Post-abortion contraceptive use among currently married women in India: New evidence from National Family Health Survey 2019-2021 (NFHS-5)

Abstract

Post-abortion contraceptive use is a critical element of reproductive healthcare aimed at preventing unintended pregnancies and promoting reproductive agency. This study investigates changes in post-abortion contraceptive use and factors associated with that use. We use reproductive calendars implemented in 2015-16 and 2019-21 National Family Health Surveys (NFHS) to investigate changes in post-abortion contraceptive use among currently married women age 15-49 in India. We then use 2019-21 NFHS to examine the factors associated with post-abortion contraceptive use. Our analysis is based on a weighted sample of 5,473 women from NFHS-4 and 5,103 women from NFHS-5. The study employs a two-stage estimation procedure using the Inverse Mills Ratio (IMR) framework to address potential biases in abortion reporting. In the second stage, we used a multinomial probit regression model to assess factors influencing post-abortion contraceptive use. Post-abortion contraceptive use increased from 49% in NFHS-4 to 57% in NFHS-5. Multinomial probit regression analysis revealed that gestational age of abortion was negatively associated with post-abortion contraceptive use, while factors such as having a son or prior contraceptive use increased the likelihood. Women who had abortions in private or non-health facilities were less likely to use post-abortion Long-Acting Reversible Contraceptives (LARC), compared to public health facilities. Those who reported unplanned pregnancy or contraceptive failure as the reason for abortion were more likely to use traditional methods of post-abortion contraception. Our findings highlight the importance of integrating family planning services into abortion care and ensuring comprehensive information and counselling on contraceptive options during the post-abortion period, as crucial measures to improve women's health.

Fig 1. Sample selection process for currently married women who had completed the one-year period after an abortion using data from NFHS-5, 2019-21.

Fig 2. Percentage distribution of currently married women by different methods of post-abortion contraception, NFHS-4 & NFHS-5.

Fig 3. Percentage of currently married women using various methods of contraception after abortion by urban-rural residence, India, NFHS-4 and NFHS-5.