Medical abortion service in rural areas of Henan Province, China: a provider survey

Challenges in the abortion supply chain: a call to action for evaluation research

BACKGROUND

Reducing the burden of unsafe abortion rests considerably on women's ability to access appropriate and timely treatment or services. A critical component of that care relies on a functional supply chain to ensure availability of abortion drugs and supplies within the health system. Disruptions in the supply of medical abortion drugs delay provision of abortion services and can increase the risks to a woman's health. We examine the ways in which supply chain management (SCM) affects women's ability to access safe and timely abortion to meet their reproductive health needs and highlight the gap in evaluation research on which SCM interventions best improve access to safe abortion care. SCM comprises a critical component of efficient and sustainable abortion service provision and is a requisite for expansion of services. Furthermore, governments are responsible for safeguarding links in the abortion supply chain, from registration to distribution of abortion drugs and supplies. Strategic public-private partnerships and use of innovative local or community-based distribution mechanisms can strengthen supply chain systems. Finally, alternatives to the pull-based models of distribution could alleviate bottlenecks in the final steps of abortion supply chains. Programs aimed at increasing access to safe and comprehensive abortion care must include SCM as a foundational component of service provision. Without access to a sustainable and affordable supply of abortion drugs and equipment, any attempt at providing abortion services will be critically limited. More implementation research is needed to identify the most effective interventions for improving SCM.

Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study

OBJECTIVE

To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors.

METHODS

A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling.

RESULTS

94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20-72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with 'east region', OR_adj=3.33, 95% CI: 2.12-5.21) conducted more PAFP counseling; providers with more knowledge (OR_adj=2.08, 95% CI: 1.38-3.15) provided more counseling; and compared with 'middle school and below', providers with higher education gave more counseling [OR_adj(95% CI)] for 'college', 'university' and 'master/doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively].

CONCLUSIONS

The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.

Assessment of effects of mifepristone administration to lactating mice on the development and fertility of their progeny

AIM

Mifepristone, a synthetic steroid compound that induces abortion, was recently found to potentially pass into human milk. This study aimed to determine the effects of mifepristone administration to lactating mice on the development and reproduction of their progeny.

METHODS

Lactating mice were gavage fed with mifepristone (8 mg/kg) daily for 4 days either from days 1-4 or from days 7-10 of lactation; controls received only peanut oil. Growth, mortality rate, organ weight to bodyweight ratio, sex hormone at 20, 40 and 60 days, fertility of these F1 progeny and litter size, sex ratio and mortality rate of the second generation were recorded.

RESULTS

No significant differences were observed in the average bodyweight, mortality rate of the female or male pups, and organ coefficient of uterus and ovaries of females in adulthood in comparison with the controls. However, the organ coefficient of testis at day 20 and 40 and testosterone concentration at day 60 were increased in male pups. Moreover, the reproductive capacity of the F1 pups was unaffected by 4 days exposure to mifepristone via their mother's milk: time to birth of F2 pups, litter size, sex ratio and mortality rate were similar to control F1 pups.

CONCLUSION

The study showed that treating lactating mice with 8 mg/kg mifepristone influenced only the organ coefficient of testis at day 40 and the testosterone concentration in male pups at day 60, however, it did not affect the development and fertility of female and male pups.

Knowledge and provision practices regarding medical abortion among public providers in Hanoi, Khanh Hoa, and Ho Chi Minh City, Vietnam

OBJECTIVE

To assess public service providers' knowledge of medical abortion (MA) and practices, and perspectives on expanding the use of MA to primary and secondary health facilities in Vietnam.

METHODS

A cross-sectional study was conducted via an interviewer-administered questionnaire among abortion providers (n=905) from public health facilities between August 2011 and January 2012.

RESULTS

Overall, 31.1% of providers performed both surgical and medical abortions; 68.9% offered only surgical abortion. Providers were knowledgeable about the regimen/dosage of mifepristone plus misoprostol regimen; however, knowledge scores were low for gestational age limits for MA, adverse effects of the combined drug regimen, and safety and effectiveness of MA compared with surgical abortion. Knowledge scores were significantly lower among providers in rural areas than among those in urban settings. A large proportion of providers (82.9%) thought that MA should be expanded to primary and secondary health facilities. Perceived barriers to MA expansion included lack of knowledge and training, qualified staff, adequate drug supplies, equipment, or facilities, guidelines and protocols on MA, and patient awareness.

CONCLUSION

Provision of MA in Vietnam was found to be disproportionate to surgical abortion provision and to vary by region. Knowledge of MA was moderate, but poorer among providers in rural settings.