Postabortion Care: Going to Scale

Abstract

Millennium Development Goal 5 aims to reduce the 1990 level of maternal mortality by 75% by 2015. The major direct causes of maternal mortality are well documented: Most women die from severe bleeding, infections, eclampsia, obstructed labor or the consequences of unsafe abortion. 1 Evidence-based interventions exist to address each of these causes. Safe abortion where legal, family planning and postabortion care-the management of the patient once she presents to a health provider with complications caused by either a miscarriage or an induced abortion-are interventions that provide options for women to ensure that every child is a wanted child. Given that 13% of maternal deaths result from unsafe abortions, 2 postabortion care has the potential to prevent maternal deaths. Postabortion care is especially relevant in countries where abortion is restricted, but is useful even in countries where abortion is legal but access to safe services is limited.For the past two decades, efforts have been made to design service delivery models that incorporate the specific elements that postabortion care programs should provide. 3,4 Currently, there are two main models-one developed by the PAC Consortium and one developed by the United States Agency for International Development (USAID); there are significant overlaps between the two. The model advocated by the PAC Consortium includes five elements: partnerships between communities and service providers; client-centered counseling at appropriate times during service delivery; treatment with emphasis on pain management; family planning; and links to reproductive and other health services. 3 The USAID model has three components: emergency treatment; family planning and STI and HIV services; and community empowerment via community awareness and mobilization. 4 Countries have been able to draw upon the two models when designing and implementing postabortion care services. Created to facilitate scale-up and increase access to postabortion care, the models provide guidance on how services could be designed and delivered; how postabortion care could be integrated with other health services, including family planning; and how to develop the partnerships required with the communities that are the ultimate beneficiaries of service improvements.The ultimate goal for postabortion care programs is scaling up-increasing service coverage by replicating the pilot program or moving a given service from its pilot orientation and integrating it into the existing health system. In order for a service model to go to scale, it must demonstrate feasibility, efficacy and potential for sustainability, in addition to being client-oriented. Furthermore, the new service must be written into policy documents; service guidelines and standards must be developed and deployed; providers must be trained; and facilities and staff must be reoriented in providing this new service. Scaling up is vitally important because it improves access for women in need of postabortion care, which ultimately contributes to...

Oral misoprostol as first‐line care for incomplete abortion in Burkina Faso

“…Indeed, although a recent publication [12] on scaling-up postabortion care made curiously little mention of medical management-despite the copious availability of evidence and the inclusion of misoprostol on the WHO Model List of Essential Medicines [9] for this indication-the authors did advocate for continued momentum to expand access to postabortion care. There is ample clinical evidence of high safety, efficacy, and satisfaction rates with this method [2][3][4][5][6][7][8] and a favorable policy climate, given the inclusion of misoprostol on the Model List of Essential Medicines and recommendations by FIGO [13].…”

‘It’s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study

“…On-the-job training promotes adoption of innovations (Cain and Mittman 2002), but the current system for doctors in Malawi appears inadequate, and nurses may not receive on-the-job training at all. Training designated staff members in teaching others to provide on-the-job training and supervision may help (RamaRao et al 2011). However, since trained nurses currently rarely perform MVA, it is possible training more nurses may not improve matters.…”

Uptake of postabortion care services and acceptance of postabortion contraception in Puntland, Somalia

“…8 Barriers to access include, but are not limited to, restrictive laws and policies, a lack of understanding of these laws and policies by providers and community members, stigma associated with abortion, negative attitudes of service providers, lack of trained medical personnel, restriction of services to higher level and cadre of care, inadequate supplies and equipment, and lack of integration into the primary health care system. 8,9 The situation is worsened in humanitarian settings, where access to general RH services for crisis-affected women is severely limited, often due to non-existent or fractured infrastructure. [10][11][12][13] The need for RH services is high in conflicts, while the availability is low.…”