Quality Of Abortion Care Research Articles

Providing quality abortion care: Findings from a study of six states in India

ObjectiveAlthough abortion has been legal in India since 1971, but very little research has been done so far on the issue of the quality of abortion services. To fill this gap, this paper examines whether the quality of abortion services provided in the country is in line with the WHO’s recommendations.Study Design: We analyse a cross-sectional health facilities survey conducted in six Indian states, representing different sociocultural and geographical regions, as part of a study done in 2015.Main outcome measures: Percentage of facilities offering different abortion methods, type of anaesthesia given, audio-visual privacy level, compliance with the law by obtaining woman’s consent only, imposing the requirement of adopting a contraceptive method as a precondition to receive abortion. ResultsExcept for the state of Madhya Pradesh, fewer than half of the facilities in the other states offer safe abortion services. Fewer than half of the facilities offer the WHO recommended manual vacuum aspiration method. Only 6–26% facilities across the states seek the woman’s consent alone for providing abortion. About 8–26% facilities across the states also require that women adopt some method of contraception before receiving abortion. ConclusionTo provide comprehensive quality abortion care, India needs to expand the provider base by including doctors from the Ayurveda, Unani, Siddha, and Homeopathy streams as also nurses and auxiliary midwives after providing them necessary skills. Medical and nursing colleges and training institutions should expand their curriculum by offering an in-service short-term training on vacuum aspiration (VA) and medical methods of abortion.

Avaliação da qualidade da atenção ao aborto na perspectiva das usuárias: estrutura dimensional do instrumento QualiAborto-Pt

Abortion complications are a major public health problem, and studies to assess the quality of abortion care require adequate measurement tools. This study is a continuation of such an instrument's refinement, the QualiAborto-Pt questionnaire. Using data from a survey of 2,336 women hospitalized for abortion complications in 19 hospitals in three state capitals in Northeast Brazil (Salvador - Bahia, Recife - Pernambuco, and São Luís - Maranhão), we implemented a series of exploratory and confirmatory factor analyses based on a 55-item prototype. The analyses indicate a structure with 17 items in five dimensions: reception, orientation, inputs/physical environment, technical quality, and continuity of care. All the items in the final model displayed acceptable reliability, absence of content redundancy, and factor specificity, as well as theoretical consistency with the respective dimensions. The solution also shows discriminant factor validity. Despite some persistent issues for further analysis and clarification, this version merits recommendation for use in Brazil.

Abortion referral patterns among generalist OB/GYNs and primary care practitioners: A qualitative study

ObjectiveAn informed, timely referral from a generalist practitioner has the potential to facilitate care for a patient seeking an abortion. However it is unclear what barriers, if any, generalist practitioners perceive in this process. The objective of this study was to qualitatively characterize abortion referral patterns among generalist practitioners. Study designWe conducted individual interviews with generalist practitioners practicing at Northwestern Medicine, encompassing four hospitals across the greater Chicago metropolitan area. The interview guide focused on abortion-related topics including: referral patterns, attitudes about providing referrals, and specifics of the abortion referral process. We analyzed the data for content and themes using an inductive approach. ResultsWe completed 37 interviews. Practitioners in all fields and practice sites were willing to provide abortion referrals. Practitioners perceived barriers in the referral process, with a lack of knowledge chief among them. Further, practitioners saw abortion referrals as more burdensome than other specialty referrals. ConclusionGeneralist practitioners are willing to provide abortion referrals, but perceive multiple barriers in the abortion referral process. Generalist practitioners can help to ensure their patients receive timely and quality abortion care if they feel prepared and empowered to assist with these referrals.

Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam

BackgroundMedical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women’s experiences of pain with MA and strategies for improving quality of care.MethodsThis qualitative study was conducted as part of a three-arm randomized, controlled trial in Nepal, Vietnam, and South Africa to investigate the effect of prophylactic pain management on pain during MA through 63 days’ gestation. We purposively sampled seven parous and seven nulliparous women with a range of reported maximum pain levels from each country, totaling 42 participants. Thematic content analysis focused on MA pain experiences and management of pain compared to menstruation, labor, and previous abortions.ResultsMA is relatively less painful compared to giving birth and relatively more painful than menstruation, based on four factors: pain intensity, duration, associated symptoms and side effects, and response to pain medications. We identified four types of pain trajectories: minimal overall pain, brief intense pain, intermittent pain, and constant pain. Compared to previous abortion experiences, MA pain was less extreme (but sometimes longer in duration), more private, and less frightening. There were no distinct trends in pain trajectories by treatment group, parity, or country. Methods of coping with pain in MA and menstruation are similar in each respective country context, and use of analgesics was relatively uncommon. The majority of respondents reported that counseling about pain management before the abortion and support during the abortion process helped ease their pain and emotional stress.ConclusionsPain management during MA is increasingly essential to ensuring quality abortion care in light of the growing proportion of abortions completed with medication around the world. Incorporating a discussion about pain expectations and pain management strategies into pre-MA counseling and providing access to information and support during the MA process could improve the quality of care and experiences of MA patients.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000017729, registered January 8, 2013.

