FP among females that had previously used FP (OR 1.659: CI 0.93-2.96;P=.086;).The most significant facility related factor associated with uptake of post abortion family planning was individual health education. Provision of a range of FP options increased the likelihood of uptake of post abortion family planning by 31 times (OR 30.759, CI 10.24-92.37; P<.001;). Results also showed that provision of individual health education increased the likelihood of uptake of post abortion family planning by about 3 times (OR 2.919, CI 1.2-7.1; P=.018;). Conclusion: The study found uptake of PAFP very low for a society where abortion prevalence is very high. The results highlighted the role of partner involvement, routine FP education and availability of a range of family planning options for women receiving reproductive and maternal health services as associated factors. Itherefore strongly recommend that interventions to improve and increase uptake of PAFP should focus on providing routine FP education that involves male partners and ensure that a range of FP options are available at facilities providing reproductive and maternal health services.