Abortion quality of care from the client perspective: a qualitative study in India and Kenya

Abstract

Quality healthcare is a key part of people’s right to health and dignity, yet access to high-quality care can be limited by legal, social and economic contexts. There is limited consensus on what domains constitute quality in abortion care and the opinions of people seeking abortion have little representation in current abortion quality measures. In this qualitative study, we conducted 45 interviews with abortion clients in Mumbai, India, and in Eldoret and Thika, Kenya, to assess experiences with abortion care, definitions of quality and priorities for high-quality abortion care. Among the many aspects of care that mattered to clients, the client–provider relationships emerged as essential. Clients prioritized being treated with kindness, respect and dignity; receiving information and counselling that was personalized to their individual situation and reassurance and support from their provider throughout the entire abortion process, including follow-up after the abortion. Many clients also noted the importance of skilled providers and appropriate care. There were similarities across the two country contexts, yet there were some differences in how clients defined high-quality care; therefore, specific political and cultural influences must be considered when implementing measurement and improving person-centred quality of care. These domains, particularly interpersonal interactions, should be prioritized in India and Kenya when health systems, facilities and providers design person-centred measures for quality in abortion care.

The intersection of stigma, quality of care, and structural barriers: a qualitative study of interactions between abortion seekers and healthcare workers in Australia

“…While the abortion decision or procedure was not emotionally di cult for some participants, others felt they needed extra support through counselling services. Compassionate care has been articulated as a priority by abortion seekers in various settings (20,39), and is essential in all contexts, not just formal counselling (23,52). The Inroads quality of care framework also focuses on the importance of kindness and empathy in abortion care and the necessity of including this in provider training (23).…”

“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system

“…Participants in our study were thus exposed to a range of healthcare provider attitudes, expertise and varying levels of support, which is noted in other studies as having a significant influence on the individual’s quality of care. 36 , 38–42 …”

Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care

“…Stigma-related fears, including those related to condemnation and mistreatment, often lead abortion seekers to self-manage their abortions ( Moseson et al, 2020 ). Furthermore, avoiding disclosure is regularly discussed as a mechanism for avoiding stigma ( Astbury-Ward et al, 2012 ), making abortion seekers' expectations and experiences of treatment and provider-client relationships an important part of quality in abortion care ( Baum et al, 2021 ; Georgsson et al, 2019 ; Doran and Nancarrow, 2015 ). Similarly, integration of abortion care into overall obstetrics and gynecology services is challenging due to the associated stigma ( Freedman et al, 2010 ) and has important consequences for the professional lives of providers ( Martin et al, 2014 ).…”