Evidence and determinants of Post-Abortion family planning utilization among Women of Reproductive age in Africa: An Umbrella Review

Doreen Kainyu Kaura¹Dereje Bayissa Demissie^2*Stefan Gebhardt³

• ¹School of Nursing, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa, Cape Town, South Africa
• ²Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
• ³Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Background: Post-abortion family planning (PAFP) is essential to prevent unplanned pregnancy. Repeat-induced abortion remains a significant challenge to women's sexual and reproductive health. Despite numerous systematic reviews and meta-analyses, inconsistent findings hinder effective policy and clinical decision-making. In Africa, high rates of unsafe abortion and unintended pregnancy persist, and health system barriers. This umbrella review consolidates global evidence on the prevalence, determinants, and use of PAFP to inform health policy. Methods: An umbrella review was conducted. The methodological quality of included studies was assessed using the AMSTAR tool. Heterogeneity was assessed using Cochran's Q and I² statistics. Egger's test and funnel plot evaluated publication bias. Random-effects meta-analysis estimated pooled effect size, with analysis performed using Stata 19. The review protocol was registered in PROSPERO (CRD420251089314). Result: This umbrella review included six systematic reviews and meta-analyses, comprising 198 primary studies conducted across 44 African countries, with a combined sample size of 420,832 women of reproductive age assessing post-abortion family planning utilization. This umbrella review found that the pooled prevalence of post-abortion family planning utilization among women of reproductive age in Africa was 62.82% (95% CI: 59.24% – 66.40%), indicating substantial uptake with (I² = 98.81%). This umbrella review identified key pooled determinants of post-abortion family planning utilization among women of reproductive age in Africa, including marital status (being married), younger maternal age (15–24 years), educational attainment, receipt of post-abortion family planning counseling, prior use of family planning, history of abortion, unintended pregnancy, and contraceptive knowledge Conclusion and Recommendation: The high prevalence of post-abortion family planning (PAFP) utilization in Africa (62.82%), and particularly in Ethiopia (69.31%), reflects encouraging progress. However, the fact that 37.18% of post-abortion women in Africa and 30.69% in Ethiopia still do not use PAFP highlights a critical gap that demands targeted policy action. The predominance of injectable contraceptives underscores the need to expand access to a broader range of methods, including long-acting reversible contraceptives (LARCs), to support informed and voluntary choice. Policymakers and health planners in Africa should urgently strengthen reproductive health policies by implementing a comprehensive, multi-pronged strategy to ensure universal access to post-abortion care.