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

Abstract

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

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)

“…This is in line with the results of most studies in SSA. 11,14,29,34,35 This study presents some limitations. Using data from EmONC surveys that are limited to health facilities that offer delivery services, we were confronted with some limits already described by studies that have used a similar approach 10,11,14,17 : hospitals that provide postabortion care do not offer delivery services.…”

“…The same findings were reported in other SSA countries (Kenya (15%) in 2010 and Tanzania (28%) in 2014-15 in East Africa 10 and Zimbabwe (21%) in 2016 11 ) and in other low- and middle-income countries. 29 These findings may be due to the fact that, in general, postabortion care, although a component of basic EmONC, is usually only offered at a referral level of care, despite the fact that primary care health centers are considered the entry point and the most accessible facilities in health systems, especially in rural areas.…”

Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review

“…Restrictions are present in access to pregnancy termination and a wide range of contraceptives. [33][34][35][36][37] Furthermore, these countries show a trend toward the privatization of health services, a punitive culture toward the free exercise of sexuality, and the criminalization of sex work. [38][39][40][41][42][43] In some instances, the countries that temporarily host migrants or refugees are neighboring states to those in conflict and are susceptible to forced migration implications (e.g., Ghana, Lebanon, and Pakistan).…”