Pre- and intra -COVID-19 trends of contraceptive use among women who had termination of pregnancy at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg South Africa (2010–2020)
Authors: Baffour-Duah Kennedy , Olorunfemi Gbenga , Shimange-Matsose Lusanda 
Published: December 2022

Background
Contraception is a key prevention strategy for maternal morbidity and mortality and is an important component of postabortion care. The trend of contraceptive uptake can guide interventions among vulnerable individuals. The aim of the study was to determine the trends of immediate post-abortion contraceptive uptake among women who had induced abortion at a dedicated abortion centre in Johannesburg, South Africa.

Method
This study was a retrospective cross-sectional and trend analysis of the contraceptive uptake among women who had legal termination of unwanted pregnancy at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1 January 2010 to 31 December 2020. We reviewed the nursing records and summaries of the induced abortion cases that were performed for the past eleven years from 1 January 2010 to 31 December 2020. The trends in the annual number of abortion seeking clients, annual contraceptive uptake rate (stratified by types), age of clients and gestational age at presentation were extracted into a spreadsheet for analysis. Join point regression modelling and Pearson’s chi square were utilized to assess the trends and association between categorical variables. The trends before and during the Corona Virus disease(COVID-19) era were also compared.

Results
In all, 12,006 clients had induced abortion over the study period. Nearly half (n = 5915, 49.26%) of the clients were aged 26–40 years, one tenth (n = 1157, 9.64%) being teenagers and one third (n = 4619, 38.47%) between age 19–25 years. There was a 16.3% annual increase in the number of abortion clients performed at the facility from 2010 to 2014 and a gradual declining trend of about 9.2% per annum from 2014 to 2019. The overall postabortion contraceptive uptake rate was 74.5%. There was an initial 15.1% annual decline in contraceptive uptake per 100 clients from 2010 to 2014 and a subsequent increasing trend of about 11.1% per annum from 53.45 per 100 clients in 2014 to 98 per 100 clients in 2019. About 66.43% of the clients opted for injectable contraceptives. There was a reduction in the number of abortion seeking clients by 32.2% from 985 in 2019 to 668 in 2020 during the COVID-19 era. However, the contraceptive uptake was still high in 2020 (90.72%). There was no statistically significant relationship between the age group and the time periods. Thus, the distribution of the age group accessing the abortion services did not significantly change over the two time periods of 2010–2014 and 2015–2019. (P-value = 0.076).

Conclusion
There was increased trends in postabortion contraceptive uptake among our clients from 2010 to 2020. Although there was reduced number of performed induced abortion during the COVID -19 era, the contraception uptake rate was still high during the COVID-19 era. About 6 out of every 10 clients accepted injectable contraceptives. More education is needed to improve uptake of other long-acting contraception that may not require frequent contact with the health facility.