Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study

Amsalu Muchie; Fentie Ambaw Getahun; Yibeltal Alemu Bekele; Tsion Samual; Tebkew Shibabaw

doi:10.1371/journal.pone.0244808

. 2021 Jan 20;16(1):e0244808. doi: 10.1371/journal.pone.0244808

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study

Amsalu Muchie ¹, Fentie Ambaw Getahun ², Yibeltal Alemu Bekele ^3,^*, Tsion Samual ⁴, Tebkew Shibabaw ⁴

Editor: Frank T Spradley⁵

PMCID: PMC7817005 PMID: 33471864

Abstract

Introduction

Globally an estimated 55.9 million abortions occur each year. The majority of abortions occur due to unintended pregnancies, which is a result of the non-use of family planning methods. World health organization recommends all clients to utilize modern contraceptive methods after any abortion procedure. However, post-abortion family planning utilization is still low in Ethiopia including the study area. Therefore, this study was expected to determine the utilization of post-abortion family planning and associated factors in Bahir Dar city health facilities in Northwest Ethiopia.

Method

Institution based cross-sectional study was conducted among 408 women from March 1 to April 30, 2019. Data were collected through face-to-face interview using a structured and pre-tested questionnaire. Systematic random sampling was used to select the study participants. Data were cleaned, coded, and entered into epi data and exported to SPSS for further analysis. Both bivariable and multivariable logistic regression were employed. Those variables that had a p-value of less than 0.2 during the bivariate analysis were retained for the multivariable analysis. P-value and confidence interval were used to measure the level of significance on multi-variable analysis and those variables whose P-value, less than 0.05 was considered as statistically significant.

Results

The finding of this study showed that the magnitude of post-abortion family planning (PAFP) utilization was 61% with 95% CI (55, 65). Secondary education level(AOR, 4.58; 95% CI (1.96, 10.69)), certificate and above education level (AOR, 3.06; 95% CI (1.32, 7.08)), Manual Vacuum Aspiration(MVA) (AOR, 7.05; 95% CI (2.94, 16.90)), both medication and Manual Vacuum Aspiration (AOR, 5.34; 95% CI (2.56, 11.13)) and received Post Abortion Family Planning (PAFP) counseling (AOR, 5.99; 95% CI (3.23, 11.18)) were significantly associated with PAFP utilization.

Conclusion

Post-abortion family planning utilization in Bahir Dar health facilities was low compared with the national figure. Secondary and above educational level, respondents who were managed by Manual Vacuum Aspiration (MVA), both Manual Vacuum Aspiration (MVA) and medication and receiving Post Abortion Family Planning (PAFP) counseling were predictors of post-abortion family planning service utilization.

Introduction

Post-abortion family planning(PAFP) is the initiation and use of family planning methods immediately after an abortion [1]. It is the part of abortion care service which increases contraceptive use prevalence and reduces unintended pregnancies and unsafe abortion [2]. The WHO guideline recommends a woman to wait at least six months after an abortion before getting pregnancy. This is important for her body time to regain its strength and prepare for healthy pregnancy [3].

Globally an estimated 55.9 million abortions occur each year. The majority (49.3 million) abortions occur in developing countries [4]. Unsafe abortion is preventable but it still causes 13% of maternal deaths and 20% of the overall burden of maternal death and long-term disability [13]. In Ethiopia, an estimated 620,300 induced abortions were performed in 2014 with an annual abortion rate of 28 per 1,000 women [5].

Studies conducted in developing countries showed that the prevalence of post abortion family planning utilization were 73%, 73%, 81%, and 97.7% in Africa and Asia, Pakistan, India and Brazil respectively [6–9]. Similar studies conducted in Sub-Saharan countries showed that the prevalence of post abortion family planning utilization ranges from 55.7% to 76% [10, 11]. Previous studies conducted in different parts of Ethiopia also showed the prevalence of post abortion family planning utilization were 47.5%, 56.5%, 59.2%, and 70% in Dessie Town, Guragie Zone, Debre Markos Town, and Jimma Town respectively [12–14].

According to different studies conducted in the developing countries, age, marital status, educational level, type of health facility, level of health facility, method mix, sex preference of health care provider, the desire of having more children, parity, gravidity, partner refusal, women accompanied by their partner, previous live birth, fear of side effects, and lack of adequate information determined post-abortion family planning utilization [12, 15–21]. Similarly, different studies in Ethiopia showed age, marital status, fear of side effect, availability of the contraceptive method, previous history of abortion, knowledge about family planning, misconception about contraceptive determined post-abortion family planning utilization [22–24].

Currently, the government of Ethiopia is committed to achieving the Sustainable Development Goal 3 (SDG-3) that promise to end all preventable causes of maternal death through providing effective maternal health care services [25, 26]. It is recognized that providing post-abortion family planning services for women minimize the risk of pregnancy-related problems. In addition, the government of Ethiopia implemented the new health sector transformation plan (HSTP) that aimed to improve the uptakes of maternal health care services utilization. One of the focus areas is expanding the infrastructure for providing post abortion family planning services since 2015/16 [21]. However, there is paucity of evidence that indicates the magnitude of post-abortion family planning services and its associated factors in Ethiopia after the implementation of the HSTP including the study area. So the aim of this study was to determine the magnitude and associated factors of post-abortion family planning service.

Methods

Study area and design

This study was carried out in Bahir Dar town, North West Ethiopia. Bahir Dar is the capital city of the Amhara regional state. It is located around 565 km far from the Ethiopian capital, Addis Ababa. In the city, there are two government hospitals, five government health centers, two higher privet clinics, and one private reproductive health-based clinic that are providing abortion care services. Institutional based cross-sectional study was conducted from March 1 to April 30, 2019. All women who were seeking abortion care service in Bahir Dar city health facilities were the source population. All women who came for abortion care services during the study period were included in this study while women who were critically ill and showed any sign of infection excluded in this study.

Sample size and procedure

The sample size was calculated using a single population proportion formula by considering the following assumption; according to a study conducted in Debre Markos Town, the proportions of post-abortion family planning service utilization was 59.2% [27]. With a 95% confidence interval, 5% margin of error, and 10% none response rate. Therefore, a total of 408 women who received abortion care services were included in this study.

All public and private health institutions (a total 10 governmental health facilities and 4 private health facilities) which are providing abortion care service found in the town were selected. All selected health care facilities provided both legal abortion services based on the country law and emergency post abortion care services for those who need the service. The participants were proportionally allocated to each health facility based on last year’s client flow of abortion care services performance. Finally, systematic random sampling was used to select the study participants in each health care facility.

Study variables

Dependent variables

Post-abortion family planning utilization (Yes/No).

Independent variables

Socio-demographic related factors. Age, monthly income, religion, marital status, occupation, family support, and educational status

Reproductive and abortion management-related factors. gravidity, parity, the desire of children, previous abortion, surgical abortion, medical abortion, and gestational age.

Facility and provider related factors. Type of health institution, level of health institutions, PAFP counseling, availability of the contraceptive, sex of the provider, method mix, and communication.

Personal and family planning method factors. Knowledge, request for service, information about family planning methods, and family planning side effects.

