Objectives: In 2005, the Ethiopian Parliament expanded the indication for legal abortion to reduce maternal mortality from unsafe abortion. Contraceptive uptake postabortion is a key element of quality abortion care to reduce unintended pregnancy. As part of ongoing quality improvement in Ipas- supported sites providing comprehensive abortion care, we reviewed contraceptive acceptance in relation to uterine evacuation method and client characteristics and surveyed providers regarding their postabortion contraceptive practices.
Methods: We performed a retrospective review of logbook data from 407 Ipas-supported facilities in five regions in Ethiopia from July to December 2012. Providers (n=147)in selected facilities answered a questionnaire about postabortion contraceptive practices.
Results: In total, 30,272 uterine evacuations were performed: 19,506 (64.4%) were medical abortions and 10,323 (34.1%) were vacuum aspirations. The majority of women (85.3%) received contraception postabortion. Women were more likely to receive short-acting methods after medical abortion than after vacuum aspiration (71.0% vs. 64.2%, p<.001). In both groups, the use of implants was similar (23.8% vs. 24.4%, p=.3), but intrauterine device (IUD) placement was lower among women who had a medical abortion (5.1% vs. 11.3%, p<.001). Most providers (82.3%) reported concerns regarding the possibility of incomplete abortion with medical abortion and IUD use but were comfortable with other methods.
Conclusions: Overall, contraceptive uptake was high. We found higher use of short-acting methods and lower use of IUDs after medical abortion. Addressing provider concerns, combining counseling on uterine evacuation method choice with contraceptive counseling and improving IUD access during medical abortion follow-up may increase the use of more effective contraceptive methods.