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      Socio-demographic and reproductive characteristics of clients that accepted contraceptives at abortion center at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa: a cross-sectional study (January-July 2021)

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          Abstract

          Introduction

          access to family planning services is an important preventive strategy against maternal mortality as it can considerably reduce unintended pregnancies and prevent sequelae of unsafe abortion. We aimed to describe the socio-demographic and reproductive characteristics of abortion seekers and investigate factors associated with uptake of contraceptives following induced abortion at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.

          Methods

          this study was a cross-sectional study among women who had legal termination of unwanted pregnancy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1 st January 2021 to July 2021. Questionnaires were administered to 80 consenting consecutive clients after undergoing induced abortion. Information on socio-demographic and reproductive characteristics and pattern of contraceptive uptake of the respondents were obtained. Descriptive and bivariate analysis were conducted to determine the pattern and relationship of socio-demographic and reproductive characteristics and contraceptive uptake.

          Results

          the mean age of the 80 respondents was 25.6 ± 6.6 years. Majority of the participants were of the Black race (96.25%, n= 77/80), single (90.00%, n= 72/80), of the Christian faith (80.00%, n= 64/80) and unemployed. The median number of children alive among the clients was 1(0-2), with about 37.5% of the participants being nulliparous. About 16.25% of the participants had had at least one previous termination of pregnancy. The prevalence of post-abortion contraceptive uptake was 97.5% (95%CI: 90.36% - 99.39%, N=78/80). More than half chose injectable contraceptive (53.85%, 95%CI: 42.60% - 64.71%, N= 42/78), followed by oral contraceptive pills (21.79%, 95%CI: 13.90% - 32.49% N= 17/78). We found no association between socio-demographic and reproductive characteristics, and contraceptive uptake among the abortion clients (p values >0.05).

          Conclusion

          the immediate post-abortion contraceptive uptake in our facility is very high. Majority of the clients accepted injectable contraceptives. The demographic and reproductive characteristics of our clients did not affect uptake of post-abortion contraception. More education is needed to improve uptake of other long-acting contraceptives that may not require frequent contact with the health facility.

          Most cited references27

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          Safe Abortion: Technical and Policy Guidance for Health Systems

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            Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.

            Of the 1.3 million abortions performed annually in the United States, approximately half are repeat procedures. Immediate postabortal intrauterine device (IUD) insertion is a safe, effective, practical and underutilized intervention that we hypothesize will significantly decrease repeat unintended pregnancy and abortion. All women receiving immediate postabortal IUD insertion in eight clinics of a Northern California Planned Parenthood agency during a 3-year period comprise the IUD cohort. We selected a cohort of controls receiving abortions but choosing other, non-IUD contraception on the day of the abortion visit in a 2:1 ratio matched by date of abortion. We obtained follow-up data on repeat abortions within the agency for both cohorts through 14 months after the 3-year period. We evaluated differences in repeat abortion between cohorts. All analyses were intent-to-treat. Women who received an immediate postabortal IUD had a lower rate of repeat abortions than controls (p<.001). Women who received a postabortal IUD had 34.6 abortions per 1000 woman-years of follow-up compared to 91.3 for the control group. The hazard ratio for repeat abortion was 0.38 [95% confidence interval (CI), 0.27-0.53] for women receiving a postabortal IUD compared to controls. When adjusted for age, race/ethnicity, marital status, and family size, the hazard ratio was 0.37 (95% CI, 0.26-0.52). Immediate postabortal intrauterine contraception has the potential to significantly reduce repeat abortion.
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              Early Effects of the COVID-19 Pandemic on Family Planning Utilisation and Termination of Pregnancy Services in Gauteng, South Africa: March–April 2020

              Background: Experiences from infectious outbreaks globally, such as Ebola and severe acute respiratory syndrome (SARS), highlight the challenges of government to maintain essential healthcare services, guarantee healthcare access and at the same time shift resources to contain and mitigate the crisis. The declaration of the State of Disaster in South Africa due to the COVID 19 pandemic (on the 15th of March) and the subsequent imposition of a total national lockdown on all usual activities were anticipated to have both direct and indirect negative consequences on healthcare utilisation including reproductive healthcare services. Objective: The objective of this study is to describe the effect of the COVID-19 pandemic on family planning and termination of pregnancy services utilisation immediately following the lockdown in Gauteng Province. Methods: We analysed the administrative data on clinical services utilisation during the previous two years, including five weeks following the enforcement of the lockdown in South Africa, from the District Health Information System database over the period 1 April 2018–30 April 2020. Results: Primary healthcare utilisation headcounts across the province declined by nearly 500,000 visits following the lockdown period. Family planning utilisation patterns which are demand-driven declined during the two months preceding the COVID-19 pandemic and further declined during the lockdown. Switching contraceptive methods to those with less effectiveness were noted as a trend over the previous two years. Year on year comparisons from April 2018 to April 2020 indicated a consistent decline in the use of injectable methods and increased use of oral contraceptive pills. Conclusion: This review highlights the importance of monitoring the utilisation of routine healthcare services during the outbreak situations to ensure that service provision is not compromised. Women of reproductive age must be able to exercise their reproductive choices to prevent unintended pregnancies and to reduce their risk of mortality as a result of diminished access to reproductive healthcare services.
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                Author and article information

                Contributors
                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                17 May 2023
                2023
                : 45
                : 39
                Affiliations
                [1 ]Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa,
                [2 ]Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
                Author notes
                [& ] Corresponding author: Kennedy Baffour-Duah, Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa. baffduah@ 123456gmail.com
                Article
                PAMJ-45-39
                10.11604/pamj.2023.45.39.37441
                10403766
                7a4198d2-af8f-41d2-9553-cc15e8d0c853
                Copyright: Kennedy Baffour-Duah et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 September 2022
                : 30 April 2023
                Categories
                Research

                Medicine
                contraceptives,induced abortion,post-abortion,family planning,johannesburg,south africa
                Medicine
                contraceptives, induced abortion, post-abortion, family planning, johannesburg, south africa

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