Jacobson Laura E, Jayaweera Ruvani, Footman Katy, Goodman Julia M, Gerdts Caitlin, Darney Blair G
Health Systems & Policy, OHSU-PSU School of Public Health, Portland, OR, United States; Oregon Health and Science University, Department of Obstetrics and Gynecology, Portland, OR, United States; Ibis Reproductive Health, Oakland, CA, United States.
Ibis Reproductive Health, Oakland, CA, United States.
Contraception. 2025 Jan;141:110700. doi: 10.1016/j.contraception.2024.110700. Epub 2024 Sep 2.
To understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care.
We conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain.
Most participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines.
Medication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care.
Follow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence.
了解中低收入国家中自行管理药物流产的人群以及接受机构管理护理的人群在机构内的后续护理寻求行为。我们探究有助于满足个人自我报告的后续护理需求的因素，这是以人为本护理的核心。
我们对67名自行管理药物流产或接受机构管理药物流产护理的人员进行的深入访谈进行了定性的、基于编码手册的主题分析。我们首先将个体分类为其后续护理需求得到满足（当参与者确信不需要或不期望额外护理时不寻求护理，或者在需要时接受护理）或未得到满足。我们的先验分析领域来自健康服务利用的安德森模型——促成或未促成后续护理需求得到满足的易患因素、促成因素或需求因素（对健康服务的感知和评估需求）。我们还描述了每个领域中出现的主题。
大多数参与者（n = 59，88%）的后续护理需求得到满足；一半（n = 33，49%）在机构中寻求后续护理。既往生育或流产经历成为后续护理需求得到满足的易患因素。有陪伴支持（来自在临床环境之外提供流产指导的活动家或热线）、了解预期情况以及信息来源是后续护理需求得到满足的关键促成因素。需求因素包括灵活的后续护理指南。那些后续护理需求未得到满足的人描述了负面的健康系统经历这一易患因素；促成因素包括健康系统挑战、提供者的污名化以及法律风险；以及所需后续护理指南的需求因素。
药物流产的后续护理经历多种多样，个人需求在医疗机构内外都能得到满足。了解既往经历、提供陪伴支持以及考虑灵活的后续护理指南有助于满足个人的后续护理需求，这对于以人为本的流产护理至关重要。
后续护理需求对于确保获得高质量流产服务至关重要，在自行管理和机构内药物流产模式中都能得到满足。要求人们在不需要或不期望时进行后续护理的政策可能会强化自行管理流产不安全或无效的观念，尽管已有相关证据。