Future health providers’ willingness to provide abortion services following decriminalisation of abortion in Chile: a cross-sectional survey

ObjectiveTo assess Chilean medical and midwifery students’ attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017.DesignWe fielded a cross-sectional, web-based survey of...

Viewing ultrasound images in the abortion clinic: clients’ and health care professionals’ opinions

Objectives: The U.K guidance recommends that health care professionals (HCPs) offer clients the opportunity to view their pre-abortion ultrasound scan. As the U.K research on this topic is limited, our objectives were to assess current practice and local population needs, through a prospective, observational survey, to improve the quality of abortion care delivery. Methods: Over a 4 month period all clients attending the Sandyford Termination of Pregnancy and Referral (TOPAR) unit for abortion assessment were asked to fill in an anonymous questionnaire. A further questionnaire was distributed to HCPs working in the TOPAR unit. Results: A total of 406 questionnaires were analysed. Almost half (n = 194; 47.8%) of respondents had been offered the opportunity to view their ultrasound scan, of whom 31.4% (61/194) had accepted. The majority of those who had accepted (n = 48; 78.7%) concluded that they were more likely to proceed with the abortion or that viewing the scan had made no difference to their decision to proceed. All HCPs (n = 18; 100%) completed the questionnaire, 55.6% (n = 10) of whom responded that they routinely offered viewing. Ultrasound was not routinely offered by 25% (n = 3) and 83.3% (n = 5) of medical and nursing staff, respectively. Conclusions: We found inconsistent practice within our unit. Despite HCPs building rapport with clients prior to the ultrasound, not all clients who wished to have the opportunity to view their scan were identified. It is evident that many clients wish to have the option to choose for themselves whether they want to view their ultrasound scan, rather than be judged by an HCP as someone who might benefit from it.

Evaluating the impact of a quality management intervention on post-abortion contraceptive uptake in private sector clinics in western Kenya: a pre- and post-intervention study

BackgroundIntegration of family planning counselling and method provision into safe abortion services is a key component of quality abortion care. Numerous barriers to post-abortion family planning (PAFP) uptake exist. This study aimed to evaluate the effect of a quality management intervention for providers on PAFP uptake.MethodsWe conducted a pre- and post-intervention study between November 2015 and July 2016 in nine private clinics in Western Kenya. We collected baseline and post-intervention data using in-person interviews on the day of procedure, and follow-up telephone interviews to measure contraceptive uptake in the 2 weeks following abortion. We also conducted semi-structured interviews with providers. The intervention comprised a 1-day orientation, a counselling job-aide, and enhanced supervision visits. The primary outcome was the proportion of clients receiving any method of PAFP (excluding condoms) within 14 days of obtaining an abortion. Secondary outcomes were the proportion of clients receiving PAFP counselling, and the proportion of clients receiving long-acting reversible contraception (LARC) within 14 days of the service. We used chi-squared tests and multivariate logistic regression to determine whether there were significant differences between baseline and post-intervention, adjusting for potential confounding factors and clustering at the clinic level.ResultsInterviews were completed with 769 women, and 54% (414 women) completed a follow-up telephone interview. Reported quality of counselling and satisfaction with services increased between baseline and post-intervention. Same-day uptake of PAFP was higher at post-intervention compared to baseline (aOR 1.94, p < 0.001), as was same-day uptake of LARC (aOR 1.72, p < 0.001). There was no overall increase in uptake of PAFP 2 weeks following abortion. Providers reported mixed opinions about the effectiveness of the intervention but most reported that the supervision visits helped them improve the quality of their services.ConclusionsA quality management intervention was successful in improving the quality of PAFP counselling and provision. Uptake of same-day PAFP, including LARC, increased, but there was no increase in overall uptake of PAFP 2 weeks after the abortion.

