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Contraceptive use among women seeking repeat abortion in Addis Ababa, Ethiopia.

Introduction

Repeat abortion, or having more than one pregnancy termination, is bound in a vicious cycle with repeat unintended pregnancy (1-5). Women who have had a recent abortion are more likely to discontinue contraceptive use during a 1-year follow up period and both recent and other previous

abortion clients have been found to be more likely to have a (repeat) unintended pregnancy during that time period (6). While safe termination of pregnancy is a relatively low-risk procedure (7), repeated terminations have been associated with numerous adverse sequelae (e.g. ectopic pregnancy, placenta previa, fetal loss, preterm delivery, and potentially lower fertility, and breast cancer) (8,9), thus avoiding repeated unintended pregnancy and associated repeat abortions is the ultimate goal (10). Limited access to effective contraception in populations that desire smaller families often leads to increased reliance on abortion to help control fertility (11). Anecdotal reports and qualitative research have documented concerns among providers about repeat abortion in the wake of legalization of abortion in the US and more recently in South Africa and Nepal (12-15). Some of the increases in repeat abortion are due to changes in the population at risk as access to pregnancy terminations has become more available (11,15,16). Repeat abortions incidence varies considerably by country but is generally quite common in high-resource settings where more reliable data is available (9,17). According to recent findings, the level of repeat abortions in Europe, Canada and the US ranges from 22% and 50% (9,17-22). A recent analysis of national data from Britain found that a third of women who reported having had an abortion also had a subsequent abortion (23). However, since abortion also is notoriously underreported for a variety of reasons including social sigma (24), repeat abortion may be as well, perhaps even more so (4,25-27). Furthermore, there is no standard definition of repeat abortion; some studies count more than one abortion ever, others focused on multiple abortions within shorter intervals (4,25,28-30). A seminal 1984 Canadian study found more similarities than differences among first-time and repeat abortion clients (31). More recent research has identified an array of potential risk factors for repeat abortion including: age; socioeconomic status; parity; education; foreign origin; race; smoking; alcohol/drug abuse; physical abuse or violence; early sexual debut; previous contraceptive use; and type of contraceptives used (4,9,10,17,22,23,32-35). Some of these characteristics were significant predictors in some studies but not others. Although still poorly understood, risk factors for repeat abortion likely vary in different countries (9).

Less is known about the women who require repeat abortion services in low-resource settings. Some of the available data from Africa is dated and/or of limited generalizability. In Vietnam, Huong et al found that more than 70% of women presenting for pregnancy termination at a hospital in the capital city had sought at least one prior abortion; education and economic status were not associated with repeat abortion but prior contraceptive use was (36). Elsewhere in Asia, repeat abortion incidence ranged from 29-46% (37-39). Following the legalization of abortion, a study of risk for repeat termination in Nepal found that nearly a third of surveyed women were seeking a repeat abortion. The study also found that significantly more repeat abortion seekers "would consider having another abortion in the future" compared with those seeking abortion for the first time (49% vs. 37%) (39). In addition, women who did not intend to have another child in the future were twice as likely to have a repeat abortion as those who intended to do so. In a study of abortion and contraception conducted in Ivory Coast in the late 1990s, the repeat abortion incidence among multi-gravid women was 18% (40). "Research from Zimbabwe reported a 1-year incidence of repeat abortion among women who both expressed a need for family planning and attended follow up appointments of between 2.5% and 5.3% (41). A 2002 study of women seeking (i.e., wanted to avoid pregnancy for at least the next 2 years) and attended follow up appointments of between 2.5% and 5.3% (41)." care for complications of unsafe abortion in Ghana found that more than 22% were presenting for their second abortion and 14% for a higher order abortion (42).

