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Onadja Y, Compaoré R, Yugbaré DB, Thomas HL, Guiella G, Lougué S, Ouedraogo HG, Bazie F, Kouanda S, Moreau C, Bell SO. Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data. BMC Health Serv Res 2024; 24:84. [PMID: 38233874 PMCID: PMC10792903 DOI: 10.1186/s12913-023-10538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. METHODS Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15-49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. RESULTS PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. CONCLUSIONS Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level-the main source of care for many women-which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.
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Affiliation(s)
- Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso.
| | - Rachidatou Compaoré
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso
| | - Siaka Lougué
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Fiacre Bazie
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, 03 BP 7118, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, F-94800, France
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Thomas HL, Alzouma S, Oumarou S, Moreau C, Bell SO. Postabortion care availability, readiness, and accessibility in Niger in 2022: results from linked facility-female cross-sectional data. BMC Health Serv Res 2023; 23:1171. [PMID: 37891572 PMCID: PMC10612209 DOI: 10.1186/s12913-023-10107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Postabortion care (PAC), which is an essential element of emergency obstetric care, is underresearched in Niger. The study aims to assess the availability, readiness, and accessibility of facility-based PAC services in Niger. METHODS This study uses female and facility data from Performance Monitoring for Action Niger. The female data include a nationally representative sample of women aged 15-49 (n = 3,696). Using GPS coordinates, these female data were linked to a sample of public and private facilities (n = 258) that are expected to provide PAC. We assessed PAC availability and facility readiness to provide basic and comprehensive PAC using the signal functions framework, overall and by facility type. We then calculated the distance between women and their closest facility and estimated the proportion of women living within five kilometers (5 km) of a facility providing any PAC, basic PAC, and comprehensive PAC, overall and by women's background characteristics. RESULTS Only 36.4% and 14% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Oxytocics and laparotomy were the most missing signal function for basic and comprehensive PAC, respectively. Private facilities were the least ready to provide the full range of PAC services. While 47% of women lived within 5 km of a facility providing any PAC services, only 33.4% and 7.9% lived within 5 km of a facility providing all basic and all comprehensive PAC signal functions, respectively. Women who were divorced/widowed, had higher levels of education, and were living in urban areas had increased odds of living within 5 km of a facility with any or basic PAC. Women who were never married had increased odds of living within 5 km of a facility with comprehensive PAC, while urban residence was fully predictive of living within 5 km of a facility with comprehensive PAC. CONCLUSIONS This study found PAC availability and readiness to be insufficient in Niger, with inadequate and disparate accessibility to facilities providing PAC services. We recommended stakeholders ensure stock of essential commodities and availability of PAC services at primary facilities in order to mitigate the negative maternal health repercussions of unsafe abortion in this setting.
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Affiliation(s)
- Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA.
| | | | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, F-94800, France
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street., Baltimore, MD, 21205, USA
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Magalona S, Thomas HL, Akilimali PZ, Kayembe D, Moreau C, Bell SO. Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC. BMC Health Serv Res 2023; 23:658. [PMID: 37340470 DOI: 10.1186/s12913-023-09647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. METHODS Data on 153 facilities from the 2017-2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017-2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. RESULTS Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. CONCLUSION Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.
