Accelerating Contraceptive Uptake and Continuation through a Post-Abortion-Care Model in India: A Randomized Control Experiment

Rajib Acharya, Population Council
Rimjhim Bajpai, PopulationCouncil Consulting Pvt. Ltd.
Garima Mathias, Ipas Development Foundation
Neelanjana Pandey, PopulationCouncil Consulting
Abhishek Kumar, PopulationCouncil Consulting Pvt. Ltd.
Sushanta Banerjee, Ipas Development Foundation
Niranjan Saggurti, Population Council

Unmet contraceptive needs drive unintended pregnancies and abortions in a population. In India, where most induced abortions are self-managed medical abortions (SMA) without health system contact, no data are available on the contraceptive needs of this group. This paper evaluates the effect of a targeted intervention among women opting for SMA. A two-armed, single-blinded randomized controlled trial (RCT) assessed the impact of post-abortion counselling provided via a telephone helpline on contraceptive uptake and sustained use over 12 months. The sample included 896 women who undergone SMA, with follow-up surveys at six and 12 months (N=750, follow-up rate=85%). Data were analysed using multivariate generalized estimating equations (GEE) models and life tables. Findings indicate that by the first month post-abortion, 40% of women in the intervention group adopted a modern contraceptive compared to 36% in the control group, which rose to 74% and 62% at the 6th month and 77% and 68%, respectively at the 12th month. GEE models confirmed the intervention effects (AOR: 1.5; CI: 1.1-2.1; p<0.05), with continuation rates 10% higher among intervention adopters. The study concludes that such an intervention model may be scaled up to a larger population effecting significant reduction in the number of unintended pregnancies.

Keywords: Family Planning and Contraception, Randomized controlled experiments , Longitudinal studies , Sexual and Reproductive Health and Rights

See paper.