Utilization of Post-Abortion Contraception among Adolescents in Makueni County, Kenya
Ngugi, Rachel Njeri
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Correct and consistent use of contraceptives has the potential to reduce the maternal mortality rate (MMR) arising from clandestine abortions by 25-35% and linking post-abortion care (PAC) clients to the family planning clinic in a hospital can reduce the MMR by a further 15%. Despite this, counselling clients on the variety of family planning methods available and allowing them to make informed choice is often overlooked during post-abortion care. Majority of healthcare providers dwell on offering emergency services and removing the retained products of conception and leave out counselling and provision of contraceptives. The main objective of this study was to investigate the utilization of post-abortion contraceptives among adolescents who had received post-abortion care in Kibwezi East sub-county, Makueni County. The specific objectives were to describe the demographic parameters that influence the use of post-abortion contraception, determine the health-care-related factors that influence the use of post-abortion contraception, and assess the impact of contraceptive perception on use. Purposive sampling was employed to identify the facility, and systematic sampling was utilized to choose the study participants in a descriptive, cross-sectional design. Self-administered semi-structured questionnaires were used to collect data. IBM SPSS® 21.0 was used for quantitative data analysis. The significance of the link between the dependent and independent variables was tested using Chi-square values, and the Spearman's Rho test was employed to see if there was any correlation between the variables. Overall, 100 adolescent girls aged 13-19 years (Mean age 17.17 yrs, sd=1.457) who had received post-abortion care at Kibwezi level 4 hospital participated in the study. Findings showed that contraceptive counselling remains an overlooked element of post-abortion care. Only 41% (n=41) of participants were counselled on contraception during their post-abortion care. Contraceptive counselling is an integral part of post-abortion care and in this study, it was found to have a positive correlation with the utilization of post-abortion contraceptives (rs=0.412, p=0.000). The more adolescent girls were counselled on contraceptives, the more likely they were to use post-abortion contraceptives. The level of education, age of the respondents and religion had a significant influence on the utilization of post-abortion contraception (X2=9.511, p-value=0.038), (X2=4.775, p-value=0.0042), (X2=1.828, p-value=0.001) respectively. The study participants perceived that contraceptives had negative side effects (42%) and believed myths that they led to decreased libido and caused infertility (47%) and these were barriers to their utilization of post-abortion contraception. In addition, 10% listed attitude of health care providers as a barrier and a minority of 1% listed spouses as a barrier.44% of study participants had a positive perception of contraceptives while 56 % had a negative perception but this had no significant influence on their utilization of post-abortion contraception (x2=1.813 CI 95% p=0.404). This study concluded that contraceptive counselling remains an important element of post-abortion care but is often overlooked as only 41% of the study participants received contraceptive counselling services and gave recommendations for more research to be done on the impact of sex education on teenage sexual debut age, contraceptive use, and utilization of youth friendly reproductive health services.