Total fertility rate (TFR) in Ethiopia has been declining but remained high at 4.8 children per woman in 2011; more than a quarter (28%) of recent births and current pregnancies were reported mistimed or unwanted (43). Modern contraceptive prevalence among married women was 29% but the 1-year discontinuation rate was 37%. In addition, a quarter of married women (25%) have an unmet need for family planning (43). In stark contrast, the TFR in the capitol city, Addis Ababa, is 1.5 children per woman, well below replacement fertility and approaching the city's estimated total wanted fertility rate of 1.3 (43,44). Contraceptive prevalence in Addis Ababa is 63%, more than twice the national average with about a tenth (11%) of married women reporting an unmet need for family planning (43). While contraceptive prevalence is high in Addis Ababa, the estimated abortion incidence is also high at 49 per 1000 women of reproductive age (WRA) compared to 23 per 1000 WRA in the country (45). Abortion contributes to Ethiopia's fertility decline and the decriminalization of the country's penal code in 2005, which broadened the circumstances under which abortion is permitted, is likely to be playing an even greater role particularly in Addis Ababa (44-46). Unlike in other African countries, the conscientious objection of providers does not seem to be a major barrier to service delivery (47). At the same time, abortion continues to contribute to Ethiopia's high maternal mortality rate (590 maternal deaths per 1000 live births in 2008) (48,49). It is estimated that only 27% of abortions in the country were safe procedures (45) and according to global estimates, unsafe abortions account for 13% of maternal mortality worldwide (49,50). A study of unwanted pregnancy in rural Tigray, Ethiopia did not report repeat abortion rates but noted that "[a] significant number of patients reported a previous history of induced abortion" (51). A nationally representative study of post-abortion complications in Ethiopia found a repeat abortion incidence of 35% among women seeking post-abortion care (52). Other estimates from Ethiopia determined that more than a third of women presenting for induced abortion (35%) had had a previous termination, as did more than a quarter (27%) of post-abortion care (PAC) clients (53). In addition to the morbidity and mortality risks associated with repeat abortion, post-abortion care represents the lion's share of abortion-related costs in Ethiopia and creates a substantial drain on scarce resources (54).

A recent study by Prata et al identified factors associated with post-abortion method choice among women seeking abortion-related care in Addis Ababa since the legal reforms (55). Briefly, among other significant factors such as age, occupation, type of clinic, education, and number of living children, the number of previous abortions was significantly associated with increased odds of adopting any method post-abortion but decreased odds of adopting a long-term one." The characteristics of women presenting for abortion-related care who have had a previous abortion might point to risk factors and interventions to interrupt the cycle of repeat abortion. This paper uses the same data to examine the socio-demographic characteristics and patterns of contraceptive use of women seeking care for initial and repeat abortions in Addis Ababa, Ethiopia.

Methods

We analyzed 1,200 records of women seeking abortion-related services (safe termination and treatment for incomplete abortion) using data collected prospectively from October 2008 to February 2009 in four public and three private health facilities in Addis Ababa. Data regarding socio-demographic characteristics, reproductive and contraceptive history, and post-abortion contraception were extracted from client records. Any women using abortion-related services for a second or higher order procedure was considered to be a "repeat abortion" client. Bivariate analyses were conducted on socio-demographic characteristics and reproductive and contraceptive history by first vs. repeat abortion. Chi-square test or t-test for comparison of two proportions were estimated and significance was established at p-value of <0.05. We used multiple logistic regression analysis to assess the likelihood of repeat abortion among the study population. We also stratified the study population according to last contraceptive method used prior to current procedure were grouped into three categories: i) none/never used a method; ii) ever used short-term reversible (pills, condoms, emergency contraception) and; iii) ever used longer term reversible (injectables, implants, intrauterine devices)." Interaction terms were tested but deemed non-significant so they were not included in the final model.

Ethical review was provided by the Committee for the Protection of Human Subjects at the University of California, Berkeley (#2008-9-56).

Results

Of the 1,200 women included in the sample, nearly one third (30%) sought a repeat abortion. The sample characteristics are provided in Table 1. Compared to women seeking first abortion, women seeking repeat abortion were more likely to be older (26 vs. 25 years old; p <0.001). The distribution of women seeking first and repeat abortion was similar in marital status and education. Students were more likely to be seeking first abortion than repeat abortion but no other statistically significant differences in occupation were observed.

