TY - JOUR
T1 - Postabortion care availability, facility readiness and accessibility in Nigeria and Côte d'Ivoire
AU - Bell, Suzanne O.
AU - Shankar, Mridula
AU - Ahmed, Saifuddin
AU - Olaolorun, Funmilola
AU - Omoluabi, Elizabeth
AU - Guiella, Georges
AU - Moreau, Caroline
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Postabortion care (PAC) is an essential component of emergency obstetric care (EmOC) and is necessary to prevent unsafe abortion-related maternal mortality, but we know little regarding the preparedness of facilities to provide PAC services, the distribution of these services and disparities in their accessibility in low-resource settings. To address this knowledge gap, this study aims to describe PAC service availability, evaluate PAC readiness and measure inequities in access to PAC services in seven states of Nigeria and nationally in Côte d'Ivoire. We used survey data from reproductive-age women and the health facilities that serve the areas where they live. We linked facility readiness information, including PAC-specific signal functions, to female data using geospatial information. Findings revealed less than half of facilities provide basic PAC services in Nigeria (48.4%) but greater PAC availability in Côte d'Ivoire (70.5%). Only 33.5% and 36.9% of facilities with the capacity to provide basic PAC and only 23.9% and 37.5% of facilities with the capacity to provide comprehensive PAC had all the corresponding signal functions in Nigeria and Côte d'Ivoire, respectively. With regard to access, while ∼8 out of 10 women of reproductive age in Nigeria (81.3%) and Côte d'Ivoire (79.9%) lived within 10 km of a facility providing any PAC services, significantly lower levels of the population lived <10 km from a facility with all basic or comprehensive PAC signal functions, and we observed significant inequities in access for poor, rural and less educated women. Addressing facilities' service readiness will improve the quality of PAC provided and ensure postabortion complications can be treated in a timely and effective manner, while expanding the availability of services to additional primary-level facilities would increase access - both of which could help to reduce avoidable abortion-related maternal morbidity and mortality and associated inequities.
AB - Postabortion care (PAC) is an essential component of emergency obstetric care (EmOC) and is necessary to prevent unsafe abortion-related maternal mortality, but we know little regarding the preparedness of facilities to provide PAC services, the distribution of these services and disparities in their accessibility in low-resource settings. To address this knowledge gap, this study aims to describe PAC service availability, evaluate PAC readiness and measure inequities in access to PAC services in seven states of Nigeria and nationally in Côte d'Ivoire. We used survey data from reproductive-age women and the health facilities that serve the areas where they live. We linked facility readiness information, including PAC-specific signal functions, to female data using geospatial information. Findings revealed less than half of facilities provide basic PAC services in Nigeria (48.4%) but greater PAC availability in Côte d'Ivoire (70.5%). Only 33.5% and 36.9% of facilities with the capacity to provide basic PAC and only 23.9% and 37.5% of facilities with the capacity to provide comprehensive PAC had all the corresponding signal functions in Nigeria and Côte d'Ivoire, respectively. With regard to access, while ∼8 out of 10 women of reproductive age in Nigeria (81.3%) and Côte d'Ivoire (79.9%) lived within 10 km of a facility providing any PAC services, significantly lower levels of the population lived <10 km from a facility with all basic or comprehensive PAC signal functions, and we observed significant inequities in access for poor, rural and less educated women. Addressing facilities' service readiness will improve the quality of PAC provided and ensure postabortion complications can be treated in a timely and effective manner, while expanding the availability of services to additional primary-level facilities would increase access - both of which could help to reduce avoidable abortion-related maternal morbidity and mortality and associated inequities.
KW - Côte d'Ivoire
KW - Nigeria
KW - Postabortion care
KW - abortion
KW - survey
UR - http://www.scopus.com/inward/record.url?scp=85114731499&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114731499&partnerID=8YFLogxK
U2 - 10.1093/heapol/czab068
DO - 10.1093/heapol/czab068
M3 - Article
C2 - 34131700
AN - SCOPUS:85114731499
SN - 0268-1080
VL - 36
SP - 1077
EP - 1089
JO - Health policy and planning
JF - Health policy and planning
IS - 7
ER -