The Uptake of Modern Contraceptive Methods Among Clients of Post-Abortion Care Services in Urban Guinea
Central African Journal of Public Health
Volume 5, Issue 5, October 2019, Pages: 203-211
Received: Jul. 11, 2019;
Accepted: Aug. 7, 2019;
Published: Aug. 26, 2019
Views 165 Downloads 53
Tamba Mina Millimouno, Research Unit, National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
Alexandre Delamou, Research Unit, National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea; Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
Sidikiba Sidibé, Research Unit, National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea; Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
Delphin Kolie, Research Unit, National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
Jean Pierre Leno, Health District of Lelouma, Lelouma, Guinea
Thérèse Delvaux, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
Yolande Hyjazi, Department of Gynecology and Obstetrics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea; Johns Hopkins Program for International Education in Gynecology and Obstetrics (Jhpiego), Conakry, Guinea
In West Africa, there are limited data on the uptake of modern contraceptive methods among post-abortion care (PAC) clients. This study aimed at describing the knowledge, attitudes and practices of PAC clients towards modern contraceptive methods and identifying the factors associated with the uptake of long-acting contraceptive methods in Guinea. We conducted a cross-sectional study from March to August 2014 with a sample of 426 PAC clients in two communal medical centres in Conakry. Data were collected using a structured questionnaire and analysed using Stata software, version 14. A logistic regression was conducted to identify the factors associated with the uptake of long-acting contraceptive methods. Overall 45,5 % were students, and among them, 66.9% had a secondary or higher level of education. Among the respondents 21,8% had a history of abortion. Induced abortion (83.6%) was the most common type of abortion leading women to seek PAC services. Most of clients (73.6%) had previously heard about family planning (FP), either at school (42.7%), in a health facility/pharmacy (26.5%) or in the neighbourhood (5.9%). Among them, only 34% had used a contraceptive method in the last six months prior to the PAC visit. However, 79.1% of the sample had an unmet need for FP. During the PAC visit, 86.6% of women expressed a desire to postpone any pregnancy in the next 12 months. Overall, 388 women (91.1%) adopted a modern contraceptive method. Most of women (n=375; 96.6%) obtained the chosen contraceptive method before discharge. The intra-uterine device (IUD) was the preferred contraceptive method for women (n=130; 34.7%) followed by implants (n=107; 28.5%). Having a history of abortion (OR= 2.5; CI= 1.3-4.7) and a non-desire for pregnancy in the following 12 months (OR= 4.8; CI= 2.0-11.5) were the factors statistically significantly associated with the uptake of long-acting contraceptive methods. In our context, induced or unsafe abortion mainly concerned students. There is a need to improve the uptake of contraceptive methods, especially among students and intensify awareness on the consequences of unsafe abortion among youths.
Tamba Mina Millimouno,
Jean Pierre Leno,
The Uptake of Modern Contraceptive Methods Among Clients of Post-Abortion Care Services in Urban Guinea, Central African Journal of Public Health.
Vol. 5, No. 5,
2019, pp. 203-211.
Kassebaum, Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sept; 384 (9947): 980–1004.
L. B. Finer and M. R. Zolna, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374 (9): 843–852, doi: 10. 1056/NEJMsa1506575.
G. Sedgh, J. Bearak, S. Singh, A. Bankole, A. Popinchalk, B. Ganatra et al., Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016 July 16; 388 (10041): 258–267.
B. Ganatra, C. Gerdts, C. Rossier, B. R. Johnson, Ö. Tunçalp, A. Assifi, et al., Articles Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017; 390 (1016).
L. Say, D. Chou, A. Gemmill, Ö. Tunçalp, A. B. Moller, J. Daniels, et al., Articles Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal. 2014; 2: e323–33.
Guttmacher institute. Adding it up: Investing in Contraception and Maternal and Newborn Health, 2017. Available at: https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-2017. Accessed on 24/01/2019.
W. Graham, S. Woodd, P. Byass, V. Filippi, G. Gon, S. Virgo, et al., Diversity and divergence: the dynamic burden of poor maternal health. Lancet. September 15, 2016. S0140-6736 (16): 31533-1.
Jhpiego, Evaluation des soins après avortement en Guinée, Juillet 2007.
F. F. Fikree, S. Mugore and H. Forrester, Soins après avortement: Evaluation des services des soins après avortement dans quatre pays de l'Afrique francophone de l'Ouest (Washington, DC: Projet Evidence to Action, June 2014).
D. R. Sarah, S. K. M. Emmanuel and J. Lori, Post-abortion contraception choices of women in Ghana: A oneyear review. Glob Public Health. 2015; 10 (3): 345–353.
L. Maxwell, G. Voetagbe, M. Paul and A. Mark, Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana. Maxwell et al. BMC Public Health. 2015; 15: 586.
O. E. Loeber and M. E. Muntinga, Contraceptive counselling for women with multiple unintended pregnancies: the abortion client's perspective. Eur J Contracept Reprod Health Care. 2017 Apr; 22 (2): 94-101.
