Pre-Conception Contraceptive Use in Women Presenting With Abortion at University Teaching Hospital,Lusaka,Zambia

Abstract

Background: Abortion is the loss of the pregnancy before the age of viability. It can be spontaneous or induced. It is the leading cases of admission to gynaecology emergency ward at UTH 30%-50%. The contraceptive knowledge is 97% but lack of uptake may contribute to the high prevalence of abortion cases at UTH. This study aimed to explore the contraceptive usage pre-conception in women presenting with abortion at UTH and its relationship to abortion. Methodology: This was a cross section study done at UTH gynaecology emergency ward. Every fourth woman presenting with abortion, undergoing uterine evacuation and meeting the eligibility criteria was selected to meet the sample size of 417. Structured questionnaire were administered by the trained nurses after obtaining informed concert. Data was entered in SPSS version 20 spread sheet. Descriptive analysis was done. Percentages and the mean were calculated. A logistic regression model was developed to test for independent factors, including current use of contraception, associated with type of abortion and adjusted for with other independent variables. The study had ethical approval from the University of Zambia Biomedical Research Ethics Committee. Results: The total number of respondents was 417. Age distribution was: 18-20 years 86 (20.6%), 20 to 25 years 136 (32.6%) and above 25 years 195 (46.8%) who were the majority. The education level had 18 (4.3%) with no education, 117 (28.1%) with primary education, 243 (58.3%) with secondary education and 39 (9.4%) had tertiary education. In the index pregnancy 92.6% had spontaneous abortion and 7.4% had induced abortion. On contraceptive knowledge 94% had knowledge of modern contraception and 6% had never heard of any form of modern contraception. 280 (67%) of the women said they had used one form of contraceptive and prior use of contraception was significantly associated with the type of abortion p- value 0.01. In the index pregnancy 13.7% of the women said they were on some form of contraceptive. The contraception on current pregnancy was not significantly associated with type of abortion at 5% significance level p- value 1.17. Bivariate relationship between abortion type and the study variables; marital status, education level and history of contraception use were significantly associated with abortion type p- value = <0.01, <0.01, <0.01 respectively. Using regression analysis to control for potential cofounders, unmarried women had 3.6 times increased risk of induced abortion compared to unmarried women (OR=3.61< CI 1.5-8.68, p- value= 0.004). Those who had ever used the contraceptive before had 70% reduced odds for induced abortion compared to the ones who had never used (OR=0.30, CI 0.12-0.177, p- value 0.013). Women who were using contraceptive in index pregnancy had 3.4 times increased odds of induced abortion compared to women who had not used (OR=3.43, CI 1.09-10.73, p- value 0.035). Conclusion: The study showed that women who present with abortion have high knowledge of contraceptives but were not using any form of modern contraceptive. Single women were more likely to have an induced abortion. A sizeable minority fell pregnant while on contraceptives.