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Asian Journal of Pregnancy and Childbirth
2(2): 1-11, 2019; Article no.AJPCB.51396
Is There a Relationship between Repeat Induced
Abortion and Current Use of Contraception among
Women in the Reproductive Age? A Study in Ghana
Michael Boah
1,2*
, Timothy Adampah
1,3
and Dominic Achinkok
4
1
Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin
Medical University, Harbin 150081, China.
2
Ghana Health Service, Private Mail Bag Bolgatanga, Ghana.
3
Education, Culture and Health Opportunities (ECHO) Research Group International, Aflao, Ghana.
4
School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.
Authors’ contributions
This work was carried out in collaboration among all authors. Authors MB, TA and DA conceived and
designed the study. Author MB carried out the analysis. Authors TA and DA interpreted the results
and wrote the draft manuscript. Author MB revised the draft manuscript. All authors read and
approved the final manuscript.
Article Information
Editor(s):
(1)
Dr. John Osaigbovoh Imaralu, Senior Lecturer, Department of Obstetrics and Gynaecology, Babcock University,
Ilishan-Remo, Nigeria.
Reviewers:
(1) Sreelatha S, Rajiv Gandhi University of Health Sciences, India.
(2)
Sarah Rominski, University of Michigan, USA.
(3)
Osabohien Mathew Okoh, Johns Hopkins University, Nigeria.
Complete Peer review History:
http://www.sdiarticle4.com/review-history/51396
Received 09 July 2019
Accepted 11 September 2019
Published 23 September 2019
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.
Original Research Article
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
2
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
(χ
2
) 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.
1. INTRODUCTION
Induced abortion is a common practice among
women. Globally, an estimated 55.7 million
induced abortions occurred annually between
2010-2014 [1]. Abortion rates have declined
significantly in developed countries but not in
developing countries [2]. The women who induce
abortion in low and middle-income countries are
highly educated, wealthier and live in urban
areas [3]. Furthermore, the reasons why women
induce abortion are known and include birth
spacing, financial challenges, no desire for more
children and partner-related concerns [4].
However, abortion contributes significantly to
maternal mortality in many countries worldwide.
In Ghana, 15-30% of maternal deaths result from
abortion [5].
Women who induce abortion may want to
prevent prospective unwanted pregnancies and
concomitant abortions. Therefore, the use of
contraception can be vital in preventing
unwanted pregnancies and reducing maternal
deaths from unsafe abortions in settings where
abortion is common. In 2012, an estimated 33%
of maternal deaths in sub-Saharan Africa (SSA)
were averted due to contraception [6]. It is
therefore not surprising that family planning (FP)
is among the pillars of the Safe Motherhood
Initiative to reduce maternal deaths in low and
middle-income countries. Nevertheless, from
the 2014 Ghana Demographic and Health
Survey (GDHS), only 23% of Ghanaian women
use any form of contraception and an additional
30% have an unmet need for contraception
[7].
Furthermore, post-abortion care (PAC) is an
integral part of the comprehensive abortion care
(CAC) strategy in Ghana. It outlines how service
providers should respond to the needs of women
who miscarry or induce abortion [8]. The
provision of sexual reproductive health services
including FP counselling and access to
contraceptives is a key component of PAC.
Nevertheless, repeat induced abortion is
becoming a normal practice among Ghanaian
women that requires attention. From a recent
national study, repeat induced abortion
accounted for 33% of induced abortions in
Ghana [9]. Unfortunately, repeat induced
abortion is linked to adverse pregnancy
outcomes in future pregnancies. Women with a
history of repeat induced abortion have
increased risk of ectopic pregnancy, foetal loss,
low birth weight babies and preterm delivery in
prospective pregnancies [10].
