Post Abortion Contraception Model: A Comprehensive Package for Improving Safe Abortion Care in Developing Countries

Background: Despite liberal abortion laws and wide availability of contraceptives in Ghana, declining Post Abortion Contraception remains a public health challenge due to early unplanned pregnancies and recurrent abortions. The development of this model was therefore to address challenges of low contraception following induced abortion in health facilities within the capital city of Ghana. Method: The development of this model was an outcome of a nested study title: ‘decision making for induced abortion in Accra metropolis, Ghana’ in 2014. This model was piloted for four years using Marie Stopes, Ipas and Ghana Health Service trained abortion providers with family planning skills in one hundred purposively selected health facilities comprising 90 private and 10 Non-Governmental Organization mandated by law to provide safe abortion care services in the capital city of Ghana. The model mainly focused on contraceptive products, pricing, placement, promotion and people. Results: There was an increase (90% average) in Post Abortion Contraception across the selected facilities following the intervention using the model. Conclusion: The study concludes that an integration of products, pricing, placement, promotion and people with options counselling prior to an induced abortion are key considerations for an improved post abortion contraception uptake in developing countries. DOI: 10.14302/issn.2640-690X.jfm-18-2088 Corresponding author: Fred Yao Gbagbo , Department of Health Administration, University of Education, Winneba. P.O.Box 25, Winneba, Ghana Mobile: +233(0)243335708, Email: gbagbofredyao2002@yahoo.co.uk


Background
Global evidence on abortion and contraception have shown that clients treated for abortion related complications leave facilities without adequate access to contraceptive services. Consequently, some of these clients become pregnant early than expected leading to unplanned pregnancy or a repeat abortion. In resent time, Post Abortion Contraception (PAC) for women who have had induced or spontaneous abortion requires various consideration such as medical eligibility, preferences, affordability, availability accessibility and counselling on when to commence a method [1].
Because fertility is likely to return within 14days after pregnancy termination, early initiation of contraception following an abortion reduces the risk of recurrent abortions due to an early unintended pregnancy [2].
In Ghana, despite less restrictive laws on induced abortion, unsafe induced abortion account for about 12% of maternal deaths in the country [3].
National estimates show that about one in five Ghanaian women aged 15 to 45 years have ever had an abortion, with significant differences by socioeconomic characteristics [4].
A study on decision making for induced abortion in Accra metropolis, Ghana reveled that women of various profiles make different decisions with justifications for abortion based on their peculiar situations during pregnancy. In taking these decision, contraception following an induced abortion is not an immediate concern rather issues about cost, safety and privacy influenced clients' choice of place and method for abortion. In making abortion decisions, some women collaborated with other people who influenced aspects or the entire decision. Pressure from sexual partners, circumstances surrounding on set of pregnancy and reproductive intentions of women were major push factors for abortion. Although first time pregnancies were mostly aborted, gestational ages, cost of abortion and partner consent did not prevent women from aborting [5].

Materials and Methods
The development of this model was an outcome

Results
This model during the pilot phase was found useful as there was a significant increase in PAC services and decrease in repeat induced abortions in the participating health facilities. Figure 2 shows results of PAC during the pilot phase of the model. There was an increase (90% average) in PAC across the selected facilities following the intervention using the model.

B). Background Characteristics of Respondents at Last Abortion
[I would like to ask you a few questions regarding your background at the time of having your immediate past abortion. Please feel free to answer the following:] Who was responsible for the pregnancy you last aborted?

Conclusion
The study concludes that an integration of

Acknowledgments
The author is grateful to all the participants in this study that lead to developing this model.

Ethics Approval and Consent to Participate
Ethical approval for the study was sought from the Ghana Health Service Ethical Review Committee. A written consent for data collection and publication was also sought from the Accra Metro Directorate of Health Services and participants.

Consent to Publish
To ensure optimal client privacy and confidentiality, the background characteristics of respondents excluded any contact information that could disclose their specific identity hence written consent for publication was "Not applicable" in this case.
However all clients involved in the study were verbally informed that their records will be used for studies of which they verbally consented. A written consent for publication was also sought from the various facilities involved in the study.

Availability of Data and Material
The data sets used and/or analyzed during the current study are available on reasonable request.

Funding
Not applicable. (This study was funded by the author).

Conflict of Interests
The author declares no conflict of interests in this study