Operational definition

Knowledgeable

Seven questions were used to measure knowledge about post-abortion modern contraceptive uses. Respondents who answered the mean and above among seven knowledge related family planning questions were considered as “knowledgeable” about post-abortion modern contraceptive uses while respondents who answered below the mean knowledge related family planning questions were considered as “not knowledgeable” [20].

Data collection procedure and tools

Data were collected through a structured questionnaire developed by reviewed different literature vie interviews. The questionnaire was first prepared in English and translated to local language Amharic and then translated back to English to check the consistency. The questionnaire was comprised of socio-demographic characteristics, individual-related characteristics, reproductive health-related and facility-related characteristics. Five BSc nurses were assigned for data collection and one MSc holder nurse was assigned to supervise during the whole data collection process.

Data quality control

Pre-test was conducted on 10% [41] respondents in Finote Selam Hospital. One day training was provided for data collectors and the supervisor on the objective, and the relevance of the study. The supervisor managed the data collection process every day, and the principal investigator also checked the completeness of the questionnaire every day.

Data processing and management

Data were cleaned, coded, and entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics were carried out to see the distributions of independent variables. Both bivariable and multivariable logistic regression analysis were employed. On bivariable analysis p-value of less than 0.2 was used to select candidate variables for multivariable analysis. P-value and 95% confidence interval were used to measure the level of significance on multivariable analysis and those variables with a P-value of less than 0.05 on multivariable analysis were considered as statistically significant.

Ethical statement

Ethical clearance was obtained from the Ethical review board of Bahir Dar University, College of Medicine and Health Sciences. A support letter was received from Amhara public health institute and Bahir Dar city administration health office.

Written consent was taken for every participant and based on their agreement the data collection took place. Consent was taken from their guardian for women whose age less than 18 years. Information was provided for all participants about the objective, the purpose and the contents of the study as well as their rights to refusal at any time of data collection. The participants were also reassured how to handling and uses of the data.

Result

Socio-demographic characteristics

A total of 408 respondents participated in this study with a response rate of 100%. One hundred fifty-six (38.2%) respondents were in the age group of 25 to 29 with the mean age of 26.23 and SD of ±4.75. Two hundred forty (58.8%) respondents were married. Three hundred thirty-six (82.6%) respondents were Orthodox religion followers and 72(17.4%) respondents were Muslims. Three hundred ninety (95.6%) respondents were from Amhara and 18(4.4%) were from Agew ethnic groups. Eighty-four (20.6%) respondents did not attend formal education while 118 (28.9%) respondents attended secondary education. Three hundred fifteen (77.2%) respondents were living in rural areas (Table 1).

Table 1. Socio-demographic characteristic of respondents in Bahir Dar town, Amhara region, Northwest Ethiopia, 2019.

Variables (n 408)	Frequency	Percent (%)
Age
15–19	19	4.7
20–24	135	33.1
25–29	156	38.2
30–34	61	15
≥ 35	37	9.1
Marital status
Single	141	34.5
Married	240	58.8
Other (widowed and divorced)	27	6.6
Level of Education
Illiterate	84	20.6
Primary education	89	21.8
Secondary education	118	28.9
Certificate and above	117	28.7
Occupation
Housewife	92	22.5
Farmer	46	11.3
Merchant	94	23
Governmental Employee	40	9.8
Daily Laborer	36	8.8
Student	100	24.5
Residence
Urban	93	22.8
Rural	315	77.2
Monthly Income
<1000	51	12.5
1001–2000	49	12
>2001	308	75.5

Open in a new tab

Reproductive hearth related characteristics

One hundred eighty-three (44.8%) respondents have prim-gravidity. Thirty-six (8.8%) respondents have had a history of previous abortion. Three hundred thirty eighty (82.8%) respondents desire to have additional children for the future. Two hundred forty-two (59.3%) respondents come with spontaneous abortion. Two hundred eighty-three (69.4%) respondents received post-abortion family planning counseling before they left the health institution and 144 (35.3%) of them got individual counseling (Table 2).

Table 2. Reproductive health related characteristics of respondents in Bahir Dar town, Amhara Region, northwest Ethiopia, 2019.

Variable	Frequency	Percent (%)
Type of abortion management
Medication	181	44.3
MVA	67	16.4
Both	160	39.2
Type of health institution
Public	248	60.8
Private	160	39.2
Want additional child
Yes	338	82.8
No	70	17.2
Planned Pregnancy
Yes	222	54.4
No	186	45.6
Know about PAFP method
Yes	172	42.2
No	236	57.8
Source of information
Neighbor	108	26.5
Husband	14	3.4
Provider	159	39
Mass media	24	5.9
Post-abortion counseling
Yes	283	69.4
No	125	30.6
Counseling type
Individual	132	46.6
With husband	111	39.2
With parents	40	14.1
Knowledge about PAFP
Knowledgeable	180	44
Not Knowledgeable	228	56
Sex preference of the health care provider
Male	162	39.7
Female	176	43.1
Both	70	17.2

Open in a new tab

Magnitudes of post abortion family planning utilization

The magnitude of post abortion family planning utilization in the study area was 249(61%) with 95% (CI: 55.0, 65.0). Two hundred eighty-two (69%) respondents were received abortion service at hospital level while 127(31%) respondents were received the service at the health centers.

Factors of post-abortion family planning utilization

In bivariable analysis, age of the women, educational status, marital status, residence, gravidity, parity, the desire of additional children, previous history of abortion, gestational age of current pregnancy, sex preference of health care provider, type of abortion management, communication skill, accompanied with a husband, type of health institution, level of the health institution, and PAFP counseling were found to be candidate variables at P-value < 0.2 for the multivariable analysis. On multivariate analysis, educational status, post-abortion family planning counseling, and type of abortion management were factors that affect post-abortion family planning utilization at p-value less than 0.05.

The odds of post-abortion family planning utilization among women who attended secondary educational level were 4.58 times higher than those who did not attend formal education [AOR = 4.58 (95%CI:1.69,10.69)]. The odds of post-abortion family planning utilization among women who attended a certificate and above educational level were 3.06 times higher than those who did not attend formal education [AOR = 3.06 (95%CI:1.32, 7.08)]. The odds of post-abortion family planning utilization among women who received post abortion family planning counseling were 5.99 times higher than those who did not received [AOR = 5.99(95%CI:3.20,11.18)].

The odds of post-abortion family planning utilization among women who managed by MVA was 4.76 times higher than those who managed by medication [AOR = 4.76 (95% CI: 1.93, 11.76)]. Similarly, the odds of post-abortion family planning utilization among women whose abortion procedure managed by both MVA and medication were 4.62 times higher than those who managed by medication alone [AOR = 4.62 (95%CI: 2.18, 9.81)] (Table 3).

Table 3. Factors associated with post abortion modern contraceptive utilization among women who came for abortion service in Bahir Dar city health institutions, North West Ethiopia, 2019.

