Evaluation of Post-Abortion Care Accessibility and Clinical Quality for Adolescents in Rural Madagascar

African Journal of Gender and Women Studies | Vol. 11, No. 9, August 2026 | pp. 265–272

DOI: 10.46882/2026/AJGWS/001281

Article Type: Original Research Article

Title: Evaluation of Post-Abortion Care Accessibility and Clinical Quality for Adolescents in Rural Madagascar

Names of Authors: Dr. Lalao N. Razafindratsima¹

Authors’ Affiliations: ¹Institut National de la Santé Publique et Communautaire, University of Mahajanga, Mahajanga, Madagascar

Abstract:
Adolescent maternal mortality remains a major public health crisis in Madagascar, often exacerbated by complications from unsafe abortions. This study evaluates the accessibility and quality of post-abortion care (PAC) services for adolescent girls aged 15 to 19 in rural communities of the Atsinanana region. A cross-sectional facility audit was conducted across 35 primary healthcare centers, supplemented by 40 narrative interviews with adolescent PAC recipients. The quantitative indicators reveal structural gaps: only 18% of surveyed facilities possessed complete PAC packages, which require emergency manual vacuum aspiration equipment, essential antibiotics, and post-abortion contraceptive options. The thematic analysis of patient narratives shows that adolescent girls face severe institutional barriers, including verbal abuse, moral condemnation, and breaches of confidentiality by healthcare providers. This systemic hostility delays care-seeking behaviors, with adolescents presenting at facilities an average of 4.2 ± 1.5 days after the onset of complications, significantly increasing the risk of sepsis and long-term infertility (p < 0.05). Furthermore, financial dependency forces many adolescents to seek cheaper, dangerous traditional alternatives before arriving at formal clinics. The study concludes that standard reproductive health policies are failing vulnerable adolescents due to cultural biases among clinicians. It recommends mandatory youth-friendly training for rural health workers, removing cost barriers for adolescent emergency care, and establishing confidential mobile reproductive health services.

Keywords: Post-Abortion Care, Adolescent Health, Reproductive Rights, Healthcare Quality, Rural Madagascar, Institutional Barriers

Manuscript Timeline: Received: March 01, 2026; Revised: May 12, 2026; Accepted: June 15, 2026; Published: August 31, 2026.

Citation: Razafindratsima, L. N. (2026). Evaluation of Post-Abortion Care Accessibility and Clinical Quality for Adolescents in Rural Madagascar. African Journal of Gender and Women Studies, 11(9), 265–272. DOI: 10.46882/2026/AJGWS/001281

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