Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services

Autoři: May Sudhinaraset aff001;  Amanda Landrian aff001;  Dominic Montagu aff002;  Ziporah Mugwanga aff003
Působiště autorů: Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America aff001;  Institute for Global Health Sciences, University of California San Francisco, School of Medicine, San Francisco, CA, United States of America aff002;  Marie Stopes Kenya, Nairobi, Kenya aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225333


Little evidence exists on women’s experiences of care during abortion care, partly due to limitations in existing measures. Moreover, globally, the development and rapid growth in the availability of medication abortions (MA) has radically changed the options for safe abortions for women. It is therefore important to understand how women’s experiences of care may differ across medication and manual vacuum aspiration (MVA) abortions. This study uses a validated person-centered abortion care scale (categorized as low, medium, and high levels, with high levels representing the greatest level of person-centered care) to assess women’s experiences of care undergoing medication abortions vs. MVA. This paper reports on a cross-sectional study of 353 women undergoing abortions at one of six family planning clinics in Nairobi County, Kenya in 2018. Comparing abortion types, we found that the MVA sample was more likely to report “high” levels of person-centered abortion care compared to the MA sample (36.3% vs. 23.0%, p = 0.005). No differences were detected with respect to Respectful and Supportive Care; however, the MVA sample was significantly more likely to report “high” levels of Communication and Autonomy compared to the MA sample (23.6% vs. 11.2%, p<0.0001). In multivariable ordered logistic regression, we found that the MVA sample had a 92% greater likelihood of reporting higher person-centered abortion care scores compared to MA clients (aOR1.92, CI: 1.17–3.17). Being employed and reporting higher self-rated health were associated with higher person-centered abortion care scores, while reporting higher levels of stigma were associated with lower person-centered abortion care scores. Our findings suggest that more efforts are needed to improve the domain of Communication and Autonomy, particularly for MA clients.

Klíčová slova:

Employment – Kenya – Palliative care – Quality of care – Surveys – Termination of pregnancy – Transportation – Women's health


1. Mohamed SF, Izugbara C, Moore AM, Mutua M, Kimani-Murage EW, Ziraba AK, et al. The estimated incidence of induced abortion in Kenya: a cross-sectional study. BMC Pregnancy Childbirth. 2015;15:185. doi: 10.1186/s12884-015-0621-1 26294220

2. The Government of Kenya (GOK). The Constitution of Kenya, 210 revised edition. Nairobi, Kenya: National Council for Law Reporting (NCLR); 2010.

3. González Vélez AC. “The health exception”: a means of expanding access to legal abortion. Reprod Health Matters. 2012;20:22–9. doi: 10.1016/S0968-8080(12)40668-1 23245405

4. Mutua MM, Manderson L, Musenge E, Achia TNO. Policy, law and post-abortion care services in Kenya. PLoS ONE [Internet]. 2018 [cited 2019 Feb 27];13. Available from:

5. Dennis A, Blanchard K, Bessenaar T. Identifying indicators for quality abortion care: a systematic literature review. J Fam Plann Reprod Health Care. 2017;43:7–15. doi: 10.1136/jfprhc-2015-101427 27172880

6. Tunçalp Ӧ., Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG Int J Obstet Gynaecol. 2015;122:1045–9.

7. Altshuler AL, Whaley NS. The patient perspective: perceptions of the quality of the abortion experience. Curr Opin Obstet Gynecol. 2018;30:407–13. doi: 10.1097/GCO.0000000000000492 30299320

8. Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity. Gates Open Res. 2017;1:1. doi: 10.12688/gatesopenres.12756.1 29355215

9. Jayaweera RT, Ngui FM, Hall KS, Gerdts C. Women’s experiences with unplanned pregnancy and abortion in Kenya: A qualitative study. PLOS ONE. 2018;13:e0191412. doi: 10.1371/journal.pone.0191412 29370220

10. Izugbara CO, Egesa C, Okelo R. ‘High profile health facilities can add to your trouble’: Women, stigma and un/safe abortion in Kenya. Soc Sci Med. 2015;141:9–18. doi: 10.1016/j.socscimed.2015.07.019 26233296

11. Izugbara CO, Egesa CP, Kabiru CW, Sidze EM. Providers, Unmarried Young Women, and Post-Abortion Care in Kenya. Stud Fam Plann. 2017;48:343–58. doi: 10.1111/sifp.12035 28940208

12. Izugbara CO, Otsola KJ, Ezeh AC. Men, Women, and Abortion in Central Kenya: A Study of Lay Narratives. Med Anthropol. 2009;28:397–425. doi: 10.1080/01459740903304009 20182971

