Women’s Satisfaction With and Perceptions of the Quality of Postabortion Care at Public-Sector Facilities in Mainland Tanzania and in Zanzibar

Colin Baynes; Erick Yegon; Grace Lusiola; Rehema Kahando; Esther Ngadaya; Justin Kahwa

doi:10.9745/GHSP-D-19-00026

Figures & Tables

Tables

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TABLE 1.

Study Population by Sociodemographic Variables, Mainland Tanzania and Zanzibar

		Parity	Married/In Union	Completed Primary School	Income-Generating Occupation^a	Christian	Muslim
Age	No. (%)	Mean	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)
<20	50 (12)	<1.0	28 (56)	37 (74)	15 (30)	18 (36)	32 (64)
20–24	113 (27)	1.0	85 (75)	86 (76)	38 (34)	49 (43)	63 (57)
25–29	82 (20)	2.0	68 (83)	61 (74)	41 (50)	46 (56)	36 (44)
30–34	70 (17)	3.0	62 (89)	51 (73)	34 (33)	34 (49)	36 (51)
35–39	54 (13)	4.3	49 (91)	31 (57)	23 (43)	29 (54)	25 (46)
40–46	30 (7)	5.4	27 (90)	21 (70)	13 (43)	22 (73)	9 (27)
Missing	13 (3)	3.6	13 (100)	10 (77)	3 (23)	10 (77)	3 (23)
Overall	412 (100)	2.3	332 (81)	297 (72)	167 (41)	208 (50)	204 (50)

↵a Participant had her own job that generated an income. Other participants reported that they were not working or were subsistence farmers or homemakers.

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TABLE 2.

Study Population by Abortion Characteristic and PAC Visit Variables, Mainland Tanzania and Zanzibar (N=412)

Measure	No. (%)
Timing of care seeking after observing danger signs of complication
1 day	110 (26.7)
2 days	98 (23.7)
3–4 days	99 (24.0)
≥5 days	105 (25.0)
Gestational age at onset of complications
≤12 weeks	283 (68.7)
13–18 weeks	65 (15.8)
≥19 weeks	64 (15.5)
Client- Report of Spontaneous or Induced Abortion
Induced	52 (12.4)
Spontaneous	360 (87.6)
Participants’ prior experience
Ever had an abortion in the past	78 (18.9)
Ever received PAC for a previous abortion	51 (12.4)
First abortion	334 (81.9)
Participants’ recall of desire for the pregnancy leading to their need for PAC
Pregnancy was intended	236 (57.3)
Pregnancy was unintended	165 (40.1)
Pregnancy was mistimed (desire to delay)	123 (29.9)
Pregnancy was unwanted (desire to limit)	28 (6.8)
Postabortion fertility preferences
Would like to get pregnant immediately	92 (22.3)
Would like to get pregnant within 2 years	120 (29.1)
Would like to get pregnant again after 2 years	100 (24.3)
Would like to cease childbearing completely	43 (10.4)
No clear intention for future childbearing	32 (7.8)
Ever used a modern family planning method	198 (48.1)
Facility type where PAC was received
Regional referral hospital	254 (61.2)
District hospital	138 (33.4)
Health center	20 (4.8)
Waiting time at facility before receiving care for abortion complication
Immediately	140 (34.7)
≤30 minutes	87 (21.6)
31–120 minutes	88 (21.8)
>2 hours	88 (21.8)
PAC treatment method used
MVA	265 (64.3)
Sharp curettage	77 (18.7)
Misoprostol	35 (8.5)
Received pain medication
Yes	215 (52.2)
No	197 (47.8)
Recall of counseling on emergency treatment procedure
MVA clients	106 (40.0)
Sharp curettage clients	30 (39.0)
Misoprostol clients	14 (40.0)
Total	150 (36.4)
Recall of other counseling messages
Post-procedure recovery and self-care practices	57 (13.8)
Post-procedure danger signs	158 (38.4)
STI/HIV	11 (2.7)
Postabortion return to fertility	113 (27.4)
Recall of postabortion family planning counseling and services
Discussed future fertility intentions with provider	55 (13.4)
Discussed contraceptive methods with provider	124 (30.1)
Chose and received a modern postabortion contraceptive method	72 (17.4)
Condom (male)	4 (<1%)
Condom (female)	1 (<1%)
Oral contraceptives	23 (5.6)
Injectable (Depo Provera)	19 (4.6)
Implant	5 (1.2)
Intrauterine device	18 (4.3)
Tubal ligation	2 (<1)
Chose a traditional method	6 (1.5)

Abbreviations: MVA, manual vacuum aspiration; PAC, postabortion care; STI, sexually transmitted infection.

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TABLE 3.

