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A practical global standard for measuring abortion care quality

Measurement of the quality of abortion care is essential to improving services. But measurement of abortion care quality has not previously been standardized, and existing tools are not all practical for use by those with the greatest need to measure abortion care quality. To address this gap, in 2017, Metrics for Management, Ibis Reproductive Health, and Ipas, launched the 4-year Abortion Service Quality Initiative, to develop a tool that was client-centered, simple, effective, and universally applicable… Read more

ACQTool resource
Introducing the ACQTool Indicator Dashboard

When using the electronic data collection option through KoBoToolbox, indicator scores for your sites can be visualized using the custom Excel performance dashboard. The dashboard is embedded with all the necessary formulas to calculate indicator scores from your raw survey data, so calculating site-specific scores is as easy as adding your data to the Excel document. With our dashboard, you can quickly assess how well each of your sites performed against our indicator quality thresholds, as well as relative to one another. Indicator scores are displayed by site and are highlighted in green when meeting… Read more

What is the ACQTool?

The Abortion Care Quality Tool (ACQTool) is a unique set of indicators that allow users to assess the quality of abortion services. The indicators are collected via in-person or phone-based client exit interviews, from abortion clients receiving services from facility based providers, pharmacies, hotline, or other service providers… Read more

Developing the Metric

Millions of women worldwide need access to safe, high-quality abortion care. Recent estimates indicate that more than 73 million abortions are performed each year, with 97% of those performed in developing countries. Despite progress in many aspects of safe abortion provision, significant disparities remain in access to and quality of abortion services around the world. Abortions are safe with extremely low risk of death in settings where abortion is legal and clinical care is consistently high quality. However, in settings where abortion is restricted… Read more

Why Abortion Service Quality Metrics Matter

Despite progress in assuring the provision of safe abortion, significant disparities remain in access to and quality of abortion services around the world. Currently, no consistent, valid, reliable method exists to routinely measure quality in abortion care, impeding learning and improvement.

To address this need, in 2018, Metrics for Management, Ibis Reproductive Health, and Ipas launched the Abortion Service Quality (ACQ) Initiative, to develop the first-ever global standard for measuring the quality of abortion services… Read more


Definitions, measurement and indicator selection for quality of care in abortion

Little consensus exists about how to measure quality of care in abortion. Our purpose is to (a) provide common language for healthcare quality definitions, frameworks and measurement; (b) synthesize literature about quality measurement in abortion; and (c) present criteria for quality metric development. Quality includes effectiveness, patient centeredness, timeliness, efficiency and equity of care. Information about structure, process and outcomes of care is used to measure quality… Read more

Quality of care and abortion: beyond safety

Joint editorial from BMJ Journal – Sexual & Reproductive Health, stating that governments, advocates, providers, policymakers and other stakeholders who want to fully support women’s rights to access abortion across the globe must address quality of care, in addition to efforts to change abortion laws, train providers and expand service provision… Read more

Toward a Standard Measure of Abortion Service Quality-A Stakeholder First Approach

Measurement of the quality of abortion services is essential to service improvement.

Currently, its measurement is not standardized, and some of the tools which exist are

very long, and may deter use. To address this issue, this study describes a process used

to create a new, more concise measure of abortion care quality, which was done with the

end users in mind… Read more

“I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria

Measurement of the quality of abortion services is essential to service improvement.

This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct… Read more

Perspectives on high‑quality interpersonal care among people obtaining abortions in Argentina

Little is known about how people who have abortions perceive the quality of the care they receive and what aspects of interpersonal interactions with providers matter to them. This qualitative study aimed to understand preferences of people who had abortions at both a reproductive health clinic and with an accompaniment group in Argentina. We interviewed 24 people who obtained abortion care in Buenos Aires and Neuquén, Argentina. We asked them about their preferences for and experiences of abortion care… Read more

Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

Young people face social and structural barriers when accessing abortions. High-quality, sexual and reproductive healthcare is needed; however, literature on youth-informed abortion services is limited. This study assesses accounts of youth who obtained an abortion in Argentina, Bangladesh, Ethiopia, and Nigeria and provides recommendations to improve person-centered aspects of abortion quality. We analyzed 48 semi-structured interviews with clients recruited from clinics, safe abortion hotlines, and patent and proprietary medicine vendors… Read more

Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries

Objective: This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion… Read more

Developing and validating an abortion care quality metric for facility and out-of-facility settings: an observational cohort study in Bangladesh, Ethiopia, and Nigeria
Despite progress in assuring provision of safe abortion, substantial disparities remain in quality of abortion care around the world. However, no consistent, valid, reliable method exists to routinely measure quality in abortion care across facility and out-of-facility settings, impeding learning and improvement. To address this need, the Abortion Service Quality Initiative developed the first global standard for measuring quality of abortion care in low-income and middle-income countries… Read more


Using the Abortion Care Quality Tool (ACQTool) to understand and compare abortion care quality
High-quality abortion care is fundamental to reproductive autonomy, health, and human rights. Quality of care is the degree to which health services produce desired outcomes and providers use the best available evidence. Ensuring high quality abortion care includes, but is not limited to, providing sufficient, accurate information on what to expect, how to recognize warning signs, and where and when to access follow up care if needed or wanted. Examining and addressing disparities in the quality of care… Read more
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