Variable	PAFP utilization
	PAFP utilization		COR (95%CI)	AOR (95% CI)
	Yes	No
Educational status of the mother
Not attained formal education	30	54	1	1
Primary education	39	50	1.40(0.76,2.58)	0.95(0.40,2.25)
Secondary education	86	32	4.83(2.64,8.84)	4.58(1.69,10.69
Tertiary education	91	26	6.30(3.77,11.75)	3.06(1.32,7.08)
Receive PAFP Counseling
Yes	170	46	5.64(3.65,8.72)	5.99(3.20,11.18)
No	76	116	1	1
Abortion Management
Procedure
Medication	69	112	1	1
MVA	53	14	6.14(3.17,11.00)	4.76(1.93,11.76)
Both	124	36	5.59(3.47,9.01)	4.62(2.18,9.81)
Number of pregnancies
One	85	100	1	1
Two	68	28	2.85(1.68,4.83)	2.22(0.99,4.97)
Three	46	12	4.51(2.24,9.06)	2.94(0.42,7.74)
Four	47	22	2.51(1.40,4.50)	0.76(0.29,2.00)
Type of institution
Public	167	81	2.11(1.40,3.18)	1.64(0.89,3.00)
Private	79	81	1	1
Number of children
No child	99	103	1	1
One	69	29	2.47(1.48,4.14)	0.15(0.01,1.59)
Two	37	12	3.20(1.58,6.50)	0.65(0.09,4.56)
Three and above	41	18	2.37(1.27,4.40)	6.90(0.27,172.7)
Previous abortion
Yes	37	9	3.02(1.41,6.45)	3.54(0.90,13.90)
No	208	154	1	1

Open in a new tab

Discussion

In this study, the overall post-abortion family planning utilization was 61% with 95% (CI: 55.0, 65.0). The finding of this study was consistent with previous studies conducted in Guragie district and Debire Markos Town, with overall post-abortion family planning utilization of 56.5% [28] and 59.2% [25] respectively. However, the finding of this study was lower than the previous studies conducted in Addis Ababa [26], Ethiopia [14] and Brazil [29]. This variation may be due to marital status differences. The percentage of married women was higher in the study from Brazil (86.7%) compared to our finding in which 58.8% of the respondents were married. Presence of more married women may increase the utilization of PAFP since they are more autonomous to decide family planning use [26]. The other reason may be due to educational level differences. A study conducted in Addis Ababa showed that, 75% of respondents attended secondary and above educational levels [25] but the current study showed only 57.6% of respondents were secondary and above educational levels accomplishers. In Brazil, 92.6% of respondents were knowledgeable which may increase the utilization of post-abortion modern contraceptive [30]. In addition, the finding of this study was higher compared to the previous study done in Dessie Town (47.5%). This difference might be due to the difference in the number of respondents who counseled about post abortion family planning. A study conducted in Dessie Town showed only 56% of respondents received post-abortion family planning counseling [31] while in the current study, 69% of the respondents received post-abortion family planning counseling [15].

The odds of post-abortion family planning use among women who attended secondary education and above was higher compared to women who did not attend formal education. The finding of this study was similar to the previous studies conducted in Debre Markose Town [32], Gambella [33], and Kenya [34]. This might be due to the reason that educated women have better access to information about family planning and reproductive health issues [35] which enables them to pass informed decisions and more concerned about their reproductive health rights [14]. This implies that extending women’s education to at least secondary level increases the uptakes of PAFP contributing to achieving SDG 3.1 to end all preventable causes of maternal death.

The odds of post-abortion family planning use among women who received post-abortion family planning counseling was higher than the counterparts. The finding of this study was similar with the previous studies conducted in Debre Markos [36], Kenya [37] and Brazil [38]. This might be due to counseling helps the women to make informed decisions about family planning services utilization [39]. Counseling is one of the critical elements in the provision of quality family planning services. It is a means, provider help clients make and carry out their own choices about reproductive health and family planning [40]. Post-abortion contraceptive counseling is an effective way of increasing the utilization of highly effective methods of contraception [41].

The odds of post-abortion family planning utilization among women whose abortion procedure managed by MVA was higher compared to women managed by medication alone. This finding was in line with the previous studies conducted in England and Wales [42] and Pakistan [43]. However, the finding of this study was different from the study conducted in India [44]. This discrepancy might be due to variation in women preference to nature of procedure, which takes a shorter time [45]. Similarly, the odds of post-abortion family planning use among women managed with both (manual vacuum aspiration and medication) were higher compared to women managed with medication. This finding was supported by the study conducted in eight countries of Africa [46].

Conclusions

The magnitude of post-abortion family planning utilization in Bahir Dar city health facilities was low compared to the national figure. Attending education, type of abortion management and receiving counseling were predictors of post-abortion family planning method utilization. Based on the findings, we recommend that making more efforts on counseling service provision by Ministry of Health (MoH) is the effective and sustainable method in increasing PAFP utilization of women.

Supporting information

S1 File. Data set, that contain the survey data of the participant.

(XLSX)

Click here for additional data file.^{(118.9KB, xlsx)}

Acknowledgments

First of all, the authors would like thanks to all participants who were volunteer to participate in this study. We are also grateful to the Bahir Dar town health office staff, health professionals for their invaluable support through the whole process and the supervisors and data collectors who have committed themselves throughout the study period.

Declaration: Consent for publication. Verbal consent for publication was received from the participant with regard to all the detail that explains the participants.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

Bahir Dar University has funded this research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

