Identifying indicators for quality abortion care: a systematic literature review; Quality and abortion services and WHO multi-country survey on abortion-related morbidity and mortality in health facilities: study protocol

by Amanda Dennis, Kelly Blanchard, Tshego BessenaarJ Fam Plann Reprod Health Care 2016; 43:7-15 DOI:10.1136/jfprhc-2015-101427Excerpts“A systematic review was conducted of 13 peer-reviewed articles and eight reports focused on indicators of quality abortion care. A total of 75 indicators of quality abortion were identified; these indicators address a variety of issues including policy, health systems, trained-provider availability, women’s decision making, and morbidity and mortality. There is little agreement about indicators for measuring quality abortion care; more work is needed to ensure efforts to assess quality are informed and coordinated….”Quality improvement efforts rely on the measurement and tracking of standardised indicators that provide insight into whose health care needs remain unmet, if there are any improvements needed in how health care is delivered in a facility, what health system issues are in need of change, and what legal and policy reforms are necessary. Reporting on these issues using standardised indicators has the potential to help drive quality improvements and influence the extent to which quality improvement efforts are supported by policymakers, philanthropic organisations, researchers, advocates, programme planners, and health care practitioners…”The indicators for which there was a high level of agreement were: (1) the availability of trained staff to provide care, (2) whether referrals for, or direct provision of, a range of sexual and reproductive health services are offered, (3) if all aspects of abortion care are explained to women, (4) if information about a range of sexual and reproductive health services is offered, (5) whether staff offer respectful care, (6) if staff work to ensure privacy, (7) if high-quality, supportive counsellingis provided, (8) the abortion complication rate, (9) if services are offered in a timely manner, (10) ifservices are geographically accessible, (11) whether policies support access to abortion, (12) if women have the opportunity to express concerns, ask questions, and receive answers, and (13) the rate of maternal deaths due to abortion complications.”***Quality and abortion servicesby Jonathan LordJ Fam Plann Reprod Health Care 2016; 43:16-17 DOI:10.1136/jfprhc-2016-101580In a short commentary in response to the Dennis et al article, the author remarks: “In other areas of medicine the quality agenda has become mainstream. In contrast, those involved in abortion care frequently work in isolation and have had to concentrate on operating in difficult legal and social environments where defined quality indicators could be used against them further to restrict access…”[As the review authors point out,] there is a need to develop a streamlined set of indicators. Such indicators need to be important to patients, clinically relevant, measurable, accessible for benchmarking, and agreed by consensus. Some measures will be more relevant to policymakers and commissioners of services, others to patients and to staff providing the service.”He also reports that in 2015 the British Society of Abortion Care Providers listed five top indicators they consider important: 1) percentage of abortions at less than 10 weeks of pregnancy, 2) access to appropriate choice of procedure, 3) waiting times of <1 week for assessment and 1 week for treatment, 4) measures of quality of care from patient reported outcomes (e.g. satisfaction surveys), and 5) engagement in quality assurance processes such as peer review and publishing results, including key quality parameters such as readmission rates.***GLOBAL WHO multi-country survey on abortion-related morbidity and mortality in health facilities: study protocolby Caron R Kim, Özge Tunçalp, Bela Ganatra, Ahmet Metin Gülmezoglu, WHO MCS-A Research GroupBMJ Global Health 2016;1:e000113. DOI:10.1136/bmjgh-2016-000113AbstractThis is a large cross-sectional study with prospective data collection. It will be implemented in health facilities in 30 countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia and Western Pacific. Countries and facilities will be identified through a multistage sampling methodology. Data collection will be at both the facility and individual levels, involving review of medical records and exit surveys with eligible women using audio computer-assisted self-interview. All women presenting to the health facilities with signs and symptoms of abortion complications will comprise the study population. Online data entry and management will be performed on a web-based data management system. Analysis will include prevalence of abortion-related complications and descriptive frequencies of procedural/non-procedural management and experience of care.What is already known about this topic?▸ Capturing accurate information on abortion is a challenge especially in settings where abortion is legally restricted.▸ As deaths resulting from unsafe abortion have decreased in recent years, the focus is shifting towards complications associated with abortionWhat will the new findings be?▸ This study will provide new information by assessing the burden, severity and management of complications due to unsafe abortion in a standardised way in the health facilities in 30 countries.▸ Findings will also include the experience of care for women with abortion-related complications received at these facilities.