Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC

BACKGROUND: The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the a...

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Autores principales: Magalona, Sophia, Thomas, Haley L., Akilimali, Pierre Z., Kayembe, Dynah, Moreau, Caroline, Bell, Suzanne O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10283295/
https://www.ncbi.nlm.nih.gov/pubmed/37340470
http://dx.doi.org/10.1186/s12913-023-09647-6
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author Magalona, Sophia
Thomas, Haley L.
Akilimali, Pierre Z.
Kayembe, Dynah
Moreau, Caroline
Bell, Suzanne O.
author_facet Magalona, Sophia
Thomas, Haley L.
Akilimali, Pierre Z.
Kayembe, Dynah
Moreau, Caroline
Bell, Suzanne O.
author_sort Magalona, Sophia
collection PubMed
description BACKGROUND: The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. METHODS: Data on 153 facilities from the 2017–2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017–2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. RESULTS: Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. CONCLUSION: Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.
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spelling pubmed-102832952023-06-22 Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC Magalona, Sophia Thomas, Haley L. Akilimali, Pierre Z. Kayembe, Dynah Moreau, Caroline Bell, Suzanne O. BMC Health Serv Res Research BACKGROUND: The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. METHODS: Data on 153 facilities from the 2017–2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017–2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. RESULTS: Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. CONCLUSION: Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings. BioMed Central 2023-06-20 /pmc/articles/PMC10283295/ /pubmed/37340470 http://dx.doi.org/10.1186/s12913-023-09647-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Magalona, Sophia
Thomas, Haley L.
Akilimali, Pierre Z.
Kayembe, Dynah
Moreau, Caroline
Bell, Suzanne O.
Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title_full Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title_fullStr Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title_full_unstemmed Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title_short Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC
title_sort abortion care availability, readiness, and access: linking population and health facility data in kinshasa and kongo central, drc
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10283295/
https://www.ncbi.nlm.nih.gov/pubmed/37340470
http://dx.doi.org/10.1186/s12913-023-09647-6
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