Table 3

Quality abortion care indicators

Indicator category or subthemeIndicatorReferences
Structure indicators
 1) InfrastructureThere are an adequate number of knowledgeable and trained staff available to provide abortion care.7, 12, 24–30
 2) InfrastructureTimely services are available.24, 27, 31, 32
 3) InfrastructureFacilities are geographically accessible.12, 26, 29, 30
 4) InfrastructureEfficient, high-quality referral systems are in place.7, 33, 34
 5) InfrastructureEssential equipment, supplies and medications are available in sufficient quantity to address needs.7, 25, 27
 6) InfrastructureAbortion care is provided in a clean facility.24, 31
 7) InfrastructureAbortion is provided in a facility with space for privacy.24, 35
 8) InfrastructureAbortion is provided in an emotionally and physically comforting space.28
 9) InfrastructureWell-functioning systems for transportation and communications for abortion are in place.7
10) InfrastructureThroughout the health system, there are mechanisms to review abortion-related complications and deaths.7
11) InfrastructureWomen enter the health care system through decentralised service delivery points and receive care at the lowest appropriate level of the networked system.7
12) InfrastructureAbortion care services are integrated with or linked to the fullest available array of medical and reproductive health services.7
13) InfrastructureServices are effectively managed and administrative and logistical factors are not obstacles to the timely delivery of high-quality care.7
14) InfrastructureFees for abortion services are within reach of women's ability to pay; emergency care is provided regardless of women's ability to pay.7
15) InfrastructureThere is an adequate percentage of abortion care service sites that meet a defined standard of quality.12
16) InfrastructureEssential equipment, supplies and medication should be managed through a system of inventory control, resupply and maintenance.7
17) InfrastructureAbortion technology is consistent with relevant regulatory requirements.7
18) InfrastructureAbortion technology is appropriate to specific service delivery settings.7
19) InfrastructureAbortion technology is manufactured to high standards.7
20) InfrastructureAbortion technology is acceptable to women and providers.7
21) InfrastructureStaff at abortion facilities have adequate supervision.7
22) Law and policiesAbortion care must be accessible and not limited by administrative or policy barriers.7, 12, 29, 36
23) Law and policiesRegulations, guidelines and other policy documents have been developed, approved by national/sub-national governments, and/or disseminated to health care facilities that are supportive of access to safe abortion care consistent with WHO guidance.25
Process indicators
24) Technical competenceAppropriate pain management techniques are in place.24, 28, 37
25) Technical competenceClients are screened for requested procedures.27, 33
26) Technical competenceClinical histories are taken.27, 33
27) Technical competencePhysical assessments of general and sexual and reproductive health are performed (including confirmation of gestational age).27, 33
28) Technical competenceStaff follow approved guidelines and protocols for medical, surgical, and incomplete abortion.27, 33
29) Technical competenceStaff use appropriate technologies.33, 38
30) Technical competenceFollow-up care is provided, where women's experience with abortion and pregnancy status are assessed.33, 34
31) Technical competenceClients are asked the reason for the visit.33
32) Technical competenceIf the woman aborts at the clinic, products of conception are examined to confirm expulsion.33
33) Technical competenceAppropriate infection prevention protocols are in place.27
34) Technical competenceBest practice guidelines are followed for monitoring during recovery period.27
35) Technical competenceStaff only use techniques for which they are adequately trained.27
36) Client–provider interactionsStaff offer respectful care.7, 27, 31, 33, 35
37) Client–provider interactionsStaff work to ensure privacy during the visit.27, 31–33, 39
38) Client–provider interactionsStaff have positive interactions with clients.24, 28, 39
39) Client–provider interactionsStaff provide confidential care.7, 24, 39
40) Client–provider interactionsStaff should promote client's dignity.27, 32
41) Client–provider interactionsCare is tailored to women's individual circumstances and needs.39
42) Client–provider interactionsStaff hold non-judgemental attitudes.7
43) Client–provider interactionsStaff–client interactions promote an atmosphere of trust.7
44) Decision makingClients are provided high-quality, supportive counseling.7, 27, 28, 34, 35
45) Decision makingStaff obtain informed consent from clients.27, 33
46) Decision makingClients are provided the opportunity to explore views on abortion options and methods.7, 33
47) Decision makingStaff trust clients’ abilities to make informed decisions.7
48) Decision makingProvider–client interactions are absent of provider bias or coercion.7
49) Information provisionStaff explain all aspects of abortion care to clients (current condition, treatment plan, follow-up needs, and potential post-abortion complications and how to obtain appropriate post-abortion care).7, 27, 31–33, 35, 39
50) Information provisionStaff provide clients the opportunity to express concerns, ask questions, and receive accurate, understandable answers.7, 27, 33, 35
51) Information provisionStaff provide basic information about conception, pregnancy and pregnancy options.33
52) Information provisionStaff use age-appropriate, non-clinical language.33
53) Ancillary servicesStaff directly provide or offer referrals for a range of sexual and reproductive health services, including contraception and screening and treatment for HIV and STIs.7, 12, 25, 27, 29, 33, 38, 39
54) Ancillary servicesStaff provide information about a range of sexual and reproductive health needs including: contraception, fertility, gender-based violence, prenatal care, cancer screening, and screening and treatment for HIV and STIs.7, 27, 30, 32, 33, 39
55) Ancillary servicesAbortion care is no way contingent on prior acceptance of contraception.7
56) SupportIf desired, staff ensure emotional comfort provided to client from support person during abortion.24, 28, 33
57) SupportStaff explore what kind of support client has for their decision.33
Output indicators
58) Procedures providedAssess the number of safe induced abortion procedures.12, 30, 40
59) Procedures providedAssess the proportion of procedures that are induced.29
60) Procedures providedAssess the percentage of uterine evacuations performed with appropriate technologies.29
61) Procedures providedAssess the percentage of abortion procedures performed with preferred technologies.12
Outcome indicators
62) Client and community knowledgeThe community is aware of the availability of safe abortion.26, 27
63) Client and community knowledgeClients understand the information given during clinic visits.35
64) Client and community knowledgeAn adequate number or percentage of women of reproductive age have accurate knowledge of abortion laws.12
65) Client and community knowledgeAn adequate number or percentage of women of reproductive age can identify a nearby source of safe abortion care.12
66) Client and community knowledgeWomen are aware of the full range of services available to them throughout the health care system.7
67) Client and community attitudesClients are satisfied with abortion care.12, 34
68) Client and community attitudesThere is an adequate number or percentage of women with positive attitudes toward seeking abortion care.12
69) Client and community attitudesWomen perceive few financial, geographic and cultural barriers to safe abortion care.12
70) Client and community attitudesClients feel that the staff have a high level of clinical competency.33
71) Client and community attitudesClients have confidence and trust in staff providing care.32
72) Client behavioursAssess overall abortion-seeking behaviours and trends.36
73) Client behavioursAssess the percentage of abortions that occur at or before 10 weeks’ gestations.41
74) Client morbidity and mortalityThere is a low number of admissions for treatment of abortion complications.12, 25, 29, 30, 36
75) Client morbidity and mortalityThere is a low percentage of maternal deaths as a result of abortion.12, 26, 29, 40
  • STI, sexually transmitted infection; WHO, World Health Organization.