Improving stigma and psychosocial outcomes among post-abortion Kenyan women attending private clinics: A randomized controlled trial of a person-centered mobile phone-based intervention

Abstract

Objectives The objective of this study was to evaluate a person-centered abortion care mobile-based intervention on perceived social stigma, social support, mental health and post-abortion care experiences among Kenyan women who received abortion services at private clinics. Methods This randomized controlled study enrolled women who obtained an abortion from private clinics in Nairobi county, Kenya and randomized them into one of three study arms: 1) standard of care (follow-up by service provider call center); 2) post-abortion phone follow-up by a peer counselor (a woman who has had an abortion herself and is trained in person-centered abortion care); or 3) post-abortion phone follow-up by a nurse (a nurse who is trained in person-centered abortion care). All participants were followed-up at two- and four-weeks post-abortion to evaluate intervention effects on mental health, social support, and abortion-related stigma scores. A Kruskal-Wallis one-way ANOVA test was used to assess the effect of each intervention compared to the control group. In total, 371 women participated at baseline and were each randomized to the study arms. Results Using Kruskal-Wallis tests, the nurse arm improved mental health scores from baseline to week two; however this was only marginally significant (p = 0.059). The nurse arm also lowered stigma scores from baseline to week four, and this was marginally significant (p = 0.099). No other differences were found between the study arms. This person-centered mobile phone-based intervention may improve mental health and decrease perceived stigma among Kenyan women who received abortion services in private clinics. Conclusions Nurses trained in person-centered abortion care, in particular, may improve women’s experiences post-abortion and potentially reduce feelings of shame and stigma and improve mental health in this context.

Regional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis

“…The COVID-19 pandemic has impacted on the safety of childbirth, access to treatment for complications in health facilities, and delivery of already-fragile maternal and child health services 10. The disruptions affected ANC, a major determinant of maternal mortality rate, and important components of maternal care11–13 including access to institutional-based deliveries 2 4 6 10 14 15. Proper utilisation of ANC considerably enhances safe motherhood with improved maternal outcomes.…”

Post-abortion needs-based education via the WeChat platform to lessen fear and encourage effective contraception: a post-abortion care service intervention-controlled trial

“…The emotional gap between women and doctors is reduced through interactive contact in WeChat groups, increasing patients' trust and satisfaction with medical professionals and lowering anxiety [ 16 , 20 , 21 , 34 ]. Patients' health behaviors are directly influenced by their cognitive needs, and by providing targeted health education, which helps improve the quality of education while helping patients change their beliefs to change their behavior, medical satisfaction is increased [ 4 , 7 ].Unplanned pregnancies can be treated with induced abortion.…”

“…First-trimester intended abortion women using the WeChat platform receive post-abortion phased needs-based education encouraging women to adopt effective contraceptive methods after an abortion actively, allowing the PAC continuation service to meet the needs of patients better, and prevent unintended pregnancy, reduce the rate of induced abortion and repeat abortion, live healthier lives, and ensure women's reproductive health and physical and mental well-being [ 34 , 38 , 40 ].…”

Motivating and inhibiting factors influencing the application of mhealth technology in post-abortion care: a review study

“…According to the results, the articles included in the current research ( n = 16) were conducted in Canada [ 19 , 30 , 35 ], Kenya [ 38 ], Venezuela [ 39 ], Vietnam [ 40 ], Pakistan [ 41 ], Myanmar [ 42 ], Cambodia [ 20 , 43 – 46 ], Australia [ 47 ], Bangladesh [ 17 ], and South Africa [ 48 ] between 2014 and 2023. Among them, 13 articles (81.2%) discussed both motivating and inhibiting factors and three studies focused on motivating factors.…”

“…Luigi-Bravo et al identified individual motivating factors such as increased access to information and easy access to accurate and timely information [ 19 ]. In two studies, an increased accessibility to post-abortion support, overcoming geographical barriers, and immediate post-abortion relief were reported [ 38 , 39 ]. The easy access to information, privacy and confidentiality and risk mitigation were reported in other studies [ 40 , 41 ].…”