Availability and readiness to provide postabortion care in refugee settlements in Uganda: a signal functions analysis

Unsafe abortions contribute to 10% of preventable maternal deaths in Africa, with higher rates in humanitarian settings. In Uganda, home to 1.8 million refugees, women and girls face heightened vulnerabilities, increasing their risk of unsafe abortions. This study assessed the availability and readiness of health facilities serving Uganda's refugee settlements to provide postabortion care (PAC), identifying gaps and opportunities for improvement.

This cross-sectional study, conducted in March 2023 across all refugee settlements in Uganda, used the health facility survey to assess the availability and readiness to provide basic and comprehensive PAC services through structured interviews with staff of health facilities within and outside refugee settlements. Availability was defined as the provision of the signal function in the past 6 months, while readiness referred to the provision of the service and availability of equipment on the day of data collection.

A total of 102 eligible health facilities provided PAC across all the 13 refugee settlements, with 91 (89.2%) located within the settlement borders. The majority of health centres (HCs) were primary-level (HC IIs: 41.2% and HC IIIs: 50.9%) facilities. Only eight (7.8%) were referral-level facilities (defined as HC IV and above). Basic PAC signal function availability and readiness was 73.5% and 51.0% for all facilities. Comprehensive PAC signal function availability and readiness was 75.0% and 37.5% among the eight referral-level facilities. Only three out of the 13 settlements had facilities offering comprehensive PAC within their borders.

While the availability of basic and comprehensive PAC signal functions was high in all facilities, overall readiness to provide these services was low, largely due to insufficient equipment and consumable commodities stockouts. Refugee women and girls from 10 out of 13 settlements have limited access to comprehensive PAC, both within the settlements and at nearby referral facilities.