Barriers to quality post-abortion care in low and middle-income countries: a systematic review

Hem Lata; Latha Venkatesan; Raksha Yadav

doi:10.18203/2394-6040.ijcmph20264126

Authors

Hem Lata College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
Latha Venkatesan College of Nursing, All India Institute of Medical Sciences, New Delhi, India https://orcid.org/0000-0003-4412-9917
Raksha Yadav College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India https://orcid.org/0000-0003-3887-8161

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264126

Keywords:

Post-abortion care, Quality of care, Barriers and facilitators, Reproductive health, Health system

Abstract

Post-abortion care (PAC) is a vital component of reproductive healthcare and essential for reducing abortion-related morbidity and mortality. Despite improvements in service availability, barriers affecting the quality and utilization of PAC services remain common across low-and middle-income countries (LMICs). The review was conducted using PubMed, Scopus, Google scholar and Open search database by following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (PROSPERO registration: CRD420261425414). The peer-reviewed studies published between 2010 and 2026 were screened according to inclusion criteria. Study selection was performed using Rayyan Software, and methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Five major categories of barriers were identified; Knowledge and awareness barriers; Socio-cultural, financial, and geographic barriers; provider-related and quality -of-care barriers; health-system and facility-level barriers; and policy and legal barriers. The common challenges included abortion-related stigma, limited awareness of services, financial hardship, inadequate counselling, shortage of trained providers, weak referral systems, and insufficient infrastructure. Barriers to quality post -abortion care are multidimensional, and addressing these barriers through coordinated interventions may improve access, quality and utilization of post-abortion care services and help bridge the persistent access-quality gap in LMICs.

References

World Health Organization. Abortion care guideline. Geneva: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240039483. Accessed on 03 August 2026.

World Health Organization. Abortion. Available from: https://www.who.int/news-room/fact-sheets/detail/abortion. Accessed on 03 August 2026.

International Federation of Gynecology and Obstetrics. Committee on Safe Abortion. Available from: https://www.figo.org/what-we-do/figo-divisions-committees/committee-safe-abortion Accessed on 03 August 2026.

Cleeve A, Nalwadda G, Zadik T, Sterner K, Klingberg-Allvin M. Morality versus duty: a qualitative study exploring midwives’ perspectives on post-abortion care in Uganda. Midwifery. 2019;77:71-7.

Lubeya MK, Munakampe MN, Mwila M, Makasa M, Mukosha M, Jacobs C, et al. Post-abortion care services in Zambian health facilities: a qualitative study of users’ experiences and perceptions. BMC Womens Health. 2024;24(1):414.

Ouedraogo R, Obure V, Kimemia G, Achieng A, Kadzo M, Shirima J, et al. “I will never wish this pain to even my worst enemy”: lived experiences of pain associated with manual vacuum aspiration during post-abortion care in Kenya. PLoS One. 2023;18(8):e0289689.

Mutua MM, Manderson L, Musenge E, Ochieng Achia TN. Policy, law and post-abortion care services in Kenya. PLoS One. 2018;13(9):e0204240.

Perera SM, Achakzai H, Giuffrida MM, Kulkarni MJ, Nagle DC, Wali MK, et al. Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members. BMC Womens Health. 2021;21:390.

Obure VA, Juma K, Athero S, Donzo V, Conteh-Khali N, Ouedraogo R, et al. “Sometimes you have knowledge but lack the equipment to save a life”: perspectives on health system barriers to post-abortion care in Liberia and Sierra Leone. Arch Public Health. 2024;82:220.

Bright S, Parnham E, Blaylock R, Bury L, Okonofua F, Mukwambo S, et al. “Making abortion safe”: abortion and post-abortion care providers’ experiences of stigma in Rwanda, Zimbabwe, Sierra Leone and Nigeria. BMJ Sex Reprod Health. 2026;52(1):45-50.

