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      Contraceptive Use Before and After Abortion: A Cross‐Sectional Study from Nigeria and Côte d'Ivoire

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          Abstract

          Post‐abortion contraception enables women to effectively manage their fertility to prevent unintended pregnancies. Using data from population‐based surveys of women aged 15–49 in Nigeria and Côte d'Ivoire, we examined contraceptive dynamics immediately before and after an abortion and examined factors associated with these changes using multivariable logistic regressions. Covariates included sociodemographic characteristics, abortion source, post‐abortion contraceptive communication (wanting to and actually talking to someone about contraception after abortion), and perceived contraceptive autonomy. We observed higher contraceptive use after abortion than before abortion. In Nigeria, wanting to talk to someone about contraception post‐abortion was associated with increased adoption and decreased discontinuation, whereas talking to someone about contraception post‐abortion was associated with increased adoption. Obtaining care from a clinical abortion source was associated with increased adoption and decreased discontinuation. Both post‐abortion contraceptive communication variables were associated with post‐abortion contraceptive use in both countries, whereas clinical source was only associated with post‐abortion contraceptive use in Nigeria. Our findings suggest that ensuring that women have access to safe abortion as part of the formal health care system and receive comprehensive, high‐quality post‐abortion care services that include contraceptive counseling enables them to make informed decisions about their fertility that align with their reproductive goals.

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          Global causes of maternal death: a WHO systematic analysis.

          Lale Say, Doris Chou, Alison Gemmill … (2014)
          Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review. We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model. We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially. Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality. © 2014 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
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            Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model

            Bela Ganatra, Caitlin Gerdts, Clémentine Rossier … (2017)
            Summary Background Global estimates of unsafe abortions have been produced for 1995, 2003, and 2008. However, reconceptualisation of the framework and methods for estimating abortion safety is needed owing to the increased availability of simple methods for safe abortion (eg, medical abortion), the increasingly widespread use of misoprostol outside formal health systems in contexts where abortion is legally restricted, and the need to account for the multiple factors that affect abortion safety. Methods We used all available empirical data on abortion methods, providers, and settings, and factors affecting safety as covariates within a Bayesian hierarchical model to estimate the global, regional, and subregional distributions of abortion by safety categories. We used a three-tiered categorisation based on the WHO definition of unsafe abortion and WHO guidelines on safe abortion to categorise abortions as safe or unsafe and to further divide unsafe abortions into two categories of less safe and least safe. Findings Of the 55· 7 million abortions that occurred worldwide each year between 2010–14, we estimated that 30·6 million (54·9%, 90% uncertainty interval 49·9–59·4) were safe, 17·1 million (30·7%, 25·5–35·6) were less safe, and 8·0 million (14·4%, 11·5–18·1) were least safe. Thus, 25·1 million (45·1%, 40·6–50·1) abortions each year between 2010 and 2014 were unsafe, with 24·3 million (97%) of these in developing countries. The proportion of unsafe abortions was significantly higher in developing countries than developed countries (49·5% vs 12·5%). When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws. Interpretation Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; David and Lucile Packard Foundation; UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; Norwegian Agency for Development Cooperation.
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              U.S. Selected Practice Recommendations for Contraceptive Use, 2016

              Kathryn M Curtis, Tara C Jatlaoui, Naomi Tepper … (2016)
              The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.
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                Author and article information

                Contributors
                Sophia Magalona: cmagalo1@jhmi.edu
                Journal
                Journal ID (nlm-ta): Stud Fam Plann
                Journal ID (iso-abbrev): Stud Fam Plann
                Journal ID (doi): 10.1111/(ISSN)1728-4465
                Journal ID (publisher-id): SIFP
                Title: Studies in Family Planning
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0039-3665
                ISSN (Electronic): 1728-4465
                Publication date (Electronic): 20 July 2022
                Publication date (Print): September 2022
                Volume: 53
                Issue: 3 ( doiID: 10.1111/sifp.v53.3 )
                Pages: 433-453
                Affiliations
                [ 1 ] Sophia Magalona is a PhD student, Meagan Byrne is PMA Survey Operations Lead, Caroline Moreau is Associate Professor, and Suzanne O. Bell is Assistant Professor, Department of Population Family and Reproductive Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
                [ 2 ] Funmilola M. OlaOlorun is Senior Lecturer, Department of Community Medicine University of Ibadan Ibadan Oyo Nigeria
                [ 3 ] Rosine Mosso is Lecturer and Researcher École Nationale Supérieure de Statistique et d'Économie Appliquée Abidjan Côte d'Ivoire
                [ 4 ] Elizabeth Omoluabi is Managing Director, Centre for Research Evaluation Resources and Development Ile‐Ife Nigeria
                [ 5 ] Caroline Moreau is Epidemiologist, CESP Centre for Research in Epidemiology and Population Health INSERM (Institut National de la Santé et de la Recherche Médicale) Villejuif France
                Author notes
                [*] [* ]E‐mail: cmagalo1@ 123456jhmi.edu .

                Article
                Publisher ID: SIFP12208
                DOI: 10.1111/sifp.12208
                PMC ID: 9545736
                PubMed ID: 35856923
                SO-VID: 524d3c90-10e1-443d-a7fc-25d0659932b9
                Copyright © © 2022 The Authors. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 2, Tables: 4, Pages: 21, Words: 9777
                Categories
                Subject: Article
                Subject: Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date September 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

                Keywords: abortion,contraception,family planning
                Data availability:
                Keywords: abortion, contraception, family planning

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