Taking postabortion care services where they are needed: An operations research project testing PAC expansion in rural Senegal
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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...
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...
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