Evaluating the implementation of post-abortion care in Shanghai using the RE-AIM framework: a qualitative study of provider perspectives.

Abstract

Background: Post-abortion Care (PAC) is a proven strategy to reduce the rate of repeat abortions and promote women's reproductive health. However, existing research has predominantly centered on patient perspectives and health outcome indicators, with limited insight into the barriers and facilitators encountered during the implementation of PAC services.

Objective: To evaluate the current state and challenges of PAC services in Shanghai, providing references for future service improvements and broader promotion.

Methods: Seven hospitals offering PAC services in Shanghai were selected through stratified sampling, and semi-structured interviews were conducted with service providers. The interview guideline was developed based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Data were analyzed using a combination of deductive and inductive analytical methods.

Results: PAC services were highly accessible to patients within the study hospitals; however, lack of promotion and inadequate awareness among potential users were identified as major barriers to broader patient access. The services had a positive impact on post-abortion recovery and contraceptive adoption, while posing challenges to the efficient and equitable allocation of medical resources. Healthcare institutions and staff reported positive attitudes towards PAC services, but insufficient funds and manpower have limited the promotion and adoption of the project and also affected the work enthusiasm of providers. PAC services had standardized processes and were well-implemented. The lack of efficient follow-up methods was the main barrier to implementation. More policy support is needed to ensure the sustainability of the project.

Conclusion: PAC services have proven feasible and effective in improving post-abortion contraceptive behaviors and protecting female reproductive health. The primary challenges are insufficient funds and difficulties in follow-up. These findings are expected to provide information for improving the quality of PAC services and promoting them as basic reproductive health services of the government in the future.