Contraceptive Preferences of Post-Abortion Patients in Ghana

Abstract

Objectives: Abortions constitute 16% of deliveries in Ghana and cause 11% of maternal deaths. Because many women resume sexual activity shortly after an uncomplicated abortion and fertility may return as early as 10 days after a first-trimester induced abortion, it is crucial that women who are not seeking another pregnancy are offered effective methods of contraception. Post-abortion counseling coupled with contraceptive services has been regarded as an appropriate vehicle to decrease unwanted pregnancies and subsequent induced abortions. The study looked at the contraceptive preferences of patients following abortion at Komfo Anokye Teaching Hospital, Kumasi. Materials: This was a prospective study done from January to December 2010. Patients admitted to the gynaecologic wards of the hospital for all types of abortions or miscarriages, except Threatened Abortion, were included in the study after obtaining consent. They had both pre- and post-evacuation counseling on contraception. Methods: Basic demographic data as well as information on previous pregnancy outcomes and contraceptive use were obtained and entered onto data collection forms. Data were later transferred onto EpiInfo ver. 3.5.1. Results: Of the 2,257 patients admitted as abortions, 2,243 were entered into the study. Majority (68%) were incomplete abortions. Mean age was 27.3 years. While 50.4% were single, 49.6% were married. Mean parity was 1.6 children. While 51% had had at least an episode of a spontaneous abortion, 42% had had at least a termination of pregnancy (mean - 1.9). Unwanted pregnancies accounted for 53% of pregnancies that aborted. While knowledge on contraception was 96%, ever use and current use were 36% and 16% respectively. Following counseling, 68% accepted a form of contraception, 19.5% declined because they wanted a child while 12% were undecided. The combined Pill (25%), Injectables (23%), Implants (16%) and Abstinence (15.6%) were most favored. Very few preferred intrauterine device. Conclusions: Although knowledge on contraception was high, less than one-third were using contraception before the abortion, indicating a high unmet need for contraception. Acceptance rate for contraception following counseling was high (68%) compared to a national average of 24%. Accepting contraception was independent of marital status (p = 0.33), age (p = 0.27) and formal education (p = 0.31). About 66% of women who chose abstinence were below age 20 and this is good for the country in the fight against HIV infection.