Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services

Healy, Joan; Otsea, K; Benson, Janie

doi:10.1016/j.ijgo.2006.08.002

Cited by 53 publications

(68 citation statements)

References 19 publications

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“…However, the EmOC model gives minimal attention to the treatment for an unsafe abortion and no attention to safe abortion services or contraception [17]. …”

Section: The Safe Abortion Care (Sac) Modelmentioning

confidence: 99%

Safe Abortion Care, Utilization of Post Abortion Contraception and associated Factors, Jimma Ethiopia

EK¹,

Abera²

2016

J Women's Health Care

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Background: Each year, throughout the world, approximately 210 million women became pregnant and around one in 10 pregnancies end in an unsafe abortion. The interventions to prevent unsafe abortion and its complications include providing safe abortion service, treatment of abortion complications and access to modern contraceptive services. In Ethiopia and the study area in particular, availability of safe abortion care (SAC) and utilization of post abortion family planning is not well documented.

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“…However, the EmOC model gives minimal attention to the treatment for an unsafe abortion and no attention to safe abortion services or contraception [17]. …”

Section: The Safe Abortion Care (Sac) Modelmentioning

confidence: 99%

Safe Abortion Care, Utilization of Post Abortion Contraception and associated Factors, Jimma Ethiopia

EK¹,

Abera²

2016

J Women's Health Care

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“…The additional 4 comprehensive signal functions are more consistent with hospitals' capacity and include surgery and blood transfusion as well as second trimester abortion care. The SMRAC indicators (listed and defined in Table 2) were used to monitor facility availability, distribution, service utilization, and quality of care [5,9,14].…”

Section: Methodsmentioning

confidence: 99%

“…Since the 1970s, Bangladesh has maintained a menstrual regulation (MR) program, which is defined as an interim method of establishing nonpregnancy in women at risk of being pregnant [7]. MR has an advantage in countries where abortion is legally banned because it can be conducted without a confirmatory pregnancy test, within 10 weeks of the beginning of the last menstrual period by family welfare visitors (health service providers having at least ten years of formal schooling and 18 months of training in family planning and maternal and child health care, and additional training specifically in MR) and within 12 weeks of a missed menstrual period by medical doctors [8,9]. Although MR services have been decentralized, estimates showed that the incidence of induced abortion was the same as that of MR in 2010, (647,000 and 653,000 respectively) which implies that the demand for MR services are not being met [10].…”

Section: Introductionmentioning

confidence: 99%

“…In this study, The SAC model was validated and adapted as the safe menstrual regulation and abortion care (SMRAC) model [9,14] with the objective of assessing the feasibility, acceptability and utility of the SMRAC model in Jessore district of Bangladesh. We also documented the availability, utilization, and quality of MR and abortion services over time, and highlighted elements of care in need of quality improvement.…”

Section: Introductionmentioning

confidence: 99%

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Strengthening health systems capacity to monitor and evaluate programmes targeted at reducing abortion-related maternal mortality in Jessore district, Bangladesh

Huda¹,

Ahmed²,

Ford

et al. 2015

BMC Health Serv Res

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Background: Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country. Methods: This quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year's records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality. Results: No facilities fulfilled criteria for 'comprehensive' care at either the baseline or end line while only one met the 'basic' criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %). Conclusion: Persistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities. Notable gaps were identified in providing post-abortion contraceptive services for women treated for PAC. By systematic implementation of the SMRAC model, health systems can track and measure progress and gaps in their implementation and identify strategies for further reduction of abortion-related morbidity and mortality in Bangladesh.

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“…21 It has also been shown that providing contraception at the same location as providing safe abortion care increases the contraceptive uptake rate, 22 and that training abortion providers to monitor this indicator is key to success. 23 There was general recognition, however, that there is no perfect contraceptive and women have always experienced unwanted pregnancies. Thus, the need to help women have abortions in safety and dignity remains an important strategy to reduce maternal mortality and morbidity.…”

Section: Recommended Indicatorsmentioning

confidence: 99%

Measuring improvements in sexual and reproductive health and rights in sub-Saharan Africa

Seims

Khadduri²

2012

Reproductive Health Matters

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Recent studies on development aid from European donors revealed that their funding of the health sector in sub-Saharan Africa rarely includes performance measures suitable for tracking operational progress in improving sexual and reproductive health and rights. Analysis of health sector agreements verifies this. Particularly lacking are metrics related to four critically important areas: 1) reducing mortality and morbidity from unsafe abortion, 2) preventing and treating gender-based violence, 3) reducing unwanted pregnancies among the poorest women, and 4) reducing unwanted pregnancies among adolescents. During 2011 and the first half of 2012, the authors interviewed 85 experts in health service delivery, ministries of health, human rights, development economics and social science from sub-Saharan Africa, Europe and the United States. We asked them to identify measures to assess progress in these areas, and built on their responses to propose up to four practical performance measures for each of the areas, for inclusion in health sector support agreements. These measures are meant to supplement, not replace, current population-based measures such as changes in maternal mortality ratios. The feasibility of using these performance measures requires political commitment from donors and governments, investment in baseline data, and expanding the role of sexual and reproductive health and rights civil society in determining priorities.

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Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services

Abstract: This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health.

Cited by 53 publications

References 19 publications

Safe Abortion Care, Utilization of Post Abortion Contraception and associated Factors, Jimma Ethiopia

Safe Abortion Care, Utilization of Post Abortion Contraception and associated Factors, Jimma Ethiopia

Strengthening health systems capacity to monitor and evaluate programmes targeted at reducing abortion-related maternal mortality in Jessore district, Bangladesh

Measuring improvements in sexual and reproductive health and rights in sub-Saharan Africa

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