Challenges and prospects in integrating abortion care with HIV/Family planning services as a one-stop maternal health service

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Therefore, integrating abortion care with HIV-FP services can enhance the utilization of maternal health services and increase client satisfaction. Method: A facility-based cross-sectional mixed-method study was conducted, collecting quantitative data through face-to-face interviews with abortion care users and self-administered questionnaires for healthcare providers. The collected data underwent verification, cleaning, and entry into EpiData version 3.1 software, followed by exportation and analysis using SPSS version 25. Result: The study included 413 women receiving abortion care and 306 healthcare providers from 58 public health facilities. Healthcare providers identified factors such as enhancing regulatory documents, providing training, improving infrastructure, ensuring a consistent supply of medical resources, program monitoring and evaluation, and fostering interaction between healthcare facility units as motivating factors for implementing integrated health services. Abortion care users emphasized that making health facilities available and equipping them with necessary materials, equipment, and supplies can enhance integrated abortion care services. Conclusion: Successful implementation of integrated maternal health services requires a strategic action plan addressing challenges and engaging with motivational factors. Integration abortion abortion care family planning service HIV service 1. Introduction Up until the late 19th century, legal constraints on abortion services were pervasive globally, impeding women's access to abortion care and restricting healthcare providers from delivering legally sanctioned services within health facilities (1, 2). These restrictions were chiefly imposed by colonizing powers like Britain, France, Portugal, Spain, and Italy (1). Nevertheless, over time, numerous nations, including Ethiopia, have undertaken reforms to their abortion laws (1, 3, 4). The changes in legislation have been geared toward promoting safer and more accessible abortion care. It is important to highlight that unsafe abortion practices contribute to approximately 70,000 maternal deaths each year, resulting in around 5 million mothers facing permanent or temporary disabilities (5). These unfortunate consequences could be substantially diminished with the widespread availability of comprehensive abortion services (6). Unplanned pregnancies, often resulting in unsafe abortions as reported by the Central Statistics Authority and ICF International in 2016 (7), can be mitigated through effective access to family planning services. Additionally, a comprehensive approach involves providing a one-stop service that incorporates abortion care into overall healthcare services. When healthcare services are delivered separately, it can lead to the inaccessibility of specific services, diminished service quality, and unnecessary increases in service costs, as highlighted by the World Health Organization in 2018 (8). The financial burden on clients is frequently associated with multiple visits to health facilities on different days or in separate locations for various healthcare needs (9). The integration of family planning and HIV services has demonstrated significant benefits in maternal healthcare, especially in developing countries like Ethiopia where the risks of unintended pregnancies and HIV transmission are high (10). There is substantial evidence supporting the improvement of maternal health services through the integration of HIV and family planning services (11). The integration of health services is widely adopted by many countries, contributing to the enhancement of maternal healthcare (12). In resource-limited settings like Ethiopia, integrating abortion care with HIV and family planning services can prove to be cost-effective (13). In modern health systems, integrated healthcare plays a crucial role by enhancing efficiency, horizontalizing vertical programs, optimizing human resource utilization, and providing clients with multiple services in a single location (14, 15). As a result, women receiving abortion care significantly benefit from the integration of family planning services, voluntary HIV counseling and testing, and screening for sexually transmitted infections, as emphasized by USAID in 2015 (16). This integration not only improves accessibility but also enhances the overall quality of healthcare (14, 17). The integration of abortion care with existing HIV-FP services contributes to the well-being of women, families, and communities (18, 19). Improving access to safe abortion care within integrated HIV and family planning services can help mitigate the occurrence of unsafe abortions, particularly those related to unintended or unwanted pregnancies (7, 20). The integration of health services not only facilitates the delivery of comprehensive healthcare but also has the potential to enhance health outcomes, improve system efficiencies, and promote sustainable development (16). Integrated abortion care encounters several challenges, including infrastructure problems, a scarcity of logistics, and a shortage of adequately trained healthcare providers, as highlighted by Mutemwa et al. in 2013 (21). Additional hurdles in this integrated approach include the lack of sufficient space and time constraints for counseling services, as noted by Newmann et al. in 2016 (22). Financial constraints and cultural issues further contribute to the complexity of providing integrated abortion care, as outlined by Maruthappu, Hasan, and Zeltner in 2015 (23). Integrating abortion care with family planning and HIV/AIDS services brings significant benefits for both abortion care users and healthcare providers, as emphasized by Mutemwa et al. in 2013 (21). This integration fosters improved teamwork, enhanced healthcare efficiency, increased quality of care, reduced healthcare service costs, and instilled confidence in the healthcare system (9). Moreover, it addresses challenges such as the fragmentation of healthcare, increases access to supplies, avoids duplication of decisions, alleviates organizational bottlenecks, and ensures coordinated responses to clients, as noted by Maruthappu, Hasan, and Zeltner in 2015, and Milford et al. in 2018 (23, 24). At the client's level, integrated services contribute to the improvement of privacy and confidentiality, reducing stigma and discrimination. The proximity of services in the same area, provided by the same or different providers, eliminates the need for numerous referrals (25). This not only ensures effective healthcare provision but also enhances job satisfaction among healthcare providers by delivering better-quality services to the community (21). Feedback from clients receiving integrated services further enriches the healthcare providers' understanding of their performance. Integration also contributes to the development of clinical and communication skills, fostering positive interactions among healthcare workers (26). Additionally, integration helps reduce the workload through decreased client visits, potentially yielding cost benefits at the health system level (24). The objective of this study was to delineate the challenges and potential advantages associated with integrating abortion care into HIV/FP services, as perceived by both healthcare providers and abortion care users. The integration of abortion care, HIV, and family planning services within healthcare facilities is seen as a consolidated and comprehensive "one-stop-shop" service, offering benefits to both healthcare users and providers alike. 2. Methods 2.1 Design A facility-based cross-sectional study was conducted. 2.2 Study setting The study was conducted in 58 public health facilities, comprising 8 public hospitals and 50 public health centers, located in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. SNNPR is one of the largest regions in Ethiopia, covering more than 10% of the country’s land area, with an estimated population of over 20 million, constituting almost a fifth of the country’s total population (27). 2.3 Population and Sample The study involved healthcare providers and abortion care users in public health centers and public health hospitals within the designated study areas. The total study population comprised 1860 health service providers, including 104 physicians, 366 midwives, 446 health officers, and 944 nurses. These professionals were actively working in public health facilities within the study region, as indicated by the 2018 annual report of the Southern Nations, Nationalities, and Peoples' Region (27). On the other hand, the population of interest among women of childbearing age (18-49 years old) who received abortion care in the Southern Region in 2018 was reported to be 46,276, as documented in the 2018 report from the SNNPR Health Bureau (27). The determination of the required sample size followed the single population proportion formula. Given the absence of recorded studies indicating the provision of integrated abortion care with FP-HIV in public health facilities, a 50% proportion was employed to ensure the maximum sample size, aligning with the approach suggested by Bordens and Abbott in 2018 (28). The selection of 58 public health facilities was conducted using a simple random sampling method. Following this, a proportional allocation strategy was employed to include abortion care users and healthcare providers within these facilities. From these health facilities, a total of 413 abortion care users and 306 healthcare providers were enrolled in the study. The healthcare provider sample comprised 157 Nurses, 72 Health officers, 60 Midwives, and 17 Physicians. The selection process utilized a stratified simple random sampling technique from public healthcare facilities. 2.4 Data Collection and Analysis The questionnaires were developed following an extensive literature review on integrated health services covering abortion, family planning, and HIV. The data collection from abortion care users was conducted using the prepared questionnaire, administered in a face-to-face manner by trained midwives. For healthcare providers, the distribution and collection of self-administered questionnaires were overseen by trained public health officers. Following data collection, the obtained information was coded and entered into EpiData 3.1 software. Subsequently, the data were exported to the Statistical Package for Social Sciences software (SPSS) version 25 for comprehensive analysis. 2.5 Validity and Reliability Validity and reliability are generally considered complementary, but there are situations where a trade-off may exist, with high validity associated with lower reliability and vice versa (29). In this context, validity refers to the capacity of an instrument or questionnaire to measure and provide true results (30, 31). To ensure the validity of the questionnaires for abortion care users and healthcare providers, a scientific review committee was engaged. This committee scrutinized and assessed the questionnaires before pretesting, aiming to identify weaknesses and strengths in capturing the required information. Reliability, on the other hand, refers to the consistency of results yielded by a measuring instrument over time and across different observers (32). The pre-test findings demonstrated that participants had a uniform understanding of the questions. The main study findings further supported this consistency, indicating the reliability of the questionnaires. 