Abstract
Background: The World health organization’s recommendations aim to provide comprehensive post-abortion care for all women coming for abortion services. Different investigations have been conducted in Ethiopia reporting the prevalence and the determinant factors of post-abortion contraception, but they lack consistency and are characterized by discrepancies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and associated factors of family planning utilization among women receiving abortion services in Ethiopia.
Methods: A systematic review and meta-analysis of published and grey literature were conducted . The protocol was registered on PROSPERO at CRD42020162969. PubMed, Google Scholar, Science Direct, HINARI and Cochrane Library and Google were used to review studies starting from January 14, 2020 to March 11, 2020. STATA 14 software was used for analysis. JBI approach was used for critical appraisal, study selection, and data extraction. The possible risk of publication bias was examined using the Funnel plot, Begg’s and Egger’s test. Statistical heterogeneity was quantified using Cochran’s Q and the I2 test statistic. A random effect model was used as a method of analysis.
Results: A total of 8236 women were involved using sixteen studies having 7 to 9 quality scores. The pooled prevalence of family planning utilization among women receiving abortion services in Ethiopia was 69.73% (95% CI: 63.67, 75.79). In addition, subgroup analysis showed the highest prevalence of post-abortion contraception on Addis Ababa city Administration,79.38 (95%- CI;66.87, 91.89). Counseling for contraceptive: (OR=3.48,95% CI: 1.94, 6.25), and history of contraceptive use: (OR=7.62, 95% CI: 3.28:17.69) have shown a positive association with post-abortion family planning utilization in Ethiopia.
Conclusion: Family planning utilization among women receiving abortion services is shown to be less than the WHO and national recommendation. Counseling and history of contraceptive use were found to be significantly associated with post-abortion family planning utilization in Ethiopia.
Keywords: Family planning, meta-analysis, post-abortion, Egger’s test, statistical heterogeneity, contraceptive.
Graphical Abstract
[1]
WHO. Report of a WHO technical consultation on birth spacing. Rep a WHO Tech Consult Birth Spacing [Internet] 2005; 13(6): 1-44. http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf [Available from: 11 Feb 2022].
[2]
Temmerman M. Missed opportunities in women’s health: Post-abortion care. Lancet Glob Health 2019; 7(1): e12-3.
[http://dx.doi.org/10.1016/S2214-109X(18)30542-4] [PMID: 30503403]
[http://dx.doi.org/10.1016/S2214-109X(18)30542-4] [PMID: 30503403]
[3]
Curtis C, Huber D, Moss-Knight T. Postabortion family planning: Addressing the cycle of repeat unintended pregnancy and abortion. Int Perspect Sex Reprod Health 2010; 36(1): 44-8.
[http://dx.doi.org/10.1363/3604410] [PMID: 20403805]
[http://dx.doi.org/10.1363/3604410] [PMID: 20403805]
[4]
Baynes C, Kahwa J, Lusiola G, et al. What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania. BMC Womens Health 2019; 19(1): 22.
[http://dx.doi.org/10.1186/s12905-018-0687-9] [PMID: 30691443]
[http://dx.doi.org/10.1186/s12905-018-0687-9] [PMID: 30691443]
[5]
Mendez A, Sawan M. Chronic monitoring of bladder volume: A critical review and assessment of measurement methods. Can J Urol 2011; 18(1): 5504-16.
[PMID: 21333041]
[PMID: 21333041]
[6]
Guttmacher Intstitute. Key facts on induced abortion worldwide fact sheet 2016. Available at: https://www.who.int/reproductivehealth/news/440KeyAbortionFactsFinal.pdf
[7]
Kaewkiattikun K. Effects of immediate postpartum contraceptive counseling on long-acting reversible contraceptive use in adolescents. Adolesc Health Med Ther 2017; 8: 115-23.
[http://dx.doi.org/10.2147/AHMT.S148434] [PMID: 29133985]
[http://dx.doi.org/10.2147/AHMT.S148434] [PMID: 29133985]
[8]
Moore AM, Gebrehiwot Y, Fetters T, et al. The estimated incidence of induced abortion in Ethiopia, 2014: Changes in the provision of services since 2008. Int Perspect Sex Reprod Health 2016; 42(3): 111-20.