The determinants of contraceptive use by
Ghanaian women in the reproductive age have
been explored by previous studies and include,
but not limited to maternal education, parity,
marital status, desire for children and wealth [11–
15]. However, none of these studies explored the
association between women’s previous history of
induced abortion and current contraceptive
behaviour. In Angola, a positive association was
reported between abortion history and current
use of contraception [16]. Besides the
differences in contraceptive prevalence and
unmet need for FP between Angola and Ghana
[17], the said study combined women with a
single history of abortion to women with multiple
histories of abortion due to the rarity of the
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
3
exposure in their sample. In addition, Marston &
Cleland observed from their review of data from
eleven countries that while the incidence of
abortion declined with an increase in
contraceptive use in some countries, the two
indicators increased simultaneously in other
countries. They concluded that induced abortion
and contraceptive use are inversely related only
when fertility itself is stabilized [18]. The
relationship between repeat induced abortion
and current use of contraception in Ghana is
therefore arguable.
Therefore, the aim of this study was to determine
the relationship between repeat induced abortion
and current use of contraception among women
in the reproductive age (15-49 years) in Ghana.
We expect more women with a history of induced
abortion to use contraception to avoid future
unwanted pregnancies that may also end in
abortion.
2. MATERIALS AND METHODS
This study used data from the most recent
Ghana Maternal Health Survey (GMHS). The
2017 GMHS was conducted by the Ghana
Statistical Service (GSS) with support from the
DHS program. The survey sample was designed
to provide national, zonal and regional estimates
of key reproductive health indicators. The survey
included women aged 15-49 years who met the
eligibility criteria. The sample was stratified and
selected in two stages from an updated sampling
frame used for the 2010 population and housing
census in Ghana. In the first stage, clusters were
selected using probability proportional to size.
The second stage involved selecting households
from each cluster. The stratification of regions
into urban and rural areas was also taken into
account. A total of 25,062 women out of 25,304
eligible women were interviewed. Additional
information about the design of the 2017 GMHS
including the questionnaires used can be found
in the published report [19].
The exposure and outcome of interest in this
study were repeat induced abortion and current
use of contraception respectively. The individual,
births and household datasets were merged to
obtain more information on the women. From the
merged dataset, information on the current use
of contraception was available for 3459 of the
3702 women with a lifetime history of induced
abortion. Therefore, the analyses in this study
involved 3459 (weighted n= 4595) women aged
15-49 years in Ghana.
2.1 Dependent Variable
The dependent variable in this study was the
current use of contraception. This was based on
women’s self-report of her current use or
partner’s current use of any form of
contraceptives. The variable was dichotomized:
women who identified as currently using any
form of contraceptives were categorized as “Yes”
for current use of contraception. Those who did
not identify as currently using any method of
contraception were categorized as “No” for
current use of contraception. The outcome of
interest—“Yes” for the current use of
contraception was coded as “1” and “0” for “No”.
2.2 Main Independent Variable
The main independent variable was repeat
induced abortion. The variable was constructed
in binary form from the number of lifetime
induced abortions reported by respondents.
Women who reported a single episode of
induced abortion in their lifetime were
categorized as “No” for repeat induced abortion.
Women who reported multiple episodes of
induced abortions were categorized as “Yes” for
repeat induced abortion.
2.3 Covariates
Respondent’s age group, current marital status,
highest level of education, religion, place of
residence (urban/rural), ecological zone of
residence (northern, middle and coastal)
1
, wealth
quintile
2
, media exposure (Yes or No)
3
,
knowledge about the fertile period (Yes or No)
4
,
knowledge about abortion legislation in
Ghana
5
and knowledge about a source for family
planning method were included as
potential confounders.
1
The northern zone comprised of Northern, Upper East and
Upper West regions, the middle zone comprised of Eastern,
Ashanti and Brong Ahafo regions, while the coastal zone
included Western, Central, Volta and Greater Accra regions.
2
The wealth quintiles in the GMHS were constructed from
household asserts using principal component analysis (PCA).
3
“Yes” for respondents who were involved in at least one of
the following activities; read newspapers, listened to the
radio, watched television or used the internet within the one
week reference period in the GMHS, or “No” if otherwise.
4
Women who responded that the fertile period was “halfway
between two periods” were classified as ‘Yes” for knowledge
about the fertile period and “No” if otherwise.
