The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment

Abstract

Of the approximately 2,000 postabortion care (PAC) clients treated over 6 months in 2016, 55% chose a contraceptive method before discharge. Gaps in PAC availability and quality spanned multiple domains including human resource capacity and availability of supplies and contraceptives. While PAC providers generally expressed commitment to providing high-quality care, several facility and systems factors constrained their efforts, including limited training and facility space, lack of time, and supply chain challenges.

The role of nurses and midwives in the provision of abortion care: A scoping review

“…The routine nursing and midwifery tasks described in the articles were pregnancy diagnosis and options counselling (Levi et al, 2009), pharmacological and nonpharmacological pain relief (Lindström, Wulff, Dahlgren, & Lalos, 2011), administration of anti‐D, and antibiotic prophylaxis (Cappiello, Beal, & Simmonds, 2011), handling the products of conception (Andersson, Gemzell‐Danielsson, & Christensson, 2014; Mauri, Ceriotti, Soldi, & Guerrini Contini, 2015; Michalik et al, 2019; Mizuno, 2011; Nicholson, Slade, & Fletcher, 2010), gestational dating, bimanual examination (Averbach, Puri, Blum, & Rocca, 2018) screening for domestic violence, postabortion contraception care (Purcell, Cameron, Lawton, Glasier, & Harden, 2016), referrals (Grace, 2016), health education (Cappiello et al, 2011; Halldén, Lundgren, & Christensson, 2011), counselling (Hulme‐Chambers et al, 2018), prescription of abortion drugs (Simmonds, Beal, & Eagen‐Torkko, 2017), administration of abortion drugs, manual vacuum aspiration abortions (MVA) (Berer, 2009; Bridgman‐Packer & Kidanemariam, 2018; Paul, Gemzell‐Danielsson, Kiggundu, Namugenyi, & Klingberg‐Allvin, 2014), postabortion phone counselling (Dawson, Bateson, Estoesta, & Sullivan, 2016), peer education (Puri, Regmi, Tamang, & Shrestha, 2014; Puri, Tamang, Shrestha, & Joshi, 2015), care of or referral for postabortion complications (Hulme‐Chambers et al, 2018; Yegon et al, 2019), screening and treatment of sexually transmitted infections and human immunovirus (Yegon et al, 2019) and management of postabortion complications (Cleeve et al, 2019; Paul et al, 2014; Yarnall et al, 2009; Yegon et al, 2019). These tasks were not ubiquitous.…”

“…Ugandan midwives had similar experiences and performed MVAs for postabortion care with or without specific training and in emergencies would perform dilatation and curettage, and manual removal of placentas (Paul et al, 2014). Tanzanian nurses and midwives reported that they performed postabortion care with inadequate training and supervision (Yegon et al, 2019). Twenty per cent of Ethiopian mid‐level healthcare workers reported training in safe abortion care despite the country having the fifth highest rate of maternal deaths in the world (Assefa, 2019).…”

Adding It Up: Investing in Sexual and Reproductive Health 2019

“…111 In many settings, women do not receive contraceptive counseling after an abortion, and reasons include lack of trained staff, heavy workloads among providers, stockouts of methods and providers' lack of knowledge about how long it takes for fertility to return. 93,99,116,117 need for and use of services for which we have age-specific data, either from country surveys or model-based estimates. For other estimates (e.g., the cost of services), the underlying data are not age-specific but are based on rates or costs pertaining to all women of reproductive age.…”

Postabortion Care and the Voluntary Family Planning Component: Expanding Contraceptive Choices and Service Options

“…The authors also document that misunderstanding and misconceptions about contraceptives remain a major stumbling block in providing the family planning component of PAC to clients; that training in counseling and values clarification is much needed; and that engaging men to support family planning for their partners is important and can be challenging 6 – 10 , 12 , 14 – 16 …”

“…This need was noted by providers, patients, and program managers 7 – 9 , 14 , 15 Establishing a contraceptive logistics system to ensure a full range of contraceptive options at every site providing PAC.Recognizing cost as a major barrier for many women and recommending that PAC services, especially a wide range of contraceptive options, be available for free or at minimal cost 6 , 7 , 9 , 10 , 12 , 15 , 16 Decentralizing PAC services to lower-level facilities and expanding the scope of practice for midlevel providers, especially nurses and midwives, to include PAC 6 , 8 , 9 , 11 , 13 – 15 …”