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Kelly Blanchard - One of the best experts on this subject based on the ideXlab platform.

  • accessing medical and surgical First Trimester Abortion services women s experiences and costs from an operations research study in kwazulu natal province south africa
    Contraception, 2017
    Co-Authors: Naomi Lincederoche, Tamara Fetters, Edina Sinanovic, Kelly Blanchard
    Abstract:

    Abstract Objective(s) To explore women's experiences accessing services and estimate costs incurred for First-Trimester Abortion at four public hospitals in KwaZulu-Natal Province, South Africa. Study design Subanalysis from a prospective cohort study (2009–2011) of women aged 18–49 years accessing Abortion services through 12 weeks' gestation. Trained study personnel conducted structured interviews with women about their reason for having an Abortion, experiences accessing services and costs incurred. Women who were 9 weeks' gestation or less were eligible to choose medication Abortion or manual vacuum aspiration (MVA); women 10–12 weeks' gestation all had MVA. Results We enrolled 1167 women; 923 (79.1%) were eligible to choose their procedure. The median age was 25 years; most were black African, single and unemployed. Many women reported concerns about the affordability of raising a(nother) child (58.9%) or not being ready for (more) children (43.4%) as their reason for having an Abortion. In total, women incurred a median cost of US$9.99 (interquartile range 6.46–14.85) for their procedure which usually required two facility visits. Many had to pay for transportation, a pregnancy test, sanitary pads or pain medication. Conclusions Despite the availability of government assistance for children through South Africa's “child grant,” the affordability of raising a child was a major concern for women. Although theoretically available free of charge in the public sector, women experienced challenges accessing Abortion services and incurred costs which may have been burdensome given average local earnings. These potential barriers could be addressed by reducing the number of required visits and improving availability of pregnancy tests and supplies in public facilities. Implications Many women cited concerns about the affordability of having a(nother) child when requesting an Abortion. Although public services are technically free or low-cost in South Africa, women incurred costs for First-Trimester Abortions. Women's costs could be lowered by reducing facility visits and improving availability of pregnancy tests and supplies.

  • the costs and cost effectiveness of providing First Trimester medical and surgical safe Abortion services in kwazulu natal province south africa
    PLOS ONE, 2017
    Co-Authors: Naomi Lincederoche, Tamara Fetters, Edina Sinanovic, Jaymala Devjee, J Moodley, Kelly Blanchard
    Abstract:

    Background Despite a liberal Abortion law, access to safe Abortion services in South Africa is challenging for many women. Medication Abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing First-Trimester medication Abortion and manual vacuum aspiration (MVA) services to inform planning for First-Trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication Abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with First-Trimester Abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete Abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a First Trimester Abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their Abortion procedure; 94.1% (n = 834) chose medication Abortion. The total average cost per medication Abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication Abortion was lower than the cost per complete MVA despite three (0.4%) medication Abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both Abortion methods. Conclusion This analysis supports the scale-up of medication Abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication Abortion with MVA as a back-up, without increasing costs.

  • introducing medication Abortion into public sector facilities in kwazulu natal south africa an operations research study
    Contraception, 2015
    Co-Authors: Kelly Blanchard, Naomi Lincederoche, Tamara Fetters, Jaymala Devjee, Ilundi Durao De Menezes, Karen Trueman, May Sudhinaraset, Errol Nkonko, J Moodley
    Abstract:

    Abstract Objectives Examine the feasibility of introducing mifepristone–misoprostol medication Abortion into existing public sector surgical Abortion services in KwaZulu-Natal, South Africa. Study Design Cohort study of women offered medication or surgical Abortion in a larger medication Abortion introduction study. The sample included 1167 women seeking First-Trimester Abortion at four public sector facilities; 923 women at ≤ 9 weeks' gestation were eligible for medication Abortion. Women who chose medication Abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe Abortion guidelines. Women who chose surgical Abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete Abortion and proportion reporting adverse events. Results Ninety-four percent of eligible women chose medication Abortion. No adverse events were reported by women who chose surgical Abortion; 3% of women in the medication Abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their Abortion, with no difference based on procedure type. Medication Abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p Conclusions Medication Abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. Implications Mifepristone–misoprostol medication Abortion was successfully integrated into public sector surgical Abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication Abortion should be expanded in South Africa and other similar settings.

  • cost effectiveness analysis of unsafe Abortion and alternative First Trimester pregnancy termination strategies in nigeria and ghana
    African Journal of Reproductive Health, 2010
    Co-Authors: Daniel Grossman, Kelly Blanchard, Carol Levin, Richard Adanu, Sue J Goldie
    Abstract:

    To explore the policy implications of increasing access to safe Abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced Abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe Abortion and three First-Trimester Abortion modalities: hospital-based dilatation and curettage, hospitaland clinic-based manual vacuum aspiration (MVA), and medical Abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe Abortion in favor over unsafe Abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe Abortion modality (Afr. J. Reprod. Health 2010; 14[2]: 85-103). RĖSUMĖ

  • cost effectiveness analysis of alternative First Trimester pregnancy termination strategies in mexico city
    British Journal of Obstetrics and Gynaecology, 2009
    Co-Authors: Daniel Grossman, Kelly Blanchard, Carol Levin, Sue J Goldie
    Abstract:

    Objective  To assess the comparative health and economic outcomes associated with three alternative First-Trimester Abortion techniques in Mexico City and to examine the policy implications of increasing access to safe Abortion modalities within a restrictive setting. Design  Cost-effectiveness analysis. Setting  Mexico City. Population  Reproductive-aged women with unintended pregnancy seeking First-Trimester Abortion. Methods  Synthesising the best available data, a computer-based model simulates induced Abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for First-Trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical Abortion using vaginal misoprostol. Main outcome measures  Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy. Results  In comparison to the magnitude of health gains associated with all safe Abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical Abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe Abortion was always more influential than shifting between safe Abortion modalities. Conclusions  This study demonstrates that the provision of safe Abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe Abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical Abortion will have the best chance to minimise Abortion-related morbidity and mortality.

Gillian Dean - One of the best experts on this subject based on the ideXlab platform.

J Moodley - One of the best experts on this subject based on the ideXlab platform.

  • the costs and cost effectiveness of providing First Trimester medical and surgical safe Abortion services in kwazulu natal province south africa
    PLOS ONE, 2017
    Co-Authors: Naomi Lincederoche, Tamara Fetters, Edina Sinanovic, Jaymala Devjee, J Moodley, Kelly Blanchard
    Abstract:

    Background Despite a liberal Abortion law, access to safe Abortion services in South Africa is challenging for many women. Medication Abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing First-Trimester medication Abortion and manual vacuum aspiration (MVA) services to inform planning for First-Trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication Abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with First-Trimester Abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete Abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a First Trimester Abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their Abortion procedure; 94.1% (n = 834) chose medication Abortion. The total average cost per medication Abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication Abortion was lower than the cost per complete MVA despite three (0.4%) medication Abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both Abortion methods. Conclusion This analysis supports the scale-up of medication Abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication Abortion with MVA as a back-up, without increasing costs.

  • introducing medication Abortion into public sector facilities in kwazulu natal south africa an operations research study
    Contraception, 2015
    Co-Authors: Kelly Blanchard, Naomi Lincederoche, Tamara Fetters, Jaymala Devjee, Ilundi Durao De Menezes, Karen Trueman, May Sudhinaraset, Errol Nkonko, J Moodley
    Abstract:

    Abstract Objectives Examine the feasibility of introducing mifepristone–misoprostol medication Abortion into existing public sector surgical Abortion services in KwaZulu-Natal, South Africa. Study Design Cohort study of women offered medication or surgical Abortion in a larger medication Abortion introduction study. The sample included 1167 women seeking First-Trimester Abortion at four public sector facilities; 923 women at ≤ 9 weeks' gestation were eligible for medication Abortion. Women who chose medication Abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe Abortion guidelines. Women who chose surgical Abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete Abortion and proportion reporting adverse events. Results Ninety-four percent of eligible women chose medication Abortion. No adverse events were reported by women who chose surgical Abortion; 3% of women in the medication Abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their Abortion, with no difference based on procedure type. Medication Abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p Conclusions Medication Abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. Implications Mifepristone–misoprostol medication Abortion was successfully integrated into public sector surgical Abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication Abortion should be expanded in South Africa and other similar settings.

  • medical vs surgical evacuation of First Trimester spontaneous Abortion
    International Journal of Gynecology & Obstetrics, 2005
    Co-Authors: S Moodliar, J S Bagratee, J Moodley
    Abstract:

    Objective: To determine whether management of incomplete First-Trimester Abortion with vaginal misoprostol in an under-resourced setting is a viable treatment option. Methods: A total of 94 women were randomized to 600 μg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the Abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow-up visit 2 weeks following complete Abortion. Results: The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow-up visit. However, more women who received the medical treatment would recommend it or choose it in the future. Conclusion: Medical management using 600 μg of misoprostol in 2 doses is effective to treat incomplete First-Trimester Abortions in an under-resourced setting when there is no evidence of uterine sepsis.

Alisa B. Goldberg - One of the best experts on this subject based on the ideXlab platform.

  • Manual versus electric vacuum aspiration for early First-Trimester Abortion: a controlled study of complication rates.
    Obstetrics and gynecology, 2004
    Co-Authors: Alisa B. Goldberg, Gillian Dean, Mi-suk Kang, Sarah Youssof, Philip D. Darney
    Abstract:

    OBJECTIVE:Manual vacuum aspiration is an alternative to electric suction curettage for First-Trimester elective Abortion. Although many studies have demonstrated that manual vacuum aspiration is safer than sharp curettage for Abortion, only a few studies have directly compared it with electric sucti

  • acceptability of manual versus electric aspiration for First Trimester Abortion a randomized trial
    Contraception, 2003
    Co-Authors: Gillian Dean, Philip D. Darney, Lilia H Cardenas, Alisa B. Goldberg
    Abstract:

    This study was conducted to compare the acceptability of manual and electric vacuum aspiration for First Trimester elective Abortion. Eighty-four women seeking Abortions at less than 10 weeks gestation were randomized to Abortion by manual or electric vacuum aspiration. Post-procedure questionnaires were administered to patients to assess pain, noise disturbance and overall satisfaction with the Abortion procedure. Physicians reported procedural difficulty, their perceptions of patient discomfort and their overall acceptance of the procedure. Other outcomes included amounts of anesthesia required and complication rates. There were no significant differences in pain levels or satisfaction reported by patients; however, significantly more women in the electric group were bothered by noise (19% vs. 2%, p = 0.03). There were no differences in physician assessments of procedural difficulty; however, there were significantly more times in the electric group that physicians would have preferred manual aspiration (43% vs. 17%, p = 0.02). There were four crossovers from manual to electric, and none from electric to manual. It is concluded that physicians and patients find manual vacuum aspiration as acceptable as electric vacuum aspiration for elective Abortions performed at less than 10 weeks gestation.

Naomi Lincederoche - One of the best experts on this subject based on the ideXlab platform.

  • accessing medical and surgical First Trimester Abortion services women s experiences and costs from an operations research study in kwazulu natal province south africa
    Contraception, 2017
    Co-Authors: Naomi Lincederoche, Tamara Fetters, Edina Sinanovic, Kelly Blanchard
    Abstract:

    Abstract Objective(s) To explore women's experiences accessing services and estimate costs incurred for First-Trimester Abortion at four public hospitals in KwaZulu-Natal Province, South Africa. Study design Subanalysis from a prospective cohort study (2009–2011) of women aged 18–49 years accessing Abortion services through 12 weeks' gestation. Trained study personnel conducted structured interviews with women about their reason for having an Abortion, experiences accessing services and costs incurred. Women who were 9 weeks' gestation or less were eligible to choose medication Abortion or manual vacuum aspiration (MVA); women 10–12 weeks' gestation all had MVA. Results We enrolled 1167 women; 923 (79.1%) were eligible to choose their procedure. The median age was 25 years; most were black African, single and unemployed. Many women reported concerns about the affordability of raising a(nother) child (58.9%) or not being ready for (more) children (43.4%) as their reason for having an Abortion. In total, women incurred a median cost of US$9.99 (interquartile range 6.46–14.85) for their procedure which usually required two facility visits. Many had to pay for transportation, a pregnancy test, sanitary pads or pain medication. Conclusions Despite the availability of government assistance for children through South Africa's “child grant,” the affordability of raising a child was a major concern for women. Although theoretically available free of charge in the public sector, women experienced challenges accessing Abortion services and incurred costs which may have been burdensome given average local earnings. These potential barriers could be addressed by reducing the number of required visits and improving availability of pregnancy tests and supplies in public facilities. Implications Many women cited concerns about the affordability of having a(nother) child when requesting an Abortion. Although public services are technically free or low-cost in South Africa, women incurred costs for First-Trimester Abortions. Women's costs could be lowered by reducing facility visits and improving availability of pregnancy tests and supplies.

  • the costs and cost effectiveness of providing First Trimester medical and surgical safe Abortion services in kwazulu natal province south africa
    PLOS ONE, 2017
    Co-Authors: Naomi Lincederoche, Tamara Fetters, Edina Sinanovic, Jaymala Devjee, J Moodley, Kelly Blanchard
    Abstract:

    Background Despite a liberal Abortion law, access to safe Abortion services in South Africa is challenging for many women. Medication Abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing First-Trimester medication Abortion and manual vacuum aspiration (MVA) services to inform planning for First-Trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication Abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with First-Trimester Abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete Abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a First Trimester Abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their Abortion procedure; 94.1% (n = 834) chose medication Abortion. The total average cost per medication Abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication Abortion was lower than the cost per complete MVA despite three (0.4%) medication Abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both Abortion methods. Conclusion This analysis supports the scale-up of medication Abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication Abortion with MVA as a back-up, without increasing costs.

  • introducing medication Abortion into public sector facilities in kwazulu natal south africa an operations research study
    Contraception, 2015
    Co-Authors: Kelly Blanchard, Naomi Lincederoche, Tamara Fetters, Jaymala Devjee, Ilundi Durao De Menezes, Karen Trueman, May Sudhinaraset, Errol Nkonko, J Moodley
    Abstract:

    Abstract Objectives Examine the feasibility of introducing mifepristone–misoprostol medication Abortion into existing public sector surgical Abortion services in KwaZulu-Natal, South Africa. Study Design Cohort study of women offered medication or surgical Abortion in a larger medication Abortion introduction study. The sample included 1167 women seeking First-Trimester Abortion at four public sector facilities; 923 women at ≤ 9 weeks' gestation were eligible for medication Abortion. Women who chose medication Abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe Abortion guidelines. Women who chose surgical Abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete Abortion and proportion reporting adverse events. Results Ninety-four percent of eligible women chose medication Abortion. No adverse events were reported by women who chose surgical Abortion; 3% of women in the medication Abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their Abortion, with no difference based on procedure type. Medication Abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p Conclusions Medication Abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. Implications Mifepristone–misoprostol medication Abortion was successfully integrated into public sector surgical Abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication Abortion should be expanded in South Africa and other similar settings.