Is There a Relationship between Repeat Induced Abortion and Current Use of Contraception among Women in the Reproductive Age? A Study in Ghana

Main Article Content

Michael Boah
Timothy Adampah
Dominic Achinkok

Abstract

Aims: Some women in the developing world use abortion to regulate fertility and space childbearing. However, repeat induced abortion has become common and it’s linked to increased risk of adverse outcomes in future pregnancies. The aim of this study was to determine the relationship between repeat induced abortion and current use of contraception among women in Ghana.

Study Design: A secondary analysis of cross-sectional survey data.

Place and Duration of Study: The study was conducted in Ghana between July 2019 and August 2019.

Methodology: Data on a weighted sample of 4595 women aged 15-49 years with a lifetime history of induced abortion from the 2017 Ghana Maternal Health Survey were analysed using Chi-square (χ2) test and multivariable survey logistic regression in STATA/IC 15.0. Statistical significance was set at the 5% level. The adjusted odds ratio was estimated.

Results: Out of 4595 women, 1591 (34.6%) experienced repeat-induced abortion. Current use of contraception was 36.7% (CI: 34.7-38.7). The majority used modern contraceptives (78%). The commonly used methods were injectables (20.3%), implants (19.7%), pills (16.6%) and rhythm (16.2%). After adjusting for potential confounding, repeat induced abortion was not significantly associated with current use of contraception. However, age, marital status, place of residence and ecological zone of residence were associated with current use of contraception. For instance, rural women with a history of repeat induced abortion were 1.3 times (AOR=1.27, 95% CI: 1.02-1.59, p=0.036) more likely to be on contraception compared to urban women.

Conclusion: Women’s previous abortion experience was not independently associated with their current use of contraception. Other factors were significantly associated with women’s use of contraception post-abortion. Further research is recommended to clearly understand this phenomenon among Ghanaian women in the reproductive age group.

Keywords:
Associated, contraception, reproductive, women, induced abortion, Ghana.

Article Details

How to Cite
Boah, M., Adampah, T., & Achinkok, D. (2019). Is There a Relationship between Repeat Induced Abortion and Current Use of Contraception among Women in the Reproductive Age? A Study in Ghana. Asian Journal of Pregnancy and Childbirth, 2(2), 1-11. Retrieved from http://journalajpcb.com/index.php/AJPCB/article/view/30099
Section
Original Research Article

References

Ganatra B, Gerdts C, Rossier C, Ronald B, Jr J, Tunçalp Ö, et al. Global, regional, and subregional classification of abortions by safety, 2010 – 14 : Estimates from a Bayesian hierarchical model. Lancet. 2017;390:2372–81.
DOI: 10.1016/S0140-6736(17)31794-4

Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: Global, regional, and subregional levels and trends. Lancet. 2016;6736:30380–4.
DOI: 10.1016/S0140-6736(16)30380-4

Chae S, Desai S, Crowell M, Sedgh G, Singh S. Characteristics of women obtaining induced abortions in selected low- and middle-income countries. PLoS One. 2017;12:e0172976.

Chae S, Desai S, Crowell M, Sedgh G. Reasons why women have induced abortions: A synthesis of findings from 14 countries. Contraception. Elsevier Inc. 2017;96:233–241.
DOI: 10.1016/j.contraception.2017.06.014

Rominski SD, Lori JR. Abortion care in Ghana: A critical review of the literature. Afr J Reprod Health. 2014;18:17–35.
DOI: 10.1111/jmwh.12243

Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet. Elsevier Ltd. 2012;380:111–125.
DOI: 10.1016/S0140-6736(12)60478-4

Ghana Statistical Service, Ghana Health Service, ICF International. Ghana Demographic and Health Survey, 2014. Rockville, Maryland, USA; 2015.

Ghana Health Service. Prevention & management of unsafe abortion: Comprehensive abortion care services standards and protocols. Accra; 2012.

