Repeat abortion and use of contraception among post-abortion women in Nepal – A prospective cohort study

Abstract

University of Washington Abstract Repeat abortion and use of contraceptive among post-abortion women in Nepal – A prospective cohort study Aradhana Thapa Chair of the Supervisory Committee: Research Professor, Annette L. Fitzpatrick Department of Family Medicine and Epidemiology Adjunct, Department of Global Health Aim: The study aims to identify the associated risk factors of repeat abortions and post-abortion contraceptive use among women in Pokhara city of Nepal. Background: Nepal legalized abortion in 2002 to promote safer motherhood (7). Safe abortion was attributed to be one of the contributing factors to a sharp decline of maternal mortality and morbidity in the country (9), however, abortion should not be considered an alternative to contraceptive use. Choosing abortions, repeatedly, can be detrimental to women and child health (11, 12). Post-abortion acceptance of contraception is low (41%) in the country and repeat abortion, high (33%) (8,11). Method: This is a prospective cohort study conducted among women who had just received an abortion procedure between January 2015 to April 2015 at three abortion clinics of Pokhara city in Nepal. We recruited 220 women immediately after their abortions to conduct a baseline interview and followed these in-person interviews with a telephone interview two months later to collect information on each woman’s current contraceptive method. Findings: The present study revealed that only half of the post-abortion women use effective contraception after abortion and there is a high prevalence of repeat abortion. The main factors positively influencing use of post-abortion contraception were presence of the woman’s husband in another country and choice of Tier II contraceptive methods. The main risk factors identified for repeat abortion were age and age at first pregnancy. Better educated women were less likely to adopt effective contraceptive measure after abortion. Conclusion: Considering low contraception use after abortion, increasing numbers of abortion, and high incidence of repeat abortion, a well targeted intervention may have substantial effect to reduce risk of unintended pregnancies.