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)

Health Services Insights, Volume 15, Year 2022

Interpretation

SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d’Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care. Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d’Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities’ capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d’Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries. We conducted a secondary data analysis of EmONC surveys data from Burkina Faso, Cote d’Ivoire, and Guinea. These SSA countries were chosen based on the criteria of a recent EmONC survey conducted, Burkina Faso in 2016, 18 Côte d’Ivoire, 19 and Guinea in 2017. 20 We received authorization from respective countries’ Ministries of Health to use the data. Like many other African countries, the health system in all 3 countries is pyramidal in type, with an administrative side and a care delivery side. Public health facilities are organized into 3 levels that provide primary, secondary, and tertiary care. The first level of care in Burkina Faso consists of 2 sublevels, with primary health facilities that can refer to district hospitals. The private health sector, essentially present in large cities or economic centers, fits into the different levels of the health pyramid. Sociodemographic and maternal health indicators are summarized in Table 1 for the 3 countries: mortality rates are very high for the 3 countries, with high fertility rates and low use of contraceptives. Abortion in the 3 countries is highly restricted and permitted only when the mother’s life is at risk or in cases of rape or incest. In Burkina Faso, safe abortion is also allowed in cases of severe fetal malformation. Reproductive health indicators in the 3 countries. Source: Burkina Faso (National general population and housing census 2009 21 ), Demographic and Health Survey (Burkina Faso 2015 22 ); Cote d’Ivoire (National general population and housing census 2014, 23 Multiple Indicator Cluster Survey 2016 24 ) and Guinea (National general population and housing census 2014, 25 Multiple Indicator Cluster Survey 2018 26 ). EmONC assessments were performed in all health facilities that provided deliveries. The evaluation used modified tools based on the Columbia University Averting Maternal Death and Disability (AMDD) Program Needs Assessment Toolkit to document the availability of infrastructure, equipment, drugs, supplies, and human resources for all EmONC services and service delivery, including PAC. 27 The questionnaire used for data collection was standardized and validated at a regional workshop in Abuja in 2016 and at each country level. For population coverage by PAC services, we considered the data sources for the population used in each country, available on the respective EmONC databases and reports.18 -20 Data on subnational regions correspond to regional health divisions in force in each country at the time of data collection of the EmONC survey.

AI Digest

Study Justification:

– The study aimed to evaluate the availability and utilization of postabortion care (PAC) services in Burkina Faso, Côte d’Ivoire, and Guinea.
– Unsafe abortion is a leading cause of maternal mortality in sub-Saharan Africa, and access to quality PAC services is limited.
– The study aimed to identify disparities in PAC services within and between the three countries and highlight the need for improvement.

Highlights:

– The study conducted a secondary data analysis of Emergency Obstetric and Neonatal Care (EmONC) surveys conducted in the three countries between 2016 and 2017.
– The study assessed the capacity of facilities to provide basic and comprehensive PAC services.
– Basic PAC capacity at the primary level was low, ranging from 16.2% in Burkina Faso to 36% in Côte d’Ivoire.
– About 82.0% of hospitals could provide comprehensive PAC.
– There were disparities in the geographical distribution of PAC services at both national and subnational levels.
– Abortion complications represented 16.2% of all obstetric emergencies.
– The uptake of PAC modern contraceptives was low (37.1%) in all countries.

Recommendations:

– Improve access to PAC services at the primary level of care in Burkina Faso, Côte d’Ivoire, and Guinea.
– Promote the adoption of family planning when providing postabortion care.
– Address disparities in the geographical distribution of PAC services.
– Increase the uptake of PAC modern contraceptives.

