Quality of Post-Abortion Care in Nigeria

Abstract

Women in Nigeria face a high rate of unwanted pregnancies, with more than half of these resulting in induced abortions, which are often unsafe. About 40% of women who resort to abortion experience complications that are serious enough to warrant medical treatment and hospital admission. Often there is limited evidence on the preparedness of public health facilities to provide post-abortion care (PAC) services as well as on patients’ experiences while seeking PAC services. A cross-sectional survey was conducted in 227 public health facilities across seven states in Nigeria using health facility assessment questionnaires to assess the preparedness of facilities to provide basic and comprehensive PAC services. In addition, a total of 1,247 exit interviews with PAC patients were conducted to document their experiences on the quality of PAC services. Using semi-structured interview guides, an additional one hundred and thirty-seven in-depth interviews (IDI) with PAC service providers, women treated for post abortion complications and policy makers were conducted to explore their views, experiences and perceptions on the quality of PAC services provided at public health facilities. The study findings revealed low levels of capacity among primary and referral level facilities to provide quality PAC services. Only 7.6% of the primary and 29.6% of referral-level facilities had the capacity to deliver a full package of basic and comprehensive PAC services respectively. At least half (53.3%) of the primary-level facilities could provide medical PAC (uterine evacuation) to first trimester pregnancies whereas only 14% of these facilities could offer surgical PAC procedures for first trimester pregnancies. This low capacity of primary-level facilities was mainly linked to the low number of PAC trained providers (only 19.6%), and lack of PAC equipment and supplies. Consequently, a large proportion of these facilities had to refer patients to higher level facilities even though majority of them had inadequate referral capabilities since barely 8.7% had fueled ambulances/vehicles. Moreover, not many secondarylevel facilities had medical and/ or surgical PAC capabilities. For instance, only 66.1% and 51.6% of the secondary-level facilities could provide medical and surgical PAC procedures respectively to second trimester pregnancies.