Hemlata, Venkatesan L. Governmental healthcare provisions, benefits and quality care of abortion services in India: a narrative review. Int J Reprod Contracept Obstet Gynecol. 2026;15(4):1487-94.

Mbehero F, Momanyi R, Hesel K. Facilitating uptake of post-abortion contraception for young people in Kenya. Front Glob Womens Health. 2021;2:733957.

Chukwumalu K, Gallagher MC, Baunach S, Cannon A. Uptake of postabortion care services and acceptance of postabortion contraception in Puntland, Somalia. Reprod Health Matters. 2017;25(51):48-57.

Adejugbe BO, Joshua AO, Akanni AI, Ogunoye OR, Adejugbe OJ. Availability and readiness of post-abortion care in public and private healthcare facilities in Ile-Ife, Osun State, Nigeria. Afr J Reprod Health. 2026;30(3 Suppl):36-49.

Ishoso DK, Tshefu A, Delvaux T, Dramaix M, Mukumpuri G, Coppieters Y. Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo. Reprod Health. 2021;18:76.

Koko VS, Küng S, Doe CR, Candy N, Harmon-Gray WM, Mutuku E, et al. Assessing facility capacity to provide safe abortion and post-abortion care in Liberia: a 2021 signal function survey across 48 public health facilities. BMC Public Health. 2025;25:1702.

Belizan M, Maradiaga E, Roberti J, Casco-Aguilar M, Ortez AF, Avila-Flores JC, et al. Contraception and post abortion services: qualitative analysis of users’ perspectives and experiences following Zika epidemic in Honduras. BMC Womens Health. 2020;20:199.

Muga W, Juma K, Athero S, Kimemia G, Bangha M, Ouedraogo R. Barriers to post-abortion care service provision: a cross-sectional analysis in Burkina Faso, Kenya and Nigeria. PLOS Glob Public Health. 2024;4(3):e0001862.

Riley T, Madziyire MG, Owolabi O, Sully EA, Chipato T. Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities. BMC Health Serv Res. 2020;20:244.

Melkamu Y, Betre M, Tesfaye S. Utilization of post-abortion care services in three regional states of Ethiopia. Ethiop J Health Dev. 2010;24(1):123-9.

Azmat SK, Shaikh BT, Mustafa G, Hameed W, Bilgrami M. Delivering post-abortion care through a community-based reproductive health volunteer programme in Pakistan. J Biosoc Sci. 2012;44(6):719-31.

Paul M, Gemzell-Danielsson K, Kiggundu C, Namugenyi R, Klingberg-Allvin M. Barriers and facilitators in the provision of post-abortion care at district level in central Uganda: a qualitative study focusing on task sharing between physicians and midwives. BMC Health Serv Res. 2014;14:28.

Sengupta D, Ghosh P. A study on abortion care services in different tiers of rural health care in Malda district of West Bengal, India. Asian Pac J Reprod. 2025;14(2):62-8.

Roemer M, Ushie BA, Akiode A, Onuoha O, Idoko O, Taiwo A. Inequities in safe abortion: women’s care trajectories in Abuja and Lagos, Nigeria. BMC Public Health. 2025;25:2869.

Ismail UM, Osman F, Klingberg-Allvin M, Egal JA. Women’s experiences of post-abortion care services at health facilities in Somaliland: a qualitative study among women with incomplete abortion. Sex Reprod Healthc. 2025;45:101136.

Baynes C, Diadhiou M, Lusiola G, O’Connell K, Dieng T. Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal. J Biosoc Sci. 2022;54(5):760-75.

Comprehensive abortion care. In: Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. NCBI Bookshelf. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305158/. Accessed on 05 August 2026.

International Federation of Gynecology and Obstetrics. FIGO calls for the total decriminalisation of safe abortion. Available from: https://www.figo.org/resources/figo-statements/figo-calls-total-decriminalisation-safe-abortion. Accessed on 05 August 2026.