2.6 Ethics Ethics approval for the research was granted by the Health Studies Research Committee of the Department of Health Studies at the University of South Africa (Certificate number: HSHDC/923/2019). Additionally, permission to conduct the research was secured from all selected health facilities, adhering to the South Region Health Bureau Human Research and Technology Transfer Support Core Process (Certificate number: የወ/19/492 12//102012). Prior to commencing data collection, an institutional support letter from the relevant health bureau in the study area was obtained. To ensure voluntary participation, abortion care users and healthcare providers were provided with a recruitment letter. Respondents were given the option to read the letter themselves or have it read aloud to them if needed. Following this, individuals who volunteered to participate signed written consent forms, affirming their willingness to be part of the study. 3. Results 3.1 Biographical data Out of the 422 abortion care users initially considered, data were successfully obtained from 413 respondents, resulting in an overall response rate of 97.9%. The age range of abortion care users varied between 18 and 44 years, with a significant proportion (66.6%) falling within the 20-29 age bracket. In terms of education, 84 respondents held degrees or diplomas, 106 had attended high school, 101 had completed elementary school, 57 were able to read and write, and the remaining 65 were unable to read and write. Occupationally, 182 respondents identified as housewives, 59 were self-employed, 56 were public servants, 33 were private employees, 22 were farmers, and 8 were entrepreneurs. Regarding marital status, 63.7% of abortion care users were married, while 150 were single, including those who were divorced, widowed, separated, or unmarried but in a relationship. The study found that the mean monthly income of respondents was US $96.5, with a standard deviation of + US $65.7 and a median income of US $77.5. Notably, 210 respondents reported an average monthly income of less than US $81 (See Table 1). Table 1 Socio-demographic and economic status of abortion care users, SNNPR, Ethiopia Abortion care users Frequency Percent Cumulative Frequency Cumulative Percent Age group 15-19 39 9.4 39 9.4 20-24 122 29.5 161 39.0 25-29 153 37.0 314 76.0 30-34 64 15.5 378 91.5 35-39 30 7.3 408 98.8 40-44 5 1.2 413 100.0 Educational status Cannot read and write 65 15.7 65 15.7 Able to read and write 57 13.8 122 29.5 Elementary school 101 24.5 223 54.0 High school (12 or 10 completed) 106 25.7 329 79.7 TVET/Diploma level 50 12.1 379 91.8 Basic degree 34 8.2 410 100 Marital status Married 263 63.7 263 63.7 Single 150 36.3 413 100 Occupation status of abortion care users Housewife 182 44.1 182 44.1 Self-employed 59 14.3 241 58.4 Public servant 56 13.6 297 71.9 Student 53 12.8 350 84.7 Private employee 33 8.0 383 92.7 Farmer 22 5.3 405 98.1 Entrepreneur 8 1.9 413 100.0 Monthly income 0-40 92 22.3 92 22.3 40-80 118 28.6 210 50.9 81-120 83 20.1 293 71.0 121-160 58 14.0 351 85.0 161-200 26 6.3 377 91.3 201 and above 36 8.7 413 100.0 Likewise, for healthcare providers, the self-administered questionnaire was distributed to 310 individuals, and completed questionnaires were received from 306 respondents, resulting in a robust response rate of 98.7%. Among the healthcare providers, 164 were female, with ages ranging from a minimum of 21 years to a maximum of 45 years. Notably, 109 healthcare providers had 36 months or longer work experience, while only 30 respondents had served between 0-11 months in their current roles. 3.2. Perceptions of abortion care users This study focused on women primarily seeking abortion care at public healthcare facilities. The majority of respondents (79.7%) specifically requested abortion care only, while 18.4% sought both abortion care along with family planning (FP) or HIV/AIDS services. Only 1.9% of respondents requested all three services concurrently. However, during healthcare providers' counseling sessions, 188 abortion care users ended up receiving family planning or HIV services in addition to abortion care. Among those who received integrated services (n=188), 113 respondents received the services in abortion care units, 52 in HIV-FP rooms, 12 in delivery rooms, 6 in ANC/PMTCT rooms, and 5 in outpatient departments. Regarding the delivery of integrated services, 111 women received services in the same room by the same healthcare provider, 46 in the same room but by different healthcare providers (with one providing one service and another offering the next service), and 31 respondents had to move to another room to receive additional care from a different healthcare provider. While only 188 respondents experienced integrated healthcare services in this study, a significant majority (332) expressed a preference for utilizing integrated healthcare in the future. However, 81 respondents indicated a reluctance to opt for integrated health services even in the future. 3.3 Perceptions of healthcare providers The majority of healthcare providers (82%) in this study received one or more types of in-service training to enhance their capacity to provide healthcare services. Among those who underwent in-service training (n=251), 124 received comprehensive abortion care training, 114 received training in long-acting family planning (FP) services, 81 in short-acting FP training, and 71 in HIV counseling in-service training. Regarding the distribution of training, 184 healthcare providers received only one type of in-service training, 58 received two types, 6 received training in three areas, and only 3 respondents received training in all four areas. In terms of the recency of training, 65 healthcare providers received in-service training within the last 12 months, 74 between 12 and 23 months ago, 47 between 24 and 35 months ago, and 35 respondents received training more than 36 months ago. The organizations responsible for providing in-service training varied, with 181 respondents receiving training from NGOs, 73 from the Southern Nations, Nationalities, and Peoples' Region health bureau, 44 from the Federal Ministry of Health, and the remaining 30 respondents receiving training from zonal health departments (see Table 2). In this study, 125 respondents indicated they were aware of at least one abortion regulatory document, 141 were aware of at least one FP-related regulatory document, 105 were aware of at least one HIV/AIDS regulatory document, and only 35 respondents indicated awareness of at least one integrated regulatory document (see Table 2). Respondents identified seven different types of abortion-related regulatory documents, nine different types of FP-related regulatory documents, six different types of HIV/AIDS-related regulatory documents, and seven different types of integrated health service-related regulatory documents. Table 2 Healthcare providers' competency in providing integrated services, SNNPR, Ethiopia Variables Frequency Percent In-service training received Comprehensive abortion 124 49.4 Long-acting FP 114 45.4 Short-acting FP 81 26.5 HIV counselling 71 32.3 Prevention of mother-to-child transmission of HIV BEmONC training 54 46 21.5 18.3 Antiretroviral treatment 30 12.0 Opportunistic infection 19 7.6 Tubal ligation 4 1.6 Vasectomy 3 1.2 Knowledge of regulatory documents Technical guidelines on abortion care 65 52.0 Abortion management protocol 33 26.4 First and second-trimester guideline 14 11.2 Women-centred guide on abortion care 12 9.6 BEMoNC guidelines 9 7.2 Abortion contraception strategies 8 6.4 Infection prevention strategies 6 4.8 3.4 Abortion care users perceived the advantages & disadvantages of one-stop-shop services Abortion care users identified several advantages of integrated health services, including low transportation costs, reduced waiting times, increased access to health services, reduced stigma and discrimination, efficient use of staff time, and decreased frequency of visits to healthcare services. However, there were also perceived disadvantages, including concerns about the loss of confidentiality, fear of stigma and discrimination, increased workload for service providers, decreased quality of services, and feelings of embarrassment when discussing HIV and/or family planning issues with healthcare providers (see Table 3) Table 3 Perception of abortion care users on the advantages and disadvantages of one-stop-shop service, SNNPR, Ethiopia Perception of abortion care users on one-stop-shop services Frequency Percent Advantages of one-stop-shop services Reduced transportation cost 249 60.3 Reduce waiting time 218 52.8 Make fewer trips to the facility 209 50.6 Reduces stigma toward accessing HIV services 167 40.4 Efficient way to access several services 159 38.5 Reduce stigma towards accessing FP services 81 19.6 Disadvantages of one-stop-shop services Fear of loss of confidentiality 114 27.6 Fear of stigma and discrimination 109 26.4 Increased workload to service providers 101 24.5 Decreased quality of services 81 19.6 Embarrassed to discuss HIV and/or FP issues with providers 67 16.2 3.5 Healthcare Providers’ Perception of the benefit and challenges of one-stop-shop services Healthcare providers identified several benefits of a one-stop-shop service, including avoiding missed opportunities, improving teamwork, increasing access to integrated health services, reducing stigma and discrimination, efficient use of staff time, and reducing visits to healthcare services. However, they also highlighted several challenges in providing one-stop-shop services, such as the lack of operational policies and guidelines, poor infrastructure in healthcare facilities, a shortage of trained staff, a poor support and monitoring system, inadequate medical supplies, inadequate budget allocation, and the time-consuming nature of integrating the services (see Table 4). Table 4 Perception of healthcare providers on the benefits and challenges of one-stop-shop service, SNNPR, Ethiopia Perception of healthcare providers on one-stop-shop services Frequency Percent Benefits of one-stop-shop services Avoid missed opportunities 256 83.7 Improve teamwork 236 77.1 Increase access to integrated health services 208 68.0 Reduce stigma and discrimination 182 59.5 Efficient use of staff time 177 57.8 Reduce visits to healthcare services 176 57.5 Reduces cost 165 53.9 Challenges of one-stop-shop services Lack of operational policies and guidelines 207 67.6 Poor infrastructure 207 67.6 Shortage of healthcare providers 207 67.6 Poor support and monitoring system Inadequate medical supplies 190 157 62.1 51.3 Inadequate budget allocation 118 38.6 Takes time to integrate the service 95 31.0 3.5 Factors associated utilization of integrated Health services The association of factors with integrated health services was assessed using both bivariable and multivariable logistic regression analysis. In the bivariable analysis, women with a monthly average income of 161-200 USD were three times more likely to receive integrated HIV-FP services compared to those with incomes ranging from 0-40 USD. Similarly, abortion care users who received the service free of charge were three times more likely to use the service compared to those whose payment was covered by health insurance (see Table 5). In the multiple logistic regression, abortion care users who had previously used family planning (FP) services were four times more likely to use FP services compared to those who had never used them, with an Adjusted Odds Ratio (AOR) of 4.299 and a 95% Confidence Interval (CI) of (2.399, 7.704), and a p-value of 0.0001 (see Table 5). However, the place of residence and the previous history of abortion were found to have no statistically significant association with the utilization of integrated services. Table 5 Odds ratios from multivariable logistic regression on the integration of abortion care with HIV-FP service (AOR 95% CI) (N=413) Covariant Integration with FP and HIV/AIDS services Crude odds ratio Adjusted OR yes No 95% CI Variables n=113 f= n=300 f= Average monthly income in USD 0-40 28 30.4 64 69.6 1 1 41-80 30 25.4 88 74.6 2.712 (0.955 7.703) 2.004 (0.564 7.12) 81-120 24 28.9 59 71.1 2.114 (0.753 5.929) 1.527 (0.434 5.37) 121-160 21 36.2 37 63.8 2.522 (0.876 7.258) 2.007 (0.58 6.943) 161- 200 5 19.2 21 80.8 3.519 (1.188 10.42) 2.475 (0.669 9.15) 201 and above 5 13.9 31 86.1 1.476 (0.380 5.73) 0.846 (0.167 4.27) Residence Urban 56 31.8 120 68.2 1.474 (.954 2.277) 1.018 (0.561 1.849) Rural 57 24.1 180 75.9 1 1 Service charge settlement Receive the service free of charge 87 28.2 221 71.8 2.913 (1.108 7.656) 2.444 (0.754 7.91) Paid in cash 21 33.9 41 66.1 3.790 (1.298 11.070) 1.470 (0.386 5.60) Covered by health insurance 5 11.9 37 88.1 1 1 Previous use of FP services Yes 83 35.8 149 64.2 2.804 (1.744 4.508) 4.067 (2.185 7.568) No 30 16.6 151 83.4 1 1 Previous abortion Yes 45 83.3 9 16.7 0.490 (0.231 1.039) 0.505 (0.202 1.263) No 104 29.0 255 71.0 1 1 4. Discussion The standalone or vertical provision of health services may not effectively promote the utilization of integrated health services, as highlighted by UNAID in 2015 (16). Offering integrated health services from the same or different healthcare providers simultaneously and at the same location has been demonstrated to enhance the uptake of various health services, as emphasized by Samuel, Fetters, and Desta in 2016 (33). In this study, among the 413 abortion care users, 188 received integrated health services, and the majority (n=332; 80.5%) expressed a preference for utilizing integrated healthcare in the future. The preference for integrated healthcare is further supported by the efficiency gained when the same healthcare provider offers integrated services in the same room, minimizing waiting times for clients, as suggested by USAID et al. in 2015 (16). Conversely, receiving healthcare services from different providers in different rooms can potentially increase waiting times as clients move between rooms to receive different services from different healthcare providers (25). Nonetheless, even when clients visit different rooms, there is still a reduction in the number of visits, thereby decreasing travel time and costs, as noted by Al-Saddique in 2018 (9). While the advantages of integrated health services are significant, some perceived disadvantages by abortion care users include increased waiting time, fear of stigma and discrimination, and increased workload. However, strategies can be implemented to address these challenges. For instance, using the same consulting room for different services can reduce waiting times, as previously mentioned. Structural integration, effective staff management, enhancing providers' skills and knowledge, empowering decision-makers, promoting teamwork, and implementing work-sharing are crucial strategies to overcome the challenges associated with integrated healthcare, as highlighted by Mayhew, Hopkins, and Warren in 2017 (34). These approaches aim to optimize the benefits of integrated services while mitigating potential drawbacks, ensuring a more seamless and patient-friendly healthcare experience. In delivering integrated health services to clients, healthcare providers, whether new or existing staff, require either pre-service or in-service training. In this study, the majority (82%) of healthcare providers received one or more types of in-service training, enabling them to provide integrated healthcare services. However, the findings of a study across five countries raise concerns, as two-thirds of healthcare providers in those settings lacked adequate training and were unfamiliar with guidelines on offering integrated healthcare services (35), even as they attempted to implement integrated services. Professional development through in-service training is crucial for enhancing the provision of quality healthcare, as emphasized by the WHO in 2016 (36). Healthcare providers need ongoing knowledge, skills, training, and professional development opportunities to maintain and update their capacity, ensuring they can continuously improve the quality of services they deliver. The government of Ethiopia is actively addressing healthcare providers' professional development through in-service training (37) and working to improve the integration of maternal health services (7). These efforts underscore the commitment to enhancing the skills and capabilities of healthcare providers to provide effective integrated healthcare services. The availability and utilization of integrated regulatory documents in public health facilities play a crucial role, serving as a guide for healthcare workers in providing integrated health services, as highlighted by Borges et al. in 2015 (38). However, challenges exist, with studies indicating that guidelines are often not readily available in public health facilities. Even when available, healthcare providers may neglect to use these guidelines during their health service consultations, as noted by Tafese, Woldie, and Megerssa in 2013 (39). This gap underscores the importance of addressing the availability and adherence to integrated regulatory documents to ensure the effective implementation and delivery of integrated healthcare services in public health facilities. Supplies such as gloves, antiseptic solutions (40), cotton balls or gauze sponges, analgesics, anesthetics (41), needles, syringes, pregnancy test kits, blood pressure apparatus, and stethoscopes are essential for providing quality abortion services, as highlighted by Tafese, Woldie, and Megerssa in 2013 (42). A lack of or shortage of medical supplies is identified as one of the factors hindering the provision of integrated health services (21). Within the study context, there were concerns, as 4.6% of respondents reported a lack of gauze sponges or cotton balls, 3.3% did not have antiseptic solutions, and 2% did not have gloves to provide integrated health services. The unavailability of medical supplies not only decreases efficiency and the horizontalization of programs but also leads to the inappropriate use of human resources (14, 15). Ensuring the availability of necessary medical supplies in health facilities is crucial for enhancing the provision of integrated health services, as emphasized by Kurpas et al. in 2021 (43), and it contributes to promoting the health status of mothers by reducing the risk of unintended pregnancies, unsafe abortions, and sexually transmitted infections like HIV/AIDS (44). In the multiple logistic regression analysis, it was found that abortion care users who had previously utilized family planning (FP) services were four times more likely to use FP services compared to those who had never used them. This suggests that women who have a history of using FP services are more inclined to utilize FP-HIV services after undergoing an abortion. The increased likelihood among these women can be attributed to their existing knowledge and information about contraceptives, making them more receptive to accessing FP-HIV services following an abortion, as highlighted by Dasa, Kassie, Roba, Wakwoya, and Kelel in 2019 (45). This underscores the importance of previous FP service utilization in influencing subsequent decisions regarding integrated health services following an abortion. 5. Conclusion Integrated healthcare systems bring about increased efficiency, horizontalization of vertical programs, and effective utilization of human resources. Clients benefit from receiving a comprehensive, one-stop service where multiple needs can be addressed simultaneously, either at the same location or through a well-organized referral system (14). The provision of abortion care with HIV and family planning (FP) services within a one-stop-shop service is particularly crucial for improving maternal and child health services. To enhance the uptake of integrated health services by the community, it is essential to ensure the availability of necessary equipment and logistics, regulatory documents, and the provision of services by trained and competent healthcare providers. Additionally, allocating fiscal resources, improving infrastructure, and implementing behavioral change interventions are critical inputs that can contribute to the successful establishment and functioning of a one-stop shop for health services. Developing a comprehensive action plan is paramount to facilitate the integration of abortion care with HIV and FP services in public health facilities. This strategic approach is aimed at improving the overall health status of the community, with a specific focus on enhancing maternal and child health outcomes. Abbreviations ANC: Anetenatal Care AOD: Adjusted Odds Ratio CI: Confidence interval FP: Pamily Planning HIV: Acquired Immune Defiency Virus PMTCT: Prevention of Mother to Child Transmission of HIV SNNPR: South Nation, nationality People Region UNAID Joint United Nations Programme on HIV/AIDS. USAID: United States Agency for International Development WHO: World Health Organization Declarations Acknowledgment We extend our gratitude to the abortion care users and healthcare providers who willingly participated in this study. Special thanks go to the Research Ethics Committee and the Department of Health Studies at the University of South Africa for providing ethical approval and granting permission to conduct the study. Additionally, we appreciate the SNNPR Regional Health Bureau Human Research and Technology Transfer Support Core Process for their approval and support, allowing the study to be conducted across various zones, districts, and health facilities within the region. Funding This study did receive funds from university of South Africa (UNISA). Data Availability The authors confirm that the data supporting the findings of this study are available and it can be presented on request from the corresponding author. Ethics approval and consent to participate Ethics approval for the research was granted by the Health Studies Research Committee of the Department of Health Studies at the University of South Africa (Certificate number: HSHDC/923/2019). Additionally, permission to conduct the research was secured from all selected health facilities, adhering to the South Region Health Bureau Human Research and Technology Transfer Support Core Process (Certificate number: የወ/19/492 12//102012). Prior to commencing data collection, an institutional support letter from the relevant health bureau in the study area was obtained. Authors’ contributions The study was conducted and the manuscript has been developed by HB. 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Bolstering the evidence base for integrating abortion and HIV care: a literature review. AIDS Research and Treatment. 2012 Dec 18;2012. Zewdie Z, Yitayal M, Kebede Y, Gebeyehu A. Status of family planning integration to HIV care in Amhara regional state, Ethiopia. BMC pregnancy and childbirth. 2020 Dec;20(1):1-0. Samandari G, Wolf M, Basnett I, Hyman A, Andersen K. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care. Reproductive health. 2012 Apr 4;9(1):7. IPAS. Induced Abortion and Postabortion Care in Ethiopia. Guttmacher Institute, 1-2. 