Katharine Footman


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    After accessing safe abortion and post-abortion care (SA/PAC), clients often have an unmet need for family planning.  We used routine programme data to assess post-abortion family planning (PAFP) uptake and PAFP contraceptive methods in Kenya. 
    Methods: We analysed routine programme data for women who visited Marie Stopes centres for SA/PAC services in Kenya from 1 Jan 2015 to 31 Oct 2017. The proportion of women who chose PAFP (contraception on same day or within 14 days of SA/PAC) and uptake of contraceptive methods were examined by type of SA/PAC service (medical or surgical).  Data were analysed in Stata version 11, using chi-square tests to assess differences in proportions. 
    Results: Over the study period there were 46,531 SA/PAC services (26,084 medical and 20,447 surgical). The proportion medical SA/PAC increased from 43.8% in 2015 to 64.5% in 2017.  Almost two-thirds of clients were single (65.0%) and their age distribution was:  <15 years (0.3%), 15-19 (8.9%), 20 -24 (31.4%), 25 – 34 (45.8%), ≥35 years (13.6%).  Overall, 26,928 clients (59.8%) chose PAFP; this increased from 50.7% in 2015 to 66.5% in 2017; p<0.0001.  PAFP uptake did not vary by age, but was greater among women who had surgical vs medical SA/PAC (71.8% and 63.5% in 2017, respectively; p<0.0001).  Surgical SA/PAC clients were more likely to choose long acting or permanent methods (76.5% vs 64.2% among medical clients), with a greater proportion choosing intrauterine devices (37.3% vs 13.1% for medical clients).  
    Conclusions: PAFP uptake was consistently greater among women who had surgical SA/PAC, and uptake of long acting methods was higher among surgical SA/PAC clients. Women may prefer to complete the SA/PAC process before choosing a PAFP method, which may explain lower PAFP uptake among medical SA/PAC clients. Client-centred interventions are essential to ensure women receive family planning methods appropriate to their needs and preferences.