5
Women who responded that abortion is legal in Ghana were
classified as “Yes” for knowledge about abortion legislation
and “No” if contrary.
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
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2.4 Statistical Analysis
Weighting and clustering were used to account
for the disproportional sampling design used by
the DHS program [20]. Pearson Chi-square (χ
2
)
test was used to compare differences in
categorical variables in univariable analysis.
Survey logistic regression model was used to
estimate the association between the
explanatory variables and the dependent variable
at a 95% confidence level in multivariable
analysis. All variables with a p-value ≤ 0.05 in the
univariable analysis were fitted in an adjusted
logistic regression model to control for potential
confounding. Educational level was included in
the adjusted model in spite of the non-significant
relationship with the outcome in the univariable
analysis. Its inclusion was based on its known
association with the trend in current use of
contraception in Ghana [15].
All analyses were carried out in STATA/IC 15.0
for Windows (StataCorp LLC, College Station,
Texas USA). The adjusted odds ratio (AOR) with
their corresponding confidence intervals (CIs)
were estimated. Statistical significance was set
at the 5% level. The goodness-of-fit of the
adjusted regression model was tested using the
Archer & Lemeshow goodness-of-fit test for
survey data [21]. We failed to reject the null
hypothesis (at the 5% level) underlying the model
that it is a good fit.
3. RESULTS AND DISCUSSION
3.1 Results
3.1.1 Background characteristics of the
women included in this study
As revealed in Table 1, the mean age of the
women was 33.3 ±8.4 years (range: 15-49
years), 67.2% were in a union (married/
cohabitating), 65.7% had basic level education,
90.7% were Christians and 66.5% resided in
urban areas.
3.1.2 Abortion and contraceptive-related
characteristics of the women included
in this study
Of the 4595 women, 34.6% had a history of
repeat induced abortion, 36.7% (CI: 34.7-38.7)
were currently using contraception, of which 78%
were on modern contraceptives and 89.4% out of
3282 women knew a source for FP method
(Table 2). The methods of contraception in order
of frequency included injectables (342), implants
(332), pills (280), rhythm (273) and so on (Fig. 1).
Table 1. Background characteristics of the
women included in this study
Category/variable
Frequency
Percent
Demographic
characteristics
Age years
(Mean:33.3, SD* :8.4)
15-24 763 16.6
25-34 1766 38.4
35-49 2066 45.0
Marital status
Single 1508 32.8
Married 1679 36.6
Cohabiting 1408 30.6
Highest level of
education
No formal education 490 10.7
Basic level 3021 65.7
Secondary or higher 1084 23.6
Religious affiliation
Traditional 104 2.3
Christian 4166 90.7
Islam 325 7.0
Place of residence
Urban 3056 66.5
Rural 1539 33.5
Ecological zone of
residence
Northern 99 2.1
Middle 2035 44.3
Coastal 2461 53.6
Wealth quintile
Poorest 211 4.6
Poorer 726 15.8
Average 1028 22.4
Richer 1365 29.7
Richest 1265 27.5
Media exposure
Yes 2420 52.7
No 2175 47.3
*SD: standard deviation
3.1.3 Factors associated w ith current use of
contraception in univariable analysis
The univariable analysis showed significant
disparities in the current use of contraception by
repeat induced abortion, age, current marital
status, place of residence, ecological zone,
wealth quintile and knowledge about the fertile
period. Comparatively, women with a previous
history of abortion, older women (35-49 years),
single women, urban women, women from the
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
5
coastal zone, women in the richest wealth
quintile, and women with knowledge about the
fertile period were significantly less likely to be on
contraception (Table 3).
