Trajectories of contraception before pregnancy and after medication abortion among women accessing clinic vs pharmacy services in Ghana

Objectives: This study examined contraceptive use before pregnancy and after medication abortion (MA) among clinic and pharmacy clients in Ghana, and factors linked to modern contraceptive uptake post-MA. Methods: Data were drawn from a non-inferiority, prospective study of 1,974 women who obtained MA with misoprostol and mifepristone from pharmacies (n = 929) and clinics (n = 1,045) in Ghana. Descriptive statistics were generated to assess contraceptive use before pregnancy and after MA, whereas binary logistic regressions were fitted to examine the factors associated with modern contraceptive uptake post-MA. Results: Overall, non-use of contraception increased from 57 % before pregnancy (n = 1123) to 66 % post-MA (n = 1293), a trend driven by pharmacy clients. While 55 % (n = 344) of the clinic clients who were not using any contraceptive method before pregnancy remained non-method users post-MA, 86 % (n = 434) was the case for the pharmacy group. Additionally, of the non-method users who switched to any contraceptive method after MA, a higher share of the clinic group (n = 274, 44 %) used modern contraceptive methods compared to the pharmacy group (n = 58, 12 %). The regression results revealed that receiving information on contraception and accessing MA from clinics significantly increased the odds of adopting modern contraception after MA. Conclusions: A relatively greater share of women who accessed MA in pharmacies did not use any contraceptive method following the abortion. Additionally, receiving contraception information enhanced modern contraception adoption after MA. Findings highlight the need to develop programmes and strategies to expand the provision of contraception information to women seeking MA, including those using the pharmacy route.