Postabortion Contraceptive Acceptance Rate and Its Determinants among Women Receiving Abortion Service before Discharge from the Health Facilities in Harar, Eastern Ethiopia

Background. Annually, around 121 million unintended pregnancies occur in the world and more than 73 million encountered abortion. Ethiopia is also losing 19.6% of mothers due to unsafe abortion. Despite that postabortion contraceptive service is a climactic entry point for the prevention of unwanted pregnancy and associated deaths, the service magnitude and determinants immediately before discharge are not characterized well in Ethiopia. Hence, this study aimed to assess the magnitude of postabortion contraceptive utilization and associated factors among women receiving abortion care service before being discharged from health facilities in Harar, Eastern Ethiopia. Methods. A facility-based cross-sectional study was conducted among 390 women receiving abortion care services. At discharge, data about contraceptive acceptance and related maternal characteristics were collected. A binary logistic regression model was used to assess the association between independent and dependent variables (postabortion contraceptive utilization). Analysis was done with SPSS 22. Statistical significance was considered at P < 0.05 . Result. The overall prevalence of postabortion contraceptive utilization was 81.5% (95% CI: 77.9, 85.4). Being unmarried (AOR, 0.05; 95% CI (0.02, 0.16)), having no history of previous abortion (AOR, 0.11; 95% CI (0.04, 0.34)), being multigravida (AOR 8.1; 95% CI (2.20, 13.40), lacking desire to have an additional child (AOR, 6.3; 95% CI (2.65, 15.34), and history of family planning use (AOR, 17.20; 95% CI (6.5, 38.60)) were determinants of postabortion contraceptive utilization before being discharged from the health facilities. Conclusion. Postabortion contraceptive utilization in Harar health facilities still needs improvement as per the WHO and national recommendations. Therefore, the family planning provision strategies should be convincing and friendly, especially for unmarried mothers, and those who had no history of abortion should be counseled in friendly and systematically convincing schemes for enabling them to take the service before discharge from the health facility.

The STress-And-coping suppoRT Intervention (START) for Chinese Women Undergoing Abortion: a Randomized Controlled Trial Protocol

Background:Undergoing an abortion is stressful. This protocol aims to assess the feasibility, acceptability, and primary effects of a complex intervention to promote positive coping behaviors and alleviating depression symptoms among Chinese women undergo abortion.Methods:A two-arm randomized controlled trial design will be used. Participants will be recruited at their first appointment with the abortion clinic, those who consent to participate will be randomly allocated to receive either the START intervention (in addition to standard abortion care) or standard care only. All participants will receive survey follow-up until six weeks post-abortion. Ethical has been granted by local and university ethics committees. This research was supported by an Australian Government Research Training Program (RTP) Scholarship Discussion:Results will assist refinement and further evaluations of the START intervention, contribute to improved abortion care practices in China, and enrich the literature evidence on improving women’s psychological well-being following abortion in ChinaTrial registration: Registered at the Chinese Clinical Trials.gov: ChiCTR2100046101. Date of registration: May 4, 2021

‘Others Will Even Call us Terminators’: Barriers and Facilitators to Provision of Comprehensive Abortion Care (Cac) in Zambia – A Qualitative Study

Background:It is estimated that one in every five pregnancies globally ends up as abortion, with about 40% being unsafe. Abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC), which aims to provide high quality, safe and affordable services to women, unsafe abortions rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia.Materials and methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August, 2021 in nine selected public health facilities of Zambia. A total of 17 interviews were conducted with participants purposively sampled. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed a number of barriers and facilitators most of which are health system related. The health system related barriers included inadequate CAC providers, healthcare provider perception that provision of CAC was optional, lack of CAC dedicated space and privacy, frequent shortages of medical supplies and lack of incentives, while individual related barriers included stigma surrounding CAC provision, religious and moral dilemmas. Facilitators to CAC provision included having providers trained and mentored in CAC, availability of a liberal legal framework, accessible services, task shifting and external financial support. Conclusions: The findings of this study on the several barriers of CAC reinforces the idea that despite having appropriate legal provisions to CAC provision in Zambia, challenges in the implementation of the law and related service provision continue to persist. The identified barrriers suggests to consider incorporating CAC services into the pre-service training to ensure more trained and skilled providers are available in the public facilities.

