Int J Gynaecol Obstet 15: 440-443, 1978
Hospital Counseling in Khartoum: A Study of Factors Affecting Contraceptive Acceptance After Abortion Hamid E. Rushwan 1 , James G. Ferguson, Jr. 2 , and Roger P. Bernard2 Department of Obstetrics and Gynaecology, Khartoum University, Khartoum, Sudan International Fertility Research Program, Research Triangle Park, North Carolina, USA
ABSTRACT Rushwan, H. E., Ferguson, J . G., J r . and Bernard, R. P. (Dept. of Obstetrics and Gynaecology, Khartoum University, Khartoum, Sudan, and the International Fertility Research Program, Research Triangle Park, North Carolina, USA). Hospital counseling in Khartoum: a study of factors affecting contraceptive acceptance after abortion. Int J Gynaecol Obstet 15: 440-443, 1978 This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis, which focused on education and parity/child desire, revealed t h a t the counseling program produced contraceptive acceptance a m o n g 47.0% of those followed up. In spite of t h e counseling efforts, half of the women in this s t u d y did not accept contraception following the abortion—regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing t o p u t themselves a t risk again. Apparently, future efforts to increase the impact of counseling p r o g r a m s m u s t also examine p a t i e n t s ' motivation to accept (or not to accept) contraception.
forms developed by the International Fertility Research Program (IFRP), Research Triangle Park, North Carolina, USA, were used for gathering information on each patient's socio-demographic characteristics and her medical and contraceptive histories. After collection, data were sent to the IFRP for computer editing, processing, and analysis. Except for the "contraceptive method used at follow-up", all items discussed in this report were transcribed from interviews taken during the patient's hospital stay. An unusual feature of this study was the verification procedure used in the contraceptive counseling program. A patient's followup data were included in the analysis only if they were accompanied by an official form from the counselor indicating what contraceptive method, if any, she was actually using at follow-up. Such a safeguard certainly enhances an investigator's confidence in the accuracy of the data.
INTRODUCTION RESULTS In an earlier study from Khartoum (4), data on postabortion contraceptive acceptance were analyzed, with an emphasis on observed differences among the three participating institutions. In this report, however, the data will be pooled because the carefully administered contraceptive counseling programs of the three hospitals were highly uniform. Such pooling will permit an inquiry into what variables may actually affect a woman's acceptance of contraception following counseling. Data for this paper were collected in the course of a study of hospital-treated incomplete abortions conducted at the Omdurman Hospital, Khartoum General Hospital, and Khartoum North Hospital. During the period of this study (March 13, 1974 to January 10, 1976), 3 263 women were treated at the three hospitals for incomplete, inevitable, or threatened abortions. Standard data collection Int J Gynaecol
Obstet
15
Table I presents an overview of selected demographic and reproductive characteristics of the 3 263 women studied. Almost all the women were Muslim (97.9%), married (99.2%), and unemployed (96.4%). Most (64.4%) were from urban areas and had little formal education (mean, 1.5 years). Data on their reproductive histories reveal a mean parity of 3.4, a mean of 0.86 abortions per woman prior to this admission, and a mean child loss of 0.08 per woman. Compared to women in a similar study conducted in Latin America (2), these patients have higher means for parity and previous abortions, but a lower mean child loss. Data on contraceptive use before and after the abortion (Fig. 1) show a familiar pattern of a marked increase in the use of oral contraceptives (OCs), intrauterine devices (IUDs), or sterilization (from
Contraceptive
acceptance
after abortion
441
Table I. Selected socio-demographic characteristics, by years of education Years of Education
Patient characteristic Mean age (years) Percent married Percent employed Percent urban Percent Muslim Mean years of education Reproductive profile Mean parity Mean number of additional children desired Mean previous abortions per woman Mean child loss per woman Contraceptive use b In month of conception None Conventional* 3 OCs, lUDs, sterilization At follow-up None Conventional OCs, lUDs, sterilization
0 (N = 2 387)
1-6 (N = 615)
7-12 (N = 232)
13+ (N = 29)
Total (N = 3 263)
28.1 99.2 1.3 62.8 97.7 0.0
24.9 99.3 4.1 64.7 99.2 3.8
24.7 99.6 21.6 76.2 96.6 9.4
26.0 96.6 41.4 96.6 96.6 15.4
27.2 99.2 3.6 64.4 97.9 1.5
3.7
2.7
1.9
1.3
3.4
1.6
1.8
2.1
2.7
1.7
Hospital Counseling in Khartoum: A Study of Factors Affecting Contraceptive Acceptance After Abortion Hamid E. Rushwan 1 , James G. Ferguson, Jr. 2 , and Roger P. Bernard2 Department of Obstetrics and Gynaecology, Khartoum University, Khartoum, Sudan International Fertility Research Program, Research Triangle Park, North Carolina, USA
ABSTRACT Rushwan, H. E., Ferguson, J . G., J r . and Bernard, R. P. (Dept. of Obstetrics and Gynaecology, Khartoum University, Khartoum, Sudan, and the International Fertility Research Program, Research Triangle Park, North Carolina, USA). Hospital counseling in Khartoum: a study of factors affecting contraceptive acceptance after abortion. Int J Gynaecol Obstet 15: 440-443, 1978 This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis, which focused on education and parity/child desire, revealed t h a t the counseling program produced contraceptive acceptance a m o n g 47.0% of those followed up. In spite of t h e counseling efforts, half of the women in this s t u d y did not accept contraception following the abortion—regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing t o p u t themselves a t risk again. Apparently, future efforts to increase the impact of counseling p r o g r a m s m u s t also examine p a t i e n t s ' motivation to accept (or not to accept) contraception.
