Abstract
Abstract
Background
Access to safe abortion is legally restricted in Kenya. Therefore, majority women seeking abortion services in such restrictive contexts resort to unsafe methods and procedures that result in complications that often require treatment in health facilities. Most women with abortion-related complications end up in public health facilities. Nevertheless, evidence is limited on the quality of care provided to patients with abortion complications in public health facilities in Kenya.
Methods
Data for this paper are drawn from a qualitative study that included interviews with 66 women who received post-abortion care in a sample of primary, secondary and tertiary public health facilities in Kenya between November 2018 and February 2019. The interviews focused on mechanisms of decision-making while seeking post-abortion care services, care pathways within facilities, and perceptions of patients on quality of care received including respect, privacy, confidentiality, communication and stigma.
Findings
The participants’ perceptions of the quality of care were characterized as either “bad care” or “good care”, with the good care focusing on interpersonal aspects such as friendliness, respect, empathy, short waiting time before receiving services, as well as the physical or functional aspects of care such as resolution of morbidity and absence of death. Majority of participants initially reported that they received “good care” because they left the facility with their medical problem resolved. However, when probed, about half of them reported delays in receiving care despite their condition being an emergency (i.e., severe bleeding and pain). Participants also reported instances of abuse (verbal and sexual) or absence of privacy during care and inadequate involvement in decisions around the nature and type of care they received. Our findings also suggest that healthcare providers treated patients differently based on their attributes (spontaneous versus induced abortion, single versus married, young versus older). For instance, women who experienced miscarriages reported supportive care whereas women suspected to have induced their abortions felt stigmatized.
Conclusion
These findings have far reaching implications on efforts to improve uptake of post-abortion care, care seeking behaviors and on how to assess quality of abortion care. There should be emphasis on interventions meant to enhance processes and structural indicators of post-abortion care services meant to improve patients’ experiences throughout the care process. Moreover, more efforts are needed to advance the tools and approaches for assessing women experiences during post-abortion care beyond just the overriding clinical outcomes of care.
Funder
William and Flora Hewlett Foundation
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,Reproductive Medicine
Reference25 articles.
1. The National Council for Law Reporting. LAWS OF KENYA. The Constitution of Kenya. 2010.
2. African Population and Health Research Center, Ministry of Health [Kenya], Ipas, Guttmacher Institute. Incidence and complications of unsafe abortion in Kenya: Key findings of a national study. Nairobi: APHRC, Ministry of Health Kenya, Ipas, Guttmacher Institute; 2013.
3. APHRC, Ipas. The cost of treating complications of unsafe abortion in public health facilities in Kenya. Nairobi: APHRC; 2017.
4. Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. The Lancet. 2006;368(9550):1887–92.
5. Kim CR, Tunçalp Ö, Ganatra B, Gülmezoglu AM, Group WM-AR. WHO Multi-Country Survey on Abortion-related Morbidity and Mortality in Health Facilities: study protocol. BMJ Glob Health [Internet]. 2016;1(3):e000113.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献