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Affiliation(s)
- Sophia Magalona
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Haley L Thomas
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Pierre Z Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dynah Kayembe
- Performance Monitoring for Action DRC, Kinshasa, Democratic Republic of Congo
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Suzanne O Bell
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Oni TO, Adebowale SA, Afolabi AA, Akinyemi AI, Banjo OO. Perceived health facility-related barriers and post-abortion care-seeking intention among women of reproductive age in Osun state, Nigeria. BMC Womens Health 2023; 23:311. [PMID: 37328732 PMCID: PMC10273618 DOI: 10.1186/s12905-023-02464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Post-abortion care (PAC) prevents death and complications caused by unsafe abortion which is widespread in Nigeria. Yet, there is sparse community-based evidence on women's intention to seek PAC should they have an abortion. This study examined the influence of perceived health facility-related barriers (HFRB) on post-abortion care-seeking intention (PACSI) among women of reproductive ages in Osun state, Nigeria. METHODS The study focused on women in a sexual relationship and who were residents of Osun state. A community-based survey was implemented using a multi-stage sampling technique. The calculated sample size (with attrition) was 1200 and data were collected from women aged 15-49 years, using open data kit (ODK). However, 1,065 complete responses were received on the ODK server, indicating an 88.8% response rate. Models were estimated using ordered logistic regression (Ologit) (α0.05) and data analysis was performed using Stata 14.0. RESULTS Mean age of the women was 29.3±7.6 years and 34.01% had the intention to seek PAC in health facilities. Lack of service confidentiality and unavailability of equipment specific to abortion were the two most reported barriers that would prevent women from seeking PAC. The adjusted Ologit model showed that respondents with perceived low HFRB had higher odds (aOR=1.60; CI=1.12-2.11) of seeking PAC in the health facility. Also, women who were employed and skilled were more likely (aOR=1.51; CI=1.13-2.01) while women who had PAC support from spouses/partners had higher odds of healthy PACSI (aOR=2.03; CI=1.48-2.78). Other identified predictors of PAC seeking intention included level of education, employment status, and spousal/partner support. CONCLUSION Perceived lack of trust in service provision and necessary equipment specific to abortion care had a negative influence on women's PACSI in Osun state. Reassuring health interventions that focus on improving the public perception of healthcare services and confidence to use the facility will likely improve the patronage of health facility for post-abortion care in Osun sate.
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Affiliation(s)
- Tosin Olajide Oni
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Stephen Ayo Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, North-West University, Mafikeng, South Africa
| | - Anuoluwapo Adeyimika Afolabi
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Postabortion and safe abortion care coverage, capacity, and caseloads during the global gag rule policy period in Ethiopia and Uganda. BMC Health Serv Res 2023; 23:104. [PMID: 36726121 PMCID: PMC9890752 DOI: 10.1186/s12913-022-09017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 12/28/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Abortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities' capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect. METHODS We collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities' capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period. RESULTS In both countries, service coverage was high and improved over time, but facilities' capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%. CONCLUSIONS The findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.
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Bazié F, Thomas HL, Byrne ME, Kindo B, Bell SO, Moreau C. Typologies of women’s abortion trajectories in Burkina Faso: findings from a qualitative study. Reprod Health 2022; 19:212. [DOI: 10.1186/s12978-022-01526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Abortion is a legally restricted, yet common reproductive life event among women in Burkina Faso; however, women’s abortion experiences vary greatly depending on their social and economic capital, partner involvement, and level of knowledge. We sought to classify women’s abortion care-seeking experiences across the life course and social conditions into typologies using qualitative data.
Methods
An initial quantitative survey among a nationally representative sample of women ages 15–49 years collected information on women’s induced abortion experiences. Women who reported an abortion in the last 10 years were asked if they would agree to participate in a subsequent in-depth interview (IDI) to learn more about their abortion experience. Twenty-five women, identified via purposive sampling, completed an IDI. Using a process of typology construction, we identified attributes of each woman’s condition at the time of her abortion and aspects of her abortion experience, created a matrix of attributes and cases, and identified emerging relationships. Three types were identified through this process.
Results
Twenty-three IDIs were analyzed, and women’s abortion experiences were grouped into three types: abortion to delay childbearing in adolescence; abortion to space childbirth among women in union; abortion to avoid childbearing among single mothers. Two cases were identified as outliers. Cases were grouped based on the context of their pregnancy, the reason for the abortion and involved decision-makers, and their patterns of care-seeking, including methods and sources used.
Conclusion
Structural inequities related to gender and wealth were prominent forces shaping women’s abortion experiences. Comprehensive sexuality education coupled with community-based interventions to promote gender-equitable relationships and address social stigma related to women’s sexuality could reduce reproductive coercion and unintended pregnancies.
