Postabortion Care

Family Planning: A Key Component of Postabortion Care – September 2009 [PDF, 153KB] This consensus statement by FIGO, ICM, ICN, and USAID stresses the importance of strengthening the family planning component of postabortion care by ensuring that family planning counseling and services are provided to all women presenting for postabortion care services prior to being discharged from the facility. Available translations: Spanish [PDF, 515KB], French [PDF, 111KB], Portuguese [PDF, 509KB], Russian [PDF, 241KB], Arabic [PDF, 253KB].

Each year in the developing world, an estimated 210 million women become pregnant. Approximately 15 to 20 percent of these pregnancies will end in miscarriage, and 67,000 women will die from complications related to unsafe abortion. This represents 13 percent of all pregnancy-related deaths. Millions more women suffer serious illness and infertility. To address these severe health problems and reduce maternal death, USAID funds postabortion care (PAC) programs that comprehensively address women’s needs through three core components:

• Emergency treatment for complications of spontaneous or induced abortion
  
  
• Family planning counseling and services and, depending on disease prevalence and available resources, sexually transmitted infection evaluation and treatment, and HIV counseling and/or referral for testing
  
  
• Community empowerment through community awareness and mobilization

Postabortion care is a programmatic priority for USAID’s Bureau for Global Health and is a key intervention in the pathway to maternal survival and the reduction of unplanned pregnancies that may result in repeat abortion. While USAID supports treatment for abortion-related complications, USAID does not support abortion as a means of family planning nor does USAID provide abortions in any circumstances. USAID does not finance the purchase or distribution of manual vacuum aspiration equipment for any purpose.

• USAID Postabortion Care Resources
• Postabortion Care Community Mobilization
• Technical Briefs
• Research and Modeling Papers on Postabortion Care

USAID Postabortion Care Resources

• Family Planning: A Key Component of Postabortion Care – September 2009 [PDF, 153KB]
  This consensus statement by FIGO, ICM, ICN, and USAID argues that all women should receive family planning counseling and services after spontaneous or induced abortion, irrespective of the procedure used to treat complications of hemorrhage and/or sepsis. The document stresses the importance of postabortion family planning in meeting the unmet need for family planning, often an underlying cause for induced abortion. Also available in the following translations:
  • Spanish [PDF, 515KB]
  • French [PDF, 111KB]
  • Portuguese [PDF, 509KB]
  • Russian [PDF, 241KB]
  • Arabic [PDF, 253KB]
    
    
• Global Postabortion Care Resource Package
  This site provides comprehensive, standardized, scientifically accurate, and evidence-based information on postabortion care. It serves as a repository of basic instruments intended for policymakers and program planners who are designing or revising their current postabortion care program. All materials found on the site are free and can be downloaded for immediate use. Materials include:
• USAID Postabortion Care Model
• What Works: A Policy and Program Guide to the Evidence on Postabortion Care
• Recommended Policies, Service Delivery Guidelines, and Training Curricula
• Assessment Tools for reviewing current policies, curricula, service delivery guidelines, and communication materials
• Client-Provider Communication Materials, including patient brochure, provider pocket-size job aids, and facility wall charts
• PAC Community Mobilization Facilitator’s Manual Allocate Model to plan funding levels for reproductive health programs
  
  
• Meeting Health Care Needs of Women Experiencing Complications of Miscarriage and Unsafe Abortion: USAID’s Postabortion Care Program – July/August 2007 [PDF, 294KB]
  This article provides information on the history of USAID’s postabortion care program, the current PAC strategy, the Global PAC Resource package, and results from focus countries involved in the current PAC strategy.
  
  

• Download the April 2007 Report of the Postabortion Care Technical Advisory Panel [PDF, 333KB]

  Report of the Postabortion Care Technical Advisory Panel – April 2007 [PDF, 333KB]
  This report’s purpose is to assist USAID in the ongoing and future scale-up of safe and effective PAC programs worldwide for women experiencing complications related to miscarriage and incomplete abortion.
  
  
• USAID Postabortion Care Strategy Paper – October 2004 [PDF, 762KB]
  The overall goal of USAID’s PAC strategy is to reduce maternal mortality, morbidity, and repeat abortion.
  
