Abstract：
BACKGROUND: Abortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities\' capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect.
METHODS: We collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities\' capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period.
RESULTS: In both countries, service coverage was high and improved over time, but facilities\' capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%.
CONCLUSIONS: The findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.
METHODS: We collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities\' capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period.
RESULTS: In both countries, service coverage was high and improved over time, but facilities\' capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%.
CONCLUSIONS: The findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.
摘要：
背景：堕胎相关并发症导致可预防的孕产妇死亡，占全球孕产妇死亡的9.8%，撒哈拉以南非洲地区为15.6%。高质量的流产后护理（PAC）可以减轻与不安全流产相关的负面健康结果。虽然扩大的全球禁酒规则政策并未禁止提供PAC，其他研究表明，该政策的过度实施对这些服务产生了影响。这项研究的目的是评估该政策生效期间，在乌干达和埃塞俄比亚提供PAC服务以及安全堕胎护理（SAC）的医疗机构的能力。
方法：我们从埃塞俄比亚（N=282）和乌干达（N=223）的公共卫生机构收集了2018年至2020年之间的堕胎护理数据。我们采用了信号功能方法来创建医疗机构能力的综合指标，以提供基本和全面的PAC和SAC，并提供描述性统计数据，记录GGR生效前后的服务提供状况。我们还调查了这段时间的案件量趋势。
结果：在这两个国家，服务覆盖率很高，并且随着时间的推移而改善，但乌干达（2019年为17.8%）和埃塞俄比亚（2020年为15.0%）的设施提供基本PAC服务的能力较低。随着时间的推移，乌干达的PAC病例数量增加了15.5%，埃塞俄比亚则减少了7%。埃塞俄比亚的基本SAC产能从66.7%大幅增加到82.8%，部分原因是药物流产的提供增加，埃塞俄比亚的安全堕胎数量增加了9.7%。
结论：这项分析的结果表明，埃塞俄比亚和乌干达的公共卫生系统能够在GGR期间维持基本的PAC/SAC服务。在埃塞俄比亚,在这段时间内,安全堕胎服务的可获得性有所改善,堕胎的安全性也有总体改善.尽管失去了伙伴关系和转诊链的潜在中断，较低级别的设施能够扩大提供PAC服务的能力。然而,乌干达的PAC案件量增加，这可能表明，正如假设的那样，堕胎变得更加污名化，更容易接近和更不安全。
方法：我们从埃塞俄比亚（N=282）和乌干达（N=223）的公共卫生机构收集了2018年至2020年之间的堕胎护理数据。我们采用了信号功能方法来创建医疗机构能力的综合指标，以提供基本和全面的PAC和SAC，并提供描述性统计数据，记录GGR生效前后的服务提供状况。我们还调查了这段时间的案件量趋势。
结果：在这两个国家，服务覆盖率很高，并且随着时间的推移而改善，但乌干达（2019年为17.8%）和埃塞俄比亚（2020年为15.0%）的设施提供基本PAC服务的能力较低。随着时间的推移，乌干达的PAC病例数量增加了15.5%，埃塞俄比亚则减少了7%。埃塞俄比亚的基本SAC产能从66.7%大幅增加到82.8%，部分原因是药物流产的提供增加，埃塞俄比亚的安全堕胎数量增加了9.7%。
结论：这项分析的结果表明，埃塞俄比亚和乌干达的公共卫生系统能够在GGR期间维持基本的PAC/SAC服务。在埃塞俄比亚,在这段时间内,安全堕胎服务的可获得性有所改善,堕胎的安全性也有总体改善.尽管失去了伙伴关系和转诊链的潜在中断，较低级别的设施能够扩大提供PAC服务的能力。然而,乌干达的PAC案件量增加，这可能表明，正如假设的那样，堕胎变得更加污名化，更容易接近和更不安全。