2017. Mutemwa R, Mayhew S, Colombini M, Busza J, Kivunaga J, Ndwiga C. Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study. BMC health services research. 2013 Dec;13(1):1-0. Newmann SJ, Zakaras JM, Tao AR, Onono M, Bukusi EA, Cohen CR, Steinfeld R, Grossman D. Integrating family planning into HIV care in western Kenya: HIV care providers’ perspectives and experiences one year following integration. AIDS care. 2016 Feb 1;28(2):209-13. Maruthappu M, Hasan A, Zeltner T. Enablers and barriers in implementing integrated care. Health Systems and Reform, 1(4), pp.250-256. http://dx.doi.org/10.1080/23288604.2015.107730 2015. Milford C, Greener LR, Beksinska M, Greener R, Mabude Z, Smit J. Provider understandings of and attitudes towards integration: Implementing an HIV and sexual and reproductive health service integration model, South Africa. African Journal of AIDS Research. 2018 Apr 3;17(2):183-92. USAID, PEPFAR, project H. Integration of family planning and hiv services in Malaw. 2015. Nkhoma L, Sitali DC, Zulu JM. Integration of family planning into HIV services: a systematic review. Annals of Medicine. 2022 Dec 31;54(1):393-403. SNNPR Health Bureau. Annual report. SNNPR, Ethiopia. 2018. Abbott BB, Bordens KS. Research design and methods: A process approach. McGraw-Hill; 2018. Neuman Lawrence W. Social Research Methods: Qualitative and Quantitative Approaches. Pearson.2014. Curley AL, editor. Population-based nursing: Concepts and competencies for advanced practice. Springer Publishing Company; 2019 Sep 3. Gliner JA, Morgan GA, Leech NL. Research methods in applied settings: An integrated approach to design and analysis. Routledge; 2011 Mar 17. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins; 2017. Samuel M, Fetters T, Desta D. Strengthening postabortion family planning services in Ethiopia: expanding contraceptive choice and improving access to long-acting reversible contraception. Global Health: Science and Practice. 2016 Aug 11;4(Supplement 2):S60-72. Mayhew SH, Hopkins J, Warren CE. Building integrated health systems: lessons from HIV, sexual and reproductive health integration. Health policy and planning. 2017 Nov 1;32(suppl_4):iv1-5. Ng C, Pacqué-Margolis S, Kotellos K, Brantley S. Integrating Family Planning and HIV/AIDS Services. World Health Organization (WHO). Education and Training technical Series on Safer Primary Care. World Health Organization. 2016. Federal Democratic Republic of Ethiopia Ministry of Health (FMOH). National Guideline for Family Planning Services in Ethiopia. 2020. Borges AL, OlaOlorun F, Fujimori E, Hoga LA, Tsui AO. Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study. Reproductive health. 2015 Dec;12(1):1-0. Tafese F, Woldie M, Megerssa B. Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia. Ethiopian journal of health sciences. 2013 Nov 11;23(3):245-54. Tesfaye G, Oljira L. Post abortion care quality status in health facilities of Guraghe zone, Ethiopia. Reproductive health. 2013 Dec;10:1-7. Federal Ministry Of Health Ethiopia (FMOH). Technical and procedural guidelines for safe abortion services in Ethiopia. Second edition. Addis Ababa: MOH. 2014. Tafese F, Woldie M, Megerssa B. Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia. Ethiopian journal of health sciences. 2013 Nov 11;23(3):245-54. Kurpas D, Stefanicka-Wojtas D, Shpakou A, Halata D, Mohos A, Skarbaliene A, Dumitra G, Klimatckaia L, Bendova J, Tkachenko V. The Advantages and Disadvantages of Integrated Care Implementation in Central and Eastern Europe–Perspective from 9 CEE Countries. International journal of integrated care. 2021 Oct;21(4). USAID. Health care financing reform in Ethiopia: Improving quality and equity. 2012. Dasa TT, Kassie TW, Roba AA, Wakwoya EB, Kelel HU. Factors associated with long-acting family planning service utilization in Ethiopia: a systematic review and meta-analysis. Contraception and reproductive medicine. 2019 Dec;4(1):1-4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Dec, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 18 Jan, 2024 Submission checks completed at journal 18 Jan, 2024 Editor assigned by journal 18 Jan, 2024 First submitted to journal 14 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3863244","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267823407,"identity":"fed05c96-1393-46a4-881e-5250feb9833f","order_by":0,"name":"Haile Bekele Adane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACAwbGxgOMDTY8bOzNBxgYG4jT0gDUkibHz3MsgVgtDAxALYeNJWf4GBCnxZz9cMOBjzuYEzfc4Pkm8XOHjRwD++GjG/BpsexJbDg48wxb4obbvdske8+kGTPwpKXdwOuwA4kNh3nbeBI33Dm7TYK37XBigwSPGX4t5x82HP7bJgF0WM4zyb9EabkBtIWxzQDo/Rw2aeJsufGw4WDvmQRQIBtby7alGbMR9Mv59IcPfu74D4rKhzffttnI8bMfPoZXCzJgkQCRbMQqBwHmD6SoHgWjYBSMgpEDAEPFV+SG75XCAAAAAElFTkSuQmCC","orcid":"","institution":"University of South Africa (UNISA)","correspondingAuthor":true,"prefix":"","firstName":"Haile","middleName":"Bekele","lastName":"Adane","suffix":""},{"id":267823409,"identity":"93a17b17-5bb0-4ad5-a572-3a14f024ff58","order_by":1,"name":"Roets Lizeth","email":"","orcid":"","institution":"University of South Africa (UNISA)","correspondingAuthor":false,"prefix":"","firstName":"Roets","middleName":"","lastName":"Lizeth","suffix":""}],"badges":[],"createdAt":"2024-01-14 12:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3863244/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3863244/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13735-0","type":"published","date":"2025-12-29T15:57:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99545235,"identity":"1e8c08ba-ebdc-49d1-ac9f-01ac9856a986","added_by":"auto","created_at":"2026-01-05 16:03:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1111704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3863244/v1/781a55ce-7681-48cb-a3b8-e0da32cc94e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Challenges and prospects in integrating abortion care with HIV/Family planning services as a one-stop maternal health service","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eUp until the late 19th century, legal constraints on abortion services were pervasive globally, impeding women\u0026apos;s access to abortion care and restricting healthcare providers from delivering legally sanctioned services within health facilities (1, 2). These restrictions were chiefly imposed by colonizing powers like Britain, France, Portugal, Spain, and Italy (1). Nevertheless, over time, numerous nations, including Ethiopia, have undertaken reforms to their abortion laws (1, 3, 4). The changes in legislation have been geared toward promoting safer and more accessible abortion care.\u003c/p\u003e\n\u003cp\u003eIt is important to highlight that unsafe abortion practices contribute to approximately 70,000 maternal deaths each year, resulting in around 5 million mothers facing permanent or temporary disabilities (5). These unfortunate consequences could be substantially diminished with the widespread availability of comprehensive abortion services (6).\u003c/p\u003e\n\u003cp\u003eUnplanned pregnancies, often resulting in unsafe abortions as reported by the Central Statistics Authority and ICF International in 2016 (7), can be mitigated through effective access to family planning services. Additionally, a comprehensive approach involves providing a one-stop service that incorporates abortion care into overall healthcare services. When healthcare services are delivered separately, it can lead to the inaccessibility of specific services, diminished service quality, and unnecessary increases in service costs, as highlighted by the World Health Organization in 2018 (8). The financial burden on clients is frequently associated with multiple visits to health facilities on different days or in separate locations for various healthcare needs (9).\u003c/p\u003e\n\u003cp\u003eThe integration of family planning and HIV services has demonstrated significant benefits in maternal healthcare, especially in developing countries like Ethiopia where the risks of unintended pregnancies and HIV transmission are high (10). There is substantial evidence supporting the improvement of maternal health services through the integration of HIV and family planning services (11). The integration of health services is widely adopted by many countries, contributing to the enhancement of maternal healthcare (12). In resource-limited settings like Ethiopia, integrating abortion care with HIV and family planning services can prove to be cost-effective (13).\u003c/p\u003e\n\u003cp\u003eIn modern health systems, integrated healthcare plays a crucial role by enhancing efficiency, horizontalizing vertical programs, optimizing human resource utilization, and providing clients with multiple services in a single location (14, 15). As a result, women receiving abortion care significantly benefit from the integration of family planning services, voluntary HIV counseling and testing, and screening for sexually transmitted infections, as emphasized by USAID in 2015 (16). This integration not only improves accessibility but also enhances the overall quality of healthcare (14, 17).\u003c/p\u003e\n\u003cp\u003eThe integration of abortion care with existing HIV-FP services contributes to the well-being of women, families, and communities (18, 19). Improving access to safe abortion care within integrated HIV and family planning services can help mitigate the occurrence of unsafe abortions, particularly those related to unintended or unwanted pregnancies (7, 20). The integration of health services not only facilitates the delivery of comprehensive healthcare but also has the potential to enhance health outcomes, improve system efficiencies, and promote sustainable development (16).\u003c/p\u003e\n\u003cp\u003eIntegrated abortion care encounters several challenges, including infrastructure problems, a scarcity of logistics, and a shortage of adequately trained healthcare providers, as highlighted by Mutemwa et al. in 2013 (21). Additional hurdles in this integrated approach include the lack of sufficient space and time constraints for counseling services, as noted by Newmann et al. in 2016 (22). Financial constraints and cultural issues further contribute to the complexity of providing integrated abortion care, as outlined by Maruthappu, Hasan, and Zeltner in 2015 (23).\u003c/p\u003e\n\u003cp\u003eIntegrating abortion care with family planning and HIV/AIDS services brings significant benefits for both abortion care users and healthcare providers, as emphasized by Mutemwa et al. in 2013 (21). This integration fosters improved teamwork, enhanced healthcare efficiency, increased quality of care, reduced healthcare service costs, and instilled confidence in the healthcare system (9). Moreover, it addresses challenges such as the fragmentation of healthcare, increases access to supplies, avoids duplication of decisions, alleviates organizational bottlenecks, and ensures coordinated responses to clients, as noted by Maruthappu, Hasan, and Zeltner in 2015, and Milford et al. in 2018 (23, 24).\u003c/p\u003e\n\u003cp\u003eAt the client\u0026apos;s level, integrated services contribute to the improvement of privacy and confidentiality, reducing stigma and discrimination. The proximity of services in the same area, provided by the same or different providers, eliminates the need for numerous referrals (25). This not only ensures effective healthcare provision but also enhances job satisfaction among healthcare providers by delivering better-quality services to the community (21). Feedback from clients receiving integrated services further enriches the healthcare providers\u0026apos; understanding of their performance. Integration also contributes to the development of clinical and communication skills, fostering positive interactions among healthcare workers (26). Additionally, integration helps reduce the workload through decreased client visits, potentially yielding cost benefits at the health system level (24).