Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Colin Baynes, Danielle Garfinkel, Justin Kahwa, Grace Lusiola, Kathryn A. O’Connell

Abstract

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women’s needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients’ access to a wide range of contraceptive options. The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention’s effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared pre-post differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40).

Full Text:

PDF

References

Commission on Population and Development. Framework of Actions for the Follow-up to the Programme of Action of the International Conference on Population and Development (ICPD) Beyond 2014. 2014.

Gerdts C, Tunçalp O, Johnston H and Ganatra B. Measuring abortion-related mortality: challenges and opportunities. Reproductive Health. 2015;12(1). doi:10.1186/s12978-015-0064-1

Melese T, Habte D, Tsima BM, Mogobe KD, Chabaesele K, Rankgoane G, Keakabetse R, Masewu M, Mokotedi M, Motana M and Moreri-Ntshabele B. High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized. PloS One. 2017;12(1). doi:10.1371/journal.pone.0166287

Pfitzer A, Hyjazi Y, Arnold B, Aribot J, Hobson RD, Pleah TG, Turke S, O’Colmain B and Arscott-Mills S. Findings and Lessons Learned From Strengthening the Provision of Voluntary Long-Acting Reversible Contraceptives With Postabortion Care in Guinea. Global Health: Science and Practice. 2019;7(Supplement 2). doi:10.9745/GHSP-D-18-00344

Mugore S, Kassouta NTK, Sebikali B, Lundstrom L and Saad A. Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception. Global Health: Science and Practice. 2016;4(3). doi:10.9745/GHSP-D-16-00212

McCurdy RJ, Jiang X and Schnatz PF. Long-acting reversible contraception in adolescents in Sub-Saharan Africa: evidence from demographic and health surveys. The European Journal of Contraception & Reproductive Health Care. 2018;23(5). doi:10.1080/13625187.2018.1519535

Benson J, Andersen K, Healy J and Brahmi D. What Factors Contribute to Postabortion Contraceptive Uptake By Young Women? A Program Evaluation in 10 Countries in Asia and sub-Saharan Africa. Global Health: Science and Practice. 2017;5(4). doi:10.9745/GHSP-D-17-00085

Huber D. Postabortion Care and the Voluntary Family Planning Component : Expanding Contraceptive Choices and Service Options. Global Health Sciences and Practice. 2019;7(2):207-210.

Schreiber CA, Sober S, Ratcliffe S and Creinin MD. Ovulation resumption after medical abortion with mifepristone and misoprostol. Contraception. 2011;84(3). doi:10.1016/j.contraception.2011.01.013

Curtis C, Huber D and Moss-Knight T. Postabortion Family Planning: Addressing the Cycle of RepeatUnintended Pregnancy and Abortion. International Perspectives on Sexual and Reproductive Health. 2010;36(01). doi:10.1363/3604410

Huber D, Curtis C, Irani L, Pappa S and Arrington L. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components. Global Health: Science and Practice. 2016;4(3). doi:10.9745/GHSP-D-16-00052

International Federation of Gynecology and Obstetrics, International Confederation of Midwives, International Council of Nurses and the United States Agency for International Development. Post Abortion Family Planning: A Key Component of Post Abortion Care: Consensus Statement. 2009.

Keogh SC, Kimaro G, Muganyizi P, Philbin J, Kahwa A, Ngadaya E and Bankole A. Incidence of Induced Abortion and Post-Abortion Care in Tanzania. PloS one. 2015;10(9):e0133933. doi:10.1371/journal.pone.0133933

Bearak J, Popinchalk A, Ganatra B, Moller A, Tucalp O, Beavin C, Kwok L and Alkema L. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. The Lancet Global Health. 2020;8(9). doi:10.1016/S2214-109X(20)30315-6

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tuncalp O, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z and Alkema L. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017;390(10110). doi:10.1016/S0140-6736(17)31794-4

Ministry of Health and Social Welfare, United Republic of Tanzania. National Package of Essential Health Interventions in Tanzania. 2010.

Baynes C, Kahwa J, Lusiola G, Mwanga F, Bantambya J, Ngosso L and Hiza M. What contraception do women use after experiencing complications from abortion? an analysis of cohort

records of 18,688 postabortion care clients in Tanzania. BMC

Women’s Health. 2019;19. doi:10.1186/s12905-018-0687-9

United States Agency for International Development. Post-abortion family planning: a critical component of postabortion care. High Impact Practices in Family Planning (HIP). Published 2019. https://www.fphighimpactpractices.org/briefs/postabortion-family-planning/

Baynes C, Yegon E, Lusiola G, Kahando R, Ngadaya E and Kahwa J. Women’s Satisfaction With and Perceptions of the Quality of Postabortion Care at Public-Sector Facilities in Mainland Tanzania and in Zanzibar. Global Health Science and Practice. 2019;7(2):S299-S314. doi:10.9745/GHSP-D-19-00026

EngenderHealth. COPE ® Handbook: A Process for Improving Quality in Health Services. Revised. 2003.

Baynes C, O’Connell K, Garfinkel D and Kahwa J. The Effects of Interventions to Integrate Long-Acting Reversible Contraception with Treatment for Incomplete Abortion: Results of a Six-Year Interrupted Time Series Analysis in Hospitals of Mainland Tanzania and Zanzibar. 2021.

Speizer IS, Calhoun LM, McGuire C, Lance PM, Heller C and Guilkey DK. Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality. BMC health services research. 2019;19(1):559. doi:10.1186/s12913-019-4388-3

Iwelunmor J, Blackstone S, Veira D, Nwaozuru U, Airhihenbuwa C, Munodawafa D, Kalipeni E, Jutal A, Shelley D and Ogedegbe G. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework. Implementation Science. 2015;11(1). doi:10.1186/s13012-016-0392-8

Gruen RL, Elliott JH, Nolan ML, Lawton PD, Parkhill A, McLaren CJ and Lavis J. Sustainability science: an integrated approach for health-programme planning. Lancet. 2008;372:1579-1589. doi:10.1016/S0140-6736(08)61659-1

Leeman J, Calancie L, Kegler MC, Escoffrey CT, Herrmann AK, Thatcher E, Hartman MA and Fernandez ME. Developing Theory to Guide Building Practitioners’ Capacity to Implement Evidence-Based Interventions. Health Education & Behavior. 2017;44(1). doi:10.1177/1090198115610572.

Refbacks

  • There are currently no refbacks.