title: Correlates of contraceptive use 4 months postabortion: findings from a prospective study in Bangladesh.
abstract: OBJECTIVE
  Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels.
  
  
  METHODS
  This prospective study assessed correlates of contraceptive use 4 months postabortion and timing of initiation using a facility-based sample of 398 abortion clients who selected pills, condoms, injectables or no method immediately following the procedure. We measured potential correlates immediately following abortion, inclusive of spontaneous or induced abortion, and assessed contraceptive use outcomes 4 months postabortion. Multivariable logistic regression models identified correlates at each level. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling.
  
  
  RESULTS
  Reported contraceptive use 4 months postabortion was high (85.4%). Contraceptive use at the index pregnancy (resulting in abortion) was the primary correlate of contraceptive use 4 months postabortion (adjusted odds ratio=2.9; 95% confidence interval: 1.5-5.9). Delayed contraceptive initiation was more common among women who reported past year IPV (36.8% vs. 19.5%; p=.03) particularly with spousal accompaniment for abortion, those in relationships with discordant fertility intentions (44.4% vs. 21.9%; p=.04) and those receiving medication abortion (56.7%) or dilation and curettage (57.1%), compared to manual vacuum aspiration (12.6%; p<.01).
  
  
  CONCLUSIONS
  Contraceptive use at the index pregnancy was the primary correlate of contraceptive use 4 months postabortion. Abortion procedure type and relationship dynamics were correlated with delayed postabortion contraceptive initiation. Women who reported IPV delayed initiation when accompanied by their spouse for abortion.
  
  
  CONCLUSIONS
  Postabortion contraceptive counseling should assess previous use patterns and provide information on using contraception effectively. Delayed initiation among women reporting IPV could be addressed through comprehensive, confidential counseling that includes violence screening, support for contraceptive initiation and offer of woman-controlled methods.
authors.affiliation: Ipas, P.O. Box 9990, Chapel Hill, NC, USA 27515; Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205. Electronic address: epearson@hsph.harvard.edu.
authors.forename: Erin
authors.initials: E
authors.lastname: Pearson
authors.affiliation: Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000.
authors.forename: Kamal Kanti
authors.initials: KK
authors.lastname: Biswas
authors.affiliation: Ipas, P.O. Box 9990, Chapel Hill, NC, USA 27515.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Andersen
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205.
authors.forename: Caroline
authors.initials: C
authors.lastname: Moreau
authors.affiliation: Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000.
authors.forename: Rezwana
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000.
authors.forename: Sharmin
authors.initials: S
authors.lastname: Sultana
authors.affiliation: Ipas Bangladesh, Eureka Saleha Palace (C2-2nd Floor) House 2F 1-3, Mymensingh Road, Shahbagh, Dhaka, Bangladesh 1000.
authors.forename: S M
authors.initials: SM
authors.lastname: Shahidullah
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D000359:Aftercare; D001459:Bangladesh; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003376:Counseling; D003657:Decision Making; D005193:Family Planning Services; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D014619:Vacuum Curettage
keywords: Abortion; Bangladesh; Intimate partner violence; Postabortion contraception