Contraceptive use and choice following abortion and associated factors among female youth in Nakawa and Kawempe Divisions, Kampala - Uganda

Abstract

Back ground: In Uganda, female youth are most prone to unintended pregnancies. These result into unsafe clandestine abortions because of their ill preparedness for the consequences and the country’s restrictive abortion legislature. It is important that contraceptive counseling and methods services are accepted by these youth following an abortion. Unfortunately, there is paucity of data on acceptance and choice of post abortion contraceptives among female youth. Objective: To determine the acceptance level, choice of contraceptive methods and associated factors among female youth receiving post abortion care at health facilities in Nakawa and Kawempe divisions, Kampala. Methodology: This descriptive cross sectional study was conducted in Kawempe general referral hospital and Naguru China Uganda friendship hospital in Kampala in May and June 2018. Data were collected from female youth receiving post abortion care, using both quantitative and qualitative techniques. The study determined acceptance levels and most preferred contraceptives. Prevalence ratios (PRs) with their corresponding 95% confidence intervals were used as measures of association between contraceptive acceptance, choice and associated factors. The PRs were obtained via a “modified” Poisson regression model using a generalized linear model. All quantitative analyses were conducted in Stata version 14. Thematic content analysis was used to analyse reasons for the choice of particular contraceptives. Results: Four key informants and 396 female youth participated in the study; mean age for youth (SD) was 21 (2.44). Majority were married 65.7%, Catholic 31.6%, Baganda 41.4%, unemployed 35.6%, with Secondary as the maximum attained education level 52.5%. Most youth had parity of 1 or more children 41.7%, 60.1 % had no previous abortions and had spontaneous abortions 70.4%. Eight out of ten were counseled about family planning. Of these, 87.6% were interested in information given to them about FP methods. Nearly all were told about methods (95.5%) and 97.9% were aware about FP prior to the visit for Post Abortion Care (PAC). Most of the youth (26.5%) reported that their source of awareness about FP methods prior to the visit was by a health worker. The acceptance level was 77.5% and the most chosen method was the injectable (47.1%). Factors associated with acceptance of a contraceptive following an abortion were: interest in being told about FP methods, having > 1 living child and attendance at Kawempe general referral hospital. Attendance at Kawempe general referral hospital was associated with selecting a short acting contraceptive. Reasons behind the selection of the different contraceptives during Post Abortion Care by the youth were summarised under four themes: - contraceptives with positive attributes, convenience in use, highly recommended by others, availability of method. Conclusions: A high prevalence of post abortion contraception acceptance among female youth in Kampala was demonstrated. Having one or more living children, interest in being told about FP methods and attendance at Kawempe General Referral Hospital were independent predictors of post abortion contraceptive acceptance. The most preferred post abortion contraceptive for these youth was the injectable. Attendance at Kawempe General Referral Hospital was the independent predictor for the choice of a short acting post abortion contraceptive. Reasons behind the selection of the different contraceptives during Post Abortion Care by the youth were: bearable side effects, cost effectiveness, long acting method, can be used stealthily, stock outs and recommendations from health workers, peers and older women.