Comprehensive Abortion Care Services Research Articles

Description of the methodology for developing and validating the WHO’s family planning and comprehensive abortion care competencies for the primary health care workforce

A qualified health workforce is essential to receiving effective, timely, affordable, equitable and respectful family planning and comprehensive abortion care. However, in many countries, health workers lack the competencies required to deliver quality family planning and comprehensive abortion care services. Competency-based education and learning aims to train and assess competencies. The theory-supported approach focuses on outcomes, emphasizes the learner’s ability to perform, promotes learner-centeredness and links the health needs of the population to the competencies required of health workers. In 2011, the World Health Organization published a guidance document, Sexual and reproductive health - Core competencies in primary care, defining the competencies that primary care providers need to safely deliver sexual and reproductive health services at the community level and included family planning and comprehensive abortion care.In this article, we describe the methodology and process undertaken in 2020, by the World Health Organization to produce the family planning and comprehensive abortion care competencies guidance, filling gaps identified in the previous guidance document. The World Health Organization’s Family Planning and Comprehensive Abortion Care toolkit for the primary health care workforce was published in 2022 and defines the key competencies for health workers in primary health care providing quality family planning and comprehensive abortion care services, as well as support for developing programmes and curricula for education and lifelong learning. The Toolkit is useful for practitioners, managers/supervisors and employers, educators, regulatory bodies, and policymakers. It is an important advance toward strengthening family planning and comprehensive abortion care services in primary health care.

Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory

The COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as “interlocutors” between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.

Expanding access to early medical abortion services in Ghana with telemedicine: findings from a pilot evaluation.

Abortion in Ghana is legally permissible under certain conditions. Updated in June 2021, the National Comprehensive Abortion Care Services Standards and Protocols included telemedicine as a recognised option for early medical abortion (EMA). Subsequently, Marie Stopes Ghana launched this pilot project to understand the feasibility and acceptability of providing EMA services through telemedicine. The pilot evaluation drew on two research protocols - a process evaluation and a qualitative study. The process evaluation focused on existing routine data sources and additional pilot-specific monitoring, while the qualitative protocol included in-depth interviews with a range of key stakeholders, including telemedicine and in-person patients, healthcare managers, and service providers. Telemedicine for EMA is feasible, acceptable, and has likely expanded access to safe abortion in Ghana. The MSIG telemedicine service package enabled 97% of patients to have a successful EMA at home. Thirty-six per cent of the total 878 patients during the pilot reported that they had no other option for accessing an abortion. Patients described telemedicine EMA services as a highly acceptable and appealing service option. Eighty-four per cent reported they would opt for the telemedicine service again and 83% reported they were very likely to recommend the service. There is potential for telemedicine to expand and improve access to critical SRH services. EMA via telemedicine can be delivered effectively in a low-resource setting. This pilot also showed how telemedicine provides access to patients who feel they do not have other safe service options, meeting specific patient needs in terms of discretion, convenience, and timing.

Health facilities readiness to provide comprehensive abortion care and factors associated with client satisfaction in Central Oromia Region, Ethiopia: a multilevel modeling approach

