Adolescents' satisfaction with care for abortion‐related complications in 11 Sub‐Saharan African countries: A cross‐sectional facility‐based study

Abstract

Objective: To assess satisfaction with care for abortion-related complications experienced among adolescents compared to older women. Methods: A secondary analysis of the WHO Multi-Country Survey on Abortionrelated Morbidity and Mortality-a cross-sectional study conducted in health facilities in 11 Sub-Saharan African countries. Women with abortion-related complications who participated in an audio computer-assisted self-interview were included. Two composite measures of overall satisfaction were created based on five questions: (1) study participants who were either satisfied or very satisfied across all five questions; and (2) study participants who reported being very satisfied only across all five [The copyright line and legal statement in this article was changed on 26 January 2022 after online publication.]

Quality of care for abortion‐related complications: Insights from the WHO Multi‐Country Survey on Abortion‐related Morbidity across 11 African countries

“…Widespread negative experiences of care were found, with 62% of women reporting at least one negative experience of care and 56.5% of women with abortion-related complications reporting that they felt anxious/stressed during their facility stay. 9,10 At first glance, this may appear to conflict with the results reported by Eboigbe et al 11 where women reported high levels of satisfaction with care when looking at different components of care individually (>75% reported being satisfied or very satisfied for four out of the five questions related to satisfaction); however, the results of the composite measure for satisfaction showed that nearly 50% of women reported being less than satisfied with at least one element of their care. 11 Women of low socioeconomic status were found to be a particularly vulnerable group in these papers, with higher odds of reporting negative experiences and high odds of reporting feeling anxious or stressed during their facility stay.…”

“…9,10 At first glance, this may appear to conflict with the results reported by Eboigbe et al 11 where women reported high levels of satisfaction with care when looking at different components of care individually (>75% reported being satisfied or very satisfied for four out of the five questions related to satisfaction); however, the results of the composite measure for satisfaction showed that nearly 50% of women reported being less than satisfied with at least one element of their care. 11 Women of low socioeconomic status were found to be a particularly vulnerable group in these papers, with higher odds of reporting negative experiences and high odds of reporting feeling anxious or stressed during their facility stay. 9,10 As has been outlined by WHO, a multipronged approach including self-care, clinical care, task sharing, human rights, and an enabling legal environment is needed to deliver high-quality abortion and postabortion care including access to family planning, 12 but the evidence presented throughout this Supplement shows that we still have considerable progress to make.…”

Prevalence and determinants of self‐reported anxiety and stress among women with abortion‐related complications admitted to health facilities in Eastern and Southern Africa: A cross‐sectional survey

“…This is partly explained by feelings of anxiety/stress over the costs of care; as reported elsewhere, there were relatively high levels of dissatisfaction reported in the MCS-A with out-of-pocket expenses paid. 6 It is plausible the women with lower levels of education have higher underlying feelings of anxiety/stress, driven by a range of factors which might include, for example, lower social capital. 21,22 It has been hypothesized that women undergoing multiple induced abortions might be more likely to report feeling anxiety/stress due to higher levels of violence or instability leading to the need to have multiple abortions, 23 but we did not observe this.…”

“…Specific potential distal determinants under the sociodemographic and obstetric characteristics were age, education, marital status, socioeconomic status (SES), individual income, gainful occupation, parity, number of previous abortions and contraceptive use prior to pregnancy termination. SES was categorized into three groups (low, middle, and high) on the basis of four questions from the ACASI as described by Eboigbe et al 6 Individual income and contraceptive use prior to pregnancy were reported in the ACASI, with other determinants extracted from medical records. Midlevel facility characteristics included facility location, facility level, and facility capability to provide PAC.…”

“…While there have been global and national level commitments to ensuring that comprehensive and safe postabortion care (PAC) is available to all women, there has been insufficient research focus on women's experience of care, which is an essential component of high-quality PAC. 4,5 Studies utilizing data from the World Health Organization (WHO) Multi-Country-Survey on Abortion (MCS-A) found that only 53% of women attending facilities for abortionrelated complications in 2017-2018 across 11 countries in Sub-Saharan Africa reported being satisfied or very satisfied with care, 6 and almost two-thirds reported negative experience of care. 7 To the best of our knowledge, there is very little published data available on levels and determinants of self-reported anxiety/stress among women attending facilities for abortion-related complications in low-and middle-income settings.…”