Availability, Accessibility and Utilization of Post-Abortion Care in Sub-Saharan Africa: a Systematic Review
HEALTH CARE FOR WOMEN INTERNATIONAL https://doi.org/10.1080/07399332.2019.1703991 REVIEW ARTICLE Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review Chimaraoke Izugbaraa, Frederick Murunga Wekesahb , Meroji Sebanya, Elizabeth Echokac, Joshua Amo-Adjeid, and Winstoun Mugab aInternational Center for Research on Women, Washington, D.C, USA; bAfrican Population & Health Research Center, Nairobi, Kenya; cCentre for Public Health Research, Kenya Medical Research Institute - KEMRI, Nairobi, Kenya; dDepartment of Population and Health, University of Cape Coast, Cape Coast, Ghana ABSTRACT ARTICLE HISTORY At the 1994 ICPD, sub-Saharan African (SSA) states pledged, Received 28 June 2019 inter alia, to guarantee quality post-abortion care (PAC) serv- Accepted 9 December 2019 ices. We synthesized existing research on PAC services provi- sion, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and avail- ability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-qual- ity treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the exist- ing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abor- tion reproductive health services in the context of PAC; and health care provider-community partnerships.
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