Research Article Open Access Quality in Primary Care (2015) 23 (3): 181-188 Research Arcle 2015 Insight Medical Publishing Group Post-abortion care in North Sulawesi, Indonesia: Patients determinants in selection of health facility Windy M V Wariki, MD, MSc, PhD Lecturer, Department of Public Health, Manado State University, Indonesia Moazzam Ali, MD, MSc, PhD Epidemiologist, Area Manager for South East Asia & Western Pacific Region at World Health Organizaon, Geneva, Switzerland Rintaro Mori, MD, PhD, MSc, FRCPCH Director, Department of Health Policy, Naonal Research Instute for Child Health and Development, Tokyo John J Wantania, MD Obstetrician/Gynecologist, Department of Obstetrics and Gynaecology, Faculty of Medicine, Sam Ratulangi University, Indonesia Chushi Kuroiwa, MD, Ph.D Physician, Yotsukaido Tokushukai Medical Center, Yotsukaido, Japan Kenji Shibuya, MD, DrPH Professor, Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Japan AbSTRACT Background: In Indonesia where abortion is prohibited by law, many women often seek unsafe services that result in complications requiring post-abortion care (PAC). This study was design to identify the characteristics of patients who sought PAC and to explore the perceptions and preferences regarding facility selection. Methods: This hospital-based cross-sectional study was conducted in 2008 at 13 hospitals in North Sulawesi province, Indonesia. In total, 153 women, aged 15-49 years and who had had a recent abortion related complication and sought PAC at hospital were participated in the study. Multivariate logistic regression analysis was performed to assess associations between the potential covariates and the decision of public or private hospital. Results: After controlling for other variables, age over 35 years (AOR 17.1; p<0.01), monthly income less than US$2.80 a day (AOR 6.9; p<0.05), low economic status (AOR 4.2; p<0.01), and choose the facility because of the low medical expenses (AOR 6.4; p<0.05) were significantly associated with selection of public hospitals [68%(104/153)] for PAC. Patients who were given information about pregnancy complications (OR 3.4; p<0.001), wished to ask questions (OR 2.4; p<0.05), willingly to return to the same hospital for follow-up (OR 3.0; p<0.001), and will recommend others due to good attitude of providers (OR 2.7; p<0.001) and good management (OR 8.1; p<0.001) of private hospital reported to be satisfied with the services [32% (49/153)]. Conclusion: Poor PAC seekers generally prefer public hospitals for the free or low-cost services. However, some poor patients still obtained PAC in the private sector due to perceived better- quality services. Thus, it is important for the government to improve the quality and amount of PAC in the public sector. Keywords: Post-abortion care, health facility selection, quality care, women`s preferences, Indonesia Intoduction Induced abortion is a major obstetric complication and among the leading causes of death among women of reproductive age in many developing countries. 1 The abortion rate (the number of abortions per 1,000 women between 15-44 years of age) remains high in Asia, it ranges from 24 (in Western Asia) to 39 (in South-eastern Asia), and in Africa, ranging from 22 (in Northern Africa) to 39 (in Eastern Africa). 2 Overall, most of all unsafe abortions were in developing countries where abortion is legally restricted or socially stigmatized. 2-7 Post-abortion care (PAC) is a package of services for women who experience complications following spontaneous or induced abortion. 1,2,8 Global awareness and support for PAC as a reproductive health intervention grew as a result of the International Conference on Population and Development (ICPD) in 1994, which recommended that ready access to post- abortion counselling, education, and family planning should be provided to help avoid repeated abortions. 7-9 The PAC programs including contraceptive counselling and services have proven effective in many countries for increasing the acceptance of contraceptive methods 2,10-12 and decreasing repeated unwanted pregnancies and abortions. 13 Unfortunately, whether PAC reduces maternal mortality and unsafe abortion morbidity at the population level has only been assessed in few countries, such as Ghana. 14 This lack of PAC assessment reflects the associated social and methodological challenges as well as the high costs of measuring changes in maternal mortality.