Presenter Biography
Laura Jacobson is a public health researcher with a focus on abortion quality of care, and medication abortion self-use, with a global focus. Laura is a PhD candidate of Health Systems and Policy and holds a master’s in public health from the University of Wisconsin-Madison. In addition, Laura supports research with OHSU department of OBGYN, Ibis Reproductive Health, and the World Health Organization.
Institution
OHSU
Program/Major
Health Systems and Policy
Degree
PhD
Presentation Type
Presentation
Start Date
4-4-2023 1:15 PM
End Date
4-4-2023 1:30 PM
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Persistent Identifier
https://archives.pdx.edu/ds/psu/40178
Keywords
Abortion, self-managed abortion, quality of care, Abortion Care Quality Tool (ACQ)
Abstract
Objective: We used the newly developed Abortion Care Quality (ACQ) Tool to compare client-reported quality of medication abortion care by modality (facility-based versus pharmacy-based self-managed abortion (SMA)) in Bangladesh.
Study Design: We used the abortion client ACQTool exit and 30-day follow-up surveys and bivariate statistics to compare 18 client-reported quality indicators grouped in six domains and eight abortion outcomes, by service modality. We used multivariable logistic regression to identify factors associated with selected quality indicators and outcomes (abortion affordability, information provision, and knowing what to do for an adverse event), controlling for client socio-demographic characteristics.
Results: Of 550 abortion clients, 146 (26.5%) received a facility-based medication abortion and 404 (73.5%) had a pharmacy-based SMA. Clients reported higher quality in facilities for five indicators; higher in pharmacies for two indicators; the remaining 11 indicators were not different by modality. Compared with facility-based clients, pharmacy clients had higher odds of reporting that the cost of abortion was affordable (aOR = 3.55; 95% CI 2.27-5.58) but lower odds of reporting high information provision (aOR = 0.14; 95% CI 0.09-0.23). Seven of eight abortion outcomes showed no differences; pharmacy clients had lower odds of knowing what to do if an adverse even occurred (aOR = 0.45; 95% CI 0.23-0.82).
Conclusions: In Bangladesh, there is no difference in client-reported quality of medication abortion care between health facilities and pharmacies for the majority of quality and outcome indicators. However, information provision and preparedness were higher quality at facilities, while pharmacies were more affordable.
Included in
Client-reported quality of in-facility medication abortion compared with pharmacy-based self-managed abortion in Bangladesh
Objective: We used the newly developed Abortion Care Quality (ACQ) Tool to compare client-reported quality of medication abortion care by modality (facility-based versus pharmacy-based self-managed abortion (SMA)) in Bangladesh.
Study Design: We used the abortion client ACQTool exit and 30-day follow-up surveys and bivariate statistics to compare 18 client-reported quality indicators grouped in six domains and eight abortion outcomes, by service modality. We used multivariable logistic regression to identify factors associated with selected quality indicators and outcomes (abortion affordability, information provision, and knowing what to do for an adverse event), controlling for client socio-demographic characteristics.
Results: Of 550 abortion clients, 146 (26.5%) received a facility-based medication abortion and 404 (73.5%) had a pharmacy-based SMA. Clients reported higher quality in facilities for five indicators; higher in pharmacies for two indicators; the remaining 11 indicators were not different by modality. Compared with facility-based clients, pharmacy clients had higher odds of reporting that the cost of abortion was affordable (aOR = 3.55; 95% CI 2.27-5.58) but lower odds of reporting high information provision (aOR = 0.14; 95% CI 0.09-0.23). Seven of eight abortion outcomes showed no differences; pharmacy clients had lower odds of knowing what to do if an adverse even occurred (aOR = 0.45; 95% CI 0.23-0.82).
Conclusions: In Bangladesh, there is no difference in client-reported quality of medication abortion care between health facilities and pharmacies for the majority of quality and outcome indicators. However, information provision and preparedness were higher quality at facilities, while pharmacies were more affordable.