Expanding contraceptive choice in Ethiopia: a comparative analysis of method mixes in post-abortion contraception versus routine family planning

Abstract

Background: In Ethiopia, a low contraceptive prevalence and high unmet need coupled with skewed method mix clearly signify the need for comprehensive family planning delivery strategies.  Ipas implemented problem-focused intervention to improve service delivery standards and provide accessible, high-quality family planning services. This analysis seeks to compare the contraceptive method mix in routine and post-abortion contraception services and to suggest how multifaceted service delivery approaches can help address the unmet family planning need. Methods: The intervention was implemented in 127 public health facilities providing both routine and post-abortion contraception services, from 2010 to 2017.  The intervention focused on service delivery and program management gaps identified during the baseline assessment.  Service data regularly collected from intervention facilities and entered into a Microsoft Excel database to conduct descriptive analysis, review trends, and monitor progress. Results: Trend analysis of method choice patterns revealed that the share of method mix for long-acting reversible contraceptives(LARCs) rose from 3% in 2010 to 40% in 2017 in routine family planning service, whereas in the post-abortion contraception service, the share for LARCs climbed from 2% in 2010 to 62% in 2017(P<0.001).  Trend analysis of LARC uptake in post-abortion contraception revealed that implant use rose from 2% in 2010 to 54% in 2017, while intrauterine device (IUD) use increased from 0.1% in 2010 to 9% in 2017.  In routine program, proportion of implant acceptors increased from 3% in 2010 to 35% in 2017, while IUD acceptance increased far more slowly, from only 0.07% to 5% over the same period. Conclusions: Comprehensive contraceptive service delivery strategies, such as integration of family planning with other maternal health services can help the service to reach clients with a variety of needs, a key factor for a higher uptake of LARCs by abortion clients as compared to routine family planning program.