Acceptability and uptake of immediate post abortion insertion of intrauterine contraceptive devices at Kenyatta National Hospital

Abstract

In Kenya, over 300000 abortions occur annually, most of which are thought to have been induced. Providing highly effective, long acting and rapidly reversible method of contraception such as an IUCD in the period immediately following abortion has the potential to decrease future unplanned pregnancies and prevent repeat abortions. Majority of women scheduled for interval insertion of IUCD do not return. However, it is unclear if women managed for abortion in Kenya who have little or no other contact with the formal healthcare system later on would use it. In Kenya, no study has been done to evaluate the acceptability of an IUCD as a method of contraception after an abortion. Objective The aim of this study was to determine acceptability and uptake of immediate insertion of an IUCD among patients managed for abortion at Kenyatta National Hospital. Methodology This was a hospital based descriptive cross-sectional study targeting women of reproductive age (18-49) years who were managed for abortion at Kenyatta National Hospital, the national teaching and referral hospital. Between 1st July and 15th October 2012, 159 women of reproductive age managed for abortion were enrolled. A written informed consent was obtained before data collection using a pretested structured questionnaire administered by research assistant. Data collected included socio-demographic characteristics, previous obstetric history, knowledge and willingness to use IUCD following termination of pregnancy. Women who reported willingness to use IUCDs were offered opportunity to have the IUCD inserted. Data was entered into a secure Microsoft Access Database and exported to SPSS version 20 software for analysis. Proportion of women willing to use IUCD and accept post-abortion insertion was determined. Categorical factors associated with willingness to use IUCD and acceptance of post-abortion insertion were identified using Chi-squared tests and Fisher’s exact tests for categorical variables and t-tests for continuous variables. Multivariate analysis was done to determine independent factors associated with willingness to use IUCD and with acceptability of post-abortion insertion of IUCD using multinomial logistic regression with variables identified to be significantly different (p<0.005) on univariate analysis. Results Of the 159 study participants, only 35(22%) accepted to use an IUCD. Of the 35 women reporting willingness to use IUCD, only 16 (10%) had the IUCD inserted (uptake) after the MVA. The mean age of the study participants who accepted to have IUCD was 26.9±SD5.8. Majority 30(85.7%) were married. Twenty-five (71.4%) had secondary school level or above level of education. Majority, 19(54.3%) had one or more living children. Ten (28.3%) did not desire the index pregnancy. The differences in socio-demographic and reproductive characteristics between those who accepted (acceptability) and those who declined to use IUCD were not statistically significant. Among those who had the IUCD inserted (uptake) and those who declined, there was no statistically significant difference in the socio-demographic and reproductive characteristic. Subjects who did not desire the index pregnancy were more likely to have the IUCD inserted. OR 9 (1.5 – 56.5), p=0.017. The most common reason cited for declined to use IUCD was safety and adverse effects concerns. Conclusion The results of this study suggest that the acceptance and uptake of immediate post abortion insertion of an IUCD is low as it faces many challenges in terms of negative perception among the women of reproductive age. Recommendations Immediate post abortion insertion of IUCD can be used as one of the innovative ways of reducing the gap in unmet contraception need among women managed for abortion who do not desire immediate future fertility. Health care providers offering post abortion care should incorporate provision of IUCD after receiving appropriate training as this will increase overall accessibility to the method. There is need to engage the public more and provide more accurate information concerning the safety of the IUCD as a mode of contraception.