PAC Service Delivery Resources
General, Counseling, Africa, Asia, Latin America
General
Title: Care for Postabortion Complications: Saving Women’s Lives
Authors: Population Reports
Organization: JHUCCP, USAID
Date: 1997
Description: This publication outlines an effective postabortion care plan that ensures that women receive care that is complete, appropriate, and prompt ("CAP").
Title: Establishing postabortion care services in low-resource settings
Authors: A. Ghosh, E.R. Lu, N. McIntosh
Organization: JHPIEGO
Date: 1999
Description: Complications from spontaneous and induced abortions remain a major cause of maternal death in many countries and contribute to the poor overall health of women in these countries. In this regard, the postabortion care (PAC) was implemented to include emergency treatment of incomplete abortion and complications; provision of family planning counseling and services; and links between emergency care and other reproductive health services. However, significant gaps still exist in implementing the overall PAC strategy. Key issues such as advocacy, access to services, institutionalization of training and sustainability of PAC services were yet to be addressed. Consequently, a number of recommendations were made to address these gaps. One of these is the need to develop a comprehensive approach to PAC services, including the design, implementation, and scale-up. In the first section of this paper, the key elements in a PAC strategic framework are briefly described. In the preceding sections, these elements are integrated into the major steps needed to introduce and expand PAC services in countries with limited resources.
Title: Meeting Women’s Health Care Needs After Abortion
Authors: D. Huntington
Organization: Population Council, USAID
Date: 2000
Description: Women who seek emergency treatment for abortion complications bleeding, infection and injuries to the reproductive tract system should be a priority group for reproductive health care programs. These women often receive poor-quality services that do not address their multiple health needs. They may be discharged without counseling on postoperative recuperation, family planning, or other reproductive health issues.
Languages: French, Spanish
Title: Postabortion Care Global Resources: A Guide for Program Design, Implementation, and Evaluation
Authors: USAID, Health Communication Partnership
Organization: USAID
Date: 2001
Description: The PAC Global Resources Guide is a compilation of basic instruments intended for policymakers and program planners who are designing or revising their current postabortion care program. Organizations that provide assistance to PAC programs worldwide may also benefit from this package.
Title: Postabortion Care: Lessons From Operations Research
Editors: D. Huntington, N.J. Piet-Pelon
Organization: Population Council, USAID
Date: 2002
Description: This 218-page book examines cost, quality of care, ethics, and other aspects of postabortion care as highlighted in operations research projects in Africa, the Middle East, and Latin America.
Title: Postabortion Care Resources (website)
Organization: USAID
Date: 2009
Description: This website includes links to documents on USAID's Postabortion Care Program, a report from the Postabortion Care Technical Advisory Panel, and USAID's Postabortion Care Strategy paper.
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Counseling
Title: Postabortion care counseling practiced by health professionals in southeastern Nigeria
Authors: Adinma, J.I. et al
Organization: International Journal of Gynecology and Obstetrics, 111, pages 53-56
Date: 2010
Description: Objective: To determine the
practice of postabortion care (PAC) counseling among healthcare professionals
in southeastern Nigeria. Methods: A cross-sectional questionnaire-based survey
conducted among healthcare professionals in Anambra State, southeastern
Nigeria, in 2006. Participants were chosen using a multi-stage sampling
technique. A pre-tested questionnaire assessing the practice of PAC counseling
was administered.
Results: A total of 431 health
professionals were questioned: 270 (62.6%) medical doctors and 161 (37.4%) nurses.
Of 302 (70.1%) respondents who reported practicing PAC counseling, only 173
(40.1%) had received formal training. PAC counseling was most commonly
practiced by health professionals working in the University Teaching Hospital
(90.5%). It was also more commonly practiced by nurses in rural areas compared
with nurses working in urban areas (75 [67.6%] vs 24 [48.0%]; P=0.02). Conclusion:
A high proportion of health professionals reported practicing PAC counseling.
However, less than half had received formal training in PAC counseling. An
increased PAC training activity program, with an emphasis on counseling, is
recommended for health professionals to improve the overall quality of PAC
service delivery.
