Availability and readiness to provide postabortion care in refugee settlements in Uganda: a signal functions analysis.
| Title: | Availability and readiness to provide postabortion care in refugee settlements in Uganda: a signal functions analysis. |
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| Authors: | Wandera B; SRMNCAH, African Population and Health Research Center, Nairobi, Kenya bwandera@aphrc.org.; Küng SA; Guttmacher Institute, New York, New York, USA.; Rich C; Guttmacher Institute, New York, New York, USA.; Obare F; Population Council Kenya, Nairobi, Kenya.; Habteyesus D; Population Council Ethiopia, Addis Ababa, Ethiopia.; Dessie Y; SRMNCAH, African Population and Health Research Center, Nairobi, Kenya.; Kisaakye P; Population Council Kenya, Nairobi, Kenya.; Odwe G; Population Council Kenya, Nairobi, Kenya.; Kabiru C; SRMNCAH, African Population and Health Research Center, Nairobi, Kenya.; Wado Y; SRMNCAH, African Population and Health Research Center, Nairobi, Kenya.; Giorgio M; Guttmacher Institute, New York, New York, USA. |
| Source: | BMJ global health [BMJ Glob Health] 2026 Jan 14; Vol. 11 (1). Date of Electronic Publication: 2026 Jan 14. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101685275 Publication Model: Electronic Cited Medium: Print ISSN: 2059-7908 (Print) Linking ISSN: 20597908 NLM ISO Abbreviation: BMJ Glob Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, [2016]- |
| MeSH Terms: | Refugees*/statistics & numerical data ; Health Services Accessibility*/statistics & numerical data ; Aftercare*/statistics & numerical data ; Health Facilities*/statistics & numerical data ; Abortion, Induced*; Uganda ; Humans ; Female ; Cross-Sectional Studies ; Pregnancy ; Adult |
| Abstract: | Introduction: Unsafe abortions contribute to 10% of preventable maternal deaths in Africa, with higher rates in humanitarian settings. In Uganda, home to 1.8 million refugees, women and girls face heightened vulnerabilities, increasing their risk of unsafe abortions. This study assessed the availability and readiness of health facilities serving Uganda's refugee settlements to provide postabortion care (PAC), identifying gaps and opportunities for improvement.; Methods: This cross-sectional study, conducted in March 2023 across all refugee settlements in Uganda, used the health facility survey to assess the availability and readiness to provide basic and comprehensive PAC services through structured interviews with staff of health facilities within and outside refugee settlements. Availability was defined as the provision of the signal function in the past 6 months, while readiness referred to the provision of the service and availability of equipment on the day of data collection.; Results: A total of 102 eligible health facilities provided PAC across all the 13 refugee settlements, with 91 (89.2%) located within the settlement borders. The majority of health centres (HCs) were primary-level (HC IIs: 41.2% and HC IIIs: 50.9%) facilities. Only eight (7.8%) were referral-level facilities (defined as HC IV and above). Basic PAC signal function availability and readiness was 73.5% and 51.0% for all facilities. Comprehensive PAC signal function availability and readiness was 75.0% and 37.5% among the eight referral-level facilities. Only three out of the 13 settlements had facilities offering comprehensive PAC within their borders.; Conclusion: While the availability of basic and comprehensive PAC signal functions was high in all facilities, overall readiness to provide these services was low, largely due to insufficient equipment and consumable commodities stockouts. Refugee women and girls from 10 out of 13 settlements have limited access to comprehensive PAC, both within the settlements and at nearby referral facilities.; (© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: None declared. |
| References: | Int Fam Plan Perspect. 2005 Dec;31(4):183-91. (PMID: 16439346); BMC Pregnancy Childbirth. 2023 Mar 4;23(1):143. (PMID: 36871004); BMC Health Serv Res. 2023 Oct 27;23(1):1171. (PMID: 37891572); Lancet. 2018 Jun 30;391(10140):2642-2692. (PMID: 29753597); BMC Health Serv Res. 2023 Jun 20;23(1):658. (PMID: 37340470); BMC Pregnancy Childbirth. 2016 May 14;16:105. (PMID: 27180000); Int J Environ Res Public Health. 2018 Jul 26;15(8):. (PMID: 30049940); Trop Med Int Health. 2011 May;16(5):627-39. (PMID: 21320245); Lancet. 2006 Nov 25;368(9550):1908-19. (PMID: 17126724); Reprod Health Matters. 2017 Nov;25(51):18-24. (PMID: 29231788); BMC Health Serv Res. 2020 Mar 24;20(1):244. (PMID: 32209080); Matern Child Health J. 2020 Aug;24(8):1073-1082. (PMID: 32377926); Glob Health Sci Pract. 2019 Aug 27;7(Suppl 2):S231-S246. (PMID: 31455621); Lancet. 2017 Nov 25;390(10110):2372-2381. (PMID: 28964589); Front Glob Womens Health. 2021 Sep 21;2:699121. (PMID: 34816236); Health Policy Plan. 2021 Aug 12;36(7):1077-1089. (PMID: 34131700); BJOG. 2014 Mar;121(Suppl 1):25-31. (PMID: 24641532); Health Policy Plan. 2014 Jan;29(1):56-66. (PMID: 23274438); BMC Health Serv Res. 2024 Jan 17;24(1):84. (PMID: 38233874); Lancet Glob Health. 2019 Jan;7(1):e110-e118. (PMID: 30503402); Glob Health Sci Pract. 2019 Aug 27;7(Suppl 2):S285-S298. (PMID: 31455625); Int J Gynaecol Obstet. 2006 Nov;95(2):209-20. (PMID: 17027759); Confl Health. 2020 Feb 12;14:6. (PMID: 32082415); Confl Health. 2016 Mar 24;10:8. (PMID: 27014367); Health Serv Insights. 2022 Apr 19;15:11786329221092625. (PMID: 35464819); Lancet Glob Health. 2020 Sep;8(9):e1152-e1161. (PMID: 32710833); PLoS One. 2023 Sep 14;18(9):e0291486. (PMID: 37708137) |
| Contributed Indexing: | Keywords: Delivery of Health Care; Health Services Accessibility; Maternal health; Obstetrics; Universal Health Care |
| Entry Date(s): | Date Created: 20260114 Date Completed: 20260114 Latest Revision: 20260121 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12815188 |
| DOI: | 10.1136/bmjgh-2025-019575 |
| PMID: | 41534946 |
| Database: | MEDLINE |
Journal Article