BackgroundIn Ethiopia only 53% of induced abortions were performed in a health facility. Even though efforts have been made to improve comprehensive abortion care (CAC), still several health facilities fail to provide the services. Even in facilities where such care is provided, significant numbers of clients report their dissatisfaction with the service. Hence, this study sought to assess availability and readiness to meet the need for CAC, client satisfaction with the service and associated factors in public health facilities of East Shawa Zone, from March 1 to July 31, 2020.MethodCross-sectional study was conducted taking a random sample of 30 health facilities and 900 women who received CAC and providers who delivered the services. Data were collected using interviewer-administered questionnaire and observational checklist. The analysis was performed using Stata-13. Descriptive summaries were used to characterize study participants, to determine service availability and readiness of facilities. The levels of satisfaction were estimated using proportion with a 95% confidence interval (CI). Multilevel ordinal logistic regression analysis was performed to identify factors associated with service satisfaction. The magnitude of association was estimated by adjusted odds ratios (AOR) with a 95% CI, and a p-value < 0.05 was used to declare statistical significance.ResultsThe study found that all health facilities fulfilled at least three-fourth (75%) of the requirements that ensure CAC services availability. However, the percentage of facilities that fulfilled at least three-fourth of equipment was 60%; medicines, 56.7%; and basic amenities, 46.7%. Overall, 19.3% of women (95% CI 16.9%, 22.0%) reported very high level of satisfaction with CAC services. The levels of Satisfaction with the services were associated with being treated with second trimester abortion (AOR) = 2.07; 95% CI 1.03, 4.15) and having good procedure outcome (AOR = 2.09; 95% CI 1.09, 4.15), being treated by younger service provider, less than 35 year old (AOR = 8.58; 95% CI 3.66, 20.12), by a nurse (AOR = 2.96; 95% CI 1.49, 5.87), provider with three to five years of experience (AOR = 0.46; 95% CI 0.23, 0.92) and with the availability of essential medicines (AOR = 4.34; 95% CI 1.06, 18.20).ConclusionsThe availability of essential medicines was below the standards set by World Health Organization. The levels of satisfaction with CAC is comparably lower than other studies findings and affected by the availability of essential medicines, procedure outcome, and gestational age of terminated pregnancy, the health care provider’s age, profession and years of experience.

Induced abortion among female students in higher education institutions in Ethiopia: A systematic review and meta-analysis.

Female students in institutions of higher education are at higher risk of abortion and its consequences. There is no nationally representative data on induced abortion among students in higher education institutions in Ethiopia. Hence, this study aimed to estimate the pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia. This study used a systematic review and meta-analysis of studies conducted from January 1, 2010, to June 30, 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health electronic databases were searched. The analysis was performed using STATA 14 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis using the random effect model. This systematic review and meta-analysis included a total of 10 studies and 4656 study participants. The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was 5.06% (95%CI: 2.16, 7.96). The rate of induced abortion was 51 per 1000 women. The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was high. Thus, concerned bodies should design and implement an effective strategy to realize friendly and non-judgmental family planning and comprehensive abortion care service to curb the problem.

Women's Satisfaction with Comprehensive Abortion Care and Associated Factors in Public Health Facilities of Mojo Town, East Ethiopia.

Client satisfaction is an important and commonly used indicator for measuring the quality of health care as it affects clinical outcomes, patient retention, and medical malpractice claims. To limit unintended pregnancies and avoid repeated abortions promoting comprehensive abortion care services is crucial. In Ethiopia problems related to abortion were neglected and access to quality abortion care was very limited. Similarly, information related to comprehensive abortion service, particularly clients' satisfaction, and associated factors are limited in the study area that the study will be going to fill. A facility-based cross-sectional study design was employed on 255 women who come for abortion service in public health facilities of Mojo town were included consecutively. The data was coded and entered into Epi info version 7 software and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression models were applied to identify the associated factors. Model fitness and multicollinearity were checked by using the Hosmer-Lemeshow goodness of fit test and the Variance Inflation Factor (VIF). Adjusted Odds Ratios and their 95% Confidence were reported. A total of 255 study subjects were included in this study with a 100% response rate. The study depicted that 56.5% (95% CI: 51.3, 61.7) of the clients were satisfied with comprehensive abortion care. Having college and above educational level (AOR: 0.27; 95% CI: (0.14, 0.95)), Employee occupation (AOR: 1.86; 95% CI: (1.41, 2.93)), medical abortion as a type of uterine evacuation (AOR: 3.93; 95% CI: (1.75, 8.83)) and natural method of family planning users (AOR: 0.36; 95% CI: (0.08, 0.60)) were factors associated with women's satisfaction. The overall satisfaction toward comprehensive abortion care was considerably lower. Waiting time, cleanness of rooms, lack of laboratory service, and availability of service providers are mentioned factors for client dissatisfaction.

