Patterns and determinants of post-abortion family planning discontinuation in Bangladesh

Provision of post-abortion family planning is an effective way of reducing subsequent unwanted pregnancy and repeat abortion. Currently, short-term methods make up over 80% of the post-abortion family planning method mix in Bangladesh; oral contraceptive pills account for 47%, while injectables account for 20% and condoms account for 15%. The high prevalence of short-term methods is of concern since these methods may not confer protection from subsequent unwanted pregnancy due to high discontinuation rates. Though discontinuation rates are high in the general population, it is unknown whether rates are also high among women who have recently undergone menstrual regulation (MR) or post-abortion care (PAC), as this group may be more motivated for family planning use. This is a prospective cohort study that will enroll a facility-based sample of women who have accepted short-term family planning methods after their uterine evacuation procedures. Women will complete a baseline interviewer-administered survey on the day of their procedures, and they will complete a follow-up survey four months later. A stratified one-stage cluster sampling approach was used to select women for the study. A total of 16 facilities were selected, and 500 women will be enrolled in the study. The proportion of women switching methods or discontinuing at the four-month follow-up will be reported by method. To identify the determinants of discontinuation, multilevel logistic regression models will be run for each family planning method to determine the association between individual, family, provider encounter, and facility-level characteristics and discontinuation status at the four-month follow-up.