  • III. Core Components of the PAC Model
  • Appendix C: USAID Global and Country Results Frameworks, Indicators, and Commentary for Use
    (see page 35) [PDF, 762KB]

Postabortion Care Community Mobilization

• SWAK News – Mobilizing Women and Girls to Fight HIV/AIDS [PDF, 2.2MB]
  The Society for Women and AIDS in Kenya (SWAK) is a national women’s organization affiliated with the Society for Women and AIDS in Africa. This issue of the organization’s newsletter features an article on the Community Postabortion Care (COMMPAC) Project and how it offered a refreshing perspective in effective and sustainable community-based solutions.
  
  
• Esther’s Story: A Health Champion Makes a Lasting Impact – April 2007 [PDF, 89KB]
  Read the story of Esther Nyokabi, who was chosen by the Piave Women’s Group in Kenya to represent them on the COMMPAC Project to help empower community members and make postabortion care training a priority.

Technical Briefs

• Decentralization of Postabortion Care in Senegal and Tanzania – March 2008 [PDF, 144KB]
  In developing countries, PAC programs frequently are available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. To improve access, USAID has worked with two focus countries, Senegal and Tanzania, to decentralize PAC activities.
  
  
• Postabortion Family Planning Benefits Clients and Providers – November 2005 [PDF, 559KB]
  Provision of family planning methods is a central feature of postabortion care. Ensuring reliable on-site availability of family planning methods for all clients following abortion or miscarriage can result in benefits for clients, providers, and programs.
  

Research and Modeling Papers on Postabortion Care

General Research

• Assessment of the Progress of the Postabortion Care Initiative in Francophone Africa – April 2008 [PDF, 310KB]
  This multicenter study documents the progress of introducing and implementing PAC in Burkina Faso, Guinea, Mali, Niger, Senegal, and Togo. The objectives of this study included assessing the situation; describing the process of the introduction, integration, and decentralization of PAC; and analyzing the successes and obstacles involved in the process of integration and institutionalizing PAC. The summary of this report is available in English [PDF, 310KB] and French [PDF, 709KB].
  
  
• What Works: A Policy and Program Guide to the Evidence on Postabortion Care – February 2007
  This guide is intended for policymakers and program planners who are designing PAC programs and deciding among priority interventions. Organizations providing assistance to programs worldwide may also benefit from this guide. This document provides a summary of the evidence that documents the effectiveness of various interventions for PAC. The modules in this guide categorize those interventions by those that are effective, those that may be on the cutting edge but for which sufficient evidence has not yet been gathered, and common interventions that are not effective. This guide includes policy and program issues related to PAC. Most evidence cited comes from developing countries; however, when such research was not available, evidence from developed countries was included.
  
  
  • Summary List of Evidence [PDF, 276KB]
    This 12-page summary pullout of the evidence on postabortion care was published in What Works: A Policy and Program Guide to the Evidence on Postabortion Care. It is a listing of summary statements arranged according to the three components of the USAID PAC model. The summary pullout also provides interventions under each component that have strong evidence, enough evidence for action but is in need of more research, and interventions that need more research. This document provides a quick reference to the evidence on postabortion care. More in-depth detail on the evidence supporting each summary statement is found in What Works: A Policy and Program Guide to the Evidence on Postabortion Care.
    
    
• Who Receives PAC Services: Evidence from 14 Countries – June 2004 [PDF, 753KB]
  This paper analyzes sociodemographic and reproductive health characteristic data of women receiving PAC from 24 studies in 14 countries in order to provide a profile of who is receiving PAC services. This paper was prepared by the Futures Group’s Policy Project after an extensive research and literature review was conducted for the publication of the research compendium of the Global PAC Resource Package titled What Works: A Policy and Program Guide to the Evidence on Postabortion Care.
  

Postabortion Care Community Mobilization

• Mobilizing Communities for PAC Services – Spring 2005 [PDF, 2.4MB]
  This article from The Michigan Fellows Newsletter, published by the USAID-funded Populations Fellows Programs, describes the implementation of Bolivia's first PAC community mobilization model.
  
