Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review

2019 ◽  
Vol 41 (7) ◽  
pp. 732-760
Author(s):  
Chimaraoke Izugbara ◽  
Frederick Murunga Wekesah ◽  
Meroji Sebany ◽  
Elizabeth Echoka ◽  
Joshua Amo-Adjei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sub Saharan Africa ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Sub Saharan ◽  
Post Abortion

scholarly journals Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

2020 ◽  
Vol 10 (09) ◽  
pp. 1295-1306
Author(s):  
Alphonse Nyong Ngalame ◽  
Robert Tchounzou ◽  
Humphry Tatah Neng ◽  
Fulbert George Nkwele Mangala ◽  
Rakya Inna ◽  
...  
Keyword(s):  
Literature Review ◽  
Sub Saharan Africa ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Sub Saharan ◽  
Post Abortion

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

scholarly journals The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Onikepe Owolabi ◽  
Taylor Riley ◽  
Easmon Otupiri ◽  
Chelsea B. Polis ◽  
Roderick Larsen-Reindorf
Keyword(s):  
Scale Up ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Safe Abortion ◽  
Signal Functions ◽  
Rural Location ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Comprehensive Abortion Care ◽  
Post Abortion

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.

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

scholarly journals Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review

2021 ◽  
Vol 3 ◽  
Author(s):  
Yasaman Zia ◽  
Nelly Mugo ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Edinah Casmir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Reproductive Health ◽  
Adolescent Girls ◽  
Young Women ◽  
Psychosocial Outcomes ◽  
Sub Saharan Africa ◽  
Unsafe Abortion ◽  
Psychosocial Experiences ◽  
Sub Saharan ◽  
Post Abortion

Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion.Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings.Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort.Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.

scholarly journals Health Systems’ Preparedness to Provide Post-abortion Care: Assessment of Health Facilities in Burkina Faso, Kenya and Nigeria

2021 ◽  
Author(s):  
Kenneth Okoth Juma ◽  
Ramatou Ouedraogo ◽  
Joshua-Amo Adjei ◽  
Ali Sie ◽  
Mamadou Ouattara ◽  
...  
Keyword(s):  
Public Health ◽  
Burkina Faso ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Unsafe Abortion ◽  
Public Health Facilities ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Care Assessment ◽  
Post Abortion

Abstract Background: In many parts of sub-Saharan Africa (SSA), access to abortion is legally restricted, which partly contributes to high incidence of unsafe abortion. This may result in unsafe abortion-related complications that demand long hospital stays, treatment and attendance by skilled health providers. There is however, limited evidence on the capacity of public health facilities to deliver post-abortion care (PAC) in these settings. We describe and discuss the preparedness and capacity of public health facilities to deliver complete and quality PAC services in Burkina Faso, Kenya and Nigeria. Methods: A cross-sectional survey of primary, secondary and tertiary-level public health facilities was conducted between November 2018 and February 2019 in the three countries. Data on signal functions for measuring the ability of health facilities to provide post-abortion services were collected and analyzed. These data included information on essential PAC equipment and supplies, PAC staffing and training among others. Results: Across the three countries, fewer primary health facilities (ranging from 4.3%–12.2% in Kenya and Burkina Faso) had the capacity to deliver on all components of basic PAC services. Only one in three (30–33%) of referral facilities across Burkina Faso, Kenya and Nigeria could provide comprehensive PAC services. Lack of trained staff, absence of necessary equipment and lack of PAC commodities and supplies were a main reason for inability to deliver specific PAC services (such as surgical procedures for abortion complications, blood transfusion and post-PAC contraceptive counselling). Further, the lack of capacity to refer acute PAC cases to higher-level facilities was identified as a key weakness in provision of post-abortion care services. Conclusions: Our findings reveal considerable gaps and weaknesses in the delivery of basic and comprehensive PAC within the three countries. There is need for increased investments by governments to strengthen capacity of primary, secondary and tertiary public health facilities to deliver quality PAC services.

Sign in / Sign up

Export Citation Format

Share Document