Strengthening Postabortion Family Planning Services in Ethiopia: Expanding Contraceptive Choice and Improving Access to Long-Acting Reversible Contraception

The health system and partners have implemented problem-solving, locally feasible, and comprehensive family planning delivery strategies to address the high unmet need for the safest, most effective, and long-acting reversible contraceptives. In the Southern Nations, Nationalities, and People's Region, Ethiopia, Ipas implemented health system strengthening efforts from fiscal year 2010 to 2014 to improve the quality of postabortion family planning services and expand method choice in 101 public facilities. The intervention significantly improved postabortion family planning uptake at the project sites, with the proportion of abortion clients receiving long-acting reversible contraceptives progressively improving during the intervention period. The proportion of abortion clients who left the facilities with a contraceptive method increased from 58% in fiscal year 2010 to 83% in fiscal year 2014. The share of method mix for long-acting reversible contraceptives rose from 2% in fiscal year 2010 to 55% in fiscal year 2014, while the share for condoms, injectables, and oral contraceptives declined from 98% to 45%. Implant use rose from 2% in fiscal year 2010 to 43% in fiscal year 2014, and the use of intrauterine devices increased from 0.1% in fiscal year 2010 to 12% in fiscal year 2014. A larger proportion of postabortion family planning users received long-acting reversible contraceptives at health centers, where midwives and nurses are the primary providers, than at hospitals (59% versus 37%, respectively). A broader method mix can satisfy clients with a variety of needs, a key factor for higher uptake of more effective methods and program success. The high unmet need for contraception coupled with high numbers of safe and unsafe abortions testifies to the need for stronger routine contraceptive services and highlights the potential benefits of strengthening postabortion contraceptive services. Postabortion family planning involves the provision of voluntary contraceptive counseling and methods to women after abortion care, whether for induced abortion or the treatment of complications from an unsafe abortion, to reduce unintended pregnancies and repeat abortions. Studies and interventions conducted in different parts of the world have shown that postabortion family planning improves women's knowledge of the benefits of contraception and increases uptake of contraceptive methods immediately after abortion, when return to fertility is almost immediate. Women's motivation to continue using a method is also likely to increase after leaving the facility. A limited method mix has been shown to adversely affect both contraceptive acceptance and continuation postabortion as well as the overall achievement of a national family planning program. Family planning programs, especially those for postabortion family planning, should offer a range of methods in order to meet the various needs of their clients. Evidence has shown that introducing a wider range of contraceptive methods in postabortion family planning significantly increases the proportion of clients leaving the facility with a method. The benefits of contraception can be particularly important for postabortion contraceptive acceptors, who face high risk of maternal mortality due to high parity or the likelihood that their pregnancies could end in unsafe abortion.