Atuhairwe Susan, Hanson Claudia, Tumwesigye Nazarius Mbona, Gemzell-Danielsson Kristina, Byamugisha Josaphat
Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda.
Department of Reproductive Medicine and Infertility, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda.
Contracept Reprod Med. 2023 Jan 14;8(1):4. doi: 10.1186/s40834-022-00199-4.
Post-abortion family planning counselling and provision are known high impact practices preventing unintended pregnancies. Little is known, however, about specific needs in the second trimester. Our study aims to assess post-abortion family planning uptake and its associated factors among women with second-trimester incomplete abortion.
We conducted a cross-sectional survey of 1191 women with incomplete second trimester abortion that received treatment at 14 comprehensive emergency obstetric care public health facilities in central Uganda from August 2018 to November 2021. We computed the post-abortion uptake of family planning within 2 weeks of treatment, described the types of methods accepted, and the reasons for declining family planning. We described the socio-demographic, reproductive, abortion-related, and health facility characteristics. We used mixed effects generalized linear models to obtain percentage differences for factors independently associated with post-abortion family planning uptake.
Second-trimester post-abortion family planning uptake was 65.6%. Implants (37.5%) and progestin only injectables (36.5%) were the commonly chosen methods; natural (0.1%), permanent (0.8%), and condoms (4%) were the least chosen methods. 45.2% of the women who declined family planning desired another pregnancy soon. Women whose spouses were aware of the pregnancy or had planned pregnancy had 11% (- 10.5, 95% CI - 17.1 to - 3.8) and 12% (- 11.7, 95% CI - 19.0 to - 4.4) less uptake compared to women whose spouses were not aware of the pregnancy or those with unplanned pregnancies respectively. Uptake was 8% (- 7.8, 95% CI - 12.6% to - 3.0%) lower among Islamic women compared to Anglicans. Women who received post-abortion family planning counselling or had more than four live births had 59% (59.4, 95% CI 42.1 to 76.7) and 13% (13.4, 95% CI 4.0 to 22.8%) higher uptake compared to women who did not receive counselling or women with no live births, respectively.
The uptake of second-trimester post-abortion family planning in Uganda was higher than previous estimates. Post-abortion family planning counselling, grand multiparity, and the need to avoid an unplanned pregnancy enhance post-abortion family planning uptake in the second trimester. Ministry of Health should strengthen post-abortion family planning counselling, especially couple counselling; at all health facilities in the country and also ensure an adequate and accessible supply of a wide contraceptive method mix.
流产后计划生育咨询与服务是预防意外怀孕的重要有效措施。然而，关于孕中期的具体需求，人们知之甚少。我们的研究旨在评估孕中期不全流产妇女的流产后计划生育服务接受情况及其相关因素。
我们对2018年8月至2021年11月期间在乌干达中部14家综合性急诊产科公共卫生机构接受治疗的1191例孕中期不全流产妇女进行了横断面调查。我们计算了治疗后2周内流产后计划生育服务的接受率，描述了所接受方法的类型以及拒绝计划生育的原因。我们描述了社会人口学、生殖、流产相关和卫生机构特征。我们使用混合效应广义线性模型来获取与流产后计划生育服务接受情况独立相关因素的百分比差异。
孕中期流产后计划生育服务接受率为65.6%。皮下埋植剂（37.5%）和单纯孕激素注射剂（36.5%）是常用的方法；自然避孕法（0.1%）、绝育法（0.8%）和避孕套（4%）是最少选用的方法。45.2%拒绝计划生育的妇女希望尽快再次怀孕。配偶知晓怀孕或有计划怀孕的妇女，其接受率分别比配偶不知晓怀孕或意外怀孕的妇女低11%（-10.5，95%CI -17.1至-3.8）和12%（-11.7，95%CI -19.0至-4.4）。与圣公会妇女相比，伊斯兰妇女的接受率低8%（-7.8，95%CI -12.6%至-3.0%）。接受流产后计划生育咨询或有四个以上存活子女的妇女，其接受率分别比未接受咨询的妇女或无存活子女的妇女高59%（59.4，95%CI 42.1至76.7）和13%（13.4，95%CI 4.0至22.8%）。
乌干达孕中期流产后计划生育服务的接受率高于先前估计。流产后计划生育咨询、多产以及避免意外怀孕的需求提高了孕中期流产后计划生育服务的接受率。卫生部应加强流产后计划生育咨询，尤其是夫妇咨询；在该国所有卫生机构中进行，并确保提供充足且可及的多种避孕方法组合。
