Women's Satisfaction With Quality of Abortion Care, Associated Factors, and Barriers in Public Health Facilities of South Gondar Zone, Ethiopia: A Mixed Study

Abstract

Background and Aims: Client satisfaction is a key indicator of abortion care quality, influencing both service use and outcomes. While Ethiopia has expanded access to comprehensive abortion care, limited evidence exists on client satisfaction in conflict-affected areas like South Gondar Zone. This study aims to assess perceived quality, identify associated factors, and explore barriers to accessing abortion services in public health facilities in South Gondar, Amhara Region, Ethiopia, in 2024. Methods: A concurrent mixed-methods study was conducted from November 1 to December 31, 2024, using cross-sectional and phenomenological designs. A multi-stage sampling was used for selection. Quantitative data were collected from 477 women using a structured, pre-tested questionnaire and analyzed using SPSS version 25. A binary logistic regression used to identify factors. Additionally, 15 purposively selected participants took part in in-depth interviews, with qualitative data thematically analyzed using Open Code software. Results: Satisfaction with abortion care quality was 38.4% (95% CI: 34.1%-42.8%). Women aged 15-24 (AOR = 3.25, 95% CI: 1.28-8.26), 25-34 (AOR = 2.49, 95% CI: 1.11-5.56), urban residence (AOR = 0.45, 95% CI: 0.24-0.82), family size (< 5) (AOR = 0.32, 95% CI: 0.16-0.63), partners with no formal education (AOR = 0.36, 95% CI: 0.18-0.74), receiving care at health centers (AOR = 0.36, 95% CI: 0.19-0.68) or primary hospitals (AOR = 0.21, 95% CI: 0.10-0.44), and male providers (AOR = 0.43, 95% CI: 0.27-0.69) were significantly associated client satisfaction. Qualitative findings revealed key barriers to satisfaction, including stigma, lack of privacy, supply shortages, and provider reluctance. Conclusion: Client satisfaction with abortion care quality in South Gondar Zone is low compared to national standards and is associated with age, residence, family size, partner's education, facility type, and provider gender. Improving satisfaction requires expanding service access, promoting respectful, client-centered care, upgrading facility conditions, training providers-especially males-and addressing stigma and privacy concerns.