Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis
Jesse Philbin1, Nugroho Soeharno2, Margaret Giorgio3
1Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA. jphilbin@guttmacher.org.
Reproductive Health
|November 26, 2020
Summary
Expanding post-abortion care (PAC) services in Indonesia by allowing midwives and general physicians to perform first-trimester uterine evacuations could significantly improve maternal health outcomes and access to care.
Area of Science:
- Public Health
- Health Systems Research
- Obstetrics and Gynecology
Background:
- Indonesia faces high maternal mortality, with restrictive abortion laws impacting post-abortion care (PAC) quality.
- Current Indonesian guidelines restrict uterine evacuation for PAC to Ob/Gyns in hospitals.
Purpose of the Study:
- To assess the capacity of Java's health system to provide PAC.
- To simulate the impact of policy reforms on PAC capacity.
Main Methods:
- A signal functions analysis was applied to data from 657 hospitals and health centers in Java.
- Simulations explored expanding first-trimester uterine evacuation for PAC to primary care and non-Ob/Gyn clinicians.
- Proportions of PAC patients treated by different uterine evacuation procedures were calculated.
Main Results:
- Only 46% of Java's hospitals offer comprehensive PAC services, with capacity concentrated in referral hospitals.
- No health centers are currently authorized or equipped for basic PAC services.
- Hypothetical reforms allowing midwives and general physicians to perform first-trimester uterine evacuations substantially increase PAC capacity.
Conclusions:
- Expanding first-trimester uterine evacuation for PAC to primary care settings (PONEDs) and non-Ob/Gyns would significantly enhance Java's health system capacity.
- Increasing the use of vacuum aspiration and misoprostol for uterine evacuation can reduce patient burden and facilitate task-shifting for improved access to essential services.
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