Objective We used the newly developed Abortion Care Quality Tool (ACQTool) to compare client-reported quality of medication abortion care by source (facility-managed vs pharmacy-sourced self-managed abortion (SMA)) in Bangladesh.
Methods We leveraged exit and 30-day follow-up surveys collected to develop and validate the ACQTool collected at nongovernmental organisation (NGO)-supported or -operated facilities in the public and private sector and pharmacies from three districts in Bangladesh. We used bivariate statistics to compare 18 client-reported quality indicators grouped in six domains and eight abortion outcomes, by source (facility vs pharmacy). We used multivariable logistic regression to identify factors associated with selected quality indicators and outcomes (abortion affordability, information provision, and knowing what to do for an adverse event), controlling for client sociodemographic characteristics.
Results Of 550 abortion clients, 146 (26.5%) received a facility-managed medication abortion and 404 (73.5%) had a pharmacy-sourced SMA. Clients reported higher quality in facilities for five indicators, and higher in pharmacies for two indicators; the remaining 11 indicators were not different by source. Compared with facility-based clients, pharmacy clients had higher odds of reporting that the cost of abortion was affordable (adjusted odds ratio (aOR) 3.55; 95% CI 2.27 to 5.58) but lower odds of reporting high information provision (aOR 0.14; 95% CI 0.09 to 0.23). Seven of eight abortion outcomes showed no differences; pharmacy clients had lower odds of knowing what to do if an adverse event occurred (aOR 0.45; 95% CI 0.23 to 0.82).
Conclusions In Bangladesh, there is no difference in client-reported quality of medication abortion care between health facilities and pharmacies for the majority of quality and outcome indicators. However, information provision and preparedness were higher quality at facilities, while pharmacies were more affordable.
- abortion, induced
- health services research
- reproductive health services
Data availability statement
Deidentified data are available from Metrics for Management upon reasonable request. The data are not publicly available due to privacy concerns for abortion clients, providers, and sites.
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Contributors LEJ: conceptualisation (lead), writing original draft (lead), data analysis (lead), data curation (equal), and guarantor of this research. SEB: writing – review and editing (supporting), data curation (equal). EP: conceptualisation (supporting), writing – review and editing (supporting), data curation (equal). RC: writing – review and editing (supporting), data curation (supporting). NMC: writing – review and editing (supporting), data curation (equal). RC: writing – review and editing (equal). JMG: conceptualisation (supporting), writing – review and editing (supporting). CG: conceptualisation (supporting), writing – review and editing (supporting). BGD: conceptualisation (supporting), data analysis (supporting), writing – review and editing (supporting).
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BGD’s institution receives research funding from Organon and the Office of Population Affairs (OPA) on which she is Principal Investigator, and she is a member of the Board of Directors of the Society of Family Planning (SFP) and a Deputy Editor on Contraception. She has received an honorarium from the American College of Obstetrics and Gynecology (ACOG) for committee work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. However, the ACQTool used in this analysis was informed by extensive qualitative interviews with abortion clients in four countries.
Provenance and peer review Not commissioned; externally peer reviewed.
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