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McMahon HV, Karp C, Bell SO, Shiferaw S, Seme A, Yihdego M, Zimmerman LA. Availability of Postabortion Care Services in Ethiopia: Estimates from a 2020 National Sample of Public Facilities. Contracept X 2022; 4:100087. [DOI: 10.1016/j.conx.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
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Magalona S, Byrne M, OlaOlorun FM, Mosso R, Omoluabi E, Moreau C, Bell SO. Contraceptive Use Before and After Abortion: A Cross-Sectional Study from Nigeria and Côte d'Ivoire. Stud Fam Plann 2022; 53:433-453. [PMID: 35856923 PMCID: PMC9545736 DOI: 10.1111/sifp.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Post‐abortion contraception enables women to effectively manage their fertility to prevent unintended pregnancies. Using data from population‐based surveys of women aged 15–49 in Nigeria and Côte d'Ivoire, we examined contraceptive dynamics immediately before and after an abortion and examined factors associated with these changes using multivariable logistic regressions. Covariates included sociodemographic characteristics, abortion source, post‐abortion contraceptive communication (wanting to and actually talking to someone about contraception after abortion), and perceived contraceptive autonomy. We observed higher contraceptive use after abortion than before abortion. In Nigeria, wanting to talk to someone about contraception post‐abortion was associated with increased adoption and decreased discontinuation, whereas talking to someone about contraception post‐abortion was associated with increased adoption. Obtaining care from a clinical abortion source was associated with increased adoption and decreased discontinuation. Both post‐abortion contraceptive communication variables were associated with post‐abortion contraceptive use in both countries, whereas clinical source was only associated with post‐abortion contraceptive use in Nigeria. Our findings suggest that ensuring that women have access to safe abortion as part of the formal health care system and receive comprehensive, high‐quality post‐abortion care services that include contraceptive counseling enables them to make informed decisions about their fertility that align with their reproductive goals.
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Affiliation(s)
- Sophia Magalona
- Sophia Magalona is a PhD student, Meagan Byrne is PMA Survey Operations Lead, Caroline Moreau is Associate Professor, and Suzanne O. Bell is Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan Byrne
- Sophia Magalona is a PhD student, Meagan Byrne is PMA Survey Operations Lead, Caroline Moreau is Associate Professor, and Suzanne O. Bell is Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Funmilola M OlaOlorun
- Funmilola M. OlaOlorun is Senior Lecturer, Department of Community Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Rosine Mosso
- Rosine Mosso is Lecturer and Researcher, École Nationale Supérieure de Statistique et d'Économie Appliquée, Abidjan, Côte d'Ivoire
| | - Elizabeth Omoluabi
- Elizabeth Omoluabi is Managing Director, Centre for Research, Evaluation Resources and Development, Ile-Ife, Nigeria
| | - Caroline Moreau
- Sophia Magalona is a PhD student, Meagan Byrne is PMA Survey Operations Lead, Caroline Moreau is Associate Professor, and Suzanne O. Bell is Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Caroline Moreau is Epidemiologist, CESP Centre for Research in Epidemiology and Population Health, INSERM (Institut National de la Santé et de la Recherche Médicale), Villejuif, France
| | - Suzanne O Bell
- Sophia Magalona is a PhD student, Meagan Byrne is PMA Survey Operations Lead, Caroline Moreau is Associate Professor, and Suzanne O. Bell is Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Compaore R, Ouedraogo AM, Baguiya A, Kpebo DO, Sidibe S, Kouanda S. Availability and Utilization of Postabortion Care Services in Burkina Faso, Côte d'Ivoire, and Guinea: A Secondary Analysis of Emergency Obstetric and Neonatal Care Needs Assessments (EmONC). Health Serv Insights 2022; 15:11786329221092625. [PMID: 35464819 PMCID: PMC9021517 DOI: 10.1177/11786329221092625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d’Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care. Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d’Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities’ capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d’Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries.
