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Abstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. Results Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. Discussion Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. Conclusions SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.

Abstract Background Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned. Methods Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

Background: Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana.Methods: We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision.Results: Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity.Discussion: Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care.Conclusions: SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care. [ABSTRACT FROM AUTHOR]

Abstract Background Unsafe abortion remains a reality for many Ethiopian women and will remain so until safe abortion is more accessible across the country. The house of representatives of Federal Democratic Republic of Ethiopia (FDRE) revised the abortion law and Ministry of Health (MoH) of FDRE developed a revised technical and procedural guideline for safe abortion services in Ethiopia; emphasizing the need to increase knowledge and practice of health service providers on safe abortion care (SAC) and access to safe terminations of pregnancy at high standard and quality. Methods A facility based descriptive cross-sectional study using structured self-administered questionnaire was conducted between July and August 2015. A total of 405 mid-level providers (MLPs) including midwives, clinical nurses and health officers were included from 30 randomly selected health centers in Addis Ababa. SPSS version-21 was used for data entry, cleaning and analysis. The results were presented using frequency tables, percentages, means, Odds ratio and 95% confidence limits. Results Among 405 MLPs 71.9% knew the definition of abortion in the in Ethiopia context, 81.5% participants were familiar with the revised abortion law. 53.1% of respondents had adequate knowledge on safe abortion care and working for 3–5 years (AOR 3.1 with CI 1.6, 5.7) and midwives (AOR = 2.9 with CI 1.8, 4.7) had better knowledge on abortion. Only eighty-three (20.5%) of MLPs were trained on safe abortion and among them sixty-eight (81.9%) were practising/used to practice safe abortion services. Half of respondents gave post abortion family planning methods. 54.1% respondents had positive attitude towards safe abortion. MLPs’ who had adequate knowledge on safe abortion care (AOR 2.02, 95% CI 1.3–3.1) and male providers (AOR 1.6, 95% CI 1.04–2.4) were more likely to have positive attitude towards safe abortion. MLPs who had adequate knowledge on abortion 3.4 times (CI of 95% =1.1–10.6) were more likely to practise safe abortion care. Conclusion The majority claimed to know the current abortion law; however, many failed to understand the specific provisions of the law. Type of profession and years of experiences were important in explaining providers’ knowledge related to abortion. Being male and having the knowledge significantly influenced providers’ attitude toward safe abortion. Knowledge related to abortion also influenced the practice of SAC. Efforts to improve mid-level as well as other health care providers’ knowledge on abortion are necessary, for example, through pre−/on-service training.

Refugees and displaced people face uniquely challenging barriers to abortion access, including the collapse of health systems, statelessness, and a lack of prioritization of sexual and reproductive health services by humanitarian agencies. This article summarizes the evidence around abortion access in humanitarian contexts, and highlights the opportunities for interventions that could increase knowledge and support around self-managed abortion. We explore how lessons learned from other contexts can be applied to the development of effective interventions to reduce abortion-related morbidity and mortality, and may improve access to information about safe methods of abortion, including self-management, in humanitarian settings. We conclude by laying out a forward-thinking research agenda that addresses gaps in our knowledge around abortion access and experiences in humanitarian contexts.

Background: Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers' competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders' experiences, recommendations for improvement, and lessons learned. Methods: Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results: Results from the workshops converged to suggest that the module contributed to increasing participants' theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions: When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia.Methods: This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis.Results: There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased.Conclusion: Ten years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels. [ABSTRACT FROM AUTHOR]

Complications of an unsafe abortion are a major contributor to maternal deaths and morbidity in Africa. When abortions are performed in safe environments, such complications are almost all preventable. This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. The safe abortion care (SAC) model, a monitoring approach to assess the amount, distribution, use and quality of abortion services, provided a framework. Data collection included key informant interviews with 335 health care providers, prospective data on 8911 women seeking treatment for abortion complications or induced abortion and review of facility logbooks. Although the existing hospitals perform most basic abortion care functions, the number of facilities providing basic and comprehensive abortion care for the population size fell far short of the recommended levels. Almost one-half (48%) of women treated for obstetric complications in the facilities had abortion complications. The use of appropriate abortion technologies in the first trimester and the provision of post-abortion contraception overall were reasonably strong, especially in private sector facilities. Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from an unsafe abortion. This study provides the first national snapshot to measure changes in a dynamic abortion care environment. [ABSTRACT FROM PUBLISHER]

Objective: To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time.Methods: The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model.Results: Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P<0.01), and the proportion performed with recommended technology increased from 30% to 85% (P<0.01). The proportion of abortion patients who received modern contraception also increased from 31% to 78% (P<0.01).Discussion: While widespread service delivery improvements were recorded using the SAC monitoring approach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was no comparison group of facilities, timing did not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support.Conclusion: Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life-saving care to reduce preventable abortion mortality in the region. [ABSTRACT FROM AUTHOR]

Background: Unsafe abortion remains a reality for many Ethiopian women and will remain so until safe abortion is more accessible across the country. The house of representatives of Federal Democratic Republic of Ethiopia (FDRE) revised the abortion law and Ministry of Health (MoH) of FDRE developed a revised technical and procedural guideline for safe abortion services in Ethiopia; emphasizing the need to increase knowledge and practice of health service providers on safe abortion care (SAC) and access to safe terminations of pregnancy at high standard and quality.Methods: A facility based descriptive cross-sectional study using structured self-administered questionnaire was conducted between July and August 2015. A total of 405 mid-level providers (MLPs) including midwives, clinical nurses and health officers were included from 30 randomly selected health centers in Addis Ababa. SPSS version-21 was used for data entry, cleaning and analysis. The results were presented using frequency tables, percentages, means, Odds ratio and 95% confidence limits.Results: Among 405 MLPs 71.9% knew the definition of abortion in the in Ethiopia context, 81.5% participants were familiar with the revised abortion law. 53.1% of respondents had adequate knowledge on safe abortion care and working for 3-5 years (AOR 3.1 with CI 1.6, 5.7) and midwives (AOR = 2.9 with CI 1.8, 4.7) had better knowledge on abortion. Only eighty-three (20.5%) of MLPs were trained on safe abortion and among them sixty-eight (81.9%) were practising/used to practice safe abortion services. Half of respondents gave post abortion family planning methods. 54.1% respondents had positive attitude towards safe abortion. MLPs' who had adequate knowledge on safe abortion care (AOR 2.02, 95% CI 1.3-3.1) and male providers (AOR 1.6, 95% CI 1.04-2.4) were more likely to have positive attitude towards safe abortion. MLPs who had adequate knowledge on abortion 3.4 times (CI of 95% =1.1-10.6) were more likely to practise safe abortion care.Conclusion: The majority claimed to know the current abortion law; however, many failed to understand the specific provisions of the law. Type of profession and years of experiences were important in explaining providers' knowledge related to abortion. Being male and having the knowledge significantly influenced providers' attitude toward safe abortion. Knowledge related to abortion also influenced the practice of SAC. Efforts to improve mid-level as well as other health care providers' knowledge on abortion are necessary, for example, through pre-/on-service training. [ABSTRACT FROM AUTHOR]