Mapping the journey: enhancing abortion care in Uganda's health systems.

Abstract

Introduction: This study explores women's experiences with abortion care in Uganda's public health system, assessing satisfaction levels and their influence on the uptake of abortion and post-abortion contraception services. Conducted across nine districts, it highlights challenges within a legally restricted abortion landscape that continues to contribute to high rates of unintended pregnancies and unsafe abortions.

Methods: The study employed a mixed-methods approach involving client exit interviews and in-depth interviews across nine Ugandan districts from January to June 2024 in 13 Ipas Alliance-supported health facilities. Data from 440 women aged 15-49 captured demographics, treatment outcomes, abortion service uptake, post-abortion contraception use, and satisfaction levels. Additionally, 63 in-depth interviews provided qualitative insights into women's care experiences. Quantitative data were analyzed using logistic regression to assess associations between sociodemographic factors, provider interaction, and satisfaction with abortion services, offering a comprehensive understanding of the client journey and care quality.

Results: Logistic regression analysis of client exit interview data revealed no statistically significant differences in satisfaction levels across sociodemographic groups, including age, marital status, facility location, education level, or type of abortion service. However, positive provider engagement was strongly associated with higher satisfaction. Clients who experienced respectful and supportive interactions were significantly more likely to report satisfaction (OR: 0.47, 95% CI: 1.14-14.47, p = 0.01), and indicated greater willingness to recommend the facility and return for future services, underscoring the importance of quality provider-client engagement. Qualitative insights offered an in-depth understanding of women's experiences with abortion care services across different levels of the health system.

Conclusion: Client satisfaction with abortion services was strongly linked to positive provider engagement rather than sociodemographic factors. Respectful, supportive interactions significantly increased the likelihood of satisfaction with care, future service use of services, and facility recommendation. These findings underscore the critical role of provider-client relationships in improving service experience. To enhance the quality of abortion care, health systems should prioritize respectful counseling, strengthen referral pathways, and address structural constraints to service delivery.