[http://dx.doi.org/10.1363/42e1816] [PMID: 28825902]
[http://dx.doi.org/10.1363/42e1816] [PMID: 28825902]
[9]
Ceylan A, Ertem M, Saka G, Akdeniz N. Post abortion family planning counseling as a tool to increase contraception use. BMC Public Health 1983; 2009(9): 1-7.
[PMID: 19146657]
[PMID: 19146657]
[10]
Samuel M, Fetters T, Desta D. Strengthening postabortion family planning services in Ethiopia: Expanding contraceptive choice and improving access to long-acting reversible contraception. Glob Health Sci Pract 2016; 4(Suppl. 2): S60-72.
[http://dx.doi.org/10.9745/GHSP-D-15-00301] [PMID: 27540126]
[http://dx.doi.org/10.9745/GHSP-D-15-00301] [PMID: 27540126]
[11]
Klitsch M. Counseling the Postabortion Client: A training curriculum, 2003. Available at: https://asksource.info/resources/counseling-postabortion-client-a-training-curriculum
[12]
USAID. Family planning: A key component of post abortion care 2013. Available at: https://www.glowm.com/pdf/PAC-FP-Joint-Statement-November2013-final_printquality.pdf
[13]
Singh S, Remez L, Sedgh G, Kwok L, Onda T. Abortion Worldwide Uneven Progress and Unequal Access 2017. Available at: https//www.guttmacher.org/report/abortion-worldwide-2017
[14]
Huber D. Postabortion care and the voluntary family planning component: Expanding contraceptive choices and service options. Glob Health Sci Pract 2019; 7(2)(Suppl. 2): S207-10.
[http://dx.doi.org/10.9745/GHSP-D-19-00128] [PMID: 31455617]
[http://dx.doi.org/10.9745/GHSP-D-19-00128] [PMID: 31455617]
[15]
International Agreement on PAC. Introduction to Postabortion Care. Available from: https://www.postabortioncare.org/sites/pac/files/CompendiumIntroPAC.pdf
[17]
Henshaw SK, Singh S, Haas T. The incidence of abortion worldwide. Int Fam Plann Persp 1999; 25(Suppl.): S30-8.
[http://dx.doi.org/10.2307/2991869] [PMID: 14627053]
[http://dx.doi.org/10.2307/2991869] [PMID: 14627053]
[18]
Dibaba Y, Dijkerman S, Fetters T, et al. A decade of progress providing safe abortion services in Ethiopia: Results of national assessments in 2008 and 2014. BMC Pregnancy Childbirth 2017; 17(1): 76.
[http://dx.doi.org/10.1186/s12884-017-1266-z] [PMID: 28257646]
[http://dx.doi.org/10.1186/s12884-017-1266-z] [PMID: 28257646]
[19]
Asrat M, Bekele D, Compton SD. Post-abortion contraceptive acceptance and choice determinants among women receiving abortion care at Saint Paul’s Hospital, Addis Ababa, Ethiopia: A cross-sectional study. Lancet Glob Health 2018; 6(S2): S37.
[http://dx.doi.org/10.1016/S2214-109X(18)30166-9]
[http://dx.doi.org/10.1016/S2214-109X(18)30166-9]
[20]
Bulcha B. Assessment of the status of HIV / AIDS Mainstreaming at the government sectors in Addis Ababa and factors affecting the implementation, BSc thesis, Faculty of Medicine School of Public Health, Addis Ababa University 2010.
[21]
Seid A. Integration of family planning services within post abortion care. Sci Technol Arts Res J 2012; 1(3): 38-46.
[22]
Seyoum D, Gebeyehu A, Gizaw Z. Assessment of post abortion contraceptive intention and associated factors among abortion clients in gambella health. Univers J Public Health 2014; 2(8): 215-25.
