Indicator category or subtheme | Indicator | References |
---|---|---|
Structure indicators | ||
1) Infrastructure | There are an adequate number of knowledgeable and trained staff available to provide abortion care. | 7, 12, 24–30 |
2) Infrastructure | Timely services are available. | 24, 27, 31, 32 |
3) Infrastructure | Facilities are geographically accessible. | 12, 26, 29, 30 |
4) Infrastructure | Efficient, high-quality referral systems are in place. | 7, 33, 34 |
5) Infrastructure | Essential equipment, supplies and medications are available in sufficient quantity to address needs. | 7, 25, 27 |
6) Infrastructure | Abortion care is provided in a clean facility. | 24, 31 |
7) Infrastructure | Abortion is provided in a facility with space for privacy. | 24, 35 |
8) Infrastructure | Abortion is provided in an emotionally and physically comforting space. | 28 |
9) Infrastructure | Well-functioning systems for transportation and communications for abortion are in place. | 7 |
10) Infrastructure | Throughout the health system, there are mechanisms to review abortion-related complications and deaths. | 7 |
11) Infrastructure | Women enter the health care system through decentralised service delivery points and receive care at the lowest appropriate level of the networked system. | 7 |
12) Infrastructure | Abortion care services are integrated with or linked to the fullest available array of medical and reproductive health services. | 7 |
13) Infrastructure | Services are effectively managed and administrative and logistical factors are not obstacles to the timely delivery of high-quality care. | 7 |
14) Infrastructure | Fees for abortion services are within reach of women's ability to pay; emergency care is provided regardless of women's ability to pay. | 7 |
15) Infrastructure | There is an adequate percentage of abortion care service sites that meet a defined standard of quality. | 12 |
16) Infrastructure | Essential equipment, supplies and medication should be managed through a system of inventory control, resupply and maintenance. | 7 |
17) Infrastructure | Abortion technology is consistent with relevant regulatory requirements. | 7 |
18) Infrastructure | Abortion technology is appropriate to specific service delivery settings. | 7 |
19) Infrastructure | Abortion technology is manufactured to high standards. | 7 |
20) Infrastructure | Abortion technology is acceptable to women and providers. | 7 |
21) Infrastructure | Staff at abortion facilities have adequate supervision. | 7 |
22) Law and policies | Abortion care must be accessible and not limited by administrative or policy barriers. | 7, 12, 29, 36 |
23) Law and policies | Regulations, guidelines and other policy documents have been developed, approved by national/sub-national governments, and/or disseminated to health care facilities that are supportive of access to safe abortion care consistent with WHO guidance. | 25 |
Process indicators | ||
24) Technical competence | Appropriate pain management techniques are in place. | 24, 28, 37 |
25) Technical competence | Clients are screened for requested procedures. | 27, 33 |
26) Technical competence | Clinical histories are taken. | 27, 33 |
27) Technical competence | Physical assessments of general and sexual and reproductive health are performed (including confirmation of gestational age). | 27, 33 |
28) Technical competence | Staff follow approved guidelines and protocols for medical, surgical, and incomplete abortion. | 27, 33 |
29) Technical competence | Staff use appropriate technologies. | 33, 38 |
30) Technical competence | Follow-up care is provided, where women's experience with abortion and pregnancy status are assessed. | 33, 34 |
31) Technical competence | Clients are asked the reason for the visit. | 33 |
32) Technical competence | If the woman aborts at the clinic, products of conception are examined to confirm expulsion. | 33 |
33) Technical competence | Appropriate infection prevention protocols are in place. | 27 |
34) Technical competence | Best practice guidelines are followed for monitoring during recovery period. | 27 |
35) Technical competence | Staff only use techniques for which they are adequately trained. | 27 |
36) Client–provider interactions | Staff offer respectful care. | 7, 27, 31, 33, 35 |
37) Client–provider interactions | Staff work to ensure privacy during the visit. | 27, 31–33, 39 |
38) Client–provider interactions | Staff have positive interactions with clients. | 24, 28, 39 |
39) Client–provider interactions | Staff provide confidential care. | 7, 24, 39 |