As shown in Table 2, women seeking repeat abortion reported higher number of pregnancies (mean of 3 pregnancies) than women seeking first abortion (mean of 1.8 pregnancies) but parity was similar owing to a mean of 1.3 previous abortions among women seeking repeat abortion. Repeat abortion patients were more likely to have ever used contraceptives than first abortion patients (69% vs. 51%, p<0.001). However, repeat abortion clients were also more likely to have ever used a short-term or coital dependent method (e.g. pills and condoms etc.) (47% vs. 29%, p<0.001).

Table 3 shows that most women sought safe termination (as opposed to treatment of incomplete abortion) with no significant differences in types of services sought between first and repeat abortion clients. Based on mean gestational age at presentation, as determined by uterine size, there was no difference in timing of abortion visit between first-time and repeat abortion clients. Although not statistically significantly different, post-abortion contraceptives were provided to 76% of women seeking first-time abortion and 81% of women seeking repeat abortion. Yet women seeking repeat abortion were significantly more likely to leave the facility with a short-term method at the time of abortion service (56% vs. 48%, p = 0.0164) than first-time clients. The same distribution shows that repeat abortion clients were significantly less likely to leave the facility with a longer acting contraceptive method than their first-time abortion counterparts (20% vs. 26%, p = 0.0397).

As shown in Table 4, after controlling for socio-demographic characteristics, the type of contraceptive method used last was a significant predictor of repeat abortion, with women who last used short-term methods facing twice the odds (p<0.001) of having a repeat abortion compared to those who had never used contraceptives. In multiple logistic regression analysis, the odds of repeat abortion tripled (p<0.001) with increasing number of pregnancies and was 1.8 times greater (p<0.05) for single (never married) women compared to ever married women. Age exerted an effect on repeat abortion risk, such that women faced a 10% (p<0.001) greater risk of repeat abortion for every 1 year increase in age. Education significantly increased the adjusted odds of repeat abortion. Primary education more than doubled (p<0.05) and higher education more than quadrupled (p<0.001) the risk of repeat abortion compared to women with no education. Adjusted odds of repeat abortion also varied significantly according to occupation/employment status, with professional/clerical and hospitality workers facing slightly greater odds of repeat abortion than unemployed women (OR =1.5, p<0.001 and OR = 1.7, p<0.001, respectively). Overall, repeat abortion patients had twice the odds of receiving a contraceptive method at the time of abortion service compared to first-time abortion patients (adjusted OR = 1.9, 95% CI 1.4-2.5) (data not shown).

Multiple logistic regression analysis by last contraceptive method used shows that among women who had never used any method in the past, each pregnancy increased the odds of repeat abortion by 2.5 times (p<0.001). Among those who had never used contraception (Table 4/Model 2), the odds of repeat abortion were lower at younger ages (OR=0.92, p<0.05). Single (never married) non-users faced lower adjusted odds (OR=0.40, p<0.05) of repeat abortion than ever married ones. A women's level of education had a significant effect on the odds of repeat abortion among women who did not use contraception, with primary education increasing the odds 4.4 times (p<0.05); secondary education increasing the odds 13.1 times (p<0.001); and above secondary education increasing the odds 11 times (p<0.001). In this group of women who did not use contraception, women with professional/clerical employment had 2.3 greater odds (p<0.05) of repeat abortion than their unemployed counterparts. Stratified analysis showed different odds of repeat abortion among users of short-term contraceptive methods as well (Model 3). The effect of increasing number of pregnancies in increasing the adjusted odds of repeat abortion was greater for short-term method users (OR=3.8, p<0.001) than for non-users. Younger short-term method users faced lower odds of repeat abortion than older ones (OR=0.86, p<0.001). Furthermore, while single marital status was protective for nonusers, being single (never married) vs. ever married increased the odds of repeat abortion more than 5-fold (p<0.001) among short-term method users. Short-term method users employed in the hospitality industry faced nearly twice the odds of repeated abortion (p<0.05) compare to their unemployed counterparts. Among women who used a long-term method as their last contraceptive method (Model 4), the adjusted odds of repeat abortion increase 2.5 times as gravidity increased (p<0.001). Long-term method users who were younger were at lower risk of repeat abortion than older long-term method users (OR=0.87, p<0.05).