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Africa
Title: Setting quality standards for postabortion care in sub-Saharan Africa
Authors: K. Rogo, V. Lema, B. French, C. Hord
Organization: Ipas
Date: 1998
Description: This publication describes the development of the manual Postabortion care: Policy and standards for delivering services in sub-Saharan Africa; a tool that offers standards and procedural guidelines for providing abortion care in the region.
Title: Burkina Faso Postabortion Care: Upgrading Postabortion Care Benefits Patients and Providers
Authors: Frontiers in Reproductive Health
Organization: Population Council, USAID
Date: 2000
Description: This resource provides information about training hospital staff to improve emergency medical care for women with miscarriages and unsafe abortions; leading to better patient care, shorter hospital stays, lower costs, and increased contraceptive use. Physicians were trained in Burkina Faso as well as in Senegal, Guinea and Haiti.
Also available in French and Spanish
Title: Scaling-up improved postabortion care in Egypt: introduction to university and Ministry of Health and Population hospitals
Authors: Population Council. Asia and Near East Operations Research and Technical Assistance Project
Organization: Population Council, USAID
Date: 1997
Description: This study expanded on a 1994 pilot study to institutionalize improved postabortion medical services and counseling in 10 hospitals in Egypt. Pre/post-tests were used to measure the effect of the introduction of improved medical care and counseling procedures on providers' knowledge and practices and on selected patient outcomes. Data were gathered by interviews with 501 physicians, 574 nurses, and 1005 postabortion patients and by review of 1036 medical records. Ways to improve services were introduced in a 5-day training-of-trainers program. Post-test results showed that the percentage of patients treated for incomplete abortion by dilatation and curettage (D&C) dropped from 98% to 40%, the use of local versus general anesthesia increased from 1% to 31%, 75% of physicians perceived lower complications with the use of manual vacuum aspiration (MVA), 61% found MVA easier to use than D&C, and 56% found MVA more effective. The intervention dramatically increased physician knowledge about fertility resumption, improved the follow-up information provided to postabortal patients, and increased the number of women intending to use a family planning method from a third to a half. It is recommended that sustainable supplies of equipment for MVA be made available at an affordable price, that a protocol for use of MVA be included in medical school curricula, that the Ministry of Health and Population play an essential role in securing necessary drugs for pain and infection control, that logistic and administrative barriers for integrated care be removed, and that nurses be trained in postabortal care.
Title: Egypt: Expand access to postabortion care
Authors: Population Council. Frontiers in Reproductive Health
Organization: Population Council, USAID
Date: 2000
Description: A 1997 pilot study sought to institutionalize improved postabortion medical care and counseling procedures in 10 hospitals in Egypt. Conducted by the Egyptian Fertility Care Society, a 5-day training course in manual vacuum aspiration (MVA), infection control, and family planning (FP) counseling was administered to five senior physicians from each hospital. The physicians then supervised 4 months of on-the-job training of doctors and nurses, and introduced a case management protocol. Researchers measured the resulting changes in knowledge and practice by administering surveys before and after the intervention. Overall, findings reveal that after the training, physicians had significant gains in knowledge about short-term complications, adverse health impacts, and the immediate return of fertility following postabortion treatment. There was also a shift from use of dilatation and curettage to use of MVA among physicians. Consequently, a shift from general anesthesia to local anesthesia was noted. Moreover, there was an increase in the proportion of PAC patients stating that the service they received at the hospital was excellent. Several policy implications are cited based on the results.
Also available in French, Spanish
Title: Responding to unsafe abortion in Ethiopia: A facility-based assessment of postabortion care services in public-health sector facilities in Ethiopia
Authors: H. Gebreselassie, T. Fetters
Organization: Ipas
Date: 2002
Description: From July to September 2000, Ipas Ethiopia collaborated with the Regional Health Bureaus in Ethiopia to conduct a cross-sectional PAC assessment in three regions: Oromia, Amhara and Addis Ababa. The main objective was to determine the current and future potential capacity and quality of postabortion care service delivery in public hospitals and health centers. The report includes a discussion of the study methodology, key findings of the assessment team and recommendations for action.
Title: Midwives deliver postabortion care services in Ghana
Authors: K. Otsea, T. Baird, D. Billings, J. Taylor
Organization: Ipas
Date: 1997
Description: This document reports on an operations research project in Ghana that tests the safety, feasibility, and acceptability of training community-based midwives to provide postabortion care.
