Abstract
Post-abortion care (PAC) integrates elements that are vital for women's survival after abortion complications and their ability to meet their subsequent fertility intentions. Currently, the utilization of PAC among women in need remains too low, particularly in settings where unsafe abortion is an appreciable cause of maternal mortality. Interventions have aimed at addressing unmet need; however, these still require information on the extent to which women value different aspects of PAC. This paper presents such evidence from Dakar, Senegal. Exit interviews with 729 PAC clients in 2018 at eight health facilities obtained information on patient characteristics, content of services received and women's perceptions of the quality of care, both overall and according to subject-specific domains. These domains reflect aspects of PAC that are relevant to clients' satisfaction: accessibility, facility environment, information and counselling, family planning, provider technical competence and readiness and client-staff interaction. Ordinal logistic regression models were estimated to identify factors that were associated with women's rating of overall quality of care (on a scale of 1 to 5, 1 being lowest). Predictors that were significantly associated with the outcome were used in a multivariate ordinal logistic regression model that estimated the probability of positive differences in the outcome associated with women's classification of each predictor. Women reported a mean rating of 3.7 for overall quality of care. The lowest domain-specific rating was for quality of information and counselling (mean=2.4) and the highest was for client-staff interaction (mean=3.8). Factors associated with clients' higher odds of being more satisfied with PAC were: physical comfort during the procedure, recall of counselling on treatment procedure, privacy, perceived availability of supplies and medicines, facility admission process, facility cleanliness, waiting time, clarity of counselling and access to different contraceptive methods. Interventions that target these factors may improve the utilization of PAC in Dakar, Senegal.
Highlights
In the 1990s, Senegal emerged as a regional leader in maternal health in part because of the government’s commitment to expanding access to life-saving treatment for abortion complications, i.e. post-abortion care (PAC) (Dieng et al, 2008)
Post-abortion care was included in the 1994 Program of Action of the International Conference on Population and Development (ICPD), which identified the right to the enjoyment of the highest attainable standard of physical and mental health, including reproductive health (Measham & Haberland, 2002)
60% of participants were treated with manual vacuum aspiration (MVA) or electric vacuum aspiration (EVA) (n=432) and 22% received misoprostol (n=158)
Summary
In the 1990s, Senegal emerged as a regional leader in maternal health in part because of the government’s commitment to expanding access to life-saving treatment for abortion complications, i.e. post-abortion care (PAC) (Dieng et al, 2008). Governments have scaled up PAC throughout health systems across low- and middle income countries (LMIC), including those, such as Senegal, where the law prohibits induced abortion unless the continuation of the pregnancy endangers the mother’s life. In these settings, PAC offers a ‘harm reduction’ approach to the public health problem of unsafe abortion and unmet need for contraception (Erdman, 2012). It is difficult to statistically isolate the contribution of PAC to maternal mortality reduction, it yields alternative evidence of public health impact, including increased contraceptive uptake following treatment and better access to care, especially in rural settings, due to task-shifting of PAC from physicians to mid-level providers (Bullough et al, 2005; Huber et al, 2016)
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