[http://dx.doi.org/10.13189/ujph.2014.020802]
[http://dx.doi.org/10.13189/ujph.2014.020802]
[23]
Tesfaye G, Oljira L. Post abortion care quality status in health facilities of Guraghe zone, Ethiopia. Reprod Health 2013; 10(1): 35.
[http://dx.doi.org/10.1186/1742-4755-10-35] [PMID: 23875945]
[http://dx.doi.org/10.1186/1742-4755-10-35] [PMID: 23875945]
[24]
Andarge F. Health assessment of the status of post-abortal family planning acceptance and its associated factors. AU Institutional Repository 2014.
[25]
Erko EK, Abera M, Admassu B. Safe abortion care, utilization of post abortion contraception and associated factors, Jimma Ethiopia. J Womens Health Care 2016; 5: 4.
[26]
Beyene FY, Tesfu AA, Wudineh KG, Sendeku FW, Ayenew AA. Utilization and its factors of post abortion modern contraceptive in Ethiopia: A systematic review and meta-analysis. Reprod Health 2021; 18(1): 143.
[http://dx.doi.org/10.1186/s12978-021-01195-8] [PMID: 34217317]
[http://dx.doi.org/10.1186/s12978-021-01195-8] [PMID: 34217317]
[27]
Hagos G, Tura G, Kahsay G, Haile K, Grum T, Araya T. Family planning utilization and factors associated among women receiving abortion services in health facilities of central zone towns of Tigray, Northern Ethiopia: A cross sectional study. BMC Womens Health 2018; 18(1): 83.
[http://dx.doi.org/10.1186/s12905-018-0582-4] [PMID: 29871631]
[http://dx.doi.org/10.1186/s12905-018-0582-4] [PMID: 29871631]
[28]
Abebe AM, Wudu Kassaw M, Estifanos Shewangashaw N. Postabortion Contraception Acceptance and Associated Factors in Dessie Health Center and Marie Stopes International Clinics, South Wollo Northeast, Amhara Region, 2017. Int J Reprod Med 2019; 2019: 1327351.
[http://dx.doi.org/10.1155/2019/1327351] [PMID: 31531342]
[http://dx.doi.org/10.1155/2019/1327351] [PMID: 31531342]
[29]
Kokeb L. Utilization of post abortion contraceptive and associated factors among women who came for abortion service: A Hospital based cross sectional study. J Fam Med Dis Prev 2015; 1(4): 4-7.
[http://dx.doi.org/10.23937/2469-5793/1510022]
[http://dx.doi.org/10.23937/2469-5793/1510022]
[30]
Mekuria A, Gutema H, Wondiye H, Abera M. Postabortion contraceptive use in Bahir Dar, Ethiopia: a cross sectional study. Contracept Reprod Med 2019; 4(1): 19.
[http://dx.doi.org/10.1186/s40834-019-0099-8] [PMID: 31700669]
[http://dx.doi.org/10.1186/s40834-019-0099-8] [PMID: 31700669]
[31]
Moges Y, Hailu T, Dimtsu B, Yohannes Z, Kelkay B. Factors associated with uptake of post-abortion family planning in Shire town, Tigray, Ethiopia. BMC Res Notes 2018; 11(1): 928.
[http://dx.doi.org/10.1186/s13104-018-4029-7] [PMID: 30591074]
[http://dx.doi.org/10.1186/s13104-018-4029-7] [PMID: 30591074]
[32]
Muche A, Bewket B, Ayalew E, Demeke E. Utilization of post abortal contraceptive use and associated factors among women who came for abortion service at Debre Berhan Hospital, Debre Berhan, Ethiopia March 2019: Institution based cross sectional study. Clin J Obstet Gynecol 2019; 2: 025-33.
[33]
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1): 1-9.
[http://dx.doi.org/10.1186/2046-4053-4-1] [PMID: 25554246]
[http://dx.doi.org/10.1186/2046-4053-4-1] [PMID: 25554246]
[34]
Modesti PA. Cross Sectional Study Newcastle - Ottawa Quality Assessment Scale. PLoS One 2016; 11(1): 1-2.
