Predictors and Barriers to Post Abortion Family Planning Uptake in Hai District, Northern Tanzania: A Mixed Methods Study

Abstract

Introduction: Post Abortion Care (PAC) encompassing family planning counselling and contraception provision is a key strategy to reducing maternal morbidity and mortality especially in countries with restrictive abortion laws. Various factors affect the uptake of PAC modern family Planning (FP) in different settings. This study aimed at determining the prevalence, assessment of factors and barriers to PAC modern FP uptake in Hai district, Northern Tanzania
Methods: A mixed-methods study was conducted using an explanatory sequential design. Exit interviews using questionnaires was conducted among 189 women. In-depth interviews were conducted with 26 healthcare providers (HCPs) and 28 women who received PAC in Hai district hospital, Machame hospital and Moshi Specialists health centre in Hai district. Quantitative data was analysed using a Statistical Package for Social Science (IMB SPSS Statistics for Windows version 20.0 (SPSS Inc., Chicago, Ill., USA)). Bivariate and multivariable analyses were applied to estimate the predictors of uptake of PAC modern FP. Thematic content analysis was employed to explore barriers to uptake of post-abortion modern family planning.
Results: The prevalence of uptake of modern family planning following PAC was 59/189(31.2%). 56% of the 189 women who received PAC did not receive counselling services on family planning. Marital status and partner’s support were predictors of PAC modern family planning uptake (p=.007 vs. p= <.05, respectively).
Misinformation and misconception about modern contraceptives, lack of knowledge and fear of side effects were reported to be the major barriers to uptake of post-abortion family planning. Most women reported to have not received comprehensive family planning information from the HCPs. On the other hand, HCPs perceived their poor counselling skills as the barrier to post-abortion family planning uptake. This study observed poor coordination of PAC services within each visited facility and this was linked to women leaving the facility without family planning counselling and/or contraceptives provision.
Conclusion: Suboptimal modern family planning counselling during PAC contributes to the low uptake of contraceptives methods in this setting. Strategies are needed to improve PAC modern family planning services uptake. Strategies such as; provision of counselling skills to HCPs with comprehensive information targeting local contextual misconception and promoting PAC provision as a one-stop service.