Factors associated with post-abortion contraceptive discontinuation

This cross-sectional study addressed 111 women aged 18-49 attending Primary Health Care Facilities in São Paulo/SP, Aracaju/SE, and Cuiabá/MT, Brazil, who reported an abortion five years before the interview held in 2015-2017. Kaplan-Meier estimates and Cox Regression were used for data analysis.

Results:

Oral hormonal contraceptives, male condoms, and injectable contraceptives were the methods most frequently used. The contraceptive discontinuation rate was 41.8% in the 12 months after the abortion. The pill was the method most frequently abandoned (58.3%); male condoms were the method that failed the most (72.7%), and injectable contraceptives were the method most frequently switched (50.0%). Being up to 24 years old, having ten or more years of education, having three or more children, and a desire to wait longer before becoming pregnant again were associated with post-abortion contraceptive discontinuation.

Conclusion:

Short-acting contraceptive methods were predominant among post-abortion women. The type of discontinuation varied according to the type of method used. The factors associated with contraceptive discontinuation were age, education, parity, and reproductive intention.

Keywords:
Contraception. Abortion. Contraceptives; oral. Contraceptive agents; hormonal. Condoms. Sexual and reproductive health

Variable	n	%
Age (years)
Up to 24 years old	38	34.2
From 25 to 35 years old	50	45.0
Older than 35 years old	23	20.7
Race
Caucasian	30	27.0
Mixed/Afro-descendant	75	67.6
Others	06	5.4
Schooling (years)
Up to 7	15	13.5
From 8 to 10	28	25.2
More than 10	68	61.3
Socio-economic class
A/B	22	19.8
C	67	60.4
D/E	22	19.8
Stable union
No	17	15.3
Yes	94	84.7
Age of the first pregnancy (years)
Up to 17	20	18.0
From 18 to 24	64	57.7
Older than 24	27	24.3
Number of children
None	34	30.6
One or two	57	51.4
Three or more	20	18.0
Reproductive intention when became pregnant^*
Did not want (more) children	26	23.4
Wanted to get pregnant at the time	48	43.2
Wanted to wait longer to get pregnant	35	31.5
Total	111	100.0

Method	Types of discontinuation
Method	Abandonment	Failure	Replacement
Injectable	1 (8.3%)	0 (0.0%)	3 (50.0%)
The pill	7 (58.3%)	2 (18.2%)	1 (16.7%)
Male condom	4 (33.3%)	9 (72.7%)	2 (33.3%)
Other^*	0 (0.0%)	1 (9.1%)	0 (0.0%)
Total	12 (100%)	11 (100%)	6 (100%)

Variables	Fitted hazard ratio	Standard-error	p-value
Age at the time of abortion (years)
Up to 24	3.84	1.86	0.030
From 25 to 35	ref	-	-
More than 35	1.87	1.87	0.317
Schooling (years)
Up to 7	ref	-	-
Between 8 and 10	1.39	2.32	0.695
More than 10	7.46	2.31	0.016
Number of children
None	ref	-	-
One or two	2.49	1.67	0.076
Three or more	18.08	2.26	0.001
Reproductive intention when became pregnant
Did not want (more) children	ref	-	-
Wanted to become pregnant at the time	1.98	1.87	0.276
Wanted to wait longer to become pregnant	3.45	1.84	0.043

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E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Ana Luiza Vilela Borges E-mail: alvilela@usp.br