Socio-clinical profile of women receiving comprehensive abortion care

Introduction: Comprehensive abortion care (CAC)is an intervention proven to prevent maternal death or injury. Disrupted health systems, limited contraception, and a higher instance of sexual violence cause an increase in the number of unintended pregnancies and demand for safe abortion. One of the leading causes of maternal mortality and morbidity is unsafe abortion. 8% of the maternal mortality is contributed by unsafe abortion. Aim &amp; Objective: To identify reasons for seeking CAC services, socio-clinical profile of its users, its effectiveness, acceptance at the level of users and complication. Observation: 65% of patient were educated &amp; were lying between 9th standard to 12th class. Only 0.4% was illiterate among the women receiving CAC. Mean age of patient receiving CAC was 29 years. 25.9% underwent medical method of abortion; maximum patients 46.9% patients did not receive any contraception. 73.8% of patients underwent abortion without complication. Conclusion: Post-abortion care is an opportunity for healthcare professionals to provide education, discuss fertility needs and the need for contraception with women seeking abortion so that appropriate decisions can be taken for suitable family planning.

Status of Comprehensive Abortion Care Service in Paschim Bardhaman District, West Bengal - A Mixed-Method Study.

Background:Delivering quality comprehensive abortion care (CAC) service, accessible and affordable to all care seekers, at every tier is essential to reduce maternal morbidity and mortality.Objectives:The study aimed to assess the infrastructural availability of the health facilities, describe beneficiary characteristics, and to explore constraints in CAC service provision from the providers' perspectives.Materials and Methods:A mixed-method study was conducted during December 2019 to February 2020 in Paschim Bardhaman District, West Bengal. All 10 public health facilities of the district providing CAC services were visited for infrastructural assessment. Record review of all care seekers from 2015 to 2018 was done to assess their characteristics. In-depth interview of the administrative heads of facilities and district level program officers was done to explore constraints faced in service provision. Quantitative data were analyzed by SPSS version 20, and qualitative data were analyzed thematically using NVivo software.Results:Physical infrastructure was adequate in only 40% of the facilities; however, drugs and contraceptives were universally available. About 49.5% of the care seekers had induced abortion; 63.5% underwent manual vacuum aspiration; 21.5% did not return for follow-up, and only 50% adopted postabortal contraception. Major issues explored were lack of trained manpower, logistics and physical infrastructure, and inadequate supervision and monitoring.Conclusion:The study highlighted gaps in preparedness of the health facilities for the provision of quality CAC services including some major constraints from the provider's perspectives.

An Overview of Comprehensive Abortion Care at Tertiary care Teaching Hospital

Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics &amp; Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of pregnancy. The reason in the first trimester was completed family (39.25%) and the main reason for the second trimester was maternal mental health (48.71%). Among the total study population, 16.37% (n=28) accepted contraception. The most common accepted contraceptive method was implant (n=14; 8.1%), followed by inj. depot medroxyprogesterone acetate (n=8; 4.6%).Conclusions: The prevalence of second-trimester abortion is high despite the availability of first-trimester comprehensive abortion care service. The main reason for induced abortion in first trimester was completed family and in second-trimester was maternal mental health. Post-abortion contraceptive acceptance among comprehensive abortion care clients was very low.

Trends in Comprehensive Abortion Care (CAC) and characteristics of women receiving abortion care in a tertiary hospital in Nepal

BackgroundOne of the leading cause of maternal mortality and morbidity is unsafe abortion. Globally 55.7million of abortions occurred each year between 2010 and 2014. In lower resource countries 24.3 million abortions were unsafe which is significantly higher. Nepal is one of the lower resource countries among others. Comprehensive abortion care (CAC) service can reduce this burden among women.MethodsA retrospective review of CAC service register at Tribhuvan University Teaching Hospital (TUTH) was conducted to collect data from 2006 to2015 with approval from the Nursing Department to identify the trends of CAC service delivery, client characteristics, category of service providers, and reason for seeking CAC services, its effectiveness and complications. The data was entered in SPSS software and descriptive analysis was performed.ResultsA total of 2367 women received CAC in ten years period showing similar trend as 272–275 cases per year. Women’s mean age was 28.4 years, 34% attained secondary level education and 98.9% were married. 70% were house wives and 84% multi gravid. The gestational period varied from 5 to 12 weeks. 85.6% had Manual Vacuum Aspiration (MVA) and 14.4% had Medical Abortion (MA). Only 37.6% women used any method of post abortion contraception. Unwanted pregnancy was the commonest reason for CAC. A majority of service providers were doctors (62.4%). The nurses were equally competent to provide CAC service as doctors.ConclusionsThe number of women receiving CAC was relatively constant over the ten-year period. Nurses should be promoted for providing CAC services to cover a larger population in need.