Table 2. Abortion and contraceptive-related
characteristics of the women included in this
study
Category/variable
Frequency
Percent
Abortion History
Number of lifetime
abortions
1 3004 65.4
2 1161 25.3
3 287 6.2
4 or more 143 3.1
Repeat induced
abortion
No 3004 65.4
Yes 1591 34.6
Knowledge about
the fertile period
(N=4190)
Yes 2262 54.0
No 1928 46.0
Knowledge about
abortion legislation
Yes 507 11.0
No 4088 89.0
Contraceptives
use/Knowledge
Currently using
contraceptives
No 2909 63.3
Yes 1686 36.7
Modern
contraceptives use
(N=1686)
No 371 22.0
Yes 1315 78.0
Knowledge about a
source for family
planning method
(N=3282)
Yes 2935 89.4
No 347 10.6
3.1.4 Factors associated with current use of
contraception in multivariable analysis
After controlling for potential confounding, a
history of repeat induced abortion was not
significantly associated with the current use of
contraception, although relatively, women with a
history of repeat induced abortion were 12%
(AOR=0.88, 95% CI: 0.73-1.06) less likely to be
on contraception (Table 4). However, age,
marital status, place of residence and ecological
zone of residence were significantly associated
with current use of contraception. Women in the
age groups of 15-24 (AOR= 2.86, 95% CI: 2.18-
3.77) and 25-34 (AOR=1.85, 95% CI: 1.54-2.23)
were more likely than their counterparts in the
age group of 35-49 years to be on contraception,
albeit with a decreasing trend in use as age
increases. Also, women in a union: married
(AOR=1.69, 95% CI: 1.36-2.10) or cohabiting
(AOR=1.37, 95% CI: 1.10-1.71), had increased
odds for current use of contraception relative
to single women. Furthermore, rural women
were about 1.3 times likely to be on
contraception compared to urban women
(AOR=1.27, 95% CI: 1.02-1.59). Finally, women
residing in the middle zone were about 2 times
favoured to be on contraception relative to
women in the coastal zone (AOR=1.52, 95% CI:
1.27-1.82) (Table 4).
4. DISCUSSION
The aim of this study was to determine the
association between women’s history of repeat-
induced abortion and their current use of
contraception. The results showed that 34.6% of
the women had a previous abortion experience.
However, 36.7% were currently on any form of
contraception which is higher than what was
reported in the 2014 GDHS [7]. After controlling
for potential confounding, repeat-induced
abortion was not significantly associated with the
current use of contraception, although
awareness about a source for family planning
method was high (89%). Post-abortion
contraceptive counselling and access to
contraceptives are part of the CAC package
implemented in Ghana [8]. In addition,
contraceptives have been subsidized across all
public health facilities in the country and these
facilities have remained the major sources for
family planning commodities [19]. Moreover,
post-abortion counselling and access to post-
abortion contraceptives are proven to increase
contraceptive uptake by women [22,23]. The
unanswered question is why Ghanaian women
with an episode of abortion do not use
contraception to prevent prospective unwanted
pregnancies and subsequent abortions? Is it an
issue of contraceptives unavailability, or poor
access, or both, or other factors are responsible
for contraceptives behaviour irrespective of
abortion experience? The reasons need to be
explored. We recommend further studies to
understand this phenomenon. Specifically,
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
6
qualitative studies would prove vital to
understanding this behaviour by women with
multiple histories of induced abortion.
Nevertheless, the following factors were
significantly associated with current use of
contraception that cannot be ignored. They are
maternal age, current marital status, place of
residence and ecological zone of residence.