13. Winikoff B, Sivin I, Coyaji KJ, Cabezas E, Bilian X, Sujuan G, et al. Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: A comparative trial of mifepristone-misoprostol versus surgical abortion. Am J Obstet Gynecol. 1997;176:431–7. doi: 10.1016/s0002-9378(97)70511-8 9065194

14. Harvey SM, Beckman LJ, Satre SJ. Choice of and satisfaction with methods of medical and surgical abortion among U.S. clinic patients. Fam Plann Perspect. 2001;33:212–6. 11589542

15. Sudhinaraset M, Landrian A, Afulani PA, Phillips B, Diamond-Smith N, Cotter S. Development and validation of a person-centered abortion care scale. Women Health. under review;

16. Sudhinaraset M, Afulani PA, Diamond‐Smith N, Golub G, Srivastava A. Development of a Person-Centered Family Planning Scale in India and Kenya. Stud Fam Plann [Internet]. 2018 [cited 2018 Sep 13];49. Available from:

17. Afulani PA, Diamond-Smith N, Golub G, Sudhinaraset M. Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reprod Health. 2017;14:118. doi: 10.1186/s12978-017-0381-7 28938885

18. Cockrill K, Herold S, Upadhyay U, Baum S, Blanchard K, Grossman D. ADDRESSING ABORTION STIGMA THROUGH SERVICE DELIVERY. 2013 [cited 2015 Oct 15]; Available from:

19. Becker D, Díaz-Olavarrieta C, Juárez C, García SG, Sanhueza P, Harper CC. Clients’ perceptions of the quality of care in Mexico city’s public-sector legal abortion program. Int Perspect Sex Reprod Health. 2011;37:191–201. doi: 10.1363/3719111 22227626

20. Blanchard K, Lince-Deroche N, Fetters T, Devjee J, de Menezes ID, Trueman K, et al. Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study. Contraception [Internet]. 2015 [cited 2015 Sep 4]; Available from:

21. Kaiser Family Foundation; From the Patient’s Perspective: Quality of Abortion Care [Internet]. Henry J Kais. Fam. Found. 1999 [cited 2019 May 9]. Available from:

22. Zhang Y, Rohrer J, Borders T, Farrell T. Patient Satisfaction, Self-Rated Health Status, and Health Confidence: An Assessment of the Utility of Single-Item Questions. Am J Med Qual. 2007;22:42–9. doi: 10.1177/1062860606296329 17227877

23. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality Prediction with a Single General Self-Rated Health Question. J Gen Intern Med. 2006;21:267–75. doi: 10.1111/j.1525-1497.2005.00291.x 16336622

24. Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999;89:1187–93. doi: 10.2105/ajph.89.8.1187 10432904

25. Hanschmidt F, Linde K, Hilbert A, Heller SGR-, Kersting A. Abortion Stigma: A Systematic Review. Perspect Sex Reprod Health. 2016;48:169–77. doi: 10.1363/48e8516 27037848

26. American Psychological Association (APA) Task Force on Mental Health and Abortion. Report of the APA Task Force on Mental Health and Abortion [Internet]. Washington, DC: APA Task Force on Mental Health and Abortion; 2008. Available from:

27. Sando D, Abuya T, Asefa A, Banks KP, Freedman LP, Kujawski S, et al. Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned. Reprod Health. 2017;14:127. doi: 10.1186/s12978-017-0389-z 29020966

28. Hameed W, Ishaque M, Gul X, Siddiqui J-R, Hussain S, Hussain W, et al. Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews. Open Access J Contracept. 2018;9:33–43. doi: 10.2147/OAJC.S153443 29760573

29. Jelinska K, Yanow S. Putting abortion pills into women’s hands: realizing the full potential of medical abortion. Contraception. 2018;97:86–9. doi: 10.1016/j.contraception.2017.05.019 28780241

30. Gerdts C, Hudaya I. Quality of Care in a Safe-Abortion Hotline in Indonesia: Beyond Harm Reduction. Am J Public Health. 2016;106:2071–5. doi: 10.2105/AJPH.2016.303446 27631756

31. Rocca CH, Puri M, Shrestha P, Blum M, Maharjan D, Grossman D, et al. Effectiveness and safety of early medication abortion provided in pharmacies by auxiliary nurse-midwives: A non-inferiority study in Nepal. PloS One. 2018;13:e0191174. doi: 10.1371/journal.pone.0191174 29351313

32. Book: Advancing measurement of abortion quality–M4MGMT [Internet]. [cited 2019 May 9]. Available from:

Článek vyšel v časopise


2019 Číslo 11