Title: Scaling up access to high-quality postabortion care in Kenya: Assessment of public and private facilities in Western and Nyanza provinces
Authors: S. Onyango, E. Mitchell, N. Nyaga, K. Turner, R. Lovell
Organization: Ipas
Date: 2003
Description: Based on the essential elements of postabortion care (PAC) identified by the PAC Consortium, this study reports the conditions at Kenyan service-delivery points and on relevant community attitudes in order to guide the design and implementation of PAC improvements.
Title: The Right Provider for the Right Place: Private Nurse-Midwives Offering Primary-Level Postabortion Care in Kenya
Authors: D. Nelson, M. Corbett, F. Githiori, R. Mason, P. Muhuhu, R. Mulindi, F. Yumkella
Organization: PRIME II, Dispatch, USAID
Date: 2002
Description: Provides a summary of PRIME II’s work and results of a four-year program to train private-sector nurse-midwives in postabortion care, includes findings from special studies on the third component of the original PAC model and peer support for sustainable supervision.
Title: The hidden emergency: A facility-based assessment of postabortion care services in public health sector facilities in northern Nigeria
Authors: T. Fetters, T. Jolayemi
Organization: Ipas
Date: 2002
Description: In Nigeria, a country with one of the highest maternal mortality rates in the world, it is estimated that approximately half of all obstetric deaths are a result of unsafe abortion. To develop an understanding of current postabortion care (PAC) services and to determine need for future service provider training, Ipas collaborated with the State Ministries of Health to create a baseline assessment of PAC services in three areas of Northern Nigeria.
Title: Senegal: Train More Providers in Postabortion Care
Authors: OR Summaries
Organization: Population Council, Frontiers in Health, USAID
Date: 2000
Description: In 1997, the Center for Training and Research in Reproductive Health and the Obstetrics and Gynecology Clinic at Le Dantec University Teaching Hospital in Dakar, Senegal, introduced new clinical techniques to improve emergency treatment for women with complications from miscarriage and abortion. Under this project, physicians, nurses, and midwives at three teaching hospitals received training in manual vacuum aspiration, family planning, and counseling. The impact of the training was measured through interview with 320 women receiving emergency treatment and 204 providers before the intervention and 543 patients and 175 providers after the intervention. Information on service delivery costs was also collected. In general, improving postabortion care (PAC) services benefits patients and reduces costs. In particular, providing PAC services resulted in shorter hospital stays, decreased patients costs, better communication between providers and patients, and increased acceptance of contraceptive use by women treated for abortion or miscarriage. Certain policy implications are discussed.
Title: Taking Postabortion Care Services Where They Are Needed: An Operations Research Project Testing PAC Expansion in Rural Senegal
Authors: R. Dabash
Organization: EngenderHealth, Packard Foundation, USAID
Date: 2003
Description: EngenderHealth, in collaboration with the MOH, conducted an OR project to examine the feasibility of introducing an integrated three-element model of PAC services in secondary- and primary-level sites in two predominantly rural regions in Senegal. The project demonstrated that quality PAC services could be offered at lower-level health facilities. Project findings attest to the benefits of expanding existing PAC programs in rural settings and suggest that the advantages of such an expansion outweigh the potential disadvantages. Findings also highlight the need for additional research to understand how referral networks could be strengthened to improve access to care and to better define the role of health posts within the referral network. Finally, the research suggests that similar expansion efforts in other regions of the country could have a major impact on improving the quality of services offered in rural settings, ultimately reducing maternal morbidity and mortality. .
Title: Senegal: Education and Public Declarations Contribute to Tostan’s Success
Authors: OR Summaries
Organization: Population Council, Frontiers in Reproductive Health, USAID
Date: 2008
Description: The Tostan program of village education effected positive changes in women’s knowledge, awareness, and social standing. With the accompanying anti-FGM/C declaration, this model strongly influenced the initiation of abandonment of FGM/C in the Senegalese villages that received the program. However, the region’s extreme poverty and lack of basic infrastructure impede full utilization of knowledge and behavior changes gained.
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Asia
Title: From community to action. Managing postabortion complications in rural Uttar Pradesh, India: a qualitative study
Authors: H.B. Johnston, R. Ved, N. Lyall, K. Agarwal
Organization: PRIME II Dispatch, USAID
Date: PRIME II Dispatch. 2001 Jun;(2):1-11
Description: Postabortion complications are considered widespread in Uttar Pradesh, India, with its tremendous unmet need for family planning. Previous site assessments of public- and private-sector health care facilities in the state found that an unexpectedly small number of women with postabortion complications were represented in the patient records. Two questions emerged from this finding: where do women seek medical attention for postabortion complications and what standard of care do they receive from the providers they visit. In this study, an in-depth exploration of the community-level dynamics of postabortion care services and their management in four villages in the state is conducted. Qualitative data collection activities were conducted with health care providers and women in the villages. Overall, the study found that the postabortion care being offered in the villages tends to exacerbate rather than alleviate postabortion complications. For reasons of familiarity, accessibility, direction, and affordability, women in the communities under study turn to untrained or poorly trained village-level providers for postabortion care. This indicates a need for a strong decentralized postabortion care program and referral framework.
Title: Integration of Post-Abortion Care: The Role of Township Medical Officers and Midwives in Myanmar
Authors: T.T. Htay, J. Sauvarin, S. Khan
Organization: Reproductive Health Matters, volume 11, issue 21
Date: 2003
Description: This study concludes that the future nationwide integration of post-abortion care services into township services should be planned in consultation with Township Medical Officers and midwives, the key providers of these services.
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Latin America
Title: Avances en la atención posaborto en América Latina y el Caribe: Investigando, aplicando y expandiendo
Authors: D. Billings, R. Vernon
Organization: Ipas and Population Council
Date: 2007
Description: This document highlights the efforts of numerous organizations and institutions in Latin America and the Caribbean who are working to improve the quality and efficiency of postabortion care. Spanish only.
Title: Testing a model for the delivery of emergency obstetric care and family planning services in the Bolivian public health system
Authors: D. Billings, E. Del Pozo, H. Arevalo
Organization: Ipas
Date: 2003
Description: Unsafe abortion is a serious public health problem in Bolivia, accounting for up to 25 percent of maternal mortality. Postabortion care (PAC) was recognized as a priority public health action in Bolivia in 1994 in the country’s preparatory statement for the ICPD. In 1999, PAC services, known as the “treatment of complications of hemorrhage during the first half of pregnancy,” were included in Bolivia’s revised national health plan, the Seguro Básico de Salud (SBS). Inclusion in the SBS makes PAC services free of charge to women and aims to: 1) increase women’s access to services; 2) reduce the cost of service delivery and hospital length of stay; and 3) improve the quality of care. The operations research (OR) project carried out from May 1999 through August 2001 and summarized in this report was undertaken at the request of the Ministry of Health (MSPS) to help guide the improvement of PAC services as the SBS was implemented. A non-experimental design with pre- and post-intervention measurements was implemented in three major maternity hospitals - Hospital de la Mujer (La Paz), Maternidad Percy Boland (Santa Cruz) and Hospital “Jaime Sánchez Porcel” (Sucre). Given the differences in infrastructure, size, and characteristics of the population served, comparisons are made between pre- and post-intervention results within but not between hospitals. A variety of data collection methods were used, including interviews, observations and record reviews. Data were collected from women treated for incomplete abortion, male partners (with women’s consent and only in the Sucre site), and physicians. Three-month follow-up interviews were conducted with women in the Sucre site. The intervention consisted of re-organization of services to ambulatory care, PAC training, refresher training, and supportive supervision.
Title: Sustainability of Postabortion Care in Peru
Authors: J. Benson, V. Huapaya
Organization: Population Council, USAID, Ipas
Date: 2002
Description: This study aimed to determine the sustainability of the PAC intervention introduced in the hospital and the extent to which the outcomes of the intervention have continued. It is the first known research to examine how well a PAC intervention and resulting improvements have been maintained over the long term. The objectives of the study were to assess changes over time in the following outcomes: the use of MVA for incomplete abortion; provision of family planning information to postabortion patients; acceptance of contraception by postabortion patients prior to discharge; provision of medical care information to patients; length of hospital stay and resources used by the hospital and patients for PAC services. An additional research objective was to describe the organizational and environmental contexts that influenced changes in the PAC outcomes.
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