\u003c/p\u003e\n\u003cp\u003eThe objective of this study was to delineate the challenges and potential advantages associated with integrating abortion care into HIV/FP services, as perceived by both healthcare providers and abortion care users. The integration of abortion care, HIV, and family planning services within healthcare facilities is seen as a consolidated and comprehensive \u0026quot;one-stop-shop\u0026quot; service, offering benefits to both healthcare users and providers alike.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA facility-based cross-sectional study was conducted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in 58 public health facilities, comprising 8 public hospitals and 50 public health centers, located in the Southern Nations, Nationalities, and Peoples\u0026apos; Region (SNNPR) of Ethiopia. SNNPR is one of the largest regions in Ethiopia, covering more than 10% of the country\u0026rsquo;s land area, with an estimated population of over 20 million, constituting almost a fifth of the country\u0026rsquo;s total population (27).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Population and Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study involved healthcare providers and abortion care users in public health centers and public health hospitals within the designated study areas. The total study population comprised 1860 health service providers, including 104 physicians, 366 midwives, 446 health officers, and 944 nurses. These professionals were actively working in public health facilities within the study region, as indicated by the 2018 annual report of the Southern Nations, Nationalities, and Peoples\u0026apos; Region (27). On the other hand, the population of interest among women of childbearing age (18-49 years old) who received abortion care in the Southern Region in 2018 was reported to be 46,276, as documented in the 2018 report from the SNNPR Health Bureau (27).\u003c/p\u003e\n\u003cp\u003eThe determination of the required sample size followed the single population proportion formula. Given the absence of recorded studies indicating the provision of integrated abortion care with FP-HIV in public health facilities, a 50% proportion was employed to ensure the maximum sample size, aligning with the approach suggested by Bordens and Abbott in 2018 (28).\u003c/p\u003e\n\u003cp\u003eThe selection of 58 public health facilities was conducted using a simple random sampling method. Following this, a proportional allocation strategy was employed to include abortion care users and healthcare providers within these facilities. From these health facilities, a total of 413 abortion care users and 306 healthcare providers were enrolled in the study. The healthcare provider sample comprised 157 Nurses, 72 Health officers, 60 Midwives, and 17 Physicians. The selection process utilized a stratified simple random sampling technique from public healthcare facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data Collection and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires were developed following an extensive literature review on integrated health services covering abortion, family planning, and HIV. The data collection from abortion care users was conducted using the prepared questionnaire, administered in a face-to-face manner by trained midwives. For healthcare providers, the distribution and collection of self-administered questionnaires were overseen by trained public health officers. Following data collection, the obtained information was coded and entered into EpiData 3.1 software. Subsequently, the data were exported to the Statistical Package for Social Sciences software (SPSS) version 25 for comprehensive analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Validity and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eValidity and reliability are generally considered complementary, but there are situations where a trade-off may exist, with high validity associated with lower reliability and vice versa (29). In this context, validity refers to the capacity of an instrument or questionnaire to measure and provide true results (30, 31). To ensure the validity of the questionnaires for abortion care users and healthcare providers, a scientific review committee was engaged. This committee scrutinized and assessed the questionnaires before pretesting, aiming to identify weaknesses and strengths in capturing the required information.\u003c/p\u003e\n\u003cp\u003eReliability, on the other hand, refers to the consistency of results yielded by a measuring instrument over time and across different observers (32). The pre-test findings demonstrated that participants had a uniform understanding of the questions. The main study findings further supported this consistency, indicating the reliability of the questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the research was granted by the Health Studies Research Committee of the Department of Health Studies at the University of South Africa (Certificate number: HSHDC/923/2019). Additionally, permission to conduct the research was secured from all selected health facilities, adhering to the South Region Health Bureau Human Research and Technology Transfer Support Core Process (Certificate number:\u0026nbsp;የወ/19/492 12//102012). Prior to commencing data collection, an institutional support letter from the relevant health bureau in the study area was obtained.\u003c/p\u003e\n\u003cp\u003eTo ensure voluntary participation, abortion care users and healthcare providers were provided with a recruitment letter. Respondents were given the option to read the letter themselves or have it read aloud to them if needed. Following this, individuals who volunteered to participate signed written consent forms, affirming their willingness to be part of the study.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Biographical data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 422 abortion care users initially considered, data were successfully obtained from 413 respondents, resulting in an overall response rate of 97.9%. The age range of abortion care users varied between 18 and 44 years, with a significant proportion (66.6%) falling within the 20-29 age bracket. In terms of education, 84 respondents held degrees or diplomas, 106 had attended high school, 101 had completed elementary school, 57 were able to read and write, and the remaining 65 were unable to read and write.\u003c/p\u003e\n\u003cp\u003eOccupationally, 182 respondents identified as housewives, 59 were self-employed, 56 were public servants, 33 were private employees, 22 were farmers, and 8 were entrepreneurs. Regarding marital status, 63.7% of abortion care users were married, while 150 were single, including those who were divorced, widowed, separated, or unmarried but in a relationship.\u003c/p\u003e\n\u003cp\u003eThe study found that the mean monthly income of respondents was US $96.5, with a standard deviation of + US $65.7 and a median income of US $77.5. Notably, 210 respondents reported an average monthly income of less than US $81 (See Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1 Socio-demographic and economic status of abortion care users, SNNPR, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbortion care users\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 15-19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Cannot read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Able to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Elementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; High school (12 or 10 completed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e79.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; TVET/Diploma level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e91.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Basic degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eOccupation status of abortion care users\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Housewife\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Self-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Public servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e71.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Student \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e84.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Private employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e92.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Farmer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Entrepreneur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Monthly income \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 40-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e50.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 81-120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 121-160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e85.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 161-200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e91.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.87237479806139%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 201 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.539579967689821%\" valign=\"bottom\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.631663974151857%\" valign=\"bottom\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.478190630048466%\" valign=\"bottom\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLikewise, for healthcare providers, the self-administered questionnaire was distributed to 310 individuals, and completed questionnaires were received from 306 respondents, resulting in a robust response rate of 98.7%. Among the healthcare providers, 164 were female, with ages ranging from a minimum of 21 years to a maximum of 45 years. Notably, 109 healthcare providers had 36 months or longer work experience, while only 30 respondents had served between 0-11 months in their current roles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Perceptions of abortion care users \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study focused on women primarily seeking abortion care at public healthcare facilities. The majority of respondents (79.7%) specifically requested abortion care only, while 18.4% sought both abortion care along with family planning (FP) or HIV/AIDS services. Only 1.9% of respondents requested all three services concurrently. However, during healthcare providers\u0026apos; counseling sessions, 188 abortion care users ended up receiving family planning or HIV services in addition to abortion care.\u003c/p\u003e\n\u003cp\u003eAmong those who received integrated services (n=188), 113 respondents received the services in abortion care units, 52 in HIV-FP rooms, 12 in delivery rooms, 6 in ANC/PMTCT rooms, and 5 in outpatient departments. Regarding the delivery of integrated services, 111 women received services in the same room by the same healthcare provider, 46 in the same room but by different healthcare providers (with one providing one service and another offering the next service), and 31 respondents had to move to another room to receive additional care from a different healthcare provider.