Marie Stopes Kenya, Kindaruma Road, P.O. Box 59328-00200, Nairobi, Kenya.
Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Reprod Health. 2018 Jan 19;15(1):10. doi: 10.1186/s12978-018-0452-4.
Integration of family planning counselling and method provision into safe abortion services is a key component of quality abortion care. Numerous barriers to post-abortion family planning (PAFP) uptake exist. This study aimed to evaluate the effect of a quality management intervention for providers on PAFP uptake.
We conducted a pre- and post-intervention study between November 2015 and July 2016 in nine private clinics in Western Kenya. We collected baseline and post-intervention data using in-person interviews on the day of procedure, and follow-up telephone interviews to measure contraceptive uptake in the 2 weeks following abortion. We also conducted semi-structured interviews with providers. The intervention comprised a 1-day orientation, a counselling job-aide, and enhanced supervision visits. The primary outcome was the proportion of clients receiving any method of PAFP (excluding condoms) within 14 days of obtaining an abortion. Secondary outcomes were the proportion of clients receiving PAFP counselling, and the proportion of clients receiving long-acting reversible contraception (LARC) within 14 days of the service. We used chi-squared tests and multivariate logistic regression to determine whether there were significant differences between baseline and post-intervention, adjusting for potential confounding factors and clustering at the clinic level.
Interviews were completed with 769 women, and 54% (414 women) completed a follow-up telephone interview. Reported quality of counselling and satisfaction with services increased between baseline and post-intervention. Same-day uptake of PAFP was higher at post-intervention compared to baseline (aOR 1.94, p < 0.001), as was same-day uptake of LARC (aOR 1.72, p < 0.001). There was no overall increase in uptake of PAFP 2 weeks following abortion. Providers reported mixed opinions about the effectiveness of the intervention but most reported that the supervision visits helped them improve the quality of their services.
A quality management intervention was successful in improving the quality of PAFP counselling and provision. Uptake of same-day PAFP, including LARC, increased, but there was no increase in overall uptake of PAFP 2 weeks after the abortion.
将计划生育咨询和方法提供纳入安全堕胎服务是优质堕胎护理的关键组成部分。许多人在堕胎后采用计划生育（PAFP）方面存在障碍。本研究旨在评估针对提供者的质量管理干预对 PAFP 采用率的影响。
我们在 2015 年 11 月至 2016 年 7 月期间在肯尼亚西部的 9 家私人诊所进行了一项预干预和干预后研究。我们在手术当天通过面对面访谈收集基线和干预后数据，并通过堕胎后 2 周内的后续电话访谈来衡量避孕方法的采用情况。我们还对提供者进行了半结构化访谈。干预措施包括为期 1 天的培训、咨询工作辅助和强化监督访问。主要结局是在获得堕胎后 14 天内接受任何形式的 PAFP（不包括避孕套）的客户比例。次要结局是接受 PAFP 咨询的客户比例和在服务后 14 天内接受长效可逆避孕措施（LARC）的客户比例。我们使用卡方检验和多变量逻辑回归来确定基线和干预后之间是否存在显著差异，同时调整潜在的混杂因素和诊所水平的聚类。
对 769 名妇女进行了访谈，其中 54%（414 名妇女）完成了后续电话访谈。报告的咨询质量和对服务的满意度在基线和干预后均有所提高。与基线相比，干预后当天采用 PAFP 的比例更高（比值比 1.94，p<0.001），当天采用 LARC 的比例也更高（比值比 1.72，p<0.001）。堕胎后 2 周内 PAFP 的总体采用率没有增加。提供者对干预措施的效果有不同的看法，但大多数人表示监督访问帮助他们提高了服务质量。
质量管理干预成功地提高了 PAFP 咨询和提供的质量。当天采用 PAFP（包括 LARC）的比例增加，但堕胎后 2 周内 PAFP 的总体采用率没有增加。