Key Role Players:

– Ministries of Health in Burkina Faso, Côte d’Ivoire, and Guinea.
– Health facility administrators and staff.
– Public and private health sector representatives.
– Non-governmental organizations (NGOs) working in reproductive health.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers.
– Infrastructure improvements in primary healthcare facilities.
– Procurement of equipment, drugs, and supplies for PAC services.
– Outreach and awareness campaigns to promote PAC and family planning.
– Monitoring and evaluation activities to assess the impact of interventions.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a secondary data analysis using recent EmONC surveys in Burkina Faso, Côte d’Ivoire, and Guinea. The study assessed the quantity, distribution, and utilization of postabortion care (PAC) services in these countries. The study used the PAC signal functions approach to evaluate facilities’ capacity to provide basic and comprehensive PAC. The study also highlighted disparities in the availability and utilization of PAC services at both national and subnational levels. However, the abstract does not provide specific details about the methodology used in the secondary data analysis or the sample size. To improve the strength of the evidence, the abstract should include more information about the methodology, such as the inclusion criteria for selecting the EmONC surveys and the sample size of the analysis. Additionally, providing more specific findings and statistical measures, such as confidence intervals or p-values, would further enhance the evidence.

Abstract

We conducted a secondary data analysis of EmONC surveys data from Burkina Faso, Cote d’Ivoire, and Guinea. These SSA countries were chosen based on the criteria of a recent EmONC survey conducted, Burkina Faso in 2016, 18 Côte d’Ivoire, 19 and Guinea in 2017. 20 We received authorization from respective countries’ Ministries of Health to use the data. Like many other African countries, the health system in all 3 countries is pyramidal in type, with an administrative side and a care delivery side. Public health facilities are organized into 3 levels that provide primary, secondary, and tertiary care. The first level of care in Burkina Faso consists of 2 sublevels, with primary health facilities that can refer to district hospitals. The private health sector, essentially present in large cities or economic centers, fits into the different levels of the health pyramid. Sociodemographic and maternal health indicators are summarized in Table 1 for the 3 countries: mortality rates are very high for the 3 countries, with high fertility rates and low use of contraceptives. Abortion in the 3 countries is highly restricted and permitted only when the mother’s life is at risk or in cases of rape or incest. In Burkina Faso, safe abortion is also allowed in cases of severe fetal malformation. Reproductive health indicators in the 3 countries. Source: Burkina Faso (National general population and housing census 2009 21 ), Demographic and Health Survey (Burkina Faso 2015 22 ); Cote d’Ivoire (National general population and housing census 2014, 23 Multiple Indicator Cluster Survey 2016 24 ) and Guinea (National general population and housing census 2014, 25 Multiple Indicator Cluster Survey 2018 26 ). EmONC assessments were performed in all health facilities that provided deliveries. The evaluation used modified tools based on the Columbia University Averting Maternal Death and Disability (AMDD) Program Needs Assessment Toolkit to document the availability of infrastructure, equipment, drugs, supplies, and human resources for all EmONC services and service delivery, including PAC. 27 The questionnaire used for data collection was standardized and validated at a regional workshop in Abuja in 2016 and at each country level. For population coverage by PAC services, we considered the data sources for the population used in each country, available on the respective EmONC databases and reports.18 -20 Data on subnational regions correspond to regional health divisions in force in each country at the time of data collection of the EmONC survey.

Materials

https://efashare.b-cdn.net/materials/43c27fc1251041c646c4606908f324c8a96e3c16e7dbf3a7ff73402fd9e588a5/sj-docx-1-his-10.1177_11786329221092625.docx

Innovations

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services could help improve access to postabortion care services in remote areas. This would allow healthcare providers to remotely assess and provide guidance to patients, reducing the need for them to travel long distances to access care.

2. Mobile clinics: Setting up mobile clinics that specifically focus on providing postabortion care services could help reach underserved populations. These clinics could travel to different regions, providing essential care and family planning services to women in need.

3. Community health workers: Training and deploying community health workers who are knowledgeable about postabortion care services could help bridge the gap in access. These workers could provide education, counseling, and basic care to women in their communities, ensuring they receive the necessary support.

4. Task-shifting: Expanding the roles of midwives and nurses to include the provision of postabortion care services could help alleviate the burden on doctors and increase access to care. This could involve training and empowering these healthcare professionals to perform certain procedures and provide comprehensive care.

5. Integration of services: Integrating postabortion care services with existing maternal health programs and facilities could help improve access. By ensuring that postabortion care is readily available in maternity wards and clinics, women can receive the care they need without having to seek separate services.

6. Strengthening referral systems: Developing and strengthening referral systems between primary, secondary, and tertiary care facilities can ensure that women who require higher levels of care are able to access it in a timely manner. This would involve improving communication and coordination between different healthcare facilities.