\u2018I felt the world crash down on me\u2019: Women\u2019s experiences being denied legal abortion in Colombia

BackgroundIn 2006, Colombia’s constitutional court overturned a complete ban on abortion, liberalizing the procedure. Despite a relatively liberal new law, women still struggle to access safe and legal abortion services. We aimed to understand why women are denied services in Colombia, and what factors determine if and how they ultimately terminate pregnancies.MethodsWe recruited women denied abortion at a private facility in Bogota. Twenty-one participants completed an initial interview and eight completed a second longer interview. Two researchers documented themes and developed and applied a codebook to transcripts using ATLAS.ti.ResultsParticipants faced barriers, such as lack of knowledge of service availability and delayed pregnancy recognition, leading to denial. Five out of eight participants ultimately received abortions in public hospitals, due to support from partners and a robust referral system; nevertheless, they received poor care. Those who continued pregnancies endured stigmatizing events and inaccurate medical counselling at referral facilities. Several women contemplated illegal abortion though were afraid to attempt it.ConclusionWe propose the following recommendations: 1) increase awareness about availability and legality of abortion services to prevent delay and consequent denial; 2) provide counseling and referral upon denial; and 3) train providers in interpersonal quality abortion care.

Perspectives on a Quality Abortion Care Experience: A Patient Centered Approach [9F

INTRODUCTION: A third of US women have an abortion—often a painful and emotional experience—during their reproductive years. Few studies have examined patients’ experience in abortion care, resulting in limited evidence to guide clinicians on aspects of abortion care most important to women. Similarly, providers’ perceptions of the patient experience have not been studied. Our study objective was to better understand women’s and providers’ perspectives on a high quality abortion experience to inform patient-centered abortion care. METHODS: We conducted semi-structured interviews with 10 abortion providers at the University of New Mexico Center for Reproductive Health, and 25 women seeking first-trimester surgical abortion. Participants underwent a pre-procedure in-person interview as well as a post-procedure phone interview. New participant interviews were performed until thematic saturation was achieved. Interviews were transcribed and coded using Dedoose.™ RESULTS: Women and providers value similar aspects of abortion care. When evaluating perspectives, an inverse hierarchy of priorities was observed. Providers consistently cited health metrics such as safety, procedure length, and pain control as primary determinants of providing quality abortion care. In contrast, patients desired empathy, a genuine connection with their abortion provider and clinic staff, as well as feeling heard and understood in a non-judgmental environment. CONCLUSION: Women and providers valued somewhat different but complementary aspects of abortion care. The global clinical care, including all clinic personnel’s attention to women’s psychosocial needs, is integral to high quality abortion care.

'This Is Real Misery': Experiences of Women Denied Legal Abortion in Tunisia.

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff.

The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post-Abortion Hemorrhage.

Maternal mortality attributable to post-abortion hemorrhage is often associated with delays in reaching or receiving definitive care. The nonpneumatic antishock garment (NASG), a low-technology first-aid device, has been shown to decrease blood loss and mortality among women experiencing hypovolemic shock secondary to obstetric hemorrhage etiologies. Women experiencing post-abortion hemorrhage face longer delays in receiving definitive treatment as a result of abortion-related stigma and lack of access to quality abortion care; thus the NASG has the potential to make an even greater impact within this population. We conducted a secondary analysis of data collected in Egypt, Nigeria, Zambia, and Zimbabwe in NASG trials, limiting our analytic sample to women who experienced post-abortion hemorrhage (n = 953). Blood loss significantly decreased when the NASG was added to standard hemorrhage management during the intervention phase, and there was a large, although not statistically significant, 52 percent decrease in mortality during the NASG phase. The results indicate that adding the NASG to post-abortion care among women experiencing severe hemorrhage and hypovolemic shock would decrease blood loss and mortality.

How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress

Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress.Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale.Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation.Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.Chinese 摘要：目的：了解健康女性和精神紧张女性对流产服务质量的不足的认知。方法：这是一项由瑞典6个妇产科参加的多中心队列研究。创伤后应激(PTSD/PTSS)由创伤后应激障碍筛查问卷来评价。焦虑和抑郁症状，用医院焦虑和抑郁量表来评价。对流产服务质量的认知用修改版的从病人角度的质量问卷来评价。流产过程中疼痛用视觉模拟评分法来评价。结果：所有受试者中，16%的人认为流产服务有缺陷，药物流产过程中，22%的人疼痛剧烈。和健康女性不同，有创伤后应激障碍（PTSD/PTSS）的女性认为流产服务整体不足，健康女性则认为在某些方面存在不足，如获得支持、得到尊重、有独处和休息的机会、过程中得到重要的人的支持的可能性等方面。在有效镇痛的不足上，PTSD/PTSS组和对照组的看法有轻微差异。结论：有创伤后应激障碍（PTSD/PTSS）女性比健康女性更经常认为流产服务有缺陷，这些女性需要额外的支持，需要相对简单的措施来提供足够的镇痛，流产过程中的支持和私密能促进流产服务。