40) Client–provider interactions | Staff should promote client's dignity. | 27, 32 |
41) Client–provider interactions | Care is tailored to women's individual circumstances and needs. | 39 |
42) Client–provider interactions | Staff hold non-judgemental attitudes. | 7 |
43) Client–provider interactions | Staff–client interactions promote an atmosphere of trust. | 7 |
44) Decision making | Clients are provided high-quality, supportive counseling. | 7, 27, 28, 34, 35 |
45) Decision making | Staff obtain informed consent from clients. | 27, 33 |
46) Decision making | Clients are provided the opportunity to explore views on abortion options and methods. | 7, 33 |
47) Decision making | Staff trust clients’ abilities to make informed decisions. | 7 |
48) Decision making | Provider–client interactions are absent of provider bias or coercion. | 7 |
49) Information provision | Staff explain all aspects of abortion care to clients (current condition, treatment plan, follow-up needs, and potential post-abortion complications and how to obtain appropriate post-abortion care). | 7, 27, 31–33, 35, 39 |
50) Information provision | Staff provide clients the opportunity to express concerns, ask questions, and receive accurate, understandable answers. | 7, 27, 33, 35 |
51) Information provision | Staff provide basic information about conception, pregnancy and pregnancy options. | 33 |
52) Information provision | Staff use age-appropriate, non-clinical language. | 33 |
53) Ancillary services | Staff directly provide or offer referrals for a range of sexual and reproductive health services, including contraception and screening and treatment for HIV and STIs. | 7, 12, 25, 27, 29, 33, 38, 39 |
54) Ancillary services | Staff provide information about a range of sexual and reproductive health needs including: contraception, fertility, gender-based violence, prenatal care, cancer screening, and screening and treatment for HIV and STIs. | 7, 27, 30, 32, 33, 39 |
55) Ancillary services | Abortion care is no way contingent on prior acceptance of contraception. | 7 |
56) Support | If desired, staff ensure emotional comfort provided to client from support person during abortion. | 24, 28, 33 |
57) Support | Staff explore what kind of support client has for their decision. | 33 |
Output indicators | ||
58) Procedures provided | Assess the number of safe induced abortion procedures. | 12, 30, 40 |
59) Procedures provided | Assess the proportion of procedures that are induced. | 29 |
60) Procedures provided | Assess the percentage of uterine evacuations performed with appropriate technologies. | 29 |
61) Procedures provided | Assess the percentage of abortion procedures performed with preferred technologies. | 12 |
Outcome indicators | ||
62) Client and community knowledge | The community is aware of the availability of safe abortion. | 26, 27 |
63) Client and community knowledge | Clients understand the information given during clinic visits. | 35 |
64) Client and community knowledge | An adequate number or percentage of women of reproductive age have accurate knowledge of abortion laws. | 12 |
65) Client and community knowledge | An adequate number or percentage of women of reproductive age can identify a nearby source of safe abortion care. | 12 |
66) Client and community knowledge | Women are aware of the full range of services available to them throughout the health care system. | 7 |
67) Client and community attitudes | Clients are satisfied with abortion care. | 12, 34 |
68) Client and community attitudes | There is an adequate number or percentage of women with positive attitudes toward seeking abortion care. | 12 |
69) Client and community attitudes | Women perceive few financial, geographic and cultural barriers to safe abortion care. | 12 |
70) Client and community attitudes | Clients feel that the staff have a high level of clinical competency. | 33 |
71) Client and community attitudes | Clients have confidence and trust in staff providing care. | 32 |
72) Client behaviours | Assess overall abortion-seeking behaviours and trends. | 36 |
73) Client behaviours | Assess the percentage of abortions that occur at or before 10 weeks’ gestations. | 41 |
74) Client morbidity and mortality | There is a low number of admissions for treatment of abortion complications. | 12, 25, 29, 30, 36 |
75) Client morbidity and mortality | There is a low percentage of maternal deaths as a result of abortion. | 12, 26, 29, 40 |
STI, sexually transmitted infection; WHO, World Health Organization.