Comprehensive Abortion Care: A Health Facility Assessment Tool
Overview
In recent years, the South-East Asia Region achieved its highest rate of decline in maternal mortality. In the period from 2007 to 2017, maternal deaths were reduced by 57.3% with an annual rate of reduction of 5%. However, deaths due to complications of unsafe abortion remain high. Comprehensive abortion care (CAC) is a continuum of standardized abortion services that include the provision of abortion-related information, abortion management, post-abortion care, and post-abortion family planning. CAC is included in the list of essential health-care services published by WHO in 2020. Safe abortion can be effectively provided by a wide range of trained health workers using medical or surgical methods with appropriate recommendations for different pregnancy durations. Management of spontaneous abortion, incomplete abortion, induced abortion, as well as intrauterine fetal demise, are all included in CAC.
All countries in the Region allow abortion to save a woman’s life, and in some countries, safe abortion services are being provided in the public sector. However, very few of these countries collect data on CAC as part of their health surveys. The scarcity of service delivery data makes it difficult to assess the extent of CAC service accessibility and quality.
The health facility assessment (HFA) tool for CAC was developed to encourage countries to collect abortion-related service delivery data as part of their health facility surveys. It was developed in close consultation with local experts to reflect country standards and guidelines, aligned with other WHO HFA tools, and pilot-tested in public health facilities at various levels. It requires facility visits for direct observation of items and conduct of interviews with identified key informants to capture data on facility infrastructure, abortion services offered, and availability of key human resources, drugs, consumables and equipment, registers and guidelines, and referral of complications of abortion. The tool provides useful information for countries to identify the gaps in safe abortion services and thereby guide programmatic planning and facility investments.
To facilitate the collection and reporting of indicators on CAC service availability and readiness, this tool includes a CAC indicator and metadata set, detailed instructions on the administration of the CAC HFA questionnaire, and guidance for indicator analysis. It also provides an overview of the survey methodology and guidance for the preparation and implementation of the assessment.
