Assessing facility capacity to provide safe abortion and post-abortion care in Liberia: a 2021 signal function survey across 48 public health facilities

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BACKGROUND: Access to safe abortion is legally restricted in Liberia, forcing women to resolve unintended pregnancies through unsafe methods, leading to severe illnesses and deaths. Liberia's Government has committed to addressing abortion-related maternal mortalities by availing comprehensive post-abortion care. However, limited information exists on the capacity of health facilities to provide quality abortion-related care. This paper assesses the extent to which health facilities in Liberia are capable of delivering safe abortion and post-abortion care services. METHODS: Data for this analysis are drawn from a signal function survey conducted across 48 public facilities in Liberia from September to November 2021. The signal function survey captures several safe abortion and post-abortion care-related services, including staff training, equipment, commodities, and supplies. Data were collected from health providers knowledgeable about abortion-related care, such as safe abortion and post-abortion care, across sampled health facilities using a structured questionnaire. Data analysis involved summarizing proportions of clinics, health centers, and hospitals with the capacity to provide either basic and/or comprehensive safe abortion and post-abortion care. RESULTS: Out of the 48 facilities, 65% and 28% were classified as capable of providing basic and comprehensive post-abortion care (PAC) services, respectively. Fewer facilities (27%) could provide basic safe abortion care (SAC) and comprehensive SAC (16%). Differences by facility level were statistically significant for comprehensive PAC. The PAC signal functions fulfilled by the fewest facilities included referral capacity, blood transfusion, and surgical or laparotomy capacity. CONCLUSION: The study highlights the limitations to providing basic SAC and PAC among our sample of public health facilities in Liberia and the poor capacity of these health facilities to provide comprehensive PAC and SAC services in particular. Full implementation of the 2019 National Comprehensive Abortion Care Guidelines could strengthen critical SAC and PAC services by ensuring adequate resources and training of the healthcare workforce.

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