Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Huber, D; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

doi:10.9745/ghsp-d-16-00052

Cited by 64 publications

(79 citation statements)

References 64 publications

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“…Rural PAC patients in Zimbabwe have significantly higher odds of developing higher severity post-abortion complications when compared to urban PAC patients [3]. Uterine evacuation is a safe procedure that can and should be performed at the primary level [9]. Therefore, it is important for public primary health centers to be equipped and providers trained to use appropriate uterine evacuation technologies, such as misoprostol, to avoid delays in treatment associated with referring patients to other facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Since abortion is one of the main causes of maternal death, it is essential to understand the coverage and quality of abortion care in a context of high maternal mortality and restrictive abortion laws, like Zimbabwe. While there is a body of literature on measuring the quality of abortion care, there is inconsistency in how the quality of abortion care is measured [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…This SAC model was further refined for PAC and termination of pregnancy services in 2016 [13]. The process component of quality of care can be measured through the provision of evidence-based standards of care [9]. The structure and process components allow for the evaluation of both the inputs and standards of care, but do not encompass all aspects of quality, such as women's experiences of care.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

Riley

Madziyire

Owolabi

et al. 2020

BMC Health Serv Res

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Background: An estimated 65,000 abortions occurred in Zimbabwe in 2016, and 40 % resulted in complications that required treatment. Quality post-abortion care (PAC) services are essential to treat abortion complications and prevent future unintended pregnancies, and there have been recent national efforts to improve PAC provision. This study evaluates two components of quality of care: structural quality, using PAC signal functions, a monitoring framework of key life-saving interventions that treat abortion complications; and process quality, which examines the standards of care provided to PAC patients. Methods: We utilized a 2016 national census of health facilities in Zimbabwe with PAC capacity (n = 227) and a prospective, facility-based 28-day survey of women seeking PAC in a nationally representative sample of those facilities (n = 1002 PAC patients at 127 facilities). PAC signal functions, which are the critical services in the management of abortion complications, were used to classify facilities as having the capability to provide basic or comprehensive care. All facilities were expected to provide basic care, and referral-level facilities were designed to provide comprehensive care. We also assessed population coverage of PAC services based on the WHO recommendation for obstetric services of 5 facilities per 500,000 residents. Results: We found critical gaps in the availability of PAC services; only 21% of facilities had basic PAC capability and 10% of referral facilities had comprehensive capability. For process quality, only one-fourth (25%) of PAC patients were treated with the appropriate medical procedure. The health system had only 41% of the basic PAC facilities recommended for the needs of Zimbabwe's population, and 55% of the recommended comprehensive PAC facilities. Conclusion: This is the first national assessment of the Zimbabwean health system's coverage and quality of PAC services. These findings highlight the large gaps in the availability and distribution of facilities with basic and comprehensive PAC capability. These structural gaps are a contributing barrier to the provision of evidence-based care. This study shows the need for increased focus and investment in expanding the provision of and improving the quality of these essential, life-saving PAC services.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

Riley

Madziyire

Owolabi

et al. 2020

BMC Health Serv Res

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“…11 Programs should ensure that both MVA and misoprostol are available at HFs, and women should be informed of appropriate treatment options, staff should be trained, and communities should be informed. 19 EmONC guidelines were available at fewer than half of public and private HFs. These guidelines indicate managing incomplete abortions and miscarriage using MVA as a signal function but lack the medical treatment of incomplete abortion and family planning component of PAC.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Evidence shows that postabortion family planning is a high-impact practice that results in higher family planning uptake when it is provided proactively at the same time and location where a woman receives facility-based PAC. 19,20 A 2010 study to assess availability of PAC in Afghanistan showed that although designated emergency obstetric facilities in Afghanistan generally have most supplies and equipment for PAC available, capacity of health care providers to deliver PAC is limited. Training on PAC-related skills was recommended in 2015 to all SBAs.…”

mentioning

confidence: 99%

Health Facility Capacity to Provide Postabortion Care in Afghanistan: A Cross-Sectional Study

Maruf

Tappis²,

Lu³

et al. 2019

Preprint

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Background: Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births, Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes. Contraceptive prevalence rate has fluctuated between 10–20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated health facilities’ capacity to provide postabortion care, and skilled birth attendants’ knowledge and perceptions. Methods: Accessible public health facilities with at least five births per day on average (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Data collection methods for provision included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions.Results: Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Seventy percent of public facilities expected to provide basic emergency obstetric and newborn care had functional manual vacuum aspiration supplies in the delivery room. More than 80% of public health facilities had male condoms, oral contraceptive pills, intrauterine devices, and injectables. Conclusions: This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, and availability of supplies.

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The effects of different abortion policy environments on women's health

Macleod¹,

Lavelanet

Liquitay

et al. 2023

Cochrane Database of Systematic Reviews

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Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Cited by 64 publications

References 64 publications

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

Health Facility Capacity to Provide Postabortion Care in Afghanistan: A Cross-Sectional Study

The effects of different abortion policy environments on women's health

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