Strengthening health system capacity for legal termination of pregnancy in Burkina Faso: A quasi‐experimental evaluation in public health facilities

OBJECTIVE: Despite legal provisions allowing access to safe abortion under specific criteria in Burkina Faso, the availability of care services remains limited. The present study evaluated the effectiveness of interventions aimed at strengthening health services' capacity to provide legal termination of pregnancy in Burkina Faso. METHODS: We conducted a quasi-experimental "before-after" study without a control group across 179 public health facilities comprising 132 primary healthcare facilities (CSPS/CM) and 47 referral hospitals. We used data from the Harmonized Health Facility Assessment (HHFA) survey conducted in 2020 as the baseline, and the endline survey was performed in December 2022 using CSPRO electronic questionnaires. We evaluated the availability and provision of legal termination of pregnancy services using the McNemar and Wilcoxon tests (Stata 18), with statistical significance set at p < 0.05. RESULTS: Service availability for the legal termination of pregnancy showed significant improvements from 2020, with notable changes in service delivery patterns across all levels. In primary healthcare facilities (CSPS/CM), misoprostol utilization increased substantially from 28.6% to 95.2% (p = 0.0455), while manual vacuum aspiration availability improved from 28.6% to 100% (p = 0.0455). Patient referrals from the CSPS/CM increased markedly from 1.5% to 97.4% (p < 0.0001). At the hospital level, although legally authorized abortion services decreased from 100% to 76.6% (p = 0.0009), post-abortion family planning coverage improved from 89.4% to 100% (p = 0.0253). Hospital referrals increased significantly from 10.6% to 51.2% (p < 0.0001), whereas misoprostol usage remained stable at approximately 83%. CONCLUSION: The findings indicated a substantial shift in the legal termination of pregnancy delivery patterns and strengthened referral networks between different levels of care. These changes suggest the successful strengthening of the health system's capability to provide comprehensive abortion care services.