1.World Health Organization(WHO). Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division: executive summary. 2015.
2.World Health Organization(WHO). Global health observation data 2015.
3.World Health Organization(WHO). Provision of effective antenatal care: integrated management of pregnancy and childbirth (IMPAC). Geneva: Standards for maternal and neonatal care (16), Department of making pregnancy safer; 2006. [Google Scholar]
4.UNICEF. Global Antenatal care coverage 2016.
5.Kuruvilla S, Bustreo F, Kuo T, Mishra C, Taylor K, Fogstad H, et al. The Global strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience. Bulletin of the World Health Organization. 2016;94(5):398 10.2471/BLT.16.170431 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.World Health Organization(WHO). New ANC recommendation for positive pregnancy experience 2016.
7.World Health Organization(WHO). Antenatal care randemization trial Geneva 2002.
8.USAID. FANC planning and providing care during pregnancy Maternal and Child Health Journal. 2004(JHPIEGO/MNH Program USA).
9.Wang W, Alva S, Wang S, Fort A. Levels and trends in the use of maternal health services in developing countries. 2011. [Google Scholar]
10.Uganda Bureau of Statistics. Uganda Demographic and Health Survey 2016 Key Indicators Report. 2017.
11.National Institute of Statistics of Rwanda. Rwanda Demographic and Health Survey 2014–15 Final Report. 2016.
12.Ethiopian Central Statistics Agency(ECSA). Ethiopian demographic health survey (EDHS). 2016.
13.Adhikari T, Sahu D, Nair S, Saha KB, Sharma RK, Pandey A. Factors associated with utilization of antenatal care services among tribal women: A study of selected States. The Indian journal of medical research. 2016;144 10.4103/0971-5916.193284 [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Rurangirwa AA, Mogren I, Nyirazinyoye L, Ntaganira J, Krantz G. Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study. BMC pregnancy and childbirth. 2017;17(1):142 10.1186/s12884-017-1328-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Mugo NS, Dibley MJ, Agho KE. Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey. BMC pregnancy and childbirth. 2015;15(1):68 10.1186/s12884-015-0491-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
16.Pandey S, Karki S. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal. International Journal of MCH and AIDS. 2014;2(2):212 [PMC free article] [PubMed] [Google Scholar]
17.Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, et al. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PloS one. 2013;8(1):747 10.1371/journal.pone.0053747 [DOI] [PMC free article] [PubMed] [Google Scholar]
18.Gebremeskel F, Dibaba Y, Admassu B. Timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch town and Arba Minch district, Gamo Gofa zone, South Ethiopia. Journal of environmental and public health. 2015;2015 10.1155/2015/971506 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Molla Gedefaw, Bilal Muche, Mekonen Aychiluhem. Current Status of Antenatal Care Utilization in the Context of Data Conflict: The Case of Dembecha District, Northwest Ethiopia. Open Journal of Epidemiology. 2014;4(04):208. [Google Scholar]
20.Kindie Muchie, Fentahun. Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey. BMC pregnancy and childbirth. 2017;17(1):300 10.1186/s12884-017-1488-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
21.The Federal Democratic Republic of Ethiopia Ministry of Health(FDRE-MOH). Health Sector Transformation Plan (HSTP) 2015/16–2019/20. 2015.
22.Bahir Dar Zuria district. Quarterly and Yearly report 2017.
23.Singh DR, Jha T. Exploring Factors Influencing Antenatal Care Visit Dropout at Government Health Facilities of Dhanusha District, Nepal. American Journal of Public Health Research. 2016;4(5):170–5. [Google Scholar]
24.Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan-Koru JA, Stevenson R, et al. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PloS one. 2014;9(7):e101893 10.1371/journal.pone.0101893 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Adewuyi EO, Auta A, Khanal V, Bamidele OD, Akuoko CP, Adefemi K, et al. Prevalence and factors associated with underutilization of antenatal care services in Nigeria: A comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey. PloS one. 2018;13(5):e0197324 10.1371/journal.pone.0197324 [DOI] [PMC free article] [PubMed] [Google Scholar]
26.Ali S, Dero A, Ali S. Factors affecting the utilization of antenatal care among pregnant women: A literature review. J Preg Neonatal Med 2018; 2 (2): 41–45. [Google Scholar]
27.Tilaye Gudina Terfasa, Mesganaw Fantahun Afework, Frew Tadesse Berhe. Antenatal Care Utilization and It’s Associated Factors in East Wollega Zone, Ethiopia. Preg Child Health 2017; 4 10.4172/2376-127X.1000316:2. [DOI] [Google Scholar]
28.Gitonga E. Determinants of focused antenatal care uptake among women in tharaka nithi county, Kenya. Advances in Public Health. 2017;2017. [Google Scholar]
29.Edgard-Marius O, Charles SJ, Jacques S, Justine GC-C, Virginie MA, Ibrahim MA, et al. Determinants of Low Antenatal Care Services Utilization during the First Trimester of Pregnancy in Southern Benin Rural Setting. Universal Journal of Public Health. 2015;3(5):220–8. [Google Scholar]
30.Audet CM, Blevins M, Chire YM, Aliyu MH, Vaz LM, Antonio E, et al. Engagement of men in antenatal care services: increased HIV testing and treatment uptake in a community participatory action program in Mozambique. AIDS and behavior. 2016;20(9):2090–100. 10.1007/s10461-016-1341-x [DOI] [PMC free article] [PubMed] [Google Scholar]
31.Abosse Z, Woldie M, Ololo S. Factors influencing antenatal care service utilization in hadiya zone. Ethiopian Journal of Health Sciences. 2010;20(2). 10.4314/ejhs.v20i2.69432 [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Khanal Vishnu, da Cruz, Jonia Lourenca, Nunes Brites, Mishra Shiva Raj, Karkee Rajendra, et al. Under-utilization of antenatal care services in Timor-Leste: results from Demographic and Health Survey 2009–2010. BMC pregnancy and childbirth. 2015;15(1):211 10.1186/s12884-015-0646-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Timor-Leste Minstry of Health. The national health sector strategic plan for 2011–2030 Timor-Leste. 2011.
34.Makenzius M, Faxelid E, Gemzell-Danielsson K, Odero TM, Klingberg-Allvin M, Oguttu M. Contraceptive uptake in post abortion care—Secondary outcomes from a randomised controlled trial, Kisumu, Kenya. PloS one. 2018;13(8):e0201214 10.1371/journal.pone.0201214 [DOI] [PMC free article] [PubMed] [Google Scholar]
35.Bbaale E, Mpuga P. Female education, contraceptive use, and fertility: evidence from Uganda. Consilience. 2011(6):20–47. [Google Scholar]
36.Kokeb L, Admassu E, Kassa H, Seyoum T. Utilization of Post Abortion Contraceptive and Associated Factors among Women who Came for Abortion Service: a Hospital Based Cross Sectional Study. J Fam Med Dis Prev. 2015;1:022. [Google Scholar]
37.Mutua MM, Achia TN, Maina BW, Izugbara CO. A cross‐sectional analysis of Kenyan postabortion care services using a nationally representative sample. International Journal of Gynecology & Obstetrics. 2017;138(3):276–82. 10.1002/ijgo.12239 [DOI] [PubMed] [Google Scholar]
38.Borges ALV, OlaOlorun F, Fujimori E, Hoga LAK, Tsui AO. Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study. Reproductive health. 2015;12(1):94 10.1186/s12978-015-0087-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
39.The ACQ UIR E Project. Counseling for effective use of family planning participant handbook New York: EngenderHealth/The ACQUIRE Project; 2008. [Google Scholar]
40.Abamecha A, Shiferaw A, Kassaye A. Assessment of Post Abortion Contraceptive Intention and Associated Factors among Abortion Clients In Gambella Health Facilities, Gambella Town, South West Ethiopia.
41.Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancyin adults. Women's Health Issues. 2002;12(2):79–95. 10.1016/s1049-3867(01)00147-5 [DOI] [PubMed] [Google Scholar]
42.Bury L, Hoggart L, Newton VL. " I thought i was protected" Abortion, contraceptive uptake and use among young women: a quantitative survey. 2014. [Google Scholar]
43.Sathar ZA, Singh S, Fikree FF. Estimating the incidence of abortion in Pakistan. Studies in family planning. 2007;38(1):11–22. 10.1111/j.1728-4465.2007.00112.x [DOI] [PubMed] [Google Scholar]
44.Dhillon B, Chandhiok N, Kambo I, Saxena N. Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study). 2004. [PubMed] [Google Scholar]
45.Azmat S, Waqas H, Muhammad I, Ghulam M, Aftab A. Post-abortion care family planning use in Pakistan. Pakistan Journal of Public Health. 2012;2(2):4–9. 10.1017/S0021932012000296 [DOI] [PubMed] [Google Scholar]
46.Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Global public health. 2018;13(1):35–50. 10.1080/17441692.2016.1174280 [DOI] [PubMed] [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0244808.r001

Decision Letter 0

Frank T Spradley

2 Oct 2020

PONE-D-20-26289

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, Facility-Based Cross-Sectional Study.