7. Increasing awareness and education: Implementing comprehensive awareness and education campaigns about postabortion care services and family planning could help reduce stigma and increase utilization. This could involve community outreach programs, media campaigns, and targeted education in schools and healthcare facilities.

These are just a few potential innovations that could be considered to improve access to maternal health. It’s important to assess the specific needs and context of each country to determine the most appropriate strategies for implementation.

AI Innovations Description

Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthen Primary Level Postabortion Care (PAC) Services: Focus on improving access to PAC at the primary level of care in Burkina Faso, Cote d’Ivoire, and Guinea. This can be achieved by enhancing the capacity of primary health facilities to provide basic PAC services, including the necessary infrastructure, equipment, drugs, supplies, and trained healthcare professionals.

2. Adoption of Family Planning in Postabortion Care: Promote the adoption of family planning methods as part of postabortion care services. This can help prevent unintended pregnancies and reduce the risk of unsafe abortions, ultimately contributing to a decrease in maternal mortality rates.

3. Address Disparities in Geographic Distribution: Address the disparities in the geographical distribution of PAC services at both national and subnational levels. This can be done by ensuring equitable access to PAC services across different regions, especially in underserved areas.

4. Increase Awareness and Utilization of PAC Services: Implement targeted awareness campaigns to increase knowledge and utilization of PAC services among women. This can involve community outreach programs, educational initiatives, and partnerships with local organizations to raise awareness about the importance of seeking timely and quality PAC services.

5. Strengthen Health System Capacity: Enhance the overall capacity of the health system in Burkina Faso, Cote d’Ivoire, and Guinea to provide comprehensive maternal health services, including PAC. This may involve improving infrastructure, increasing the availability of essential drugs and supplies, and ensuring an adequate number of skilled healthcare professionals.

By implementing these recommendations, it is expected that access to maternal health, specifically postabortion care, will be improved, leading to a reduction in maternal mortality rates and better overall maternal health outcomes in Burkina Faso, Cote d’Ivoire, and Guinea.

AI Innovations Methodology

To improve access to maternal health in Burkina Faso, Côte d’Ivoire, and Guinea, the following recommendations can be considered:

1. Strengthen Primary Level Care: Focus on improving access to postabortion care (PAC) services at the primary level of care. This can be achieved by enhancing the capacity of primary health facilities to provide basic PAC services, including the availability of infrastructure, equipment, drugs, supplies, and trained healthcare professionals.

2. Adoption of Family Planning: Promote the adoption of family planning methods as part of postabortion care services. This can help prevent unintended pregnancies and reduce the need for unsafe abortions, ultimately reducing maternal mortality rates.

3. Improve Geographic Distribution: Address disparities in the geographical distribution of PAC services at both national and subnational levels. Ensure that PAC services are accessible to women in rural and remote areas by establishing more healthcare facilities or mobile clinics in these areas.

4. Increase Comprehensive PAC Capacity: Enhance the capacity of referral-level healthcare facilities to provide comprehensive PAC services. This includes ensuring that hospitals have the necessary resources and trained staff to handle complicated abortion cases and provide appropriate care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Data Collection: Collect data on the current availability and utilization of PAC services in the selected countries. This can be done through surveys, interviews, and analysis of existing health facility records.

2. Modeling Population Coverage: Use the World Health Organization (WHO) benchmark to estimate the population coverage of PAC services based on the data collected. This will help identify gaps in access and areas that require improvement.

3. Impact Assessment: Simulate the impact of the recommendations by comparing the current situation with the projected scenario after implementing the proposed interventions. This can be done using statistical modeling techniques and considering factors such as population size, healthcare infrastructure, and resource allocation.

4. Evaluation and Monitoring: Continuously evaluate and monitor the implementation of the recommendations to assess their effectiveness in improving access to maternal health. This can involve tracking key indicators such as maternal mortality rates, utilization of PAC services, and contraceptive uptake.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health services in Burkina Faso, Côte d’Ivoire, and Guinea.

Author

Dima Health

Identifiers:

DOI: 10.1177/11786329221092625

Research Areas:

Disability, Disparities, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Violence and Injury

Study Countries:

Burkina Faso, Guinea, Multi-Countries

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative