Evidence map›Paper›PMID 36726121›Full record

ArticleBMC health services research2023

Postabortion and safe abortion care coverage, capacity, and caseloads during the global gag rule policy period in Ethiopia and Uganda.

Melissa Stillman, Simon P S Kibira, Solomon Shiferaw, Fredrick Makumbi, Assefa Seme, Elizabeth A Sully, Lilian Ha, Margaret Giorgio

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Review
  7. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Melissa StillmanGuttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA. mstillman@guttmacher.org.ORCID http://orcid.org/0000-0002-1318-2419
Simon P S KibiraSchool of Public Health, College of Health Sciences, Makerere University, New Mulago Hill Rd, Kampala, Uganda.ORCID http://orcid.org/0000-0002-7385-423X
Solomon ShiferawSchool of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.ORCID http://orcid.org/0000-0002-9285-1480
Fredrick MakumbiSchool of Public Health, College of Health Sciences, Makerere University, New Mulago Hill Rd, Kampala, Uganda.ORCID http://orcid.org/0000-0002-6460-7325
Assefa SemeSchool of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.ORCID http://orcid.org/0000-0001-9667-4859
Elizabeth A SullyGuttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA.ORCID http://orcid.org/0000-0002-0736-2237
Lilian HaGuttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA.
Margaret GiorgioGuttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA.ORCID http://orcid.org/0000-0003-0006-9465

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAbortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities' capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect.

methodsWe collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities' capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period.

resultsIn both countries, service coverage was high and improved over time, but facilities' capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%.

conclusionsThe findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.

Indexed as

Abortion, InducedAftercareEthiopiaFemaleGlobal HealthHumansPolicyPregnancyUgandaUnited StatesGlobal gag rulePostabortion careQualitySafe abortionSignal functions

Identifiers

PMID36726121
PMCPMC9890752

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.