scholarly journals Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shiromi M. Perera ◽  
Haroon Achakzai ◽  
Monica M. Giuffrida ◽  
Meghana Jayne Kulkarni ◽  
Devin C. Nagle ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Poor Quality ◽  
Community Members ◽  
Group Discussions ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Life Saving ◽  
Post Abortion ◽  
To Receive

Abstract Background Unsafe abortion is a leading cause of maternal mortality. In Afghanistan, which has experienced decades of armed conflict and where abortion is highly restricted, maternal mortality is high at 638 maternal deaths per 100,000 live births. Post-abortion care (PAC) is a lifesaving package of interventions to reduce morbidity and mortality related to induced or spontaneous abortion, but is rarely provided and often of poor quality, particularly in humanitarian settings. In July 2018, we conducted a study to identify the factors that influence access to and use of PAC services at Sharana Provincial Hospital. Methods In-depth interviews (IDIs) were conducted with ten women who had received PAC services at Sharana Hospital, and eight focus group discussions (FGDs) were conducted with 40 married women and 40 married men aged 18–45 from four villages surrounding Sharana Hospital. Results PAC clients and community participants discussed similar barriers to seeking PAC, including cost, distance to the health facility, the need for male accompaniment to seek care, perceived and actual quality of care, stigma and shame. Despite the mentioned stigma around abortion, community members expressed willingness to help women to receive PAC. Conclusions Our results suggest that while some barriers are not unique to PAC, others, especially those related to stigma around abortion, may be specific to PAC. It is important for the Ministry of Public Health and its partners to prioritize addressing these barriers to ensure that women have access to this critical life-saving care.

DELIVERING POST-ABORTION CARE THROUGH A COMMUNITY-BASED REPRODUCTIVE HEALTH VOLUNTEER PROGRAMME IN PAKISTAN

2012 ◽  
Vol 44 (6) ◽  
pp. 719-731 ◽  
Author(s):  
SYED KHURRAM AZMAT ◽  
BABAR T SHAIKH ◽  
GHULAM MUSTAFA ◽  
WAQAS HAMEED ◽  
MOHSINA BILGRAMI
Keyword(s):  
Reproductive Health ◽  
Group Discussions ◽  
Community Based ◽  
Family Planning Services ◽  
Abortion Care ◽  
Care Services ◽  
Post Abortion Care ◽  
Post Abortion ◽  
Depth Interviews

SummaryThis qualitative study was conducted in May–June 2010 with women using post-abortion care (PAC) services provided by the Marie Stopes Society in Pakistan during the six month period preceding the study, more than 70% of whom had been referred to the clinics by reproductive health volunteers (RHVs). The aim of the study was to establish the socio-demographic profile of clients, determine their preferred method of treatment, explore their perceptions of the barriers to accessing post-abortion services and to understand the challenges faced by RHVs. The sample women were selected from six randomly selected districts of Sindh and Punjab. Eight focus group discussions were conducted with PAC clients and fifteen in-depth interviews with RHVs. In addition, a quantitative exit interview questionnaire was administered to 76 clients. Medical, rather than surgical, treatment for incomplete and unsafe abortions was preferred because it was perceived to ‘cause less pain’, was ‘easy to employ’ and ‘having fewer complications’. Household economics influence women's decision-making on seeking post-abortion care. Other restraining factors include objection by husbands and in-laws, restrictions on female mobility, the views of religious clerics and a lack of transport. The involvement of all stakeholders could secure social approval and acceptance of the provision of safe post-abortion care services in Pakistan, and improve the quality of family planning services to the women who want to space their pregnancies.

scholarly journals Quality Of Post-Abortion Care In Java, Indonesia: An Essential Services Analysis 

2020 ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Dilation And Curettage ◽  
Essential Services ◽  
Post Abortion

Abstract Background High maternal mortality in Indonesia persists despite economic growth and a reform that extended health insurance to all Indonesians. Quality of obstetric health services, in general, has been identified as a factor for this; in addition, the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC) services. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we used the essential services framework to measure the health system’s capacity to offer PAC. We then used this framework to explore how Java’s capacity to offer PAC could change given two hypothetical reforms. Finally, we calculated the proportion of PAC patients treated using each of four different procedures. Results No emergency obstetric health centers (PONEDs) are adequately staffed or authorized to offer basic PAC services, while 46% of all hospitals in Java have the full set of services needed. These proportions increase in hypothetical scenarios in which PAC authorization is expanded to midwives, general physicians, and PONED facilities. Eighty-eight percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Allowing clinicians other than Ob/Gyns to perform uterine evacuation and offering first-trimester PAC service in PONEDs would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol would lower the burden of treatment for patients, reduce costs to the health system, and facilitate the task-shifting efforts needed to expand access to this life-saving service.

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

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.

scholarly journals Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal

2021 ◽  
pp. 1-16
Author(s):  
Colin Baynes ◽  
Mohamed Diadhiou ◽  
Grace Lusiola ◽  
Kate O’Connell ◽  
Thierno Dieng
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Unmet Need ◽  
Patient Characteristics ◽  
Ordinal Logistic Regression ◽  
Health Facilities ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Post Abortion

Abstract Post-abortion care (PAC) integrates elements that are vital for women’s survival after abortion complications and their ability to meet their subsequent fertility intentions. Currently, the utilization of PAC among women in need remains too low, particularly in settings where unsafe abortion is an appreciable cause of maternal mortality. Interventions have aimed at addressing unmet need; however, these still require information on the extent to which women value different aspects of PAC. This paper presents such evidence from Dakar, Senegal. Exit interviews with 729 PAC clients in 2018 at eight health facilities obtained information on patient characteristics, content of services received and women’s perceptions of the quality of care, both overall and according to subject-specific domains. These domains reflect aspects of PAC that are relevant to clients’ satisfaction: accessibility, facility environment, information and counselling, family planning, provider technical competence and readiness and client–staff interaction. Ordinal logistic regression models were estimated to identify factors that were associated with women’s rating of overall quality of care (on a scale of 1 to 5, 1 being lowest). Predictors that were significantly associated with the outcome were used in a multivariate ordinal logistic regression model that estimated the probability of positive differences in the outcome associated with women’s classification of each predictor. Women reported a mean rating of 3.7 for overall quality of care. The lowest domain-specific rating was for quality of information and counselling (mean=2.4) and the highest was for client–staff interaction (mean=3.8). Factors associated with clients’ higher odds of being more satisfied with PAC were: physical comfort during the procedure, recall of counselling on treatment procedure, privacy, perceived availability of supplies and medicines, facility admission process, facility cleanliness, waiting time, clarity of counselling and access to different contraceptive methods. Interventions that target these factors may improve the utilization of PAC in Dakar, Senegal.

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

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.

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

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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