Despite advancements in safe abortion care around the world, the playing field is far from level. Some people have easy access to quality care, while others face significant barriers.
To improve services, it’s crucial to measure their quality. However, existing tools often lack standardization, ignore patient perspectives, and are impractical for many providers. To address this gap, in 2017, Metrics for Management, Ibis Reproductive Health, and Ipas launched the four-year Abortion Service Quality Initiative, to develop a tool that was client-centered, simple, effective, and universally applicable. The result of this collaborative research, the Abortion Care Quality (ACQ) Tool, is the first ever global standard for measuring the quality of abortion services in low- and middle-income countries.
“While developing the ACQTool, we found over a thousand different indicators being used to measure the quality of abortion services globally. There was little agreement across stakeholders about what was most important to measure, and on top of that, the voices of people receiving abortion care were underrepresented,” says Sally Dijkerman, Ipas’s senior research scientist.
The ACQTool fills these gaps. It is a short set of indicators developed by an international panel of experts, validated through extensive testing in three countries in sites and with providers offering abortion care, including health facilities, pharmacies, medicine sellers, hotlines, and clients, to provide an accurate assessment of the quality of abortion care an individual has received during and after their abortion experience.
A ‘stakeholder first’ approach
A critical part of the process and eventual success was using a collaborative, “stakeholder first approach.”
“From the very first consensus-building meeting attended by over 40 participants from 16 countries representing a broad cross-section of stakeholders, throughout the process by continual engagement of the ASQ Resource Group to provide broad expert insight at key decision points, and by collecting information on quality and outcomes from over 1,900 abortion clients recruited from 131 sites in three countries in Asia and Africa, we continually engaged key stakeholders, most importantly abortion clients themselves,” explains Bill Powell, Ipas’s senior medical scientist.
We collected information on abortion quality and outcomes from over 1,900 abortion clients from 131 sites in three countries in Asia and Africa.
At Ipas, we believe that centering the needs of abortion care seekers is critical to improving access to high quality abortion care — and that applies to the metrics we use as well. The ACQTool looks beyond the safety of the immediate procedure, assessing how well the client’s actual needs and values for their abortion care have been met, across seven primary domains:
- Referral services
- Supplies, medicines, and equipment
- Access
- Technical competence
- Decision making
- Information provision
- Client-provider interactions
One of the most unique aspects of the tool is that it is designed for both in-facility and out-of-facility use, such as at pharmacies or hotlines. This means it can be used to monitor and evaluate interventions and programs supporting self-managed abortion, in addition to facility-based care.
Read more about:
The study:
- Developing and validating an abortion care quality metric for facility and out-of-facility settings: an observational cohort study in Bangladesh, Ethiopia, and Nigeria
- Our “stakeholder first” approach
- The ACQTool
Other published articles related to the ACQTool:
- Darney BG, Kapp N, Andersen K, Baum S, Blanchard K, Gerdts C, Montagu D, Chakraborty N, Powell B. (2019). Definitions, measurement and indicator selection for quality of care in abortion. Contraception, 100: 354-359.
- Darney BG, Powell B, Andersen K, et al. (2018). Quality of care and abortion: beyond safety. BMJ Sexual & Reproductive Health, 44:159-160.
- Baum SE, Jacobson L, Ramirez AM, et. al. Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries. BMJOpen, 2023;13:e067513.
- Katz AJ, Ramirez AM, Bercu C, Filippa S, Dirisu O, Egwuatu I, et al. (2022) “I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria. PLoS ONE 17(2): e0263072.