[PMID: 26808317]
[PMID: 26808317]
[35]
Lo CK, Mertz D, Loeb M. Newcastle-Ottawa Scale: Comparing reviewers’ to authors’ assessments. BMC Med Res Methodol 2014; 14(1): 45.
[http://dx.doi.org/10.1186/1471-2288-14-45] [PMID: 24690082]
[http://dx.doi.org/10.1186/1471-2288-14-45] [PMID: 24690082]
[36]
Prata N, Bell S, Holston M, Gerdts C, Melkamu Y. Factors associated with choice of post-abortion contraception in Addis Ababa, Ethiopia. Afr J Reprod Health 2011; 15(3): 51-7.
[PMID: 22574492]
[PMID: 22574492]
[37]
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50(4): 1088-101. http://www.jstor.org/stable/2533446
[http://dx.doi.org/10.2307/2533446] [PMID: 7786990]
[http://dx.doi.org/10.2307/2533446] [PMID: 7786990]
[38]
Erickson SB, Lieske JC. Medical management. Clin Rev Bone Miner Metab 2004; 2: 237-51.
[http://dx.doi.org/10.1385/BMM:2:3:237]
[http://dx.doi.org/10.1385/BMM:2:3:237]
[39]
Ethiopian Health Sector Transformation Plan.2015/16 - 2019/20. Fed Democr Repub Ethiop Minist Heal 2015; 20(5): 50.
[40]
Mutua MM, Achia TNO, Maina BW, Izugbara CO. A cross-sectional analysis of Kenyan postabortion care services using a nationally representative sample. Int J Gynaecol Obstet 2017; 138(3): 276-82.
[http://dx.doi.org/10.1002/ijgo.12239] [PMID: 28631406]
[http://dx.doi.org/10.1002/ijgo.12239] [PMID: 28631406]
[41]
Padmadas SS, Lyons-Amos M, Thapa S. Contraceptive behavior among women after abortion in Nepal. Int J Gynaecol Obstet 2014; 127(2): 132-7.
[http://dx.doi.org/10.1016/j.ijgo.2014.05.012] [PMID: 25047427]
[http://dx.doi.org/10.1016/j.ijgo.2014.05.012] [PMID: 25047427]
[42]
Azmat SK, Hameed W, Ishaque M, Mustafa G, Ahmed A. Post-abortion care family planning use in Pakistan Post-abortion care family planning use in Pakistan. Pak J Public Health 2014; 2(2): 4-9.
[43]
Yegon E, Ominde J, Baynes C, et al. The quality of postabortion care in Tanzania: Service provider perspectives and results from a service readiness assessment. Glob Health Sci Pract 2019; 7(Suppl 2): S315-26.
[http://dx.doi.org/10.9745/GHSP-D-19-00050] [PMID: 31455627]
[http://dx.doi.org/10.9745/GHSP-D-19-00050] [PMID: 31455627]
[44]
Benson J, Andersen K, Brahmi D, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Global Public Health 2018; 13(1): 35-50.
[http://dx.doi.org/10.1080/17441692.2016.1174280] [PMID: 27193827]
[http://dx.doi.org/10.1080/17441692.2016.1174280] [PMID: 27193827]
[45]
WHO. Health Worker Roles in Providing Safe abortion care and post-abortion contraception, 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/181041/9789241549264_eng.pdf
[46]
Fruhauf T, Zimmerman L, Kibira SPS, et al. Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda. Health Policy Plan 2018; 33(7): 828-39.
[http://dx.doi.org/10.1093/heapol/czy058] [PMID: 30010860]
[http://dx.doi.org/10.1093/heapol/czy058] [PMID: 30010860]
[47]
Zaidi S, Yasmin H, Hassan L, Khakwani M, Sami S, Abbas T. Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan. Int J Gynaecol Obstet 2014; 126(Suppl. 1): S40-4.
[http://dx.doi.org/10.1016/j.ijgo.2014.03.016] [PMID: 24743026]
[http://dx.doi.org/10.1016/j.ijgo.2014.03.016] [PMID: 24743026]
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