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Affiliation(s)
- Rachidatou Compaore
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso.,Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso
| | - Adja Mariam Ouedraogo
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso.,Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso.,Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso
| | - Denise Olga Kpebo
- Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso.,Public Health Department, Felix Houphouet Boigny University, Cote d'Ivoire
| | - Sidikiba Sidibe
- Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso.,Department of Public Health, Gamal Abdel-Nasser University of Conakry, Guinea
| | - Seni Kouanda
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso.,Doctoral School, Saint Thomas d'Aquin University, Ouagadougou, Burkina Faso.,Seni Kouanda is also affiliated to African Institute of Public Health, Ouagadougou, Burkina Faso
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Juma K, Ouedraogo R, Amo-Adjei J, Sie A, Ouattara M, Emma-Echiegu N, Eton J, Mutua M, Bangha M. Health systems' preparedness to provide post-abortion care: assessment of health facilities in Burkina Faso, Kenya and Nigeria. BMC Health Serv Res 2022; 22:536. [PMID: 35459161 PMCID: PMC9027923 DOI: 10.1186/s12913-022-07873-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background In many parts of sub-Saharan Africa, access to abortion is legally restricted, which partly contributes to high incidence of unsafe abortion. This may result in unsafe abortion-related complications that demand long hospital stays, treatment and attendance by skilled health providers. There is however, limited knowledge on the capacity of public health facilities to deliver post-abortion care (PAC), and the spread of PAC services in these settings. We describe and discuss the preparedness and capacity of public health facilities to deliver complete and quality PAC services in Burkina Faso, Kenya and Nigeria. Methods A cross-sectional survey of primary, secondary and tertiary-level public health facilities was conducted between November 2018 and February 2019 in the three countries. Data on signal functions (including information on essential equipment and supplies, staffing and training among others) for measuring the ability of health facilities to provide post-abortion services were collected and analyzed. Results Across the three countries, fewer primary health facilities (ranging from 6.3–12.1% in Kenya and Burkina Faso) had the capacity to deliver on all components of basic PAC services. Approximately one-third (26–43%) of referral facilities across Burkina Faso, Kenya and Nigeria could provide comprehensive PAC services. Lack of trained staff, absence of necessary equipment and lack of PAC commodities and supplies were a main reason for inability to deliver specific PAC services (such as surgical procedures for abortion complications, blood transfusion and post-PAC contraceptive counselling). Further, the lack of capacity to refer acute PAC cases to higher-level facilities was identified as a key weakness in provision of post-abortion care services. Conclusions Our findings reveal considerable gaps and weaknesses in the delivery of basic and comprehensive PAC within the three countries, linked to both the legal and policy contexts for abortion as well as broad health system challenges in the countries. There is a need for increased investments by governments to strengthen the capacity of primary, secondary and tertiary public health facilities to deliver quality PAC services, in order to increase access to PAC and avert preventable maternal mortalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07873-y.
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Affiliation(s)
- Kenneth Juma
- African Population and Health Research Center, P.O. Box 10787, Manga Cl, Nairobi, Kenya.
| | - Ramatou Ouedraogo
- African Population and Health Research Center, P.O. Box 10787, Manga Cl, Nairobi, Kenya
| | | | - Ali Sie
- Centre de Recherche en Santé de Nouna, Ouagadougou, Burkina Faso
| | - Mamadou Ouattara
- Centre de Recherche en Santé de Nouna, Ouagadougou, Burkina Faso
| | | | | | - Michael Mutua
- African Population and Health Research Center, P.O. Box 10787, Manga Cl, Nairobi, Kenya.,University of the Witwatersrand, Johannesburg, South Africa.,Bristol Park Group of Hospitals, Nairobi, Kenya
| | - Martin Bangha
- African Population and Health Research Center, P.O. Box 10787, Manga Cl, Nairobi, Kenya
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