Abstract
Background: Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods: Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results: Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions: This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.
| Original language | English |
|---|---|
| Article number | 160 |
| Journal | Reproductive Health |
| Volume | 18 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Dec 2021 |
Bibliographical note
Funding Information:The authors would like to thank UNICEF and USAID for funding the study and technical collaboration, the central and provincial MoPH for their guidance and support, the nongovernmental organizations implementing Afghanistan?s health care services, and those professionals who participated in the study. Thanks to Ariel Higgins-Steele, and Shirin Varkey from UNICEF; Sher Shah Amin from USAID; Sayed Attaullah Saeedzai, MoPH general director of evaluation and health information systems; Zelaikha Anwari, MoPH director of the Reproductive, Maternal, Newborn, Child, and Adolescent Health Department; Catherine Todd, Reproductive, Maternal, Newborn Child Health Division, and Patsy Bailey, senior scientist, Health Services Division, FHI360; Nasrat Ansari, Faridullah Atiqzai, Partamin Manali, Zahra Sultani, Sayed Esmati, Ahmad Eklil Husain, Mahmood Azimi, Enayatullah Mayar, Abdul Qader Rahimi, Raouf Saidzadah, Matiuallah Noorzad, and Laila Natiq from Jhpiego Afghanistan; facility staff participating in the study; and women allowing observation of care. Thanks to Nuriye Hodoglugil Sahin and Neeta Bhatnager from Jhpiego Baltimore, and Brendan Michael Hayes from Global Financing Facility, World Bank Group, for providing support and technical advice during the drafting of this manuscript. Thanks to all the midwives and doctors who served as data collectors in very difficult situations.
Funding Information:
The United States Agency for International Development (USAID) Afghanistan FP/MNCH Project (AID-306-A-15-00002) and UNICEF Afghanistan National Maternal and Newborn Health Quality of Care Assessment award provided funding for this research. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of the funder.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Funding
The authors would like to thank UNICEF and USAID for funding the study and technical collaboration, the central and provincial MoPH for their guidance and support, the nongovernmental organizations implementing Afghanistan?s health care services, and those professionals who participated in the study. Thanks to Ariel Higgins-Steele, and Shirin Varkey from UNICEF; Sher Shah Amin from USAID; Sayed Attaullah Saeedzai, MoPH general director of evaluation and health information systems; Zelaikha Anwari, MoPH director of the Reproductive, Maternal, Newborn, Child, and Adolescent Health Department; Catherine Todd, Reproductive, Maternal, Newborn Child Health Division, and Patsy Bailey, senior scientist, Health Services Division, FHI360; Nasrat Ansari, Faridullah Atiqzai, Partamin Manali, Zahra Sultani, Sayed Esmati, Ahmad Eklil Husain, Mahmood Azimi, Enayatullah Mayar, Abdul Qader Rahimi, Raouf Saidzadah, Matiuallah Noorzad, and Laila Natiq from Jhpiego Afghanistan; facility staff participating in the study; and women allowing observation of care. Thanks to Nuriye Hodoglugil Sahin and Neeta Bhatnager from Jhpiego Baltimore, and Brendan Michael Hayes from Global Financing Facility, World Bank Group, for providing support and technical advice during the drafting of this manuscript. Thanks to all the midwives and doctors who served as data collectors in very difficult situations. The United States Agency for International Development (USAID) Afghanistan FP/MNCH Project (AID-306-A-15-00002) and UNICEF Afghanistan National Maternal and Newborn Health Quality of Care Assessment award provided funding for this research. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of the funder.
Keywords
- Afghanistan
- Capacity of health services
- Medical treatment
- Postabortion care
- Reproductive health
