Uptake of long-acting reversible contraceptive methods among women receiving post-abortion care in Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: In Kenya, 41.9% of all pregnancies are unintended and 14% of these end in unsafe abortions and about 3000 deaths annually, accounting for 8% of all maternal mortalities. The use of effective immediate post-abortion contraception such as long acting reversible contraceptives (LARC) reduces the number of subsequent unintended pregnancies, repeat abortions and maternal complications including deaths. Despite these benefits, its uptake in the immediate post abortion period remains low in Kenya. The actual uptake of post abortion LARC and factors that influence its choice in Moi Teaching and Referral Hospital (MTRH), Eldoret is unknown. Objectives: To determine the proportion of women in the immediate post abortion period who would choose LARC and the factors that influence their choice at Moi Teaching and Referral Hospital, Eldoret. Methods: A cross-sectional study where 526 women who received post abortion services between 1st of August 2021 and 28th of July 2022 in Faraja ward of MTRH were systematically sampled. Contraceptive counselling was done and the selected method issued. Data on sociodemographic, obstetric and family planning characteristics was collected using a structured interviewer administered questionnaire. Associations between these factors and uptake of LARC were tested on bivariate analysis using binary logistic regression, significance was accepted at a p value ≤ 0.05. Those found to be significant were fitted into the multivariate logistic regression model. Results: The proportion of women who chose a modern contraceptive method was 54.9% (289/526) with 19.2% (102/526) choosing LARC methods. The distribution of contraceptives chosen include 16% Depo Provera injection, 15.6% combined oral contraceptive pills, 15.2% progesterone contraceptive implants, 4% Intrauterine device (IUCD), 3% male condoms and bilateral tubal ligation (BTL) at 1.1%. Factors found to be significantly associated with LARC uptake were being unemployed {aOR 2.6 CI (1.51-4.64) p=0.001}, previous LARC use {aOR 3.53 CI (1.84-6.76) p<0.001}, desire to delay next pregnancy for 2 or more years (aOR 5.72 CI (2.68-12.16) p <0.001}, having boys or having both girls and boys as living children {aOR 2.92 CI (1.18-7.24) p=0.021} and belief that LARC offers long term contraception {aOR 3.61 CI (2.1-6.21) p<0.001}. Conclusion: Post abortion LARC uptake at MTRH is low compared to similar studies carried out in the region. Factors significantly associated with increased uptake of LARC include, belief that it offers long term contraception, gender of living children as either boys or both boys and girls, previous LARC use, being unemployed and desire to delay next pregnancy for 2 or more years. Recommendation: Routine contraceptive counselling on a wide range of available contraceptive methods including LARC for post abortion women. This may reduce missed opportunities and reduce the unmet need for family planning.