Huda Fauzia Akhter, Ahmed Anisuddin, Ford Evelyn Rebecca, Johnston Heidi Bart
Centre for Reproductive Health, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh.
Oregon Health & Science University School of Medicine, Portland, OR, USA.
BMC Health Serv Res. 2015 Sep 28;15:426. doi: 10.1186/s12913-015-1115-6.
Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country.
This quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year's records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality.
No facilities fulfilled criteria for 'comprehensive' care at either the baseline or end line while only one met the 'basic' criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %).
Persistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities. Notable gaps were identified in providing post-abortion contraceptive services for women treated for PAC. By systematic implementation of the SMRAC model, health systems can track and measure progress and gaps in their implementation and identify strategies for further reduction of abortion-related morbidity and mortality in Bangladesh.
在孟加拉国，与堕胎相关的死亡占孕产妇死亡率的比例似乎已从2001年的5%大幅降至2010年的1%。然而，月经调节（MR）和不安全堕胎引发的并发症继续给该国妇女带来有害的健康、经济和社会后果。
这项采用准实验设计的研究，包括基线调查（2008年1月至12月）和终期调查（2009年8月至10月），在孟加拉国杰索尔地区的69家公立、私立和非政府组织部门的卫生设施中开展，目的是采用并实施一套过程指标，特别是补充用于监测产科急诊干预措施的指标。在基线调查阶段，我们通过查阅所有69家提供MR、合法堕胎或堕胎后护理（PAC）的卫生设施过去一年的记录，收集回顾性数据。在引入安全月经调节和堕胎护理（SMRAC）模式三个月后，收集终期数据。采用信号功能（设施为预防和治疗堕胎并发症必须提供的关键服务）分析，将设施划分为提供基本护理、全面护理或两者都不提供的类型。通过设施地图绘制以及所提供服务和治疗并发症的记录，进一步描述服务的可及性，并说明服务的使用情况和质量。
在基线调查和终期调查时，没有一家设施符合“全面”护理的标准，而在项目终期只有一家设施符合“基本”标准。推荐的子宫排空技术，即手动真空吸引术（MVA），100.0%的MR患者使用了该技术，但PAC患者中只有8.0%或更少的人使用。采用避孕方法离开设施的MR患者比PAC患者多37.5倍（75.0%对2.0%）。
尽管推荐技术在各设施中广泛可得，但仍观察到持续使用较陈旧的子宫排空技术的情况。在为接受PAC治疗的妇女提供堕胎后避孕服务方面存在明显差距。通过系统实施SMRAC模式，卫生系统可以跟踪和衡量其实施过程中的进展和差距，并确定进一步降低孟加拉国与堕胎相关的发病率和死亡率的策略。