Five years of improving abortion care and postabortion contraception: final results from the Maximizing Healthcare Provider Performance (MAX) program in Kenya and South Africa

Objectives: This study evaluated the effectiveness of the Maximizing Healthcare Provider Performance (MAX) program intervention over 5 years as a holistic approach to change healthcare provider behavior and influence patient outcomes in comprehensive abortion care, including postabortion contraception. MAX utilized field representatives to offer monthly support at the provider level to identify barriers to effective comprehensive abortion care service provision and to implement customized solutions to increase access to quality care in Kenya and South Africa.

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia

BackgroundAlthough abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation.MethodsAn intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country’s abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships.ResultsAfter 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47% after the intervention. Despite progress in attitudes towards abortion clients, such as empathy, and improved community engagement, the evaluation revealed continuing stigma on both provider and client sides.ConclusionsThese findings provide a case study of the medical abortion introduction in Zambia and offer important lessons for expanding safe and legal abortion access in similar settings across Africa.

Maternal mortality: scenario, causes and prevention of the tragedy in Indian context with special consideration to Assam, India

Though child birth gives joy to mother and family, yet this joy may transform to tragedy in the event of maternal death. Maternal mortality has been identified as a priority on health policy and research agendas for developing countries. MMR has been decreased from 398/100,000 live births in 1997 to 178 in 2013 India and 347 in 2011 to 301 in 2013 in Assam, India. Maternal death may occur during antenatal, intranatal or postnatal period thus necessitating services during these periods. For pregnant women during antenatal, intranatal or postpartum period – ante natal care services, institutional delivery, access to basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care ( CEmOC), post natal care, referral services should be provided. In the event of injection oxytocin not being available due to constraints of optimal storage conditions or other logistical barriers, misoprostol is recommended to be given for prevention of PPH. Government of India policies and strategies (NPP/RCH II) have focused on enhancing-access and availability of comprehensive abortion care services in both the public and private sector. Maternal death review should be done in case of any maternal death to find out the associated factors. “Maternal near miss” surveillance is an effective tool for improving safe motherhood programs. Government of Assam has kept goal 2 under Assam bikas yojna: reduction in maternal mortality ratio to 210 per 100000 live births. Some planned strategy taken for achieving this goal. But for success in reducing maternal death the community will need to be involved not only through educating them about the signs and symptoms of emergency but also to develop appropriate mechanisms for ensuring that women in distress get the quality care .

What makes a likely abortion provider? Evidence from a nationwide survey of final-year students at Ghana’s public midwifery training colleges

BackgroundEven in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students’ reported likelihood to provide abortion services. MethodsFinal-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted. ResultsA total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, for a response rate of 91.8%. In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion. DiscussionMidwifery students at Ghana’s public midwifery training colleges report that they are likely to provide CAC. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana.

Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana.

BackgroundUnderstanding what factors influence the receipt of postabortion contraception can help improve comprehensive abortion care services. The abortion visit is an ideal time to reach women at the highest risk of unintended pregnancy with the most effective contraceptive methods. The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method.MethodsWe used retrospective cohort data collected from 64 health facilities in three regions of Ghana. The dataset includes information on all abortion procedures conducted between 1 January 2008 and 31 December 2010 at each health facility. We used fixed effect Poisson regression to model the associations of interest.ResultsMore than half (65 %) of the 29,056 abortion clients received some form of contraception. When midwives performed the abortion, women were more likely to receive postabortion contraception compared to house officers (RR: 1.18; 95 % CI: 1.13, 1.24) or physicians (RR: 1.21; 95 % CI: 1.18, 1.25), after controlling for facility-level variation and client-level factors. Compared to women seen by house officers, abortion clients seen by midwives and physicians were more likely to receive a long-acting and permanent rather than a short-acting contraceptive method (RR: 1.46; 95 % CI: 1.23, 1.73; RR: 1.58; 95 % CI: 1.37, 1.83, respectively). Younger women were less likely to receive contraception than older women irrespective of provider type and indication for the abortion (induced or PAC).ConclusionsWhen comparing consultant physicians, house officers, and midwives, the type of abortion provider is associated with whether women receive postabortion contraception and with whether abortion clients receive a long-acting and permanent or a short-acting method. New strategies are needed to ensure that women seen by physicians and house officers can access postabortion contraception and to ensure that women seen by house officers have access to long-acting and permanent contraceptive methods.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1875-2) contains supplementary material, which is available to authorized users.

