Fertility desires of women following manual vacuum aspiration for incomplete abortion at the University Teaching Hospital, Lusaka

Abstract

Objectives: To explore and determine the fertility desires of women who underwent Manual Vacuum Aspiration (MVA) procedure for the management of incomplete abortion at The University Teaching Hospitals (UTH) Women and new born hospital emergency gynaecology ward.

Methods: An unmatched case control study design with 142 women who had undergone an MVA enrolled into the study while the 142 controls were sampled from women attending the antenatal clinic with pregnancies below age of viability. Systematic random sampling with a sampling interval of 5 was used to select both cases and controls. Data was collected using an investigator-administered questionnaire. Association between fertility desire (birth interval) and demographic and socioeconomic factors was determined by bivariate analysis. Odds ratios were used to determine statistical significance. Associations with a p-valueof <0.05 were further analyzed by multivariate logistic regression.

Results: Logistic regression showed that post-MVA most women would like to wait for 2 years or more before the next pregnancy (p<0.001). Multivariate  analysis model after adjusting for confounders also showed that exposure to MVA procedure was a statistically significant factor (p<0.001, 95%CI 2.281, 14.153) associated with determining future fertility desire. In bivariate analysis, statistically significant factors included residence, religion, having experienced a miscarriage before and type of contraceptive method chosen after counseling. On average 50% of the cases of abortions were incomplete abortions with most of them managed with MVA procedure and experiences by the women post-MVA were different. Of the 142 women who underwent MVA, 56 described the pain as severe with 89 accepting to undergo a similar procedure in future should need arise while 53 would not. Ninety women preferred to wait for more than two years before the next pregnancy while 45 wanted to try for another pregnancy earlier, which is in conflict with the options for contraception, more preferred short acting methods.

Conclusion: Manual Vacuum Aspiration had a negative effect on preferred birth interval, with a significant number of women post MVA desiring to wait two or more years before the next pregnancy despite the poor outcome of the index pregnancy. Most of the women cited the pain and the discomfort from the procedure as the main reason for the preferred birth interval. Other independent variables  that affected fertility desire included residence, religion and also level of education.