Discussion

This study found that 30% of women seeking abortion-related services at urban public and private facilities in Addis Ababa, Ethiopia had had a previous abortion. Women seeking repeat abortion tended to be older than those seeking first-time abortions and the proportion reporting ever use of contraceptives was significantly greater. Age, gravidity, education, being single, being employed in professional/clerical or hospitality work, and use of short-term contraceptives as last method were significantly associated with repeat abortion. Age and gravidity remained significant predictors of repeat abortion across all categories of last method used (short-term, long-acting, and none). The effect of marital status varied according to the last contraceptive method use category. Education only remained significant for increased risk of repeat abortion among non-contraceptive users but had no effect by type of method last used for both short-term and long-acting contraceptive users. Working in the hospitality industry was a significant predictor of repeat abortion among those who last used a short-term method.

Our findings fall within the range of repeat abortion found in developed countries (18-20,22). Our results also show a repeat abortion level remarkably similar to the incidence seen in Nepal (32%) where abortion has been legalized in recent years (39). In Nepal, increasing age, parity and education were all associated with higher odds of having a repeat abortion. However, while we found a difference between first-time and repeat abortion clients in the category of last method used, Thapa et al found no difference between these groups by contraceptive use or specific method (39). In addition, while repeat abortion clients in Nepal were as likely to adopt a contraceptive method post-abortion as first-time clients, in keeping with the results from our data, they were more likely to choose condoms and less likely to choose injectables. While our sample included both pregnancy terminations and treatment of incomplete abortion clients, similar repeat abortion incidences were reported in samples limited to women presenting with post-abortion complications in Ethiopia and Ghana (42,52). Some researchers have found older age and higher parity to be associated with repeat abortion but several others have concluded that these associations reflected confounding and/or were an artifact of greater time at risk (10,23,31,36,39). Our results differ from a similar study in the Vietnamese capitol which found much higher levels of repeat abortion (70%) and no associations with education (36).

Our finding that repeat abortion is associated with use of short-term reversible contraceptive methods is consistent with some of the existing literature, (17,19,32). In contrast, Berger et al (31) found slightly higher contraceptive prevalence among repeat abortion seekers, but no differences between repeat abortion and first-time abortion seekers in type of method used at the time of conception. While our study found no association between repeat abortion and the use of long-term methods as last method, Prager et al found a positive association between injectable contraceptives and repeat abortion that approached significance (10). Ultimately, the link between abortion and contraceptive use is extremely complex and "paradoxical" (11,15,16,40). High contraceptive use among repeat abortion clients likely reflects stronger desires to control fertility, more active family planning efforts and persistent difficulties in achieving fertility goals (17,19,32,36). Ethiopia, and more specifically Addis Ababa, appears to be following a pattern observed in six other countries where contraceptive use and abortion incidence rose simultaneously during a period of fertility transition because increases in contraceptive prevalence were insufficient to meet needs stemming from an increasing desire to limit fertility (11). In these countries, abortion incidence eventually fell and contraceptive use remained high.

A major strength of this study is the prospective enrollment of women resulting in a complete, uninterrupted time series of clients who presented at participating facilities. Our sample size and the number of covariates allowed us to investigate the association between aspects of contraceptive history/socio-demographic factors and repeat abortion. Our study is unique in including women presenting for both induced abortion and treatment of incomplete abortion in a developing country, yielding insights regarding women who have different experiences accessing safe abortion in a very low fertility environment.