The effect of post-abortion care (PAC) on anxiety in women with spontaneous abortion based on MicroRNA-21 expression, cortisol level, and Fordyce happiness pattern

Abortion is one of the most common complications in pregnancy, and the cause of its occurrence in many cases remains unknown. The high prevalence and consequences of anxiety in women with spontaneous abortion could highlight the importance and role of post-abortion care (PAC). Detection and identification of biomarkers related to abortion and anxiety can effectively diagnose and prevent complications. Among the known biomarkers, microRNAs and the cortisol level have high potential. Therefore, the present study evaluated the effect of post-abortion care (PAC) on anxiety in women with spontaneous abortion based on MicroRNA-21 expression, cortisol level, and Fordyce happiness pattern. In this randomized clinical trial, 72 women with spontaneous abortion were studied and randomly divided into two groups of intervention (n = 36) and control (n = 36). Data were collected through a demographic questionnaire and HADS. To assess PAC, the intervention group was consulted in 8 sessions of 60 minutes in the first 72 hours after abortion. Meetings were held twice a week for four weeks. Both groups were followed up immediately after and one month after the intervention. To evaluate biological factors, 4ml of blood sample was obtained from the subjects. Blood cortisol levels were measured by the Cortisol Competitive Human ELISA Kit (Thermo-Fisher, USA), and microRNA-21 evaluation was performed by Real-time PCR technique. Data were analyzed using SPSS16 software. Results showed that before the intervention, there was no significant difference in the mean score of anxiety between the control and intervention groups (P> 0.05); But at the time immediately and one month after the intervention, there was a significant difference in the mean score of anxiety (p <0.001). The results of biological factors evaluation showed that in the intervention group, serum cortisol levels and microRNA-21 expression decreased significantly (p <0.05). In general, PAC based on the happiness pattern can control the anxiety of women with spontaneous abortion. Therefore, it is recommended as an effective and non-invasive intervention in preventing women's psychological problems after spontaneous abortion.

Abortion care-seeking and reproductive rights violation in health facilities: evidence from six states of India

Background: Unsafe abortion continues to draw the researcher's attention due to its close association with maternal morbidity and mortality. Empirical evidence on the role of health facilities in providing safe abortion care addressing the reproductive rights of Indian women is limited.Methods: Using data from the 2015 ‘unintended pregnancy and abortion in India’ study, the present paper aimed to understand the violation of the reproductive rights of abortion care seekers in health facilities (n=4001) in six states of India. The health facilities were sampled using a stratified random sampling strategy. Univariate and bivariate analysis was carried out using SPSS (V 25) on cleaned and weighted data.Results: A sizeable percentage of public and private health facilities across states found seeking the consent of the husband or family members before abortion provision, compel women to adopt contraception and turn away abortion seekers, commonly citing non-medical reasons. The provision of post-abortion complications services is usually not 24/7, even at the primary health centre level, hindering access to an urgent health care need.Conclusions: There is a need to improve access to facility-based abortion services, especially in underserved rural areas, by ensuring that all public-sector facilities have adequate equipment and supplies, including MMA drugs and trained providers. Sensitization of health care providers about the importance of ethical issues and women’s reproductive rights is urgently required to ensure safe, legal, and accessible abortion care.

Impact of contraceptive counselling, an essential element of post-abortion care, on uptake of contraceptives: a cross-sectional study of adolescents who received post-abortion care services in Makueni County, Kenya

Background: Contraceptive counselling and provision of contraceptives are essential elements of the post-abortion care model which was first published in 1994 with an aim of promoting post-abortion care as an effective public health strategy. Despite being core elements of this model, they are often overlooked during provision of post-abortion care services as health care workers focus on emergency services and removing the retained products of conception. The aim of this study was to assess the impact of contraceptive counselling on uptake of contraceptives among adolescents presenting for post-abortion care.Methods: A cross-sectional study involving 100 adolescent girls who presented for post-abortion care at the Kibwezi-east sub-county hospital, Makueni county, Kenya. Self- administered questionnaires were used for data collection and data was analyzed using SPSS version 25. Chi-square was used to compare study participants who received/did not receive contraceptive counselling and their uptake of contraceptives.Results: The mean age of the 100 participants was 17 years (SD=1.457). 98% of them were formally educated, 57% had the mother as their only guardian and majority of them were of Christian religion (56%). 41% (n=41) received contraceptive counselling services and 59% (n=59) were not counselled. Among the 41 participants who received contraceptive counselling, 92% (n=37) of them took up a contraceptive method and 8% (n=4) did not take up any method and among the 59 participants who did not receive contraceptive counselling, 51% (n=30) of them took up a contraceptive method while 49% (n=29) did not.Conclusions: Contraceptive counselling remains an integral part of post abortion care and in this study it was found to have a positive correlation with utilization of post abortion contraceptives (rs=0.412, p=0.000).