Is there an association between abortion method received and post-abortion contraception uptake? A secondary analysis on data from services in Nepal, Cameroon and Ethiopia

Background: Contraception is routinely offered at IPPF Member Association (MAs) to support client’s choice. It is part of comprehensive abortion care intended to prevent unintended pregnancy and promote reproductive autonomy. Study Objective: To examine the relationship between abortion type (medical, surgical, treatment of incomplete abortion) and post-abortion contraception uptake (short-acting and reversible contraceptive (SARC), long acting and permanent methods (LAPM)) in Cameroon, Ethiopia and Nepal. Methods: Retrospective secondary analysis of clinical service data from IPPF MAs between 2015 to 2023 using multivariable linear regression to assess associations. Results: Over nine years, 241,617 abortion services were provided in three countries, with an overall post-abortion contraceptive uptake of 87.5%. Among the 211,438 post- abortion contraceptive services, 57% were LAPM and 43% were SARC methods. LAPM post-abortion contraception was positively correlated with later gestation surgical abortion (PCC = 0.9). Linear regression demonstrated a 0.85% increase in LAPM post-abortion contraception uptake (p < 0.001) after first 12 weeks surgical abortion and 2.1% increase following later gestation surgical abortion. SARC post-abortion contraception was 0.85% more likely after medical (P<0.01) than first 12 weeks surgical abortion at 0.26% (P<0.05). Conclusion: Later gestation surgical abortions were associated with higher LAPM post-abortion contraception uptake compared to first 12 weeks surgical and medical abortions. Medical abortions were associated with higher uptake of SARC post-abortion contraception. Comprehensive abortion care inclusive of methods counselling, provider training on LAPM contraceptive insertion immediately after surgical abortions can support client preferences, potentially increasing post-abortion contraceptive acceptance and contribute to reducing unintended pregnancies.