Identifying women with poor experience of post-abortion care: a cross-sectional study in two African hospitals in humanitarian settings

Background
High quality post-abortion care (PAC) is essential to reducing abortion-related morbidity and mortality. However, the experience of receiving PAC, a key component of care quality, remains understudied in humanitarian settings. We assessed the experience of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR) and identified characteristics associated with poor experience of PAC.

Methods
We analyzed data from two components of a multi-methods cross-sectional study: a prospective medical records review and a survey of women hospitalized for abortion complications in the Nigerian (n = 360) and CAR (n = 362) hospitals. We measured women’s experience of PAC with two questions related to communication with health providers (explanations received and ability to ask questions) and five questions related to respect and preservation of dignity (privacy, waiting times, health provider’s kindness, painkillers provision and overall care assessment). Association between women’s characteristics and the two communication outcomes were investigated using multivariate logistic regressions. A latent variable was constructed using the five respect and dignity questions and its association with women’s characteristics was assessed using multivariate linear regression.

Results
Nearly 51% in Nigeria hospital and 41% in CAR hospital reported receiving no explanation of their care, and over 80% in both hospitals said they felt unable to ask questions during examination and treatment. Less than 20% of women in Nigeria reported a lack of respect and preservation of their dignity. In CAR, almost 63% of women said that their privacy was not always respected during the physical examination and 38% said waiting times were long or very long before seeing a health provider. We found associations between low education level and poor experience of communication in both settings. Being adolescent was associated with one poor communication outcome in CAR and poor experience of respect and preservation of dignity in Nigeria.

Conclusion
A non-negligible proportion of PAC patients faced poor communication and mixed experiences of respect, with poorer experiences in women with low education and adolescents. Socio-demographic inequalities in PAC experiences must not be overlooked in humanitarian settings, and further research is critical to identify and support the most vulnerable women.