PLOS ONE

Dear Dr. Bekele,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Four experts in the field handled your manuscript. Although they found some interest in your study, several major comments arose during review. ALL of the reviewers' comments need to be addressed in your revised manuscript.

Please submit your revised manuscript by Nov 16 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants.

Please ensure you have provided sufficient details to replicate the analyses such as:

- a description of any inclusion/exclusion criteria that were applied to participant recruitment,

- a statement as to whether your sample can be considered representative of a larger population,

- a description of how participants were recruited, and

- descriptions of where participants were recruited and where the research took place.

3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses.

For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible.

4. Please provide additional details regarding participant consent.

In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed).

If your study included minors, state whether you obtained consent from parents or guardians.

If the need for consent was waived by the ethics committee, please include this information'

5. Thank you for stating the following above the Acknowledgments Section of your manuscript:

'Funding

Bahir Dar University has funded this research'

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

a. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

'The author(s) received no specific funding for this work.'

b. Please include your amended statements within your cover letter; we will change the online submission form on your behalf

6. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: No

Reviewer #3: Partly

Reviewer #4: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Introduction

Para 2: “Globally an estimated 55.9 million abortions occur each year, from this 49.3 million occur in the developing”. This sentence is obscure, please make it clear.

Para 2: What the author meant by writing “long-term disability”?

Para 3: “Studies conducted in developing countries showed that the prevalence of post abortion family planning utilization was 73%, 73%, 81%, and 97.7% in Africa and Asia, Pakistan, India, and Brazil respectively” . Pakistan and India are Asian countries, why do you mention prevalence in Africa and Asia?

The last paragraph: Why do you conduct the same research in this area since there are studies concerning the utilization of family planning service in your country?

Method

The author should provide the data on the health institutions, such as the number of abortions and socioeconomic and obstetric profile of population studied.

I missed one paragraph describing inclusion and exclusion criteria.

It’s not clear the criteria for the inclusion of explanatory variables in the multivariate logistic regression. It should be explained.

Discussion

Again, why do you conduct the same research in this area since there are studies concerning the utilization of family planning service in your country? It is important to compare this result with findings from other studies from Ethiopia and eventually from abroad? The author stated” in the number of respondents who counseled about post abortion family planning” when explaining the difference, this is not convincing.

When the author explain: “The odds of post-abortion family planning use among women who received post-abortion family planning counseling were higher than the counterpart”, you should focus on the benefits which post-abortion family planning counseling might bring to abortion patients.

I missed one paragraph explaining: “sex preference of health care providers, and counseling about post-abortion family planning were predictors of post-abortion family planning method utilization”.

Conclusion

It should be shorter and concise. Recommendations should be more specific and target the risk factors in your research.

Reviewer #2: Understanding the utilization of postabortion family planning is a worthwhile undertaking and critical to reducing unintended pregnancies as well as maternal mortality in places like Ethiopia. Congratulations to the authors for conducting this research and putting together this draft for publication. Some specific feedback to strengthen the paper is listed here:

-Spend more time on the definitions and ensure the use of globally recognized definitions. It's unclear whether the authors are considering contraception after INDUCED abortions or also considering contraception after SPONTANEOUS abortions (miscarriages). Postabortion care generally refers to both and PAFP is important in both cases--and spontaneous abortions are much more common than induced (which means the globally cited numbers should be higher). It would be helpful to define PAC services broadly (treatment of complications, counseling, and provision of contraception) and emphasize that PAFP is an essential component of quality PAC services. Also consider using the global estimate for abortion from Guttmacher or another source.

-What's the population of Bahir Dar town? How many women of reproductive age? What's the contraceptive prevalence rate in the region/area? What's the total fertility rate? What other contextual information and population data can you provide to give a better picture of why understanding PAFP rates in Bahir town is important? What does studying this area contribute to broader learning about PAFP in Ethiopia / Horn of Africa / Globally?

-Why was Debre Markose town used as a proxy to calculate the sample size? What are the similarities? what are the differences? How was this considered?

-How many public and private health institutions provide abortion services in Bahir Dar town? What source of information was used to ensure ALL public and private institutions were included (assuming it's often difficult to enumerate all private providers)? Did all included institutions offer postabortion contraception in addition to abortion services? Did all institutions offer similar method options? Were there differences in PAFP acceptance rates for each facility? Was there any learning here? how did this factor into the statistical analysis?

-The methods section needs clarified. Were you collecting this information from patient register books (register extraction?)? Or were you contacting the women for a survey prospectively as they went in for their abortion? Were women approached in their homes? At the facilities? How was the data collected and protected? How many women were approached? How many women gave consent to participate? How many women refused? Would you expect any differences in those who consented and those who refused? The data quality control "pretest" does not make sense, what was done here?

-ETHICS: Was there any sort of ethical approvals for this study (I see in the declaration, but include in your methods section of the paper)? How did you ensure informed consent to approach these women and include their information? "Written verbal consent" does not make sense. How did you protect their information, given the sensitivity of the subject matter? A 100% response rate is quite impressive, but also raises questions about the consent process.

-In the discussion, PAC-FP research has been conducted in many places. Why choose to compare this data to Brazil? I'm sure there are many differing factors in addition to the marriage rate that should be considered.

-Is there any data on the quality of the PAC-FP counseling provided? The quality of the counseling matters for PAFP uptake.

-I would recommend to re-do the discussion and instead of comparing the results of this study to those conducted in other places far away, instead re-work to discuss what the implications of this data are. How can these findings be used programmatically to improve PAC and PAFP uptake in Bahir Dar? What should the MOH be doing? What should the private facilities be doing? What should change now that we have these data? What's next? So what?

Reviewer #3: The manuscript is riddled with a lot of typos and grammatical errors that could have been easily corrected. It is not clear what the sample size was and with such a large volume of clients sampled it would be important to add an exclusion criteria. The number of respondents is very high for the period of the study (one month). Had the study subjects come for treatment for abortion complications related to incomplete abortion or come for termination of pregnancy/safe abortionm is it legal in Ethiopia? at what stage post treatment were the interviews conducted?

Also, how were the data collectors assigned to the facilities for data collection? Finally would be good to revise the referencing - not clear what and where online the references were accessed or whether these were accessed as hard copies. Finally not clear what new learning the study is contributing and if it is specifc learning for the study area please add how the findinsg are expected to be applied. Globally there is not new evidence the study adds.

Reviewer #4: Thank you for inviting me to review this manuscript. It contributes to the science of postabortion care family planning globally and gives further data points on factors related to postabortion family planning. It is clear the authors and researchers worked diligently on this research.

1. Is the manuscript technically sound, and do the data support the conclusions? For the most part this manuscript is technically sound. The conclusions and discussion could be developed further. More specific recommendations are needed.

2. Has the statistical analysis been performed appropriately and rigorously? Yes, although an additional table with the bivariate analysis results would be useful as would the p values for the multivariate table. Also there is a need to clarify the title of Table 3

3. Have the authors made all data underlying the findings in their manuscript fully available? The information in the manuscript just states the data are available in an Excel form, but not exactly how to access them.