Our study also has limitations. We must acknowledge that four years have passed since the data was collected in 2008 & 2009, which could potentially limit their current relevance. However, like other recent reports drawing pertinent lessons from data from the same early post-legal reform period (cf. Abdella 2013 and Vlassoff 2012) (15,47) and pending of more recent comparable data, the findings presented here capture a telling "snapshot", offering a useful benchmark for gauging progress while also providing some insight, which is likely still valid, regarding a "dynamic abortion environment" (47). The analysis was based on record review relying on the data recorded at the time of service. Recall bias, underreporting or misreporting of abortion, or contraceptive use may have occurred (26,27)." Thus, the actual incidence of repeat abortion may be higher than we found. In addition, the last method used does not necessarily reflect the type of contraceptive used, if any, at the time of the conception leading to the index abortion. Therefore, contraceptive failure cannot be inferred and discontinuation rates are not captured, both of which represent major risk factors for repeated unintended pregnancy and thus abortion (1,2). Moreover, some studies focus on repeat abortion during a limited follow up period28,41. However, typical of many studies of abortion, we captured the occurrence of more than one abortion ever (4), but not the interval (i.e. lengthen of time) between the index abortion and any previous one. Consequently, we were not able to distinguish between those seeking immediate repeat abortions from those seeking subsequent abortions at longer intervals (e.g. years apart), even though their characteristics, contraceptive use patterns and needs might differ in ways that could have important implications for targeting services.

Our study findings are specific to our facility-based sample in Addis Ababa not necessarily generalizable to the rest of Ethiopia. However, the study may provide insights into the characteristics and contraceptive use patterns of women at risk for repeat abortion in other low fertility, high contraceptive use, low-resource urban settings.

Conclusions

Abortion-related services in urban areas of developing countries should pay special attention to women at higher risk for repeat abortion including single, high gravidity, educated, and working women. It is also important to bear in mind that some of these risk factors for repeat abortion vary according to contraceptive use history (never or ever use of short-term or long-term methods). Contraceptive counseling for repeat abortion clients should address reasons for repeat unintended pregnancy, which might include contraceptive failure, method discontinuation, or non-use. Given that Ethiopia appears to be following one of the classic trajectories involved in continuing fertility transition after the decriminalization of abortion, every effort should be made to support the process by strengthening family planning services, addressing unmet need, preventing unintended pregnancy and interrupting the cycle of repeat abortion.

Contributions of authors

NP conceived and designed the study and conducted data analysis and contributed to the writing of the manuscript; MH analyzed the data; AF contributed to the preparation of the manuscript; YM contributed to the study design and collected the data. All authors approved the manuscript.

Acknowledgements

We would like to thank Dr. Caitlin Gerdts for her invaluable insights on data analysis and earlier iterations of this article. We are also grateful to Suzanne Bell who provided useful comments and feedback as well.

References

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Ndola Prata [1] *, Martine Holston [2], Ashley Fraser [3] and Yilma Melkamu [4]

[1] Associate Professor in Residence, & Scientific Director, Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, 229 University Hall, 6390; [2] c/o The Bixby Center, 17 University Hall, School of Public Health, University of California, Berkeley, CA 94720-7360; [3] 17A University Hall, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-7360; [4] International Planned Parenthood Federation, Africa Regional Office, Nairobi, Kenya

* For correspondence: Email: ndola@berkeley.edu; Phone: (1) 510-643-4284
Table 1: Socio-demographic characteristics of women seeking
abortion-related services by first vs. repeat abortion

                              Total             First Abortion
                              %                 %

Total (%)                     N = 1200 (100%)   n = 837 (69.8%)

Age (years)
Mean age ([+ or -] SD)        25.1 (4.4)        24.7 (4.3)
15-19                         7.3               9.1
20-24                         41.0              42.4
25-29                         37.8              37.2
30-34                         9.3               8.4
35-44                         4.5               3.0

Marital Status
Single (never married)        53.5              55.9
Ever Married                  46.5              44.1

Current Residence
Addis Ababa                   91.3              89.5
Outside Addis Ababa           7.4               9.2
Abroad                        1.3               1.3

