News & Resources

March 2021 Project Status Update:

Effects of the COVID-19 pandemic on ASQ

Pilot testing of the Abortion Service Quality (ASQ) indicators began in February 2020 and was halted in March 2020 due to the COVID-19 pandemic. The challenges of assuring the safety of providers, clients, and researchers during the COVID-19 pandemic have led to significant delays in work by ASQ and many other research and service provision agencies. In September 2020, the ASQ project organized a webinar for Resource Group members to cross-share on their plans and considerations for restarting field research in the context of the COVID-19 pandemic. In October 2020, pilot testing of ASQ indicators was able to resume with COVID-19 risk mitigation strategies in place.

Indicator alignment, consolidation, and refinement

Following the outline we set forward (Darney et al.), we gathered members of the Resource Group at the Women Deliver Conference in Vancouver in June 2019. Together, we reviewed 111 safety, technical, and client-centered quality indicators. This list of indicators was developed based on 1) quality measurement tools provided by 12 participating Ministries of Health and abortion service provision agencies, and 2) formative qualitative work with people who obtained abortions in Argentina, Bangladesh, Ethiopia, and Nigeria.

ASQ fieldwork

Ethics approvals were received for studies in Ethiopia, Bangladesh, and Nigeria in early 2020.  Data collection began in February 2020 and was halted in March 2020 due to the COVID-19 pandemic. ASQ fieldwork restarted in October 2020, and as of late February 2021, we are between 70% – 100% complete for all facility data collection (Bangladesh and Ethiopia), Pharmacy/PPMV data collection (Bangladesh and Nigeria), and hotline data collection in Nigeria.  Hotline data collection in Bangladesh is scheduled to start in the first weeks of March 2021.

2021 plans

All data collection is projected to be complete by June 2021.  Analysis of indicators measured against outcomes will be completed during the fall, and the resulting decisions regarding simplification and prioritization of a narrower set of indicators will be undertaken together with the Resource Group at the end of 2021.  This will be followed by feasibility testing of the simplified indicator list.

August 2019 Project Status Update:

Metrics for Management, Ibis Reproductive Health, and Ipas have completed Year 1 of the Abortion Service Quality project supported by the Children’s Investment Fund Foundation and the Packard Foundation. Accomplishments from the first year included: 1) completion of a comprehensive literature review; 2) formative qualitative research; 3) alignment and consolidation of indicators; and 4) indicator reduction and outcome mapping.

    1. LITERATURE REVIEW: Prior to drafting instruments, project partners conducted a scoping review of literature addressing client preference and abortion experiences. The scoping review examined client experiences with abortion, identifying 32 relevant articles covering topics such as decision making, information provision, client-provider interaction, and pain management. The review sought to fill the gaps of systematic literature reviews in areas of person-centered family planning and maternal care. The literature review was presented to the Resource Group during routine webinars and was used to prepare interview and focus group guides, as well as to inform qualitative analysis.
    2. FORMATIVE QUALITATIVE RESEARCH: Project partners completed formative qualitative work in Ethiopia, Nigeria, Bangladesh, and Argentina to assess client perspectives on quality of abortion care. In order to identify recruitment sites, they built and strengthened partnerships with public hospitals, non-governmental organization (NGO) clinics and call centers, abortion hotlines, and accompaniment models. Between November 2018 and March 2019, partners conducted 98 interviews and seven focus group discussions with medication and surgical abortion clients. Interim results of qualitative analysis were shared at an in-person meeting with the Resource Group at the International Conference on Family Planning (ICFP) in November 2018 to seek feedback. Partners then used the preferences and priorities described by abortion clients in the qualitative study to draft an additional 79 quality of care indicators from the client perspective. Preliminary thematic results were shared with the ASQ Resource Group at an in-person meeting at Women Deliver 2019.
    3. INDICATOR ALIGNMENT AND CONSOLIDATION: Project partners began the indicator alignment process by collecting the existing safety and technical quality indicators from implementation partners and supporting agencies around the world. By starting with measures of quality that are already widely in use, partners sought to make it easier for service delivery points to prioritize and use these indicators as a core quality measure. Indicators were collected from 12 different organizations (NGO and public) in low- and middle- income countries (LMIC) and Organization for Economic Co-operation and Development (OECD) countries, covering over 80 countries and producing a total list of 1860 indicators. Through a multi-phase removal of duplicates and the exclusion of measures that were overly-similar, agency-specific, or unrelated to abortion quality, partners reduced the list to 271 consolidated facility-service-derived indicators aggregated into 107 categories, including primarily structure and process indicators.
    4. INDICATOR REDUCTION AND OUTCOME MAPPING: Resource Group members assisted in the reduction of the 271 facility-service-derived indicators of safety and technical quality through their participation in two surveys, in which they prioritized measurement categories most critical to providing high quality abortion services that were also necessary to measure in a standardized way across organizations. In a parallel effort, a small group of Resource Group members worked together to identify and prioritize the 13 outcomes of a quality abortion against which the safety, technical, and patient-centered indicators would be assessed. The reduction process resulted in a total of 111 retained safety and technical quality indicators. Resource Group members in attendance at an in-person meeting at the Women Deliver Conference in June 2019 reviewed and validated safety, technical and client-centered indicators, as well as outcomes, offering suggestions, identifying gaps, and mapping indicators to outcomes.


Project partners have synthesized feedback from Resource Group members to develop the list of indicators and outcomes that will be used for Year 2 field testing in Africa and Asia. Following field testing, partners will analyze results to arrive at a final, abbreviated list of abortion service quality indicators. Final results will be shared in late 2020 and disseminated via publications, presentations and the ASQ and partner websites.

Articles and Reports:

In the News:

    • July 2018: Launch of ASQ Project to Strengthen and Standardize Abortion Quality Measurement: Press Release
        Metrics for Management (M4M), Ibis Reproductive Health and Ipas have joined forces to launch the Abortion Service Quality (ASQ) Initiative. Launched in April 2018, this three-year project will develop, validate, disseminate, and champion the widespread adoption of a common measure of abortion service quality for use in and out of facilities. The resulting measures will be used by governments, policy makers, and healthcare providers to strengthen healthcare quality, as well as by donors to assess and support evidence-based interventions in abortion care

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