forms developed by the International Fertility Research Program (IFRP), Research Triangle Park, North Carolina, USA, were used for gathering information on each patient's socio-demographic characteristics and her medical and contraceptive histories. After collection, data were sent to the IFRP for computer editing, processing, and analysis. Except for the "contraceptive method used at follow-up", all items discussed in this report were transcribed from interviews taken during the patient's hospital stay. An unusual feature of this study was the verification procedure used in the contraceptive counseling program. A patient's followup data were included in the analysis only if they were accompanied by an official form from the counselor indicating what contraceptive method, if any, she was actually using at follow-up. Such a safeguard certainly enhances an investigator's confidence in the accuracy of the data.
INTRODUCTION RESULTS In an earlier study from Khartoum (4), data on postabortion contraceptive acceptance were analyzed, with an emphasis on observed differences among the three participating institutions. In this report, however, the data will be pooled because the carefully administered contraceptive counseling programs of the three hospitals were highly uniform. Such pooling will permit an inquiry into what variables may actually affect a woman's acceptance of contraception following counseling. Data for this paper were collected in the course of a study of hospital-treated incomplete abortions conducted at the Omdurman Hospital, Khartoum General Hospital, and Khartoum North Hospital. During the period of this study (March 13, 1974 to January 10, 1976), 3 263 women were treated at the three hospitals for incomplete, inevitable, or threatened abortions. Standard data collection Int J Gynaecol
Obstet
15
Table I presents an overview of selected demographic and reproductive characteristics of the 3 263 women studied. Almost all the women were Muslim (97.9%), married (99.2%), and unemployed (96.4%). Most (64.4%) were from urban areas and had little formal education (mean, 1.5 years). Data on their reproductive histories reveal a mean parity of 3.4, a mean of 0.86 abortions per woman prior to this admission, and a mean child loss of 0.08 per woman. Compared to women in a similar study conducted in Latin America (2), these patients have higher means for parity and previous abortions, but a lower mean child loss. Data on contraceptive use before and after the abortion (Fig. 1) show a familiar pattern of a marked increase in the use of oral contraceptives (OCs), intrauterine devices (IUDs), or sterilization (from
Contraceptive
acceptance
after abortion
441
Table I. Selected socio-demographic characteristics, by years of education Years of Education
Patient characteristic Mean age (years) Percent married Percent employed Percent urban Percent Muslim Mean years of education Reproductive profile Mean parity Mean number of additional children desired Mean previous abortions per woman Mean child loss per woman Contraceptive use b In month of conception None Conventional* 3 OCs, lUDs, sterilization At follow-up None Conventional OCs, lUDs, sterilization
0 (N = 2 387)
1-6 (N = 615)
7-12 (N = 232)
13+ (N = 29)
Total (N = 3 263)
28.1 99.2 1.3 62.8 97.7 0.0
24.9 99.3 4.1 64.7 99.2 3.8
24.7 99.6 21.6 76.2 96.6 9.4
26.0 96.6 41.4 96.6 96.6 15.4
27.2 99.2 3.6 64.4 97.9 1.5
3.7
2.7
1.9
1.3
3.4
1.6
1.8
2.1
2.7
1.7