Education
No Education                  7.9               8.4
Primary                       16.9              18.3
Secondary                     51.8              49.5
Above Secondary               23.3              23.8
Occupation

Housewife/unemployed          27.9              28.4
Student                       15.6              18.0
Professional/Clerical/Sales   35.8              34.0
Hospitality/Housework (a)     20.8              19.5

                              Repeat Abortion    p-value for [chi
                              %                  square] or t-test

Total (%)                     n = 363 (30.3 %)

Age (years)                                      0.000
Mean age ([+ or -] SD)        26.1 (4.6)         <0.001
15-19                         3.3                <0.001
20-24                         37.7               0.1308
25-29                         39.4               0.4633
30-34                         11.6               0.0795
35-44                         8.0                0.0001

Marital Status                                   0.0400
Single (never married)        47.9               0.0109
Ever Married                  52.1               0.0107

Current Residence                                0.0020
Addis Ababa                   95.3               0.0010
Outside Addis Ababa           3.3                0.0003
Abroad                        1.4                0.9302

Education                                        0.1120
No Education                  6.9                0.3847
Primary                       13.8               0.0559
Secondary                     57.3               0.0125
Above Secondary               22.0               0.5134

Occupation                                       0.0020
Housewife/unemployed          26.7               0.5438
Student                       9.9                0.0004
Professional/Clerical/Sales   39.7               0.0516
Hospitality/Housework (a)     23.7               0.1198

(a) Includes hostess, cleaner, waitress, housemaid, commercial sex
worker, and cook

Table 2: Reproductive history

                                  Total             First Abortion
                                  %                 %

Total (%)                         N = 1200 (100%)   n = 837 (69.8%)

Mean gravity ([+ or -] SD)        2.2 (1.4)         1.8 (1.3)
Mean parity ([+ or -] SD)         0.8 (1.2)         0.8 (1.3)
Mean number of living children    0.7 (1.2)         0.8 (1.2)
  ([+ or -] SD)
Mean number of previous           ---               ---
  abortions ([+ or -] SD)
Ever use of contraceptives        56.6              51.1

Last contraceptive method used
  (grouped by type)
None                              43.4              48.9
Short-term reversible modern      34.6              29.0
  methods (a)
Long-term reversible modern       20.4              20.9
  methods (b)
Traditional/non-modern method     1.6               1.2

                                  Repeat Abortion    p-value for [chi
                                  %                  square] or t-test

Total (%)                         n = 363 (30.3 %)

Mean gravity ([+ or -] SD)        3.0 (1.3)          <0.001
Mean parity ([+ or -] SD)         0.7 (1.1)          0.6052
Mean number of living children    0.7 (1.0)          0.5483
  ([+ or -] SD)
Mean number of previous           1.3 (0.7)          ---
  abortions ([+ or -] SD)
Ever use of contraceptives        69.2               <0.001

Last contraceptive method used                       <0.001
  (grouped by type)
None                              30.9               <0.001
Short-term reversible modern      47.4               >0.001
  methods (a)
Long-term reversible modern       19.3               0.5218
  methods (b)
Traditional/non-modern method     2.5                0.1017

(a) Pills, condoms, emergency contraception

(b) Injectable, implant, intrauterine device

Table 3: Service Provision and Post-abortion Contraception Provision

                                  Total             First Abortion
                                  %                 %

Total (%)                         N = 1200 (100%)   n = 837 (69.8%)

Type of service provided
Safe termination                  82.2              82.4
Treatment of incomplete           17.8              17.6
  abortion
Uterine size/Gestational age

  (weeks)
Mean # of weeks                   3.2               3.2
4-9                               68.1              67.0
10-12                             23.4              24.6
13-27                             8.5               8.4
Post-abortion contraceptive       77.7              76.2
  method provided

Type of contraceptive provided
  (grouped by type)
None                              22.3              23.8
Short-term reversible modern      50.7              48.4
  methods (a)
Long-term reversible modern       24.3              25.9
  methods (b)
Other                             2.8               1.9

                                  Repeat Abortion    p-value for [chi
                                  %                  square] or t-test

