Health systems' capacity to provide post-abortion care: a multicountry analysis using signal functions

Abstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. Results Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. Discussion Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. Conclusions SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.

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Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis

Reproductive Health ◽

10.1186/s12978-020-01033-3 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Jesse Philbin ◽

Nugroho Soeharno ◽

Margaret Giorgio ◽

Rico Kurniawan ◽

Meghan Ingerick ◽

...

Keyword(s):

Health System ◽

First Trimester ◽

Health Centers ◽

Signal Functions ◽

Abortion Care ◽

Post Abortion Care ◽

Maternity Hospitals ◽

Referral Hospitals ◽

Post Abortion

Abstract Background The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

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Health System Capacity for Post-Abortion Care in Java, Indonesia: A Signal Functions Analysis

10.21203/rs.2.22138/v2 ◽

2020 ◽

Author(s):

Jesse Philbin ◽

Nugroho Soeharno ◽

Margaret Giorgio ◽

Rico Kurniawan ◽

Meghan Ingerick ◽

...

Keyword(s):

Health System ◽

First Trimester ◽

Health Centers ◽

Signal Functions ◽

Abortion Care ◽

Post Abortion Care ◽

Maternity Hospitals ◽

Referral Hospitals ◽

Post Abortion

Abstract Background: The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods: Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results: Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions: Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

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Constrains for seeking post-abortion care among adolescents and young women in Guangzhou, China: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06263-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yiding Wang ◽

Jinzhi Liu ◽

Ribo Xiong ◽

Yan Liu

Keyword(s):

Young Women ◽

Cross Sectional Study ◽

Public Hospitals ◽

Sectional Study ◽

Cross Sectional ◽

Services Utilization ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion ◽

Youth Friendly

Abstract Background In China, post-abortion care (PAC) services mainly focus on married couples, such that adolescents and unmarried young womenhave limited access to those services for contraception counseling. The provision of youth-friendly PAC services in public hospitals is a new concept in China. This study examined the magnitude of PAC services utilization as well as factors influencing it’s uptake among adolescents and young women in Guangzhou, China. Methods A cross-sectional study was performed from 1st March 2020 to 30th September 2020 using anonymous self-administered questionnaire among 688 women aged 15–24 years in Tianhe district, Guangzhou. The Multivariate logistic regression was used to determine factors that were significantly associated with the uptake of PAC services. Results The magnitude of PAC services utilization was 35.9% among adolescents and young women in Guangzhou, China. Students were 69.0% significantly less likely to use PAC services compared to women who had no job. Immigrants were 59.0% significantly less likely to use PAC services than their native counterparts. Women who had a feeling of stigma were 70.0% significantly less likely to use PAC services compared to those who did not feel stigmatized. Conclusions The study highlights the need to strengthen youth-friendly PAC services provision, and emphasizes the importance of education about both family planning and abortion services among disadvantaged sub-groups of women in the study setting.

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MEETING THE NEEDS OF ADOLESCENT POST-ABORTION CARE PATIENTS IN THE DOMINICAN REPUBLIC

Journal of Biosocial Science ◽

10.1017/s0021932010000015 ◽

2010 ◽

Vol 42 (4) ◽

pp. 493-509 ◽

Cited By ~ 7

Author(s):

DONNA R. McCARRAHER ◽

MARIO CHEN-MOK ◽

ANA SOPHIA ORONOZ ◽

SONIA BRITO-ANDERSON ◽

THOMAS GREY ◽

...

Keyword(s):

Dominican Republic ◽

Older Women ◽

Contraceptive Method ◽

Public Hospitals ◽

Time Of Arrival ◽

Abortion Care ◽

Post Abortion Care ◽

Provider Knowledge ◽

Post Abortion ◽

Counselling Intervention

SummaryCounselling on contraception and contraceptive method provision are key components of post-abortion care (PAC). Some studies have suggested that adolescent PAC patients receive worse care than older women seeking these services. This study aimed to evaluate an intervention whose goal was to improve the counselling and contraceptive uptake of PAC patients, with special attention given to the needs of adolescent patients, in the four public hospitals in the Dominican Republic where PAC services were not being routinely offered. The counselling intervention effort included provider training and the development of adolescent-friendly information, education and communication (IEC) materials. Eighty-eight providers were interviewed at baseline and 6 months after the intervention was implemented. Six months after providers were trained, 140 adolescent PAC patients (≤19 years of age) and 134 older PAC patients (20–35 years) were interviewed about the contraceptive counselling messages and contraceptive methods they received before they were discharged from hospital. The adolescent and older PAC patients were matched on study hospital and time of arrival. Significant improvements were noted in provider knowledge and attitudes. No changes were noted in provider-reported PAC counselling behaviours, with close to 70% of providers reporting they routinely assess patients' fertility intentions, discuss contraception, assess STI/HIV risk and discuss post-abortion complications. Adolescent and older PAC patients reported receiving PAC counselling messages at similar rates. Forty per cent of adolescent PAC patients and 45% of older PAC patients who wanted to delay pregnancy were discharged with a contraceptive method. Adolescents were more likely to receive an injectable contraceptive method whereas older women were discharged with a variety of methods. The PAC counselling intervention increased provider knowledge and improved their attitudes and benefited both adolescent and older patients.

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Clinical issues in post-abortion care

The Nurse Practitioner ◽

10.1097/01.npr.0000396475.68812.06 ◽

2011 ◽

Vol 36 (5) ◽

pp. 35-40 ◽

Cited By ~ 3

Author(s):

Joyce D. Cappiello ◽

Margaret W. Beal ◽

Katherine E. Simmonds

Keyword(s):

Clinical Issues ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion

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Improving post-abortion care in a public hospital in Oaxaca, Mexico

Reproductive Health Matters ◽

10.1016/s0968-8080(97)90002-1 ◽

1997 ◽

Vol 5 (9) ◽

pp. 20-28 ◽

Cited By ~ 8

Author(s):

Ana Langer ◽

Cecilia Garcia-Barrios ◽

Angela Heimburger ◽

Karen Stein ◽

Beverly Winikoff ◽

...

Keyword(s):

Public Hospital ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion

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“Fear, Shame and Embarrassment”: The Stigma Factor in Post Abortion Care at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Asian Social Science ◽

10.5539/ass.v9n10p134 ◽

2013 ◽

Vol 9 (10) ◽

Cited By ~ 7

Author(s):

Eva Tagoe-Darko

Keyword(s):

Teaching Hospital ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion

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Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00168116 ◽

2018 ◽

Vol 34 (6) ◽

Cited By ~ 1

Author(s):

Thália Velho Barreto de Araújo ◽

Estela M. L. Aquino ◽

Greice M. S. Menezes ◽

Maria Teresa Seabra Soares de Britto e Alves ◽

Maria-da-Conceição C. Almeida ◽

...

Keyword(s):

Good Condition ◽

Northeastern Brazil ◽

Care Seeking ◽

Middle Income ◽

Risk Of Death ◽

Abortion Care ◽

Post Abortion Care ◽

Abortion Complications ◽

Post Abortion ◽

Almost All

Abstract: Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women’s health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.

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