\u003c/p\u003e\n\u003cp\u003eWhile only 188 respondents experienced integrated healthcare services in this study, a significant majority (332) expressed a preference for utilizing integrated healthcare in the future. However, 81 respondents indicated a reluctance to opt for integrated health services even in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Perceptions of healthcare providers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of healthcare providers (82%) in this study received one or more types of in-service training to enhance their capacity to provide healthcare services. Among those who underwent in-service training (n=251), 124 received comprehensive abortion care training, 114 received training in long-acting family planning (FP) services, 81 in short-acting FP training, and 71 in HIV counseling in-service training. Regarding the distribution of training, 184 healthcare providers received only one type of in-service training, 58 received two types, 6 received training in three areas, and only 3 respondents received training in all four areas.\u003c/p\u003e\n\u003cp\u003eIn terms of the recency of training, 65 healthcare providers received in-service training within the last 12 months, 74 between 12 and 23 months ago, 47 between 24 and 35 months ago, and 35 respondents received training more than 36 months ago. The organizations responsible for providing in-service training varied, with 181 respondents receiving training from NGOs, 73 from the Southern Nations, Nationalities, and Peoples\u0026apos; Region health bureau, 44 from the Federal Ministry of Health, and the remaining 30 respondents receiving training from zonal health departments (see Table 2).\u003c/p\u003e\n\u003cp\u003eIn this study, 125 respondents indicated they were aware of at least one abortion regulatory document, 141 were aware of at least one FP-related regulatory document, 105 were aware of at least one HIV/AIDS regulatory document, and only 35 respondents indicated awareness of at least one integrated regulatory document (see Table 2). Respondents identified seven different types of abortion-related regulatory documents, nine different types of FP-related regulatory documents, six different types of HIV/AIDS-related regulatory documents, and seven different types of integrated health service-related regulatory documents.\u003c/p\u003e\n\u003cp\u003eTable 2 Healthcare providers\u0026apos; competency in providing integrated services, SNNPR, Ethiopia\u0026nbsp;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn-service training received\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Comprehensive abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Long-acting FP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e45.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Short-acting FP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;HIV counselling\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Prevention of mother-to-child transmission of HIV\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;BEmONC training\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Antiretroviral treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Opportunistic infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tubal ligation\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Vasectomy\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eKnowledge of regulatory documents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Technical guidelines on abortion care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e52.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Abortion management protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; First and second-trimester guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Women-centred guide on abortion care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; BEMoNC guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Abortion contraception strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.88847583643123%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Infection prevention strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.65799256505576%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.453531598513012%\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Abortion care users perceived the advantages \u0026amp; disadvantages of one-stop-shop services\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbortion care users identified several advantages of integrated health services, including low transportation costs, reduced waiting times, increased access to health services, reduced stigma and discrimination, efficient use of staff time, and decreased frequency of visits to healthcare services. However, there were also perceived disadvantages, including concerns about the loss of confidentiality, fear of stigma and discrimination, increased workload for service providers, decreased quality of services, and feelings of embarrassment when discussing HIV and/or family planning issues with healthcare providers (see Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3 Perception of abortion care users on the advantages and disadvantages of one-stop-shop service, SNNPR, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003ePerception of abortion care users on one-stop-shop services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvantages of one-stop-shop services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Reduced transportation cost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Reduce waiting time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Make fewer trips to the facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Reduces stigma toward accessing HIV services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Efficient way to access several services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Reduce stigma towards accessing FP services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisadvantages \u0026nbsp;of one-stop-shop services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fear of loss of confidentiality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fear of stigma and discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Increased workload to service providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Decreased quality of services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.42472266244057%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Embarrassed to discuss HIV and/or FP issues with providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.312202852614897%\" valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263074484944532%\" valign=\"top\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Healthcare Providers\u0026rsquo; Perception of the benefit and challenges of one-stop-shop services\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare providers identified several benefits of a one-stop-shop service, including avoiding missed opportunities, improving teamwork, increasing access to integrated health services, reducing stigma and discrimination, efficient use of staff time, and reducing visits to healthcare services. However, they also highlighted several challenges in providing one-stop-shop services, such as the lack of operational policies and guidelines, poor infrastructure in healthcare facilities, a shortage of trained staff, a poor support and monitoring system, inadequate medical supplies, inadequate budget allocation, and the time-consuming nature of integrating the services (see Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4 Perception of healthcare providers on the benefits and challenges of one-stop-shop service, SNNPR, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003ePerception of healthcare providers on one-stop-shop services\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenefits of one-stop-shop services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Avoid missed opportunities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e83.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Improve teamwork\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e77.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Increase access to integrated health services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Reduce stigma and discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e59.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Efficient use of staff time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Reduce visits to healthcare services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Reduces cost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e53.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChallenges of one-stop-shop services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Lack of operational policies and guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Poor infrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Shortage of healthcare providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Poor support and monitoring system\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Inadequate medical supplies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e62.1\u003c/p\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Inadequate budget allocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.05324459234609%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Takes time to integrate the service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97171381031614%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Factors associated utilization of integrated Health services\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe association of factors with integrated health services was assessed using both bivariable and multivariable logistic regression analysis. In the bivariable analysis, women with a monthly average income of 161-200 USD were three times more likely to receive integrated HIV-FP services compared to those with incomes ranging from 0-40 USD. Similarly, abortion care users who received the service free of charge were three times more likely to use the service compared to those whose payment was covered by health insurance (see Table 5).\u003c/p\u003e\n\u003cp\u003eIn the multiple logistic regression, abortion care users who had previously used family planning (FP) services were four times more likely to use FP services compared to those who had never used them, with an Adjusted Odds Ratio (AOR) of 4.299 and a 95% Confidence Interval (CI) of (2.399, 7.704), and a p-value of 0.0001 (see Table 5). However, the place of residence and the previous history of abortion were found to have no statistically significant association with the utilization of integrated services.\u003c/p\u003e\n\u003cp\u003eTable 5 Odds ratios from multivariable logistic regression on the integration of abortion care with HIV-FP service (AOR 95% CI) (N=413)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCovariant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.48%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntegration with FP and HIV/AIDS services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude odds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.940298507462686%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.119402985074625%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.537313432835822%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.40298507462686%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.83381088825215%\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.18624641833811%\" colspan=\"2\"\u003e\n \u003cp\u003en=113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472779369627506%\"\u003e\n \u003cp\u003ef=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472779369627506%\" colspan=\"2\"\u003e\n \u003cp\u003en=300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.034383954154729%\"\u003e\n \u003cp\u003ef=\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003eAverage monthly income in USD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e0-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e28\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e64\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e41-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e74.