Table 3. Factors associated with the current use of contraception in univariable analysis
Variable n Current use of contraception P-value
No Yes
Repeat induced abortion .01
No 3004 1847(61.5) 1157(38.5)
Yes 1591 1062(66.8) 529(33.2)
Age <.001
15-24 763 387(50.7) 376(49.3)
25-34 1766 1049(59.4) 717(40.6)
35-49 2066 1473(71.3) 593(28.7)
Marital status .002
Single 1508 1025(68.0) 483(32.0)
Married 1679 1041(62.0) 638(38.0)
Cohabiting 1408 843(59.9) 565(40.1)
Highest level of education
.67
No formal education 490 310(63.3) 180(36.7)
Basic level 3021 1894(62.7) 1127(37.3)
Secondary or higher 1084 705(65.0) 379(35.0)
Religious affiliation .95
Traditional
104
67(64.4)
37(35.6)
Christian 4166 2634(63.2) 1532(36.8)
Islam 325 208(64.0) 117(36.0)
Place of residence <.001
Urban 3056 2033(66.5) 1023(33.5)
Rural
1539
876(56.9)
663(43.1)
Ecological zone of residence <.001
Northern 99 59(59.6) 40(40.4)
Middle 2035 1183(58.1) 852(41.9)
Coastal 2461 1667(67.7) 794(32.3)
Wealth quintile .003
Poorest 211 126(59.7) 85(40.3)
Poorer 726 426(58.7) 300(41.3)
Average 1028 606(58.9) 422(41.1)
Richer
1365
904(66.2)
461(33.8)
Richest 1265 847(67.0) 418(33.0)
Media Exposure .29
Yes 2420 1542(63.7) 878(36.3)
No 2175 1367(62.9) 808(37.1)
Knowledge about the fertile period
(N=4190)
.02
Yes 2262 1464(64.7) 798(35.3)
No 1928 1146(59.4) 782(40.6)
Knowledge about abortion legislation .90
Yes 507 323(63.7) 184(36.3)
No 4088 2586(63.3) 1502(36.7)
Knowledge about a source for family
planning method (N=3282)
.19
Yes 2935 2591(88.3) 344(11.7)
No 347 318(91.6) 29(8.4)
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
7
Fig. 1. Major contraceptives used by methods
(FS: Female sterilization, MS: Male sterilization, IUD: Intrauterine device, EC: Emergency contraception,
LAM: Lactational amenorrhea method, RM: Rhythm method, OTM: Other traditional methods)
Table 4. Factors associated with the current use of contraception in multivariable analysis
Variable
Current use of contraception
P-value
AOR [95% CI]
Repeat induced abortion
No Reference
Yes 0.88 [0.73-1.06] .17
Age
15-24 2.86 [2.18-3.77] <.001
25-34 1.85 [1.54-2.23] <.001
35-49 Reference
Marital status
Single Reference
Married 1.69 [1.36-2.10] <.001
Cohabiting 1.37 [1.10-1.71] .004
Highest level of education
No formal education 1.25 [0.85-1.83] .25
Basic level 1.16 [0.90-1.49] .24
Secondary or higher Reference
Place of residence
Urban Reference
Rural 1.27 [1.02-1.59] .04
Ecological zone of residence
Northern 1.04 [0.72-1.49] .82
Middle 1.52 [1.27-1.82] <.001
Coastal Reference
Wealth quintile
Poorest 1.06 [0.64-1.76] .81
Poorer 1.23 [0.89-1.71] .22
Average 1.20 [0.91-1.60] .19
Richer 0.99 [0.78-1.28] .98
Richest Reference
Knowledge about the fertile period
Yes Reference
No 1.15 [0.95-1.39] .14
Goodness of fit test: F-adjusted test statistic = F(9,710)= 0.827, Prob>F = 0.591
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
8
The positive association between younger
maternal age and the current use of
contraception in this study is in contrast to the
findings of a study in Angola [16]. In spite of that,
a study by Achana et al. in northern Ghana found
no significant association between age and use
of contraception, although they observed a
decline in use with increasing age which
supports our findings [11]. Differences in findings
might have emerged from differences in study
locations and study methodologies.
Notwithstanding, sexual intercourse outside
marriage is a practice in Ghana [24]. Also,
younger women may be unmarried or currently in
school but engaged in risky sexual behaviour
including unprotected sex and multiple sexual
partners. Therefore, younger women’s use of
contraceptives may be motivated by their desire
to prevent out of wedlock children and to stay in
school. Conversely, older women may rely on
their perceived insusceptibility to pregnancy due
to a decrease in fecundity not to use
contraception. In Ghana, 10% of women 30-49
years are menopausal [7]. Moreover, older
women in this study were more involved in
repeat induced abortion relative to younger
women (data not shown). Therefore, we
speculate that older women who become
pregnant may be using induced abortion to
control fertility [24]. This might have in one way
or the other contributed to diluting our findings at
the multivariable level hence the lack of
significant association between repeat induced
abortion and current contraceptives use by
women in Ghana.