P774 Improving quality of abortion care in Republic of Moldova applying WHO strategic approach to strengthening reproductive health policies and programmes

P774 Improving quality of abortion care in Republic of Moldova applying WHO strategic approach to strengthening reproductive health policies and programmes

Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam

Vietnam has one of the highest abortion rates in the world and adolescent abortions are thought to constitute at least one-third of all cases. Lack of balanced reproductive health information and services to adolescents and negative social attitudes towards adolescent sexuality are contributing factors to the high abortion rates. Health providers are important in guiding and counselling adolescents on how to protect their reproductive health. There is a lack of studies on health providers' perspectives on their work in adolescent reproductive health care. To explore the perspectives of midwives and doctors on adolescent sexuality and abortion, and what they considered to be quality abortion care for adolescents and the barriers to it, as well as to their own training needs. Observations of care in abortion clinics and focus-group discussions (FGD) were used to collect data. Doctors and midwives from three healthcare facilities in Quang Ninh province in Northern Vietnam participated in a total of eight FGDs. Data were analysed using latent content analysis. Major barriers identified for quality abortion care were of technical and managerial nature. Participants considered that counselling unmarried clients in connection with abortion should focus on warning against the risks and dangers of abortion and pre-marital sexual relations, which they strongly disapproved of. However, they also expressed a pragmatic and caring attitude towards the unmarried girls and couples coming for abortion. Adolescent sexuality and abortion are morally sensitive issues in the Vietnamese culture. The contradictions between cultural norms and the reality facing health providers while counselling unmarried adolescents need to be addressed in education and training programmes.

Using Human Rights Principles to Promote Quality of Abortion Care in Brazil

IT is estimated that almost 1.5 million abortions occur annually in Brazil with almost 30% of pregnancies ending in abortion. The practice of abortion in Brazil is a clear demonstration of social inequality; historically under-privileged women have had no access to expensive private clinics and suffered more complications due to unsafe abortion. Unsafe abortion represents the fourth largest cause of maternal mortality in Brazil and is highest in the northeast region where poverty is high. Although abortion is legal on two grounds when there is no other way to save the womans life and when pregnancy is a result of rape until very recently legal abortions were not being provided. (excerpt)

Breaking the cycle of unsafe abortion in Africa.

Globally, nearly half of all maternal deaths from unsafe abortion occur in Africa. Abortion-related deaths and injuries are especially tragic, because when properly performed, abortion is one of the safest of all medical procedures. Factors contributing to this neglected public health crisis include inadequate health care resources and infrastructure, restrictive laws and policies, stigma, and women's lack of empowerment. Actions needed include making high quality abortion care more available and accessible, especially at the primary care level and to the full extent permitted by law. Others include removing medically unnecessary policy and legal restrictions on abortion; and better informing health care professionals, women and communities about the impact of unsafe abortion and the circumstances under which abortion can be legally obtained.

Quality of care in abortion services in Finland

The aim of this study was to describe the quality of abortion services and women's experiences with the care they had received during their abortion. A population-based postal survey of 3000 randomly selected 18-44-year old Finnish women in 1994. The response rate was 74% (n=2189). The following were used as indicators of quality of services: referral problems, loss of follow up, adequacy of counseling, and satisfaction with treatment. Fifteen percent (n=320) of the respondents had experienced at least one abortion. After adjusting for age, women who had an abortion were more likely to come from the lower social class, to be divorced, widowed, or in a nonmarital relationship, and to have had previous pregnancies. Fifty-two percent reported not using any contraceptive method when getting pregnant. Altogether 6% reported referral problems and 8% did not have post-abortion follow-up. Twenty-five percent would have preferred more discussion with a physician or a nurse before the abortion and 30% after it. Psychological effects of abortion was the most often mentioned subject upon which they needed discussion. The need for discussion was not influenced by the length of time lapsed since the abortion. The satisfaction with treatment increased from 69% (abortion >10 years ago) to 82% (abortion <5 years ago). Dissatisfaction was related to need for more discussion and the abortion having been performed in a central hospital. The overall quality of abortion care was good but there is still a need for improvement, especially in the communication and human part of the care.

Technology Introduction and Quality of Abortion Care

ABSTRACT Unsafe abortion is a significant cause of mortality and morbidity throughout the world, especially in developing countries. Improving women's access to safe, high-quality abortion care is a growing concern in developed and developing country settings. A framework for quality of care is provided as a management tool for guiding responsible introduction of abortion care technologies.