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e2.712 (0.955 7.703)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e2.004 (0.564 7.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e81-120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e59\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e2.114 (0.753 5.929)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1.527 (0.434 5.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e121-160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e63.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e2.522 (0.876 7.258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e2.007 (0.58 6.943)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e161- 200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e80.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e3.519 (1.188 10.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e2.475 (0.669 9.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003e201 and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e31\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e86.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1.476 (0.380 5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e0.846 (0.167 4.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003eResidence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e56\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e120\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e68.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1.474 (.954 2.277)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1.018 (0.561 1.849)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e180\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003eService charge settlement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eReceive the service free of charge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e87\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.64%\" colspan=\"2\"\u003e\n \u003cp\u003e221\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.72%\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e2.913 (1.108 7.656)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e2.444 (0.754 7.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003ePaid in cash\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.64%\" colspan=\"2\"\u003e\n \u003cp\u003e41\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.72%\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e3.790 (1.298 11.070)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1.470 (0.386 5.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eCovered by health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.64%\" colspan=\"2\"\u003e\n \u003cp\u003e37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.72%\"\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003ePrevious use of FP services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e83\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e149\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e2.804 (1.744 4.508)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e4.067 (2.185 7.568)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e151\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e83.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003ePrevious abortion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e0.490 (0.231 1.039)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e0.505 (0.202 1.263)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.36%\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.52%\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.6%\" colspan=\"2\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\"\u003e\n \u003cp\u003e255\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.68%\" colspan=\"2\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.12%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe standalone or vertical provision of health services may not effectively promote the utilization of integrated health services, as highlighted by UNAID in 2015 (16). Offering integrated health services from the same or different healthcare providers simultaneously and at the same location has been demonstrated to enhance the uptake of various health services, as emphasized by Samuel, Fetters, and Desta in 2016 (33). In this study, among the 413 abortion care users, 188 received integrated health services, and the majority (n=332; 80.5%) expressed a preference for utilizing integrated healthcare in the future.\u003c/p\u003e\n\u003cp\u003eThe preference for integrated healthcare is further supported by the efficiency gained when the same healthcare provider offers integrated services in the same room, minimizing waiting times for clients, as suggested by USAID et al. in 2015 (16). Conversely, receiving healthcare services from different providers in different rooms can potentially increase waiting times as clients move between rooms to receive different services from different healthcare providers (25). Nonetheless, even when clients visit different rooms, there is still a reduction in the number of visits, thereby decreasing travel time and costs, as noted by Al-Saddique in 2018 (9).\u003c/p\u003e\n\u003cp\u003eWhile the advantages of integrated health services are significant, some perceived disadvantages by abortion care users include increased waiting time, fear of stigma and discrimination, and increased workload. However, strategies can be implemented to address these challenges. For instance, using the same consulting room for different services can reduce waiting times, as previously mentioned. Structural integration, effective staff management, enhancing providers\u0026apos; skills and knowledge, empowering decision-makers, promoting teamwork, and implementing work-sharing are crucial strategies to overcome the challenges associated with integrated healthcare, as highlighted by Mayhew, Hopkins, and Warren in 2017 (34). These approaches aim to optimize the benefits of integrated services while mitigating potential drawbacks, ensuring a more seamless and patient-friendly healthcare experience.\u003c/p\u003e\n\u003cp\u003eIn delivering integrated health services to clients, healthcare providers, whether new or existing staff, require either pre-service or in-service training. In this study, the majority (82%) of healthcare providers received one or more types of in-service training, enabling them to provide integrated healthcare services. However, the findings of a study across five countries raise concerns, as two-thirds of healthcare providers in those settings lacked adequate training and were unfamiliar with guidelines on offering integrated healthcare services (35), even as they attempted to implement integrated services.\u003c/p\u003e\n\u003cp\u003eProfessional development through in-service training is crucial for enhancing the provision of quality healthcare, as emphasized by the WHO in 2016 (36). Healthcare providers need ongoing knowledge, skills, training, and professional development opportunities to maintain and update their capacity, ensuring they can continuously improve the quality of services they deliver. The government of Ethiopia is actively addressing healthcare providers\u0026apos; professional development through in-service training (37) and working to improve the integration of maternal health services (7). These efforts underscore the commitment to enhancing the skills and capabilities of healthcare providers to provide effective integrated healthcare services.\u003c/p\u003e\n\u003cp\u003eThe availability and utilization of integrated regulatory documents in public health facilities play a crucial role, serving as a guide for healthcare workers in providing integrated health services, as highlighted by Borges et al. in 2015 (38). However, challenges exist, with studies indicating that guidelines are often not readily available in public health facilities. Even when available, healthcare providers may neglect to use these guidelines during their health service consultations, as noted by Tafese, Woldie, and Megerssa in 2013 (39). This gap underscores the importance of addressing the availability and adherence to integrated regulatory documents to ensure the effective implementation and delivery of integrated healthcare services in public health facilities.\u003c/p\u003e\n\u003cp\u003eSupplies such as gloves, antiseptic solutions (40), cotton balls or gauze sponges, analgesics, anesthetics (41), needles, syringes, pregnancy test kits, blood pressure apparatus, and stethoscopes are essential for providing quality abortion services, as highlighted by Tafese, Woldie, and Megerssa in 2013 (42). A lack of or shortage of medical supplies is identified as one of the factors hindering the provision of integrated health services (21). Within the study context, there were concerns, as 4.6% of respondents reported a lack of gauze sponges or cotton balls, 3.3% did not have antiseptic solutions, and 2% did not have gloves to provide integrated health services.\u003c/p\u003e\n\u003cp\u003eThe unavailability of medical supplies not only decreases efficiency and the horizontalization of programs but also leads to the inappropriate use of human resources (14, 15). Ensuring the availability of necessary medical supplies in health facilities is crucial for enhancing the provision of integrated health services, as emphasized by Kurpas et al. in 2021 (43), and it contributes to promoting the health status of mothers by reducing the risk of unintended pregnancies, unsafe abortions, and sexually transmitted infections like HIV/AIDS (44).\u003c/p\u003e\n\u003cp\u003eIn the multiple logistic regression analysis, it was found that abortion care users who had previously utilized family planning (FP) services were four times more likely to use FP services compared to those who had never used them. This suggests that women who have a history of using FP services are more inclined to utilize FP-HIV services after undergoing an abortion. The increased likelihood among these women can be attributed to their existing knowledge and information about contraceptives, making them more receptive to accessing FP-HIV services following an abortion, as highlighted by Dasa, Kassie, Roba, Wakwoya, and Kelel in 2019 (45). This underscores the importance of previous FP service utilization in influencing subsequent decisions regarding integrated health services following an abortion.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIntegrated healthcare systems bring about increased efficiency, horizontalization of vertical programs, and effective utilization of human resources. Clients benefit from receiving a comprehensive, one-stop service where multiple needs can be addressed simultaneously, either at the same location or through a well-organized referral system (14). The provision of abortion care with HIV and family planning (FP) services within a one-stop-shop service is particularly crucial for improving maternal and child health services.