4. Is the manuscript presented in an intelligible fashion and written in standard English? There are a number of grammar, spelling, and proof reading issues in this manuscript that need to be addressed as well as inconsistencies in the use of acronyms.

Additional comments for the authors:

- Clarification of education levels – unclear to global audience what “Certificate and above” indicates for education - is also does not correspond to the levels in the analysis or discussion.

- Third paragraph percentage reports are confusing, recommend putting them in parenthesis next to the places

- Be more specific in aim of the study – include the region/area

- Define what you mean by post abortion family planning utilization

- Give what currency the monthly income is in

- Include information about legality of abortion/postabortion care in Ethiopia

- In the introduction and discussion, previous studies don’t specify exactly where they took place – for example in the first paragraph of the discussion is lists Addis Ababa and then Ethiopia – would be helpful to be more specific with the general Ethiopia information – list like with like places. This is the case also in the third paragraph of the discussion – I assume that Debre Markose and Gambella are in Ethiopia, but would be helpful to clarify this as the next one is about Kenya generally

- The last line of the conclusion does not really summarize the findings of the study or give specific recommendations – this is a broad recommendation that could be difficult to complete – it may be useful to specify more specific interventions – which could be related to education but also to the other variables.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: STEMBILE MUGORE

Reviewer #4: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: renamed_669b2.docx

Click here for additional data file.^{(13.9KB, docx)}

Attachment

Submitted filename: Reviwer Comments.docx

Click here for additional data file.^{(13.2KB, docx)}

PLoS One. 2021 Jan 20;16(1):e0244808. doi: 10.1371/journal.pone.0244808.r002

Author response to Decision Letter 0

27 Oct 2020

Point by point responses

Reviewer Comments

General comments Authors response

The paper is good but is riddled with typos and could do with thorough editing. Thank you for your suggestion. For addressing the issue we consulted senior public health staff and language professors in my university.

1 While the sample size is clear, it is not clear how the clients for the study were recruited and agreed to participate in the study. Were all the 408 women post abortion care clients – please specify in the methodology section? In addition, please clarify the inclusion and exclusion criteria. Thank you for your comment. Based on your comment we amended it on the revision manuscript.

Line number 189-191

2 Under method: Please clarify the number of health facilities as 408 post abortion clients in one month seems to be high.

Thank you for your comment. Based on your recommendation we add the numbers health facilities included in the study on the revision manuscript.

Line number 198-199

3 Please clarify whether these women had come for abortion services, is it legal or whether they had come for treatment of abortion complications.

Thank you for your comment. All selected facilities provided legal abortion services based on the country law and post abortion care services for those women who came for emergency post abortion care services. We included this information in method section.

Line Number 199-201

4 The difference by type of treatment is specified please clarify who the level of the provider (nurse, midwife, doctor etc.) as this has implications on whether the client was counseled or not.

Thank you for your comment. In Ethiopia there is special training (post abortion care training) gave for the profession who gave abortion service otherwise they are not eligible for providing abortion services whatever the level and the types of health professional. The main aim of the training is to increase the capacity of the professionals to provide all components of abortion care including counseling and providing post abortion family planning care. Otherwise there is no variation on counseling’s of family planning on the level of the provider (nurse, midwife, doctor etc.)

5 Four towns as well as the capital are mentioned as part of the comparison – are these like the study area in terms of whether these are rural, similar client demographics and socio-cultural factors that affect family planning decision making? In other words, did they have the same variables that influence FP uptake? Thank you for your comment. The socio-cultures of the capital (Addis Ababa) is almost the same in the study area Bahir Dar with regards of the availability of facilities like health facilities, educational centers that directly influence the uptakes of family planning services since Bahir Dar is one of the second economic centers of the country.

6 Difficult to understand what was evidence this study added to what is already known to influence PAFP from Ethiopia itself as well as global. Thank you for your comments. As a country Ethiopia implements a strategy that focus on providing post abortion family planning services for all women who receive abortion services while this study find out, the current levels of the post abortion family planning in study area was low only half of them were used family planning services that is contradict the current implemented strategy. Therefore, the lesson we learned from this study is still the country needs to do great attention in the area. In addition, providing counseling for clients is one of the means to improving the uptakes of post-abortion family planning. Therefore, this finding providing a clue to see the way the strategy was implemented.

Additional points need clarification

Introduction

1 Para 2: “Globally an estimated 55.9 million abortions occur each year; from this 49.3 million occur in the developing”. This sentence is obscure, please make it clear. Thank you for your comments. Based on your comment we correct it on the updated manuscript.

Line number 8 to 9

2 Para 2: What the author meant by writing “long-term disability”? Thank you for your comments. As we know abortion responsible for maternal mortality and morbidity. From the morbidity abortion causes “long-term disability.” Long term disability mean scarring of the uterine lining, secondary infertility; ectopic pregnancy, damage to internal organs and breast cancer.

3 Para 3: “Studies conducted in developing countries showed that the prevalence of post abortion family planning utilization was 73%, 73%, 81%, and 97.7% in Africa and Asia, Pakistan, India, and Brazil respectively” . Pakistan and India are Asian countries, why do you mention prevalence in Africa and Asia? Thank you for your comment. There is no specific reason that we include African and Asia. But we are interested to show what the magnitudes post-abortion family planning utilization out sides of the study country because of that we found astudy conducted in eight country found in Africa and Asia (Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Global public health. 2018;13(1):35-50.) that is why we include it.

4 The last paragraph: Why do you conduct the same research in this area since there are studies concerning the utilization of family planning service in your country?

Thank you for your comment. based on your comment we incorporate some additional evidence that lead as to conduct this study by including “The governments of Ethiopia implemented the new health sector transformation plan to improve the health system utilization one of the focus areas is expanding the infrastructure and post abortion family planning services since 2015/26.”

Line number 178 to 183

Method

5 The author should provide the data on the health institutions, such as the number of abortions and socioeconomic and obstetric profile of population studied. I missed one paragraph describing inclusion and exclusion criteria.

It’s not clear the criteria for the inclusion of explanatory variables in the multivariate logistic regression. It should be explained. Thank you for your comment. Based on your comment we amended it on the revision manuscript by including the inclusion criteria “All women who came for abortion care services during the study period were included in this study while women who critically ill and any sign of infection were not included in this study.”

Line number 189-191

Discussion

6 Again, why do you conduct the same research in this area since there are studies concerning the utilization of family planning service in your country? It is important to compare this result with findings from other studies from Ethiopia and eventually from abroad? The author stated” in the number of respondents who counseled about post abortion family planning” when explaining the difference, this is not convincing.

Thank you for your comment. There is different research conducted in Ethiopia in the area of post abortion care before 2015. But in 2015/16 Ethiopia design and implemented the new Health sector transformation plan since with aim of improving quality and equity, universal health coverage and transformation. One of the main focus areas is expanding the infrastructure of post abortion care and components of services. However there is limited finding with area of post abortion family planning services to understand whether there is improvement in the uptake of post abortion family planning. That why we conduct this research.