A Maternal Death due to an Unsafe Abortion in Rural Nepal - A Case Report

Background : Abortion was illegal before 2002 A.D. in Nepal and was legalized under the 11th amendment to the Country Code (Muluki Ain) in March 2002, receiving royal assent in September 2002. Nepal Government began providing comprehensive abortion care services from March 2004 after 18 months of legalization of abortion, when the government issued Safe Abortion Service Procedure. The maternal mortality ratio in Nepal is among the highest in South Asia. Unsafe abortion is defined as an induced abortion process either conducted by less skilled personnel or performed in a non-accredited facility. Though abortion has been legal in Nepal for more than 14 years now; physicians in Nepal still face problems of abortions done by less qualified personnel. Case Report : We report a fatal case of unsafe abortion in a 32 year old lady whose cause of death was ascertained as irreversible septic shock due to septic abortion. Conclusion : Prompt diagnosis and appropriate intervention might provide better outcome in these types of cases. Therefore, we stress the importance of safe abortion services provided by skilled personnel at rural areas in developing countries and of early referral in case complication arises so that the life of the patient is not endangered.

Study of Contraceptive Use Among Comprehensive Abortion Care Clients in Family Planning Clinic of Tribhuban University Teaching Hospital

Aims: This study was done to assess the use of family planning method among comprehensive abortion care clients in Tribhuvan University Teaching Hospital (TUTH). Methods: A hospital based observational study was conducted in family planning clinic at TUTH from 14th April 2009 to 14th June 2010 among one hundred clients who opted for comprehensive abortion care (CAC) at the hospital CAC centre and met the inclusion criteria of this study. Results: Around 98% women had knowledge of different types of modern contraceptive methods. Majority of CAC clients (91%) had ever used contraceptive methods in the past. Injectables were the most common method of contraceptive used by the CAC clients (55%). Almost 22% clients had come for repeat induced abortion. About 43% clients opted CAC service for complete family and 33% for contraceptive failure. Withdrawal method failure was seen in 17% of clients. Almost 86% women intend to use contraceptive after CAC service in future. Conclusions: This study concluded that despite knowledge of modern contraceptive methods and ever uses of different family planning methods, majority of clients had no consistency in use of various contraceptives. Effective family planning counseling along with information of emergency contraceptive is required for each CAC clients to prevent unwanted pregnancy and abortion.DOI: http://dx.doi.org/10.3126/njog.v9i2.11740

The impact of Ghana's R3M programme on the provision of safe abortions and postabortion care.

In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion care services. This article examines whether this intervention made a difference to the provision of safe abortion services and postabortion care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ∼2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC.

Post Abortion Choice and Acceptance of Contraception

Aims: This study was conducted to find out choice and acceptance of contraceptives in clients coming for first trimester abortion. Methods: This was a cross sectional descriptive study carried out from the records of clients who received comprehensive abortion care service in first trimester at Kasthamandap health care centre from June 2008 to June 2010. Results: Total 707 clients came for abortion who fulfilled inclusion criteria. Contraceptive acceptance was 49.5%. Most frequently used contraceptives were injectable (depot medroxyprogesterone) 22.8%, oral contraceptive pills 19.6%, condom 6.1%, intra-uterine contraceptive device 0.8% and norplant 0.3%. Conclusions: This study showed a low acceptance rate of contraception. This suggests the need for reviewing the policy of post abortion contraception. The study also highlighted that depot provera was the most accepted contraception. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 14-17 DOI: http://dx.doi.org/10.3126/njog.v8i1.8854

Comprehensive abortion care: evidence of improvements in hospital-level indicators in Tigray, Ethiopia

ObjectiveApproximately 18% of maternal deaths in East Africa is attributable to unsafe abortion. Availability of comprehensive abortion care (CAC) services at all levels of the healthcare system, including medical abortion,...