  
• Engaging Communities as Partners in Postabortion Care: A Desk Review of the Community Postabortion Care Project in Nakuru, Kenya – August 2008 [PDF, 379KB]
  In an effort to demonstrate a global model for community mobilization for postabortion care, the USAID Postabortion Care Working Group funded the ACQUIRE Project to replicate the Bolivia community mobilization program in Kenya. The program, known as COMMPAC, was implemented by the Society for Women and AIDS in Kenya, a partner on the ACQUIRE Project. The goal of the program was to empower the community to mobilize itself to reduce maternal mortality and morbidity associated with complications related to miscarriage and incomplete abortion. This review discusses the achievements made by the project, such as community-funded improvements in human resources and infrastructure; increased retention of health personnel; repair of bridges and roads; development of male, female, and youth community champions for PAC; strengthened partnerships between communities and health facilities, which has led to improved quality of care and resources; and increased uptake of new and returning family planning users in communities reached with this activity.
  
  
• Assessment of the Bolivia Postabortion Care Community Mobilization Program – May 2008 [PDF, 804KB]
  This project and assessment, funded and led by USAID, was conducted in June 2007 at the request of the USAID Postabortion Care Working Group to evaluate the PAC Community Mobilization Program, known as the C-PAC project. This project, initiated by the Catalyst Project, was continued under the bilateral project, Socios para el Desarrollo in El Alto, Santa Cruz, and Cochabamba, Bolivia. The assessment included a document review, interviews with key stakeholders, and visits to program sites. Key findings included increased self-esteem and empowerment by women and youth; improved client-provider communication and improved quality of care; increased knowledge of the prevention of unintended pregnancy and symptoms of obstetric complications; the establishment and strengthened linkages among communities, health providers, and facilities; and the engagement of men and youth.
  
  

Decentralization of PAC Services to Health Center and Health Post Levels

• Documentation of Postabortion Care Program Process in Nepal – April 2007 [PDF, 1.2MB]
  This report documents and assesses the status of the PAC program in Nepal and suggests recommendations for improvements to the existing program and expansion to cover the whole country.
  
  
• Assessment of the Extension of Postabortion Care Services in Senegal – July 2007 [PDF, 551KB]
  This paper documents the existing model of decentralized PAC services to 23 health centers and 300 health posts in Senegal. Lessons learned and challenges encountered are documented to inform national and global replication and scale-up efforts.
  
  
• Assessing the Feasibility, Acceptability and Cost of Introducing Postabortion Care in Health Centers and Dispensaries in Rural Tanzania – July 2007 [PDF, 700KB]
  This report documents the process of decentralizing PAC to health centers and dispensaries in Tanzania and prospectively assesses the feasibility, effectiveness, and cost. The report also discusses changes in provider knowledge, attitudes, and practices; experiences of postabortion clients and their perceptions of the new services; changes in community attitudes and knowledge about abortion complications; effectiveness of varied types of referral networks; and additional resources that would be required of the Ministry of Health to support the introduction of these services.

Postabortion Family Planning

• Is There Value in Adding a Follow-up Visit to Postabortion Care? – June 2006 [PDF, 203KB]
  This modeling paper reports the findings of a USAID-funded review that responds to the question of whether there is benefit in adding a follow-up visit to the current one-visit model for PAC services. The paper offers evidence of the benefits to women receiving services, progress toward development goals, and potential cost savings.

Cost Projection Models

• Cost-Effective Interventions to Reduce Maternal Mortality in Senegal: The Role of Postabortion Care and Family Planning – An Application of the Allocate Model – June 2006 [PDF, 298KB]
  The Allocate Model, funded by USAID, is an interactive, user-friendly computer tool designed to assist countries in developing integrated national reproductive health plans with realistic budgets. Its objectives are to help planners understand the relationship between funding levels and safe motherhood, postabortion care, and family planning programs. It also aims to, and to demonstrate the effects of resource allocation on a variety of national indicators. This paper reports the findings of the use of the Allocate Model in the development of Senegal’s national reproductive health strategic plan.