Satisfaction and Associated Factors of Comprehensive Abortion Care Users in Public and Private Health Facilities of Addis Ababa, Ethiopia: Comparative study

Abstract Background Client satisfaction is a key indicator of healthcare quality and influences continued use of safe abortion services. Despite expanded access to comprehensive abortion care in Ethiopia, evidence comparing client satisfaction and its determinants between private and public facilities is limited. This study aimed to assess and compare satisfaction levels and associated factors among women receiving CAC services in Addis Ababa. Methods -A facility-based comparative cross-sectional study was conducted from June 7 to September 9, 2025, among 612 women (306 from private and 306 from public facilities) selected through a multi-stage cluster sampling technique from 18 facilities across three sub-cities. Data were collected via structured, pre-tested questionnaires through exit interviews. Satisfaction was measured using a five-point Likert scale. Data were analyzed using SPSS version 27. Descriptive statistics, comparative tests (Welch’s t-test), and multiple linear regression were used, with statistical significance determined at p < 0.05. Results -The overall mean satisfaction score was 3.62 (SD = 0.87). Clients in private facilities reported significantly higher satisfaction (M = 3.71, SD ± 0.76) than those in public facilities (M = 3.54, SD ± 0.97; p = 0.015). Overall, 66.2% of respondents were satisfied, with higher satisfaction in private (70.3%) than in public facilities (62.1%). Major predictors of satisfaction were receiving care in private facilities ( B = 0.070, p < 0.001), being attended by male providers ( B = 0.019, p < 0.001), undergoing medical abortion ( B = 0.015, p = 0.008), being offered family planning ( B = 0.015, p = 0.009), receiving follow-up appointments ( B = 0.014, p = 0.001), and paying moderate service fees ( B = 0.020, p = 0.001). Among service quality domains, access, timeliness, and fairness were the strongest predictors ( B = 0.412, p < 0.001). Conclusion This study shows that client satisfaction with comprehensive abortion care (CAC) services in Addis Ababa is strongly influenced by the type of facility. While key aspects of service quality such as accessibility, timeliness, and responsiveness are important in all facilities, their impact varies between private and public health centers. Private facilities may need to focus on cost transparency and patient-centered communication, while public facilities could prioritize improving infrastructure, reducing waiting times, and supporting provider motivation.