Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP, UK.
Marie Stopes Kenya, Kindaruma Road, P.O. Box 59328-00200, Nairobi, Kenya.
Reprod Health. 2018 Apr 24;15(1):70. doi: 10.1186/s12978-018-0509-4.
To inform improvements in safe abortion and post-abortion family planning (PAFP) services, this study aimed to explore the pathways, decision-making, experiences and preferences of women receiving safe abortion and post-abortion family planning (PAFP) at private clinics in western Kenya.
We conducted semi-structured interviews with 22 women who had recently used a safe abortion service from a private clinic. Interviews explored abortion-seeking behaviour and decision-making, abortion experience, use and knowledge of contraception, experience of PAFP counselling, and perceived facilitators of and challenges to family planning use.
Respondents discovered their pregnancies due to physical symptoms, which were confirmed using pregnancy testing kits, often purchased from pharmacies. Respondents usually discussed their abortion decision with their partner, and, sometimes, carefully-selected friends or family members. Some reported being referred to private clinics for abortion services directly from other providers. Others had more complex pathways, first seeking care from unsafe providers, trying to self-induce abortion, being turned away from alternative safe facilities that were closed or too busy, or taking time to gather financial resources to pay for care. Participants wanted to use abortion services at facilities reputed for being accessible, clean, medically safe, and offering quick, respectful, private and courteous services. Awareness of reputable clinics was gained through personal experience, and recommendations from contacts and other health providers. Most participants had previously used contraception, with some reports of incorrect use and many reports of side effects. PAFP counselling was valued by clients, but some accounts suggested the counselling lacked comprehensive information. Many women chose contraception immediately following PAFP counselling; but others wanted to delay decision-making about contraception until the abortion was complete.
Women's pathways to safe abortion care can be complex, including use of multiple abortion methods, delays due to financial barriers, and challenges accessing safe providers. Improvements in community knowledge of safe abortion care and accessibility of services are needed to reduce recourse to unsafe abortion. PAFP counselling is valued by clients but quality of counselling can be improved by exploring women's contraceptive histories, including information on more contraceptive methods, and inclusion of support for women who want to delay family planning uptake until their abortion is complete.
为了改进安全堕胎和堕胎后计划生育（PAFP）服务，本研究旨在探索在肯尼亚西部私人诊所接受安全堕胎和堕胎后计划生育（PAFP）的妇女的途径、决策、经验和偏好。
我们对最近在私人诊所使用安全堕胎服务的 22 名妇女进行了半结构化访谈。访谈探讨了寻求堕胎行为和决策、堕胎经验、对避孕措施的使用和了解、PAFP 咨询的经验，以及对计划生育使用的促进因素和挑战的看法。
受访者因身体症状而发现怀孕，这些症状通常通过在药店购买的妊娠测试包来确认。受访者通常会与伴侣讨论堕胎决定，有时也会与精心挑选的朋友或家人讨论。一些人报告说，她们是直接从其他提供者那里被转介到私人诊所进行堕胎服务的。其他人的途径则更为复杂，她们首先寻求不安全提供者的护理，试图自行堕胎，被其他安全设施拒绝，这些设施要么关闭，要么太忙，要么花时间筹集资金来支付护理费用。参与者希望在以易于接近、干净、医疗安全、提供快速、尊重、私密和礼貌服务而闻名的设施中使用堕胎服务。对声誉良好的诊所的了解是通过个人经验以及联系人的推荐和其他卫生提供者获得的。大多数参与者之前曾使用过避孕措施，但有些报告显示使用不当，许多报告显示有副作用。PAFP 咨询受到客户的重视，但有些说法表明咨询缺乏全面的信息。许多妇女在 PAFP 咨询后立即选择避孕措施；但也有一些人希望在堕胎完成后再决定是否使用避孕措施。
妇女获得安全堕胎护理的途径可能很复杂，包括使用多种堕胎方法、因经济障碍而导致的延迟，以及获得安全提供者的挑战。需要提高社区对安全堕胎护理的认识，并改善服务的可及性，以减少不安全堕胎的发生。PAFP 咨询受到客户的重视，但可以通过探讨妇女的避孕史来提高咨询质量，包括提供更多避孕方法的信息，并为希望在堕胎完成后再开始计划生育的妇女提供支持。
