From the shadows to light. Perceptions of women and healthcare providers of post-abortion care in Burkina Faso

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Study Justification:
– Despite political commitments, women and girls in Burkina Faso still face obstacles in accessing post-abortion care (PAC) services.
– Stigma, high costs, and negative patient-provider relationships are identified as key impediments.
– This study aims to provide an in-depth examination of the experiences and perceptions of patients and healthcare providers regarding PAC in Burkina Faso.
Highlights:
– Three-year ethnographic study conducted in Ouagadougou, Burkina Faso (2011-2014).
– Extensive participant observation and in-depth interviews with healthcare providers and patients.
– Thematic analysis approach used to analyze data.
– Findings reveal patients and providers conceptualize PAC differently, with patients viewing it as a life-saving intervention and providers facing dilemmas in delivering care.
– Perceptions of PAC drive decision-making and patient-provider interactions.
Recommendations:
– Interventions should focus on improving access and quality of PAC services.
– Addressing stigma, reducing costs, and improving patient-provider relationships are crucial.
– Training and support for healthcare providers in delivering PAC services should be provided.
– Strategies to mitigate discomfort and dilemmas faced by providers in delivering care should be developed.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Healthcare Providers: Involved in delivering PAC services.
– Women’s Rights Organizations: Advocate for improved access and quality of PAC services.
– Community Leaders: Play a role in reducing stigma and promoting awareness.
– Researchers and Academics: Provide evidence-based recommendations for policy and practice.
Cost Items for Planning Recommendations:
– Training and Capacity Building for Healthcare Providers: Includes workshops, seminars, and skill-building programs.
– Awareness and Education Campaigns: Costs associated with developing and disseminating information materials.
– Infrastructure and Equipment: Upgrading health facilities and providing necessary medical equipment.
– Support Services: Funding for counseling services and support groups for patients.
– Monitoring and Evaluation: Costs for assessing the impact and effectiveness of interventions.

Despite political commitments to address maternal deaths due to abortion, women and girls in Burkina Faso still face impediments to accessing post-abortion care (PAC) services, including stigma, high costs, and negative patient-provider relationships. Based on a three-year ethnographic study in Ouagadougou, Burkina Faso (2011–2014), this paper provides an in-depth examination of the experiences and perceptions of patients and healthcare providers when seeking or delivering PAC. Extensive participant observation of PAC service delivery was carried out in five primary and three referral health facilities, as well as in-depth interviews with 13 healthcare providers and 39 patients. Data were analyzed using a thematic analysis approach and discussed using relevant literature. Patients and providers conceptualized PAC as literally “womb washing’’, vividly reflecting on the realities around health risks of abortion, procreation and role of health providers. Moreover, women described PAC as a life-saving intervention capable of averting infections and other complications, but also bears significant risks of disclosure depending on the uterine evacuation technology used (manual vacuum aspiration versus medical abortion). In delivering PAC services, healthcare providers agonize over the dilemmas they face, mainly derived from their conceptualization of PAC services and how they cope with discomfort using PAC technology options. Our findings present the intersection between patients’ and providers’ conceptions of PAC, and how these perceptions drive the choice of technology for uterine evacuation to mitigate stigma. We argue that these perceptions drive patient and healthcare provider practices around decision making to seek or deliver care, and patient-provider interactions in health facilities. These findings offer important guidance for interventions seeking to improve access and quality of PAC.

Innovation 1: Stigma reduction
– Develop targeted awareness campaigns and educational programs to reduce the stigma associated with seeking post-abortion care (PAC) services.
– Create a more supportive environment for women and girls in Burkina Faso, encouraging them to access the care they need without fear of judgment or discrimination.

Innovation 2: Cost reduction
– Implement measures to reduce the financial burden of accessing PAC services.
– Subsidize or provide free PAC services.
– Create insurance schemes specifically for maternal health.
– Partner with NGOs and international organizations to secure funding for these services.

Innovation 3: Training and capacity building
– Provide comprehensive training and capacity building programs for healthcare providers on PAC services.
– Address their dilemmas and discomforts related to providing PAC.
– Ensure healthcare providers have the necessary skills and knowledge to deliver high-quality care.

