Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America.
Institute for Global Health Sciences, University of California San Francisco, School of Medicine, San Francisco, CA, United States of America.
PLoS One. 2019 Nov 25;14(11):e0225333. doi: 10.1371/journal.pone.0225333. eCollection 2019.
Little evidence exists on women's experiences of care during abortion care, partly due to limitations in existing measures. Moreover, globally, the development and rapid growth in the availability of medication abortions (MA) has radically changed the options for safe abortions for women. It is therefore important to understand how women's experiences of care may differ across medication and manual vacuum aspiration (MVA) abortions. This study uses a validated person-centered abortion care scale (categorized as low, medium, and high levels, with high levels representing the greatest level of person-centered care) to assess women's experiences of care undergoing medication abortions vs. MVA. This paper reports on a cross-sectional study of 353 women undergoing abortions at one of six family planning clinics in Nairobi County, Kenya in 2018. Comparing abortion types, we found that the MVA sample was more likely to report "high" levels of person-centered abortion care compared to the MA sample (36.3% vs. 23.0%, p = 0.005). No differences were detected with respect to Respectful and Supportive Care; however, the MVA sample was significantly more likely to report "high" levels of Communication and Autonomy compared to the MA sample (23.6% vs. 11.2%, p<0.0001). In multivariable ordered logistic regression, we found that the MVA sample had a 92% greater likelihood of reporting higher person-centered abortion care scores compared to MA clients (aOR1.92, CI: 1.17-3.17). Being employed and reporting higher self-rated health were associated with higher person-centered abortion care scores, while reporting higher levels of stigma were associated with lower person-centered abortion care scores. Our findings suggest that more efforts are needed to improve the domain of Communication and Autonomy, particularly for MA clients.
关于妇女在堕胎护理过程中的体验，几乎没有证据，部分原因是现有措施存在局限性。此外，在全球范围内，药物流产（MA）的发展和迅速普及极大地改变了妇女安全堕胎的选择。因此，了解药物流产和手动真空抽吸（MVA）堕胎之间妇女护理体验的差异非常重要。本研究使用经过验证的以患者为中心的堕胎护理量表（分为低、中、高水平，高水平代表以患者为中心的护理程度最高）来评估接受药物流产与 MVA 的妇女的护理体验。本文报告了 2018 年肯尼亚内罗毕县六家计划生育诊所之一对 353 名堕胎妇女的横断面研究。比较堕胎类型，我们发现 MVA 样本比 MA 样本更有可能报告“高水平”的以患者为中心的堕胎护理（36.3%比 23.0%，p=0.005）。在尊重和支持性护理方面没有差异；然而，MVA 样本报告高水平的沟通和自主权的可能性明显高于 MA 样本（23.6%比 11.2%，p<0.0001）。在多变量有序逻辑回归中，我们发现 MVA 样本报告更高水平的以患者为中心的堕胎护理评分的可能性比 MA 客户高 92%（aOR1.92，CI：1.17-3.17）。就业和自我报告的健康状况较高与以患者为中心的堕胎护理评分较高相关，而报告的耻辱感较高与以患者为中心的堕胎护理评分较低相关。我们的研究结果表明，需要更加努力改善沟通和自主权领域，特别是对于 MA 客户。
