Attributes and perspectives of public providers related to provision of medical abortion at public health facilities in Vietnam: a cross-sectional study in three provinces

Abstract

Thoai D Ngo,1,2 Caroline Free,1 Hoan T Le,3 Phil Edwards,1 Kiet HT Pham,4 Yen BT Nguyen,4 Thang H Nguyen5 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 2Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK; 3Department of Environmental Health, 4Department of Health Economics, Hanoi Medical University, 5Research and Metrics Team, Marie Stopes International Vietnam, Hanoi, Vietnam Background: The purpose of this study was to investigate attributes of public service providers associated with the provision of medical abortion in Vietnam. Methods: We conducted a cross-sectional study via interviewer-administered questionnaire among abortion providers from public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City in Vietnam between August 2011 and January 2012. We recruited abortion providers at all levels of Vietnam's public health service delivery system. Participants were questioned about their medical abortion provision practices and perspectives regarding abortion methods. Results: A total of 905 providers from 62 health facilities were included, comprising 525 (58.0%) from Hanoi, 122 (13.5%) from Khanh Hoa, and 258 (28.5%) from Ho Chi Minh City. The majority of providers were female (96.7%), aged ≥25 years (94%), married (84.4%), and had at least one child (89%); 68.9% of providers offered only manual vacuum aspiration and 31.1% performed both medical abortion and manual vacuum aspiration. Those performing both methods included physicians (74.5%), midwives (21.7%), and nurses (3.9%). Unadjusted analyses showed that female providers (odds ratio 0.1; 95% confidence interval 0.01–0.30) and providers in rural settings (odds ratio 0.3; 95% confidence interval 0.08–0.79) were less likely to provide medical abortion than their counterparts. Obstetricians and gynecologists were more likely to provide medical abortion than providers with nursing/midwifery training (odds ratio 22.2; 95% confidence interval 3.81–129.41). The most frequently cited advantages of medical abortion for providers were that no surgical skills are required (61.7%) and client satisfaction is better (61.0%). Conclusion: Provision of medical abortion in Vietnam is lower than provision of manual vacuum aspiration. While the majority of abortion providers are female midwives in Vietnam, medical abortion provision is concentrated in urban settings among physicians. Individuals providing medical abortion found that the method yields high client satisfaction. Keywords: Vietnam, medical abortion, misoprostol, mifepristone, health service delivery, surgical abortion