Institut National des Statistiques, Enquête Démographique et de Santé, Guinée 2012.
Institut National de la Statistique, Enquête par grappes à indicateurs multiples (MICS): Rapport final. Conakry, Guinée: Institut National de la Statistique; 2016. Available at: https://mics-surveys-prod.s3.amazonaws. com/MICS5/West%20and%20Central%20Africa/Guinea/2016/Final/Guinea%202016%20MICS_French. pdf. Accessed on 8th March 2018.
J. Tripney, I. Kwan and K. Bird, Postabortion family planning counseling and services for women in low-income countries: a systematic review. Contraception. 2013; 87 (1): 17-25.
WHO, Safe abortion: technical and policy guidance for health systems, Second edition, 2012. Available at: http://apps.who int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1. Accessed on 6th October 2018.
WHO, Health worker roles in providing safe abortion care and post-abortion contraception, 2015. Available at: http://apps.who.int/iris/bitstream/10665/181041/1/9789241549264_eng.pdf?ua=1&ua=1. Accessed on 6th October 2018.
S. Suh, “Right tool,” wrong “job”: Manual vacuum aspiration, postabortion care and transnational population politics in Senegal. Soc Sci Med. 2015 June; 135: 56–66.
S. Drabo, Access to Post Abortion Care (PAC) in Burkina Faso: an ethnographic study. June 2013 (Thesis). Available at: https://www.duo.uio.no/bitstream/handle/10852/36107/SeydouxDrabo.pdf?sequence=1&isAllowed=y Accessed on 19 October 2018.
Jhpiego, Stratégie de renforcement de la composante PF dans les SAA en Guinée: SAGO, Niamey 21-25 Janvier 2013, 8p
Institut National de la Statistique, Récensement Général de la Population et de l'Habitation (RGPH). Guinée: Institut National de la Statistique. Avril 2014. Available at: http://www.ins.ci/n/documents/RGPH2014_expo_dg.pdf. Accessed on: 15th April 2018.
C. Curtis, D. Huber and T. Moss-Knight, Planification familiale après avortement: rompre le cycle des grossesses non planifiées et avortements répétés, 2011. Available at: https://www.guttmacher.org/sites/default/files/article_files/3703111f.pdf. Accessed on 2nd September 2018.
Ministère de la Santé, Plan d'action national pour repositionnement de la planification familiale en Guinée, 2014 - 2018. Guinée, 2014.
G. Hagos, G. Tura, G. Kahsay, K. Haile, T. Grum and T. Araya, 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 Women's Health. 2018; 18: 83.
A. Delamou, K. Koivogui, D. Dubourg and T. Delvaux, Family planning in Guinea: a need for better public commitment. Tropical Medicine and International Health. January 2014; volume 19 no 1 pp 65–73.
F. F. Fikree, S. Mugore and H. Forrester, Renforcement de la planification familiale après avortement en Guinée, appui technique continu (Washington, DC: Evidence to Action Project, Janvier 2014).
WHO, Ensuring human rights in the provision of contraceptive information and services. Geneva: World Health Organization, 2014. Available a: (http://apps.who.int/iris/bitstream/10665/102539/1/9789241506748_eng.pdf. Accessed on 20th June 2015).
USAID, Pratiques à Haut Impact dans la Planification Familiale (HIP), Planification familiale après avortement: renforcer la composante de planification familiale dans les soins après avortement. Washington: USAID, November. 2012. Available at: www.fphighimpactpractices.org/resources. Accessed on 30th July 2018.
S. Staveteig, Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana. PLOS ONE. July 31, 2017; 12 (7): e0182076.
J. K. Wulifan, S. Brenner, A. Jahn and M. Manuela De Allegri, A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. Wulifan et al. BMC Women's Health. 2016; 16: 2.
M. A. Lamina, Prevalence and determinants of unintended pregnancy among women in South-Western Nigeria. Ghana Medical Journal. Sep2015, Vol. 49 Issue 3, p187-194. 8p.
OMS, Planification familiale: un manuel à l’intention des prestataires de services du monde entier. 2011. p109-133.
Y. B. Amanda, G. Edith, H. Fareen and C. Ismini, The cost of unintended pregnancies in canada: estimating direct cost, role of imperfect adherence, and the potential impact of increased use of long-acting reversible contraceptives. J Obstet Gynaecol Can. 2015; 37 (12): 1086–1097.
A. Delamou, G. Samandari and B. S. Camara, Prevalence and correlates of intimate partner violence among family planning clients in Conakry, Guinea. BMC Res Notes. 2015; 8: 814.
A. Bajracharya, Knowledge, Attitude and Practice of contraception among postpartum women attending Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J (KUMJ). 2015 Dec; 13 (52): 292-7.
E. O'Neill, J. Tang, J. Garrett and D. Hubacher, Characteristics of Kenyan women in a prospective cohort study who continue using subdermal contraceptive implants at 12 months. Contraception. 2014 Mar 89 (3): 204-8.
E. Von Elm, D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche and J. P. Vandenbroucke, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.