Total (%)                         n = 363 (30.3 %)

Type of service provided
Safe termination                  81.5               0.1383
Treatment of incomplete           18.5
  abortion

Uterine size/Gestational age
  (weeks)
Mean # of weeks                   3.1                0.3913
4-9                               70.5               0.3320
10-12                             20.7
13-27                             8.8
Post-abortion contraceptive       81.0               0.0690
  method provided

Type of contraceptive provided                       0.0010
  (grouped by type)
None                              19.0               0.0687
Short-term reversible modern      55.9               0.0164
  methods (a)
Long-term reversible modern       20.4               0.0397
  methods (b)
Other                             4.7                0.0070

(a) Pills, condoms, emergency contraception

(b) Injectable, implant, intrauterine device

Table 4: Multiple logistic regression models, of the odd s of repeat
abortion to socio-demographic characteristics and stratified by last
contraceptive method used

                           Model                  Model 2--None
                           1--Socio-demographic
                           characteristics

Last Contraceptive           Stratified by Last Contraceptive Method
  Method Used                                 Used
None                       --
Short-term reversible      2.12 (1.52, 2.95) **
Longer-term reversible     0.72 (0.47, 1.11)
Traditional/non-modern     1.26 (0.42, 3.75)
Gravida (number)           3.15 (2.67, 3.77) **   2.46 (1.88, 3.23) **
Age (years)                0.89 (0.85, 0.93) **   0.92 (0.85, 1.00) *

Marital Status
Single                     1.78 (1.21, 2.62) *    0.40 (0.21, 0.76) *
Married/Divorced/Widowed   --                     --

Education
No education               --                     --
Primary                    2.25 (1.06, 4.78) *    4.40 (1.29, 15.1) *
Secondary                  4.61 (2.27, 9.34) **   13.1 (3.95, 43.7) **
Above secondary            4.32 (2.01, 9.30) **   11.0 (3.00, 40.6) **

Occupation
Unemployed/housewife       --                     --
Student                    0.79 (0.46, 1.37)      1.39 (0.59, 3.25)
Professional/clerical      1.51 (1.01, 2.25) *    2.27 (1.09, 4.70) *
Hospitality                1.69 (1.09, 2.62) *    1.75 (0.78, 3.93)
-2Log Likelihood           1160.68                421.68
Number of observations     1200                   521

                           Model                  Model
                           3--short-term          4--Long-term

Last Contraceptive           Stratified by Last Contraceptive Method
  Method Used                                 Used
None
Short-term reversible
Longer-term reversible
Traditional/non-modern
Gravida (number)           3.78 (2.94, 4.86) **   2.48 (1.76, 3.50) **
Age (years)                0.86 (0.81, 0.92) **   0.87 (0.78, 0.98) *

Marital Status
Single                     5.21 (3.22, 8.43) **   2.32 (0.99, 5.47)
Married/Divorced/Widowed   --                     --

Education
No education               --                     --
Primary                    0.79 (0.31, 2.02)      0.36 (0.10, 1.34)
Secondary                  1.30 (0.55, 3.04)      0.77 (0.24, 2.46)
Above secondary            1.37 (0.54, 3.46)      0.52 (0.13, 2.01)

Occupation
Unemployed/housewife       --                     --
Student                    0.70 (0.32, 1.54)      1.40 (0.30, 7.53)
Professional/clerical      1.51 (0.91, 2.51)      1.08 (0.47, 2.50)
Hospitality                1.80 (1.08, 3.24) *    1.22 (0.48, 3.07)
-2Log Likelihood           678.8                  251.22
Number of observations     660                    245

* p<0.05

** p<0.001
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Article Details
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Title Annotation:ORIGINAL RESEARCH ARTICLE
Author:Prata, Ndola; Holston, Martine; Fraser, Ashley; Melkamu, Yilma
Publication:African Journal of Reproductive Health
Article Type:Report
Geographic Code:6ETHI
Date:Dec 1, 2013
Words:6316
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