Also, the study found that women in a union were
more likely to use contraception which is
consistent with previously published studies from
Ghana [11,13]. Logically, single women without
sexual partners have no pregnancy risk. In
contrast, women in a union may use
contraception to space births or limit childbearing
[11,12]. Additionally, spousal support encourages
the use of contraception among women in union
[25]. The finding that rural women were more
likely to be on contraception contrasts other
published studies [26,27]. However, this finding
has been reported by other scholars [15]. The
scale-up of the Community-based Health
Planning and Services (CHPS) initiative in
Ghana might have contributed to closing the gap
in access to contraceptives by rural women. As
part of the initiative, FP services are provided
free of charge and the commodities are highly
subsidized such that rural women can afford [28].
In addition, non-profit organizations such as
Maries Stopes International have supported in
improving access to FP services in rural areas in
all the ten administrative regions in Ghana.
These and other factors explain the increasing
trend in contraceptives use by rural women in
Ghana [29].
Finally, the association between the ecological
zone of residence and current use of
contraception can be explained by differences in
cultural and religious beliefs, variations in fertility
rates, desire to limit childbearing and access to
reproductive health services [7]. A study in
Malawi supports this finding [27]. The non-
significant association of the socioeconomic
factors (education and wealth) in this study with
the current use of contraception in the adjusted
model is contrary to previous documentation
[14,15,30]. The decline in socioeconomic-related
inequalities in the use of contraception in many
countries in SSA including Ghana and the
positive association of wealth status with long-
term contraceptives use may partly explain this
finding [31].
The results of this study should be interpreted
with caution under the following limitations and
strengths. Firstly, the survey is cross-sectional in
design and causal deductions cannot include
birth. Secondly, it involved a recall of events on
the exposure and outcome so recall bias cannot
be ruled out. In addition, information was
collected on current practices such as current
use of contraceptives and current marital status.
We are, therefore, not able to determine the state
of these variables prior to the day the respondent
was interviewed. Hence, it is possible that
women’s current practices may not reflect their
previous practices. Thirdly, the independent
variable did not differentiate modern
contraceptives use from traditional
contraceptives use. It is, possible that the
explanatory variables may exhibit different
relationship based on the type of contraception.
Nevertheless, the key strength of this study is
that it used a nationally representative sample
and applied robust statistical analyses that allow
for reliable conclusions and generalization of
results across women in the reproductive age
group in Ghana. The findings of this study serve
as a foundation for future studies to promote
post-abortion contraceptive use among women,
especially those with a history of induced
abortion. The findings also add to the growing
literature on abortion and contraception in
developing countries with limited information
such as Ghana.
Boah et al.; AJPCB, 2(2): 1-11, 2019; Article no.AJPCB.51396
9
5. CONCLUSION
The study aimed at determining the relationship
between repeat induced abortion and current use
of contraception. After controlling for potential
confounding, repeat induced abortion was not
independently associated with current use of
contraception. The findings suggest that other
factors such as age, marital status, place of
residence and ecological zone of residence were
significantly associated with women’s current use
of contraception post-abortion regardless of a
previous abortion experience. Our findings can
inform future research and examine how to
improve post-abortion contraception to prevent
future unwanted pregnancies leading to induced
abortion.
CONSENT
This study used already published data and did
not require a review by an Institutional Review
Board (IRB). However, permission to use the
datasets was obtained from the DHS program
through ICF international. The ethical
considerations followed in the DHS surveys are
published online (www.dhsprogram.org).
ETHICAL APPROVAL
It is not applicable.
ACKNOWLEDGEMENTS
We are grateful to ICF International for approving
our request to use the 2017 GMHS datasets for
this study.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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