Assessing the Prevalence and Determinants of Post Abortion Contraceptive Use among Post Abortion Clients of Reproductive Age in Neno District, Malawi.

Abstract

Background Malawi has the highest un-met need for contraception currently estimated at 39.8% among unmarried women. This has contributed to high unintended pregnancy rate of 53%; 30% of which end up in abortions. The Southwest zone where Neno is located contributed 28.5% to all abortions in Malawi in 2015. Provision of PAFP was introduced in 1994 in Malawi to prevent repeated unintended pregnancies, but there is low utilization (22.4%). The aim of this study was to assess prevalence and determinants of post abortion contraceptive use in Neno district where abortion rate is high at 5.4%. Methods This was a facility based cross-sectional study conducted at Neno district hospital and Lisungwi community hospital from October to December 2022, using proportional sampling procedure. Data was analysed using statistical package for social sciences (SPSS) version 22 and excel. Chi Square test and binary logistic regression models at bivariate and multivariate levels were used. Results Prevalence of PAFP was found to be at 61.8%. Factors positively associated with use were unemployement (aOR = 4.131, 95%CI: 1.069–14.968), previous contraceptive use (aOR = 6.068, 95%CI: 2.282–16.132), provider availablity in PAC room (aOR = 4.581, 95%CI: 1.056–19.866), PAFP counselling (aOR = 16.314, 95%CI: 5.554–47.921), short waiting time (aOR = .104, 95%CI:.37-.295) and MVA use (aOR = 13.454, 95%CI: 1.004-180.361). Whilst Spouse’s high education, (aOR = 0.185, 95%CI: 0.039–0.879) and having intended pregnancy (aOR.197, 95%CI: .56-.698) were negatively associated with PAFP use. Conclusion and recommendations The study found a higher contraceptive prevalence rate (CPR) among PAC clients than the district CPR. Long waiting time, counselling and low use of MVA need to be addressed to improve uptake of PAFP among PAC clients which can help in improving overall district CPR.