7 When the author explains: “The odds of post-abortion family planning use among women who received post-abortion family planning counseling were higher than the counterpart”, you should focus on the benefits which post-abortion family planning counseling might bring to abortion patients. Thank you for your comment. We incorporate it on the updated manuscript “Counseling is one of the critical elements in the provision of quality family planning services. It is a means, provider’s help clients make and carry out their own choices about reproductive health and family planning.”

Line number 330 to 333

8 I missed one paragraph explaining: “sex preference of health care providers, and counseling about post-abortion family planning were predictors of post-abortion family planning method utilization”. Thank you for your comment. We know sex preference of the professional is one of the significant variables on multivariate analysis. But we are not confortable to discuss the variable since it’s not such important for intervention.

Conclusion

9 It should be shorter and concise. Recommendations should be more specific and target the risk factors in your research. Thank you for your comment. Based on your comment we correct conclusion and recommendation section on the updated manuscript.

Line Number 346 to 349

Attachment

Submitted filename: Response to reviwers.docx

Click here for additional data file.^{(25.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0244808.r003

Decision Letter 1

Frank T Spradley

23 Nov 2020

PONE-D-20-26289R1

PLOS ONE

Dear Dr. Bekele,

There are still major concerns about your article. Notably, a professional copyeditor must be contacted to proof your manuscript for typographical errors and standard English. Please address ALL comments in your revised manuscript.

Please submit your revised manuscript by Jan 07 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: No

**********

6. Review Comments to the Author

Reviewer #1: the language in submitted articles is clear, correct, and unambiguous. the statistical analysis has been performed appropriately and rigorously.

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

PLoS One. 2021 Jan 20;16(1):e0244808. doi: 10.1371/journal.pone.0244808.r004

Author response to Decision Letter 1

15 Dec 2020

Response to review

1. There are still major concerns about your article. Notably, a professional copy editor must be contacted to proof your manuscript for typographical errors and standard English.

Thank you for your suggestion. For addressing the issue we consulted senior public health staff and language professors in my university. We also used online software specifically grammerly and scribens (check for correctness of spellings).

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(14.9KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0244808.r005

Decision Letter 2

Frank T Spradley

17 Dec 2020

PONE-D-20-26289R2

Dear Dr. Bekele,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

PLoS One. doi: 10.1371/journal.pone.0244808.r006

Acceptance letter

Frank T Spradley

2 Jan 2021

PONE-D-20-26289R2

Dear Dr. Bekele:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Frank T. Spradley

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 File. Data set, that contain the survey data of the participant.

(XLSX)

Click here for additional data file.^{(118.9KB, xlsx)}

Attachment

Submitted filename: renamed_669b2.docx

Click here for additional data file.^{(13.9KB, docx)}

Attachment

Submitted filename: Reviwer Comments.docx

Click here for additional data file.^{(13.2KB, docx)}

Attachment

Submitted filename: Response to reviwers.docx

Click here for additional data file.^{(25.5KB, docx)}

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(14.9KB, docx)}

Data Availability Statement

All relevant data are within the manuscript and its Supporting Information files.

[pone.0244808.ref001] 1.World Health Organization(WHO). Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division: executive summary. 2015.

[pone.0244808.ref002] 2.World Health Organization(WHO). Global health observation data 2015.

[pone.0244808.ref003] 3.World Health Organization(WHO). Provision of effective antenatal care: integrated management of pregnancy and childbirth (IMPAC). Geneva: Standards for maternal and neonatal care (16), Department of making pregnancy safer; 2006. [Google Scholar]

[pone.0244808.ref004] 4.UNICEF. Global Antenatal care coverage 2016.

[pone.0244808.ref005] 5.Kuruvilla S, Bustreo F, Kuo T, Mishra C, Taylor K, Fogstad H, et al. The Global strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience. Bulletin of the World Health Organization. 2016;94(5):398 10.2471/BLT.16.170431 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref006] 6.World Health Organization(WHO). New ANC recommendation for positive pregnancy experience 2016.

[pone.0244808.ref007] 7.World Health Organization(WHO). Antenatal care randemization trial Geneva 2002.

[pone.0244808.ref008] 8.USAID. FANC planning and providing care during pregnancy Maternal and Child Health Journal. 2004(JHPIEGO/MNH Program USA).

[pone.0244808.ref009] 9.Wang W, Alva S, Wang S, Fort A. Levels and trends in the use of maternal health services in developing countries. 2011. [Google Scholar]

[pone.0244808.ref010] 10.Uganda Bureau of Statistics. Uganda Demographic and Health Survey 2016 Key Indicators Report. 2017.

[pone.0244808.ref011] 11.National Institute of Statistics of Rwanda. Rwanda Demographic and Health Survey 2014–15 Final Report. 2016.

[pone.0244808.ref012] 12.Ethiopian Central Statistics Agency(ECSA). Ethiopian demographic health survey (EDHS). 2016.

[pone.0244808.ref013] 13.Adhikari T, Sahu D, Nair S, Saha KB, Sharma RK, Pandey A. Factors associated with utilization of antenatal care services among tribal women: A study of selected States. The Indian journal of medical research. 2016;144 10.4103/0971-5916.193284 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref014] 14.Rurangirwa AA, Mogren I, Nyirazinyoye L, Ntaganira J, Krantz G. Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study. BMC pregnancy and childbirth. 2017;17(1):142 10.1186/s12884-017-1328-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref015] 15.Mugo NS, Dibley MJ, Agho KE. Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey. BMC pregnancy and childbirth. 2015;15(1):68 10.1186/s12884-015-0491-6 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref016] 16.Pandey S, Karki S. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal. International Journal of MCH and AIDS. 2014;2(2):212 [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref017] 17.Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, et al. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PloS one. 2013;8(1):747 10.1371/journal.pone.0053747 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref018] 18.Gebremeskel F, Dibaba Y, Admassu B. Timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch town and Arba Minch district, Gamo Gofa zone, South Ethiopia. Journal of environmental and public health. 2015;2015 10.1155/2015/971506 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref019] 19.Molla Gedefaw, Bilal Muche, Mekonen Aychiluhem. Current Status of Antenatal Care Utilization in the Context of Data Conflict: The Case of Dembecha District, Northwest Ethiopia. Open Journal of Epidemiology. 2014;4(04):208. [Google Scholar]

[pone.0244808.ref020] 20.Kindie Muchie, Fentahun. Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey. BMC pregnancy and childbirth. 2017;17(1):300 10.1186/s12884-017-1488-0 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref021] 21.The Federal Democratic Republic of Ethiopia Ministry of Health(FDRE-MOH). Health Sector Transformation Plan (HSTP) 2015/16–2019/20. 2015.

[pone.0244808.ref022] 22.Bahir Dar Zuria district. Quarterly and Yearly report 2017.

