Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings
Abortion-related complications remain a leading cause of maternal mortality, yet there is limited evidence on the availability and quality of post-abortion care in humanitarian settings. This study assessed the quality of care in two hospitals supported by an international organisation in Jigawa State, Nigeria, and Bangui, Central African Republic.
Using the WHO quality of care framework for maternal and newborn health, the study evaluated inputs, clinical care, patient experience and outcomes through a multi-method cross-sectional design. Data was gathered from facility assessments, clinician surveys, medical record reviews and interviews with hospitalised women.
Both hospitals had most essential services in place and delivered life-saving care. Fewer than 2.5% of patients were treated with outdated procedures such as sharp curettage. Over 80% received blood transfusions or antibiotics when clinically indicated, although antibiotics were also given without documented need in around 30% of cases. Contraceptive counselling rates varied significantly, with 99% coverage in CAR compared to 39% in Nigeria.
Patient experiences were mixed. Most women in Nigeria reported respectful care, but only 15% of patients in either setting felt able to ask questions. Privacy was particularly limited in CAR. Despite these challenges, the rate of abortion-related near-miss events after 24 hours was very low.
The study concludes that while both hospitals provided essential, life-saving care, further improvements are needed to make services more patient centred. Priorities include strengthening communication, safeguarding privacy and dignity, and improving antibiotic stewardship.