UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
Department of Health Financing and Economics, WHO, Geneva, Switzerland.
BMJ Glob Health. 2023 Aug;8(Suppl 4). doi: 10.1136/bmjgh-2023-012321.
Service inclusion in a country's health benefit package (HBP) is an important milestone towards universal health coverage. This study aimed to explore HBP inclusion of abortion interventions globally.
Secondary analysis of the WHO HBP survey, in which officially nominated survey focal points were asked which interventions were included within the HBP of their country or area's largest government health financing scheme. Abortion inclusion was compared by region, income, legal status of abortion and HBP design process variables. Abortion inclusion was compared with other sexual and reproductive health (SRH) services.
Below half (45%) reported that abortion is included, but treatment of complications from unsafe abortion was more commonly included (63%). Fewer fully included essential abortion medications (22% mifepristone, 42% misoprostol). Abortion was less commonly included than any other SRH service in the survey. Unlike most SRH services, higher cost, higher technology care to treat complications of unsafe abortion was more commonly included than the relatively lower cost, lower technology service of induced abortion. Higher-income contexts and less restrictive legal environments had higher abortion inclusion. Some contexts had additional restrictions, with abortion inclusion dependent on the patient's reason for seeking care.
This global survey finds that abortion services and medications are often not included within HBPs, while treatment of complications from unsafe abortion is more commonly included. There are opportunities to improve HBP abortion inclusion across different legal contexts, which can improve health outcomes and reduce the need for higher cost treatment of complications from unsafe abortion.
服务纳入一个国家的健康福利套餐（HBP）是实现全民健康覆盖的一个重要里程碑。本研究旨在探讨全球范围内 HBP 对堕胎干预措施的涵盖情况。
对世卫组织 HBP 调查进行二次分析，向正式提名的调查协调人询问其国家或地区最大政府卫生筹资计划的 HBP 中包含哪些干预措施。根据区域、收入、堕胎的法律地位以及 HBP 设计过程变量来比较堕胎的纳入情况。将堕胎纳入情况与其他性健康和生殖健康（SRH）服务进行比较。
不到一半（45%）的人报告堕胎被纳入其中，但治疗不安全堕胎并发症的服务更常见（63%）。完全纳入基本堕胎药物的情况较少（22%米非司酮，42%米索前列醇）。堕胎比调查中的任何其他 SRH 服务都更不常见。与大多数 SRH 服务不同，治疗不安全堕胎并发症的高成本、高科技护理比相对低成本、低技术的人工流产服务更常见。高收入环境和限制较少的法律环境的堕胎纳入率更高。一些国家有额外的限制，堕胎的纳入取决于患者寻求治疗的原因。
这项全球调查发现，堕胎服务和药物通常不纳入 HBP，而治疗不安全堕胎的并发症则更常见。在不同的法律环境下，有机会改善 HBP 堕胎纳入情况，这可以改善健康结果，并减少对不安全堕胎并发症的高成本治疗的需求。
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