Boah M, Bordotsiah S, Kuurdong S. Predictors of unsafe induced abortion among women in Ghana. J Pregnancy. 2019;2019:1–8.
DOI: 10.1155/2019/9253650

Heikinheimo O, Gissler M, Suhonen S. Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion. Contraception. 2008;78: 149–154.
DOI: 10.1016/j.contraception.2008.03.013

Achana FS, Bawah AA, Jackson EF, Welaga P, Awine T, Asuo-Mante E, et al. Spatial and socio-demographic determinants of contraceptive use in the Upper East region of Ghana. Reprod Health. 2015;12:29.
DOI: 10.1186/s12978-015-0017-8

Apanga PA, Adam MA. Factors influencing the uptake of family planning services in the Talensi district, Ghana. Pan Afr Med J. 2015;20:1–9.
DOI: 10.11604/pamj.2015.20.10.5301

Beson P, Appiah R, Adomah-Afari A. Modern contraceptive use among reproductive-aged women in Ghana: Prevalence, predictors, and policy implications. BMC Women's Health. 2018;18:157.
DOI: 10.1186/s12905-018-0649-2

Crissman HP, Adanu RM, Harlow SD. Women’s sexual empowerment and contraceptive use in Ghana. Stud Fam Plann. 2012;43:201–212.
DOI: 10.1111/j.1728-4465.2012.00318.x

Nonvignon J, Novignon J. Trend and determinants of contraceptive use among women of reproductive age in Ghana. African Popul Stud. 2014;28:956–967.

Morris N, Prata N. Abortion history and its association with current use of modern contraceptive methods in Luanda, Angola. Open Access J Contracept. 2018;9:45– 55.
DOI: 10.2147/oajc.s164736

United Nations, Department of Economics and Social Affairs, Population Division. Trends in contraceptive use worldwide 2015. New York; 2015.
Available:www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf

Marston C, Cleland J. Relationships between contraception and abortion: A review of the evidence. Int Fam Plan Perspect. 2003;29:6-13.

Ghana Statistical Service, Ghana Health Service, ICF. Ghana Maternal Health Survey 2017. Accra, Ghana; 2018.
Available:www.dhsprogram.com/publications/publication-fr340-other-final-reports.cfm

Demographic and Health Survey. Guide to DHS statistics. Demographic and Health Surveys Methodology. Rutstein SO, Rojas G, Editors. Calverton, Maryland, Maryland, USA: Demographic and Health Surveys, ORC Macro; 2006.

Archer KJ, Lemeshow S. Goodness-of-fit test for a logistic regression model fitted using survey sample data. Stata J. 2006;6: 97–105.
DOI:https://www.stata-journal.com/sjpdf.html?articlenum=st0099

Rogers C, Dantas JAR. Access to contraception and sexual and reproductive health information post-abortion: A systematic review of literature from low- and middle-income countries. J Fam Plan Reprod Heal Care. 2017;43:309–318.
DOI: 10.1136/jfprhc-2016-101469

Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Glob Public Health. 2018;13:35–50.
DOI: 10.1080/17441692.2016.1174280

Blanc AK, Grey S. Greater than expected fertility decline in Ghana: Untangling a puzzle. J Biosoc Sci. 2002;34:475–495.
DOI: 10.1017/s0021932002004753

Tekelab T, Melka AS, Wirtu D. Predictors of modern contraceptive methods use among married women of reproductive age groups in Western Ethiopia: A community based cross-sectional study. BMC Women's Health. 2015;15:52.
DOI: 10.1186/s12905-015-0208-z

Islam AZ, Mondal MNI, Khatun ML, Rahman MM, Islam MR, Mostofa MG, et al. Prevalence and determinants of contraceptive use among employed and unemployed women in Bangladesh. Int J MCH AIDS. 2016;5:92–102.
DOI: 10.21106/ijma.83

Mandiwa C, Namondwe B, Makwinja A, Zamawe C. Factors associated with contraceptive use among young women in Malawi: Analysis of the 2015–16 Malawi demographic and health survey data. Contraception and Reproductive Medicine. 2018;3:12.
DOI: 10.1186/s40834-018-0065-x

Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20:25–34.
DOI: 10.1093/heapol/czi003

Aviisah PA, Dery S, Atsu BK, Yawson A, Alotaibi RM, Rezk HR, et al. Modern contraceptive use among women of reproductive age in Ghana: Analysis of the 2003-2014 Ghana Demographic and Health Surveys. BMC Women's Health. 2018;18:141.
DOI: 10.1186/s12905-018-0634-9

Bakibinga P, Matanda DJ, Ayiko R, Rujumba J, Muiruri C, Amendah D, et al. Pregnancy history and current use of contraception among women of reproductive age in Burundi, Kenya, Rwanda, Tanzania and Uganda: Analysis of demographic and health survey data. BMJ Open. 2016;6.
DOI: 10.1136/bmjopen-2015-009991

Creanga AA, Gillespie D, Karklins S, Tsui AO. Low use of contraception among poor women in Africa: An equity issue. Bull World Health Organ. 2011;89:258–266.
DOI: 10.2471/BLT.10.083329