Measuring improvements in sexual and reproductive health and rights in sub-Saharan Africa

Abstract

Recent studies on development aid from European donors revealed that their funding of the health sector in sub-Saharan Africa rarely includes performance measures suitable for tracking operational progress in improving sexual and reproductive health and rights. Analysis of health sector agreements verifies this. Particularly lacking are metrics related to four critically important areas: 1) reducing mortality and morbidity from unsafe abortion, 2) preventing and treating gender-based violence, 3) reducing unwanted pregnancies among the poorest women, and 4) reducing unwanted pregnancies among adolescents. During 2011 and the first half of 2012, the authors interviewed 85 experts in health service delivery, ministries of health, human rights, development economics and social science from sub-Saharan Africa, Europe and the United States. We asked them to identify measures to assess progress in these areas, and built on their responses to propose up to four practical performance measures for each of the areas, for inclusion in health sector support agreements. These measures are meant to supplement, not replace, current population-based measures such as changes in maternal mortality ratios. The feasibility of using these performance measures requires political commitment from donors and governments, investment in baseline data, and expanding the role of sexual and reproductive health and rights civil society in determining priorities.

Abortion metrics: a scoping review of abortion measures and indicators

“…Our list also includes examples of country level indicators that can measure the performance of health sector programmes in ensuring sexual and reproductive health, including for abortion services. 11 We have conducted this review as the first step in a multi-stage process for deriving a set of standardised indicators which can be used across reproductive health programmes in diverse settings.…”

“…These results also aim to inform a future research agenda on abortion indicators measurement. While our list of indicators is extensive, there remains a need in some areas to develop or test new indicators: for example, to broaden the type of health outcome indicators for abortion to quality of life and functioning; to respond to the challenge of collecting valid data in the community as the provision of abortion care is shifting to community-based distribution of medical abortion; to standardise indicators, in particular those that are morbidity related 29 ; to measure performance of the health sector 11 and to align with other initiatives on effective coverage 30 and health system strengthening monitoring. 31 Comprehensive measurement of patient-centred indicators, such as women's experience of care is also required.…”

“…While there have been efforts to refine and standardise the methodology around capturing the incidence of abortion, 8 9 and measuring access to, delivery of, and quality of abortion care, 10 consensus on the most appropriate measures or indicators is lacking and there are gaps in 'practical' implementation metrics. 11 For example, different sets of abortion indicators are used or have been proposed by international non-governmental organisations (NGOs), and other international actors such as MEASURE Evaluation. As part of its coordinating role in establishing standards, the WHO published a technical document on national-level monitoring for achievement of universal access to reproductive health, proposing related indicators of safe abortion care that countries are encouraged to report within the context of monitoring national reproductive and maternal health programmes.…”

Sexual and Reproductive Health Knowledge of In-school Adolescents: A Comparative Study of Visually Impaired and Non-visually Impaired Students

“…This aspect is of focus in that it is particularly important to adolescent health [7], [8]. It is indispensable to their growth and the impact of such knowledge will greatly influence their lives as they proceed into adulthood [9]- [11].…”

Developing and validating an abortion care quality metric for facility and out-of-facility settings: an observational cohort study in Bangladesh, Ethiopia, and Nigeria

“…Existing indicators for abortion care quality are poorly defined, inconsistently used, incomplete, and no consensus has been formed around their relevance within quality frameworks. 3 , 4 , 5 Furthermore, existing measures do not fully address client-centred elements of quality and are not applicable to increasingly common out-of-facility administration of medication abortion (MA). A 2017 systematic review by Dennis, Blanchard and Bessenaar found 75 unique indicators used to measure abortion care quality with varying application.…”