One key to high-quality abortion care: post-training support for providers

Thursday, January 4, 2018

provider support in Nepal

Very few studies have examined the impact of post-training support for abortion providers on the quality of care they provide. A new Ipas study, published in the journal Reproductive Health, fills that gap. It found that providers who received individualized clinical and programmatic support for the 12 months following their training were more likely to provide an increased and more consistent number of abortion services and to offer clients a wider range of contraceptive methods.

The study, led by Janie Benson, who at the time directed Ipas’s research and evaluation work, analyzed results of an intervention involving 3,471 abortion providers in India, Nepal and Nigeria. They received post-training support in the form of in-person visits and phone and/or email contacts from a clinical and programmatic support team. Technical assistance and upgrades to the facilities where they worked was also part of the intervention.

In Nepal, for example, Ipas partnered with the Government of Nepal to implement a program offering newly trained abortion providers individualized follow-up support from mentors who are experienced clinicians with a background in abortion provision. The mentors offered support on clinical issues and issues such as management and logistics, and ensured that providers had the latest clinical information and knowledge to provide high-quality safe abortion care.

As one clinical mentee reported during an informal assessment of the program, “If there are any clinical problems, the mentors say, ‘We are here to support you,’ and they do support us.” The assessment noted that, overall, the Nepal mentees gave the program high marks, saying they had felt comfortable talking with their mentors about clinical problems and had learned new skills.

“Because the intervention spanned three countries with varying contexts and legal frameworks for abortion, it allowed us to identify factors associated with achieving provider performance that are relevant to a range of country settings,” says Sally Dijkerman, Ipas senior research and evaluation advisor who was one of the study authors.  “We found that post-training support holds promise for strengthening abortion providers’ performance and strongly recommend that health systems offer this support for providers of abortion, contraceptive and other reproductive health care.”

Quantitative measures the study assessed were:  increase in service provision; consistent service provision; provision of high-quality care (use of WHO-recommended uterine evacuation technologies, management of pain, and provision of postabortion contraception); and postabortion contraception method mix offered. Most health workers provided high-quality services, the study found, and 62% consistently provided services.

“Our goal,” adds Dijkerman, “is to make high-quality abortion care available for all women, even those living in the most remote areas. This study will help to establish an effective model of post-training provider support that can be applied across the abortion field.”

Read the full study

Ipas research generates new knowledge for the larger reproductive health and rights community. We also focus on targeted research to understand more about women’s needs and wants regarding reproductive health care and how they make decisions about contraception and abortion.