[pone.0244808.ref023] 23.Singh DR, Jha T. Exploring Factors Influencing Antenatal Care Visit Dropout at Government Health Facilities of Dhanusha District, Nepal. American Journal of Public Health Research. 2016;4(5):170–5. [Google Scholar]

[pone.0244808.ref024] 24.Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan-Koru JA, Stevenson R, et al. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PloS one. 2014;9(7):e101893 10.1371/journal.pone.0101893 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref025] 25.Adewuyi EO, Auta A, Khanal V, Bamidele OD, Akuoko CP, Adefemi K, et al. Prevalence and factors associated with underutilization of antenatal care services in Nigeria: A comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey. PloS one. 2018;13(5):e0197324 10.1371/journal.pone.0197324 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref026] 26.Ali S, Dero A, Ali S. Factors affecting the utilization of antenatal care among pregnant women: A literature review. J Preg Neonatal Med 2018; 2 (2): 41–45. [Google Scholar]

[pone.0244808.ref027] 27.Tilaye Gudina Terfasa, Mesganaw Fantahun Afework, Frew Tadesse Berhe. Antenatal Care Utilization and It’s Associated Factors in East Wollega Zone, Ethiopia. Preg Child Health 2017; 4 10.4172/2376-127X.1000316:2. [DOI] [Google Scholar]

[pone.0244808.ref028] 28.Gitonga E. Determinants of focused antenatal care uptake among women in tharaka nithi county, Kenya. Advances in Public Health. 2017;2017. [Google Scholar]

[pone.0244808.ref029] 29.Edgard-Marius O, Charles SJ, Jacques S, Justine GC-C, Virginie MA, Ibrahim MA, et al. Determinants of Low Antenatal Care Services Utilization during the First Trimester of Pregnancy in Southern Benin Rural Setting. Universal Journal of Public Health. 2015;3(5):220–8. [Google Scholar]

[pone.0244808.ref030] 30.Audet CM, Blevins M, Chire YM, Aliyu MH, Vaz LM, Antonio E, et al. Engagement of men in antenatal care services: increased HIV testing and treatment uptake in a community participatory action program in Mozambique. AIDS and behavior. 2016;20(9):2090–100. 10.1007/s10461-016-1341-x [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref031] 31.Abosse Z, Woldie M, Ololo S. Factors influencing antenatal care service utilization in hadiya zone. Ethiopian Journal of Health Sciences. 2010;20(2). 10.4314/ejhs.v20i2.69432 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref032] 32.Khanal Vishnu, da Cruz, Jonia Lourenca, Nunes Brites, Mishra Shiva Raj, Karkee Rajendra, et al. Under-utilization of antenatal care services in Timor-Leste: results from Demographic and Health Survey 2009–2010. BMC pregnancy and childbirth. 2015;15(1):211 10.1186/s12884-015-0646-5 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref033] 33.Timor-Leste Minstry of Health. The national health sector strategic plan for 2011–2030 Timor-Leste. 2011.

[pone.0244808.ref034] 34.Makenzius M, Faxelid E, Gemzell-Danielsson K, Odero TM, Klingberg-Allvin M, Oguttu M. Contraceptive uptake in post abortion care—Secondary outcomes from a randomised controlled trial, Kisumu, Kenya. PloS one. 2018;13(8):e0201214 10.1371/journal.pone.0201214 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref035] 35.Bbaale E, Mpuga P. Female education, contraceptive use, and fertility: evidence from Uganda. Consilience. 2011(6):20–47. [Google Scholar]

[pone.0244808.ref036] 36.Kokeb L, Admassu E, Kassa H, Seyoum T. Utilization of Post Abortion Contraceptive and Associated Factors among Women who Came for Abortion Service: a Hospital Based Cross Sectional Study. J Fam Med Dis Prev. 2015;1:022. [Google Scholar]

[pone.0244808.ref037] 37.Mutua MM, Achia TN, Maina BW, Izugbara CO. A cross‐sectional analysis of Kenyan postabortion care services using a nationally representative sample. International Journal of Gynecology & Obstetrics. 2017;138(3):276–82. 10.1002/ijgo.12239 [DOI] [PubMed] [Google Scholar]

[pone.0244808.ref038] 38.Borges ALV, OlaOlorun F, Fujimori E, Hoga LAK, Tsui AO. Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study. Reproductive health. 2015;12(1):94 10.1186/s12978-015-0087-7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0244808.ref039] 39.The ACQ UIR E Project. Counseling for effective use of family planning participant handbook New York: EngenderHealth/The ACQUIRE Project; 2008. [Google Scholar]

[pone.0244808.ref040] 40.Abamecha A, Shiferaw A, Kassaye A. Assessment of Post Abortion Contraceptive Intention and Associated Factors among Abortion Clients In Gambella Health Facilities, Gambella Town, South West Ethiopia.

[pone.0244808.ref041] 41.Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancyin adults. Women's Health Issues. 2002;12(2):79–95. 10.1016/s1049-3867(01)00147-5 [DOI] [PubMed] [Google Scholar]

[pone.0244808.ref042] 42.Bury L, Hoggart L, Newton VL. " I thought i was protected" Abortion, contraceptive uptake and use among young women: a quantitative survey. 2014. [Google Scholar]

[pone.0244808.ref043] 43.Sathar ZA, Singh S, Fikree FF. Estimating the incidence of abortion in Pakistan. Studies in family planning. 2007;38(1):11–22. 10.1111/j.1728-4465.2007.00112.x [DOI] [PubMed] [Google Scholar]

[pone.0244808.ref044] 44.Dhillon B, Chandhiok N, Kambo I, Saxena N. Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study). 2004. [PubMed] [Google Scholar]

[pone.0244808.ref045] 45.Azmat S, Waqas H, Muhammad I, Ghulam M, Aftab A. Post-abortion care family planning use in Pakistan. Pakistan Journal of Public Health. 2012;2(2):4–9. 10.1017/S0021932012000296 [DOI] [PubMed] [Google Scholar]

[pone.0244808.ref046] 46.Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Global public health. 2018;13(1):35–50. 10.1080/17441692.2016.1174280 [DOI] [PubMed] [Google Scholar]

PERMALINK

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study

Amsalu Muchie

Fentie Ambaw Getahun

Yibeltal Alemu Bekele

Tsion Samual

Tebkew Shibabaw

Roles

Abstract

Introduction

Method

Results

Conclusion

Introduction

Methods

Study area and design

Sample size and procedure

Study variables

Dependent variables

Independent variables

Operational definition

Knowledgeable

Data collection procedure and tools

Data quality control

Data processing and management

Ethical statement

Result

Socio-demographic characteristics

Table 1. Socio-demographic characteristic of respondents in Bahir Dar town, Amhara region, Northwest Ethiopia, 2019.

Reproductive hearth related characteristics

Table 2. Reproductive health related characteristics of respondents in Bahir Dar town, Amhara Region, northwest Ethiopia, 2019.

Magnitudes of post abortion family planning utilization

Factors of post-abortion family planning utilization

Table 3. Factors associated with post abortion modern contraceptive utilization among women who came for abortion service in Bahir Dar city health institutions, North West Ethiopia, 2019.

Discussion

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Frank T Spradley

Roles

Author response to Decision Letter 0

Decision Letter 1

Frank T Spradley

Roles

Author response to Decision Letter 1

Decision Letter 2

Frank T Spradley

Roles

Acceptance letter

Frank T Spradley

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases