ABSTRACT
BACKGROUND: Postabortion family planning is a major primary prevention strategy for unwanted pregnancies at which contraceptive use reduces approximately 230 million births every year worldwide. However, evidence that assesses postabortion family planning utilization and associated factors among women who received abortion services at governmental and nongovernmental health facilities is limited. OBJECTIVE: This study aimed to compare the rates of postabortion family planning utilization and associated factors among women who received abortion services at governmental and nongovernmental health facilities. STUDY DESIGN: A comparative cross-sectional study design was employed among 324 women who received abortion services. A systematic sampling technique was used to select the study participants, and data were collected by face-to-face interview using a structured questionnaire. Data were cross-checked, coded, and entered into EpiData (version 3.1; The EpiData Association, Odense, Denmark) and exported to Statistical Package for Social Sciences (version 25; IBM Corp, Armonk, NY) for analysis. Descriptive statistics, such as frequency, proportion, and mean with standard deviation, were computed. The association between independent variables and postabortion family planning utilization was made using a binary logistic regression model. Adjusted odds ratio with its 95% confidence interval was used as a measure of association, and variables with a P value of ≤.05 were considered significant. RESULTS: The rate of postabortion family planning utilization among women who received abortion services was 71.91% (95% confidence interval, 66.74-76.56). The rates of postabortion family planning utilization at governmental and nongovernmental health facilities were 55.6% (95% confidence interval, 47.75-63.10) and 88.27% (95% confidence interval, 82.27-92.43) respectively. Being counseled about contraceptive use (adjusted odds ratio, 33.130; 95% confidence interval, 6.089-180.243), not needing near-future pregnancy (adjusted odds ratio, 3.350; 95% confidence interval, 1.541-7.282), and receiving abortion service at nongovernmental health facilities (adjusted odds ratio, 4.732; 95% confidence interval, 1.900-11.787) were significantly associated with postabortion family planning utilization. CONCLUSION: The rate of postabortion family planning utilization was lower among women who received abortion services at governmental health facilities than among women who received abortion services at nongovernmental health facilities. Counseling about contraceptive use, need for near-future pregnancy, and type of health facility were significantly associated with postabortion family planning utilization. Therefore, efforts are needed to promote and strengthen the counseling of contraceptive use and birth spacing of women who are receiving abortion services.
ABSTRACT
BACKGROUND: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. METHODS: Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. FINDINGS: 69â176 women were allocated to be interviewed by either FBH+ (n=34â805) or FPH (n=34â371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p<0·0001). Using FPH, the estimated SBR was 17·4 per 1000 total births, 21% (95% CI -10 to 62) higher than with FBH+ (15·2 per 1000 total births; p=0·20) in the 5 years preceding the survey interview. There was strong evidence of between-site heterogeneity (I2=80·9%; p<0·0001), with SBR higher for FPH than for FBH+ in four of five sites. The estimated NMR did not differ between modules (FPH 25·1 per 1000 livebirths vs FBH+ 25·4 per 1000 livebirths), with no evidence of between-site heterogeneity (I2=0·7%; p=0·40). INTERPRETATION: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. FUNDING: Children's Investment Fund Foundation.
Subject(s)
Infant Mortality , Stillbirth/epidemiology , Surveys and Questionnaires , Adolescent , Adult , Bangladesh/epidemiology , Ethiopia/epidemiology , Female , Ghana/epidemiology , Guinea-Bissau/epidemiology , Humans , Infant , Infant, Newborn , Middle Aged , Reproducibility of Results , Uganda/epidemiology , Young AdultABSTRACT
BACKGROUND: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths. METHODS: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken. CONCLUSIONS: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.