Although it is well known that post-abortion contraceptive
use is high when family planning services are provided following spontaneous or
induced abortions, this relationship remains unclear in Brazil and similar
settings with restrictive abortion laws. Our study aims to assess whether
contraceptive use is associated with access to family planning services in the
six-month period post-abortion, in a setting where laws towards abortion are
highly restrictive.
This prospective cohort study recruited 147 women
hospitalized for emergency treatment following spontaneous or induced abortion
in Brazil. These women were then followed up for six months (761 observations).
Women responded to monthly telephone interviews about contraceptive use and the
utilization of family planning services (measured by the utilization of medical
consultation and receipt of contraceptive counseling). Generalized Estimating
Equations were used to analyze the effect of family planning services and other
covariates on contraceptive use over the six-month period post-abortion.
Women who reported utilization of both medical consultation
and contraceptive counseling in the same month had higher odds of reporting
contraceptive use during the six-month period post-abortion, when compared with
those who did not use these family planning services [adjusted aOR = 1.93,
95 % Confidence Interval: 1.13–3.30]. Accessing either service alone did
not contribute to contraceptive use. Age (25–34 vs. 15–24 years) was also
statistically associated with contraceptive use. Pregnancy planning status,
desire to have more children and education did not contribute to contraceptive
use.
In restrictive abortion settings, family planning services
offered in the six-month post-abortion period contribute to contraceptive use,
if not restricted to simple counseling. Medical consultation, in the absence of
contraceptive counseling, makes no difference. Immediate initiation of a
contraceptive that suits women’s pregnancy intention following an abortion is
recommended, as well as a wide range of contraceptive methods, including
long-acting reversible methods, even in restrictive abortion laws contexts.
Table 1
Demographic characteristics of all participants, of participants who used contraception, and of participants who reported a pregnancy. Sao Paulo, 2012
| Variables | All participants | Participants who used contraception | Participants who reported pregnancy |
|---|
| Time Point | Time Point | Time Point |
|---|
| Month 1 | Month 6 | Month 1 | Month 6 | Endline |
|---|
| Mean age (years) | 29.1 (7.4) | 29.6 (7.3) | 29.5 (6.8) | 29.7 (7.4) | 26.8 (6.9) |
| Mean age at first intercourse (years) | 17.2 (2.9) | 17.4 (2.9) | 17.2 (3.1) | 17.4 (2.8) | 16.9 (1.9) |
| Mean age at first pregnancy (years) | 21.7 (5.2) | 21.9 (5.1) | 22.0 (4.9) | 21.7 (5.0) | 20.7 (5.1) |
| Mean number of previous pregnancies | 2.5 (1.4) | 2.5 (1.4) | 2.6 (1.4) | 2.6 (1.5) | 2.3 (1.1) |
| Mean educational level (years) | 9.3 (2.5) | 9.5 (2.5) | 9.5 (2.6) | 9.3 (2.6) | 9.8 (1.4) |
| Color (%) | | | | | |
| White | 49.6 | 55.2 | 50.6 | 52.9 | 47.1 |
| Brown | 45.6 | 40.0 | 47.1 | 44.7 | 52.9 |
| Black | 4.8 | 4.8 | 2.3 | 2.4 | - |
| Religion (%) | | | | | |
| Catholic | 43.5 | 43.8 | 46.0 | 45.9 | 35.4 |
| Protestant | 32.7 | 35.2 | 31.0 | 34.1 | 29.4 |
| Other | 6.1 | 5.7 | 6.9 | 5.9 | 17.6 |
| None | 17.7 | 15.3 | 16.1 | 14.1 | 17.6 |
| Employed (%) | 59.9 | 60.9 | 64.4 | 58.8 | 58.8 |
| Current living with partner (%) | 76.9 | 76.2 | 82.8 | 74.1 | 88.2 |
| Desire to have more children (%) | 66.7 | 66.7 | 70.1 | 66.5 | 76.5 |
| Previous pregnancy plan (%) | | | | | |
| Planned | 29.9 | 31.4 | 29.9 | 27.1 | 41.2 |
| Ambivalent | 49.0 | 49.5 | 50.6 | 50.6 | 35.3 |
| Unplanned | 21.1 | 19.1 | 19.5 | 22.3 | 23.5 |
| Total number of women | 147 | 105a | 87 | 85 | 17 |
Standard deviation (sd) in parentheses
anot included 17 women who reported a pregnancy
Below: Utilization of medical consultation and receipt of contraception counseling reported by study respondents over a 6-month period post-abortion, by month. Sao Paulo, 2012
Below: Percent of study respondents using contraception over the six-month post-abortion period, by month. Sao Paulo, 2012
Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria
Department of Maternal, Child and Psychiatric Care, University of São Paulo School of Nursing, São Paulo, Brazil
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 419, cep 05403-000 São Paulo, Brazil
Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil
