PDF(Pubmed)
Abstract：
BACKGROUND: The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access.
METHODS: Data on 153 facilities from the 2017-2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017-2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively.
RESULTS: Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth.
CONCLUSIONS: Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.
METHODS: Data on 153 facilities from the 2017-2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017-2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively.
RESULTS: Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth.
CONCLUSIONS: Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.
摘要：
背景：刚果民主共和国（DRC）于2018年将堕胎合法化，以维护健康，并承诺提供优质的堕胎后护理（PAC），然而，人们对堕胎护理服务的可用性以及设施是否准备提供这些服务知之甚少；对这些服务的可及性知之甚少。利用金沙萨和孔戈中部的设施和人口数据，这项研究调查了堕胎服务的可用性，准备好提供它们的设施，和访问不平等。
方法：使用来自2017-2018年刚果民主共和国人口与健康调查服务提供评估（SPA）的153个设施的数据来检查信号功能和设施在三个堕胎护理领域（终止妊娠，流产并发症的基本治疗，和流产并发症的综合治疗）。检查堕胎非刑事化前后的PAC和药物流产规定，我们将2017-2018年SPA设施的估计值与2021年收集的绩效监测行动(PMA)数据的估计值进行了比较(n=388).最后,我们通过在地理上将设施与金沙萨和KongoCentral的2,326和1,856名妇女的代表性样本联系起来，使用PMA评估了与PAC和药物流产的接近程度，分别。
结果：很少有设施具有每个堕胎护理领域下的所有信号功能，但是大多数设施具有许多信号功能：每个领域的总体准备分数>60％。总的来说,与主要设施相比，转诊设施的就绪性较高。设施准备的主要障碍是米索前列醇的库存短缺，可注射抗生素，和避孕。总的来说,非刑事定罪后提供的服务更高。金沙萨城市几乎普遍使用提供PAC和药物流产的设施，但是KongoCentral农村的模式与受教育程度和财富呈正相关。
结论：大多数设施具有提供堕胎服务的许多必要信号功能，但大多数人经历了商品供应方面的挑战。服务的可及性也存在不平等。应对供应链挑战的干预措施可能会提高设施提供堕胎护理服务的准备程度。需要进一步努力缩小可访问性的差距，特别是来自农村地区的贫困妇女。
方法：使用来自2017-2018年刚果民主共和国人口与健康调查服务提供评估（SPA）的153个设施的数据来检查信号功能和设施在三个堕胎护理领域（终止妊娠，流产并发症的基本治疗，和流产并发症的综合治疗）。检查堕胎非刑事化前后的PAC和药物流产规定，我们将2017-2018年SPA设施的估计值与2021年收集的绩效监测行动(PMA)数据的估计值进行了比较(n=388).最后,我们通过在地理上将设施与金沙萨和KongoCentral的2,326和1,856名妇女的代表性样本联系起来，使用PMA评估了与PAC和药物流产的接近程度，分别。
结果：很少有设施具有每个堕胎护理领域下的所有信号功能，但是大多数设施具有许多信号功能：每个领域的总体准备分数>60％。总的来说,与主要设施相比，转诊设施的就绪性较高。设施准备的主要障碍是米索前列醇的库存短缺，可注射抗生素，和避孕。总的来说,非刑事定罪后提供的服务更高。金沙萨城市几乎普遍使用提供PAC和药物流产的设施，但是KongoCentral农村的模式与受教育程度和财富呈正相关。
结论：大多数设施具有提供堕胎服务的许多必要信号功能，但大多数人经历了商品供应方面的挑战。服务的可及性也存在不平等。应对供应链挑战的干预措施可能会提高设施提供堕胎护理服务的准备程度。需要进一步努力缩小可访问性的差距，特别是来自农村地区的贫困妇女。
