Abstract
Background
Post-abortion care is a lifesaving intervention to address abortion-related complications. Yet, several women who experience abortion-related complications face difficulties accessing quality and comprehensive Post-abortion care within health facilities. Research on barriers to post-abortion care from multiple perspectives is critical to inform specific programmatic improvements to enhance access to quality Post-abortion care services.
Objectives
This study explored stakeholder perspectives on the barriers to accessing quality post-abortion care in health facilities in Liberia and Sierra Leone.
Methods
This was a cross-sectional qualitative study targeting both post-abortion care health providers in selected health facilities and stakeholders in Liberia and Sierra Leone. Data collection included in-depth interviews conducted with health providers and policy actors (representatives from religious institutions, ministries of health, civil society organizations, and non-government organizations) working on sexual and reproductive health issues in the two countries. Data were coded using Dedoose analytic software and analyzed using a thematic approach.
Findings:
Stakeholders in Sierra Leone and Liberia had varying viewpoints of what constitutes quality post-abortion care, reflecting on their practices and behavior around the service. Our analysis showed several weaknesses and gaps in the capacity of health facilities to deliver post-abortion care. Lack of trained providers was more pronounced in Sierra Leone than Liberia. In both countries, the absence of and faulty post-abortion care equipment, inadequate supplies, and infrastructure-related challenges were commonplace. For instance, the lack of rooms with audio-visual privacy during post-abortion care services curtailed quality services and impaired confidentiality. Inadequate dissemination of post-abortion care guidelines implied that providers had no or limited knowledge of the law, and best practices, leading to delays, denial of post-abortion care, overcharging fees, and stigmatization of some patients.
Conclusion
Despite the existing policies and interventions on post-abortion, many health facilities in Liberia and Sierra Leone still lack essential post-abortion care equipment and supplies, and trained providers. There is a need to recruit and train willing providers, along with a clear referral system. Further, sensitizing health providers, stakeholders, and communities on abortion-related policies, guidelines, and value clarification could help improve post-abortion care service provision and uptake.