title: Contraceptive behavior among women after abortion in Nepal.
abstract: OBJECTIVE
  To investigate the timing of contraceptive use and estimate the discontinuation rates of temporary methods among women after abortion, or a live birth or stillbirth.
  
  
  METHODS
  A sample of married women with detailed pregnancy and contraceptive histories was analyzed in a population-based cross-sectional study based on calendar data extracted from the 2011 Nepal Demographic and Health Survey. Kaplan-Meier cumulative and discrete-time hazard models were used to estimate the timing of contraceptive use and discontinuation rates among users of temporary methods.
  
  
  RESULTS
  The final analysis sample included 3190 women. Of 684 women who had had an abortion, 298 (43.6%) had not initiated any contraceptive use in the 12 months afterwards. Women initiated contraceptive use significantly earlier after abortion (hazard ratio [HR] 2.25; 95% CI, 1.96-2.59; P<0.001). The rate of discontinuation among contraceptive users was significantly higher in the postabortion group (HR 1.32; 95% CI, 1.05-1.65; P<0.05). Women who were educated, wealthier, had used contraceptives before the index pregnancy, had two sons and had autonomy initiated contraceptive use significantly earlier in the post-abortion period than their counterparts.
  
  
  CONCLUSIONS
  Postabortion contraceptive use is low in Nepal. Postabortion family-planning counseling and related services should be strengthened with systematic monitoring and follow-up interventions.
authors.affiliation: Department of Social Statistics and Demography, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK; Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK. Electronic address: s.padmadas@soton.ac.uk.
authors.forename: Sabu S
authors.initials: SS
authors.lastname: Padmadas
authors.affiliation: ESRC Centre for Population Change, University of Southampton, Southampton, UK; Department of Quantitative Social Science, Institute of Education, University of London, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lyons-Amos
authors.affiliation: Nepal Public Health Foundation, Kathmandu, Nepal.
authors.forename: Shyam
authors.initials: S
authors.lastname: Thapa
mesh_terms: D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D050498:Live Birth; D009390:Nepal; D011247:Pregnancy; D012959:Socioeconomic Factors; D050497:Stillbirth; D055815:Young Adult
keywords: Abortion; Calendar data; Contraceptive discontinuation; Contraceptive use; Demographic and Health Surveys; Nepal