There are critical gaps in the provision of postabortion care (PAC) at facilities that offer childbirth delivery services in many countries, highlighting a disconnect between national governments’ commitments to address the consequences of unsafe abortion and the capacity of health systems to provide essential services, according to a new study published today in The Lancet Global Health. “Health Systems' Capacity to Provide Post-Abortion Care: A Multicountry Analysis Using Signal Functions,” by Guttmacher researchers Onikepe Owolabi, Ann Biddlecom and Hannah Whitehead, found an unacceptably low level of appropriate medical care provided to women who experienced complications from abortion or miscarriage and who sought treatment in one of 10 countries across three regions.  

“High-quality postabortion care is essential to reducing negative health outcomes related to unsafe abortion,” says lead author Onikepe Owolabi. “Yet health facilities in many countries lack the capacity to provide either basic or comprehensive postabortion care.”

Although support for PAC is common and governments in many countries have made long-standing commitments to addressing abortion-related complications through the provision of high-quality services, the reality is that many health systems are unable to provide essential care. The authors found that, in seven of 10 study countries, fewer than 10% of primary-level facilities could provide basic PAC, and in eight of 10 study countries, fewer than 40% of facilities where patients were referred for care could provide comprehensive PAC.  One positive finding in the study showed that almost all primary-level facilities providing childbirth delivery in the 10 countries had at least one contraceptive method available for patients.

The evidence from this study underscores the importance of increased government investments in their health care system to ensure that PAC includes all of the critical components of care. Increasing the provision of quality PAC is essential to reduce the level of abortion-related morbidity and mortality around the world.

“Providing high-quality, easily accessible PAC is an ethical and humanitarian imperative,” says Owolabi. “Governments must prioritize this issue not just on paper but in practice, by investing in health care systems to ensure they are able to provide needed care.”

This study is the first multi-country analysis using standardized, nationally representative data and a signal functions approach to assess the capacity of health systems to provide PAC. This approach measures capacity with aggregate indicators of the essential components of care (signal functions) used to treat the most common complications from incomplete or unsafe abortion. The authors used nationally representative Service Provision Assessment surveys conducted from 2007–2015 by the Demographic and Health Surveys program in 10 countries (Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda) across three regions (Sub-Saharan Africa, Southern Asia and the Caribbean). The 10 countries share consistently high levels of maternal mortality, despite having broadly different contexts in which abortion-related morbidity and mortality occur.

Health Systems' Capacity to Provide Post-Abortion Care: A Multicountry Analysis Using Signal Functions,” by Onikepe Owolabi, Ann Biddlecom and Hannah Whitehead, is available online in The Lancet Global Health.