Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services

Abstract

Little evidence exists on women’s experiences of care during abortion care, partly due to limitations in existing measures. Moreover, globally, the development and rapid growth in the availability of medication abortions (MA) has radically changed the options for safe abortions for women. It is therefore important to understand how women’s experiences of care may differ across medication and manual vacuum aspiration (MVA) abortions. This study uses a validated person-centered abortion care scale (categorized as low, medium, and high levels, with high levels representing the greatest level of person-centered care) to assess women’s experiences of care undergoing medication abortions vs. MVA. This paper reports on a cross-sectional study of 353 women undergoing abortions at one of six family planning clinics in Nairobi County, Kenya in 2018. Comparing abortion types, we found that the MVA sample was more likely to report “high” levels of person-centered abortion care compared to the MA sample (36.3% vs. 23.0%, p = 0.005). No differences were detected with respect to Respectful and Supportive Care; however, the MVA sample was significantly more likely to report “high” levels of Communication and Autonomy compared to the MA sample (23.6% vs. 11.2%, p<0.0001). In multivariable ordered logistic regression, we found that the MVA sample had a 92% greater likelihood of reporting higher person-centered abortion care scores compared to MA clients (aOR1.92, CI: 1.17–3.17). Being employed and reporting higher self-rated health were associated with higher person-centered abortion care scores, while reporting higher levels of stigma were associated with lower person-centered abortion care scores. Our findings suggest that more efforts are needed to improve the domain of Communication and Autonomy, particularly for MA clients.

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

“… 12 Globally, there is growing interest in measuring person-centred reproductive healthcare including abortion care, contraception and maternity care. 38 45–47 While the evidence around measuring women’s experiences seeking abortion-related care, in particular, is limited, research efforts are increasing to support the development of measurement tools. 38 …”

“… 38 45–47 While the evidence around measuring women’s experiences seeking abortion-related care, in particular, is limited, research efforts are increasing to support the development of measurement tools. 38 …”

“…The management of abortion-related complications using safe and low-cost technologies, such as MVA, which is the recommended method of uterine evacuation regardless of severity, 3 is on the rise across countries in our study; however, the use of non-recommended and unsafe methods such as D&C still persists. This may be due to lack of resources (eg, equipment and supplies) 38 and/or training, which might lead providers to use BMJ Global Health outdated methods like D&C. 10 12 39 Furthermore, half of our cases received oxytocin as the most common method of uterotonics, rather than misoprostol, which is recommended to manage abortion-related complications. 6 40 The less frequent use of misoprostol may be due to lack of availability, familiarity, training and guidelines as well as providers' perceptions on misoprostol being a less effective and safe method of postabortion care.…”

Validation of a Spanish-Language Scale for Evaluating Perceived Quality of Care of Medical Abortions Before 9 Weeks Gestation

“…Prior to this study, the effectiveness of the MA process had already been demonstrated and supported by protocols [5], but no data had been collected on quality as perceived by patients. In 2019, the rst article on a validated, person-centered abortion care scale was published in Kenya [22]. The lack of data on the quality of abortion care may be due to the highly stigmatized status of the procedure.…”

Perspectives on Interpersonal Care Among People Who Obtain Abortions Through Clinical and Accompaniment Models in Argentina

“…Studies addressing person-centered care in contraceptive and maternal health services have shown that women value interpersonal factors such as trust, empathy, respect, support, con dentiality and nonjudgmental care from providers [7][8][9][10] and that these shape perceptions of quality and future care seeking behavior [11][12][13] . There is more recent evidence emerging within the context of abortion demonstrating how client experiences of quality are positively impacted by person-centeredness 14 , such as receiving comprehensive counseling, non-judgmental care and supportive care, as well as feelings of autonomy and choice [15][16][17] . Though limited in number, studies from Latin America focusing on patient perspectives of abortion quality have found that client-provider interactions and information provision were identi ed as some of the most salient aspects of patients' experiences 18,19 .…”