Study Population by Likert Scale Measures on Client Satisfaction, Mainland Tanzania and Zanzibar (N=412)

		No. (%)
Satisfaction Measure		Very Low (1)	Low (2)	High (3)	Very High (4)
1	Waiting time before receiving care	42 (10)	12 (3)	63 (16)	292 (71)
2	Privacy of counseling and procedure	31 (8)	9 (2)	55 (14)	312 (77)
3	Cleanliness of facility/PAC room	21 (5)	19 (5)	111 (27)	258 (63)
4	Organization of services	15 (4)	12 (3)	78 (19)	304 (74)
5	Treatment from staff of the facility	9 (2)	12 (3)	58 (14)	327 (81)
6	Treatment from the PAC provider	17 (4)	2 (<1)	45 (11)	344 (84)
7	Clarity, thoroughness of counseling	46 (11)	17 (4)	67 (16)	279 (68)
8	Contraceptive counseling and access to methods	66 (16)	23 (6)	60 (15)	260 (64)
9	Perception of confidentiality of client information.	35 (9)	21 (5)	47 (11)	306 (75)
10	Technical skills of PAC provider	49 (12)	10 (2)	111 (27)	240 (58)
11	Agreement to recommend service to a friend	33 (8)	—	18 (4)	356 (87)
12	Agreement to come back to the same facility for the service again	20 (5)	1 (>1)	16 (4)	340 (90)
Composite score on satisfaction^a		115 (28)^b	83 (20)^c	131 (32)^d	83 (20)^e

Abbreviation: PAC, postabortion care.
↵a Cronbach’s alpha coefficient was calculated to validate the scale (α=.80).
↵b Mean score of 1–12, ≤2.5.
↵c Mean score of 1–12, >2.5 and ≤2.67.
↵d Mean score of 1–12, >2.67 and ≤2.75.
↵e Mean score of 1–12, >2.75.

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TABLE 4.

Service Characteristics and Client Satisfaction at High- and Lower-Level Facilities, Mainland Tanzania and Zanzibar

	Regional Hospital (N=254)	District Hospital or Health Center (N=158)
Service Characteristics and Client Satisfaction	No. (%)	No. (%)
Waiting time at facility before receiving care^**
Immediately	82 (33.3)	58 (36.9)
≤30 minutes	43 (17.5)	45 (28.7)
30–120 minutes	45 (18.3)	42 (26.8)
>120 minutes	76 (30.9)	12 (7.6)
PAC treatment method used^**
MVA	169 (72.8)	96 (65.8)
Sharp curettage	53 (22.8)	25 (17.1)
Misoprostol	10 (4.3)	25 (17.1)
Received pain relief medication^*
Yes	146 (57.4)	69 (43.7)
No	108 (42.6)	89 (56.3)
Recalled receiving counseling on treatment procedure^*
Yes	88 (34.6)	70 (44.3)
No	166 (65.4)	88 (55.7)
Recalled receiving counseling on post-procedure danger signs^**
Yes	114 (44.9)	27.9 (44)
No	140 (55.1)	114 (72.1)
Recalled receiving counseling on HIV/STIs
Yes	8 (3.2)	3 (1.9)
No	246 (96.8)	155 (98.1)
Recalled receiving counseling on postabortion fertility^*
Yes	60 (23.6)	53 (33.5)
No	194 (76.4)	105 (66.5)
Recalled discussing fertility intentions^**
Yes	16 (6.3)	39 (24.7)
No	238 (93.7)	119 (75.3)
Recalled receiving counseling on contraceptive methods^**
Yes	50 (19.7)	68 (43.0)
No	204 (80.3)	90 (57.0)
Chose and received a modern family planning method^**
Yes	24 (9.5)	48 (30.4)
No	230 (90.5)	110 (69.6)
Composite satisfaction score^**
Very low	92 (36.2)	26 (16.4)
Low	48 (18.9)	35 (22.2)
High	76 (29.9)	55 (34.8)
Very high	38 (15.0)	42 (26.6)

Abbreviations: MVA, manual vacuum aspiration; STI, sexually transmitted infection.
↵* P<.05;
↵** P<.001.

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TABLE 5.

Factors Associated With Experience of Service Quality: Multivariate Analysis

Measure	OR (95% CI)	P Value
Parity
No children	Reference
≥1 child	1.66 (1.10, 2.52)	.02
Time to facility
≤30 minutes	Reference
>30 minutes	1.09 (0.69, 1.53)	.72
Facility type
Referral hospital	Reference
Lower-level site	1.79 (1.27, 2.56)	.001
Time waited at the facility prior to seeing a provider
≤30 minutes	Reference
>30 minutes	0.74 (0.58, 0.93)	.02
PAC treatment method
MVA	Reference
Other evacuation method	0.69 (0.51, 0.92)	.01
Received pain relief medication
Yes	Reference
No	0.90 (0.61, 1.32)	.58
Recalled counseling information on PAC treatment procedure
No	Reference
Yes	1.01 (0.67, 1.50)	.98
Recalled counseling information on contraceptive methods
No	Reference
Yes	1.05 (0.67, 1.65)	.81
Chose and received a modern family planning method
No	Reference
Yes	1.23 (0.98, 1.92)	.28