Post-abortion family planning use and its determinants among women who received abortion care in sub-Saharan Africa: a systematic review and meta-analysis.

Background: Post-abortion family planning (PAFP) refers to the use of modern contraceptive methods, preferably immediately following an abortion and within 48 h of the abortion, or before fertility returns. It is highly recommended to delay pregnancy for at least 6 months following an induced or spontaneous abortion to reduce the occurrence of adverse maternal and neonatal outcomes. In sub-Saharan Africa (SSA), there is a high burden of unsafe abortions and an unintended pregnancy rate. Additionally, there are inconsistent study findings that have been done to investigate the prevalence and determinant factors of post-abortion family planning use in the region.

Methods: This systematic review followed standard methods and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. The eligible publications were searched by PubMed, Research4Life, Scopus, EMBASE, and Google Scholar. The data were extracted using Microsoft Excel 2019 and analyzed using Stata software version 17. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's (JBI) Critical Appraisal Checklist. Publication bias was assessed by using the funnel plot and Egger's test. A random-effects model was used to estimate the pooled prevalence of post-abortion family planning. The I² test was performed to assess the statistical heterogeneity among the included studies.

Results: This systematic review and meta-analysis included 80 eligible articles from 16 sub-Saharan African countries, with a total of 248,299 study participants. The pooled prevalence of post-abortion family planning use in sub-Saharan Africa was 60.67% (95% CI 55.61-65.73). In addition, the commonly adopted contraception methods after abortion were injectables, 34.98% (95% CI 27.59, 42.37), followed by 20.71% (95% CI 17.20, 24.22) of oral contraception pills, and 20.38% (95% CI 16.82, 23.94) utilized implants. Women aged 15-24 years (AOR = 3.40, 95% CI 2.12, 5.44), being married (AOR = 2.70, 95% CI 1.68, 4.34), attaining secondary school (AOR = 2.75, 95% CI 1.62, 4.66) and college or above (AOR = 2.92, 95% CI 1.85, 4.62), unplanned pregnancy (AOR = 5.03, 95% CI 2.93, 8.61), having prior history of abortion (AOR = 1.88, 95% CI 1.35, 2.62), having good knowledge about family planning (AOR = 2.86, 95% CI 2.37, 3.46), prior family planning use (AOR = 3.82, 95% CI 2.62, 5.58), positive attitude towards family planning methods (AOR = 2.78, 95% CI 1.81, 4.28), partner support (AOR = 2.32, 95% CI 1.64, 3.30), and received post-abortion family planning counseling (AOR = 2.86, 95% CI 2.37, 3.46) were predictors that significantly associated with contraceptive utilization following abortion.

Conclusions: This meta-analysis indicates that the pooled prevalence of post-abortion contraception use in sub-Saharan Africa remains low. Therefore, appropriate planning and implementation of effective strategies are crucial to scaling up post-abortion family planning use, including improving educational attainment, advocating for post-abortion contraceptive methods, and providing effective post-abortion family planning counseling.

Systematic review registration: PROSPERO CRD42024518297.