PT - JOURNAL ARTICLE AU - Baynes, Colin AU - Yegon, Erick AU - Lusiola, Grace AU - Kahando, Rehema AU - Ngadaya, Esther AU - Kahwa, Justin TI - Women’s Satisfaction With and Perceptions of the Quality of Postabortion Care at Public-Sector Facilities in Mainland Tanzania and in Zanzibar AID - 10.9745/GHSP-D-19-00026 DP - 2019 Aug 22 TA - Global Health: Science and Practice PG - S299--S314 VI - 7 IP - Supplement 2 4099 - http://www.ghspjournal.org/content/7/Supplement_2/S299.short 4100 - http://www.ghspjournal.org/content/7/Supplement_2/S299.full SO - GLOB HEALTH SCI PRACT2019 Aug 22; 7 AB - Tanzanian women expressed greater satisfaction with postabortion care received at district hospitals and health centers, where they experienced shorter waiting times, more family planning counseling, and threefold greater voluntary uptake of family planning, than at regional hospitals. Continued decentralization to district hospitals would likely enhance client satisfaction with postabortion care.Background: In 2015, the government of Tanzania began to strengthen the quality of postabortion care (PAC). Limited research has been conducted to understand clients’ perceptions of public sector provision of PAC. Accordingly, we carried out a mixed-method study between April and July 2016, using client surveys and in-depth interviews, both implemented immediately following PAC. Results were used to help guide the government’s initiative.Methodology: We assessed the quality of PAC in 25 public-sector facilities through a client survey of 412 women. Questions included satisfaction with client-staff interaction, counseling, provider competence, postabortion family planning, accessibility of care, and the facility environment. Based on responses, we developed and validated a scale representing women’s overall satisfaction with the quality of care. We conducted bivariate analysis to identify the levels of care associated with clients’ ranking of individual and composite measures of the quality of care. We used multivariate ordinal logistic models to assess the relative influence of multilevel factors on clients’ overall satisfaction. We coupled our survey with qualitative analysis of in-depth interviews with 30 PAC clients.Results: Clients reported moderately high levels of satisfaction with the quality of PAC, with an overall mean score of 2.6 on a 4-point scale. Bivariate analysis identified several areas for improvement, including family planning counseling and provision, especially at regional hospitals; pain management; and reduced use of sharp curettage. The factors most strongly associated with satisfaction were advanced parity, receiving care at lower-level facilities, brief waiting periods, and manual vacuum aspiration for treatment of incomplete abortion. Qualitative analysis illuminated how client-provider interactions; pain; desire for counseling and information, especially on family planning; and congested facility environments shape clients’ perceptions of the care they received.Conclusions: Although clear areas for improvement in public-sector provision of PAC existed at all sites, women were less likely to report satisfaction with care at referral facilities owing primarily to inadequate counseling, delays in receiving PAC treatment after admission, and poor emphasis on postabortion fertility, family planning information, and contraceptive provision. PAC programs should ensure availability of a wide range of contraceptive methods and high-quality family planning counseling, especially at tertiary facilities.