User-reported quality of self-managed medication abortion by care source in Nigeria

To evaluate and compare self-managed abortion (SMA) user-reported quality of care between users accessing a safe abortion hotline versus proprietary patent medicine vendors (PPMVs) that provide medicines to rural communities in Nigeria, and identify factors associated with increases in total quality scores and key indicators of abortion access and information provision.

We leveraged exit surveys and 30-day follow-up data collected from users of a safe abortion hotline and PPMVs in Nigeria used to develop the Abortion Care Quality Tool (ACQTool). We used bivariate statistics to compare 17 user-reported quality indicators across six domains and eight abortion outcomes, by care source (hotline vs PPMV). We used multivariable linear regression to identify factors associated with total quality scores and multivariable logistic regression to identify factors associated with abortion affordability and preparedness for a complication, controlling for user sociodemographic characteristics.

Hotline users (n=182; 40.8%) scored higher than PPMV users (n=264; 59.2%) on 9 of 17 quality indicators, particularly in the decision-making and information provision domains. Mean total quality score was significantly higher for hotline users (16.53 vs 14.53; p<0.001). Hotline users were associated with an increase of 1.87 points in the total quality and higher odds (aOR=3.23; 95% CI 1.07 to 12.02) of feeling prepared if a complication occurred, but had lower odds (aOR=0.10; 95% CI 0.05 to 0.21) of indicating the abortion was affordable, adjusting for sociodemographic factors.

This study highlights the high overall quality of abortion care from both hotlines and PPMVs but identifies key areas for improvement, such as affordability for hotline users and decision and information support for PPMV users.