Study
Mapping the journey: enhancing abortion care in Uganda’s health systems
Published in Frontiers in Reproductive Health
This study looks at the experiences of 440 women who received abortion care at 13 Ipas Africa Alliance-supported public health facilities in nine districts of Uganda. It identifies factors associated with high levels of client satisfaction and examines how satisfaction levels influenced the uptake of abortion and postabortion contraception services.
Main takeaway
Positive engagement with providers was strongly associated with higher satisfaction levels and increases the likelihood that clients will return for future services and recommend the facility to others. Respectful, supportive interactions between providers and clients are an essential step toward delivering high-quality, equitable, and respectful abortion care in Uganda’s health system.
Why it matters
Abortion is highly restricted in Uganda, permitted only to save a woman’s life. The challenges of this restrictive landscape continue to contribute to high rates of unintended pregnancies and unsafe abortions. Addressing both provider-related barriers to care and social and cultural barriers is critically important to improving women’s overall experiences with abortion services and supporting their autonomy in making reproductive health care decisions.
“The doctor spoke to me in a calm and humble manner. He explained to me what he was going to do…and he never judged me anywhere in our interaction.” – from in-depth interview with 32-year-old client
Key findings
- Analysis of client exit interviews with 440 women, aged 15-49, who received abortion services at 13 Ipas Alliance-supported clinics in 2024 showed that positive provider engagement was strongly associated with higher levels of satisfaction.
- Clients who experienced respectful and supportive interactions with providers were significantly more likely to report satisfaction and indicated a greater willingness to recommend the facility and return for future services.
- Analysis of client exit interview data also revealed no statistically significant differences in satisfaction levels across sociodemographic groups such as age, marital status, facility location, education level or type of abortion service.
- Although infrequent, some participants reported negative interactions with healthcare providers, particularly during contraceptive counseling. These interactions were primarily characterized by poor provider attitudes and ineffective communication.
- Additional in-depth interviews with 63 women offered deeper insights into their experiences with abortion services across different levels of the health system. For many of these women, the urgent need was to terminate the pregnancy, often with limited attention to postabortion services such as contraceptive counseling.
- Women who participated in qualitative, in-depth interviews expressed overall satisfaction with the abortion services they received. High levels of client satisfaction were evident through several indicators: women reporting that they were treated with dignity and respect, women who reported that providers listened to their needs, and women who stated they received private and confidential care.
- Overall, the findings underscore the importance of investing in provider training, ensuring consistent availability of contraceptive methods, and addressing social stigma to improve client experiences. Strengthening referral systems, standardizing counseling protocols, and promoting client-centered approaches are essential steps toward delivering high-quality, equitable, and respectful abortion care in Uganda’s health system.
Noteworthy
This is the first study conducted by Ipas in Uganda using the client journey mapping approach in conjunction with quantitative survey data collected from client exit interviews at the facility level. Journey mapping captures more qualitative information than client exit interviews and also helps to uncover unmet health needs, emotional challenges, and ways that health systems responses and patient engagement can be improved.