Innovation 4: Technology options
– Offer a range of technology options for uterine evacuation during PAC.
– Provide information and counseling on the different methods available, their effectiveness, and potential risks and benefits.
– Take into consideration the preferences and concerns of both patients and healthcare providers.

Innovation 5: Patient-provider communication
– Improve patient-provider interactions by promoting open and non-judgmental communication.
– Train healthcare providers on effective communication skills.
– Encourage active listening and foster a patient-centered approach to care.

By implementing these innovations, access to post-abortion care services can be improved, stigma can be reduced, and the quality of care can be enhanced, ultimately leading to better maternal health outcomes in Burkina Faso.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the described study is to address the perceptions and experiences of patients and healthcare providers regarding post-abortion care (PAC) services. This can be achieved through the following steps:

1. Stigma reduction: Develop targeted awareness campaigns and educational programs to reduce the stigma associated with seeking PAC services. This can help create a more supportive environment for women and girls in Burkina Faso, encouraging them to access the care they need without fear of judgment or discrimination.

2. Cost reduction: Implement measures to reduce the financial burden of accessing PAC services. This could include subsidizing or providing free PAC services, creating insurance schemes specifically for maternal health, or partnering with NGOs and international organizations to secure funding for these services.

3. Training and capacity building: Provide comprehensive training and capacity building programs for healthcare providers on PAC services. This should include addressing their dilemmas and discomforts related to providing PAC, as well as ensuring they have the necessary skills and knowledge to deliver high-quality care.

4. Technology options: Offer a range of technology options for uterine evacuation during PAC, taking into consideration the preferences and concerns of both patients and healthcare providers. This could involve providing information and counseling on the different methods available, their effectiveness, and potential risks and benefits.

5. Patient-provider communication: Improve patient-provider interactions by promoting open and non-judgmental communication. This can be achieved through training healthcare providers on effective communication skills, encouraging active listening, and fostering a patient-centered approach to care.

By implementing these recommendations, it is expected that access to PAC services will be improved, stigma will be reduced, and the quality of care will be enhanced, ultimately leading to better maternal health outcomes in Burkina Faso.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach could be used. Here is a brief methodology:

1. Quantitative survey: Conduct a survey among women in Burkina Faso to assess their perceptions and experiences regarding post-abortion care (PAC) services. The survey should include questions related to stigma, cost, patient-provider communication, and technology options. The survey can be administered through face-to-face interviews or online platforms.

2. Qualitative interviews: Conduct in-depth interviews with healthcare providers in Burkina Faso to understand their perspectives on PAC services. Explore their perceptions of stigma, cost, training, and patient-provider communication. These interviews can provide insights into the challenges faced by healthcare providers and their willingness to adopt the recommended innovations.

3. Data analysis: Analyze the survey data and interview transcripts using qualitative and quantitative analysis techniques. Identify common themes and patterns related to access barriers and the impact of the recommended innovations. This analysis will help understand the current situation and potential areas for improvement.

4. Simulation modeling: Develop a simulation model to estimate the potential impact of the recommended innovations on improving access to maternal health. The model should consider factors such as the reduction in stigma, cost, improved patient-provider communication, and increased utilization of PAC services. Use available data and assumptions to estimate the potential increase in access to PAC services and the resulting improvements in maternal health outcomes.

5. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model. Vary key parameters such as the effectiveness of stigma reduction campaigns, the extent of cost reduction measures, and the level of training and capacity building for healthcare providers. This analysis will help understand the potential range of impacts and identify areas where additional efforts may be needed.

6. Policy recommendations: Based on the simulation results, develop policy recommendations for improving access to maternal health in Burkina Faso. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of implementing the recommended innovations. They should also address the specific needs and challenges faced by women and healthcare providers in Burkina Faso.

By following this methodology, researchers and policymakers can gain insights into the potential impact of the recommended innovations and make informed decisions to improve access to maternal health in Burkina Faso.

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