Women's perceptions of person-centered comprehensive abortion care and associated factors in Northern Ethiopia: a facility-based cross-sectional study in a humanitarian setting.

Background: In humanitarian settings, women and girls face limited access to contraceptives, increasing the risk of unintended pregnancies, unsafe abortions, and related complications. Strengthening abortion care is essential to ensure quality and accessibility in Ethiopia's humanitarian context. However, evidence on person-centered abortion care remains limited, highlighting the need to bridge this gap. This study aimed to assess women's perceptions of person-centered comprehensive abortion care (PC-CAC) and identify associated individual, clinical, and facility-level factors in public health facilities in the humanitarian setting of northern Ethiopia.

Methods: An institution-based cross-sectional study was conducted from September 2023 to March 2024 in 31 health facilities, involving 1,642 women and girls who received abortion care. Data were collected using a standardized questionnaire. The perceived quality of PC-CAC was categorized into three levels based on percentile cut-offs: low (< 25th percentile), medium (25th-75th percentile), and high (> 75th percentile). An ordered generalized linear mixed-effect model was fitted using STATA 17 to identify factors associated with PC-CAC.

Result: Among the participants, 23.6% reported experiencing a high level of PC-CAC, 25.9% a low level, and 50.5% a medium level of care. The odds of experiencing high-level PC-CAC were significantly higher among women and girls who did not experience abortion-related complications (AOR: 2.05; 95% CI: 1.43-2.95), received care at a health center (AOR: 1.49; 95% CI: 1.02-2.21), and obtained abortion care at the first visited health facility (AOR: 1.51; 95% CI: 1.18-1.94). In contrast, the likelihood of experiencing high-level PC-CAC was significantly lower among those whose pregnancy termination was due to rape (AOR: 0.44; 95% CI: 0.29-0.67) and those admitted with incomplete abortion (AOR: 0.67; 95% CI: 0.52-0.87).

Conclusion: Only one in four women and girls experienced high-level PC-CAC in this humanitarian setting. These findings underscore the urgent need to standardize PC-CAC across all facility types, with particular attention to improving care in hospitals and for women who are survivors of rape, as well as those presenting with incomplete abortions and related complications.