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.
- 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.
- 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.
- 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.
- 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:
- May 2018: Quality of care and abortion: beyond safety: Editorial in BMJ Sex Reprod Health by Darney, BG; Powell, B; Andersen, K; et al.
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