\u003c/p\u003e\n\u003cp\u003eTo enhance the uptake of integrated health services by the community, it is essential to ensure the availability of necessary equipment and logistics, regulatory documents, and the provision of services by trained and competent healthcare providers. Additionally, allocating fiscal resources, improving infrastructure, and implementing behavioral change interventions are critical inputs that can contribute to the successful establishment and functioning of a one-stop shop for health services.\u003c/p\u003e\n\u003cp\u003eDeveloping a comprehensive action plan is paramount to facilitate the integration of abortion care with HIV and FP services in public health facilities. This strategic approach is aimed at improving the overall health status of the community, with a specific focus on enhancing maternal and child health outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: Anetenatal Care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAOD: \u0026nbsp; Adjusted Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFP: Pamily Planning\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHIV: Acquired Immune Defiency Virus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePMTCT: Prevention of Mother to Child Transmission of HIV\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSNNPR: \u0026nbsp; South Nation, nationality People Region\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUNAID Joint United Nations Programme on HIV/AIDS.\u003c/p\u003e\n\u003cp\u003eUSAID: United States Agency for International Development\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to the abortion care users and healthcare providers who willingly participated in this study. Special thanks go to the Research Ethics Committee and the Department of Health Studies at the University of South Africa for providing ethical approval and granting permission to conduct the study. Additionally, we appreciate the SNNPR Regional Health Bureau Human Research and Technology Transfer Support Core Process for their approval and support, allowing the study to be conducted across various zones, districts, and health facilities within the region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did receive funds from university of South Africa (UNISA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available and it can be presented on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the research was granted by the Health Studies Research Committee of the Department of Health Studies at the University of South Africa (Certificate number: HSHDC/923/2019). Additionally, permission to conduct the research was secured from all selected health facilities, adhering to the South Region Health Bureau Human Research and Technology Transfer Support Core Process (Certificate number:\u0026nbsp;የወ/19/492 12//102012). Prior to commencing data collection, an institutional support letter from the relevant health bureau in the study area was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted and the manuscript has been developed by HB. LR guided how the researched need to be conducted starting from the conception to the final submission of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBerer M. Abortion law and policy around the world: in search of decriminalization. Health and human rights. 2017 Jun;19(1):13.\u003c/li\u003e\n\u003cli\u003eJohnson Jr BR, Mishra V, Lavelanet AF, Khosla R, Ganatra B. A global database of abortion laws, policies, health standards and guidelines. Bulletin of the World Health Organization. 2017 Jul 7;95(7):542.\u003c/li\u003e\n\u003cli\u003eErdman JN, Johnson Jr BR. Access to knowledge and the global abortion policies database. International Journal of Gynecology \u0026amp; Obstetrics. 2018 Jul;142(1):120-4.\u003c/li\u003e\n\u003cli\u003eFMOH. Technical and Procedural Guidelines for Safe Abortion Services in Ethiopia. Addis Ababa: MOH. 2006.\u003c/li\u003e\n\u003cli\u003eMelese T, Habte D, Tsima BM, Mogobe KD, Nassali MN. Management of post abortion complications in Botswana-The need for a standardized approach. PLoS One. 2018 Feb 16;13(2):e0192438.\u003c/li\u003e\n\u003cli\u003eUnited Nations. Reproductive Health Policies. 2017\u003c/li\u003e\n\u003cli\u003eCentral Statistical Agency international. Ethiopia Demographic and Health Survey, Addis Ababa, Ethiopia. ICF, Rockville, M, USA. 2016. Addis Ababa, Ethiopia. 2016.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). Improving the quality of health services: tools and resources. 2018.\u003c/li\u003e\n\u003cli\u003eAl-Saddique A. Integrated delivery systems (IDSs) as a means of reducing costs and improving healthcare delivery. 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Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative. Health policy and planning. 2017 Nov 1;32(suppl_4):iv82-90.\u003c/li\u003e\n\u003cli\u003eRutaremwa G, Kabagenyi A. Utilization of integrated HIV and sexual and reproductive health services among women in Uganda. BMC Health Services Research. 2016 Dec;16(1):1-9.\u003c/li\u003e\n\u003cli\u003eLenka SR, George B. Integrated health service delivery: why and how?. National Journal of Medical Research. 2013 Sep 30;3(03):297-9.\u003c/li\u003e\n\u003cli\u003eUSAID. Integrated HIV programming: Effectiveness and lessons learned from a literature Synthesis. 2015.\u003c/li\u003e\n\u003cli\u003eManski R, Dennis A, Blanchard K, Lince N, Grossman D. Bolstering the evidence base for integrating abortion and HIV care: a literature review. AIDS Research and Treatment. 2012 Dec 18;2012.\u003c/li\u003e\n\u003cli\u003eZewdie Z, Yitayal M, Kebede Y, Gebeyehu A. Status of family planning integration to HIV care in Amhara regional state, Ethiopia. BMC pregnancy and childbirth. 2020 Dec;20(1):1-0.\u003c/li\u003e\n\u003cli\u003eSamandari G, Wolf M, Basnett I, Hyman A, Andersen K. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care. Reproductive health. 2012 Apr 4;9(1):7.\u003c/li\u003e\n\u003cli\u003eIPAS. Induced Abortion and Postabortion Care in Ethiopia. Guttmacher Institute, 1-2. 2017.\u003c/li\u003e\n\u003cli\u003eMutemwa R, Mayhew S, Colombini M, Busza J, Kivunaga J, Ndwiga C. Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study. BMC health services research. 2013 Dec;13(1):1-0.\u003c/li\u003e\n\u003cli\u003eNewmann SJ, Zakaras JM, Tao AR, Onono M, Bukusi EA, Cohen CR, Steinfeld R, Grossman D. Integrating family planning into HIV care in western Kenya: HIV care providers\u0026rsquo; perspectives and experiences one year following integration. AIDS care. 2016 Feb 1;28(2):209-13.\u003c/li\u003e\n\u003cli\u003eMaruthappu M, Hasan A, Zeltner T. Enablers and barriers in implementing integrated care. Health Systems and Reform, 1(4), pp.250-256. http://dx.doi.org/10.1080/23288604.2015.107730 2015.\u003c/li\u003e\n\u003cli\u003eMilford C, Greener LR, Beksinska M, Greener R, Mabude Z, Smit J. Provider understandings of and attitudes towards integration: Implementing an HIV and sexual and reproductive health service integration model, South Africa. African Journal of AIDS Research. 2018 Apr 3;17(2):183-92.\u003c/li\u003e\n\u003cli\u003eUSAID, PEPFAR, project H. Integration of family planning and hiv services in Malaw. 2015.\u003c/li\u003e\n\u003cli\u003eNkhoma L, Sitali DC, Zulu JM. Integration of family planning into HIV services: a systematic review. 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Ethiopian journal of health sciences. 2013 Nov 11;23(3):245-54.\u003c/li\u003e\n\u003cli\u003eKurpas D, Stefanicka-Wojtas D, Shpakou A, Halata D, Mohos A, Skarbaliene A, Dumitra G, Klimatckaia L, Bendova J, Tkachenko V. The Advantages and Disadvantages of Integrated Care Implementation in Central and Eastern Europe\u0026ndash;Perspective from 9 CEE Countries. International journal of integrated care. 2021 Oct;21(4).\u003c/li\u003e\n\u003cli\u003eUSAID. Health care financing reform in Ethiopia: Improving quality and equity. 2012.\u003c/li\u003e\n\u003cli\u003eDasa TT, Kassie TW, Roba AA, Wakwoya EB, Kelel HU. Factors associated with long-acting family planning service utilization in Ethiopia: a systematic review and meta-analysis. Contraception and reproductive medicine. 2019 Dec;4(1):1-4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Integration, abortion, abortion care, family planning service, HIV service","lastPublishedDoi":"10.21203/rs.3.rs-3863244/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3863244/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Delivering a standalone health service not only reduces the accessibility of comprehensive healthcare at a given time but also diminishes service quality, raises service costs, increases facility visits, and amplifies stigma and discrimination especially given the religious, moral, cultural, and political implications associated with abortion care. Therefore, integrating abortion care with HIV-FP services can enhance the utilization of maternal health services and increase client satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A facility-based cross-sectional mixed-method study was conducted, collecting quantitative data through face-to-face interviews with abortion care users and self-administered questionnaires for healthcare providers. The collected data underwent verification, cleaning, and entry into EpiData version 3.1 software, followed by exportation and analysis using SPSS version 25.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e The study included 413 women receiving abortion care and 306 healthcare providers from 58 public health facilities. Healthcare providers identified factors such as enhancing regulatory documents, providing training, improving infrastructure, ensuring a consistent supply of medical resources, program monitoring and evaluation, and fostering interaction between healthcare facility units as motivating factors for implementing integrated health services. Abortion care users emphasized that making health facilities available and equipping them with necessary materials, equipment, and supplies can enhance integrated abortion care services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Successful implementation of integrated maternal health services requires a strategic action plan addressing challenges and engaging with motivational factors.\u003c/p\u003e","manuscriptTitle":"Challenges and prospects in integrating abortion care with HIV/Family planning services as a one-stop maternal health service","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-22 12:58:09","doi":"10.21203/rs.3.rs-3863244/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-18T11:16:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-18T10:24:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-18T10:24:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-01-14T12:27:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33f965ad-9d6d-40f0-ac3e-d48b79fbe95a","owner":[],"postedDate":"January 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T15:59:32+00:00","versionOfRecord":{"articleIdentity":"rs-3863244","link":"https://doi.org/10.1186/s12913-025-13735-0","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-12-29 15:57:22","publishedOnDateReadable":"December 29th, 2025"},"versionCreatedAt":"2024-01-22 12:58:09","video":"","vorDoi":"10.1186/s12913-025-13735-0","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13735-0","workflowStages":[]},"version":"v1","identity":"rs-3863244","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3863244","identity":"rs-3863244","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}